Pain Managment
Pain management is essential because, even when the
underlying disease process is stable, uncontrolled pain prevents patients from
working productively, enjoying recreation, or taking pleasure in their usual
roles in the family and society. Chronic pain may have a myriad of causes and
perpetuating factors, and therefore can be much more difficult to manage than
acute pain, requiring a multidisciplinary approach and customized treatment
protocols to meet the specific needs of each patient.
Optimal treatment may involve the use of medications that
possess pain-relieving properties, including some antidepressants,
anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA
(N-methyl-D-aspartate) antagonists. NMDA-receptor antagonists, such as
dextromethorphan and ketamine, can block pain transmission in dorsal horn
spinal neurons, reduce nociception, and decrease tolerance to and the need for
opioid analgesics. [Anesth Analg 2001 Mar;92(3):739-44] By combining various agents which utilize
different mechanisms to alter the sensation of pain, physicians have found that
smaller concentrations of each medication can be used.
Topical and transdermal creams and gels can be formulated to
provide high local concentrations at the site of application (e.g., NSAIDs for
joint pain), for trigger point application (e.g., combinations of medications
for neuropathic pain), or in a base that will allow systemic absorption. Side
effects associated with oral administration can often be avoided when
medications are used topically. Studies suggest that there are no great
restrictions on the type of drug that can be incorporated into a properly
compounded transdermal gel. When medications
are administered transdermally, they are not absorbed through the
gastrointestinal system and do not undergo first-pass hepatic metabolism.
We work together with prescriber and patient to solve
problems by customizing medications that meet the specific needs of each
individual. Please contact our compounding pharmacist to discuss the dosage
form, strength, and medication or combination that is most appropriate for your
patient.
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