Chronic pain afflicts approximately 10-20% of the adult population. And about half of these pain sufferers fail to receive adequate treatment for their pain. Pain control is essential, because even when the underlying disease process is stable, uncontrolled pain prevents patients from being efficient and productive workers, from finding pleasure in recreational activities, or from enjoying their usual roles in family and broader society.
Physicians must determine the severity and frequency of their patients’ pain experience to prescribe the most appropriate and effective pain management regiment. Pain treatment needs to be individualized. Chronic pain may have a myriad of causes and perpetuating factors, thereby making it extremely difficult to manage when compared to acute pain. Therefore, a multidisciplinary approach and customized treatment protocol is necessary to meet the unique needs of unique patients.
When compounding into a combined formulation, Diclofenac and Lidocaine make for a powerful pain management solution for many patients.Learn More
Compounding Gabapentin, Lidocaine, Keotprofen, Cyclobenzaprine, and Capsaicin into a cream provides pain relief without many of the side effects.Learn More
Normally used as an anesthetic, Ketamine can be compounded in small doses to treat pain and treatment-resistant major depressionLearn More
Neuropathic pain includes a variety of conditions, including diabetic neuropathy, post herpetic neuralgia, post mastectomy pain, phantom limb pain, reflex sympathetic dystrophy (or RSD/ Complex Regional Pain Syndrome), and pain originating from blunt trauma or crushing injuries.
Neuropathic pain’s symptoms may not become evident for weeks to months after an injury, and can therefore be difficult to diagnose. As the duration of symptoms becomes longer and longer, the odds of effectively managing neuropathic pain lessens. Therefore, it’s important to have your pain evaluated by a physician, and follow up with that physician about suitable treatment, as soon as possible.
You’ll first undergo an initial pain management assessment, the goal of which is to characterize the pain by location, intensity, and by the different factors you notice aggravate or alleviate the pain. Oftentimes, your physician may work with a 10-point Numeric Pain Intensity Scale, asking you to rate your pain on a scale of 1-10; or with a Visual Analog Scale as a way to communicate between you, the patient, and your healthcare professional. Use of a consistent form of pain measurement from assessment through treatment is also an effective way of monitoring the adequacy of treatment and therapy over time. You should follow-up regularly and routinely record your pain intensity, along with other key vital signs, during and after the course of therapy.
The treatment of chronic pain frequently involves the use of non-steroidal anti-inflammatory medications (NSAIDs), as well as opioid analgesics. These two classes of medication can be very effective at treating and managing pain when administered by the most appropriate route and in the most suitable dose for the specific patient. However, other drugs — including gabapentin, ketamine, and lidocaine may be more suitable for particular kinds of pain, or may be utilized by healthcare professionals to treat pain when either NSAIDs or opioids are not appropriate.
Optimal treatment for your particular pain may involve the use of pain-relieving properties, including certain anti-depressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA antagonists. Through the combination of different agents utilizing unique mechanisms to change your sensation of pain, physicians have found it effective to use small concentrations of each medication rather than broader systemic use of a single pain relieving agent.
Adjuvant drugs, which include antihistamines and corticosteroids, are invaluable in all phases of pain management as a way of relieving pain, treating concurrent symptoms, and counteracting negative side-effects.
Some chronic pain sufferers are placed on a variety of medications to help address the symptoms associated with their condition. On many occasions, multiple medications can be combined into a single dose of a specially prepared compound that combines the medications into a single capsule or topical preparation, providing greater convenience for the patient.
The International Association for the Study of Pain defines a dermatome as “the sensory segmental supply to the skin and subcutaneous tissue”. A dermatome is the area of skin supplied by the spinal nerve by way of its dorsal root. Oftentimes, the origin of your pain is not the part of the body in which the pain is perceived, but rather, the root of your pain may occur at the spinal level, following a pathway along your entire dermatome to what we call the trigger point.
When you lightly touch a pain trigger point, even with a material as soft as a cotton swab, a pain is generated that may feel as though it comes from deep within the terminal area of a particular nerve, like your leg or stomach. Dermatome maps and trigger point application, therefore, may be a useful tool in the pain management toolbox when a physician selects transdermal administration as the most effective route to manage your pain.
A properly-formulated cream or gel, therefore, can be rubbed on your skin as a thin film over the site of your pain, and the dermatomes can then be traced around to an area like your back, where the pain cream can additionally be applied at the spinal level. In this way, you can identify where on your body you perceive pain, and where on your body your pain originates, and these sites can be marked for ease and effectiveness of future application.
Administration of medication through the skin or mucosa is an increasingly popular method of drug delivery for a variety of reasons. Transdermal creams and gels can be formulated to provide high local concentrations at the site of application (i.e., directly under the area you apply the medication), for trigger point application, or in a base that will allow systemic absorption throughout the body.
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 through the skin, they do not pass through the gastrointestinal system and therefore bypass hepatic metabolism, thereby avoiding side effects that are the result of taking medication by mouth. What’s more, blood levels are not impacted as much, and there is less impact of changing liver function. Creams and gels aren’t the only transdermal routes of administration for compounded medications; buccal troches and sublingual routes of administration are other forms that can be compounded.
Oral dosage forms