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.
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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 can also be customized to meet the unique needs of unique patients. Davis Islands Pharmacy is able to compound various compatible medications into single dosage forms for easier administration, and to simplify complex or confusing dosage schedules or instructions. Our compounding experts can create oral dosages in the form of lollipops, popscicles, gummy bears, various suspensions — and in a variety of flavors according to each patient’s preference.
Rectal formulations include suppositories, solutions and gels, along with enemas. “Rectal rockets” facilitate simultaneous internal and external application of medication that are frequently used to treat hemorrhoids and other issues.
Nasal preparations (sprays, gels, drops) are being used at an increasing rate as a method of delivery many types of medications. Our compounding lab is able to formulate various pain treatments into nasal preparations for ease of administration and quick absorption.
As in business and other aspects of life, effective and efficient pain management is best achieved through a team approach. Such a team involves your physician, you as the patient, your family, and very frequently other healthcare providers. Each of these aspects works in collaboration to aid in alleviating your ailments and restoring you to functional life. Successful long-term pain management requires fast-moving, flexible, and expert responses to the changing needs of the patient.
Patients and their loved ones should never allow pain to destroy their lives due to concerns about “being a complainer”, medication-related side effects, or the fear of addiction or loss of control as a result of using your pain medication. Patients with pain or other distressing symptoms that persist despite the best efforts of their current healthcare providers should request a referral or seek out specialists in pain management or palliative care.
Pain is one of the most common reasons people consult a physician, yet it frequently is inadequately treated, leading to enormous social cost in the forms of lost productivity, needless suffering, and excessive healthcare spending.
It can take the form of a stress-induced headache, a muscle group strained from sports activities, or be the result of an injury at work or an automobile accident. For some, pain can be chronic in nature and something they live with on a daily basis.
Across the world, pain is the most common symptom for which individuals seek medical help. Acute pain easily can evolve into chronic pain, which can become difficult to treat. Many commonly prescribed, commercially available pain relief medications help the symptoms associated with chronic conditions such as arthritis, fibromyalgia, migraine headaches, and other nerve and muscle pain, but they can also result in unwanted side effects such as drowsiness, dizziness or stomach irritation. Many patients taking these medications come to accept these conditions as part of daily life, but they may find a better solution through pharmacy compounding. We offer personalized pain relief.
Many patients experience stomach irritation or other unpleasant side effects from taking pain medication. Some have difficulty taking the medication in its commercially available form. Pharmacy compounding can provide alternate methods of delivery to make the process easier. Instead of a capsule or tablet, pain medications often can be compounded as dosage forms such as:
Such dosage forms may bypass the gastrointestinal tract, providing optimal results with less GI irritation, and help patients who have difficulty swallowing pills, removing yet another source of aggravation.
Because patients vary in size, symptoms, and pain tolerance, commercially available medications sometimes may not provide the appropriate dosage strength for an individual patient. Through compounding, a prescriber and pharmacist can customize the dosage to the exact amount the patient requires, and find a dosage form that best suits the patient’s needs.
Pain can be debilitating, whether it’s acute muscle or nerve pain resulting from an accident, or a chronic condition such as arthritis or fibromyalgia. Pharmacy compounding may help improve a patient’s quality of life by providing relief with potentially fewer side effects and less overall medication.
Struggling through chronic pain or the side effects of pain medication does not have to be a daily activity. Pharmacy compounding offers patients customized options for pain medication. Compounding is the art and science of preparing customized medications for patients. It provides valuable benefits to those for whom pain management has become a way of life.
Every individual is unique, and the types of pain experienced can be equally diverse. By working with a compounding pharmacist, your healthcare provider can prescribe treatments tailored specifically for your pain management needs.
Through compounding, pain relief can be customized to your specific needs. Ask your physician or pharmacist today about the benefits of personalized compounding.
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