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Pain Management Compounded Medications

Even if the source of a patient’s pain is stabilized, chronic pain can affect all areas of the patient’s life -- from the ability to work or take part in recreation, to the simple enjoyment of family life. That’s why pain management is crucial.

Pain can be chronic or acute in nature. Chronic pain often has a number of different causes and mitigating factors, making it more of a challenge to treat. In such a case, a combination approach often yields the best results. Our compounding pharmacist can help develop customized treatment protocols to address the patient’s specific pain management needs.

The best treatment method may require the use of medications that are not solely pain medicines, but that offer pain-relief properties among their other uses. That’s why a pain management protocol may involve certain anticonvulsants, antidepressants, antiarrhythmics, antiviral agents, anesthetics, and NMDA (N-methyl-D-aspartate) antagonists.

NMDA-receptor antagonists, such as ketamine and dextromethorphan, have the ability to block the transmission of pain in dorsal horn spinal neurons. They can also reduce nociception, as well as decreasing the patient’s tolerance to and need for opioid analgesics. [Anesth Analg 2001 Mar;92(3):739-44]

One of the advantages of using a combination of medications that use different mechanisms for pain management is that less of each medication is needed. Also, the use of topical medications can allow the patient to avoid side effects that may be present with medications taken orally. Medications that are administered transdermally do not undergo first-pass hepatic metabolism, are not absorbed through the GI system. Thus there are no significant restrictions on the types of medications that can be incorporated into a transdermal gel.

So, for example, the compounding pharmacist can formulate topical and transdermal creams that deliver a high concentration at the site of application (such as NSAIDS used for joint pain), in a base that allows for the systemic absorption of the medications, or for trigger point application (as in combinations of medications used to combat neuropathic pain).

Our compounding pharmacist works with both the patient and his or her practitioner to develop customized medications to meet specific needs. We invite practitioners to contact us regarding the dosage strength, form, medication or combination of medications that best fits the patient’s needs.