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Our compounding specialists offer many unique options for pain management. Regardless of origin, and whether the pain is acute or chronic, our efforts are directed at meeting the specific needs of each patient. We work together with patient and physician to reach treatment goals. Please call our compounding pharmacy regarding individualized pain therapy to meet your specific needs.
Optimal treatment may involve not only the use of traditional analgesics such as non-steroidal anti-inflammatory drugs (NSAIDS) and opiods, but may also include medications that posses pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA antagonists. 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. Adjuvant drug – including antihistamines and corticosteroids – are also valuable during all phases of pain management to enhance pain relief, treat concurrent symptoms, and counteract side effects.
Creams and gels can be formulated to provide high local concentrations at the site of application (i.e. NSAIDs for joint pain, morphine mouthwash for radiation mucositis), for trigger point application (i.e. combinations of medications for neuropathic pain). Research indicates that topical analgesics create an efficacious option for adjuvant drug therapy with minimal risk of significant systemic absorption and drug-drug interactions. For example, topical administration of NSAIDs offers the advantage of local, enhanced drug delivery to affected tissues with a reduced incidence of systemic adverse effects, such as peptic ulcer disease and GI hemorrhage, seen with oral formulations.
Trans-dermal medications utilize the skin or mucosa to facilitate absorption. Studies suggest the there are no great restrictions on the type of drug that can be incorporated into a properly compounded trans-dermal gel, buccal troche, and/or sublingual preparations. Trans-dermal medications are also a very useful option when patients are unable to take medication orally, and this route of administration can often eliminate the need for injectable therapy. Trans-dermal administration avoids first pass hepatic metabolism, and is an excellent option in patients with fluctuating hepatic function.
Oral dosage forms can also be customized to meet the specific needs of each patient. We can combine numerous compatible medications into a single dose for ease of administration or simplification of a confusing dosage schedule. We can compound medicated lollipops, freezer pops, “gummy bears”, solutions and suspensions, flavored to suit the individual.
Rectal formulations include suppositories, solutions, gels, and enemas. “rectal rocket” facilitate simultaneous internal and external application of medication for hemorrhoids and other problems.
Dextromethorphan - Dextromethorphan, an NMDA receptor antagonist, can block pain transmission in dorsal horn spinal neurons and reduce nociception. However, most commercially available dextromethorphan preparations have drawbacks to use for pain management. Dextromethorphan is frequently combined in cough/cold preparations with various antihistamines, decongestants, expectorants, or analgesics. Decongestants may raise concerns for hypertensive patients, and antihistamines may cause problems for those with benign prostate hypertrophy or glaucoma. Liquid “cough syrups” often contain sugar and/or alcohol, and have an unpleasant taste. Out compounded pharmacy can prepare a dosage form containing dextromethorphan as the only active ingredient, in the most appropriate dose and dosage form for each patient – including capsules or a pleasantly –flavored liquid.
Hydrocodone – There are several commercially available hydrocodone with acetaminophen drug products. In order to avoid liver damage from the acetaminophen these products have dosage limits. We can compound capsules of pure hydrocodone without acetaminophen to provide optimal pain control without hepatic risks associated with high doses of acetaminophen.
Article: Trans-Dermal Treatment of Pain (Healthwise)
Article: Trans-Dermal Treatment of Pain (MD News)
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