Compounding for Pain Management
One of the most prevalent conditions healthcare professionals treat today is chronic pain. While patients do not die from benign chronic pain, many patients suffer greatly reducing their quality of life. There are generally three types of pain:
- Nociceptor Pain – Nociceptor Pain results from chemical, mechanical or thermal injury or inflammation of tissues such as the skin, muscle or viscera. Nociceptor pain is usually described as a dull and aching pain originating from skin, bones, muscle or viscera (abdomen).
- Neuropathic Pain – Neuropathic pain results from injury to the peripheral or central nervous system. It is described as a sharp and burning pain.
- Idiopathic Pain – Idiopathic pain is a non-specific pain of unknown origin. Stress, anxiety and depression can influence this type of pain, which is usually located in the head, neck, shoulders and abdomen.
The treatment of pain depends on the type of pain present.
Neuropathic Pain
Neuropathic Pain is characterized by shooting/stabbing pain, as well as sensations of burning, tingling and numbness. Many different types of neuropathic pain share a common pathway of pathophysiology. Diabetic peripheral neuropathy, postherpetic neuralgia, complex regional pain syndrome type 1, fibromyalgia, postsurgical neuropathy, post-trauma neuropathy, visceral neuropathy, xenobiotic neuropathy and the idiopathic neuropathies all share the same pathway of sensory input and central modulation and inhibition. The treatment of central and peripheral neurogenic pain is difficult. Patients are refractory to non-opiate analgesics, including NSAID’s, and rarely respond to opiates except at very high doses. This usually causes an array of side effects and leads to the rapid development of tolerance. Other medications used for neuropathic pain include oral amitriptyline and carbamazepine, however side effects are numerous.
A new approach is now emerging that is able to effectively reduce suffering and side effects by using Low Dose, Combination, Transdermal Pain Therapy (LCTPT). The knowledge of receptor location now provides a different route of administration to avoid oral or systemic doses and their associated side effects.
The theory of LCTPT starts with three medications with complementary modes of action being incorporated into a penetration enhanced topical gel. If inflammation is implicated a NSAID should also be included. One gram of this starting formula is applied directly to the localised area of pain and to the corresponding dorsal horn area of the involved dermatome. It is applied at eight hour intervals on a regular basis and every two hours in-between, as needed, for breakthrough pain. Dose escalation can occur daily or every other day until pain is relieved or, rarely, if side effects occur. Many prescription drug combination creams are available.
Some of the most commonly prescribed ingredients include:
Ketamine
Ketoprofen
Lignocaine
Amitryptyline
Baclofen
Capsaicin
Tetracaine
Benzocaine
Gabapentin
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