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PAIN MANAGEMENT


"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 form of lost productivity, needless suffering , and excessive healthcare expenditures."

Compounding combines an ageless art with the latest medical knowledge and state-of-the-art technology with the latest , enabling specially trained professionals to prepare customized dosage forms that are just what the doctor ordered.

The optimal dosage form depends upon the specific needs of  each patient. Options include:

Transdermal and topical
administration are increasingly popular methods of drug delivery. Creams and gels can be formulated to provide high local concentrations at the site of applications (e.g. ,NSAIDs for joint pain, morphine mouthwash for radiation mucositis), for trigger point application (e.g., combinations of medications for neuropathic pain), or in abase that will allow systemic absorption. Transdermal medications utilize the skin or mucosa to facilitate absorption. Studies suggest that there are no great restrictions on the type of drug that can be incorporated into a properly compounded transdermal gel. Other transdermal dosage forms include buccal troches and sublingual preparations ( tablets which melt in the mouth) .

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 rockets" facilitate simultaneous internal and external application of medication for hemmerhoids and other problems.

Nasal preparations (spray, gel, drops, etc.) may be used as a method of delivering many types of medication.

These are the most commonly used active ingredients for acute and chronic pain:

Dexamethasone Is a corticosteroid that can be used is an anti-inflammatory and anti-pruritic
Diclofenac Is a non-steroidal anti-inflammatory drug (NSAID).
Piroxicam A member of the oxicam family, is able to inhibit edema, erythema, tissue

proliferation , fever and pain.
Ketoprofen Is a non-steroidal anti-inflammatory agent(NSAID). Whose use is best

indicated for pain involving torn muscles and like injuries.
Phenylbutazone Is a pyrazoline derivative that exhibits anti-inflammatory, anti-pyretic,

analgesic, and uricoseuric property. It is primarily used for the treatment of

all types of athritis, including gout and osteoarthritis, and is also indicated

for the treatment of painful shoulder and superficial thrombophlebitis.
Cyclobenzaprine Is a muscle relaxant and anti-spastic agent that affects muscle function.
Lidocaine Is a local anasthetic, which, applied topically, is able to numb the area.
Ketamine Typically used for reflex sympathetic dystrophy, is for nerve pain that may

not be responsive to other medications. This topical application allows

practitioners to reduce the dose of more potent narcotic painkillers.
Naproxen Is a non-steroidal anti-inflammatory drug (NSAID) with anti-pyretic and

analgesic properties.
Guaifenesin Has been shown in several veterinary studies to be an effective muscle

relaxant. Its mechanism of action is unknown .
Amitriptyline Has been shown to reduce nerve pain when used topically. Its mechanism

of action is unkown.
Capsaicin Is effective for relieving neurologic, neuropathic and athritic pain.
Baclofen Is a very effective muscle relaxant and anti-spastic agent. It possible works

by decreasing excitatory neurotransmitter release.
Carbamazepine Is efffective for treating trigeminal neuralgia. It decreases polysynaptic

responses and blocks poset-tetanic potentiation. This topical formulation

is good relieving for nerve pain.
Gabapentin Has been shown to be effective in relieving nerve pain. Gabpentin acts by

mimicking GABA, an inhibitory neurotransmitter. Carbazepine is also a

good treatment for nerve pain.
Clonodine Stimulates alpha-adrenoreptors in the brain, resulting in reduced

sympathetic outflow from the central nervous system.
Methadone Is a synthetic opioid agonist that has been shown to be effective in the

treatment of chronic malignant and non-malignant pain. It has a great oral

and rectal absorptio, no active metabolites, prolonged duration of actions

resulting in longer adminstrations intervals, and lower cost than other opioids
Loperamide Loperamide, an opioid agonist produces an antihyperalgesic effect through

peripheral opioid receptors in inflamed tissue



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