Forms of chronic pain include:
- neuropathic pain (diabetic neuropathy, post herpetic neuralgia, post mastectomy pain, phantom limb pain, and reflex sympathetic dystrophy (RSD or Complex Regional Pain Syndrome)
- musculoskeletal (back, knee, hip) pain
- rheumatoid arthritis
- cancer pain
Pain is one of the most common reasons people consult a physician, yet frequently it is inadequately assessed and under treated, resulting in needless suffering, lost productivity, and excessive healthcare expenditures.
Effective pain management is best achieved by a team approach involving the patient, the doctor and appropriately trained pharmacist. Dr Michael Serafin, one of our compounding pharmacists, has received advanced training in individualized pain therapies and is happy to work with any doctor to design an effective pain relief solution. This individualized approach can be used to avoid or minimize the use of opioids which are often prescribed for severe pain however are also responsible for numerous deaths, drug addiction and side effects.
This individualized approach not only utilizes a synergistic combination of safer medications but also a mixture of various dose forms such as penetration enhanced transdermal therapy, nasal sprays, suppositories, lozenges and oral capsules, are available. Each case is unique and thus the treatment and mode of administration needs to be tailored to suite each individual.
This individualized approach to pain management utilizes a combination of analgesics with different but synergistic modes of action that target different points along the pathophysiological pathway. It has successfully been used to provide more efficient and safer pain relief than traditional treatments, such as the opioids. Using a combination of drugs that may target peripheral, central and descending modulation targets can be combined into a single transdermal cream to help target the area involved and minimize any unwanted systemic side effects. Penetration enhanced transdermal technology can be used to maximize absorption into the target area administered with the use of a convenient airless pump.
This approach requires an understanding of the pathophysiology pathway of pain to identify the various possible targets to inhibit the pain signal. These targets include:
- Peripheral Targets – This includes the use of NSAIDS such as Ketoprofen for COX 1 and 2 inhibition, Capsaicin depletes substance P, Corticosteroids, Loperamide as peripheral Mu opioid analgesic, NMDA receptor antagonists like Detromethorphan, Sodium channel blockers like local anaesthetics and Sodium channel stabilisers like carbamazepine.
- Peripheral/Central Interface at the Dorsal Horn – NMDA receptor antagonists like Detromethorphan, Anticonvulsants like Gabapentum enhance GABA to reduce release of glutamate at synaptic junction while Carbamezepine blocks Sodium channels to reduce action potential across the neuron.
- Central Targets – GABA(b) receptor agonists like baclofen (muscle relaxant/antispasmodic) enhance GABA effects at post synapse, alpha2 adrenergic agonists like Clonidine.
Descending Modulation – Tricyclic antidepressants or SNRI’s increase serotonin and dopamine to enhance the inhibitory signal from the descending pathway to reduce pain.
Ideally a combination of medications which target each of these 4 target sites should be used to ensure effective blockade of the pain signal.
Specific Types of Pain
For more information click on the appropriate type of pain below:
We have developed drug combinations for neuropathic pain, Regional pain syndrome, fibromyalgia pain, diabetic neuropathy, Shingles, to name a few, on prescription. Contact us for details.
If you or your doctor need any help or advice in determining an effective pain treatment feel free to contact us.