http://www.americanpainexperts.com/
Chronic pain may have a myriad of causes and perpetuating factors,
and therefore can be much more difficult to manage than acute pain,
requiring a multidisciplinary approach and customized treatment
protocols to meet the specific needs of each patient.
Optimal treatment may involve the use of medications that possess
pain-relieving properties, including some antidepressants,
anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and
NMDA (N-methyl-D-aspartate) antagonists. NMDA-receptor antagonists, such
as dextromethorphan and ketamine, can block pain transmission in dorsal
horn spinal neurons, reduce nociception, and decrease tolerance to and
the need for opioid analgesics. [Anesth Analg 2001 Mar;92(3):739-44] 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.
Topical and transdermal creams and gels can be formulated to provide
high local concentrations at the site of application (e.g., NSAIDs for
joint pain), for trigger point application (e.g., combinations of
medications for neuropathic pain), or in a base that will allow systemic
absorption. Side effects associated with oral administration can often
be avoided when medications are used topically. Studies suggest that
there are no great restrictions on the type of drug that can be
incorporated into a properly compounded transdermal gel. When
medications are administered transdermally, they are not absorbed
through the gastrointestinal system and do not undergo first-pass
hepatic metabolism.
We work together with prescriber and patient to solve problems by
customizing medications that meet the specific needs of each individual.
Please contact our compounding pharmacist to discuss the dosage form,
strength, and medication or combination that is most appropriate for
your patient.
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