Palliative : Pain Management
Pain management is essential because, even when the underlying disease
process is stable, uncontrolled pain prevents patients from working
productively, enjoying recreation, or taking pleasure in their usual
roles in the family and society. 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. Palliative care often
involves the use of opioid analgesics. 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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