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Pain Management

How Does Pain Management Work?

Pain is our body’s way to let us know that something is wrong. It is a common symptom of many illnesses and injuries and serves as a deterrent for certain behaviors. When we stub our toe, the pain helps us be more careful about where we step. However, once we have a handle on what the problem is, pain is no longer necessary. If we have a broken arm, we no longer need to feel pain once we’ve received the proper treatment.

Additionally, some treatments may be hard on the body and cause pain. In this case, we know it is working to help relieve the actual problem, so pain management can help reduce the side effects. Treatments such as surgery or chemotherapy can cause pain while also addressing a much more serious and debilitating illness. Pain management is essential because even when the underlying disease process is stable, uncontrolled pain prevents patients from working productively and enjoying recreation.

Types of Pain

Patients may experience two types of pain: chronic and acute. Chronic pain may have a myriad of causes and perpetuating factors, and therefore can be much more difficult to manage than acute pain. Chronic pain may require a multidisciplinary approach and customized treatment protocols to meet the specific needs of each patient. Acute pain may hurt more but does not last as long. Treating this pain may be more straightforward.

Chronic Pain vs. Acute Pain

Chronic Pain

Chronic pain is the persistent presence of pain in the body. Once it lasts for at least 12 weeks (3 months) or longer, it can be defined as chronic. This type of pain has a multitude of causes. Past injuries, nerve damage, recent surgery, infections, and other factors can lead to pain that persists even after the root source has been healed. However, there are instances where the cause is unknown.

Acute Pain

Acute pain can be sudden and sharp. It is normally a large amount of pain that is a result of injury or other bodily harm. Even situations such as surgery and dental work that are meant to fix a greater problem will create acute pain themselves. Acute pain does not last long, however. It is usually defined by occurring for less than 12 weeks (3 months). Once the pain has subsided, the patient should be able to return to their usual activities.

Treatments for Pain

Managing your pain with the help of medical professionals can be a great way to improve your quality of life while remaining as safe as possible. When dealing with chronic or acute pain, it may take a unique strategy to reduce pain levels. 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. 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 Anesthetics

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. Pain medication that is taken orally can come with side effects such as nausea, drowsiness, and even addiction. These side effects can often be avoided when medications are used topically. Studies suggest that most drugs 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. Because of the limited side effects, transdermal pain medication may help with the opioid crisis by reducing adverse effects, increasing patient compliance, and limiting exposure to abusive drugs.

Nonsteroidal Anti-Inflammatory Drugs (NSAID)

Nonsteroidal anti-inflammatory drugs (NSAID) are medicines used to relieve pain. They also commonly reduce inflammation and fever in the body. Many are used in common brands and are available over the counter. NSAIDs include ibuprofen, naproxen, and high-dose aspirin. When taken orally, NSAIDs may cause indigestion, stomach aches, and even stomach ulcers. Taking higher doses for longer periods of time may increase the chances of side effects.

NSAIDs can be compounded to contain other medications to simultaneously treat other symptoms such as autoimmune conditions, high blood pressure, and depression. They can also be compounded into transdermal creams in order to bypass many of the side effects and have a more targeted approach to pain

Ketamine

Ketamine is normally used for maintaining anesthesia. It provides a trance-like feeling in the body, especially at high doses. This drug influences pain in a variety of ways. Recent studies have shown that ketamine reduces neurogenic pain and has anti-inflammatory effects. Applications of ketamine over a span of 2 weeks can lead to long-term analgesic effects. Some side effects of ketamine include nausea/vomiting, psychedelic symptoms, cardiovascular stimulation, and others. However, this drug can also be compounded to be combined with others to reduce these side effects. For example, benzodiazepines may reduce the psychotropic symptoms of ketamine.

Low Dose Naltrexone (LDN)

Naltrexone is originally approved to treat disorders such as alcoholism and opioid addiction. Its main function in the body is to block opioid receptors. At low doses, however, naltrexone has shown positive results in managing pain in patients. Low-dose naltrexone (LDN) has made a niche as an alternative to opioids. Because it blocks opioid receptors, patients will not become addicted to the drug. LDN will inhibit glial cells and prevents inflammation and reduces pain. While naltrexone is commercially available at 50 mg, low doses of naltrexone need to be compounded by a compounding pharmacy.

Lidocaine and Prilocaine

Lidocaine and Prilocaine are anesthetic drugs. They are commonly used in creams and topical gels for skin application. They work as a local anesthetic and numb the nerve endings of the area where they are applied. This is helpful for prepping a patient for injections, wart removals, or any other abrasion to the body. A lidocaine and prilocaine topical cream may cause slight side effects such as redness, burning sensation, or swelling. If these effects worsen over time, discontinue using the cream and contact your doctor or pharmacist.

We Can Help with Pain Management

Your pharmacist is a great resource for pain management. We work together with your doctor to make sure that your plan and strategy are tailored to your needs. ClearSpring pharmacy is able to provide traditional prescriptions as well as compounded prescriptions. This means that we’ll be able to develop the drug you need in the form you’d like. Whether it needs to be applied transdermally, orally ingested, or even in a suppository. Check us out today! Give us a call in Littleton or Denver. Or fill out the form on this page! Our response times are generally within one business day.

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