Acute pain, regardless of the degree, resolves when tissues heal and is usually a short-term problem. Chronic pain, which is a disease state in itself, may persist for months or years. Acute pain usually involves brief nociceptive input to the central nervous system (CNS), but chronic pain is primarily the result of a neuropathic injury or modulation within the CNS.
Discomfort is ameliorated by a variety of medications, among which are opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and steroids. Chronic discomfort can be caused by malignant or non-malignant diseases. Chronic or acute discomfort that results from a malignant condition is usually relieved by opioid therapy; however, some patients become opioid tolerant. Opioids often do not provide relief from acute or chronic discomfort caused by a nonmalignant condition, and the management of those types of pain is more complicated.
Chronic Neuropathic Pain
The treatment of chronic neuropathic pain requires the use of medications such as N-methyl-D-aspartate (NMDA) receptor antagonists, glutamate antagonists, alpha-2 agonists, sympatholytics, gammy-aminobutyric acid beta agonists, mu receptor agonists, and tumor necrosis factor 1-alpha antagonists, which are not usually indicated for that purpose. As a mu agonist, methadone displays very weak NMDA antagonist action.
How Compounding Can Help
Historically, physical discomfort or suffering has been addressed pharmacologically with oral, parenteral, rectal or transdermal monotherapy. However, the multifaceted nature of chronic neuropathic pain requires a departure from those treatments. Today, many compounded topical medications are used to treat this distress effectively. The recent use of multifaceted regimes of topically applied medications has been reported as being successful. An algorithm can help be created by qualified compounding pharmacists.
What is the Base Cream
The bases of choice for use with the algorithm created by the compounding pharmacist must possess components that actively mediate the water soluble medication through the lipophilic stratum corneum in the form of a liposome. Several bases are available. The compounding pharmacist can help the patient decide which base is right for their, specific needs. When such topical compounds are applied two to three times daily on a regular basis to the pain site and to the corresponding dorsal horn of the dermatome involved, as well as every hour or two when needed, the results can be quite profound.
About the Article
This appeared in the November-December 2003 issue of Greater Akron/Canton M.D. News. It was titled Chronic Neuropathic Pain, Alternative Treatment Options. It appeared under “caring for the elderly: rx solutions”
About the Author
Dr. Ken Speidel, Vice President of Compounding Compliance at Gates Healthcare Associates, has more than 25 years of experience across all facets of pharmacy practice. He has received numerous industry awards and recognition. Dr. Speidel is known throughout the pharmaceutical sector in North America, and is distinguished as a consultant in the development of national standards for pharmacy compounding practices. He provides consulting services for companies and provider organizations in the U.S. and abroad.
A frequent presenter and speaker at clinical and industry educational programs from coast to coast, Dr. Speidel is a prolific author of articles and papers for leading pharmaceutical industry publications. He assisted in developing, writing, and researching several nationally recognized continuing educational programs for the University of Florida.
Dr. Speidel served two terms as president of a large hospice program and guided and advised the organization through a period of growth and organizational restructuring. Dr. Speidel is a former multi-term president of the National Home Infusion Association.
Dr. Speidel received his bachelor of science and doctor of pharmacy degrees from Ohio Northern University.