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Pain Management

http://www.youtube.com/watch?v=ZwK4LbyKGyk

 

 

 

 


At The Compounding Lab we compound many preparations that support and assist in creating wellness in all areas of pain managment.


Specific areas we target with our transdermal pain program:

• Neuropathic pain (Nerve and referred pain)
• Diabetic pain problems
• Fibromyalgia pain
• Arthritis inflammation
• Sports injury
• Tendonitis
• Podiatry problems.

Reasons for Transdermal Pain treatments

• Local Application of Drugs
• Peripheral Activity
• Reduced Systemic Absorption
• Reduced Side Effects Associated with Oral Drugs
• Controlled Pain Relief
• Easy to Manage
• Absorbs easily

How to Apply your Pain Cream

Classes of Medication for Transdermal / Topical Pain:


1. Nonsteroidal Anti-inflammatory : NSAIDS (Ketoprofen, Meloxicam, Diclofenac, Fliproefen) . These are commonly used to treat inflammation and treat the pain . The mechanism of action is to inhibit cyclooxygenase 1 & 2 enzymes. These convert Arachidonic Acid to Prostoglandins which inhibit the inflammatory repsonse. These drugs are good for Sports injuries, muscle strains, arthritis, tendonitis.We compound these NSAIDS in 5 to 10 times stronger than products readily available.
2. Muscle Relaxers: (Baclofen) Use for mild muscle spasms. Safe , non addictive active and works as well as benzodiazepine orally.
3. NMDA Receptor Antagonist (Ketamine) This medication is commonly used in anesthesia but is now well known for its NMDA . Ketamine is a drug with multiple applications used in medical procedures with humans and subsequently adopted for veterinary medicine, mainly for starting and maintaining general anesthesia. Other uses include sedation in intensive care, as a pain killer (particularly in emergency medicine and patients with potentially compromised respiration and/or allergies to opiate and barbiturate analgesics), and as treatment of bronchospasm, and as a treatment for complex regional pain syndrome.
4. Local Anesthetics (Lignocaine, Prilocaine)
5. Neuropathic Agents (Gabapentin) . Used often orally so applied topically you eliminate unwanted drowsiness.
6. Tricyclic Antideppressants (Amytriptyline) also used to modify pain perception.
7. Liposomal Bases make applying these creams WORK!


Transdermal Pain FAQ


Why look to a compounded versus a commercially manufactured drug medication for Pain Management

A: To overcome side affects, regimen issues, and compliancy problems. Many patients experience issues such as:
• Stomach upset when taking oral medication like Codeine & Ibuprofen
• Dizziness and Drowsiness
• Constipation or Diarrhea
• Reluctance to take the medication due to its taste
• Issues with the route of administration, such as difficulty swallowing pills
• Allergy, sensitivity, or other aversion to ingredients such as flavors or dyes, lactose, sugar, alcohol, gluten, or casein.

Do Compounded Medications Require TGA Approval?


A: The TGA approval process is intended for mass-produced drugs made by large manufacturers.
• Because compounded medications are personalised for individual patients, it is not possible for each formulation to go through the TGA drug approval process, which takes years to complete and is prohibitively expensive, often costing hundreds of millions of dollars.
• Our compounding pharmacy must comply with the regulations set by the Qld State Board .

Why use a compound to treat pain? What is considered the appropriate pain patient?


Pain is the most common symptom for which individuals seek medical help.
• Acute pain easily can evolve into chronic pain, which can become difficult to treat. Many commonly prescribed, commercially available pain relief medications help the symptoms associated with chronic conditions such as arthritis, fibromyalgia, migraine headaches, and other nerve and muscle pain, but they can also result in unwanted side effects such as drowsiness, dizziness or stomach irritation.
• Many patients taking these medications come to accept these conditions as part of daily life, but they may find a better solution through pharmacy compounding. Compounding offers personalized pain relief. Struggling through chronic pain or the side effects of pain medication does not have to be a daily activity. Pharmacy compounding offers patients customized options for pain medication.



How does a compounding pharmacist go about dosing a transdermal pain therapy?

A: Many patients experience stomach irritation or other unpleasant side effects from taking pain medication. Some have difficulty taking the medication in its commercially available form. Pharmacy compounding can provide alternate methods of delivery to make the process easier. Instead of a capsule or tablet, pain medications often can be compounded as dosage forms


What is the expected penetration of your transdermal pain gels? What would we look at as a reference to view deposition of the base?

A: We utilize a base called LipoDerm Active Max. This base is provided to us via way of PCCA . PCCA presents their “Breakthrough” study regarding the evaluation of percutaneous absorption of Ketamine HCI, Gabapentin, Clonidine HCI and Baclofen in Lipoderm® into human trunk skin, In Vitro test, using the Franz skin finite dose model. These four drugs were selected due to their frequent use in topical pain formulation nationwide. The study was designed to evaluate the percutaneous absorption pharmacokinetics of these drugs. Absorption was measured in human cadaver skin, in vitro, using the finite dose technique and Franz Diffusion Cells. This is a specific study design that is the gold standards in the pharmaceutical industry. These products were tested on replicate section from three different cadavers. The study resoundingly demonstrates that LipoDerm® has the power and reliability compounders are looking for. (PCCA handout-Breakthrough Study).

PAIN MANAGEMENT LIPOSOMAL CREAM OPTIONS (combinations can be changed and % these are suggestions Only)

Anti-inflammatory Creams & Osteo-Arthritis
1. KETOPROFEN 10% - CYCLOBENZAPRINE 2% - LIDOCAINE 5% CREAM
2. KETOPROFEN 5% - AMITRIPTYLINE 2% - GABAPENTIN 2% - LIDOCAINE 2% CREAM
3. KETAMINE 5% KETOPROFEN 5% BACLOFEN 4% AMITRIPTYLINE 2%
4. DICLOFENAC 3% - BACLOFEN 2% - CYCLOBENZAPRINE 2% - LIDOCAINE 2% CREAM

SHINGLES PAIN:
1. (AAFL) ACYCLOVIR 2% - AMITRIPTYLINE 2% - Dexy -DG 0.1% - FLURBIPROFEN 10% - LIDOCAINE 2%

Neuropathic Pain: (Neuralgia, Post Herpatic Neuralogia, Vuvyldynia, TMJ) Formula Suggestions


1. DICLOFENAC 3% - BACLOFEN 2% - CYCLOBENZAPRINE 2% - GABAPENTIN 6% - LIDOCAINE 2% CREAM – Neuropathic Pain
2. BACLOFEN 2% - CYCLOBENZAPRINE 2% - DICLOFENAC 3% - GABAPENTIN 6% - LIDOCAINE 2%
3. KETOPROFEN 20% - CYCLOBENZAPRINE 2% - GABAPENTIN 6% LIDOCAINE 2.5% (Anti-Inflammatory/Neuropathic Pain)
4. BACLOFEN 2% - CYCLOBERNZAPRINE 2% - GABAPENTIN 6% - LIDOCAINE 5% CREAM
5. Gauiphenisen 5% Baclofen 4% KETOPROFEN 5% : Speed Gel muscle relaxant
6. FLURBIPROFEN 10% - BACLOFEN 4% - GABAPENTIN 6% - LOPERAMIDE 7% - AMITRIPTYLINE 2% - NIFEDIPINE 2% - CLONIDINE 0.2%


Plantar Fasciitis & Burning Feet & Diabetic Toes & Peripheral Neuropathy


1.BACLOFEN 2% - GABAPENTIN 10% - AMITRIPTYLINE 2% - CLONIDINE 0.2%
2.Baclofen 2% Gabapentin 5% Ketamine 5% Amitriptyline 2%
3.FLURBIPROFEN 15% - DEXTRAMETHORPHAN 5% - LIDOCAINE 5% - PIROXICAM 2.5% - AMITRIPTYLINE 2% - DEXAMETHASON 1% (FDLPAD) anti-inflammatory with muscle relaxant
4.GABAPENTIN 6% - NIFEDIPINE 2% - PENTOXFYLLINE 5% - LIDOCAINE 5% - CLONIDINE 0.2% ( Fissures and anal pain) PLANTAR FASCIITIS