Pain varies from person to person, which means effective pain management must be flexible. Because there are many types and causes of pain, the most effective treatment plans consider all aspects of a patient’s situation, including:

  • The type of pain (acute or chronic)
  • The cause of pain
  • The patient’s medical history

Finding the Right Treatment Path

Individualized medicine offers unique treatments for pain that can enhance your current treatment plan, attack your pain from various angles and improve your quality of life.

Pain Solutions

With a prescription from your physician, our pharmacists offer customized medication options – along with the ability to combine multiple medications and customize dosing – possibly making a significant difference in managing pain.

Pain Management

Pain varies from person to person, which means effective pain management must be flexible. Because there are many types and causes of pain, the most effective treatment plans consider all aspects of a patient’s situation, including:

  • The type of pain (acute or chronic)
  • The cause of pain
  • The patient’s medical history

Finding the Right Treatment Path

Individualized medicine offers unique treatments for pain that can enhance your current treatment plan, attack your pain from various angles and improve your quality of life.

pain management

Pain Solutions

With a prescription from your physician, our pharmacists offer customized medication options – along with the ability to combine multiple medications and customize dosing – possibly making a significant difference in managing pain.

Pain is a symptom that can have a large variety of causes and it comes in various degrees of intensity. Some forms of pain can be addressed by internal medicine doctors, some by oncologists, sports medicine doctors, orthopedic doctors, podiatrists, chiropractors, etc. But most of the severe or chronic pain sufferers seek help from pain management doctors who use an arsenal of techniques, procedures, programs, devices, and last but not least: medications.

A compounding pharmacy can help the doctor & patient by preparing custom formulations from unique combinations of various medications:

  • Topical creams or lotions that can penetrate through the skin.
  • Suppositories or rectal gels.
  • Oral liquid suspensions that can be custom flavored.
  • Unique capsule dosage forms as well as extended or immediate release.There are guidelines created by pain management association in collaboration with compounding pharmacists on how to create a compounded formulation based on several criteria.

    Sample criteria:

    Algorithm for Chronic Neuropathy (PCCA)
    Mode of Action and members of the class (not exhaustive)

    1) NMDA-Ca Channel Blocker

    • Ketamine 5-10% in PLO, 10-30mg PO or PR tid regularly + up to q2h prn
    • Nasal soln 10-50mg/ml-1-2 sprays prn
    • Orphenadrine 10% in PLO or 100mg PO tid
    • Dextromethorphan 10% in PLO or <400mg/day PO
    • Amantadine 200mg/250-500cc IV over 3 hours once (repeat x1 prn).
    • PLO 10 to 20% tid

    2) AMPA-Na Channel Blocker

    • Anticonvulsant – * Gabapentin 6-10% in PLO tid + up to q2h prn or up to 2-3Gm/day PO
      *Probably blocks glutamate at the NMDA also
    • Carbamazepine 10% in PLO tid + up to q2h prn or 100mg-200mg PO bid/tid (Max 800mg/day)
    • Antiarrhythmic – Lidocaine 5-10% in PLO tid + up to q2h prn
    • Mexilitine 2% in PLO tid + up to q2h prn

    3) Alpha II-agonist

    • Clonidine 0.2% in PLO tid + up to q2h prn

    4) Substance P blocker

    • MU agonists (MS, Hydrocodone, Oxycodone, etc) (low dose) PO or PLO
    • MU Agonist also: Loperamide 7% and up PLO

    5) GABA b Agonist

    • Baclofen 2% PLO tid + up to q2h prn
    • Non-specific GABA agonist – Klonopin 0.5mg-1mg SubL.Qhs

    6) Tricyclic Antidepressant

    • Desipramine 2-10% in PLO tid + up to q2h prn or 25-100mg PO qHS
    • Amitriptyline 2-10% in PLO tid + up to q2h prn or 25-150mg PO qHS
    • Magnesium: Intracellular Resident NMDA Ca Channel Blocker

    Valuecare Pharmacy maintains intellectual property on several pain management compounds. Please contact us for proprietary formulations, the conditions that doctor prescribe them for, and their efficacy!

    Notes:

    1. Ketamine 10%, Gabapentin 6%, Clonidine 0.2% is standard starting regimen.
    2. Add Baclofen 2%, Amitriptyline 2%, Nifedipine, Opioid, Mg as needed. (I.e., use baclofen specifically in FM patients but also in others and use Amitriptyline in CRPSType I patients but also in others.)
    3. In allodynic Post Herpetic Neuralgia use Ketamine 10% + Bupivacaine 0.5% in aNormal Saline spray to the area, wait for 5 to 10 minutes and apply the PLO gel chosen.
    This spray also has been reported to ease burn pain.
    4. Evidence exists for the presence of NMDA receptors in the dermal-epidermal junction.AMPA receptors always lie close to NMDA receptors.
    5. Evidence exists for the presence of Gabapentin receptors in the periphery.
    6. Evidence exists for the presence of adrenergic receptors in the periphery.
    7. Evidence exists for the presence of opioid receptors in the periphery.