A New Way to Manage Acute and Chronic Pain

Whether you are experi- encing plantar fasciitis or facing knee replacement surgery, there are specialty compounded prescription creams that can provide in- dividualized therapy specif- ically for you. Multimodal compounded prescription creams are designed to help control pain in acute and chronic conditions found in areas of inflam- mation, musculoskeletal disorders, and neuropathy. The term multimodal simply means more than one mode of action. For example, the compounded medication may have an anti-inflammatory plus a muscle relaxant and a numbing agent. Com- binations of drugs are a considerable alternative, as multimodal therapies tar- get several receptors, often producing additive or even synergistic effects. Treating pain with traditional (oral) medica- tions may be effective in the short term, but can have serious potential side effects, especially with oral NSAIDs (non-steroidal anti-inflammatory drugs). A few unwanted effects to note are stomach upset, stomach lining bleeding or they could exacerbate ulcers. Contraindications include high blood pres- sure, fluid retention, and kidney and heart condi- tions. NSAIDs can also cause nutrient depletions of melatonin, folic acid, iron, zinc, magnesium, cal- cium, A, B6, B12, B5, C, D, and potassium. The major- ity of these side effects can be avoided by using topical applications.

Topical medications are now first-line options for certain conditions like osteoarthritis. They have localized activity and low systemic absorption, resulting in a favourable safety profile and low risk for drug interactions. The most popular uses for these compounded creams include degener- ative joint disease like os- teoarthritis, inflammatory conditions like rheumatoid arthritis, soft tissue trauma, overuse conditions like rotator cuff injuries, plantar fasciitis, tendonitis, bursi- tis and even TMJ. They are a solution for chronic back pain pa- tients who do not want to take opioids or any oral medication. These topical pain creams are ideal for challenging conditions like post-op pain after knee replacement surgery, and post fracture care that in- cludes painful neuropathy. They also assist to subside symptoms associated with shingles and autoimmune disorders. Looking at the nutritional side of therapy is also very important in pain man- agement. For any inflam- matory disease state, one must look at food allergies that could exacerbate the condition. Dietary factors play a huge role and nutritional supplements are neces- sary as nutrient depletions from diet or medications exist.

Magnesium glycinate works as a muscle relaxant and blocks pain receptors with minimal laxative side effects. Magnesium defi- ciency was found in 45% of patients with fibromyalgia. Vitamin D deficiency has been associated with musculoskeletal pain. These injuries include a variety of disorders that cause pain in bones, joints, and muscles. The pain can be acute or chronic, local or diffuse. Low back pain is the most common example of chronic musculoskeletal pain. Melatonin also has analgesic properties that help with sleep patterns. Omega 3 fatty acids have anti-inflammatory effects, as well as cardiovascular, dermatological, GI effects, neurological and a host of other beneficial effects. Incorporating physio- therapy and chiropractic care would also be ben- eficial in your treatment plan. These highly skilled individuals will not only use manual techniques to alleviate pain or prevent injury, but they will educate you about changing your biomechanics, discuss rehabilitation and suggest other treatments and tech- niques. Choosing the right compounding pharmacy is extremely important as well. Not all pharmacies have the training, advanced knowledge and proper equipment and laborato- ry to make these special creams. Topical creams provide a viable solution over oral medications for acute and chronic pain. They are not absorbed through the gas- trointestinal tract and are not extensively metabolism by the liver. Multimodal creams can be used alone or as part of a multi-treatment regimen as these creams target specific issues and only have active ingredients necessary for treatment. The ultimate goal is to help patients relieve pain and better manage their condition.

Maria Musitano, BSc Pharm
Compounding Pharmacist


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