Tag: pain management medications

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Skin Care

6 Benefits of Transdermal Therapy for Pain

Pain is one of America’s greatest challenges; but there are many types of medication available to help reduce pain – including transdermal therapy.

Some 50 million people suffer from chronic pain in our country on a regular basis; many are either partially or even fully disabled by their symptoms.

Doctors work hard to help patients like these reduce their pain to gain a better quality of life, but it isn’t always easy to find the right option.

  • Surgery is invasive and often kept as a last resort.
  • Oral medications come with significant side effects, some of which can be life-threatening in the right conditions (like addiction and gastrointestinal bleeding).
  • And lifestyle changes can certainly be beneficial, as can physio and massage, but what about when they aren’t enough?

Enter transdermal therapy for pain.

By delivering medication directly to the area affected by chronic pain, via the skin, some patients are able to achieve significantly more relief.

From topical steroids to advanced compounded neuropathy drugs, we’ll tell you about them in today’s post.

 

First: What is a Transdermal Therapy?

The term “transdermal” comes from the latin root words “trans” (meaning across or through) and “derma” (meaning skin).

In the scope of medicine, any substance formulated to cross the natural skin barrier is, in effect, a transdermal medication.

  • Some of these formulas may be designed to treat the skin itself, the tissues directly underneath the skin, or the muscles and joints.
  • Others simply use the skin as a transfer point, entering the bloodstream after they absorb.

Transdermal therapy delivery is available in a variety of formats, including:

  • Creams
  • Gels
  • Solutions
  • Patches

However, the “gold standard” definition is that true transdermal therapy is more than just topical; it’s almost always formulated in a patch for better absorbency.

 

The Benefits of Transdermal Delivery Systems

Transdermal medications have a number of benefits over traditional oral medications.

First, they aren’t swallowed, so there’s no need to worry about trying to give medications to someone who refuses to take them, cannot swallow, or even just plain doesn’t like to swallow pills.

But that’s really just the beginning.

 

1. Fewer Gastrointestinal Problems

Many transdermals also bypass the gastrointestinal tract entirely, lessening the chance for stomach and bowel side effects.

This includes:

For patients who are prone to ulcers, this can be the difference between being able to medicate safely and being unable to medicate at all.

 

 

2. Less Stress on Liver and Kidneys

Then, there is also the issue of how much stress oral medications can place on the liver and kidneys.

Many oral drugs must be metabolized by the liver in order to become effective in the body (especially opioids). This places stress on the liver.

To add insult to injury, the kidneys eventually need to filter the drug out and excrete unneeded metabolites created by the liver during uptake.

Thus, the kidneys are also under stress, too.

 

3. Fewer Long-Term Use Risks

The amount of stress placed on the liver and kidneys with either oral drugs or transdermals really depends on the dose, the oral drug used, and the person.

However, studies do show that because most transdermals treat pain locally or enter the bloodstream directly, they don’t put as much strain on internal organs.

  • This can help to limit damage over time when ongoing pain control is a must.
  • In the case of steroid drugs, transdermal therapy may also lessen other side effects, such as hormone imbalance due to chronic use.

When used as directed, topical steroids reach a much lower systemic level, even with regular use, especially when compared to oral steroid drugs like Prednisone.

Thus, the risk of associated side effects is much, much less.

 

4. Better Resolution of Skin Symptoms

Sometimes, transdermal medications are used to treat skin symptoms specifically.

This is often the case in conditions like:

In these conditions, treatment works best applied directly to the affected area because the drug can absorb and provide benefit on the spot.

For patients who experience pain with skin conditions like these, transdermal therapy may also be compounded with numbing or nerve-deadening agents that lessen pain.

The patient can then use the solution, cream, or patch on an “as-needed” basis.

This very often provides much better pain control coverage than using pills alone.

 

5. Better Pain Control Coverage

Transdermals like non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxers can also give patients “another option” when combined with traditional oral medications.

Even if the patient is taking a painkiller orally to relieve their symptoms, they can often use topicals as a “backup” for localized breakthrough pain.

The result is that the patient is much more comfortable and better in control of their symptoms as they happen – without needing to worry about addiction.

 

 

6. Combine Medications Into a Single Solution

Some drugs work synergistically when combined into the same product (for example, steroids and antibiotics).

Similarly, some patients achieve better pain control by combining several different medications into a single treatment plan.

With transdermal therapy, compounding pharmacies work with base ingredients, allowing them to combine multiple drugs or treatments into just one or two formulas.

This significantly increases patient compliance and improves treatment outcomes.

Let’s say after joint surgery, you normally need to apply a:

  • Topical muscle relaxer
  • Painkiller
  • Numbing cream
  • Antibiotic

Using all of these separately will take you a significant amount of time.

Using them in a single solution solves the need for treatment in one step – and just might give you the best coverage, too.

 

Which Medications Are Available in Compounded Transdermal Formulas?

There’s no easy answer to this question; the list of potential drugs that can be compounded into transdermal versions is exhaustive and long.

However, we can help you better understand which transdermals are most likely to benefit you when you are experiencing acute or chronic pain:

  • NSAIDs: like ketoprofen and diclofenac
  • Muscle relaxants: like cyclobenzaprine or baclofen
  • Anesthetics: like lidocaine or benzocaine
  • Nerve blockers: like ketamine and amantadine
  • Nerve agents: like amitriptyline and Lyrica
  • Icy-Hot solutions: like menthol and capsaicin

If you have chronic pain, and are interested in reducing side effects or improving your pain control, talk to your pharmacist about transdermal therapy medications.

Whether compounded or not, there are options to help you achieve your goals.

Categories
Medicine

Finding the Right Pain Management Medication for You

If you are in pain, it’s likely that your pain changes you and your daily life. Whether you experience the occasional headache or migraine you suffer from serious conditions like Rheumatoid Arthritis (RA), managing your pain effectively is an important part of good self-care. Unfortunately, pain management medication is a complex and difficult topic – what works for every patient isn’t necessarily the same.

Some patients experience pain on a chronic, unrelenting basis. This chronic pain can exacerbate itself, becoming highly debilitating and leading to a significant reduction in quality of life. These patients often find themselves sacrificing a significant amount of their freedom, independence, and lifestyle just to prevent further pain. Eventually, some patients even become housebound.

No matter what your condition, there are effective ways to manage your pain at whatever level you experience it. Suffering alone in silence doesn’t have to be your only option. Pain management medication ranging from OTC narcotics to stronger post-surgical opiates all have a role to play in preserving function and providing relief.

 

First Things First

Before exploring your options for pain management medication, it’s important to visit your doctor. In doing so, you can learn about the source of your pain and gain insight about the best approach for its management. What works for back pain, for example, won’t necessarily be as effective for someone experiencing chronic pancreatitis. Because there are so many different types of treatments available today, this step helps to narrow down the options that are best to manage your particular pain.

 

What is the Official Definition of Pain?

What exactly is “pain?”

The answer to this question is exactly what makes treating pain so complicated: the definition of pain often differs patient to patient. Pain tolerances and individual biochemistry can also predict whether not a patient defines an experience as painful or just uncomfortable. Even physicians often have their own definitions of pain.

While doctors might vary on what criteria they personally use to assess the pain of their patients, the International Association for the Study of Pain developed a consensus statement that offers an excellent baseline starting point. Essentially, the description notes that pain is an emotional and sensory experience that’s unpleasant. This description is important in that it acknowledges pain as not just something that you feel, but something you experience. The IASP also recognizes that pain can affect the patient’s holistic well-being, including both physical and mental health.

 

Why is Your Pain Different Than Others?

There is a general consensus that pain is both a sensory and emotional experience, but that doesn’t mean that everyone experiences pain the same way or to the same degree. Pain measurement is determined by what a particular person brings to the experience.

If you are anxious or depressed, your perception of pain could be much greater than someone who is not suffering from these conditions. Similarly, if you have a fear of pain, this can make any pain you do experience worse than if you weren’t fearful. Feeling negative emotions like fear, anxiety, and sadness can amplify perceptions, making pain more severe.

Because pain has an emotional and mental aspect, doctors often prefer to address both aspects of the patient at once. This is wise; research shows that pain patients experience mental health illnesses at a much higher rate. This is logical – being in chronic pain certainly isn’t a fun experience for anyone!

 

Managing Pain in a Holistic Manner

Pain management medication works best when it is part of a holistic treatment for pain. Treating the source of the pain, adjusting lifestyle or diet, and even utilizing hands-on therapies like massage and chiropractic may all help your pain while addressing the whole person.

While opioids are the frontline choice for treating extreme pain (such as after surgery or end-of-life care), they aren’t necessarily the best choice for treating chronic pain. Most opiates have a relatively short life-span and build tolerance quickly. This makes chronic use problematic as doses must be escalated regularly. However, each patient is unique, and some conditions may call for aggressive pain management medication with opiates despite national recommendations.

Other potential pain management medication includes:

  • Acetaminophen – (Tylenol) This drug works by blocking prostaglandins in the body which heighten pain reception. It is available over the counter, but must be taken carefully to avoid liver damage.
  • Steroids – (Prednisone; Dexamethasone) – these drugs suppress the immune system locally or systemically. This may reduce pain and the inflammation that often accompanies it.
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) – these drugs work by blocking prostaglandins and reducing inflammation. This class of pain relievers includes Aspirin, Naproxen and Ibuprofen. While effective, NSAIDs can cause gastrointestinal bleeding if taken in high doses.
  • Selective Serotonin Reuptake Inhibitors (SSRIs/SNRIs) – these drugs change brain chemicals to alter mood and/or pain interpretation. They can help alleviate pain as well as help you sleep.
  • Anti-Seizure Drugs (Depakote, Neurontin; Lyrica) – these drugs change chemicals and electrical signals in the brain. While typically used to prevent seizures, research does show that they can reduce the intensity of pain signals – especially nerve pain.

 

Compound Medications and Your Pain

Many people find it difficult to manage their pain, even with medications. Patient drug viability varies dramatically – some patients may become very nauseous from opiates or may be virtually unable to take NSAIDs due to stomach conditions. They might be allergic to a component that is typically found in pain management medication. These experiences can be seriously frustrating and limiting, but there are still options.

A compounding pharmacy can strip down pain management medication to their base ingredients and reformulate a better solution that works. This includes changing dosage format, ingredient lists, or even flavors to make medication easier to take. For example, a compounding pharmacy may take an NSAID medication and make it into a topical salve to avoid damaging the stomach.

Compounding pharmacies create prescriptions right on the spot to the patient’s needs. That means that, should a commercial dose fail to be effective for you, they can micro-adjust the dose to get it just right. You receive all of the benefits of your pain management medication without risking higher-dose-than-necessary side effects. This is especially important for sensitive populations like children and the elderly.

Compounding offers patients access to combination medications that aren’t normally produced for sale by manufacturers because there’s simply not enough of a demand for them to do so. With your doctor’s guidance, the compounding pharmacist can create a customized medication. This medication is designed specifically to treat your pain and make it manageable. Just speak with your pharmacist if you want to know more!

 

Other Pain Management Medication Methods

Pain management medication often works best if it’s used in conjunction with other techniques that you can use on your own. Taking the time to meditate, employing specific relaxation techniques (such as deep breathing or guided visualization) can significantly reduce emotional reaction, which in turn reduces pain. The beauty of these approaches is that you can use them anywhere at any time.

Using cold and heat therapy (or a combination of the two), massage, or physical  manipulation of the area also reduces pain. You can perform basic massage and manipulation right at home just by stretching or rubbing your muscles. Alternatively, you can seek the assistance of a physiotherapist instead.

Biofeedback provides you with the training that allows you to control your heart rate, muscle tension, temperature and other aspects of your body. By strengthening the connection between body and mind, you may find it easier to deal with your pain.

Some patients find transcutaneous electrical nerve stimulation (TENS) therapy effective. In this therapy, light electrical signals travel through the muscles; the signals aren’t high enough to be painful, but trick the muscles into relaxing. TENS treatment can also interrupt nerves to make them feel numbed, rather than transmitting pain.

 

Mental Health Approaches

As mentioned previously, some patients benefit most from addressing the emotional influences of pain. One of the best ways to do this is by attending dialectical behavioral therapy (DBT) or cognitive behavioral therapy (CBT) with a registered therapist. During sessions your therapist will teach you about your pain. They will also empower you to better understand its role in your life.

If your doctor believes you may be suffering from depression or anxiety, treating those conditions with therapy and/or medication may have a secondary side effect on your pain. By reducing stress and emotional upheaval, you will be better equipped to handle your pain when it comes.

What is probably the most important piece of advice to remember when it comes to pain is to not wait to address it. As soon as you notice your pain is affecting your life in a negative way, seek help. The longer you suffer from pain, the more likely it is to become chronic and require long-term treatment. Rather than letting your pain chip away at your ability to function and enjoy the life you envision, reach out to your pharmacist or physician and take advantage of the resources available.

Categories
Medicine

5 Best Non-Addictive Pain Management Medications

Pain: it’s one of the most common complaints for Americans of all ages today. From tension headaches to more serious disorders like arthritis, dealing with and alleviating pain is often one of the biggest challenges medical professionals face. Overtreating and undertreating are both potentially dangerous; pain is the body’s way of telling us that something is wrong. However, undertreating it can lead to brain fog, issues with concentration, anxiety, depression, and even an inability to focus on and complete everyday tasks. Migraineurs know this affect very well; sometimes it hurts just to look at the screen.

Unfortunately, many of the best pain management medications come with serious side effects like addiction, increased blood pressure, or increased strain on the liver. It’s very difficult to find solutions that balance safety with the need for pain control–but that doesn’t mean it’s completely impossible. These five non-addictive pain management medications are not only safe for the majority of patients, but are remarkably effective at reducing aches and pains, too.

Important: Although the pain management medications listed here are relatively safe, you should always consult your pharmacist or physician before starting a new medication. This is especially true if you suffer from pre-existing health conditions. Always be safe!

 

Anticonvulsants

Anticonvulsants first came to fame for treating epilepsy, but as it turns out, they have an unintended consequence: most also seem to reduce neuropathic pain levels. This class of drugs isn’t addictive, though they can carry certain bothersome side effects. Titrating the dose upward from a very small dose to the average daily dose ameliorates most of these side effects, as does weaning the dose down slowly.

Drugs that fall into the anticonvulsant family include:

  • Lyrica
  • Gabapentin
  • Depakote
  • Lamictal
  • Tegretol

 

How do Anticonvulsants Work?

Anticonvulsants work by impacting both calcium channels and GABA levels in the brain, both of which have a direct impact on pain in the body. By influencing these brain chemicals, they reduce pain signals, causing your brain to interpret them as being less severe than they really are. They are best used in tandem with other pain management medications or treatments.

 

When are Anticonvulsants Indicated?

Anticonvulsants do show efficacy in many conditions, but they aren’t right for every kind of pain. They are most effective for conditions that bring on neuropathic (nerve) pain, including:

  • Herpes viruses
  • Shingles
  • Diabetes-related neuropathic pain
  • Multiple Sclerosis
  • Sciatica
  • Spinal degeneration
  • Fibromyalgia
  • Myalgic Encephalomyelitis
  • Peripheral neuropathy

These pain management medications do require a prescription, and many also necessitate regular blood work, too. Getting the right level is important; too much can cause drowsiness, while too little is ineffective. That said, the vast majority of patients experience few to no side effects if the dose is titrated correctly. See your physician if you have questions about whether they’re right for you.

 

SNRIs and SSRIs

Officially known as “Selective Norepinephrine Reuptake Inhibitors” (SNRIs) or “Selective Serotonin Reuptake Inhibitors,” (SSRIs), these two drug categories are most commonly known as antidepressants. They can significantly improve mood for people with clinical depression, and show marked efficacy in treating chronic pain conditions, too. A few of the most common drugs in this category include:

  • Effexor
  • Cymbalta
  • Zoloft
  • Prozac
  • Celexa

 

How do SNRIs and SSRIs Work?

Each of these drugs influences serotonin and norepinephrine in the brain, both of which impact how and when the body experiences pain signals. Much like anticonvulsants, they can reduce the perceived severity of pain so you can better focus on everyday tasks. They may also reduce the risk of chronic pain-associated depression, too.

 

When are SNRIs and SSRIs Indicated?

As some chronic pain patients experience depression and/or anxiety after extended bouts with pain, some doctors are proactive about treating pain with SNRIs and SSRIs. Others prefer to use it only when the ability to treat pain exceeds over-the-counter options. Both are most commonly used to treat these conditions:

  • Fibromyalgia
  • Multiple Sclerosis
  • Migraines
  • Diabetes-related neuropathic pain
  • Tension headaches
  • Cervicogenic headaches
  • Lower back pain
  • Spinal cord injuries
  • Certain traumatic brain injuries

SNRIs and SSRIs aren’t addictive, but they may not be right for everyone. They are contraindicated in patients with a history of suicidal thoughts and those with bipolar disorder. They also cannot be taken with MAO inhibitors, other serotonin-boosting drugs, or pain drugs like Tramadol that may also have a weak effect on serotonin levels. Your doctor can help you to calculate the best dose for your condition.

 

Tricyclic Antidepressants

Tricyclic antidepressants share the same ability to reduce pain as SNRIs and SSRIs; they change the levels of certain brain chemicals to reduce how your body interprets pain. Unlike the previous two drug classes, tricyclics are older, better studied, and may be better tolerated in certain patient populations. They are also more effective at treating certain pain conditions (like migraines). Tricyclics often cause sleepiness and are most frequently prescribed at bedtime, and may help you to achieve a better sleep at night, too.

Drugs that fall into the tricyclic family include:

  • Amitriptyline
  • Nortriptyline
  • Norpramin
  • Doxepin
  • Tofranil
  • Protriptyline

Some people seem to naturally respond better to certain analogues, so you may need to try one or two versions before you see results. You should expect full efficacy to take between two and four weeks, though many patients experience a reduction in pain in just a week when taking these pain management medications.

 

How do Tricyclic Antidepressants Work?

Tricyclic antidepressants work by directly increasing the levels of norepinephrine and serotonin, but they also block a chemical known as acetylcholine, too. It’s the latter effect that probably results in better results for people who don’t respond to treatment with SNRIs or SSRIs. Most researchers agree that achieving balance between these three brain chemicals is one of the best ways to reduce pain.

When are Tricyclics Indicated?

Tricyclic antidepressants are remarkably safe and effective, even in sensitive populations like the elderly or liver-compromised. They’re also very easy to scale, so the dose can be reduced or increased in very small increments. However, they can cause confusion or a worsening of symptoms in people with dementia or other neurological disorders. They are most effective for these conditions:

  • Migraines
  • Chronic daily headache
  • Fibromyalgia
  • Multiple Sclerosis
  • Rheumatoid Arthritis
  • AIDS-related neuropathies
  • Diabetes-related neuropathic pain
  • Shingles and/or chickenpox
  • Other nerve pain disorders
  • Osteoarthritis, in tandem with anti-inflammatories

Because tricyclics are an older class of drugs, we know more about them and how they act in certain patient populations. This may make them safer, too. Some doctors provide them solely for the fact that they improve sleep in patients who struggle with painsomnia.

 

Topical Anti-Inflammatories

Just a decade ago, the primary way to take non-steroidal anti-inflammatory drugs (NSAIDs) was via oral ingestion or intramuscular injection. While remarkably effective for conditions like arthritis and soft tissue injury, these drugs can also have very serious side effects on the gastrointestinal tract.

NSAIDs are commonly associated with stomach and duodenal ulcers, and may also cause a condition known as Barrett’s Esophagus–erosion of the esophagus that may increase a patient’s risk for cancer. These risks are significantly lowered to almost negligible amounts if you’re taking them only once in awhile. Take them daily for long periods of time and the risk increases. That’s why researchers came up with topically-applied NSAIDs like Voltaren Emulgel.

Drugs that fall under topical NSAIDs include:

  • Diclofenac
  • Ibuprofen
  • Ketoprofen

These are the only three NSAIDs to be officially approved for topical use in America at this time. By far, the most common brand is Voltaren Emulgel. Voltaren is applied directly to the area in pain and rubbed in deeply. Though relief is temporary, it can be an excellent adjunct to other treatments.

In some areas of the United States, topical NSAIDs may be available over-the-counter. You should still speak with your pharmacist to verify whether they’re safe for you to use.

 

Toradol/Ketoralac

For patients in whom narcotics are contraindicated, yet they are experiencing severe pain, Toradol may be the answer. It is an exceptionally strong NSAID-class drug with a proven ability to reduce pain related injury, post-surgical pain and swelling, and visceral or cancer-related pain, too.

Unfortunately, Toradol’s strength isn’t only in efficacy, but in side effects, too: it can seriously injure the lining of your stomach if the recommended dose is exceeded. Most doctors will not prescribe Toradol more than four days at a time, or for breakthrough pain, for this reason.

 

How does Toradol Work?

Toradol works in the body in a similar way to all other NSAID-class drugs; it blocks the production of inflammation-causing chemicals in the body. Officially, it is a cyclo-oxygenase (COX) inhibitor. In the body, COX plays a role in triggering the body to respond to injury, increasing circulation and swelling in the area to help heal you. That’s desired in minor injuries, but can complicate healing in chronic or long-term conditions.

 

When is Toradol Indicated?

Toradol is rarely used as a first-line treatment for chronic conditions due to its side effect profile. It is most commonly used for presurgical pain, intense breakthrough pain, dental pain, and other forms of acute injury. It may be appropriate for migraines if taken only seldomly. Side effects and risks are reduced when the drug is taken infrequently, so always follow your doctor’s treatment recommendations.

 

The pain management medications listed here are non-addictive and remarkably effective, but that doesn’t make them right for every patient or every condition. The best way to approach unresolved pain is to speak with your pharmacist or physician and get to the root of why it’s occurring. Once you begin to understand the cause of your pain, you can work towards relieving it from all possible avenues, including taking pain management medications. Wellness in the event of chronic or acute pain is possible!

 

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