Pain Management and Physical Therapy

Pain management is essential because even when the underlying disease process is stable, uncontrolled pain prevents patients from working productively, enjoying recreation, or taking pleasure in their usual roles in the family and society. Chronic pain may have a myriad of causes and perpetuating factors, and therefore can be much more difficult to manage than acute pain, requiring a multidisciplinary approach and customized treatment protocols to meet the specific needs of each patient.


Optimal treatment may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA (N-methyl-D-aspartate) antagonists. NMDA-receptor antagonists, such as dextromethorphan and ketamine, can block pain transmission in dorsal horn spinal neurons, reduce nociception, and decrease tolerance to and the need for opioid analgesics. Combining various agents which utilize different mechanisms to alter the sensation of pain, physicians have found that smaller concentrations of each medication can be used.


Topical and transdermal creams and gels can be formulated to provide high local concentrations at the site of application (e.g., NSAIDs for joint pain), for trigger point application (e.g., combinations of medications for neuropathic pain), or in a base that will allow systemic absorption. Side effects associated with oral administration can often be avoided when medications are used topically. Studies suggest that there are no great restrictions on the type of drug that can be incorporated into a properly compounded transdermal gel. When medications are administered transdermally, they are not absorbed through the gastrointestinal system and do not undergo first-pass hepatic metabolism.


We work together with patient and practitioner to solve problems by customizing medications that meet the specific needs of each individual. 


Don’t Let Chronic Pain Keep You From Enjoying Your Life.  

Alternative Dosage Forms  

Some patients have difficulty taking medication in its commercially available form. Instead of a capsule or tablet, pain medications often can be compounded as a topical gel, cream or spray that can be applied directly to the site of the pain and absorbed through the skin. They also may be available in the form of a custom-flavored troche that dissolves under the tongue, a nasal spray, or suppository. Such dosage forms may bypass the gastrointestinal tract, providing optimal results with less GI irritation. These dosage forms also help patients who have difficulty swallowing pills, removing yet another source of aggravation. 

Combined Formulations  

Some chronic pain sufferers are placed on a variety of medication to help address the symptoms associated with the disease. On many occasions, these multiple products can be combined into a single dose of a specially prepared compound that combines the medications into a single capsule or topical preparation, providing greater convenience for the patient.

Strength Variations  

Because patients vary in size, symptoms, and pain tolerance, a healthcare provider and a pharmacist can customize the dosage to the exact amount the patient requires and improve patients’ quality of life by providing relief with fewer potential side effects and less overall medication.