Chronic Pain-
A Silent Catastrophe (Part Two)
By Gene Gresh,
R.Ph, FIACP
I
n the first part of this article I discussed the “problem” relating to chronic pain. The scope of this problem is so massive and yet hardly known. Who would have known that with all of our tech- nology and science in a society as advanced as ours that we were so inefficient in treating pain resulting in this silent catastrophe. The fact that almost one-third of the American population is
impacted by chronic pain is staggering – not to mention the financial burden estimated at more than $500 billion a year. It is clear that our current understanding and beliefs about conventional pain therapies are not accurate and are in need of reexamination. By studying the most current scientific literature and learning about the nature of pain and then combining this information with our ability to customize medications as we do in compounding pharmacy, we have been able to provide new and unique options in the treatment of pain. This coupled with the education and tools provided to us by Maureen Carling, RN, of Williamsburg, Va., has provided the foundation for extraordinary experiences in the treat- ment of pain resulting in significant relief in the vast majority of our patients as well as a dramatic decrease in opioid use at the same time.
Compounding pharmacists are a specialized group of experts within the pharmacy field. Extensive training in the formulation and creation of unique medications is required. With the use of innova-
tive equipment and pure pharmaceutical ingredients, compounding pharmacists are able to create customized medication therapies, which can be designed and created for each individual patient to help solve their unique needs. By customizing drug therapy, our goal is to create a treatment,
which enhances the therapeutic outcome at the same time reducing the incidence of side effects. As we have evidenced, this is difficult to achieve in a “one size fits all” medical model. Over the last two decades, compounding pharmacists have
developed and refined the ability to formulate transdermal bases, which allow for the transport of medicines through the skin in order to deliver these medications to a desired area in the body. This tar- geted delivery method has several advantages over the more typical drug delivery routes especially the oral route. When drugs are delivered orally they must be absorbed via the gastro-intestinal tract which then transports that medicine directly to the liver in what is known as “the first pass effect.” Many patients in our society have GI issues, which may impact drug absorption, and the liver is often associated with limitations and problems in drug metabolism and drug interactions. This drug then gets distributed via the systemic circulation to all parts of the body where we hope that a significant dose gets to the actual site we want it to work. This method of drug distribution results in the entire body being exposed to the drug thus increasing the risk of side effects and drug interactions, which as we know is very common. Much attention is being paid in the area of pharmaceutical research to better deliver medicines in ways to increase the effectiveness yet limit the risk of side effects. The transdermal route has done just that. As mentioned in the first part of this article, new findings in re-
search have shown that there are changes in the nervous system that occur in chronic pain situations.
One of the areas frequently mentioned is the “dorsal root gan-
glion” which is located in an area on either side of the spinal cord where spinal nerves exit the spine and become peripheral nerves going out to the various areas of the body. I like to think of this area like an electrical system of your house and the fuse box is similar to the spinal cord from which all the wires feeding the entire house come from.
26 Natural Nutmeg October 2012
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