We use what is known as a dermatome map, which is similar to
a wiring schematic. This map helps to determine where on the spine that particular nerve branch exits and then feeds the corresponding area in which the pain is perceived. This area next to the spine where the dorsal root ganglion is located is like a junction box of an electri- cal system and allows us access to this nerve branch and becomes our primary target for our transdermal pain gel. By enhancing the absorption of the appropriate medications through the skin using a customized transdermal pain gel, the intent is to direct most of the medicine into the local area where we want it to go while limiting absorption into the systemic circulation. Nu- merous studies have supported this theory. This compounded delivery method allows us to combine medications and get them delivered right to where we want them to go thus, increasing their effectiveness and decreasing the risk of drug interactions and side-effects. As we shall see this is exactly why the customized compounded transdermal pain gel is an excellent delivery method for the various medications used in the successful treatment of pain.
As a compounding pharmacist I have been using the transder- mal route for various types of pain conditions over the past 16 years with seemingly good results. It wasn’t until I met Maureen Carling, RN at a pain conference about six years ago that our experience became quite extraordinary. In 1994 Maureen developed and pub- lished an algorithm for the accurate assessment of pain. At that time she was the pain management coordinator for Riverside Regional Medical Center in Virginia. Maureen states, “Without an accurate assessment of the pain, we are just shooting in the dark.” That is, if we don’t properly assess the pain to identify exactly which types of pain we are treating then how would we know which medica- tions to choose for appropriate treatment. This concept completely changed my belief about effective pain therapies. At the end of her first year after the introduction of her system of assessment (The Carling Method), the amount of morphine being used in the hospice program went down by 50% and the number of PCA pumps being used decreased by 75%. Maureen’s algorithm, which is a component of her pain assess- ment tool, identifies different types or classifications of pain. Each type of pain is unique and has its own characteristics. One of the most significant differences among the types of pain is the fact that
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