Pain Management Compounding

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 many contributing factors, and therefore can be much more difficult to manage than acute pain, requiring customized protocols to meet the specific needs of each patient.

What is Pain?

Pain is the most frequent reason people seek medical attention. It is one of the most common symptoms of disease and can significantly interfere with a person’s quality of life. 

It includes a nociceptive (sensory) component, caused by stimulation of nerve fibers and an affective (emotional) component. Pain is usually transitory, but some painful conditions may persist for years. Sometimes pain arises in the absence of any detectable stimulus, damage, or disease.

Pain Pathways

Nociceptive Pain (tissue damage)

  • Nociceptors are the nerves which sense and respond to parts of the body which suffer from damage. They signal tissue irritation, impending injury, or actual injury. When activated, they transmit pain signals (via the peripheral nerves as well as the spinal cord) to the brain.
  • Somatic and visceral causes
  • The pain is typically localized, constant, and often with an aching or throbbing quality.
  • This type of pain tends to respond well to opioids.

Neuropathic Pain (nerve damage)

  • Pain caused by damage or dysfunction to neural pathway of the peripheral or central nervous system. Pain signals continue to be generated in the injured/damaged area long after it has healed.
  • The pain can be continuous or intermittent burning, shooting, or electrical shock qualities.
  • The pain may persist for months or years beyond the apparent healing of any damaged tissues.
  • This type of pain is frequently chronic, and tends to have a lesser response to assisting with opioids, but may respond well to other drugs.

Importance of Targeting Different Pathways

The pain therapy depends on the type of pain. The benefit of addressing different pain pathways helps to address pain where it hurts and to target and relieve pain from all different mechanisms of action. In addition, it allows for more consistent and reliable pain relief, reduces drug dosages, reduces side effects, and allows for more options to meet each patient’s specific needs.

Importance of Targeting Different Pathways

  • ACUTE PAIN: Diagnose the source and remove or block the pain until damage or injury is healed.
  • CHRONIC PAIN: Complete relief of this type of pain is rare. The more realistic goal is to decrease the level of pain to a tolerable level.


  • Skeletal muscle & joints
  • AMPA Sodium Channels
  • NMDA Calcium Channels
  • Opioid Receptors
  • GABA Receptors
  • Peripheral Alpha-2 Adrenoreceptors
  • Substance P

Transdermal Creams

Optimal assistance may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA antagonists. By combining various agents that utilize different mechanisms to alter the sensation of pain, physicians have found that smaller concentrations of each medication can be used.

Transdermal creams and gels can be formulated to provide high, localconcentrations at the site of application (e.g., NSAIDs for joint pain),for trigger-point application (e.g., combinations of medications forneuropathic pain), or in a base that will allow systemic absorption. Studies suggest that there are limited 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 hepaticmetabolism; therefore, side effects associated with oral administration can often be avoided.

The following is a list of pain conditions for which we commonly compound medications:

Ankle Pain
Back Pain
Burning Foot Syndrome
Carpal Tunnel Syndrome
CRPS (Chronic Regional Pain Syndrome)
Diabetic Neuropathy
Foot Pain
Head, Neck, and Facial Pain

Knee Pain
Muscle Spasms
Myofacial pain
Neuropathic Pain
Post Herpetic Neuralgia
Shoulder Pain
Tennis Elbow
(Temporomandibular Disorders)

We work together with the prescribing physician and the patient to solve problems by customizing medications that meet the specific needs of each individual. Please contact our compounding pharmacist to discuss the appropriate dosage form, strength, and medication.

Low Dose Naltrexone & Pain Management

An Excerpt from The use of low-dose naltrexone (LDN) as a novel anti-inflammatory option for chronic pain by Younger, Partkitny, and Mclain

“Low-dose naltrexone (LDN) has been demonstrated to reduce symptom severity in conditions such as fibromyalgia, Crohn’s disease, multiple sclerosis, and complex regional pain syndrome. We review the evidence that LDN may operate as a novel anti-inflammatory agent in the central nervous system, via action on microglial cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone’s better-known activity on opioid receptors.”

As the off-label use of LDN has gained popularity, it has been widely accepted as an alternative medicine option and is used for various medical conditions.  These off-label conditions include:

Multiple Sclerosis
Complex Regional Pain Syndrome
Crohn’s Disease
Gastrointestinal Disorders

Skin Conditions
Inflammatory Bowel Disease
…and more.