Acute Pain vs. Chronic Pain: How Compounding Helps Pharmacists Take the Right Approach
No one likes to be in pain. Even the smallest amount of pain in any part of our bodies can cause discomfort that interferes with our lives. Pharmacists see every type of pain imaginable. The 25-year-old former Division I athlete with chronic pain in her knees. The 72-year-old retiree with chronic pain from renal disease and diabetic neuropathy. The four-year-old with acute pain from a broken wrist on the playground. All require different pharmacotherapeutic approaches.
Pain is the number one reason people see a doctor or a pharmacist. Understanding whether your patient’s pain comes from acute or chronic sources can help pharmacists develop the right pain relief or treatment regimen. Where acute pain usually has identifiable trauma and is likely to respond to therapeutic options, chronic pain can be a very different challenge altogether. By working with patients, other physicians involved in the patient’s care and utilizing the benefits of compounding, pharmacists can ensure patients get the type of pain relief or treatment their condition needs.1
Compounding for Conditions Resulting in Acute Pain
Acute pain has a known cause, usually some kind of trauma or surgical antecedent, and is generally defined as pain that will resolve within 1 to 3 months with treatment. Since pharmacists are more involved in direct patient care these days than ever before, it’s entirely possible that a pharmacist may be the first medical personnel to see a patient after the initial trauma.
For example, someone who sustains a severe knee bruise in a bicycle accident may skip a visit to his primary care physician and come straight to the pharmacy for pain management if the pain worsens after a few hours. As the first medical professional to see this patient, it’s up to the pharmacist to identify the underlying cause before assigning treatment. In the example of the bicycle accident, it’s important to take a moment to talk to the patient. Does he have a history of pain in that knee? Has he had any knee surgeries in the past that could be contributing to the pain? Don’t make the mistake of assuming that because the bicycle accident just happened, the pain must be acute.
Once it’s established that the patient is experiencing acute pain from a specific episode, such as postoperative pain, pharmacists have several options for treatment. This is where knowing the patient’s medical history can be crucial. First-line pharmacologic agents for mild to moderate pain symptoms usually includes acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID). However, NSAIDs carry much higher risk of adverse effects for patients with existing gastrointestinal, renovascular or cardiovascular conditions. A topical analgesic like lidocaine can also help pharmacists avoid adverse effects if patients are already taking many oral medications for other conditions.2
Compounding offers pharmacists a distinct advantage in patient care when faced with stubborn acute pain. If a patient’s pain will not respond to first-line treatments, targeting multiple pain pathways simultaneously can offer more relief. Compounding can allow you to create medications such as combination acetaminophen/opioids. For severe pain, compounding can help you create full opioid agonists with high affinity for opioid receptors, such as morphine, which can be combined an NSAID.3
When practicing compounding, you can also more effectively use adjuvants during the treatment process. For example, you could utilize antidepressants like tricyclics for acute neuropathic pain, anticonvulsants such as gabapentin, or glucocorticoids like dexamethasone to reduce post-op pain or nausea. This adjuvants can be added to the treatment regimen at any step in the process, allowing much more flexibility and responsiveness to the patient’s needs.4
The Challenges of Treating and Relieving Chronic Pain
As difficult as treating acute pain can be, chronic pain brings far more challenges for physicians and pharmacists. Often, the cause can be difficult to pinpoint, and even with a distinct diagnosis, treatment or relief can involve a long process of trial and error that can be trying for a patient’s care team and the patient themselves.
As part of that care team, pharmacists treating patients with one or more chronic conditions can keep a few things in mind:
- Consult everyone: Decisions affecting a patient’s complex regimen must be made jointly with other physicians and specialists working with your patient. Depending on the chronic condition involved, or if your patient has been undergoing many different treatments trying to find the cause of their chronic pain, there could be a lot of things happening inside your patient’s body that could put them at risk for higher systemic absorption, toxicity and adverse effects. Make sure you are fully aware of them before prescribing any kind of treatment, and ensure that everyone on the patient care team knows every time any drug regimen changes.5
- Make sure your patient knows his or her options: As the pharmacist, you are uniquely qualified to offer patients treatment and relief with myriad combinations of opioids/opiates, NSAIDs, muscle relaxants, antiemetics, antidepressants, anticonvulsants, sedatives or other analgesics. You can also offer them in forms ranging from suppositories to topical creams. Even though patients these days often do a lot of their own research, patients and even physicians may not be aware of all the options. You have an opportunity to educate as well as treat in every patient interaction.
- Compound for quality of life: Many times chronic pain isn’t something that can be resolved. It may be related to a degenerative condition or simply part of a patient’s aging process. In these cases, you should always make sure you are aiming for quality of life in all of your pharmacological decisions with your patient and the care team. Compounding can help increase patient comfort even as conditions worsen. For instance, for a patient who must take up to 40 pain relief pills, like Oxycontin, daily just to experience some relief, life can be a miserable experience full of insomnia, constipation, lethargy, liver and metabolic problems and depression. Custom compounding an alternate solution for that patient can not only offer better pain relief, but restore actual quality to their life.6
All pain is misery, but not all pain is created equal, especially not in the eyes of a pharmacist. Resist the urge to simply treat the problem in front of you, and always make sure you’re seeing the whole picture. Learn about a patient’s medical history in consultation with other involved physicians and specialists. Really talk to the patient and listen to what they are telling you about the nature of their pain. For a compounding pharmacist, all of this can ensure that you are treating or relieving the right kind of pain in the right way.
Pharmaceutica North America is a premier provider of high-quality bulk active pharmaceutical ingredients, unit-dose APIs and custom compounding kits, including kits and APIs for treating chronic and acute pain. Contact us to learn more about how our products can help you provide the best possible patient care.
- “Pharmacologic Management of Acute and Chronic Pain: Focus on Drug Interactions and Patient-Specific Pharmacotherapeutic Selection,” 2010, http://www.medscape.com/viewarticle/410825 ↩
- “Acute Pain Assessment and Opioid Prescribing Protocol,” January 2014, https://www.icsi.org/_asset/dyp5wm/Opioids.pdf ↩
- “Meeting the Challenges of Acute Pain Management: Medication Choices for Acute Pain,” 2008, http://www.medscape.org/viewarticle/574105_3 ↩
- “Pharmacologic Therapy for Acute Pain,” June 1, 2013, http://www.aafp.org/afp/2013/0601/p766.html ↩
- “Compounding for Chronic, Debilitating Disease,” 2003, http://www.ijpc.com/rxtriad/pdf/RxTriad_V06_N12_Sample.pdf ↩
- “Compounded pain medications ease pain and restore quality of life,” Jan. 15, 2013, https://www.pharmacist.com/compounded-pain-medications-ease-pain-and-restore-quality-life ↩