Written by: Jeanhie Kim PharmD. Candidate Class of 2019

 

Opioids are commonly prescribed pain medications, which have recently been realized as causing an epidemic in the United States. Many people are overprescribed these medications which can lead to addiction, abuse, and death. While people are becoming more aware of the dangers of opioids, sometimes they are necessary.

 

What are opioids?

Opioids are naturally found in opium poppy plants which have pain-relieving effects in the body. Some are derived from the plant directly, while others are synthetically created.  Some of the most commonly prescribed opioids are1:

  • hydrocodone
  • oxycodone
  • codeine, morphine
  • hydromorphone, and
  • fentanyl.

 

Why are opioids causing a problem?

While considered generally safe if used appropriately for a short period, there is often misuse and abuse associated with opioids due to their euphoric or “high” like effects.1

  • Taking medication in a fashion or dose other than prescribed
  • Taking medication that is not prescribed for you
  • Taking medications seeking a euphoric effect

 

Some common side effects can include constipation, dizziness/drowsiness, headache, nausea, and vomiting. The most dangerous side effect that we worry about with opioid pain medications is decreased breathing. When combined with other medications that have the same side effects, they can add to each other to increase the severity.

According to the CDC, an estimated 11% of adults experience daily pain. Contrary to belief, efforts have made an impact and prescribing has been on a downward trend after its peak in 2010, but still >11.5 million Americans (12 years and older) reported misusing opioids in 20162-3. Efforts have managed to show a decrease in prescribed opioids, but even so, there has been a steady increase in overdose-related deaths.

Figure 1A 2A

 

What are some ways to fix this?

Opioids are not considered first-line or routine therapy for chronic pain patients2. So now what? You still have pain, none of the over the counter medications work, and you’re on an opioid. Here’s the good news. Compounded medications can address various types of pain you might have (neuropathic pain, nociceptive pain, and musculoskeletal pain). There are several non-opioid treatments you probably have not tried yet that can be compounded for you to manage your pain symptoms.

A multi-modal treatment plan, using a small variety of therapies, is often recommended to minimize opioid burden or avoid them altogether.  These compounded products can address pains associated with:

  • Complex regional pain syndrome (CRPS)
  • Temporomandibular disorders (TMD)
  • Trigger point therapies (TP)
  • Headaches (migraines/cluster and tension)
  • Neuropathies (peripheral neuropathy, phantom limb pain, postherpetic neuralgia)
  • Bone and joint disorders (osteoarthritis, rheumatoid arthritis, carpal tunnel syndrome, joint pain)
  • Muscular pain (fibromyalgia, muscle spasms, muscle strains, muscle spasticity)
  • Transdermal creams and gels

Topical application of agents can help minimize pain while reducing systemic side effects, drug-drug interactions, and are easily applied by patients4. Some of the agents that can be utilized in topical application are:

  • NSAIDs
  • Nerve blocking agents
  • Anesthetics
  • Muscle relaxers
  • Pain blockers
  • Nerve stimulating agents for pain desensitization
  • Trigger point injections

Trigger Point Injections

Deep muscle pain can present itself with multiple symptoms such as tension and tenderness in the surrounding muscles and tension-type headaches5. Injection therapy into these trigger points can relieve the root problem and clear up these symptoms. Some examples of the agents used in these injections are NSAIDs, steroids, and pitcher plant extract.

Trigger Point Injections

Intra-articular Injections

Injections into the intra-articular space or joint space, can deliver medications that aid in decreasing pain in those areas. This type of therapy is often used to treat osteoarthritis pain and delivers medication directly to the site of discomfort. Common agents used in these injections can include steroids to decrease inflammation or hyaluronic acid therapy6 to improve movement.

Intra Articular Injections

Our Approach to Wellness

Innovation Compounding prides itself on combating overuse and misuse by offering alternative treatment options and avoiding the use of opioids in our products whenever possible. Pain should be managed with a healthcare team that includes physician, pharmacist, and patient.  We choose to utilize a collaborative, hands-on, and consultative approach in helping our patients find a solution to feeling better and safer.

Contact our team of pharmacists to review your medications and find an optimal treatment regimen for you. Physicians should also contact our pharmacists to speak about pain management options for your patients.

Contact Innovation Compounding pharmacy:
For more information about our pharmacy or standards for quality, please contact us at (800) 547-1399 or complete the form below:

Pharmacy Hours (EST)
Sunday Closed
Monday 9AM - 6PM
Tuesday 9AM - 6PM
Wednesday 9AM - 6PM
Thursday 9AM - 6PM
Friday 9AM - 5PM
Saturday Closed


 

IMAGE CREDITS
https://www.cdc.gov, https://www.sportspainmanagementnyc.com 

REFERENCES

  1. National Institute on Drug Abuse. Prescription Opioids. NIDA. https://www.drugabuse.gov/publications/drugfacts/prescription-opioids. Accessed March 28, 2019.
  2. Opioid Overdose. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/prescribing/guideline.html. Published August 29, 2017. Accessed March 28, 2019.
  3. Hoots B, Xu L, Kariisa M, et al. 2018 Annual Surveillance Report of Drug-Related Risk and Outcomes United States.; 2018. https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf. Accessed March 28, 2019.
  4. Gudin J, Brennan M, Harris D, Hurwitz P, Dietze D, Strader J. Changes in pain and concurrent pain medication use following compounded topical analgesic treatment for chronic pain: 3- and 6-month follow-up results from the prospective, observational Optimizing Patient Experience and Response to Topical Analgesics study. Journal of Pain Research. 2017;10:2341-2354. doi:https://doi.org/10.2147/JPR.S143513
  5. Kocak A, Ahiskalioglu A, Sengun E, Gur S, Akbas I. Comparison of intravenous NSAIDs and trigger point injection for low back pain in ED: A prospective randomized study. American Journal of Emergency Medicine. January 2019.
  6. Henrotin Y, Raman R, Richette P, et al. Consensus statement on viscosupplementation with hyaluronic acid for the management of osteoarthritis. Seminars in Arthritis and Rheumatism. 2015;45:140-149.

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