In part one of this two-part series on chronic pain, I discuss why chronic pain has become an epidemic and how conventional treatments are failing to address it. The scope of this problem is so massive yet nobody is talking about it. Who would have known that with all of our technology and science in a society as advanced as ours that we’re so inefficient at chronic pain treatment, which has led to this silent catastrophe?
The fact that almost one-third of the American population is impacted by chronic pain is shocking — not to mention the financial burden, estimated at more than $500 billion a year. It’s clear that our current understanding and beliefs about conventional pain therapies are not accurate and are in need of a re-examination.
Through studying the most current literature and learning about the nature of pain, combined with our ability to customize medications as we do in compounding pharmacy, we have been able to provide new and unique options in chronic pain treatment. This, coupled with the education and tools provided to us by experts like Maureen Carling, RN, has provided the foundation for extraordinary experiences chronic pain treatment, resulting in significant relief in the vast majority of our patients as well as a dramatic decrease in opioid use.
Compounding Pharmacy is Changing Chronic Pain TreatmentCompounding pharmacists are a specialized group of experts within the pharmacy field. Through the use of innovative equipment and pure pharmaceutical ingredients, we’re able to create customized medication therapies to help patients solve their unique needs. By customizing drug therapy, our goal is to create a treatment that enhances the therapeutic outcome while at the same time reduces the incidence of side effects. One such advancement is the development of transdermal bases, allowing the transport of medicines through the skin in order to deliver medications to a specific area of the body. This bypasses the digestive system altogether, giving the medication a much higher chance of getting to where we need it to go.
I had been using transdermal treatments for various types of chronic pain conditions in my 15 years as a compounding pharmacist, but it wasn’t until I met Maureen Carling at a pain conference that our experience became quite extraordinary.
The Most Accurate Assessment for PainIn 1994, Maureen developed and published an algorithm for the accurate assessment of pain. At that time, she was the pain management coordinator for the Riverside Regional Medical Center in Virginia. Maureen explained, “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 type of pain we are treating, how can we know which medications to choose for treatment? Over and over again, we hear of patients on very strong narcotics report that in spite of their drug therapy, they are still in pain. So, physicians increase their dose, yet there is still no reduction in pain.
A year after she introduced her system of assessment, (called The Carling Method), the amount of morphine being used in the hospice program in Virginia decreased by 50% and the number of PCA pumps being used decreased by 75%.
Maureen’s algorithm identifies eight different types, or classifications, of pain. Each type of pain is unique and has its own characteristics. An example of this is burning pain versus sharp, stabbing pain. We know that they’re not the same, but conventional medicine doesn’t address that — especially when it comes to choosing a treatment. This is one of the biggest problems in conventional pain management — treatment is based off a zero to ten scale based on how severe it is, not what kind it is. This only determines how much medication to give, not what medication is appropriate. Maureen’s algorithm is about identifying the type of pain so that we can choose the right type of therapy. Oftentimes, it’s not an opioid.
One of the most significant differences among the types of pain is the fact that certain pains don’t completely respond to the opioids and some don’t respond at all. In fact, Maureen found that only two types of pain will fully respond to opioids. This fact along sheds much light on the huge problem of our conventional pain therapy.
We were taught to prescribe opiates based on the severity of pain, not on the type of pain. We were never taught about different types of pain or that opioid resistance even existed. This new understanding completely changed my understanding of pain.
A Case StudyA recent patient experience exemplifies this situation. We will call her “Sue”. A physician referred Sue to us shortly after being admitted to the hospital with an apparent Oxycontin overdose, which was prescribed following a surgical implantation of mesh in her lower abdomen. We were able to formulate a topical pain gel based on an assessment of her pain. We dispensed this prescription to her on a Friday as she was discharged. On Monday, I called to reassess the situation and Sue told us that the pain was “completely gone”.
Most patients don’t respond that quickly and we often find that the longer someone has been in pain, the longer the process of pain relief is. Sue’s example exemplifies that when the appropriate medicines are used and properly titrated, the results can be remarkable. Not only does this result in true pain relief, but we are also seeing a consistent reduction in opioid use.
Customizing Pain TreatmentWe currently have 20 to 30 different medication options that we can choose from to customize a pain gel. By accurately identifying the types of pain, we can now more accurately choose the appropriate combination of medications that would best treat a particular patients’ pains. Current research states that one-third of pain patients are dealing with four or more types of pain. As you can imagine, it can be quite complicated to treat this, yet the assessment tool developed by Maureen allows us to systematically and scientifically choose the most appropriate medications unique to that individual. Our ability to compound these drugs into a transdermal pain gel and deliver them to the targeted area has been shown to increase the effectiveness of the chronic pain treatment, and at the same time, significantly reduce the incidence of side effects.
Moving Patients ForwardThe Carling Method includes a process whereby we can reassess the patient and titrate the medication by calibrating the gel and the opioid. During the re-assessment, we can now use the 0-10 scale to determine how well a medication is working and then appropriately titrate the dose based on our findings. It may take many weeks of re-assessing and recalibrating, but eventually, we almost always achieve significant pain relief and in many cases “pain-free”, with very little side effects and a corresponding reduction in opioid use.
Is this not the desired outcome?
My experience using the pain management process has been nothing short of amazing. Our biggest obstacle has been the difficulty in sharing and educating the medical community. I value the opportunity to speak to physician groups and patients about chronic pain treatment. If you are interested in having me speak at an upcoming event, please get in touch here.
If you are a physician interested in collaborating with us on these new pain management techniques, contact us here. And if you are a patient with questions about your pain management treatment and would like a recommendation for a physician, don’t hesitate to reach out to us.