O'Brien Pharmacy

Pain Management

• Options For Pain Management
• Topical Pain Management
• Management Of Pain And Neuropathy 

OPTIONS FOR PAIN MANAGEMENT

• Custom Capsules
  • Combined medications
  • Sustained release
  • Custom dosing
• Sterile Products
  • Hyaluronidase
  • Intrathecals
    • Morphine, fentanyl, baclofen, clonidine, hydromorphone, tetracaine, levorphanol, etc.
  • Hypertonic Saline
  • Prolotherapy
    • Procaine
    • Phenol/Glycerin
    • Pumice
  • Omnipaque
• Topical Pain Management
  • Ketoprofen, Gabapentin, Ketamine, Clonidine, Amitriptyline, Baclofen, Lidocaine, Tetracaine etc.
  • Enhanced transdermal bases
  • Topical sprays
• Suppositories
  • Combined medications
  • Sustained release
  • Custom dosing

TOPICAL PAIN MANAGEMENT

• Advantages
  • No documentation of nausea, drowsiness, dizziness, liver or kidney effects
  • No documentation of drug interaction with oral medications.
  • Higher local tissue concentration (where you want it)
  • Synergistic effect of multiple medications
  • Extensive range of drug concentrations
  • Infinite combinations of drugs and concentrations
• Medications
  • Ketoprofen
  • Ketamine
  • Gabapentin
  • Clonidine
  • Amitriptyline
  • Baclofen
  • and more…
• Important Considerations to Successful Therapy

• Use of creams/gels documented to enhance penetration
• Pure chemicals:  No unnecessary binders, fillers, excipients
• Mixed and dispensed in special packaging that reduces exposure to contaminants and oxidation.
• We use the only USP, odor-free DMSO available with FDA approval for medical use.  No garlic odor or breath.
• Ointment mill / high-speed homogenizer essential for:
  • Reduced particle size
  • Absorption, penetration
  • Cosmetic quality
  • Equipment found in very few pharmacies

MANAGEMENT of PAIN and NEUROPATHY

• Muscular / Ligament / Joint
  • Ketoprofen 10%
  • with Amitriptyline 2% and/or Cyclobenzaprine 1%
• Complex Regional Pain Syndrome Types I and II
  • Ketamine 5%
  • with Ketoprofen 10% and/or Amitriptyline 2%
• Diabetic Peripheral Neuropathy
  • Ketamine 5% / Gabapentin 5% / Clonidine 0.2% / Nifedipine 2%
• Neuropathy
  • Ketamine 5% / Gabapentin 5% / Clonidine 0.2%
  • Baclofen 5% / Amitriptyline 2% / Gabapentin 5%
• Post-Surgery
  • Lidocaine 5% / Gabapentin 5% / Amitriptyline 2%
  • Add Ketoprofen 10%, Antibiotic
• Fibromyalgia
  • Ketoprofen 15% / Cyclobenzaprine 3% / Amitriptyline 3%
  • Ketoprofen 15% / Ketamine 5% / Baclofen  5%
• Topical Anesthesia
  • Tetracaine 4% / Prilocaine 10% / Lidocaine 10%
  • Tetracaine 4% / Lidocaine 20% / Phenylephrine 2%

These are a few of the formulas that have been used by practitioners.  Many combinations and concentrations are available at the physician’s discretion.  While larger sizes are available and more economical, 45g is suggested for the initial prescription