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For more information about these community pharmacy/education/wellness centers, contact:

Bill Burch, RPh
Jennifer Burch, PharmD
Sejjal Patel, PharmD
Donna Ferrell, RPh
Michael Verble, PharmD
Kayla Harris, PharmD
Ziyad Jabar, PharmD


2609 North Duke Street, #103
Durham, NC 27704
Telephone: (919) 220-5121
Fax: (919) 220-6307


6224 Fayetteville Rd, #104
Durham, NC 27713
Telephone: (919) 484-7600

Call to schedule a consultation with our pharmacists.

Effective Approaches to Relieving Pain

Experts agree that patients are finding it much harder to obtain medical relief from their pain because of the opioid epidemic in the United States

Dr. Burch is experiencing good results with clients in the use of CBD oil to relieve pain.

“We don’t dispense opioids at our compounding pharmacy,” says Dr. Jennifer Burch of Central Compounding Center in Durham, “but I still work enough at my other pharmacy, Central Pharmacy, to know that it’s becoming more difficult for patients to get these pain medications.

Dosages are being decreased because doctors are nervous about opioid addiction. But the patient’s pain is still there and we’ve got to be sympathetic to that and treat it. One way to find relief is by trying specially formulated medications. Customizing medication for patients is what compounding is all about.”

Custom Strategies
for Managing Pain

“We take three different approaches here,” explains Dr. Burch, “that either augment the patient’s current pain management strategy or work in lieu of opioid treatment.

“One effective option that is used frequently for pain relief—particularly for fibromyalgia or any painful autoimmune illness—is Low-Dose Naltrexone (LDN), a medication that has multiple mechanisms of action that regulate inflammation and pain. We always start patients on the lowest dose, and then slowly increase it.

“This medication won’t work for those who are on opioids, but for many patients, this is a very effective option. For example, we recently treated a lady who’s had fibromyalgia pain for 20 years, and after just five days on therapy her pain was gone. She had almost complete, 100 percent resolution of her pain.”

Relief from Pain, Depression

A second treatment that has been effective in moving patients off opioids, notes Dr. Burch, “is Ketamine. We’ve had patients move off opioids onto Ketamine for pain, which is a non-opioid therapy, just so that they can start low-dose Naltrexone. Ketamine nasal spray has had amazing results for chronic headaches, bi-polar depression, and suicidal ideations. And,” she points out, “Ketamine oral capsules can be used indefinitely for physical pain. It works well, doesn’t have the side effects that opioids do, and isn’t addictive.

“I worked with a gentleman in his 70s, who was depressed, wouldn’t get out of bed, and had no joy left in life. He’d used every therapy there was; none had worked. About four months ago he started on Ketamine nasal spray and I worked closely with his doctor on the dosing protocol. He was in the other day, smiling and laughing, and said that since starting Ketamine he’s wanted to get out of bed for the first time in 30 years, which is quite a home run.”


 “The third approach to non-opioid pain relief that we have found very effective,” says Dr. Burch, “is CBD oil. This is hemp-derived cannabidiol oil—not medical marijuana. It includes less than 0.3 percent THC—which is the psychoactive ingredient in cannabis—so there is no psychoactive effect in using CBD oil.

“Pain relief has been impressive with CBD,” reports Dr. Burch. “For example, we recently saw a lady who was going to have a hip replacement; she started CBD oil and now she doesn’t want the hip replacement. Obviously, CBD didn’t heal the structure of the hip, but for this patient, it resolved her pain and she was happy.”

And there are many other examples, she notes. “We’ve had people with Complex Regional Pain Syndrome whose pain was almost completely resolved—which is remarkable because most of these patients have typically tried many drugs, including opioids, without relief from intense pain.

“If you have chronic arthritis, taking CBD on a regular basis—usually twice a day—is the best way to use it. It may help for headaches and such, but I haven’t found it as effective as people taking it long-term have. There are also topical preparations of CBD, which are great to apply to sprains and joint aches. People think that a higher dose of CBD is better. But, we’ve found is that everyone reacts to CBD a bit differently, so we recommend starting with a low dose and increasing as necessary.”

Cautions Apply

But Dr. Burch urges caution in using CBD oil. “This product is sold over-the-counter and it’s everywhere. You can buy it on Amazon or at the gas station. And we’ve had patients who’ve done that and then come to us asking why it didn’t work. The answer is related to the quality of the product. Probably 30-40 percent of what’s on the market may not even contain CBD, or contain CBD that’s tainted with additives, or contaminant pesticides, or heavy metals. Remember this is derived from the hemp plant—so where and how those plants are grown affect the quality of the CBD oil.

“Both of our pharmacies carry CBD oil,” notes Dr. Burch. “And I’ve vetted the quality of our CBD products and they’re good preparations with good quality control.”

In addition to quality, there are other considerations in using CBD effectively, says Dr. Burch. “There are all types of CBD out there, and CBD does have a few drug interactions, so talking to a knowledgeable pharmacist is important. That is why physicians refer folks to us so that we can help guide them with dosing and picking the right preparation.”

Compounding: Knowledge and Nuance

“More and more,” notes Dr. Burch, “we are understanding the power of customized medication for patients—going beyond ‘one-size-fits-all’ drugs, and adjusting dosages and delivery mechanisms to benefit individual patients. But as the experience with CBD oil shows us, this requires knowledge. We’re learning on the Internet that people are trying to make their own low-dose Naltrexone at home, and—not surprisingly—aren’t getting a good response.

“Making medications is what pharmacists have done since the beginning of time,” emphasizes Dr. Burch. “In our compounding pharmacy, we make them without certain fillers and other additives that can counteract potency; we adjust dosages for individual patients; we buffer nasal sprays so they don’t burn; we alter flavors and pill types—and many other adjustments, large and small, to maximize the benefit of the medications.

“There are nuances to compounding,” notes Dr. Burch, “and we try to find the most effective way to formulate the medication so that it works best for the patient. We begin by taking a good patient history—what they’ve tried, their reaction to it, what meds they’re on, any allergies they have—and then we individualize their medication. Sometimes we advise the doctor to try something a little different. Our goal is for the patient to stay on the medication so that we can see what efficacy they experience over time.

“The key to compounding is having a close working relationship with the prescribing physicians, who generally have more difficulty writing compounding scripts. Practitioners need to call us and say, ‘Hey, how do I write this?’ Frequently, we have patients come directly to us and ask for recommendations. We give them some ideas to talk to their doctor about.”