Chapel Hill Compounding
For more information, contact:
CHAPEL HILL COMPOUNDING
Zoe Stefanadis, RPh/Owner
105 Conner Drive
Wilshire I building, Suite 1200
Chapel Hill, NC 27514
Telephone: (919) 967-8805
Fax: (919) 967-8205
Pain relief is big business—and omnipresent. Ads for pain-killing prescription medications bombard us on television, radio, and the Internet; whole aisles in pharmacies offer over-the-counter pain remedies; and new products emerge every day. For those seeking relief, navigating the world of pain medications can be a formidable challenge.
“That is why it is so important to have a relationship with your pharmacist,” says Zoe Stefanadis, owner and founder of Chapel Hill Compounding. “In the world of pharmacy, we deal with pain—and pain medications—on a daily basis. That expertise is an invaluable resource when trying to find the best option for managing pain.
“And in this respect, compounding pharmacists play an especially valuable role,” she explains. “Because, if there’s one lesson I’ve learned, it’s that pain management is complex and it’s all about addressing the specific needs of the individual patient. That is precisely what compounding pharmacists do—we customize medications to meet patients’ unique needs.
“When it comes to pain medication,” she emphasizes, “one size most definitely does not fit all. But the options—whether over-the-counter or prescription—are standardized, so finding the right options, the right dosages, for each individual is difficult, especially for those dealing with chronic pain conditions.”
In a conversation with Health&Healing, Ms. Stefanadis discusses the challenges and concerns related to pain management.
Transdermal Medications: Targeted Pain Relief
“Compounding offers many options for pain management,” she notes, “and it benefits from a vastly improved delivery method known as PLO.”
PLO is short for Pluronic Lecithin Organogel, which, Ms. Stefanadis explains, “is an excellent transdermal vehicle, a gel-like substance. Transdermal simply means the medication is delivered in a targeted way, through the skin, rather than orally and systemically.
“What makes this such an important and exciting delivery vehicle,” she explains, “is that PLO carries drugs directly into the local tissues. Transdermal delivery of medications has numerous benefits for all patients, especially for kids, who may have a fear of needles or issues about taste.”
And, she says, “We see so many people suffering with chronic pain from an injury, arthritis, or some sort of neurological dysfunction and they pain that goes on and on, sometimes for years.
“Often, they are terribly frustrated. They want to avoid habit-forming, systemic medications, such as a codeine derivative, but it’s the only medication that can ease their pain. It’s a joy for us to prepare compounds for such problems, taking full advantage of the PLO gel. It’s designed to penetrate tissues and joints, and to deliver anti-inflammatory medications or muscle relaxers to the site of inflammation and pain. Patients don’t need to swallow a pill that produces effects throughout the body.”
She adds, “Pain affects people quite significantly on a number of levels. For example, it’s quite common to observe chronic pain evolve into depression so that it becomes not only a physical issue but a psychological issue, as well. It can and often does become a vicious cycle. Oral medications usually work by affecting the brain; transdermal medications work along the nerve itself. I like the term quieting; transdermal medications quiet the nerve.
She concludes, “there are many advantages in targeting the actual source of pain and discomfort, rather than introducing powerful systemic medications that have the potential to affect the entire system, mind and body.”
Health&Healing: You’ve described pain management as complex. What are the major challenges?
MS. STEFANADIS: The primary challenge has to do with the fact that each of us is unique, and responds differently to pain and to medication. So, I can’t emphasize enough the importance of understanding the complete picture. You need to understand the source and nature of the pain. And you need to understand the individual patient: their health issues, other medications they’re taking, their allergies, and more.
Pain relief takes many forms. It might be an over-the-counter remedy for somebody who’s overdone it at the gym, or is dealing a headache. Others need prescription medications for acute pain from an injury or surgery; some may be dealing with a chronic condition such as fibromyalgia.
Regardless of the source of the pain, they all want is relief so they can focus on their normal daily activities. But although the goal is the same, the path to that goal will be different for each, and will present different risks and challenges.
This is especially true for people dealing with chronic pain, where long-term medications—and often multiple medications—are needed. But even over-the-counter medications—the ones we reach for when we have a headache—are not risk-free.
H&H: What are the concerns about over-the-counter pain management?
MS. STEFANADIS: The primary problem is one that we encounter daily—often referred to as “polypharmacy.” Serious problems can arise when someone is taking multiple prescription medicines that interact in harmful ways. Often, it’s just that one medicine interferes with the effectiveness of another, but sometimes the interactions can be toxic.
The bigger problem, however, is that prescription medicines not only interact with each other, they interact with over-the-counter medicines, with dietary supplements, even food. Pharmacists are diligent in reviewing a patient’s medications to minimize such problems, but when someone self-medicates over-the-counter, no one is monitoring that process.
Opioid overdoses are, of course a major concern, but in fact, it is acetaminophen (as in Tylenol) overdoses that are the leading cause for
calls to Poison Control Centers. And that often occurs because people are not aware they are taking in so much of the medication. Over-the-counter medications are labeled to be treating many different things—a headache, a cold, joint pain—even though they’re the same medication. And—since acetaminophen is in each—people often ingest a toxic level of the drug without realizing it.
NSAIDs (Non-Steroidal Anti-inflammatory Drugs), such as Advil, pose similar problems. So, even with common over-the-counter remedies it’s important to be aware of dosages and consider things related to a person’s unique physical situation. People with kidney disease, for example, are less tolerant of NSAIDs. And any such medications pose risks if taken long-term.
H&H: What are the issues related to prescription medications for pain management?
MS. STEFANADIS: Addiction is certainly a concern, especially when people are chasing pain versus getting a handle on it. dose. But for a majority of people, if you treat pain in the right way, you have a low chance of addiction. It’s such an individual thing. That’s what I love about this work. You come to understand and appreciate that each of us is unique and, when you find the right pain remedy for that specific person, it will work.
A more common issue—and one we deal with every day—are adverse effects from prescription medications—especially those taken long-term. For one patient the problem might be an allergy to the dye used in the commercial medication. For another patient, the pain medication for their arthritic knee is irritating their GI tract. Someone else might have difficulty swallowing the medication they need, or maybe the optimum dosage is unavailable.
Addressing those problems is what compounding is all about. And we have many, many tools to work with. With pain medications, for example, a common problem is that the medications irritate the GI tract and, taken long-term, can cause considerable harm. It’s worth remembering that although your pain might be in your knee, when you swallow pill to treat it, you’re medicating your whole body. By compounding a medication that can be absorbed through the skin, we can provide pain relief locally, and bypass the digestive system.
Beyond pills, there are many other ways we can adjust the medicine’s “delivery” system, to meet the needs of the patient—including nasal sprays, transdermal creams, and suppositories. And our ability to adjust dosages is extremely important, especially when a drug must be gradually increased or when a patient is slowly withdrawing from a medication.
Compounding is, in fact, all about meeting the unique needs of each individual patient. That is why the relationship between patient and pharmacist is so important. When we know the patient—and understand their health issues, their medications, their concerns—we’re able to guide them down the most effect path to pain relief.