“There is absolutely no argument about the health benefits of exercise,” acknowledges Dr. Jennifer Burch, of Central Compounding Center in Durham.  “It’s a foundation for overall health, and helps prevent and heal health problems from heart disease, back pain, and arthritis to high blood pressure, diabetes, and depression. And studies show that exercise increases life span by reversing many of the physiological changes we call ‘aging.’

“It’s also true—unfortunately—that, as we age, we often face significant challenges as we try to include exercise in our lives. Chief among these is chronic pain. Whether from injury, disease, or just worn-out joints, chronic pain is probably the greatest obstacle to maintaining healthy movement,” says Dr. Burch. “And treating chronic pain, safely and effectively, is a major challenge as well, because effective anti-inflammatory medications—such as NSAIDs—are unsafe when used long-term and opiates are addictive.

“That’s a challenge that compounding pharmacies are uniquely designed to meet—and are meeting right now,” says Dr. Burch. “By compounding individualized medications—such as Low-Dose Naltrexone and Ketamine—we are able to either augment a patient’s current pain management strategy or provide an effective option to opioid treatment.”

Compounding: Custom Strategies for Managing Pain

“More and more,” says 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.

“In our compounding pharmacy, we make medications without fillers and other additives; we adjust dosages for individual patients; we remove dyes and other allergens; we buffer nasal sprays so they don’t burn; we prepare medical creams for those who can’t take pills; we alter flavors and pill types—and many other adjustments, large and small, to maximize the benefit of the medications.

“And sometimes the solution to a problem is not the medication, but how it’s delivered,” she notes. “Arthritis pain might prevent you from moving, but the medications you need to relieve pain—if taken orally—cause problems. Providing a medication in a form that can be applied topically—directly on the spot that hurts and bypassing the GI system—is an efficient solution to that problem.”

And compounding goes beyond these adjustments, she explains. “We also offer unique medications for pain. One recent case is a good example. It was a patient suffering from a muscle spasm that brought her to tears. With her physician we were able to prepare a medication that combined an anti-inflammatory, a drug to help with nerve pain, and a muscle relaxant—in a form that could be applied topically. It broke the spasm after a couple of applications.”

Low-Dose Naltrexone: Remarkably Flexible for Pain Relief

“When dealing with chronic pain,” says Dr. Burch, “there’s no doubt that one of the best and most versatile medications available is compounded Low-Dose Naltrexone (LDN). It’s certainly the number one medication that we prepare—in many different formulations—for pain, inflammation, and many other conditions.

“LDN is an anti-inflammatory drug that has proven remarkably successful in treating a wide range of chronic health problems,” she explains; “and with very few side effects. Naltrexone is not new, but it’s only recently been used broadly to treat chronic inflammatory problems. It’s in a class of drugs known as opiate antagonists, normally used to treat addiction to heroin or morphine. It’s an FDA-approved drug at 50 milligrams. However, taken in small dosages—anywhere from .5 to 10 milligram—it’s effective in treating chronic pain, depression, fibromyalgia, Crohn’s Disease—in fact, more than 205 chronic and inflammatory conditions.”

Where compounding comes in, explains Dr. Burch, “is that LDN requires a prescription, but everyone does not need the same dose. Typically, people max out at 4.5 milligrams; but there’s a process. It takes about a month of gradually adjusting the dosage to determine the optimal amount for the given patient, and it usually takes one to two months to see a full response.

“This is the beauty of compounding. We can prepare dosages of LDN in very specific amounts, adjusting them repeatedly until we’ve found the right amount for an individual patient.”

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.

“It’s also worth noting,” she adds, “that physical pain isn’t the only thing that inhibits movement; mental pain—depression—will grind you to a halt. Relieving mental pain can help you get moving in a healthy way; and exercise helps relieve depression—so it’s a positive, win-win cycle.”

Pain Relief in Many Forms

While prescription medications are a primary focus of her practice, Dr. Burch also has considerable interest in non-pharmaceutical options for treating medical conditions, and has become a dedicated student of the uses for cannabidiol (CBD). Since its approval in 2014 for over-the-counter sale in North Carolina, CBD has been widely used as an alternative, non-pharmaceutical treatment for pain and other conditions.

“The body’s endocannabinoid system plays a number of stabilizing roles, with hundreds of receptors throughout the body,” explains Dr. Burch. “And while researchers continue to learn more about this system, they do know it plays a role in regulating sleep, mood, appetite, memory, even fertility. When there’s a deficiency in the body’s endocannabinoid system,” she says, “CBD can help to boost that.”

Dr. Burch emphasizes that “CBD is notmedical marijuana. Cannabidiol is one of 104 chemical compounds found in cannabis; THC—the psychoactive ingredient that makes one high—is not part of CBD.

“CBD is effective for all kinds of pain,” says Dr. Burch, “including musculoskeletal, neuropathic, even vaginal pain. It’s a proven treatment for epilepsy, and helps with a range of mood disorders, including anxiety, panic, and PTSD. And I have found it particularly useful for patients who are on medications for anxiety. Many use prescription benzodiazepines, such as Xanax, which can be effective. But taking those medicines long-term is a concern, because long-term benzodiazepine use can increase the risk of dementia.”

While CBD doesn’t require a prescription, its effectiveness does depend on guidance and education. “We have learned the importance of careful, individualized dosing,” says Dr. Burch. “And we work closely with our patients to find the ‘sweet spot’ that produces the desired result. More is not necessarily better with CBD,” she emphasizes. “We start everyone on a lower dose and teach them how to titrate until they get the appropriate effect.” Just as important as the dosage, she adds, is the quality of the product. “The hemp plant—which is the source of CBD—is much like a sponge. So, you don’t want to use CBD from hemp planted in toxic soil. We carefully vet all products to ensure they have the appropriate level of CBD and are not contaminated with pesticides, herbicides, or heavy metals.”