Hospice / Palliative Care: Pain Management
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Codeine, morphine, oxycodone, hydrocodone, hydromorphone, fentanyl, and more are available at Phusion Pharmacy for custom compounding into dosage forms that can be more easily administered to hospice patients. Call to speak to one of our compounding pharmacists for details. 401-823-0000.

Optimal treatment may involve the use of medications that possess pain-relieving properties, including some antidepressants, anticonvulsants, antiarrhythmics, anesthetics, antiviral agents, and NMDA (N-methyl-D-aspartate) antagonists. Palliative care often involves the use of opioid analgesics. NMDA-receptor antagonists, such as dextromethorphan and ketamine, can block pain transmission in dorsal horn spinal neurons, reduce nociception, and decrease tolerance to and the need for opioid analgesics. [Anesth Analg 2001 Mar;92(3):739-44]  By combining various agents which utilize different mechanisms to alter the sensation of pain, physicians have found that smaller concentrations of each medication can be used.
Topical and transdermal creams and gels can be formulated to provide high local concentrations at the site of application (e.g., NSAIDs for joint pain), for trigger point application (e.g., combinations of medications for neuropathic pain), or in a base that will allow systemic absorption. Side effects associated with oral administration can often be avoided when medications are used topically. Studies suggest that there are no great restrictions on the type of drug that can be incorporated into a properly compounded transdermal gel.  When medications are administered transdermally, they are not absorbed through the gastrointestinal system and do not undergo first-pass hepatic metabolism.
We work together with prescriber and patient to solve problems by customizing medications that meet the specific needs of each individual. Please contact our compounding pharmacist to discuss the dosage form, strength, and medication or combination that is most appropriate for your patient.
Effectiveness of Topical Administration of Opioids in Palliative Care    The discovery of peripheral opioid receptors has become the scientific basis for topical use of opioids in malignant and nonmalignant ulcers and oropharyngeal mucositis. A systematic review assessed the quality of published literature and examined whether topical opioids are effective in controlling pain in palliative care settings. Eighteen studies favored topical opioids in pain relief, but time to onset and duration of analgesia varied widely, perhaps due to variances in formulations. “N-of-1 trials should be encouraged for specific clinical circumstances.”   J Pain Symptom Manage. 2009 May;37(5):913-7. Effectiveness of topical administration of opioids in palliative care: a systematic review. Click here to access the PubMed abstract of this article.



Please select a topic below to learn more about our pharmacists' abilities to compound custom palliative care products:

Anti-emetics

Therapy for Dry-Mouth (xerostomia)

Anti-Secretory Agents

Pain Management

Wound Care

Dyspnea

Prevention / Treatment of Radiation Mucositis / Proctitis

Examples of Compounded Medications
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