By the time a prescription for a pain medication reaches Jacob Beckel, BSPharm, the patient may not even remember a life without pain. Some patients have survived heinous car accidents. Others have fallen from extreme heights. Still others grew up with congenital defects that prevent normal development of the spine. But the one thing Beckel’s patients have in common is that they have tried everything.
That’s when doctors prescribe individualized pain medications to be injected into the spine. For 30,000 Americans, the prescription is filled at Beckel’s compounding pharmacy, AnazaoHealth in Tampa, FL.
“It is not uncommon for patients to have to take 30 or 40 Oxycontin a day to get rid of their pain. What kind of lifestyle would you have on 30 or 40 Oxycontin a day?” Beckel said.
The answer is chronic constipation, alternating bouts of insomnia and lethargy, dilated pupils, night sweats, liver damage that leads to metabolic problems, and most likely depression. If the pain does not prevent patients from working and living normal lives, the adverse effects alone can.
Many patients who require excessive quantities of oral medications or who aren’t helped by surgeries ultimately have a pump implanted in their spine through which a physician can deliver medication right to the source of the pain without any of these adverse effects. But with only three drugs commercially available for this purpose, many patients rely on special preparations from compounding pharmacies.
Beckel estimates that some 75,000 to 80,000 people rely on pumps for the treatment of chronic pain. Almost every one of these patients requires an individualized treatment, whether in dosing or in combinations of ingredients.
“We’ve done at least 15 different drugs and combinations of those drugs in these pumps,” Beckel said. “They have to be custom-compounded for that individual patient for that specific time. What works in April may not work during the stress of the holidays.”
Sometimes it takes the doctor, patient, and pharmacist years of adjustments to find just the right formulation. “But patients are saying that this is the last resort, so they’re willing to go through these steps,” Beckel said. “And once that happens, they’re able to be ambulatory just like anybody else.”
Pain treatment is not one size fits all. Patients, physicians, and pharmacists who understand pain know that its treatment requires extensive trial and error. Beckel is drawn to the field because it allows him to be an integral part of that collaboration with patients and physicians.
“I can sit at the table with a group of interventional pain physicians, and we can have a great dialogue, colleague to colleague, that is very rare in this world today, where the doctors are really interested in how you can help solve these problems,” Beckel explained.