Since Park Physical Therapy’s inception in 1977, our privately owned physical therapist practice has been recognized as a creative leader providing clinical programs that go beyond the basic, customary modalities and procedures often seen in standard physical therapy organizations. We strive to offer services that are unique and not readily available in mainstream clinics. It is in this spirit that we are proud to introduce Compoundingas the newest service in our Pain Management Program.
Medicinal Compounding is an ageless art combining the latest medical knowledge with state-of-the-art technology, allowing specially trained professionals to prepare and deliver customized medications to meet the client’s specific needs. Compounding is fundamental to the profession of pharmacy and was a standard means of providing prescription medications before drugs began to be produced in mass quantities by pharmaceutical manufacturers. The demand for professional compounding has increased as healthcare professionals and patients realize that commercially available medications do not meet the needs of many patients, and that these patients may have a better response to a customized dosage form that is just what the doctor ordered! When a client has a sensitivity problem with medications or in tolerating the adverse side effects, compounding can help.
Research shows that non-steroidal anti-inflammatory drugs, which are commonly used to treat arthritis, tendonitis, bursitis, and other painful conditions, are effective and have fewer side effects when they are properly formulated as a transdermal gel and applied topically over the affected area. This specialized medication is then ‘driven’ into the painful region by applying ultrasound waves. This ’process’ is called - Phonophoresis. Clinical findings demonstrate that this approach effectively delivers the treatment medication directly to the site of discomfort and dysfunction. By treating the pain at its trigger point or site of origin, relief and recovery can be facilitated without side effects!
PLO - Pluronic Lecithin Organogel
Transdermalmedication delivery has always been challenged with overcoming the ‘skin barrier’ for penetration and transmission of molecules of medication. This barrier - the stratum corneum - has finally been broken with the advent of PLO transmission Gel.
PLO is a micro emulsion-based gel and originates from water-in-oil micro emulsions. PLO is a rather stable compound and shows no harmful effects when applied to the skin for prolonged periods. PLO has been used for many years for prescription compounding by pharmacists and physicians to effectively and safely deliver hydrophilic and lipophilic drugs transdermally.
PLO safely disrupts the lipid layers of the stratum corneum without damaging them. PLO allows the combined medication to slip through the stratum corneum into the tissue and the systemic circulation via the dermal-epidermal blood flow so that it is more likely to be absorbed.
Alternative Drug Delivery System
Phonophoresis is the utilization of high frequency, low intensity ultrasound waves to administer various drugs including local anesthetics and antibiotics. This system has been successful in delivering anti-inflammatory medication to inflamed subcutaneous tissues. In essence, phonophoresis is used to enhance the delivery of transdermal drugs to areas affected by pain and inflammation.
Phonophoresis is an effective medicinal transport system for lipid soluble molecules while facilitating the protein binding aspect of the drugs selected.
The transport mechanism of phonophoresis is currently theoretical in nature. It is believed that the mechanism of transport is both thermal as well as non-thermal. Both of these mechanisms have been considered to enhance diffusion of topically applied drugs. The heating created by the ultrasound waves increases the kinetic energy of the molecules in the drug and in the cell membrane, dilates points of entry such as hair follicles and the sweat glands, and also increases the circulation to the area sonicated. These physiological changes enhance the opportunity for drug molecules to diffuse through the stratum corneum and be collected by the capillary network in the dermis.
The non-thermal mechanical characteristics of the ultrasound may enhance drug effusion by oscillating the cells at high speed, changing the resting potential of the cell membrane and potentially disrupting the cell membrane of some cells in the area.
Pulsed wave ultrasound appears to be more beneficial than continuous. Patients will not experience ‘heat build up’ and this will allow stationary ultrasound head placement to drive drugs directly into the area of discomfort or dysfunction.
Some substances currently utilized with phonophoresis:
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A patient suffering from a localized chronic or acute ailment is often placed on a variety of oral pain medications in an attempt to help manage their painful symptoms. Frequently, these various medications cause undesirable “side effects”. It is now possible that many of these oral drugs may be eliminated, by a specially prepared compound that combines several medications into a single topical gel. This gel can then be applied directly to the affected area. The obvious benefit for each client is that the pain medication can be directly administered to the specific area of discomfort — rather than taking multiple oral meds which affect the entire body and its systems!
Specially trained compounding pharmacists can provide the client with a topical preparation using the same anti-inflammatory or analgesic medication that their doctor has prescribed.
Physical therapists with special training are currently treating clients by applying these special formulations deep into the tissue via a novel and painless drug delivery system - Phonophoresis.
Our trained physical therapists identify clients who might benefit from these special compounding formulations. The physical therapist then contacts the physician and suggests a medication prescription protocol for the physician’s approval. The pharmacist then takes the necessary ingredients, compounds them, and dispenses the medicine to the patient. The patient purchases their customized medication for Phonophoresis application in physical therapy and individual use.
We believe that this process provides the patient with the personalized care that they deserve and a superior patient-oriented service.