Integrative Pain Therapies - Supplements and Personalized Medicine

Chronic pain is a heartbreaking condition. It takes a major toll not only on someone physically, but also emotionally and mentally. To make matters worse, chronic pain often stems from either an ambiguous diagnosis or one with a poor prognosis for full recovery.

For the longest time, opioids were our go to medication option for pain. At this point we all understand the limitations that opioid pain medications offer. Most patients that I meet on opioids only have 1 goal - getting off of them. There are, of course, other pharmacological options, and these all have their pros and cons.

Depending on the severity and duration of pain, my approach to pain relief typically involves 5-6 agents. Each agent allows for an incremental improvement in pain. When you add each of these together, you not only get incremental pain relief and improved quality of life, you limit the side effects of each agent by using the smallest amount needed. The importance of this should not be overlooked! Chronic pain is a long battle and by keeping tolerance and side effects low, we continue to have more treatment options for the most prolonged time period possible.

I would like to note that I am an Integrative Compounding Pharmacist; therefore, the treatments I specialize in are personalized medications and supplements. These modalities are effective and helpful when it comes to pain management. However, I believe they are most impactful when combined with modalities from both Western and Eastern medical philosophies. I strongly believe in the foundational benefits of anti-inflammatory diets and mindfulness practices for ALL people suffering from pain. Furthermore, depending on the root cause of pain, I have seen the benefits of physical therapy, spinal manipulation, acupuncture, and PRP (to name a few) on making pain more manageable. 

In this article, I review options for acute and chronic pain, how to use herbs to reduce the side effects of the common OTC pain medications Tylenol and Ibuprofen, and also list out a few of your popular compounded medication options for pain management.

Acute Pain

Acute pain due to damaged tissue (bones, muscles, tendons, skin) that is otherwise expected to heal fully is more straightforward to address compared to chronic pain. When the predicted need for pain medications is less than one week, one can often be more accepting of the compromises/side effects that come along with the most effective OTC pain-relieving medications. Yes, Tylenol is hard on the liver and NSAIDs are hard on the kidneys, but if you only need them for a few days and keep these tips below in mind, you can feel more comfortable with their use. 

Tylenol (acetaminophen/paracetamol) is hard on the liver because it depletes glutathione when it is eliminated via phase II conjugation reactions in the liver. Glutathione is a major antioxidant needed for proper elimination and healing and when depleted of this molecule but your body becomes more vulnerable to insult of any kind. Luckily for us, glutathione is available as a supplement and can be taken with Tylenol to help mitigate this risk. The glutathione precursor N-Acetylcysteine (NAC for short) is also available and, in my opinion, can be used interchangeably with glutathione. There are conflicting opinions on which might be more effective to replete glutathione, yet I have found no study that gives a definitive answer. NAC is generally more affordable than glutathione, and that may be enough to tip the balance in favor of NAC for me.

Ibuprofen, naproxen, and other NSAIDS are corrosive to the gut lining and hard on the kidneys. However, the advantage over Tylenol is that NSAIDS are not just a pain reliever but also an anti-inflammatory medication, reducing pain and inflammation. Taking NSAIDs with food can minimally help with the GI effects. Still, their corrosive nature is related to their effects on prostaglandins and therefore is not just due to a local impact on the stomach but inherent to the medication itself. Using demulcent herbs while taking NSAIDs can be helpful as a temporary measure to protect the gut lining and reduce the degree of NSAID-induced gastritis. Demulcents are herbs that contain a mucilaginous substance that is somewhat gelatinous and thick. This mucilage is prebiotic and also highly soothing and inflammation-reducing to bodily tissues. They travel along the digestive tract to soothe, heal, and seal the gut lining. Demulcent herbs include Cornsilk, Flaxseed, Licorice, Marshmallow, Mullein, and Slippery Elm. Licorice root extract is available in a chewable tablet like this one, and capsules of marshmallow extract can be mixed with water or beverage of choice to make a gut-healing slurry.

Herbs that are used to address pain include willow bark and boswellia. The most active constituent of willow bark is thought to be salicin. Salicin is metabolized to salicyl alcohol and then to salicylic acid. From there, metabolism is the same as aspirin (2). Boswellia serata (aka Frankincense) contains boswellic acids, which inhibit 5-lipoxygenase and reduce leukotriene synthesis which are the likely mechanisms for its anti-inflammatory and analgesic properties (3). We have a natural pain reliever called Willow Relief that contains both willow bark and boswellia and other anti-inflammatory herbs for relieving minor pain, modulating healthy inflammatory responses, and supporting the body’s natural healing processes.

Neuropathic Pain

Pain that results from nerve damage can feel different from other pain. It is often described as sharp, burning, tingling or numb. 

One of my favorite supplements for nerve pain actually promotes nerve healing and regeneration - which itself is a very slow process. The mushroom Lion’s Mane (Hericium erinaceus) contains compounds that stimulate the synthesis of Nerve Growth Factor NGF, a protein responsible for boosting neurite outgrowth. These compounds have been identified as erinacines, erinacerins, and hericinones (4). 

My other favorite is better at protecting nerve tissue in the setting of continued damage, as in the case of diabetes or spinal cord compression, for example. Alpha Lipoic Acid has antioxidant activity and can scavenge free radicals to prevent nerve damage. Preliminary data suggests that these antioxidant effects might provide protection for muscle, brain or neural tissue against injury (5). This supplement is also helpful for neurodegenerative diseases that are in part due to neuronal inflammation.

See also information on PEA below, another great option for neuropathic pain.

Inflammatory Pain

The origin of all pain is inflammatory (6). Therefore anything someone can do, to reduce inflammation helps with pain. Focusing on an anti-inflammatory whole foods diet is a great place to start. Avoiding common inflammatory foods such as gluten and dairy is step 2. Food sensitivity and intolerance testing is the final step in truly eliminating YOUR offending food agents. 

Palmitoylethanolamide (PEA) is a substance that has been piquing my interest more and more lately. It works a few different ways to reduce pain. It has an analgesic effect that is thought to be related to increasing natural endorphins (such as anandamide), while also desensitizing one of the pain receptors TRPV1 and also providing local anti-inflammatory action (7). We have brought in a new product that combines both PEA and Anandamide to really boost its short-term and long-term effects for pain relief.

Botanical Treasures is an anti-oxidant jam-packed supplement. There is no supplement that has a better bang for your buck for antioxidant activity than this one. The big hitters in this supplement include turmeric, green tea, Japanese knotweed (full of resveratrol), quercetin and grape seed extract.


Caffeine and Butterbur are the natural products that I found are most helpful for pain related to migraines. 

Clinical research shows that taking a specific butterbur rhizome extract, which is pyrrolizidine alkaloid (PA)-free and standardized to 15% petasin and isopetasin (Petadolex), 75 mg once or twice daily for up to 16 weeks, reduces the frequency of migraine headache by about 48%. It also reduces the intensity and duration of the headaches (8). We also carry a migraine-specific blend that contains butterbur and other herbs and nutrients shown to be helpful with migraines, and increase the likelihood of migraine reduction over just taking the single-agent petadolex. These are both taking on a daily basis for migraine prevention.

If you are looking for something in the moment, our supplement Head-Aid is a better option, as it contains ingredients that works more at the moment. Combining this with a cup of coffee for the caffeine would be even better. 

We also provide several compounds that are helpful for migraines; these do require a prescription, but are frequently better tolerated than other migraine medications. 

Compounds for Pain

Many people are unaware of the option for compounded medications until their doctor prescribes them. The caveat is that not all doctors are familiar with compounded medications, and so if you have “tried all the options” in terms of pharmaceuticals and have NOT tried some of the items below, you may need to see a different doctor who is more educated on these personalized medications. Please check out our Doctor Affiliates Page or give us a call if you need a recommendation on a doctor who offers these medication options.

Compounded Pain Creams

Topically applied pain creams allow an option for a personalized blend of 3-4 agents that can help address pain in different ways. Not only can you get multiple medications in one cream, you can also use medications topically that otherwise are not available in that form. 

Agents typically used in pain creams:

  • Muscle Relaxants (ex. Cyclobenzaprine)
  • NSAIDS (ex. Ketorolac)
  • Numbing agents (ex. Lidocaine)
  • GABA agents (ex. Gabapentin)
  • Anesthetics (ex. Ketamine)

One or a combination of the above medication agents can be combined to address your specific cause of pain.

Compounded Low Dose Naltrexone

Low Dose Naltrexone (LDN) is currently under study in patients with various types of chronic pain, including migraines, fibromyalgia, and neuropathy. Other chronic pain states, multiple types of cancers, and autoimmune-related disorders are also being studied. While these studies are underway, it is used widely in the U.S. for a variety of pain-related disorders and autoimmune conditions but is only available from compounding pharmacies like Remedy. There is a great amount of excitement around this therapy and a comprehensive resource for collecting more info on it is the LDN Research Trust, which Remedy is a member of. 

Compounded Nasal Sprays for Migraines

The most common medication for acute migraine relief are the “triptan” medications. This includes medications like sumatriptan, rizatriptan and others. Not everyone tolerates these medications well or gets full relief from them. Options that can be used instead of or with triptans include compounded nasal sprays that provide medication to local nerve cells called trigeminal nerve ganglia (9). Options for nasal sprays for addressing pain include:

  • Lidocaine Nasal Spray
  • Bupivacaine Nasal Spray
  • Ketamine Nasal Spray

These medications are meant to be tailored specifically to you, and working with your doctor and pharmacist closely is the best way to get maximum benefit. Please give us a call if you have any questions on the options discussed in this article, we have friendly pharmacists and herbalists happy to help!




  1. Safayhi, H., Mack, T., Sabieraj, J., Anazodo, M. I., Subramanian, L. R., and Ammon, H. P. Boswellic acids: novel, specific, nonredox inhibitors of 5-lipoxygenase. J Pharmacol.Exp.Ther 1992;261(3):1143-1146.
  2. Schmid B, Kotter I, Heide L. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. Eur J Clin Pharmacol. 2001;57:387-91. View abstract.
  3. Safayhi, H., Mack, T., Sabieraj, J., Anazodo, M. I., Subramanian, L. R., and Ammon, H. P. Boswellic acids: novel, specific, nonredox inhibitors of 5-lipoxygenase. J Pharmacol.Exp.Ther 1992;261(3):1143-1146. 
  4. Lai PL, Naidu M, Sabaratnam V, Wong KH, David RP, Kuppusamy UR, Abdullah N, Malek SN. Neurotrophic properties of the Lion's mane medicinal mushroom, Hericium erinaceus (Higher Basidiomycetes) from Malaysia. Int J Med Mushrooms. 2013;15(6):539-54. doi: 10.1615/intjmedmushr.v15.i6.30. PMID: 24266378.
  5. Packer L. Antioxidant properties of lipoic acid and its therapeutic effects in prevention of diabetes complications and cataracts. Ann N Y Acad Sci 1994;738:257-64. View abstract.
  6. Omoigui S. The biochemical origin of pain: the origin of all pain is inflammation and the inflammatory response. Part 2 of 3 - inflammatory profile of pain syndromes. Med Hypotheses. 2007;69(6):1169-1178. doi:10.1016/j.mehy.2007.06.033
  7. Gatti A, Lazzari M, Gianfelice V, Di Paolo A, Sabato E, Sabato AF. Palmitoylethanolamide in the treatment of chronic pain caused by different etiopathogenesis. Pain Med. 2012 Sep;13(9):1121-30.
  8. Diener HC, Rahlfs VW, Danesch U. The first placebo-controlled trial of a special butterbur root extract for the prevention of migraine: reanalysis of efficacy criteria. Eur Neurol 2004;51:89-97.
  9. Chi PW, Hsieh KY, Chen KY, et al. Intranasal lidocaine for acute migraine: A meta-analysis of randomized controlled trials. PLoS One. 2019;14(10):e0224285. Published 2019 Oct 23. doi:10.1371/journal.pone.0224285