Assessing and Managing Pain at the Pharmacy Level

Pharmacists are uniquely positioned to help counsel patients about pain management, as they are often the most accessible health care providers to many patients in their community.

According to Dominic DeFilipi, PharmD, a former retail pharmacist who is now an adjunct clinical assistant professor at the Western New England University College of Pharmacy & Health Sciences in Springfield, Massachusetts, some of the most common questions patients ask at pharmacies include the following:

• What is the difference between Tylenol and Advil? Is one better than the other?
• What can I give my child for pain/fever?
• Is this safe with my other medication (usually heart medication)?
• Can I drink alcohol while on this medication?

“The answers to these questions always depend on the patient and what they’re specifically sick with; although I do say that, generally, ibuprofen [Advil] is better for inflammation, and acetaminophen [Tylenol] works better as an antipyretic (fever reducer),” DeFilipi wrote via email.

To counsel patients on the safe and effective use of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, particularly when they may already be taking other medications, it is important to ensure that patients are not doubling up on any OTC medicines when they are already taking a prescription-strength formulation with the same active ingredients. For example, this ensures patients don’t take more than 4 g of acetaminophen in a 24-hour period.

"Patients with chronic pain are often taking multiple medications, including multiple analgesics, usually on a rotating or as-needed basis for ‘breakthrough’ pain,” DeFilipi wrote. “Normally, patients are not prescribed more than 3 g of acetaminophen per day, and they are instructed not to exceed that dose. However, if they are taking OTC acetaminophen regularly and are then prescribed a combination acetaminophen/analgesic (like Vicodin, a combination drug containing acetaminophen and hydrocodone), they could exceed the maximum daily dose without knowing, leading to potential toxicity and liver injury.”

DeFilipi noted that taking some extra time to interview patients about “all of their OTC medications, vitamins, supplements, tinctures, and teas can make a difference in preventing potentially dangerous drug, herb, and supplement interactions, [especially for] patients with complex drug regimens for acute or chronic pain.”

Pharmacists can also counsel patients on nonpharmacologic pain relief options, including heat and cold therapy and topical treatments.

“Heat and/or cold therapy (30 minutes on, 30 minutes off) is a mainstay of self-care recommendations, especially for more acute bumps, bruises, or sprains with which patients present to the pharmacy,” DeFilipi wrote.

Many patients also prefer topical treatments to oral medications, and pharmacists can provide counseling on those options as well. “A lot of folks prefer topicals to taking medication for a number of reasons, whether it is discomfort in taking another prescription and/or oral medication or simply a personal preference toward nonpharmacological or more natural options,” DeFilipi wrote.

“In my experience with natural products, I would often recommend topical turmeric creams or balms for joint pain, as [tumeric] inhibits COX [cyclooxygenase]-2 using the same mechanism as OTC NSAIDs. Capsaicin creams can also be useful, as long as you counsel the patient to wash their hands after application (and avoid touching their eyes!),” DeFilipi wrote.

However, pharmacists often face challenges when counseling patients. A lack of guidelines can leave pharmacists wondering how to best advise them.¹ Another struggle is balancing the accessibility of health care at the pharmacy with referring patients to other health care providers when pain may be a symptom of something more serious.

“This is a huge question, and, honestly, it’s a struggle,” DeFilipi wrote. “A community pharmacy setting can become chaotic, so pharmacists may not have the optimal time to conduct patient interviews and make referrals.

“That being said, community pharmacists are uniquely poised to intervene if a patient needs a referral when pain may be a symptom of something more serious. After years of working in a pharmacy, you get to know your patients and their families," DeFilipi wrote. "You see them at baseline and when they are sick, and you see how their medical conditions may progress or ameliorate after weeks, months, and years of consistently filling their medications. Over time, after building patient rapport, they are much more likely to come to you with questions regarding new aches and pains, which may be emblematic of something more serious. If the pharmacist knows the patient and their medical history, they can make a potentially life-changing referral.”

The ability of pharmacists to prescribe medicines for pain depends on the state or country in which they are located. Florida is an example of a state that allows pharmacists to prescribe a limited amount of pain medicines,² but this is not the norm for most US states.

"Pharmacists have been trying to earn provider status for years, striving to work at the ‘top of our license,’” DeFilipi wrote. “If pharmacists are given the opportunity to prescribe for minor ailments (as many pharmacists can in other countries, like Canada), we could take the burden off often-strained health systems by treating patients after a thorough consultation. These limited prescribing abilities could certainly be applied to outpatient pain management strategies, as they are already applied in certain pharmacies that recommend naloxone to patients who are dispensed certain doses of opioid narcotics or narcotic drug combinations.”

Some organizations, including the University of Rhode Island’s Community First Responder Program, teach best practices in naloxone use to both health care providers and the general public.³

References

1. Mujtaba SH, Gazerani P. Exploring the role of community pharmacists in pain management: enablers and challenges. Pharmacy (Basel). 2024;12(4):111. doi:10.3390/pharmacy12040111

2. Fla. Admin. Code Ann. R. 64B8-36.003 - Medicinal Drugs Which May Be Ordered by Pharmacists. Cornell Law School. Accessed October 28, 2025. https://www.law.cornell.edu/regulations/florida/Fla-Admin-Code-Ann-R-64B8-36-003

3. Get free training & naloxone by mail. The University of Rhode Island. Accessed October 28, 2025. https://web.uri.edu/cfrp