Pharmacists Help Patients Manage Chronic Pain
Chronic pain is associated with a significant financial burden, with an estimated cost placed at $650 billion annually in the US.
Nearly a quarter of Americans are impacted by chronic pain.1 Individuals living with chronic pain are at higher risk of experiencing comorbidities such as depression, anxiety, sleep disruptions, and substance use disorders, although this is not an exhaustive list.2 In addition to impacts on quality of life, chronic pain is associated with a significant financial burden; a recent estimate placed the cost to the US at $650 billion annually.3
Chronic pain is associated with a significant financial burden, with an estimated cost placed at $650 billion annually in the US. Image Credit: SasinParaksa - stock.adobe.com
Despite the high prevalence of chronic pain and its far-reaching consequences, it often has suboptimal management, typically involving a combination of pharmacotherapy that can quickly become complex and require expertise. Pharmacists are uniquely well positioned to provide this expertise and optimize medication management for chronic pain.
In literature, medication review is the most commonly reported pharmacist-led intervention for chronic pain. In a pilot study, the implementation of a pharmacist previsit chart review and providing recommendations for adult patients with chronic pain who were prescribed more than 50 morphine milligram equivalents (MMEs) was associated with a 14% decrease in daily MMEs without impacting pain scores.4 Significant reduction in pain severity and disability scores was seen after implementing a multidisciplinary pain management program, which included internists, clinical pharmacists, and a psychiatrist.5 Notably, substance misuse was identified in nearly a third of patients, which allowed for subsequent referral to substance use disorder treatment when appropriate. Similar interventions in the community pharmacy setting also demonstrated significant value, with pharmacists identifying unaddressed issues with mood in nearly two-thirds of patients and increasing the uptake of naloxone.6
Furthermore, pharmacists play key roles in educating other health care professionals and patients about safe and effective chronic pain management. In a physician-pharmacist collaboration, an academic medical center embedded a clinical pharmacist in 2 primary care clinics to provide pain management support for patients and their primary care providers (PCPs).7 After an initial meeting with the pharmacist, education, recommendations, and ongoing support were provided to PCPs and patients. Following the intervention, patient attitudes toward buprenorphine for pain management changed significantly, and PCPs involved in the intervention noted the value the pharmacist provided in education about buprenorphine. Although this example highlights the impact of pharmacists in the clinic setting, it is vital to remember that nearly 90% of Americans live within 5 miles of a pharmacy. Pharmacists in the community setting are often the first providers to help provide education and support about chronic pain management.8
A growing body of literature describes pharmacists prescribing for chronic pain management. One study described the impact of including a clinical pharmacist practicing under a collaborative prescribing agreement in a team-based care model for patients with chronic, nonmalignant pain.9 Compared with physician-only management, patients who had at least 5 visits with the pharmacist had an average reduction in morphine equivalent doses of 207 mg and were more likely to have risk mitigation strategies such as urine drug screening and medication agreement reviews completed. Importantly, this study identified that each patient had an additional 2 visits per year with their physician due to sharing the workload. Other studies support the benefit of pharmacist prescribing for pain management, reducing pain severity, improving mood outcomes, and patient satisfaction.10,11
There is an immense need for safe and effective medication management in chronic pain, and pharmacists have a unique role to play in meeting this need. Literature clearly demonstrates the value of pharmacists in chronic pain management, and the field is rising to the challenge. The number of postgraduate pain and palliative care residency programs is growing; there is a newly minted board certification in pain management available; and educational opportunities for currently practicing pharmacists abound. These opportunities are shaping the landscape for pharmacists in pain management, highlighting the impact pharmacists have within the field.
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REFERENCES
1. Lucas JW, Sohi I. Chronic pain and high-impact chronic pain in U.S. adults, 2023. NCHS Data Brief. 2024;(518):CS355235. doi:10.15620/cdc/169630
2. Murphy L, Ng K, Isaac P, Swidrovich J, Zhang M, Sproule BA. The role of the pharmacist in the care of patients with chronic pain. Integr Pharm Res Pract. 2021;10:33-41. doi:10.2147/IPRP.S248699
3. Smith TJ, Hillner BE. The cost of pain. JAMA Netw Open. 2019;2(4):e191532. doi:10.1001/jamanetworkopen.2019.1532
4. Cox N, Tak CR, Cochella SE, Leishman E, Gunning K. Impact of pharmacist previsit input to providers on chronic opioid prescribing safety. J Am Board Fam Med. 2018;31(1):105-112. doi:10.3122/jabfm.2018.01.170210
5. Chelminski PR, Ives TJ, Felix KM, et al. A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity. BMC Health Serv Res. 2005;5(1):3. doi:10.1186/1472-6963-5-3
6. Manzur V, Mirzaian E, Huynh T, et al. Implementation and assessment of a pilot, community pharmacy-based, opioid pain medication management program. J Am Pharm Assoc (2003). 2020;60(3):497-502. doi:10.1016/j.japh.2019.11.029
7. Lagisetty P, Smith A, Antoku D, et al. A physician-pharmacist collaborative care model to prevent opioid misuse. Am J Health Syst Pharm. 2020;77(10):771-780. doi:10.1093/ajhp/zxaa060
8. Berenbrok LA, Tang S, Gabriel N, et al. Access to community pharmacies: a nationwide geographic information systems cross-sectional analysis. J Am Pharm Assoc (2003). 2022;62(6):1816-1822.e2. doi:10.1016/j.japh.2022.07.003
9. Boren LL, Locke AM, Friedman AS, Blackmore CC, Woolf R. Team‐based medicine: incorporating a clinical pharmacist into pain and opioid practice management. PM R. 2019;11(11):1170-1177. doi:10.1002/pmrj.12127
10. Jorgenson D, Halpape K. Evaluation of a pharmacist-led interprofessional chronic pain clinic in Canada. Can Pharm J (Ott). 2023;156(5):265-271. doi:10.1177/17151635231188334
11. Bruhn H, Bond CM, Elliott AM, et al. Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial. BMJ Open. 2013;3(4):e002361. doi:10.1136/bmjopen-2012-002361
