The Role of the Pharmacist in the Care of Patients with Chronic Pain

Posted on 14th November 2023

By Paaven Patel, Operations and Quality Assurance Pharmacist at Specialist Pharmacy

Pain is the main reason patients seek healthcare, affecting more than 1.5 billion people worldwide, and, despite innovations in pain research and knowledge, pain is still inadequately treated.

Current challenges in pain management include harmful systemic side effects, insufficient therapeutic efficacy, poor patient compliance and the need for greater understanding by the medical community on how to appropriately target pain pathways.

So, what is a pharmacist’s role in the care of patients with chronic pain?

Patients seeking pain management for chronic pain, can be through a personalised pain management plan involving a pharmacist. The predominant goal of personalised pain management is to address the major challenges patients are experiencing. This can be achieved by reducing systemic harmful events, through topical and local analgesic applications. Therefore, optimising therapeutic outcomes by carefully targeting pain at its source, selecting the right pain medications based on pharmacodynamics, safety and efficacy profiles and applying combination therapy. Through all of this, patient health would naturally improve, and treatment regimens would become more simplified.

How pharmaceutical compounding can help?

Personalised pain management through pharmaceutical compounding allows the prescriber, patient, and pharmacist to work together to create a more optimised treatment plan. Pharmaceutical compounding is the practice of preparing customised medications to address a patient’s unique set of conditions, tolerances, and preferences. Pharmaceutical compounding allows healthcare professionals the flexibility to address unmet needs such as:

Personalised dosing: Effective dosage strengths that are suitable to the patient, without restriction to fixed dosing increments set by commercial products.
Tailored dosage forms: Selecting a dosage form based on compatibility and stability with the ingredients chosen, therapeutic intent, application site, and patient preference.
Eliminating unwanted ingredients: Choosing ingredients that are better tolerated by the patient and avoid ingredients common in commercial medication products that a patient may be intolerant, sensitive, or allergic to.
Combining multiple ingredients: Certain ingredients may be best suited together. This would maximise treatment efficacy, tolerability, and safety. Reduce treatment regimen complexity and enhance patient compliance.
Addressing product unavailability: Create solutions where the commercially available product is not available.

At compounding pharmacies pain medications can be customised to patient and prescriber specifications. An effective treatment plan can be created, whilst collaborating more closely with a specialist pharmacist.

Formulations are continually being developed at the pharmacy, and include common pain ingredients such as amantadine, amitriptyline, benzocaine, baclofen, clonidine, diclofenac, lidocaine, ketoprofen and tetracaine. They also include uncommon ingredients, currently not used in pain management, which allows the pharmacy to work with more outside of the box medications. Verapamil (a voltage gated calcium channel blocker) is an example of one. Formulated into a 15% topical gel at the pharmacy, to help patients suffering from fibrotic tissue disorders such as plantar fibromatosis. Another uncommon ingredient is Loperamide (an opioid agonist), which is commonly known to treat diarrhoea. However, patients may not know that topical loperamide 5% cream can reduce neuropathic pain within 30 minutes, lasting 2.5 hours. Therefore, patients have been able to reduce oral intake of harmful ingredients.

Either combined or alone, pain ingredients can be compounded into a topical hypoallergenic drug delivery system at Specialist Pharmacy, which can offer tailored, effective pain management, optimising multiple pain pathways, whilst also providing the opportunity to reduce adverse side effects, increase efficacy, reduce opioid use, and improve patient compliance.

Due to differences in pain conditions and patient-specific needs, responses, and tolerances, pain management may need to be highly personalised. Providers and patients need topical options as an alternative, due to the challenges with mainstream pain management using oral pain medications. Direct access to the target site is key, and the clinical evidence supporting topical application directly to the pain site, shows improvement in therapeutic efficacy with lower or negligible systemic absorption. Topical therapy is optimal for multimodal pain therapy and has revolutionised pain relief with the provision of effective synergistic analgesia. Personalised pain management is to guide the prescriber and pharmacist in a joint approach, to effective local chronic pain treatment.