By: 29 February 2024
Empowering patient care: The pharmacist’s crucial role in addressing chronic pain

Paaven Patel, Operations and Quality Assurance Pharmacist at Specialist Pharmacy, discusses the pharmacists’ role in treating chronic pain


Pain, an omnipresent facet of the human experience, is a formidable adversary that drives millions of individuals to seek healthcare worldwide. Chronic pain, persisting for extended periods, poses a complex challenge that requires a comprehensive and patient-centric approach. In this article, we delve into the crucial role that pharmacists play in empowering patient care, particularly in the context of chronic pain. Despite significant strides in pain management, chronic pain remains inadequately addressed, necessitating a deeper exploration of the pharmacist’s contributions to this field.

Understanding Chronic Pain

Chronic pain, defined as persistent discomfort lasting beyond the expected time for healing, affects millions globally, diminishing the quality of life for those it afflicts. Conditions such as arthritis, neuropathy, and migraines are just a few examples of ailments that can lead to chronic pain. Addressing this pervasive issue requires a multidisciplinary approach, with pharmacists emerging as pivotal healthcare professionals.

The Pharmacist’s Expertise

Pharmacists, traditionally known for their role in dispensing medications, have evolved into integral members of the healthcare team. Their expertise extends beyond the pharmacy counter, encompassing a deep understanding of medications, their interactions, and their effects on the human body. In the context of chronic pain, pharmacists bring a unique skill set that goes beyond merely filling prescriptions.

Current Challenges in Chronic Pain Management

Despite advancements in medical science, chronic pain management faces significant challenges. Harmful systemic side effects, insufficient therapeutic efficacy, poor patient compliance, and a need for a more profound understanding of pain pathways within the medical community are persistent hurdles. The pharmacist, with their in-depth knowledge of pharmacology, can navigate these challenges to optimise patient outcomes.

Empowering Patient-Centric Care

Pharmacists play a pivotal role in transitioning from a traditional disease-focused model to a patient-centric one. Empowering patients involves understanding their unique pain experiences, considering individual responses to medications, and tailoring interventions to address not just the physical aspects of pain but also its emotional and psychological dimensions.

Targeting Chronic Pain at Its Source

A crucial aspect of effective chronic pain management is targeting the pain at its source. Pharmacists contribute significantly by assisting in the selection of appropriate medications based on pharmacodynamics, safety profiles, and efficacy. This targeted approach involves a nuanced understanding of pain pathways and the individual patient’s response to different medications.

Topical and Local Analgesic Applications

Pharmacists champion the use of topical and local analgesic applications as part of a personalised pain management strategy. By differentiating between topical and transdermal routes of delivery, pharmacists ensure that medications are applied directly to the affected area, reducing the risk of systemic side effects. This localised approach not only enhances therapeutic efficacy but also minimizes systemic absorption, addressing concerns related to adverse reactions.

Furthermore, topical treatments enable the pharmacist to address peripheral sensitisation processes. By limiting peripheral sensitisation, the cascade effect on central sensitisation – a phenomenon linked to heightened pain perception in the brain and spinal cord – is reduced. Pharmacists, through their expertise, guide patients and prescribers in understanding the nuances of these processes, thereby contributing to a more targeted and effective pain management plan.

Multimodal Pain Therapy

Pharmacists advocate for a multimodal approach to chronic pain management, recognising that no single intervention can comprehensively address the multifaceted nature of persistent pain. This approach involves the combination of different groups of medications and non-pharmacological interventions. Pharmacists guide prescribers and patients through the selection of medications with diverse mechanisms of action, such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anaesthetics, and muscle relaxants.

The incorporation of non-medication therapies, including physical therapy and counselling, is also emphasised. This holistic approach not only enhances pain relief but also contributes to overall function and well-being. Pharmacists, as educators and advocates for comprehensive care, ensure that patients and prescribers are well-informed about the benefits of multimodal therapy in chronic pain management.

The Role of Pharmaceutical Compounding

Pharmaceutical compounding emerges as a powerful tool in the pharmacist’s arsenal for personalised pain management. This practice involves the preparation of custom medications tailored to meet the unique needs of individual patients. Compounding allows for flexibility in addressing unmet needs, such as personalised dosing, tailored dosage forms, elimination of unwanted ingredients, combining multiple ingredients, and addressing product unavailability.

Pharmacists work collaboratively with prescribers and patients to create optimised treatment plans through pharmaceutical compounding. This collaborative approach ensures that medications are not one-size-fits-all but rather customised to the patient’s conditions, tolerances, and preferences. Examples of compounded formulations include common pain ingredients such as amantadine, amitriptyline, benzocaine, baclofen, clonidine, diclofenac, lidocaine, ketoprofen, and tetracaine.

Moreover, pharmaceutical compounding allows for the inclusion of uncommon ingredients, not typically used in mainstream pain management due to insufficient research into their efficacy and safety. For instance, verapamil, a voltage-gated calcium channel blocker, formulated into a 15% topical gel, has demonstrated efficacy in helping patients suffering from fibrotic tissue disorders like plantar fibromatosis. Loperamide, an opioid agonist traditionally used to treat diarrhoea, formulated into a 5% topical cream, showcases the innovation that compounding brings to pain management. This topical application of loperamide has demonstrated the potential to reduce neuropathic pain within 30 minutes, lasting 2.5 hours, allowing patients to minimise oral intake of potentially harmful ingredients.

Challenges in Pain Management and the Pharmacist’s Guidance

Due to the inherent differences in pain conditions, patient-specific responses, and tolerances, effective pain management must be highly personalised. Pharmacists, through their guidance, help bridge the gap between providers and patients, ensuring that the intricacies of chronic pain are understood and addressed.

Topical options emerge as a valuable alternative to mainstream pain management using oral medications. Pharmacists highlight the importance of direct access to the target site, emphasising the clinical evidence supporting topical application directly to the pain site. This approach not only shows improvements in therapeutic efficacy but also minimises systemic absorption, reducing the risk of side effects associated with oral medications.

Pharmacists advocate for a paradigm shift in the approach to chronic pain management, where personalised care becomes the guiding principle. Through their expertise, they contribute to the development of treatment plans that prioritise patient needs, responses, and tolerances. By championing topical therapies and embracing pharmaceutical compounding, pharmacists actively contribute to the evolution of chronic pain management strategies.

In conclusion, empowering patient care in chronic pain management necessitates recognising the pharmacist as a crucial ally. Their expertise in pharmacology, coupled with a patient-centric approach, positions them at the forefront of the battle against chronic pain. As the healthcare landscape evolves, the pharmacist’s role becomes increasingly vital in addressing the multifaceted challenges posed by persistent pain. Through targeted interventions, advocacy for multimodal approaches, and the innovative potential of pharmaceutical compounding, pharmacists pave the way for a future where chronic pain is not just managed but comprehensively addressed, empowering patients to regain control of their lives.


Specialist Pharmacy

Specialist Pharmacy is the first compounding pharmacy of its kind in the UK, producing custom-made medications across a wide range of treatment areas such as bioidentical hormones, pain management, dermatology, haircare, sports medicine, and veterinary medications.