Introduction:
In a world in which the prescription of opioids is under close scrutiny, the emphasis is now placed on the implementation of multimodal analgesic practices. One such key player in the implementation of such procedures is the pharmacist. As many suffer from the undertakings of chronic pain and the world battles an opioid epidemic, the need for the implementation of evidence-based practices, necessary for every provider to understand, cannot be neglected. Being a PharmD, we are in a unique position to recommend such situations.
Body:
Non-Opioid Pharmacological
Acute Pain Management:
NSAIDs - Ibuprofen, Naproxen, Ketorolac - First Line
Acetaminophen - Safe when used correctly, great for musculoskeletal pain
Topical agents - Lidocaine patches and diclofenac gel for local pain
Muscle relaxants – cyclobenzaprine, methocarbamol
Chronic Pain Management:
Neuropathic Pain: Gabapentin, Pregabalin, Dul
Fibromyalgia - Duloxetine,
Osteoarthritis – Topical NSAIDs, intra
Low Back Pain: SNRIs, Muscle Relaxants, Topical Agents
Multimodal Approach
The trick lies in the combination of drugs with different mechanisms of action to achieve synergy, while ensuring minimal side effects. For instance:
Acetaminophen plus NSAID for post-operative pain
Gabapentin + duloxetine for diabetic neuropathy
Topical + oral NSAIDs for localized musculoskeletal pain
Non-Pharmacological Interventions to Advise:
Physical Therapy and Exercise Programs
Cognitive Behavioral Therapy - CBT
Acupuncture for chronic pain conditions
Heat/cold therapy
TENS machines
Weight Management for Joint Pain
Patient Counseling Points:
Establish realistic pain goals (function over complete pain elimination)
Timing: Discuss scheduled dosing versus pro re nata for chronic pain.
Monitor for NSAID GI/CV/renal risks
Screen for drug interactions: Especially with anticoagulants, SSRIs
Emphasize adherence with neuropathic agents; takes 2-4 weeks for effect
What’s your go-to non-opioid multimodal approach for a chronic back pain patient who also has depression and diabetes?
MBH/PS