As Nonopioid Alternatives for Pain Management Emerge, Pharmacists Prove Essential

Opioids have been the standard treatment for the management of acute and neuropathic pain for decades. By binding to receptors in the brain or body, the intensity of pain signals transmitted by nerve fibers can be mitigated, and analgesic effects can be produced. Oftentimes, treatment with opioids can effectively reduce pain. However, research has described the dangers associated with opioid use, including potential addiction, tolerance, and overdose, and its effectiveness in many disorders has been reevaluated in recent years.^1,2

Suzetrigine is a novel nonopioid therapy that is FDA approved to treat acute pain. | Image Credit: © luchschenF - stock.adobe.com

Gradually, clinical practice has moved away from the immediate use of opioids for acute pain. The CDC, in its Clinical Practice Guideline for Prescribing Opioids for Pain, notes that nonopioid therapies can be at least as effective as opioids for many common forms of acute pain and that clinicians should “maximize use of…non-opioid pharmacologic therapies.” Opioid treatment should only be considered for acute pain management after thorough patient counseling and “if benefits are anticipated to outweigh risks.” For longer-lasting pain, nonopioid therapies are preferred due to the risk of addiction surrounding opioids.³

Comparative evidence is limited regarding the use of nonopioid medications for neuropathic pain, but the CDC again recommends the maximized use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate. Nonopioid options for neuropathic pain syndromes include tricyclic, tetracyclic, and serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressants; selected anticonvulsants (such as pregabalin, gabapentin enacarbil, and oxcarbazepine); and capsaicin and lidocaine patches, according to the CDC.³

Pharmacists' Role in Pain Management

Pharmacists play a critical role in proper patient counseling and education on nonopioid therapies for acute and neuropathic pain management, just as they do with opioids. As they are often a primary point of contact for patients, pharmacists must be prepared to provide appropriate education and counseling not only on the risks associated with even limited opioid use but also on the available nonopioid options for reducing pain. Often, patients may prioritize immediate pain relief and may ask to be prescribed an opioid-based treatment; pharmacists are critical to providing thorough, fact-based reasons why a nonopioid strategy is safer and more effective than opioid use.³

Advising patients on the serious adverse effects of opioids is paramount. Even short-term treatment can lead to an unintended, long-term period of opioid use. Long-term opioid use can cause potentially fatal respiratory depression and opioid use disorder that can lead to an inability to fulfill major responsibilities at school, work, or home. Beyond serious long-term effects, common short-term effects can also be burdensome, including drowsiness, confusion, tolerance, vomiting, nausea, and ultimately developing physical dependence. Dangerous interactions with other drugs, including SNRIs or nonsteroidal anti-inflammatory drugs (NSAIDs), could lead to a fatal overdose or other severe complications. These aspects should be appropriately relayed to patients when counseling them on the use of non-opioids for pain management.³

The effectiveness of opioids, while proven in short-term pain, is questionable for long-term use. According to the CDC, nonopioid therapies such as NSAIDs or acetaminophen have been associated with similar effectiveness in relief of acute pain conditions, including musculoskeletal injuries, pain related to minor surgeries, dental pain, kidney stone pain, and headaches. Pharmacists must ensure they are educated on the range of nonopioid therapies available to patients, and they should be prepared to inform patients on their options. Furthermore, recommending nonpharmacologic strategies, such as using ice, heat, rest, or exercise, in combination with a nonopioid therapy could provide additional improvements to patient pain.³

Many nonopioid therapies can reduce instances of short-term acute and neuropathic pain, but effective non-opioid treatments for more severe pain have been lacking. Recently, though, a novel nonopioid alternative was granted FDA approval, becoming the first new class of medication approved to treat acute pain in over 2 decades.⁴

Suzetrigine Reduces Acute Pain

Suzetrigine (Journavx, previously VX-548; Vertex Pharmaceuticals) is a nonopioid, selective NaV1.8 pain signal inhibitor designed to reduce moderate-to-severe acute pain. Investigators observed a reduction in acute pain over a 48-hour period in patients treated with suzetrigine after abdominoplasty or bunionectomy in 2 phase 2, randomized, double-blind, placebo-controlled studies that included patients aged 18 to 75 years, according to data published in the New England Journal of Medicine. Common adverse events included nausea, headache, dizziness, and vomiting.⁴

The regulatory approval of suzetrigine was celebrated as a groundbreaking move in pain management, with the potential for the drug to become a new standard of care for patients with acute pain. Reshma Kewalramani, MD, CEO and president of Vertex, said the approval was “a historic milestone for the 80 million people in America who are prescribed a medicine for moderate-to-severe acute pain each year" and noted “the opportunity to change the paradigm of acute pain management.”⁴

With suzetrigine’s approval, pharmacists will soon have a new, effective, and safe nonopioid therapeutic option for patients with acute pain. Patient monitoring will remain paramount, as adverse effects are possible with suzetrigine, and proper dosing will be essential. Patients in clinical trials for suzetrigine received multiple doses of the therapy over the course of their treatment, so pharmacists must work with members of the multidisciplinary team to ensure dosing is appropriate based on the patient’s clinical presentation.

Suzetrigine is poised to change the landscape of pain management and could lead to more nonopioid NaV1.8 pain signal inhibitors being studied and approved in the future. Nonopioid treatments like suzetrigine provide benefits for both pharmacists and patients, but above all, patients will not be at risk for the debilitating effects of opioid addiction, improving outcomes across the board.

REFERENCES

1. CDC. Overdose prevention: Opioid therapy and different types of pain. Uploaded May 8, 2024. Accessed online February 13, 2025. https://www.cdc.gov/overdose-prevention/manage-treat-pain/index.html#:~:text=Opioids%20are%20natural%20or%20synthetic,Hydrocodone

2. Gallagher A. FDA accepts new drug application for suzetrigine to manage acute pain. Pharmacy Times^®. Published July 31, 2024. Accessed February 13, 2025. https://www.pharmacytimes.com/view/fda-accepts-new-drug-application-for-suzetrigine-to-manage-acute-pain

3. Dowell D, Ragan KR, Jones CM, et al. CDC clinical practice guideline for prescribing opioids for pain—United States, 2022. Recommendations and Reports. 2022;71(3):1-95. doi:10.15585/mmwr.rr7103a1

4. Gallagher A. FDA approves suzetrigine, new alternative to opioids for acute pain. Pharmacy Times. Published January 30, 2025. Accessed February 14, 2025. https://www.pharmacytimes.com/view/fda-approves-suzetrigine-new-alternative-to-opioids-for-acute-pain