Pharmacists Can Help Alleviate Pain

Brown bag consults can be essential educational and safety tools to measure and ensure quality care. By asking patients to bring in all their current medications, including OTC, mail order, specialty, and herbal products, pharmacists can guarantee appropriate and up-to-date care.

Pharmacists are key providers in the continuum of care, consistently identifying potential problems and concerns that may require follow-up with prescribers or a medication therapy management (MTM) session. It is essential that a pharmacist’s workflow allow for brown bag consults, which can do the following:

• Develop the pharmacist—patient relationship to help create better individualized service, forge patient loyalty and trust, and prevent medical errors
• Provide insight into a patient’s lifestyle and quality of care
• Show how well patients understand their conditions and medications

Offering to review medications one-on-one gives pharmacists the opportunity to connect with patients by serving as trusted medical professionals in the community. Brown bag sessions do not have to be time-consuming scheduled events. They can be offered any time a pharmacist thinks that a patient needs follow-up care after a typical counseling session.

Patients should weave preventive health care into every aspect of their lives, as it paves the way for better outcomes and quality of life. By being active, eating more nutritious foods, maintaining a healthy environment, and staying on top of wellness screenings, individuals can be their best selves. The community pharmacy is a hub for preventive care and services. Pharmacists can play a big role in keeping patients safe and helping them identify conditions early, potentially preventing hospitalizations and unnecessary doctor visits. They can also offer vaccines, screenings, and services, such as MTM, that can reduce costs.

Pharmacists have a positive impact by identifying and helping patients in pain. Although patients frequently visit unattended pharmacy aisles and multiple health care providers for various conditions, the pharmacist behind the counter remains the quintessential community health care provider who sees it all. Pharmacists tend to know patients individually and can identify their health care concerns. Knowing patients and their ailments is essential when recommending OTC pain relievers for short-term use or when assessing complex chronic pain management therapy.

Many patients are hesitant to ask their health care provider questions regarding pain-related issues, as pain is something that is not seen. Pain management scales are useful tools, but pain remains difficult to properly diagnose. Often, patients who are experiencing acute pain self-medicate with OTC agents without professional knowledge or recommendation. Some patients who suffer from painful chronic conditions control pain episodes by adjusting their prescribed medications without their provider’s knowledge or self-treat undesirable adverse effects (AEs) from pain medications without a consult. By acting as a cornerstone of trust within the community and being approachable, pharmacists can educate patients who are suffering from any type of pain. The pharmacy team can help improve their patients’ quality of life by helping them understand more about their specific condition, treatment options, AEs, and optimal medical management.

JA is a 48-year-old man who is a pharmacy customer. You know from past counseling sessions that he is an office manager for a local downtown company. JA has a history of arthritis, mental illness, and pain, and he tends to drop off his prescriptions an hour before closing time and can be very impatient. Based on transfer records, he uses multiple pharmacies in the surrounding area. You review his profile and note some concerns regarding adherence.

When JA approaches the counter to collect his prescriptions, you ask if he would be interested in extra medication counseling. You explain what happens during a brown bag consult and tell him that you are interested in reviewing his medications. JA appreciates the opportunity to talk but says he does not have time right now. He confesses that he “never even thought the pharmacist could help him.” You encourage JA to think about the offer and come back when he can make the time.

He calls the next day and asks if he can stop by the following week to discuss his medications. Upon reviewing JA’s medication profile at your pharmacy, you find the following:

• Hydrocortisone cream 2.5%, apply to affected areas, as needed
• Ibuprofen, 800 mg, every 12 hours, as needed (usually filled 3 to 4 days early)
• Lorazepam, 2 mg, daily at bedtime, as needed
• Norco, 10/325 mg, every 4 to 6 hours, daily, as needed
• Quetiapine extended release, 600 mg, daily (refill overdue)
• Sertraline, 100 mg, daily (refill overdue)

When JA comes in for his appointment, you notice the following additional medications in his brown bag:

• Alprazolam, 0.5 mg, twice daily, as needed (filled at competitor pharmacy the previous month; no refills)
• Hydrocodone/acetaminophen, 5/500 mg, every 4 to 6 hours, daily, as needed (filled at competitor pharmacy 2 weeks earlier)
• OTC acetaminophen, 500-mg tablets
• OTC caffeine pills
• OTC calcium carbonate chews
• OTC ibuprofen, 200-mg tablets
• OTC multivitamin, daily
• OTC omeprazole, 20-mg capsules
• Tussinex syrup (~60 mL remains; bottle unlabeled; not from your pharmacy)

After reviewing the medications in JA’s possession, you realize that he might benefit from an MTM session, and you schedule a follow-up appointment. An MTM session will allow you to further communicate with all of JA’s health care providers, obtain lab values, and further evaluate JA’s medical goals. In the meantime, you have some questions and suggestions about his medications.

JA relies on anxiety and pain medications to get him through the day. He is taking OTC acetaminophen and ibuprofen daily, along with his prescribed pain medications. He says that his hip has not recovered from a bad fall this past winter. You offer to speak to his providers regarding his pain and duplicate therapy. You are unsure how much JA is using, and you do not want him to stop cold turkey. He needs a plan to help him appropriately manage his pain. You explain that he also needs tests to identify broken or fractured bones, along with tests to determine medication toxicity. Medication toxicity may be the reason behind JA’s use of OTC omeprazole and calcium carbonate for his upset stomach. You counsel him about AEs and toxicity concerns and plan to follow up. You ask JA to set some goals for the MTM session. You explain that after he receives medical clearance from his providers, you think it would be wise to review diet and exercise goals, as JA mentions his sedentary lifestyle at home and work.

He tells you the Tussinex prescription was his wife’s, but he keeps it around for when he needs extra pain control. JA says that it tastes good and works quickly. You counsel him on the dangers of sharing medications and dispose of the unlabeled medication for him. JA has not been taking his quetiapine and sertraline as prescribed. He complains that the medications make him feel tired, and he often supplements by taking caffeine pills. JA also says that he feels heart palpitations every now and then after having caffeine. You offer to follow up with his providers immediately and encourage him to visit an emergency department or urgent care if necessary. You check JA’s blood pressure, and it is within normal range. You plan to get in touch with his care team to better help him and address adherence at a follow-up MTM session.

What additional counseling would you offer JA?