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13 Articles in Volume 18, Issue #6
Advice for the Advanced Practice Provider
Authorities’ Use of Big Data May Harm—or Help—Your Chances of Investigation
Considering Comorbidities When Selecting Medications (Part 2)
Gaps in the Pharmacist’s Pain Management Role
How can cyproheptadine manage complicated chronic pain cases?
Letters to the Editor: Trackable Pills; Buprenorphine; CRPS Diagnosis
Managing Opioid Use Disorder
Mobile Trackers and Digital Therapeutics
New Insights in Understanding Chronic, Central Pain
Nocebo Effects: How to Prevent them in Patients
Polarizing Topics in Chronic Pain
The Fight to End Peripheral Neuropathy
Urine Drug Monitoring

Gaps in the Pharmacist’s Pain Management Role

A study provides insight into pharmacists' perceptions of pain practice and the realities of dispensing scheduled pain medications.
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The Current Role of Pharmacists in Pain Care

One of the primary reasons patients visit community pharmacies is to ask for advice about managing pain, signifying chronic pain disease as a notable public healthcare challenge.1,2 Yet, pain is largely undertreated,1 poorly assessed, and managed. Appropriate pain care has been associated with fewer hospital stays and readmissions, faster recovery times, and better quality of life.3 All healthcare professionals involved in pain management, including pharmacists, therefore have a responsibility to help relieve pain and suffering for the best possible patient outcomes and for the good of the greater medical community.3,4

Effective pain treatment involves a multidisciplinary, personalized, and often multimodal effort, and having pharmacists on a pain treatment team has been associated with better pain symptom control. As medication experts, pharmacists play a crucial role in facilitating patient access to pharmacological analgesics,5,6 making their clinical skills in pain management—and those of pharmacy managers—of the utmost importance.1

Many factors encumber pharmacists’ participation in pain management, however, including regulatory issues, documentation difficulties, fear of regulatory scrutiny and reprisal from state and federal authorities, fear of promoting addiction, limited training in pain control,7,8 negative misconceptions about pain and its treatment,9 and the complexity of pain regimens. Additionally, pharmacists’ limited knowledge pertaining to pain, pain management, and the addiction, physical dependence, or tolerance to medications, also plays a significant role.1,3,4,7,8,10,11 Further, pharmacists may be viewed as a hindrance to patients’ legitimate access to controlled substances for pain management,7 resulting in inadequate pain relief. These factors alone or combined may compromise pharmacists’ willingness to dispense even valid prescriptions for controlled substances to patients suffering from acute or chronic pain and thereby reduce pharmacists’ involvement in the pain management continuum.

The Need for Research on this Group

Most studies in the available literature on pain management involving pharmacists have been undertaken primarily in the inpatient setting and focused on cancer-related pain. Few studies have been conducted in the outpatient setting and even fewer have involved community pharmacists.7 The authors conducted a study to evaluate the knowledge of and attitudes toward pain management among pharmacists based in the state of Virginia. Specific objectives were to:

  • Determine pharmacists’ knowledge about pain management
  • Describe pharmacists’ comfort levels regarding dispensing pain medications
  • Identify pharmacists’ opinions and beliefs regarding pain management
  • Identify pharmacists’ perceived barriers and factors that may contribute to suboptimal pain management.

Study Setup

The cross-sectional study used a mail survey to collect data from 1,000 community and hospital pharmacists practicing in Virginia. The study protocol was submitted for approval to the Virginia College of Osteopathic Medicine’s Institutional Review Board (IRB). Data were collected through a mail survey instrument with a total of 30 items. The instrument was designed based on the existing literature on the subject and was divided into three main: attitudes toward pain and pain management, general practice issues/information, and demographic characteristics.

A survey was pilot-tested on a convenience sample of five hospital and community pharmacists in Southwest Virginia; necessary changes were made to the survey based on this feedback results. Next, a random sample of 1,000 active pharmacists was drawn from a Virginia Pharmacists Association list of licensed Virginia pharmacists. Only registered and currently active pharmacists practicing pharmacy in the state of Virginia were included in the study. Pharmacists working in community (independent, chain, clinic and other), long-term care, and hospital pharmacies were included.

A survey packet including a cover letter explaining the purpose of the project and a self-addressed postage paid questionnaire was mailed to each of the 1,000 pharmacists, with request for a two-week turnaround. Initial surveys were mailed in the winter of 2013 and spring of 2014 and questionnaires were collected over a six-week period.

In addition to sharing their gender, age, ethnic/racial background, job title, type of practice (retail-independent, retail-chain, hospital-independent, hospital-chain, other), size and setting of practice (inner city/city/suburban/rural), years of experience, hours worked, and number of prescriptions/medication orders dispensed per day, survey respondents had the opportunity to provide comments about the practice of pain management (see Table I). They were also asked to address whether they faced any impediments in attaining good pain management for their patients and whether their job required them to collaborate with hospice.

Analysis and Results

Data analysis was conducted using PASW Statistics Software (SPSS), with means, standard deviations, and frequency distributions computed for all variables. A p value of α < 0.05 was used for statistical significance. Correlation analyses examined whether the pharmacists’ age, years of experience, and hours worked were related to the attitude level (ranging from “strongly disagree” to “strongly agree,” see Table I) of the pharmacist. An independent groups t-test examined the differences in attitude scores between male and female pharmacists as well. Analysis of variance (ANOVA) was used to determine whether attitude levels differed by ethnic and racial background, job title, type of practice setting, and size/setting of employment of the pharmacist.

Demographics

A total of 147 responses were obtained for a 14.7% (147/1,000) response rate. Most respondents were female (n = 83; 56.5%), Caucasian (n = 119; 81.5%) and worked in retail chain stores (n = 76; 51.7%). The average age of the participating pharmacists was 51.9 (SD = 12.1) years. On average, pharmacists had practiced pharmacy for 26.2 (SD = 12.6) years.

Last updated on: September 5, 2018
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Considering Comorbidities When Selecting Medications (Part 2)
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