Collaborating with prescribers to treat chronic pain

APhA Pain Institute held with APhA2018 in Nashville

Pain is an emotional condition, and a big part of addressing chronic pain is addressing its emotional component. “Having a team approach to that is fundamental,” said Noah Nesin, MD, FAAFP, vice president of medical affairs at Penobscot Community Health Care (PCHC), a federally qualified health center in Maine.

Prescribers are open to having another partner on the team, he added.

Felicity Homsted, PharmD, DPLA, chief pharmacy officer at PCHC, described PCHC’s interdisciplinary Controlled Substance Stewardship Committee, including provider–patient agreements, policies with oversight, and proactive case reviews. “The patient is at the heart of our care,” she said.

Penobscot pharmacists’ published research and real-life successes in partnering with prescribers to minimize opioid misuse were the focus of Teaming Up for Safer Pain Management: Strategies for Effective Collaboration, a panel discussion moderated by Stephanie Gernant, PharmD, MS, assistant professor of pharmacy practice at the University of Connecticut in Storrs.

The discussion closed out the day-long APhA Pain Institute 2018: Innovative Approaches to Chronic Pain on Thursday, March 15, held in conjunction with the 2018 APhA Annual Meeting & Exposition in Nashville.

In the Teaming Up for Safer Pain Management session, Nesin said, “We can trust our primary care team, including our pharmacists, to hold us accountable”—to tell prescribers when they’re missing something important about that patient’s care.

The benefit to the prescriber of this partnership is having pharmacists as “eyes,” but the advantage for the pharmacist is having the prescriber support the pharmacist, Homsted said. At Penobscot, “we’ve had the prescriber sit down with the patient to say: ‘The pharmacist is part of the care team.’”

For pharmacists seeking a quick win to help prescribers they haven’t worked with previously, offer to do the pill counts, Homsted advised.

While barriers to collaboration include emotional and workflow issues, Homsted said that prescribers are ready for the pharmacist to say: “How can we help?”

In its second year, the APhA Pain Institute 2018’s education sessions also included the following:

  • Bridging the Gap Between Pain Management and Drug Diversion. Ted Parran, MD, described the concept of addiction as a chronic disease and explained how this affects treatment paradigms.
  • Opioid Calculation and Conversion:101. Courtney Kominek, PharmD, BCPS, CPE, and Abigail Brooks, PharmD, BCPS, provided practical guidance for calculation morphine equivalents and converting among opioids when needed to meet patients’ pain management needs.
  • A Case Study of Opioid Dose De-escalation. In this interactive session, Kominek and Brooks explored patient-centered opioid management through a complex case.
  • Chronic Pain Management: Best Practices and Clinical Pearls. Chris Herndon, PharmD, CPE, shared clinical pearls that highlight creative therapeutic approaches for supporting patients with chronic pain.
  • Expert Debate: Addressing Controversial Topics in Pain Management. There is no formula that works for all situations or all patients with the disease of addiction who need pain management. This session presented debates on complex topics among Herndon; Michele Matthews, PharmD, CPE, BCACP, FASHP; and Joseph Cammilleri, PharmD, BCACP, CPE.
  • Naloxone: Understanding Its Role and Expanding Access in Community Pharmacies. Anita Jacobson, PharmD, and Sarah Melton, PharmD, BCPP, BCACP, FASCP, presented on the laws surrounding naloxone’s use, the available naloxone products, and the logistics of dispensing take-home formulations.
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