Pharmacists on the frontline of pain care

Pharmacists can play key role in helping patients living with pain, especially those from underserved communities

In a busy pharmacy, pharmacists play key roles in managing acute and chronic pain. Whether they are helping patients manage pain during a COVID-19 vaccination, compounding children’s doses of pain medication during a nation-wide shortage or checking for drug interactions for patients with chronic pain, pharmacists are on the frontlines of providing pain care.

 “There is a lot of stigma around pain, and not everyone is able to communicate their pain,” says Jaris Swidrovich, assistant professor – teaching stream at U of T’s Leslie Dan Faculty of Pharmacy. “Pharmacists are the most accessible health professionals and often ranked as one of the most trusted professionals of any kind, so we have a big role in asking the right questions, eliciting that there is pain going on, and helping patients manage their pain appropriately.”

“There is a lot of stigma around pain, and not everyone is able to communicate their pain,” says Jaris Swidrovich, assistant professor – teaching stream at U of T’s Leslie Dan Faculty of Pharmacy. “Pharmacists are the most accessible health professionals and often ranked as one of the most trusted professionals of any kind, so we have a big role in asking the right questions, eliciting that there is pain going on, and helping patients manage their pain appropriately.”

Pain, particularly chronic pain, is a growing concern in health care, affecting people’s physical and mental health, contributing to substance use disorders, and affecting the ability of people to participate in daily activities. According to the U of T Centre for the Study of Pain, pain is the most common reason that people seek health care, accounting for 78 per cent of hospital visits.

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Rates of pain higher in already-underserved communities

Approximately one in five Canadians experiences chronic pain, which is pain that lasts for three months or more. But pain does not affect populations equally: older adults, veterans, and people who use drugs all have higher reported rates of chronic pain. Indigenous Peoples, people of colour, and 2SLGTBQ+ people may have higher rates of chronic pain, but also face barriers to accessing care which means their pain may go untreated.

“For Indigenous Peoples and others who interact with health care in ways that aren’t as safe, they may hold off on accessing care for a longer period of time, and their pain level may grow,” says Swidrovich, who was a member of the now-complete Canadian Pain Task Force and currently serves on Pain Canada’s national advisory committee. “Or if there is a particular cause for their pain, it goes untreated for a period of time.”

Canadian Pain Task Force makes recommendations to better address pain

Several years ago, the World Health Organization recognized chronic pain as a distinct disease, not just a symptom of other conditions. Since then, more research, training, and policy changes have taken place to improve knowledge of pain and care for people living with pain. In Canada, the Canadian Pain Task Force was established in 2019 to provide advice and recommendations to the federal government to help improve the prevention and management of chronic pain.

In the task force’s final 2021 report, Swidrovich and the other expert members made more than 100 recommendations to improve training for all health care professionals, invest in pain research, and ensure equitable access to person-centred pain care, particularly for populations disproportionately impacted by pain.

As a pharmacist, Swidrovich feels very strongly that pharmacists have an important role to play in helping with pain management, particularly patients from communities who may not feel safe in the health care system.

“Engaging in the learning and practice of anti-racism and anti-oppression, understanding and applying the social determinants of health, being inclusive, and having diverse representation on your pharmacy team will help people feel more safe accessing care,” he says.

“Believe people when they say they are in pain. Not being believed is a big frustration for people living with pain. Sometimes there is an obvious cause of pain, but many forms of pain will never show up on any test or scan. Believing people’s pain, using the tools we have available to help people communicate their pain, and following up with them to make sure their therapies are working are all important ways pharmacists can help.”

Molecular research aims to address root causes of chronic pain

Researchers like Rob Bonin, associate professor at the Leslie Dan Faculty of Pharmacy and co-director of the University of Toronto Centre for the Study of Pain (UTCSP), have helped to change how pain is understood and managed.

Bonin’s research focuses on nervous system plasticity – how the connections between nervous system cells are modified

based on individual experiences to permit learning and memory. Strengthening the connections that transmit pain information between cells can contribute to chronic pain that continues after the original source of the pain is long gone. “Opioids can dampen the pain signals but don’t address the underlying causes,” he says. “We hope it will someday be possible to tap into the ability of the nervous system to learn and adapt to treat some of these underlying causes and reduce the need for opioids.”

Bonin and his team hope that a better understanding of the nervous system plasticity that contributes to chronic pain will allow for the development of new therapies that address the molecular causes of pain.

As part of the UTCSP, Bonin is also engaged in the training of future pharmacists and other health professionals in interprofessional approaches to pain management. “It’s not possible to treat pain by focusing on sensory processing,” he says. “Pain is a personal experience, and we need to consider the complete picture of the patient in terms of biology, psychology, and society.”