The Role of the Pharmacist in the Management of Chronic Pain

An Interview with Mary Lynn McPherson, PharmD, MA, BCPS, CPE

Mary Lynn McPherson, PharmD, MA, BCPS, CPE, is professor and vice chair for education in the Department of Pharmacy Practice and Science at the University of Maryland School of Pharmacy in Baltimore. Dr. McPherson has maintained a practice in both hospice and palliative care, as well as ambulatory care throughout her career. She teaches extensively in the Doctor of Pharmacy (PharmD) program on the topics of pain management and end-of-life care, including didactic and experiential content. She also developed one of the first palliative care pharmacy residency programs in the United States. Dr. McPherson serves on the Board of the Hospice Network of Maryland and is also president of the American Society of Pain Educators. She has received many honors for her work, including the American Pharmacists Association Distinguished Achievement Award in Specialized Practice, the University of Maryland Teacher of the Year Award, the Maryland Society of Health-Systems Pharmacists W. Purdum Lifetime Achievement Award, and the Robert K. Chalmers Distinguished Pharmacy Educator Award from the American Association of Colleges of Pharmacy. She has written four books, including the best-selling Demystifying Opioid Conversion Calculations, A Guide to Effective Dosing.

Kevin L. Zacharoff, MD: 

What would you like our PainEDU Community to know about the role of the pharmacist in the management of chronic pain and chronic opioid therapy?

Mary Lynn McPherson, PharmD, MA, BCPS, CPE: I really believe that the pharmacist is the “last line of defense” in the safe and effective use of chronic opioid therapy in patients with pain. There are essentially two competing public health crises in the United States today — chronic pain and problems associated with opioid overdose and unintended deaths. I think that it is critically important that everybody involved needs to bring their “A-game” to maximize pain treatment and minimize the risks. There needs to be fair balance of the risks and benefits and of the different healthcare providers involved in the care of these patients. I know this may sound a bit cliché, but it really does “take a village” to accomplish this. We should be looking at hospice care as a good model for true trans-disciplinary care.

KZ: What are your thoughts about the recent rescheduling of hydrocodone?

MLM: I think the intention is to try to enforce a higher level of scrutiny on the prescribing of these medications. That’s probably a good thing, but I worry about the possible “balloon effect” it may have on the scheduling of Schedule III medications as well. I’m really not sure that it solves the problem and may just be a different kind of “Band-Aid” solution — a Hello Kitty one instead of a Spider-Man one.

KZ: So what do you think might be a good solution towards the problem of abuse and misuse of opioid medications?

MLM: I think we need to stop the “shotgun” approach to this multifaceted problem, and use a good, consistent approach to it, along with education about rationale and appropriate practices.

 

KZ: What are your thoughts about the role of abuse-deterrent formulations of opioids and their utility in making prescribing safer?

MLM: I think that abuse-deterrent formulations of opioids may make prescribers feel better, as they may not need to worry about people manipulating these medications, but the reality is that these formulations are often out of reach for many patients for a variety of reasons — from formulary restrictions, to cost, and other reasons as well. These may not be the answer to the crises that we are seeing in the pain management environment today.

KZ: What do you see that’s new on the horizon in the area of managing patients with chronic pain?

MLM: I really don’t see any “game changers” in the near future. I think that clinicians are still lacking the basics in approaching patients with chronic pain. There may be some promise in exploring and capitalizing on the benefits of combination therapy, instead of putting all of the emphasis on one single treatment. At the end of the day, I thing we need to go back to the “3 Rs” of pain management — reading, writing, and arithmetic about being as safe and effective as we can be in a reproducible, and rational way.

KZ: We hear a lot about the educational gaps that exist even today for many healthcare providers regarding pain and its management. What is your opinion about the quality of education for pharmacists in this area?

MLM: In a single word, terrible. Pharmacists are a dichotomous group regarding their role in the management of patients with chronic pain. Pharmacists have a corresponding responsibility to do their job, and also to make sure that everyone else has done their job as well. This is especially important when it comes to the use of opioids as part of the treatment plan. Although things are improving, we still have a long way to go in educating student pharmacists about safe and effective pain management. Not only students, but continue our education efforts all the way up to pharmacists in active practice. And it’s not just pharmacists – physicians, nurses and other healthcare disciplines also need a big dose of pain management in their curriculum.

KZ: Are there any final comments you have regarding what we have discussed today?

MLM: Yes. As I mentioned, I think we need to go back to the basics in this area. We need to apply simple principles to the education of pharmacists about chronic pain management and opioid therapy. Online educational training is another good approach to helping pharmacists achieve this goal. Anything we can do to use advanced technology is a good thing, but at the end of the day, people usually learn best by doing. Ultimately, I think we need to Teach, Model, and Coach — so that pharmacists will be able to relate to the education, and get better at what they do, and how they interact with other members of the healthcare team.