August 2026 in Pain Management: 7 Developments Shaping Patient Care

August 2026 brought meaningful developments across acute pain treatment, opioid-use disorder (OUD), overdose prevention, and sickle cell disease–related pain. Postapproval evidence continued to define how suzetrigine (Journavx; Vertex Pharmaceuticals) may fit into multimodal surgical care, while prescribing data suggested that payer coverage and health-system adoption are expanding.

Other findings exposed persistent weaknesses in the treatment continuum. Patients prescribed buprenorphine increasingly failed to receive their first fill, and racial disparities remained evident in treatment retention during and after pregnancy. A phase 3 trial also challenged earlier evidence supporting intravenous arginine for sickle cell acute pain episodes.

As a collective, August of 2026 developments demonstrated that improving pain management requires more than introducing new therapies. Pharmacists remain central to selecting appropriate treatments, identifying access barriers, monitoring safety, and ensuring that efforts to reduce opioid exposure do not result in inadequately treated pain.

Suzetrigine Approaches 1 Million Prescriptions as Coverage Expands

Suzetrigine continued its transition from a newly approved analgesic to a treatment used in broader clinical practice. Vertex reported that nearly 1 million prescriptions had been written since the drug’s February 2025 launch. Approximately 90% of commercially insured patients had reimbursed access, and Medicaid coverage had expanded to approximately 75% of beneficiaries.¹

The growth is notable because suzetrigine is the first approved member of a new class of nonopioid analgesics that selectively inhibit the peripheral NaV1.8 sodium channel. Unlike opioids, it does not directly activate opioid receptors. Its current indication remains limited to moderate to severe acute pain in adults.¹

Coverage does not guarantee practical access. Pharmacists must still manage formulary restrictions, discharge coordination, CYP3A-mediated interactions, administration requirements, and patient affordability. Hospitals also need to determine whether increased use improves pain control and reduces opioid exposure, rather than measuring success by acquisition alone.

Phase 4 Data Support Suzetrigine After Laparoscopic and Arthroscopic Procedures

A prospective phase 4 study evaluated suzetrigine as part of multimodal therapy in 47 adults undergoing laparoscopic or arthroscopic procedures. Patients received a 100-mg loading dose followed by 50 mg every 12 hours for up to 14 days, with acetaminophen and ibuprofen incorporated into the regimen and opioids available for rescue.²

Overall, 76.1% of participants recovered without using oxycodone or hydromorphone. Among patients who required rescue therapy, the mean exposure was 2.2 opioid tablets over 1.7 days. Approximately 90.9% rated their pain control as good, very good, or excellent.²

The findings demonstrate that suzetrigine can be incorporated into multimodal surgical pathways while preserving access to rescue medication. However, the small, single-arm design prevents comparison with conventional multimodal care without suzetrigine. Pharmacists should therefore avoid interpreting the results as evidence that every surgical patient can safely avoid opioids.

Separate Phase 4 Study Finds Low Opioid Use After Plastic Surgery

Another single-arm phase 4 study evaluated 99 adults undergoing aesthetic or reconstructive procedures, including breast surgery, abdominoplasty with liposuction, and turbinoplasty. Suzetrigine was initiated before surgery and continued as part of an individualized multimodal regimen.³

Approximately 90.9% of participants did not require postoperative opioid rescue, and 90.7% rated their pain control as good, very good, or excellent. The 9 patients who used rescue opioids received a mean of 2.4 tablets over 2 days. Most participants also received acetaminophen, ibuprofen, or both.³

These findings provide procedure-specific evidence supporting opioid-sparing postoperative pathways. Still, neither phase 4 study contained a randomized comparator, and outcomes reflected the entire multimodal regimen rather than suzetrigine alone.

Implementation requires medication reconciliation and careful counseling. Strong CYP3A inhibitors are contraindicated with suzetrigine, dosage reduction is required with moderate CYP3A inhibitors, and strong or moderate CYP3A inducers should be avoided. Grapefruit-containing foods and beverages should also be avoided during treatment.

First-Fill Abandonment of Buprenorphine Nearly Doubles

A retrospective cohort study published in JAMA Network Open identified a widening gap between buprenorphine prescribing and dispensing. Among 1428 commercially insured or Medicare Advantage adults receiving their first buprenorphine prescription for OUD, the proportion without a dispensing claim within 30 days increased from 19% in 2020 to 37% in 2024. Overall, 25.8% of prescriptions were abandoned.⁴

Patients whose prescriptions were not dispensed were younger, were more likely to have commercial insurance, and had higher mean pharmacy deductibles. Hispanic patients represented 10.6% of the abandonment group compared with 4.8% of patients whose prescriptions were dispensed.⁴

The analysis could not distinguish between patient nonpickup, insurer rejection, pharmacy refusal, or inventory problems. Nevertheless, it demonstrates why expanded prescribing authority cannot be treated as equivalent to expanded treatment access.

Pharmacists can protect this vulnerable transition by confirming inventory, resolving rejected claims, identifying in-network pharmacies, and communicating unresolved barriers to prescribers. Health systems should also consider tracking “prescribed but not dispensed” buprenorphine as a quality measure.

Treatment-Retention Disparities Persist During Pregnancy and Postpartum

A nationwide Medicaid study of 8572 pregnancies found substantial racial disparities in buprenorphine treatment retention. At 180 days after initiation, 45.0% of Black patients had discontinued buprenorphine compared with 27.0% of White patients. Black patients had a 69% higher adjusted risk of discontinuation during pregnancy and a 51% higher adjusted risk through 1 year postpartum.⁵

Differences were smaller among patients initiating methadone. Discontinuation during pregnancy did not differ significantly between Black and White patients, although Black patients had a 22% higher adjusted risk through 1 year postpartum.⁵

The observational study cannot determine why the disparities occurred. Potential contributors include pharmacy availability, insurance barriers, transportation, stigma, fragmented obstetric and addiction care, and discriminatory treatment.

Pharmacists can monitor refill timing, address dispensing barriers before treatment is interrupted, provide naloxone, and coordinate with obstetric and addiction-treatment teams. These interventions are particularly important postpartum, when disrupted care can increase vulnerability to recurrence of opioid use and overdose.

Phase 3 Trial Finds No Benefit With Intravenous Arginine for Sickle Cell Acute Pain

The phase 3 PECARN STArT trial found that intravenous arginine did not shorten sickle cell disease–related acute pain episodes or reduce parenteral opioid use among children and young adults. The trial randomized 274 participants at 10 US pediatric hospitals to receive arginine or saline placebo and was stopped early for futility.⁶

Median time to acute pain episode resolution was approximately 77 hours with arginine and 81 hours with placebo, a difference that was not statistically significant. Total parenteral opioid exposure was also similar between groups.⁶

The results contrast with earlier, smaller studies that suggested arginine could improve pain outcomes. They also highlighted substantial site-level variation: time to episode resolution differed by as much as 61 hours across participating hospitals, while mean parenteral opioid exposure varied by up to 3.0 mg/kg.⁶

For pharmacists, the findings do not support adding intravenous arginine to routine acute-pain protocols. The site variation may be more clinically informative, pointing to differences in analgesic pathways, reassessment, escalation practices, hydration, and discharge criteria that could be addressed through standardized multidisciplinary care.

Fentanyl-Responsive Patch Automatically Releases Naloxone in Preclinical Testing

Researchers developed a wearable microneedle device designed to detect fentanyl and automatically release naloxone. The penny-sized iNal patch contains naloxone-loaded porous silica nanoparticles capped with fentanyl-sensitive molecular gates. When fentanyl binds to the gates, the pores open and release naloxone through microneedles into the skin.⁷

Laboratory and mouse studies demonstrated dose-responsive delivery, repeated activation across at least 3 fentanyl exposures, and naloxone release lasting as long as 24 hours. The platform was designed to address unwitnessed overdose and recurrent opioid toxicity after the initial effect of naloxone has diminished.⁷

The technology remains preclinical. It has not been evaluated in humans, and questions remain regarding dosing reliability, false activation, stability, pharmacokinetics, skin tolerability, and performance outside controlled conditions.

The patch should therefore be viewed as an investigational harm-reduction platform, not an alternative to currently approved naloxone products. Pharmacists should continue prioritizing naloxone access, overdose-recognition counseling, repeat dosing when needed, and immediate emergency response.

Looking Ahead

August’s developments illustrate 2 parallel shifts in pain management. Nonopioid treatment options are moving into real-world postoperative care, but the evidence needed to define comparative effectiveness remains incomplete. At the same time, the greatest treatment failures may occur not because an effective therapy is unavailable, but because patients cannot obtain or remain on it.

Pharmacists are positioned at both points of care. Their responsibilities include evaluating new analgesics, screening for interactions, preserving appropriate rescue therapy, resolving buprenorphine access barriers, supporting treatment continuity, and distinguishing promising preclinical technologies from interventions ready for clinical use.

References

1. Vertex Pharmaceuticals Incorporated. Vertex reports second quarter 2026 financial results. Published August 3, 2026. Accessed August 31, 2026. https://news.vrtx.com/news-releases/news-release-details/vertex-reports-second-quarter-2026-financial-results

2. Habib, A. S., Solanki, D., Hoff, J., D’Aunno, D., Konis, G., Moore, J., … Weiner, S. G. (2026). Suzetrigine as Part of Multimodal Therapy Enables Opioid-Free Recovery after Laparoscopic or Arthroscopic Procedures. Pain Ther. https://doi.org/10.1007/s40122-026-00865-4

3. Lin SJ, McCoun J, Solanki D, et al. Suzetrigine as Part of Multimodal Therapy Enables Opioid-Free Recovery After Aesthetic or Reconstructive Procedures. Plast Reconstr Surg. Published online July 6, 2026. doi:10.1097/PRS.0000000000013299

4. Jiang X, Zhang K, Chen Y, Shih YW, Nataraj N, Guy GP Jr. Abandonment of Prescribed Buprenorphine for Opioid Use Disorder, 2020-2024. JAMA Netw Open. 2026;9(8):e2627142. Published 2026 Aug 3. doi:10.1001/jamanetworkopen.2026.27142

5. Zakoul H, Lin CG, Straub L, et al. Racial and Ethnic Disparities in Treatment Discontinuation in Pregnant Females With Opioid Use Disorder. JAMA Psychiatry. Published online August 19, 2026. doi:10.1001/jamapsychiatry.2026.2506

6. Morris CR, Hatabah D, Korman R, et al. Arginine Therapy for Sickle Cell Disease Acute Pain Episodes: The STArT Randomized Clinical Trial. JAMA. Published online August 19, 2026. doi:10.1001/jama.2026.13310

7. Zhao P, Zhou Z, Wolter T, et al. A fentanyl-responsive microneedle patch for harm reduction. Adv Sci (Weinh). Published online July 9, 2026. doi:10.1002/advs.202524301. https://www.drugsandalcohol.ie/46569/