Pharmacists are frontline providers in the fight against depression and pain. Community pharmacists can have a positive impact by identifying and assisting patients suffering from depression and/or pain. Patients frequently visit multiple physicians for different conditions, and yet return to the same pharmacy to fill medications prescribed by a disparate group of physicians. This can present challenges (and opportunities) for community pharmacists. For example, frequent contact and meaningful interactions allow pharmacists to get to know their patients, and their conditions and ailments. This critical knowledge allows pharmacists to recommend proper OTC pain relievers for short-term use and to assess more complex chronic pain or depression therapies.
Unfortunately, many patients are hesitant to ask their provider questions about pain and depression. For some, there is a perceived stigma associated with depression and certain types of pain. Other patients may believe that conditions that can’t be seen will be unduly examined or dismissed. Pain management and depression scales are useful tools. However, generalized or specific pain can be difficult to understand, diagnose, and treat.
Too often, patients with acute pain self-medicate with OTC agents without their prescriber’s recommendation or knowledge. Some patients with chronic pain control episodic pain by adjusting their prescribed medications without their doctor’s knowledge.
This is where pharmacists can make a difference. By being approachable and asking the right questions, community pharmacists play a key role in educating patients with “unseen” ailments. The pharmacy team can improve quality of life by helping patients understand their conditions and emphasizing the importance of proper use of prescription medications. Pharmacists can act as a sounding board for patients who may be more willing to discuss their pain or depression in the pharmacy than at a doctor’s office. Pharmacists can offer alternative treatment options, explain side effects, and optimize treatment and management.
Case: Pain Management and Depression
LB is a 55-year-old female who has been visiting your pharmacy for 3 years. From previous counseling sessions, you know LB works at the local university and visits a number of providers who rotate through the campus health center. LB usually drops off her prescriptions an hour before the pharmacy closes, and she is impatient. You assume she uses multiple pharmacies based on transfer records. LB has a history of chronic back and shoulder pain, migraine headaches, attention-deficit/ hyperactivity disorder, and depression.
When LB comes to collect her medication, you ask if she would be interested in participating in a brown bag session. LB appreciates the opportunity to talk to you and confesses that she “never even thought the pharmacist could help” her. She even apologizes for dropping off her refills “so last minute,” and says she now understands that the pharmacy isn’t a place to “rush through.” You schedule a time to meet with LB.
Upon reviewing LB’s current medication profile at your pharmacy, you find the following:
When LB comes in for her scheduled appointment, you notice the following additional medications in her brown bag:
By reviewing LB’s medications, you recognize that LB would benefit from a medication therapy management (MTM) session. You schedule a follow-up appointment with her. An MTM session will allow you to further communicate with LB’s health care providers, obtain lab values, and evaluate LB’s medical goals. In the meantime, you have the following questions and suggestions regarding her medications.
What else would you suggest to LB?
Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, appears on www.PharmacyTimes.com.