Condition Watch: Opioid Use Disorder

FDA Approves Meloxicam Injection for Managing Moderate to Severe Pain in Adults

Meloxicam injection (Xifyrum; Azurity Pharmaceuticals, Inc) received FDA approval for use in adults for the management of moderate to severe pain, alone or in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). The approval comes amid ongoing efforts across the US to reduce reliance on opioids for pain management. Multimodal pain control has become a widely endorsed approach in perioperative and acute care settings. NSAIDs such as meloxicam play a key role in these regimens, as they reduce inflammation and provide analgesia without the addiction risk associated with opioids.^1,2

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The injection offers once-daily dosing in a 30-mg/mL vial and is administered via intravenous (IV) bolus injection over 15 seconds. The convenience of once-daily dosing and a rapid IV bolus administration may offer workflow efficiencies in hospital or surgical settings, where minimizing polypharmacy and streamlining medication administration are important goals. The approval also aligns with FDA and Centers for Medicare & Medicaid Services incentives to encourage the development and use of nonopioid analgesics, particularly given the opioid crisis.

“[Meloxicam injection] demonstrates our commitment to improving patient care by providing an alternate dosage form for pain management,” Ron Scarboro, CEO at Azurity Pharmaceuticals, said in a news release. “[Meloxicam injection] addresses an important clinical need, especially for patients requiring a nonopioid component to multimodal analgesia strategies.”²

Although meloxicam injection delivers a nonopioid alternative for pain control, it is not recommended as a first-line agent when rapid onset of analgesia is needed, due to its delayed onset. Additionally, like all NSAIDs, meloxicam injection should be used with caution in patients with cardiovascular, gastrointestinal, or renal risk factors. —Alexandra Gerlach, Associate Editor

REFERENCES

1. Schwenk ES, Mariano ER. Designing the ideal perioperative pain management plan starts with multimodal analgesia. Korean J Anesthesiol. 2018;71(5):345-352. doi:10.4097/kja.d.18.00217

2. Azurity Pharmaceuticals announces the FDA approval of Xifyrm (meloxicam injection) for the management of moderate-to-severe pain in adults. News release. Azurity Pharmaceuticals. June 10, 2025. Accessed July 17, 2025. https://azurity.com/azurity-pharmaceuticals-announces-the-fda-approval-of-xifyrm-meloxicam-injection-for-the-management-of-moderate-to-severe-pain-in-adults/

Pharmacists Play Crucial Roles in Opioid Use Disorder Treatment

In 2022, there were more than 100,000 opioid-related deaths in the US, representing the highest annual toll since 1999. Although these rates have dropped significantly since then, opioid use disorder (OUD) remains a critical public health crisis, affecting thousands of individuals and straining health care systems nationwide.¹

OUD is characterized by problematic, compulsive opioid use that significantly impacts a person’s life, often to the detriment of their health. Patients with OUD frequently present with social, occupational, and compulsive behaviors and cravings with rapid escalation of use. Chronic pain is prevalent in 45% to 64% of patients with OUD, making pain management particularly complex in this population.²

The cornerstone of OUD treatment is medication-assisted treatment, which combines pharmacologic therapy with psychosocial support. Among available medications, buprenorphine is preferred, especially in the context of widespread fentanyl use. Effective dosing typically ranges between 24 and 32 mg/d to adequately manage cravings and withdrawal symptoms.²

Effectively addressing OUD and complex persistent opioid dependence requires a comprehensive, individualized approach that incorporates pharmacologic and nonpharmacologic strategies. Pharmacists, through their accessibility and clinical expertise, are key partners for supporting safe medication use, optimizing pain management, and advocating for equitable, stigma-free care. —Alexandra Gerlach, Associate Editor

REFERENCES

1. Drug overdose deaths: facts and figures. National Institute on Drug Abuse. Updated August 2024. Accessed May 21, 2025. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates#Fig1

2. Zerfas I, Galligan A. Pain and progress: providing care and compassion in OUD. Presented at: 2025 Virtual Conference on Pain and Palliative Care 2025; May 20, 2025. Accessed May 20, 2025.

Micronutrient Deficiencies Are a Modifiable Contributor to Chronic Pain

A cross-sectional analysis published in Pain Practice examined the relationship between serum micronutrient levels and chronic pain intensity in the extensive All of US NIH Research Database. The study compared up to 93,445 US adults categorized as having no, mild to moderate, or severe chronic pain, using numeric pain rating scales to define each group. Researchers evaluated serum concentrations of vitamins D, B12, C, folate, and magnesium, classifying levels as normal, deficient, or borderline deficient per standard ranges.¹

Findings included significantly lower mean levels of vitamins D, B12, and folate in the severe pain group compared with those with less or no pain. Male participants with chronic pain showed an increased risk of vitamin C deficiency, and a higher incidence of magnesium deficiency was also noted in those with severe pain. In race and sex stratified analysis, both Black and White individuals with severe pain had significantly lower vitamin D levels, with folate reduced across most subgroups and B12 deficiency predominantly in White participants. Female Asian and Hispanic groups also showed reduced folate levels.¹

Pharmacists are uniquely positioned to integrate nutritional care into chronic pain management, offering expertise beyond medication dispensing. They can identify at-risk patients, particularly those with persistent severe pain, polypharmacy, or nutritional deficits, and recommend serum testing for key micronutrients such as vitamin D, folate, magnesium, and vitamin C to detect subclinical deficiencies.¹ —Danielle Valletti, Assistant Editor

REFERENCES

1. Goon M, Schmidt N, Berwal D, et al. Micronutrients and chronic pain: a cross-sectional analysis. Pain Pract. 2025;25(5):e70053. doi:10.1111/papr.70053

2. Pigott S. Micronutrient deficiency linked to chronic pain in new study. News release. The University of Arizona Health Sciences. July 11, 2025. Accessed July 17, 2025. https://healthsciences.arizona.edu/news/releases/micronutrient-deficiency-linked-chronic-pain-new-study