Pharmacy U

Helping your patients manage their pain is a growing role for pharmacists


by Nardine Nakhla, PharmD



Non-prescription drug recommendations from pharmacists enable patients to make safe and informed decisions regarding their health and the proper use of self-care products.


Tailoring non-prescription product recommendations for patients with cardiovascular concerns to optimize health outcomes is important for pharmacists. Additional evidence-based recommendations and pharmacy services can be offered to this subset of patients.


Pain is one of the most common conditions for which individuals seek relief from healthcare providers. Its prevalence is known to increase with age, which poses many challenges, especially in patients with cardiovascular disease or other health concerns. As pharmacists, a key component of our pharmacotherapeutic role is to provide evidence-based, patient-centred, individualized care when it comes to pain management as well as to help inform a patients’ self-care decisions by engaging in a discussion of the risks/benefits and ultimately facilitating the safe and effective use of analgesic agents.1


Some of the most common pain conditions that present to pharmacy include headache (tension-type, cluster, migraine) as well as musculoskeletal conditions (acute sports injuries, osteoarthritis, low back pain). Managing pain begins with prompt assessment and triage. A 3-step process for assessing patients with pain can be found below:

Pain management Picture1


Note that optimal pain management involves tailoring the approach to the individual and includes employing both non-pharmacological and pharmacological treatments.

Pain Management Picture2

Key Learning Points:

There is NO perfect treatment for pain. It is about choosing the option that balances the benefits of pain relief against possible risk


Special considerations for pain management in patients with CVD:

NSAIDs may:

  • Increase blood pressure
  • Decrease the efficacy of antihypertensive drugs (e.g., loop diuretics, ACEis, β-blockers)
  • Increase the the risk of heart attack and stroke, particularly at higher doses
  • Decrease the cardioprotective effects of low-dose ASA (prevents ASA binding to platelet COX-1


Acetaminophen is less likely to have these effects, and therefore, may be the preferred 1st line agent for the treatment of mild-moderate pain in patients with hypertension or CVD. The decision about whether to use an NSAID and which one should be based on a patient’s risk of developing adverse GI and CV events.


Other products/devices that can be recommended to this subset of patients are found below:

Pain Management Picture3

A useful roapmap for navigating pain options for patients with other medical conditions can be found below:

Pain Management Picture4



  1. Am J Ther. 2015 Nov-Dec;22(6):423-30. Pharmacist’s evolving role in the nonopioid, over-the-counter, analgesic selection process.



Nardine Nakhla, PharmD is a Clinical Lecturer at the School of Pharmacy at the University of Waterloo . She recently presented at Pharmacy U Toronto.