Assembling The Right Pain Management Lineup

What options should a DME pharmacy make available to customers who are looking for non-prescription and non-drug options for relieving their pain?

• By David Kopf, Joseph Duffy
• Dec 01, 2020

With pain sufferers becoming more aware of the dangers of strong painkillers and seeking non-addictive alternatives, pharmacies are in a good position to offer consumers non-prescription and non-pharmacological solutions for managing pain. Alternative options include over-the-counter painkillers, CBD products, TENS and EMS units, hot and cold therapies, braces, compression and kinesiology tape.

And pharmacies have good reasons to offer those options. Where customers are concerned, much of the desire for alternatives is born out of the opioid epidemic, or people wish in general to cut down on the number of medications they are taking.

Besides that, non-drug options give pharmacists the opportunity to increase revenue streams by offering different options. It makes a ton of business sense to respond to that market desire by educating patients on the best products to decrease pain without pills, and then serve up those options.

There are a variety of alternative pain management product categories that DME pharmacies should consider carrying. Let’s look at some key offerings you should consider stocking:

CBD

CBD is the alternative pain management product that has certainly received the most recent media attention, and for a good reason: patients want it and it offers a variety of delivery formats, such as oils and creams. To put it simply, CBD embodies the business case for alternative pain. That said, it also requires some understanding.

CBD is one of the compounds called cannabinoids produced by the cannabis plant. The cannabinoid most everyone has heard of is THC, the psychoactive component in recreational marijuana. CBD, also known as cannabidiol, is the cannabinoid often used in managing chronic pain, insomnia and anxiety. Using CBD to manage pain is analogous to using an over-the-counter pain killer; the pain is simply diminished and there is no “high.”

CBD products are sold in varying dosages that might or might not contain very small percentages of THC, as well. The products range from oil tinctures taken under the tongue, capsules, gummies and lotions. Consumers can buy them online and, depending on what state a person lives in, her or she can buy it at retail establishments.

An initial point of trepidation for many providers when it comes to CBD is the law. From a legal and cultural perspective, cannabis has been so stigmatized that some providers might think there’s something illicit about CBD. There isn’t. In fact, the Federal government has made it a point to legitimize CBD when it comes to the law.

The 2018 Farm Bill, which was signed into law at the very end of the 115th Congress in late December 2018, removed industrial hemp production from the Controlled Substances Act. This gave Federal protection to both hemp farmers and CBD sellers for producing industrial hemp and hemp-derived products, such as CBD, that contain less than 0.3 percent THC.

Also, there are still state statutes to keep in mind. Fortunately, there has been an evolution over the last two years. At present, 33 states have legalized medical marijuana, and CBD usage is legal in some form in every U.S. state. Some states have specific restrictions, and there are special guidelines pertaining to food items that incorporate CBD. Also, if a CBD product is derived from marijuana rather than industrial hemp, that too can complicate matters. Various online guidelines, such as www.cbdoil.org/cbdlaws-by-state/ can help you better understand where you stand in your state.

Assuming we’re talking about industrial hemp-derived CBD, there are different types of CBD. Some CBD products are based on an isolate of CBD, meaning that it is just the CBD and nothing else. Other products are what is called full- or broad-spectrum CBD products. This means the CBD is harvested and packaged in a product in such a way that it contains other chemicals found in the cannabis plant that work together with the CBD in a way that experts say increases its efficacy.

Bearing that in mind, it will be important for HME providers to ensure that both their patients and staff have the right understanding about CBD in terms of options, benefits and use. This starts with educating staff so that they are completely on top of the product options and benefits available to patients just like any other product that a provider might offer. Then they want to ensure that their marketing communications and advertising to patients continues with that educational approach.

And, like many HME offerings, the vendors of CBD products are often there to help with educational materials and pamphlets, and some even offer sales support in the form of advisors that can help steer patients to the most sensible, appropriate solution for them.

Also, providers do need to keep in mind that there is an inventory expense component to the CBD equation, and they will want to pay attention to retail turn times to ensure their inventory overhead doesn’t complicate their cash flow.

TENS & EMS UNITS

Standing for transcutaneous electrical nerve stimulation, TENS devices use electrodes attached to the user’s skin via adhesive pads. TENS therapy is based on two theories of pain relief:

First, the electrodes send electrical impulses that flood the user’s nerves and make it hard for the nervous system to transmit pain signals. So the brain interprets the pain signal in a different way. The result is that the user either no longer feels the pain, or no longer feel the intensity of that pain.

Second, there is a theory that using the TENS devices help endorphin production, where endorphins are released as a result of the TENS waveform, so that users actually get a physiological benefit after TENS use. Anecdotally, it’s not uncommon for TENS users to cite a sense of relief after using a TENS device.

TENS units are made for both acute and chronic pain relief, and were first marketed to address the sort of pain that older customers and arthritis sufferers cite. That said, they also appeal to younger users, and some TENS devices also provide electrical muscle stimulation (EMS), which is intended for muscle strength, recovery, and muscle conditioning.

Standing for electrical muscle stimulation, EMS devices might seem similar to TENS units in terms of their format — a small device with electrodes connected to adhesive pads that users attach to their skin — but that’s where the similarity ends.

EMS devices are designed to stimulate muscles so that they contract. The result is that blood flow is increased to the area, which reduces inflammation. The devices can also be used to reduce muscle spasms.

Also, because they are so small in size, TENS and EMS units can be worn discreetly and used by patients throughout the day. These units have controls that let the user control the intensity of the stimulation, the frequency of the stimulation (impulses per second), and duration (in milliseconds) of each pulse.

Lastly, one of the big appeals is that TENS devices have been around for decades. They have a track record of offering non-invasive, non-addictive pain relief, which makes a strong case with people looking for alternatives.

COMPRESSION, BRACES & TAPES

A familiar product category for many DME pharmacies, compression is often used to help treat diabetic patients and elderly patients with venous diseases, as well as wound care lymphedema patients. However, compression, typically using wraps, can also help with pain management by reducing swelling and promoting circulation.

Another familiar HME category, orthopedic braces, provide the kind of support that many injuries need to recover. Moreover, that support helps diminish pain through stabilizing a part of the body that has been injured and limiting motion, which in turn limits inflammation.

For example, knee braces support mild sprains, strains and swelling and fluid retention. A back brace provides support and compression for the lower back and abdominal regions. In fact, it’s ideal for pulled muscles, sprains or strains. It’s often marketed to older adults. Ankle braces can be used as support to an injury or as a preventative measure.

In the same group of pain relief products is kinesiology tape. Kinesiology tape is used to support common injuries. Its elastic properties provide support while letting the patient perform a wide range of motion. The tape helps improve blood flow and lymphatic circulation.

Orthopedic braces and kinesiology tape are also great solutions for weekend warrior types and adult athletes who are suffering from joint pain and even back, shoulder and even neck pain.

HOT AND COLD THERAPY

There are various products that use either heat or cold to reduce pain. Heat tends to relax sore muscles and joints, while cold helps numb pain and reduce inflammation. The available products range from simple heat packs and cold packs to specialized devices that pump hot or cold water to special wraps or sleeves that are placed around the part of the body feeling pain.

Basically, heat increases blood flow, while cold slows it. So, hot therapy is good for pain coming from musculoskeletal injuries such as pulled or strained muscles or aching joints. Cold therapy is good for killing pain from anything that is causing inflammation and swelling.

And, the two can be used together. So, a customer might use cold therapy to reduce swelling and inflammation and then use heat to increase blood flow to the area. This can reduce swelling and pain more quickly.

Furthermore, hot and cold therapy can be used in conjunction with other pain relief products. For instance, there are hot and cold therapy products that also integrate compression so that they provide multiple pain management benefits. Or hot and cold therapy can be used with a TENS unit.

Like all DME offerings, the best thing to do is work with vendors to learn more about the options they offer, and then, once you’ve decided on companies you want to partner with, get your staff trained up. Many vendors will offer product education to help put your team in a position where they can help your customers identify the right solutions for them.

This article originally appeared in the DME Pharmacy December 2020 issue of HME Business.