Pharmacy Revenue: Managing Pain Beyond Drugs

Pain is an epidemic in America — and with the opioid crisis causing concerns about addictive pain killers, more people are looking for drug-free pain relief. DME pharmacies are perhaps in the most ideal spot to serve this need.

managing painChronic pain is a major public health epidemic that costs the United States $299 billion to $324 billion in lost productivity every year, according to About 100 million Americans suffer from chronic pain, with one in 10 experiencing pain every day for three months or more. For pain that lasts longer than 24 hours, the problem is even worse — one in four Americans are affected (according to the National Center for Health Statistics).

Today’s discussions about pain typically include references to the devastating effects of the opioid crisis in America, where more than 20 million Americans are struggling from addiction. Severe pain medication is such a concern that Connecticut and Alaska may be the first two states to allow patients to put “non-opioid directives” into their medical file, which tells healthcare prescribers to avoid opioid medications.

With pain sufferers becoming more aware of the dangers of strong pain killers and seeking non-addictive alternatives, pharmacies are in a good position to offer consumers non-pharmacological solutions to managing pain.

“There are a few reasons why pharmacists should carry non-pharmacological products in their store,” says Ryan Moore, vice president of Compass Health, which carries a line of pain relief products, including electrotherapy, hot and cold therapies, topical analgesics and kinesiology tape. “First, you start off with the fact that over 58,000 people died in 2016 from an opioid-related death. It’s been in the news, so everyone is aware and trying to cut down on the amount of opioid prescriptions per year. And pharmacists are really on the leading edge of that, and should be offering patients alternatives to opioids.”

Moore also says that pharmacists have the opportunity to increase revenue streams by offering non-pharmacological pain management solutions.

“It’s a great business opportunity to capture these patients who are also looking for alternatives,” he says. “There are so many people now who are scared of pain meds but are still in pain. So, it just makes incredible business sense for pharmacies to offer and educate patients on the best products to decrease pain without pills.”

According to experts interviewed for this article, there are a variety of product categories that pharmacies should consider carrying.


Mike Williams, ATP, president and CEO of iReliev, which sells electrotherapy solutions, owned 14 DME facilities in California from 2001 to 2010. Now, his company is specifically focused on TENS for both acute and chronic pain relief, as well as electrical muscle stimulation, which is intended for muscle strength, recovery, and muscle conditioning.

“TENS is transcutaneous electrical nerve stimulation,” he explains. “It’s based on two theories of pain relief. The first is that electrical impulses interrupt the pain signal to the brain, so the brain interprets the pain signal in a different way. So if you’ve got the TENS device on, you’ve got these impulses interrupting the pain signal to the brain, and you no longer feel the intensity of that pain, or you no longer feel the pain.

“The second theory is the idea of endorphin production,” Williams continues. “This is backed by empirical data. We have customers across the country who literally talk about how they take the TENS device off and they still have relief, and that lends to this idea of the endorphin production theory, where you’ve got endorphins that are being released as a result of the TENS waveform, and, therefore, they actually get a physiological benefit after the use of TENS.”

And although TENS is great for chronic pain and arthritis seen in older adults, it also lends well to a younger demographic.

“For pharmacies that are looking to broaden the offering to incorporate sports medicine type of products, electrotherapy is a no brainer, next to the knee bracing, or next to other soft line supports,” he says. “It’s broadening the demographic you can target as a pharmacy.”

One of the units sold by iReliev combines TENS with electrical muscle stimulation (EMS).

“Even if you’re a pharmacy focused on pain relief, somebody will endure some type of acute injury, so there’s a need for initial pain relief, but also there’s the need to condition that muscle and help that muscle get better by increasing blood flow to that area,” Williams says. “Muscle stimulation can do that.

“We all have pills in our medicine cabinet, but why don’t we have electrotherapy devices?” he continues. “Everybody should have an electrotherapy device in the medicine cabinet, and I think that’s the approach that pharmacies should take. Pharmacies absolutely should be in this category if they’re not already, because everybody could benefit from it at one point or another.”
Compass Health’s Moore notes that his company has been making prescription and over-the-counter TENS units for over 20 years and he feels it’s a missed opportunity for pharmacists who don’t carry these products.

“It’s a proven, effective relief that’s non-invasive, non-addictive and has been around for a long time,” he says. “And there is a repeat disposable component to TENS: people come back every month and get new electrodes.”

Josh Lefkovitz, president of ITENS LLC, offers wearable pain relief for back pain, arthritis, carpal tunnel and other external nerve pain conditions. The device is controlled by a smartphone app.

“One key point I like to reference is that pain management is never one silver bullet,” he says. “This will help pharmacists to up-sell consumers on more than one option, and help set their expectations that it is not about one product eliminating their pain, but rather lowering their pain scale a few notches.”


One item that is very simple for pharmacies to carry are simple hot/cold therapy items. Moore advises that DME pharmacies should stock both. When you have patients with chronic pain lasting longer than 30 days, some patients will respond better to cold while others will respond better to heat, he says.

“I love using a TENS unit with a hot/cold therapy,” Moore says. “I’ll tell a patient to use hot, moist therapy first and then use a TENS unit. Bottom line is you want to have as many non-invasive, non-addictive, tools in your tool belt.”

Another option: 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 and has been popularized by the many professional athletes who wear the products during well-attended and televised sporting events.

“People think you have to be LeBron James to wear StrengthTape [kinesiology tape brand sold by Carex Health Brands],” Moore says. “It’s for weekend warriors with knee, shoulder or low back injuries. They can put the tape on and it applies immediate relief. And we have a lot of videos online where they can learn how to apply the tape.”

Topical analgesics are another non-addictive, non-invasive pain management category that is easy DME pharmacies to stock. They are portable and help with pain emanating from strenuous exercise; sore muscles; strains; spasms; joint pain; back, shoulder and neck pain; and arthritis.


Another key offering is orthopedic braces. There are a variety of specialized offerings that target specific areas and address specific types of pain in those areas.

For example, knee braces support mild sprains, strains and swelling and fluid retention. The product can be marketed to both children and adults. A back brace provides support and compression for lower back and abdominal region. 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. While the product can be marketed to multiple demographics, they’re commonly worn by athletes when there’s fast-paced weight changes.

Even more specialized, tennis elbow braces deliver support for symptoms of tennis elbow, inflammation, irritation or slight tearing of the muscles and tendons just below the elbow. And while targeting a specific type of injury related to a specific pursuit, there is some crossover appeal. Case in point: tennis elbow braces are commonly marketed to athletes and consumers careers such as painting, plumbing, construction and culinary.


Pharmacists have to look for clues from their patients to begin a dialog about non-pharmacological pain management solutions. For example, occupations can be telling regarding possible muscle pain, such as construction workers, military servicemen or law enforcement officers.

“Another big area for pain is diabetic neuropathy,” Moore says. “In diabetes what happens is your lower parts of your body that have decreased blood flow. And your nerves start to deteriorate because they’re not getting enough blood. And when that happens it is painful. I mean, there are people who have diabetic neuropathy, and they can’t get on top of their toes at night.”

Pharmacists should always ask product manufacturers if they offer sales literature, point-of-purchase displays and other marketing collateral. In addition, the best sales tool is an educated employee. Look for product webinars and in-house training that can get a sales staff up to speed.

“We do webinars quite frequently on a case by case basis, but we’ll absolutely work with any store that’s interested,” Williams notes. “We’ve got point-of-purchase displays where if you buy 12 of them you get a free display that comes with a demo unit.”

Moore says to make sure healthcare providers in your area know that you are the center of excellence within your community for non-addictive/non-invasive pain relief.

“Go to physical therapy centers and say, ‘If you need product, come and see us,’” he suggests. “Also, chiropractors sometimes don’t want to mess with retail sales, so there’s another opportunity.”

Moore also says not to forget the local cross-fit gym, because their rigorous routines result in a fair share of strains and pulls.

Ultimately, there are as many marketing opportunities as there are injuries and products to serve them. The key is to look at the local market, they types of clients coming in looking for pain relief, and coming up with the right mix of non-prescription drug offerings to start stocking. Doing so will only help broaden and emphasize a pharmacy’s reputation as a complete solution provider.

This article originally appeared in the DME Pharmacy November 2017 issue of HME Business.

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