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?
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With pain sufferers becoming
more aware of
the dangers of strong
painkillers and seeking
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
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 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
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
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
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.