Arumugam K^1,3, Khorramak K², Fiore Jr JF^3,4, Bessissow A^3,5, Rajabiyazdi F⁶, Morin SN^3,5
[1.]Faculty of Medicine and Health Sciences, McGill University,
[2.]Faculty of Science, Ryerson University,
[3.]Research Institute of the McGill University Health Centre,
[4.]Department of Surgery, Faculty of Medicine and Health Sciences, McGill University, [5.]Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, [6.]Department of Systems and Computer Engineering, Faculty of Engineering, Carleton University

Purpose: Acute pain, such as following a fracture, is often under-treated and results in negative health outcomes. The involvement of community pharmacists (CP) in acute pain care has the potential to support self-management and improve outcomes. We conducted a scoping review to describe CPs’ interventions in adult acute pain management and identify barriers and facilitators of CPs’ engagement in acute pain care.

Methods: According to the Joanna Briggs Institute framework, we searched the literature in five bibliographic databases for eligible studies published after 1990. Search results were independently screened for inclusion criteria by 2 reviewers. Study design, participants, and CP intervention characteristics were extracted. Results were synthesized and organized thematically.

Results: We identified 2424 studies and retained 34 studies for extraction; most were published between 2010 and 2021 (76%). Identified studies were predominantly observational cross-sectional studies (n = 21 [65%]), and the remainder were experimental and non-experimental studies (n = 9 [27%]), and knowledge synthesis studies (n = 2 [6%]). CPs intervene mostly in the domains of acute non-specific low back pain (n = 17), dental pain (n = 6), and musculoskeletal injuries (n = 6). Interventions designed to manage these acute pain conditions were categorized into interventions targeting CPs and interventions targeting patients. The CP-targeted interventions included the implementation of professional associations’ clinical practice guidelines or processes of care to assess and expand their role in acute pain care. The patient-targeted interventions included tools and educational interventions to properly manage their acute pain condition (s). Patient- and CP- targeted patient counselling (n = 19), professional educational programs (n = 7), pamphlets (n = 4), simulated-patient scenarios (n = 5) covering disease management services, opioid stewardship, non-pharmacological therapies, self-care advice, and referrals to specialists were identified as interventions. Barriers identified by CPs included lack of knowledge and training in acute pain care, lack of patient knowledge on acute pain, and time constraints (Figure). Patients’ tendencies to self-medicate, their lack of awareness of the role of CPs in acute pain care, and patient-specific time constraints were cited as barriers limiting patients’ ability to manage their acute pain in the community setting. Proposed solutions comprised expanding CPs’ knowledge and education on acute pain, implementing patient-oriented programs and point-of-care tools, improving CPs' collaboration with healthcare professionals, and providing financial and institutional support (Figure). Solutions to mitigate patient-specific barriers also included increased educational practices through the use of digital tools for self-management of acute pain, education on appropriate acute pain management practices, and health promotion tools highlighting CPs' contribution to acute pain care.

Conclusion: Our findings identified the presence of knowledge gaps in CPs’ roles and engagement in the management of acute pain in adults in the community setting which should be the focus of future research. As such, the knowledge gained from this work will provide the foundation for the development and implementation of efficient tools (including digital health tools) and educational programs for CPs to support adults in better management of acute pain within their community circle of care.

Keywords: acute pain, pharmacist, intervention