PA Perspectives on Non-Opioid Pain Management

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October 29, 2026

By AAPA Research

Non-opioid pain treatments have been evolving to provide innovative and effective alternatives to pain management.^1,2 Physician associates (PAs) and other healthcare professionals are integral to implementing such emerging treatments and may benefit from additional continuing education on changing guidelines and evidence-based best practices.^3,4 AAPA gathered a group of 12 PAs in urgent care, family medicine, emergency medicine, obstetrics and gynecology, and orthopaedic surgery from the PA Insights Network to understand how they incorporate non-opioid treatments for pain management in their practice; what factors influence their counseling practices; and what tools or resources support evidence-based decision-making. The findings reflect the experiences of this 12-PA discussion group.

What role are PAs playing in non-opioid pain-management?
PAs frequently treat patients with acute and recurring pain conditions from sprains and strains to preoperative and post-operative pain. PAs are involved in the continuum of pain management — from assessing patient risks to educating patients on treatment options and monitoring treatments. Often this care involves recommendations for over the counter (OTC) pain treatment and prescription nonsteroidal anti-inflammatory drugs (NSAIDs). Sometimes, these treatment plans can include a combination of OTC and prescription options in multiple delivery modalities, such as topical creams, gels, and patches. For example, a PA in orthopaedics explained that OTC topical gel seems to be “less strenuous on [patients’] gastrointestinal systems” particularly for his elderly patients, when treating a focal spot, or if patients prefer not to take oral medications. PAs carefully evaluate patients’ history, current medications, comorbidities, age, and personal preferences to deliver relief while avoiding side effects from medications.

When asked about their approach to non-opioid pain management and OTC treatment options, PAs stressed the importance of evaluating a variety of factors. Depending on the type of pain and patient, treatment often starts with non-opioid options along with supportive measures such as ice, heat, stretching or contrast therapy, and — if needed — physical therapy. PAs in our discussion groups frequently mentioned consulting pain guidelines, with those in obstetrics and gynecology citing ACOG guidelines which helped them contextualize pain management in pregnancy. Knowing other factors related to the patients’ health history was also important for evaluating prospective therapies, such as gastrointestinal and bariatric conditions, allergies, and any hepatic or renal injury.

PAs are also careful about medication interactions when considering treatments for pain, especially when patients indicate being on blood thinners. A PA in emergency medicine, for example, emphasized making sure their patients are not on anticoagulants or that they are not a bariatric patient. Patients’ age and individual preferences are also important factors both when it comes to evaluating risk factors, such as kidney function, but also how medication is administered. Participants shared that young teens might prefer liquids versus pills while older patients may prefer topicals. PAs also monitor patients’ response and adjust treatment, starting with a lower dose and gradually escalating if needed depending on the patient, or what a PA in family practice described as a “stepwise approach” when treating migraines and headaches.

Factors impacting patient counseling
PAs navigate a variety of factors when counseling patients on OTC pain relievers, including cultural preferences, local availability, and ability to obtain recommended treatments. They also assess whether patients are using remedies such as essential oils, herbs, or topical products to treat pain before appointments. As a PA in women’s health shared, “If it’s something that’s not harmful to do and they feel like there’s a benefit, then that’s something to consider, but just basically some shared decision making and making sure that they’re not doing or taking anything that could be harmful, or not very well studied or dangerous.”

Educating patients on the difference between NSAIDs and acetaminophen — especially when treating for acute pain — was mentioned as helpful. Explaining brand and generic names or active ingredients so that patients are aware of options is important, as a PA in internal medicine and pediatrics explained, “because they might only follow a medication by one name versus the other.” Another important part of the PAs’ counseling practices is educating patients on how products may be used together while avoiding duplicate active ingredients and doses beyond labeled directions. For example, most of the participating PAs were at least somewhat familiar with fixed dose OTC combinations for pain management and expressed that their two biggest benefits are easier scheduling and reduced burden, especially when patients need to alternate medications. While one PA mentioned that those combinations may be more expensive to find, several PAs also expressed concern about the risk of accidentally exceeding labeled dosing, particularly when patients use multiple products containing the same active ingredient or do not keep a medication log.

Setting expectations on efficacy, length of treatment, and educating patients on dosing for OTC pain relievers is a standard part of PAs’ counseling practices. For example, when asked about what factors most influenced their decision to recommend Naproxen Sodium versus another NSAID pain reliever, PAs agreed that the two advantages of Naproxen are the dosing and overall patient preference. Some PAs mentioned that patients may prefer Naproxen if other NSAIDs have not worked for them or haven’t provided enough relief. They also saw better compliance with treatment plans involving Naproxen — which was referenced as an additional benefit of the dosing schedule. However, PAs in our group also mentioned the importance of warning patients about GI issues that may stem from long-term Naproxen use.

Patients’ perceptions of a medication’s effectiveness is a common concern that PAs navigate in their patient encounters when recommending pain management. For example, with post-operative patients, it is especially important to set realistic expectations about the degree and timing of pain relief while reinforcing labeled dosing intervals and maximum daily limits. Moreover, some PAs shared that patients may perceive OTC medicine as less effective than prescriptions, which can cause resistance to recommendations. A PA in family medicine mentioned potential financial burden, with some patients asking for a prescription because it may be covered by insurance.

Educating on timing and safety of medications is also part of PAs’ interactions. For example, a PA in obstetrics and gynecology added that some patients wait until the pain has exacerbated to take anything or, if pregnant or breastfeeding, worry about putting anything in their bodies.

Educating patients extends beyond the visit
All PAs in our discussion group include OTC treatment recommendations in their discharge instructions, go over them with patients before they leave, and make sure patients know the instructions are in their notes so they can refer to them after they leave. PAs also tailor discharge instructions based on patient background, including other medications they are taking or if they have any substance abuse history. Individualized, detailed discharge instructions and summary notes that include step-by-step instructions and dosing can support patient understanding and adherence. A PA in orthopaedic surgery added that “spelling out exactly what [patients] should take in their after-visit summary. . .  goes a long way” and provides added credibility.

PAs are also leveraging EHR tools to support their recommendations, and AI-enabled tools to summarize notes or create smart sets that they then personalize based on patient needs. For example, a PA in orthopaedics utilizes an AI scribe tool that summarizes discharge instructions for patients to have in their notes. A PA in emergency medicine also described how pain management smart sets can be useful in personalizing discharge instructions by customizing them based on patient factors such as pregnancy, comorbidities, anticoagulant use, and acetaminophen dosing considerations.

When asked about what gaps exist in the resources currently available to them for OTC pain management, PAs emphasized the need for evidence-based, practical, and easily accessible OTC pain management resources. Some examples include:

• Trusted patient education. PAs overwhelmingly mentioned the need for patient-facing education that is trustworthy and backed by “true, unbiased research” as a PA in family and internal medicine put it.
• Quick-access learning formats for patients. When it comes to learning formats, quick-access materials such as web links, QR codes on OTC bottles with more detail on medication-risks and possible side effects, or one-pagers — as well as alternative modalities like short videos — are preferred.
• Practical patient tools. Practical take-home tools such as refrigerator magnets or dosing calculators were also proposed as helpful patient reminders.
• Alternative and holistic patient practices. Information on what patients are doing outside of traditional medicine, like supplements or holistic medicine, was also suggested.
• Employer support for CME time. For resources for PAs, participants expressed the need for “encouraging our employers to support our CME time to continue to stay up to date.”
• OTC Pain Management Guidelines. Organizational guidelines by a clinical pharmacy team were an example of a frequently referenced resource, but more guidelines about OTC pain management are needed.

PAs are involved in the continuum of pain management. They play a central role in delivering individualized non-opioid pain care, and need trusted, practical resources to support patient education and safe treatment decisions.

Mariya Constanti is a Research Program Analyst with AAPA. She can be reached at [email protected].

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About the project
This research was sponsored by Kenvue. The analysis and presentation of information within this article is the work of AAPA.

References
[1] Pulskamp TG, Johnson LM, Berlau DJ. Novel non-opioid analgesics in pain management. Pain Manag. 2024;14(12):641-651. doi:10.1080/17581869.2024.2442292

[2] White P. The Changing Role of Non-Opioid Analgesic Techniques in the Management of Postoperative Pain Anesthesia & Analgesia. 2005;101(5S):S5-S22. doi:10.1213/01.ANE.0000177099.28914.A7

[3] Niyonkuru E, Iqbal MA, Zhang X, Ma P. Complementary Approaches to Postoperative Pain Management: A Review of Non-pharmacological Interventions. Pain Ther. 2025;14(1):121-144. doi:10.1007/s40122-024-00688-1

[4] Hoffmann C, D’Souza RS. A pragmatic approach to teaching physician assistant students basic pain management. Biomol Biomed. 2025;25(2):274-277. Published 2025 Jan 14. doi:10.17305/bb.2024.11109