The medication, suzetrigine (JOURNAVX®), was FDA-approved in January 2025 and became available at HSS in April 2025. It is the first non-opioid pain reliever released in more than 25 years.

Alexandra Sideris, PhD, Director of the Pain Prevention Research Center at HSS, and Faye Rim, MD, FAAPMR, a physiatrist and pain management specialist within the Department of Anesthesiology, Critical Care & Pain Management, co-led the study.

One advantage of the new medication is that it works differently from standard over-the-counter pain relievers and stronger medications like opioids.

“What's exciting about this new medication is that it is targeting pain signal on the nerves outside of the brain, so you're presumably getting to the acute pain source right at the time where that happens,” Dr. Sideris said. "Early studies also suggest that it's devoid of those classical addictive properties that opioids have.”

It’s even more targeted than local anesthetics, which block pain messengers known as sodium channels. Instead, suzetrigine blocks just one sodium channel, Nav1.8, which means patients should experience fewer side effects and more targeted pain relief.

HSS was an early adopter in New York City to add suzetrigine to its formulary, and Dr. Rim was instrumental in bringing it to surgical patients. Patients managed by the Perioperative Pain Service often have complex needs that opioids alone may not be able to meet. Some patients may have other conditions that contraindicate the use of opioids. suzetrigine presents a novel, non-habit-forming option that can either replace or augment opioid use after surgery.

For this study, the team evaluated 103 HSS patients who took suzetrigine after undergoing a variety of surgical procedures, but primarily joint arthroplasty or spine surgery. Eight patients (7.8%) experienced at least one adverse reaction during admission, likely related to the drug, and ended up stopping the medication. The remaining 95 patients (92.2%) generally tolerated it well.

“The longer-term goal is to see if adding on suzetrigine actually decreases your need for opioids or if it is an effective option for patients undergoing major orthopedic surgery who cannot tolerate opioids,” Dr. Sideris said.

Pain has historically been a challenging area for drug development, in part because preclinical models do not always predict human response.

“Unfortunately, many things that work in animals just haven't translated into humans, and it's been a quest to understand [why],” Dr. Sideris said.

But this drug’s novel approach makes it an exciting advance in the field and one that HSS pain researchers were eager to capitalize on. This initial study gives a first look at how suzetrigine is tolerated in surgical patients at HSS, with an ongoing study in patients undergoing total hip replacements, and more research planned in patients knee, and spine surgery. Further studies will evaluate who may benefit from the medication the most, and who is more likely to require additional support. Currently, it is not a first-line medication, but Dr. Rim anticipates that will change as the drug becomes more widely available and additional evidence emerges on its efficacy in various surgical populations.

“We need to look more carefully at why certain patients may not do as well on this medication as we think they would,” she said. “It’s not a panacea, but it's definitely promising.”

She added that HSS was an obvious choice for the medication’s early adoption due to the institution’s reputation for cutting-edge science and advanced care.

“HSS is known for being innovative and this falls in line with that,” Dr. Rim said. “We want to try to utilize anything that's safe and effective within an arsenal to make sure patients recover well and become functional.”

There are many reasons why optimizing patients with chronic pain for surgery can be challenging.

“What ‘optimization’ means is different for every individual,” said Faye Rim, MD, FAAPMR, assistant attending physician and Director of Pre-Surgical Chronic Pain Management at HSS. “Part of the optimization process is setting realistic expectations and then working from there. This may take more time than we have with a scheduled surgery.”

Patients with chronic pain often have higher preoperative opioid use. Long-term opioid use can cause physical dependence as well as opioid-induced hyperalgesia, which is an abnormally increased sensitivity to pain. As a result, these patients often request increased amounts of opioids after surgery and have decreased opioid independence.

Patients with chronic pain also often have a higher prevalence of psychiatric disorders such as depression and anxiety that contribute to poor pain management. Alcohol and recreational drug use can also cause perioperative complications.

“While standardization of processes and procedures helps minimize medical errors and improve overall standard of care, it does not account for individual preferences and needs,” said Dr. Rim. “Preoperative pain screening and an integrated perioperative pain service allows a patient-centered model to exist within ‘checklist medicine.’ For those patients who don’t fit a standard mold, we can tailor a pain program to best meet their needs.”

HSS has developed a method of identifying opioid-tolerant patients before surgery, as well as interventions to reduce their risk profile and increase optimal outcomes.

During preoperative evaluation, patients are asked five questions as part of screening questionnaires administered at the surgical office. If patients answer “yes” to any of the questions, they are reviewed for a possible substance use disorder and opioid tolerance and are referred for a pain management consultation before surgery.

In the pain management consultation, there are three main goals: identifying patients who are at risk for opioid misuse or poor pain control; setting expectations regarding the planned procedure and the expected intensity and duration of pain; and developing a plan for postoperative pain management.

During the consultation, a pain history is taken regarding the patient’s past and current treatments for pain and comorbid disorders. A urine toxicology screening is conducted, and prescription monitoring databases are reviewed. Patients with inconsistent finds or evidence of aberrant behavior are referred to a pain management social worker or to addiction medicine services. Patients who are on high opioid doses (defined as greater than 100 mg oral morphine equivalents) are tapered to lower doses before surgery, with coordinated care from their outside pain medicine prescribers.

A series of case studies from HSS published by A&A Practice Journal demonstrates examples of the program’s success. These case studies contain both men and women ranging in age from 38 to 72. All were using high doses of opioids before surgery. Some were using high doses of prescribed medications; some were “doctor shopping” to acquire prescription opioids from multiple sources; and some were using concurrent prescription medications and illicit drugs. In most cases, patients had surgery delayed for approximately three months to taper off high doses of medication and to treat dependence or addiction; all were able to taper off high doses of medication prior to surgery and had positive outcomes. In one case, stopping opioid and benzodiazepine use reduced pain levels and improved mental health so thoroughly that surgery was no longer necessary.

These success stories demonstrate that a structured program to identify and optimize patients before elective orthopedic surgery can lead to better clinical outcomes and eventual opioid independence.

The Preoperative Pain Screening Service at HSS has been in place since 2015 and has formally screened about 800 patients per year.

“It is specifically the cooperation within the hospital that makes this program so successful,” said Dr. Rim. “We have had the support of administration, surgical services, nursing and anesthesia. We coordinate from outpatient and inpatient and cooperate with physicians outside the HSS system as needed.”

Surgeons raised initial concerns that referral to pain management might deter patients from getting surgery that was important to their care. However, this coordinated, patient-centered care model does not appear to affect overall patient satisfaction.

It will be important for future work to identify which preoperative interventions are beneficial; the best methods for opioid tapering and to what levels; and how various interventions for substance use may affect overall morbidity, mortality or length of stay.

HSS is currently in the process of collecting data on adherence to tapering plans, drop-out rates, missed patients and outcome data such as opioid use, patient satisfaction and lengths of stay.

While starting a program similar to this one may require additional resources, it may be cost-efficient over time, and it is likely that larger systems will be able to implement and support similar programs.

Reference

1. Justin Donofrio, LCSW, Christine Peterson, MD, Spencer Liu, MD, Faye Rim, MD. “Impact of structured patient centered pre-operative pain consult and interventions from a dedicated Perioperative Pain Service: A case series of four patients [published online July 17, 2020].” A&A Practice. doi: 10.1213/XAA.0000000000001279

Faye Rim, MD, FAAPMR, medical director of Presurgical Chronic Pain Management at HSS, explains that there haven't been a lot of studies on either product but that she recommends patients start off with CBD oil instead of hemp oil

"I generally tend to use it to treat musculoskeletal pain," said Dr. Rim. "I see a lot of patients with arthritis. If they're not tolerating the usual anti-inflammatory medications, or if it's not effective, it's definitely something that can be added to their regimen."

Watch the segment at YouTube.com. It also aired on Tuesday, January 8, 2019.