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Digital EditionA Breakthrough in Pain Management: Inside the Promise of Journavx
The pharmaceutical landscape for pain treatment is undergoing a quiet revolution. For decades, healthcare providers have wrestled with limited options: traditional non-opioid analgesics like acetaminophen and ibuprofen, or opioid medications with their inherent risks of addiction and severe side effects.
In a recent interview, Enlyte’s Nikki Wilson, Pharm.D./MBA, Senior Director of Clinical Pharmacy Services, breaks down the significance of Journavx, a newly FDA-approved nonopioid pain medication that’s generating substantial excitement in the workers’ compensation space.
Risk & Insurance: Why should we be paying attention to Journavx right now?
Nikki Wilson: This particular medication approval is getting so much attention, because it’s essentially considered a breakthrough development. The FDA approved it on January 30 [2025].
The reason it’s getting so much attention is it works through a little different pain pathway to block pain signals when compared to the other true analgesics that are on the market today. We have essentially two main categories: We have nonopioid analgesics, and we have opioids. And this is fitting into that nonopioid bucket, but it’s working through a different pathway than the current nonopioid analgesics, which are acetaminophen, so Tylenol, and the nonsteroidal anti-inflammatory drugs. Those are things like ibuprofen, naproxen, meloxicam – many of which are available over the counter.
This medication works differently than those and differently than opioids. The manufacturer is touting it as a nonaddictive other option for pain management. I refer to it as “euphoria sparing” – that’s another term that’s used quite a bit – where it doesn’t work in the brain to create that same sort of danger of a rewarding effect that we see with opioids.
It’s working through sodium channel inhibition, which is important to know because it’s a different pathway that helps transmit pain signals to the brain. There are multiple ways pain signals travel – from an injury occurring, then traveling up through the nerves in the spinal cord to the brain to interpret the pain, and then there’s a descending pathway that can also be impacted.
R&I: What’s the chatter about it in the workers’ comp space?
Nikki Wilson, senior director of clinical pharmacy services, Mitchell
NW: A lot of people are asking how it’s going to impact comp. Where is it going to be placed in therapy? Is it safer than opioids? Does it work better than opioids? How much does it cost?
The average wholesale price is $18.60 per tablet, with twice-a-day dosing. You can see how the cost could roll up pretty quickly, especially when most of our alternatives are less than a dollar per tablet. It could be a better trade-off for patients who aren’t good candidates for opioids because of addiction risks.
There’s an estimated annual cost of opioid use disorder in the US economy of around $180 billion. So, the trade-off might be worthwhile – a higher price tag upfront for acute use, meaning maybe ninety days or less of pain, and then getting off the medication. Probably easier to discontinue a drug like this because there are no known rewarding properties in the brain.
Right now, opioids are the most-utilized class in workers’ comp – the number one therapeutic category by utilization year over year. It’s not surprising given the nature of workplace injuries, but it would be nice to see that go down if we can make that happen.
R&I: What are the key things leaders in workers’ comp should know?
NW: It’s important to look at this carefully. Right now, I don’t think it should be first-line treatment. It’s cost-prohibitive, and we’re still learning about it. I would recommend a stepwise approach where it fits in a middle bucket but probably shouldn’t be approved for most patients outright.
The current FDA approval is only for acute pain management, studied in two surgery types: abdominoplasty and bunionectomy. The company, Vertex Pharmaceuticals, is pursuing additional indications, like diabetic peripheral neuropathy, which is currently in phase three clinical trials.
Importantly, opioids aren’t generally recommended for chronic pain either, except in cancer-related pain scenarios. But they’re used extensively nonetheless. So transitioning patients requires careful consideration. Everything we’re seeing in the safety profile for this drug is promising – it appears more consistent with shorter-term use and a lower incidence of very negative adverse effects.
R&I: Why is this such exciting news?
NW: This is the first time in something like twenty years that a new mechanism of action for an acute pain drug has been FDA-approved. It’s the first time we’ve had a truly new approach that’s gone through the full approval process for a specific pain indication.
The promise is significant because we’ve been using many things off-label – like lidocaine, topicals, anticonvulsants, antidepressants – but this is different. We’re seeing fascinating research into pain management, including toxin-based treatments. There are studies looking at things like pufferfish toxins, snail toxins, even cactus-based treatments – all exploring ways to block pain signals more effectively and safely.
Journavx Need-to-Know Top 5:
- Journavx represents a novel non-opioid option for acute pain management, introducing a unique mechanism of pain signal interruption.
- The medication works through sodium channel inhibition, creating a “euphoria-sparing” approach that minimizes addiction risks.
- Currently approved only for moderate-to-severe acute pain based on studies involving specific surgical procedures and has not been evaluate beyond 14 days of use; the drug is priced at $18.60 per tablet with potential for expanded future indications.
- The medication offers a promising alternative in the workers’ compensation space, potentially reducing the heavy reliance on opioid treatments.
- Ongoing research and post-marketing studies will continue to evaluate the drug’s long-term safety, efficacy, and potential expanded applications. &
