JOURNAVX: Non-Opioid Pain Control After Joint Replacement

JOURNAVX (suzetrigine): a new non-opioid pain medicine

JOURNAVX is a new type of prescription pain medication that is not an opioid or narcotic. It was approved by the FDA on January 30, 2025, for adults with moderate-to-severe short-term pain, including pain following surgery. It was the first medication approved in an entirely new class of non-opioid pain medicines.

JOURNAVX works differently from medications such as oxycodone or hydrocodone. Instead of acting on opioid receptors in the brain, it selectively blocks a sodium channel called NaV1.8, which is found on pain-sensing nerves in the peripheral nervous system. These channels help transmit electrical pain signals from an injured area toward the spinal cord and brain. By blocking NaV1.8, JOURNAVX essentially turns down the pain signal before it reaches the brain. Because it does not work through opioid receptors, it does not have the same mechanism responsible for opioid addiction, respiratory depression and sedation.

What has been found specifically after knee replacement?

A particularly relevant 2026 study by Louis Battista and orthopedic surgeon Andrew Wickline, MD examined JOURNAVX as part of a multimodal pain program for outpatient total knee and hip replacement. This was a retrospective, single-surgeon study rather than a randomized trial. For the knee-replacement portion, 120 patients were studied: 60 before JOURNAVX was introduced and 60 after. Patients receiving JOURNAVX were given 100 mg before surgery, while the remainder of the perioperative recovery protocol was kept the same.

The results were encouraging. After knee replacement, only 20% of JOURNAVX patients required additional fentanyl in the recovery room compared with 51.7% without JOURNAVX. Later in the recovery process, 21.7% versus 55% required a rescue opioid. Total opioid exposure while at the surgical center decreased by 23%, from 68.8 to 53.0 morphine-milligram equivalents. All of these differences were statistically significant.

The practical message for knee-replacement patients: JOURNAVX gives us another way to control surgical pain while reducing reliance on narcotics. It is not necessarily a complete replacement for every other pain medication, and the Wickline study does not prove that every patient can undergo knee replacement without opioids. Rather, it suggests that adding JOURNAVX to a modern multimodal pain program can substantially reduce the number of patients who need additional narcotics immediately after surgery. Because JOURNAVX has only been available since 2025, the knee-replacement evidence is still relatively new, and larger randomized studies would strengthen these findings.

Read the Battista & Wickline 2026 study (opens in a new tab) (Journal of Orthopaedic Experience & Innovation).

How Dr. Maish uses it

Surgery is only one component of the recovery process. Dr. Maish has developed a comprehensive multimodal, opioid-sparing recovery pathway incorporating modern pain-management strategies, including newer non-opioid medications such as JOURNAVX when appropriate. The goal is to control pain while facilitating early mobility, restoration of range of motion, and rapid return to independence.

Dr. Maish hosted Dr. Wickline as a visiting professor. Dr. Wickline has pioneered less swelling, less pain protocols and advocates for opioid-free joint replacement recoveries through his March 2 A Million campaign. An IRB protocol to study JOURNAVX in patients with hip fractures has also been submitted.

Related: Less Swelling, Less Pain recovery and the subvastus approach.

This page is general education, not medical advice. Whether JOURNAVX is appropriate for you is a decision for you and your care team. JOURNAVX® is a trademark of Vertex Pharmaceuticals.