4 minute read
Pain
MILD TO MODERATE PAIN
The management of pain places a huge burden on health resources, with the number of patients seeking help for chronic pain increasing due to Ireland’s ageing population. Oral analgesics are commonly used for relieving pain such as headache, menstrual pain, toothache, back pain and arthritis. Some analgesics work on the body’s peripheral and central nervous systems to block or decrease sensitivity to pain. Others act by inhibiting the formation of certain chemicals in the body that mediate pain. Oral forms include capsules, syrups, suspensions and powders. Over the counter (OTC) analgesics containing codeine or dihydrocodeine in combination with other analgesics, such as paracetamol or ibuprofen, are intended for short-term use (no longer than three days) to minimise dependence and addiction. Concerns that codeine or dihydrocodeine containing analgesics are being taken regularly should be discussed with the patient and the patient should be encouraged to seek medical advice and access appropriate services. The biggest problem areas are the lower back, knee, back, shoulder and hip. But it can also involve living with pain in the foot, abdomen, head or ankle.
TYPES OF PAIN
Acute or short-term pain usually has a sudden onset and a clearly identifiable cause, such as sustaining a burn while cooking, and lasts no longer than a few days. While unpleasant, it often serves a useful purpose in triggering reparative action, eg taking a baking tray out of the oven with bare hands causes pain that results in the individual dropping the tray, thereby minimising further damage. Addressing the cause usually resolves the problem, eg taking heat out of the burned area by applying a towel soaked in cold water. • Recurrent or intermittent pain is acute pain that comes and goes, for example, toothache. Again, addressing the issue usually eases the pain, though the exact cause may be difficult to pinpoint and some conditions – period pain, for instance – require regular management, though usually not for long on each occurrence. • Chronic pain differs from recurrent pain in that it is unrelenting, though there will be times when it feels more severe than others, and it lasts three months or longer. The cause is usually a long-term condition such as arthritis, though it may be less specific, for example a painful back. Chronic pain can have a huge effect on quality of life, causing problems with mobility, dexterity, sleep and concentration. It often results in the sufferer changing how they live in order to cope. This, in turn, can have a huge bearing on emotional wellbeing, causing anxiety, helplessness and depression.
Approaches to Management
In terms of management, a good approach is the ‘analgesic ladder’ advocated by the World Health Organisation. Originally developed to help improve the management of cancer pain, the stepwise tactic is equally applicable to many painful conditions: Step 1 (mild pain): non-opioid, eg aspirin, paracetamol or an NSAID, with an adjuvant if appropriate. If the pain persists or worsens, move to step 2. Step 2 (mild to moderate pain): weak opioid, eg codeine, with or without a nonopioid and/or adjuvant. If the pain improves markedly and the cause is resolving, drop back to step 1. If it persists or worsens, move to step 3.
Step 3 (moderate to severe pain):
strong opioid, eg morphine, with or without a non-opioid and/or adjuvant. If the pain improves markedly and the cause is resolving, drop back to step 2.
TREATMENT OPTIONS
Various formulations and dosage forms are available for the self-treatment of pain, and pharmacists can help patients choose the one that meets their needs. Helping customers choose the right topical analgesic for their individual needs is key if they are to gain optimum benefit.
Musculoskeletal pain
Topical analgesics are recommended for targeted relief where pain is localised to a small area. This may also help with adherence. Improved adherence may also depend on the site of pain. For superficial joints with easy access, such as the hand, adherence may be easier than for larger, deeper joints, such as the hip. Patient confusion regarding the wide array of topical products and formats available can also hinder usage. Consumers want help and reassurance when it comes to self-treating. For the treatment and management of musculoskeletal injuries and disorders, many patients commonly use non-prescription topical analgesics. Available in several different formulations, including gels, ointments, creams, lotions, sprays, and patches, and as single entity or combination formulations, these products may have local analgesic, anesthetic, antipruritic and/or counterirritant effects.
Topical OTC treatments broadly divide into those with active ingredients and those that are drug-free. OTC options are suitable for treating acute musculoskeletal problems, such as soft tissue injuries (e.g. sprains, which are an injury to the ligament, or strains – an injury to the muscle fibres). OTC treatments can also be used in chronic conditions such as persistent back pain and osteoarthritis (OA).
