Dr Rod Hughes on helping patients suffering from

Managing pain in pharmacy

Dr Rod Hughes suggests ways in which pharmacy teams can help patients suffering from inflammation of joints and surrounding tissues…

Arthritis is a chronic condition that results in inflammation of the joints and surrounding tissues. Osteoarthritis (OA) is the most common type of arthritis, with eight million people affected in the UK and the numbers are increasing at an alarming rate due to our ageing population.

Over 50 per cent of people over 50 have some form of OA. The condition is generally agerelated, with wear and tear of joint tissues causing lubricant cartilage lining in the joint to gradually wear away.

OA changes and the inflammation involved causes difficulty moving and considerable pain. Rheumatoid arthritis (RA) affects about 1 per cent of the population and can impact people of any age, including children, although it is most commonly starts in the 3rd or 4th decade of life.

RA is caused by the body’s immune system wrongly attacking healthy joints and can eventually cause joint damage if not treated early.

As the development of OA is largely a genetically inherited risk, patients need to understand what lifetime factors make arthritis more likely. Of these, weight is the most important.

Maintaining a healthy weight is important to reduce the load and protect weight-bearing joints such as the back, knees and hips.

OA can sometimes result from an untreated acute joint injury, so it is important to always stretch and warm up before exercise and allow injuries to heal properly so as not to cause long term damage.

Lifestyle changes

Currently there is no cure for OA so treatment will often focus on the self-management and lifestyle changes that can lead to pain relief.

Ideally everyone with OA should have a tailored selfmanagement plan to encourage positive changes such as exercise, regular stretching, dietary changes, weight loss in some cases and trials of supplement use.

Enjoying a healthy balanced diet helps to keep your weight in check, reducing the strain on load bearing joints, whilst adding an anti-inflammatory supplement may help to calm the body’s immune response. Poor sleep has also been linked to inflammation, so good sleep hygiene can be recommended to promote a restful sleep.

As all arthritis involves inflammation, foods with antiinflammatory properties may be of benefit to calm the body’s immune response.

Ginger has been shown to have anti-inflammatory properties to reduce morning joint stiffness, an early indicator of OA, and has been shown to benefit symptoms of arthritis in the knee by relieving pain and improving mobility.

Oily fish and leafy green vegetables are also commonly considered to reduce inflammation and joint health. Vitamin C is important for the formation of collagen, a key component of protective joint cartilage, and is plentiful in lots of citrus fruits and vegetables, or available as a supplement.

It is also important to stay well hydrated throughout the day, as water contributes to keeping your soft tissues (tendons and muscles) hydrated and moving smoothly.

It’s extremely important to encourage patients to keep as active as they can. Exercise helps to strengthen joints and their surrounding tissues, aiding pain and stiffness, and keeping supporting tissues strong and supple.

Even simple exercises like daily walking, gentle yoga classes and Pilates can all make a big difference. Any worries that the joints might ‘wear out’ quicker with exercise is untrue and strong muscles protect adjacent joints.

Community pharmacists are ideally placed to screen for OA and make treatment recommendations, as they are often consulted about the choice of over-the-counter analgesics to manage OA pain.

Osteoarthritis is the most common type of arthritis

Supplementation

There is some clinical evidence to support the efficacy of a small number of nutritional supplements, including rose-hip, for symptom relief in OA, rheumatoid arthritis and musculoskeletal pain. Some supplements such as glucosamine are widely used but have no evidence of effect to support their use.

Many people with painful joint conditions feel they benefit from taking joint supplements –either instead of, or in addition to, their prescribed medications. Taking a supplement at the earliest signs of joint pain or stiffness may well offer protection to safeguard the future of your joints.

Rose-hip extracts have a long history of medicinal use, with consistent and robust research having been undertaken on extracts from a specific species of rosehip called Rosa canina, which has been found to contain a potent anti-inflammatory galactolipid (or GOPO for short), with analgesic and antioxidative affects.

GOPO has been investigated in a number of well-designed studies involving people with both OA and RA. These studies found that daily supplementation of GOPO can rapidly reduce joint pain, stiffness and swelling, improve joint mobility and reduce the need for standard painkillers over several months. In one combined analysis of all GOPO studies, the researchers concluded that GOPO can be more effective than either paracetamol or glucosamine in the treatment of Osteoarthritis.

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Support for joint health

Pharmacists have a key role when it comes to advising customers on options to support their long-term joint health. Newly launched, GOPO® Joint Health Plus Ginger is the first UK supplement to contain the unique combination of ginger extract and cultivated rose-hip, high in levels of GOPO® . Longstanding Scandinavian research has established that rosehip may play a valuable role in the care of joints and joint tissues, with the galactolipid GOPO® having been studied in over 20 scientific trials. Ginger is loaded with bioactive compounds that may help to support morning joint flexibility

and good muscle function.

This new product is also rich in Vitamin C, essential for normal collagen formation, needed by the body for healthy bones and cartilage.

For more information visit the GOPO® Website: www.gopo.co.uk

Or call GR Lanes Health: 01452 524012

Relief from constipation

In many cases, digestive health issues can be combatted, with OTC products, stimulant laxatives, faecal softeners, and lactulose all having the desired effect. Natural stimulant laxatives, such as Senna, are more effective as they increase the wave-like muscle movements that push the contents of the GI tract forward and can work within 6-12 hours. Glycerin suppositories, as another option, can offer gentle relief from occasional constipation.

Care has developed a number of NPA-approved training modules which offer insight into a variety of conditions commonly encountered in pharmacy, with an ever-extensive workload, it’s important that pharmacy staff can quickly access resources to help them in their role. Care has developed “The Ultimate Guide to Care” mobile app where colleagues can complete learning modules and tests, supporting their CPD.

Training modules can also be accessed online via (www.carehp.co.uk/ training).

Senna is available to consumers behind the counter with an RRP of £1.49. Pharmacies can buy direct from Thornton & Ross or via wholesale.

Bamboo toothbrush for kids

Aquafresh has combined its oral health expertise with the sharp rise in demand for sustainable products, to launch its new ‘Bamboo for Kids’ Toothbrush. With almost six in 10 willing to change their purchasing habits to help reduce negative environmental impact1, this sustainable innovation will tap into the consumer shift towards more environmentallyfriendly products. The Aquafresh ‘Bamboo for Kids’ Toothbrush, available in two different colours, is the perfect solution for pharmacy teams wanting to offer their customers sustainable and efficient ways to maintain their dental health. The sustainably-sourced bamboo toothbrush, is perfectly suited for children aged 6+ and is packaged in 100 per cent biodegradable and plastic free packaging. MSRP: £4 For further information please email: group.gsk-trade@cirkle.com

Childhood eczema

Free CPD for pharmacy professionals

The Pharmacy Business has teamed up with the Pharmacy Academy to bring a new featured CPD in every issue. This month we’re focusing on childhood eczema, focusing on the symptoms and diagnosis, to assist pharmacy professionals in practice.

Eczema (atopic dermatitis) affects up to 20% of children and refers to a group of conditions that cause skin to become itchy, inflamed and red (lighter skin) or brown, purple, grey or ashen (darker skin). Eczema can develop at any age; however, most cases emerge during early childhood, typically between 3 and 6 months of age.

Itch is the hallmark of eczema

People with eczema show a variety of signs and symptoms, including:

Eczematous lesions and intense itch (pruritus) are the most common symptom and sign

Itch is the hallmark feature: rashes that do not itch are unlikely to be eczema

The skin damage that characterises eczema triggers inflammation in the stratum corneum, which contributes to itch. This leads to scratching, which releases more proinflammatory mediators further exacerbating eczema and xerosis.

Symptoms of eczema differ in skin colour

Eczema is more common in people of Asian and Black descent than White, the clinical presentation of eczema can differ depending on ethnic background, for example:

Patients of African and Asian descent more commonly present with extensor dermatitis than flexural involvement

Patients with darker skin types are at higher risk of postinflammatory dyspigmentation

In Asian, Black Caribbean and Black African children, discoid (circular) or follicular (around hair follicles) patterns may be more common than in White children1

NICE guidance on diagnosis

NICE suggests diagnosing eczema when a child has at least three of the following signs and symptoms in addition to itch;

Visible dermatitis involving skin creases (flexural dermatitis), such as the bends of the elbows or behind the knees

Personal history of flexural dermatitis. In children aged 18 months and younger a personal history of dermatitis on their cheeks, extensor areas or both

Personal history of dry skin in the last 12 months

Personal history of asthma or allergic rhinitis or, in children younger than 4 years of age, history of atopic disease in a first-degree relative

Onset of signs and symptoms when the child was younger than 2 years of age. This criterion does not apply to children aged 2-4 years of age2

Eczema treatment and management

Parents and carers should start treatment of flares as soon as signs and symptoms emerge. Treatment other than moisturisers should continue for about 48 hours after symptoms resolve to dampen the subclinical inflammation that can remain once acute symptoms resolve.

Moisturisers (commonly known as emollients) are the first-line therapy during acute flares and as maintenance therapy during remission and can also be used with, when necessary, other active treatments and can have steroid-sparing effects.

REFERENCES: 1. Kaufman BP, Guttman-Yassky E and Alexis AF Atopic dermatitis in diverse racial and ethnic groups—Variations in epidemiology, genetics, clinical presentation and treatment Experimental Dermatology 2018;27:340-357 2. NICE Atopic eczema in under 12s: Diagnosis and management Available at www.nice.org. uk/guidance/cg57/resources/atopic-eczemain-under-12sdiagnosis- and-managementpdf-975512529349 Accessed May 2021

The Pharmacy Academy provides free CPD which can be used towards your revalidation with the Managing acute dental pain General Pharmaceutical This CPD module is for the use of pharmacy professionals. Much of the information will also be relevant to Council (GPhC).dental practitioners and other health professionals who have a role in signposting patients to appropriate dental services

Take this FREE CPD to benefit from:

An age-by-age guide to how eczema presents JANUARY 2021 Understanding eczema pathophysiology Being able to offer practical advice about eczema management and moisturiser use

Visit www.healthprofessionalacademy. co.uk/eczema-pb or scan this QR code to access this free CPD

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Pharmacy Business

Natural Healthcare Innovation

Farina Jabbari, Global Head of Innovation and Strategic Portfolio Development at Nelsons, shares her thoughts on the future of natural healthcare innovation.

Natural healthcare has been given a huge opportunity over the last year. We have seen that consumer behaviours and attitudes are changing because of the pandemic and this is likely to continue in the coming years. Consumers are continuing to shift towards a proactive approach to their health and turning to natural healthcare products.

Key areas for growth include the importance of maintaining a healthy immune system, taking care of our mental and emotional well-being, ensuring quality sleep and generally wanting to feel good and have natural energy. At Nelsons, we have a range of products within both our current diverse portfolio but also as part of our future innovation pipeline.

Longer term, the importance of natural healthcare will only grow, as more and more people will continue the shift towards a proactive approach to their health and will prefer natural effective products that work in harmony with the body. Pharmacists should be aware of this and look to have a comprehensive natural healthcare offering for their customers.

It’s an exciting time for natural healthcare. The healthcare industry as a whole, including pharmacists, have a leading role to play in terms of understanding and rapidly responding to evolving consumer and customer needs.

Innovation is one of key building blocks here at Nelsons. With a consumer centric approach to all our future innovation plans we have invested heavily into understanding what are the key consumer unmet needs within natural healthcare across a number of markets.

We are focused on developing naturally inspired products that consumers want with pace and agility. We emphasise effective, natural ingredient blends, sustainable packaging and ensuring suitability for those on a plant-based diet.

CBD is an example of an innovative ingredient that is on the rise and should be something pharmacists consider offering. At Nelsons, we are assessing the use of CBD as a key ingredient as part of our future innovation plans, working with leading 3rd party suppliers in the sector and local regulatory authorities. In August, we launched our fi rst cosmetic product with pure CBD isolate (proven and tested to contain 0% THC) and we expect that we will have more CBD innovation in the coming years.

Pharmacists should keep an eye on natural healthcare trends and new innovative ingredients, as it’s rising rapidly in popularity and awareness amongst consumers.