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Australian Journal of Pharmacy : November 2006
chronic pain management neuropathic pain, is taking traditional analgesics and not getting satisfactory results then their condition should be properly assessed. If left untreated it could lead to psychological and well as physical symptoms, with a large number of patients suffering from some degree of depression.’ He said patients may become depen- dent on medications, particularly nar- cotic analgesics and also experience side effects such as constipation, resulting in the need for regular laxative use. To assist patients with persistent pain, adjuvant analgesics can be used that typ- ically include tricyclic antidepressants such as amitriptyline supplemented in some cases with an antiepileptic medica- tion like carbamazepine or gabapentin. ‘When added to analgesic regimens adjuvants do help a lot of people with effective relief of pain. This strategy does not always work but it has shown good response in many patients.’ Professor Carroll said one of the bene- fits of conducting a HMR is the pharma- cist has time to sit with the patient and fully discuss the situation. ‘This does not always happen in surg- eries where GPs are busy and have time constraints. Often the GP is unaware of what the patient could be buying over the counter from a pharmacy, supermarket or health food store. ‘HMRs can lead to a better under- standing of which medications the patient is taking, whether they are effec- tive or producing any side effects or drug interactions. Often the pharmacist will find that despite the best efforts of every- one at the time, there is an ongoing chronic situation, the analgesics have worked to a certain extent, but clearly are not as effective as they might be. ‘People just take more of them, whereas they really have reached the point where they need to visit a pain man- agement clinic for further assessment and treatment,’ Professor Carroll said. But, according to Dr Gowan, pain management clinics have huge waiting lists as they, like other healthcare services, suffer from a lack of funding. Professor Carroll continued: ‘People with unresolved pain will try anything and may not only be taking prescription medicine but OTC analgesics and possi- bly talking to natural therapists and buy- ing complementary and herbal therapies as well. ‘From a pharmacy point of view it is important to discuss what is going on, what additional medications the patient is taking and their level of effectiveness. Whether the patient is visiting other prac- titioners, a chiropractor or physiothera- pist. Can they exercise, what makes the pain worse, do they go to two or three dif- ferent doctors or different pharmacies? ‘Pharmacists are able to assess the situ- ation as patients who may not be bene- fiting from a particular treatment will investigate another in an effort to find some relief. A HMR is an ideal opportu- nity to do all of that and then the recom- mendations come. There is a role for prescription but referred to a pain man- agement centre,’ Professor Carroll con- tinued. ‘Pain is prevalent in the community and could be a warning sign of an under- lying problem and should not be ignored. If pain does not go away in a reasonable period of time, and there is no obvious reason for the pain, it should be investi- gated. ‘Also, chronic pain type is not always neuropathic in nature. For example joint damage associated with osteoarthritis can result in chronic pain and is best treated initially with paracetamol.’ Professor Carroll said often patients are also prescribed nonsteroidal anti- inflammatory drugs (NSAIDs) but because of the potential for side effects these should only be used in the lowest possible dose and for the shortest possible time. ‘These may also be unsuitable for some ‘HMRs can lead to a better understanding of which medications the patient is taking, whether they are effective or producing any side effects or drug interactions.’ —PROFESSOR PETER CARROLL other therapies as part of an overall pain management plan that includes such pro- cedures as transcutaneous electrical nerve stimulation (TENS) and acupunc- ture. ‘No-one can actually measure pain. You can measure many things such as blood pressure but it is difficult for any- one to describe the level of pain they are experiencing. ‘Some people tolerate pain a lot better than others and one of the biggest mis- takes that can be made in understanding pain is to label someone who has chronic pain a malingerer. It is important that these people are not just given another 42 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 NOVEMBER 2006 patients groups, for example, those with cardiovascular or renal disease. ‘From a complementary point of view, glucosamine may give effective pain relief of osteoarthritis pain in some patients. Lifestyle issues such as exercise and weight loss can be beneficial for those who are overweight or inactive. ‘A number of patients with cancer also suffer from chronic pain, particularly if the cancer is advanced. ‘Depending on the severity of the pain, it may be treated with simple analgesics like paracetamol and NSAIDs, or adju- vant analgesics or stronger agents like the narcotic analgesics, if pain is more severe.