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Australian Journal of Pharmacy : November 2006
chronic pain management older patients, that they are afraid to take the medication as they fear addiction. So what we have to do is reassure them, explain how to optimise their pain man- agement regimes and provide other tech- niques to support their pain management options. ‘What we would like to see is HMR becoming part of an annual assessment for patients, particularly those over 75, even those as young as 65.’ Dr Gowan said using diversional ther- apy was proving to be successful with dementia patients in nursing homes. Instead of visiting nursing homes in the morning, she said diversional therapists visit in the afternoon when people seem to suffer increased behavior problems. FOUNDATION FACTS Dr Timothy F Chen for the research team of Ms Salina Badam, Dr Linda Gelgor, Dr Tim Chen and Dr Winnie Hong The pharmacist and multidisciplinary pain management T HE International Association for the Study of Pain defines pain as: ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’. When pain lasts longer than three months or beyond the time of an acute injury is expected to have healed, it may be termed chronic or persistent pain. Chronic pain affects up to one in five Australians and is estimated to cost the community between $10bn to $30bn per annum. Chronic pain is a complex phenomenon and involves physical as well as social and psychological domains. Hence, a multidisciplinary approach to the management of chronic pain is recommended. As pharmacotherapy plays an important part of treatment, it makes sense that pharmacists are involved in the multidisciplinary team for the management of chronic pain. In addition to drug therapy, other non-drug treatments should include (among others) education, lifestyle modification and exercise, with the view to improving quality of life. The overall aim of this study was to investigate the impact of pharmacist-conducted medication review and patient medication counselling for patients attending a specialist multidisciplinary pain clinic. A randomised comparative study design was used in which patients were randomly allocated to either the intervention ‘Keeping people occupied with activi- ties such as board games, singing, danc- ing and even baking cakes helps with cog- nitive behavior and eases pain. Pain can be a trigger especially in dementia patients,’ she said. ‘Behavioural treatments are in at the moment,’ said Dr Goucke. ‘Changes in lifestyle, short- and long-term goals in managing pain, how to get involved in a regular exercise program, how to lose weight, how to get the diet right. ‘Exercise physiologists are fairly certain you can do significant things for osteo- porosis by starting older people exercis- ing. They don’t need to become Olympic athletes. Pain management is on that sort of bandwagon—trying to get people to exercise to help strengthen the back, help decrease back pain and help prevent ver- tebral crush fractures. ‘There is a whole range of things you can do but it is hard sometimes to change people’s behaviour,’ said Dr Goucke. ‘There are exercises you can do lying down, sitting in chairs. You can exercise your legs even if you cannot stand on them. Unfortunately there are not enough physiotherapists available to try and encourage people.’ Dr Goucke said research on cone snails that involved extracting amino acids is being carried out in Australia. Results look promising. ‘This is a very potent analgesic that does not cause any muscle side effects.’ s group (Group 1) or the comparison group (Group 2). Group 1 participants received medication counselling and review by the pharmacist, as well as usual care in the clinic. Group 2 participants received usual care in the clinic plus a pharmacist-conducted ‘sham’ interview. Evaluation measures of medication, pain, physical functioning and psychological factors were recorded at baseline and every two months over a six-month period. For the 31 patients in this study, there was a larger reduction in the number of medications in Group 1 compared to Group 2.The mean difference between Group 1 and Group 2 also indicated greater improvement in current pain management, average pain scores over the last week, physical functioning and psychological factors over time. This study showed that pharmacists can play an important role in the management of patients with chronic pain. However, these findings should be considered as preliminary, because of the small number of participants in this study. This study was approved by the Human Research Ethics Committee of Concord Repatriation General Hospital, Sydney. This research was undertaken at Concord Repatriation General Hospital. It formed part of the Master of Pharmacy (Clinical) treatise of Salina Badam, under the supervision of Dr Linda Gelgor and Dr Tim Chen in conjunction with Dr Winnie Hong. 46 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 NOVEMBER 2006