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Australian Journal of Pharmacy : September 2006
fessional NPS program focuses on analgesic use T HE National Prescribing Service (NPS) is rolling out a new health pro- fessional education program on the use of analgesics in persistent, non-malig- nant pain. The program, ‘Analgesic choices in persistent pain’, focuses on the use of anal- gesics, including paracetamol, non- steroidal anti-inflammatory drugs (NSAIDs) and opioids. ‘It is timely to re-examine practice in the use of analgesics in persistent muscu- loskeletal conditions, particularly in light of newer evidence of risks of NSAIDs and the good safety profile of paracetamol, which is now available in a modified release formulation,’ said Associate Pro- fessor Milton Cohen, Department of Medicine, St Vincent’s Clinical School in Sydney. The program explores the newer COX- 2 selective NSAIDs, the importance of avoiding adverse reactions and drug inter- actions with tramadol. It also discusses the appropriate use of strong opioids. Prescribing by GPs of NSAIDs was high- est in 2000–01 at 6.8 per 100 encounters, after the introduction of the first COX-2 selective NSAIDs. In 2004–05 it had fallen to 5.6 per 100 encounters. According to the NPS, it is important that GPs prescribe or recommend over-the-counter (OTC) purchase of paracetamol, ‘which is the analgesic of choice for most conditions’, at a similar rate: 5.5 per 100 encounters. ‘Non-drug measures also play an important role in the management of per- sistent pain; however, Quality Use of Medicines remains central to creating gen- uine positive health outcomes for health professionals and their patients,’ said NPS chief executive officer Dr Lynn Weekes. Despite the NPS’s recommendations, research presented at the recent Interna- tional Symposium on Paediatric Pain in Vancouver showed that ibuprofen equalled paracetamol in terms of efficacy and tolerability. The randomised, double-blind first dose study (Gibb I, et al. Pain Res Manage Vol 11 Suppl B Summer 2006; 73B abstract F4) evaluated the efficacy of paracetamol (15mg/kg) and ibuprofen (10mg/kg) dur- ing an eight-hour period from the first dose. It also compared the tolerability of up to three days for subsequent dosing (open-label) in children with fever. As part of the study, a questionnaire saw more parents rate ibuprofen as ‘very effi- cacious’ than they did for paracetamol. ¦ HARMACISTS and assistants can take a more proactive role in the treatment and prevention of hayfever, particularly in the lead-up to the hayfever season, with new research iden- tifying missed opportunities to alleviate the significant quality of life issues expe- rienced by hayfever sufferers. The national hayfever survey revealed that one in two sufferers prefer to use combination therapy—an intranasal cor- ticosteroid (INCS) spray and an antihista- mine—rather than an antihistamine alone to manage their symptoms. Nearly two-thirds of chronic sufferers (those who experience nine or more hayfever bouts annually) indicated they would purchase both treatments at the same time. According to Sue Holzberger, vice- president, Pharmacy Guild of Australia, Queensland Branch, hayfever sufferers are often reluctant to discuss their condi- Hayfever: a missed opportunity P tion and downplay the severity of their symptoms, so pharmacists and assistants need to be proactive in discussing treat- ment and prevention options with suffer- ers. ‘Hayfever sufferers miss out on the best treatment because almost two-thirds endure their symptoms in silence, and only 14 per cent discuss their condition with their pharmacist,’ she said. Furthermore, one in five Australians underestimate the severity of their hayfever and therefore may not receive appropriate therapy. Ms Holzberger said that by underesti- mating the severity of their condition suf- ferers may not be on appropriate therapy which can cause far-reaching disruption to their quality of life. Research indicates that sleep and work are the most adversely affected activities, with more than one-in-two sufferers com- plaining about disrupted sleep and more than one million full-time workers having their work interrupted by hayfever symp- toms. According to the Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines, INCS should be regarded as first-line treatment for people whose quality of life has been affected including disruption to sleep and impediment to daily activities. The survey also showed that the aver- age sufferer spends approximately $46 each year on hayfever preparations. That amounts to an estimated gross national spend of $230m annually, which is more than three times that of cold and flu preparations. Ms Holzberger recommended that pharmacists and assistants discuss both symptom and prevention management with hayfever sufferers, and move toward combination therapy. ¦ THE AUSTRALIAN JOURNAL OF PHARMACY VOL.87 SEPTEMBER 2006 ? 19