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Australian Journal of Pharmacy : March 2005
identifying and treating pain cists to educate patients about the mod- ern approach to pain management— using groups of drugs and groups of inter- ventions—and not have this desperate search which is often adding to the pain because the patient thinks that no one understands,’ she said. Ms Moses said pharmacists should be able to educate people about the impor- tance of treating it early to conquer the pain, therefore avoiding long-term problems. ‘What we deal with a lot is people who leave their pain unrelieved because they are trying to be the hero. What a lot of people haven’t learned is that pain that is unrelieved will just crescendo, a process called wind-up,’ Ms Moses said. ‘Pain is supposed to be a signal that something is wrong and if you don’t do something to relieve that pain and if the pain does not go away, your body thinks you haven’t felt it yet so it will just increase the signal. pain, thinking they have to put up with it, being a hero and it multiplies itself and it winds up. Once you are at that stage of wind-up it is very, very hard to bring you back again,’ Ms Moses said. Educating pharmacy assistants Pharmacy assistants too, needed good education about pain. ‘The problem is that a lot of pharmacy assistants get their training from manu- facturers; I think it is exciting that the pharmaceutical society is finally offering some structured training and regular lec- tures for pharmacy assistants that will come from health professionals,’ said Ms Moses. Pharmacists could also ask themselves what they did besides merchandising ‘Most people think the opposite: they think if they put up with the pain for a lit- tle while it will just go away. They are judging that from their childhood, where they experienced mostly acute, short- lived pain that was probably nociceptive —the tissues healed and the pain went away. ‘With chronic pain the doctors pre- scribe the big guns early and many patients say “I don’t need morphine, I’m not that bad”,’ Ms Moses said. ‘What they don’t understand is that the other thing about the modern approach to pain is to try to get you pain-free early —if you can switch the signal off you can do so much more about making it a short- lived problem. ‘If they don’t stop it early they then get into that scenario of experiencing the ‘We owe it to our assistants to recog- nise them as the front line of pharmacy, so they need to be keyed up on exactly the same issues that I have already described and to understand the basics of pain management,’ Ms Moses said. ‘The trick, of course, is helping phar- macy assistants know when to refer to the pharmacist and to be aware of Quality Use of Medicines principals, judicious use and safe use and appropriate medicines. Dr Nissen recommends the Analgesic edition of the Therapeutic Guidelines series of publications as a good source of information about pain management. ‘Even the introductory section of the guidelines will provide enough basic information to help pharmacists and other staff deal with patients when they come in,’ Dr Nissen said. Ms Moses said as a lot of pain was man- aged by self medication, pharmacy assis- tants were very much in the front line of pain management. ‘I’d like to see more of them asking questions such as, “What do you hope to achieve by using this product?”, “Are you intending to have it now or are you going to put it in the bathroom cupboard for later?”, and to ask open questions like “How can I help you to use this medicine to its best effect?”,’ Ms Moses said. She suggested that setting up a men- toring program for pharmacy assistants could help ensure key messages about pain management were dealt with appro- priately. 176 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 Dr Nissen said it was important for pharmacists and their assistants to make time to listen to their customers. ‘Pain patients, in my experience, often feel like we are not interested in them - especially if you are in a really busy phar- macy. But it’s important to listen and to know if there are any issues which may be contributing to the pain.’ she said. A systematic approach to advice delivery Victorian pharmacist Mark Feldschuh suggested that a systematic approach to delivering advice about pain would be useful. ‘Pharmacists have product knowledge and the product knowledge is pretty good, but the advice delivery as it stands comes from when you are asked a question and you answer it. The advice is not sys- temised for the patient,’ Mr Feldschuh said. Dr Nissen added: ‘It would be good for pharmacies to have a core group of things that they know well, or a plan of what they are going to do when somebody comes in with a sprain, or how they will deal with someone who comes in with headache. ‘If somebody comes in with a sprained ankle, for example, the plan could be to advise them how to use an ice pack, pro- vide them with elastic bandage to help them compress the injury...maybe give them an oral non-steroidal and tell them to take it on a regular basis for a week,’ Dr Nissen said. Mr Feldschuh said pharmacists’ prod- uct knowledge in general was good, how- ever it took time and motivation to offer a pain advisory service in pharmacy. He said areas for pharmacists to con- sider included merchandising, how it was explained, and what happened when somebody with a certain painful condi- tion asked a question. Pharmacists could also ask themselves what they did besides merchandising. Do they have seminars, for example? Did they talk to people, how could you reduce the numbers of tablets that a patient might be taking? What other measures of pain relief are there?