PAIN
Tramadol is no longer recommended in children due to a lack of evidence supporting its efficacy and safety. Codeine is not recommended as individuals show a varying response, posing a safety risk. Opioids have no “ceiling effect” – the dose has no upper limit and can be titrated safely up in accordance with the child’s weight6. According to WHO, opioids should be administered regularly, not “as required”5
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TOPICAL ANALGESICS Topical analgesics, despite having the benefit of reduced systemic effects, are not as popular as oral analgesics in the treatment of pain.
NICE guidance recommends prioritising the use of topical NSAIDs over oral treatment in painful osteoarthritis of the knees and hands1
Some studies have shown topical NSAID treatment to be equally as effective as oral treatment.
Flexiseq® is a medical device used for the treatment of osteoarthritis. Flexiseq is an aqueous gel composed of SequessomeTMvesicles that are composed of phospholipids. The sequessomeTM vesicles are hydrophilic in nature and following absorption through the skin they travel further down into joint cavities, join to cartilage and form a film, lubricating the joint. One multicentre randomised placebo and active-controlled trial compared the efficacy of Flexiseq to Ketoprofen gel and oral celecoxib. After twelve weeks of treatment, Flexiseq was found to have improved pain from the baseline in 38.9% of patients, compared to 40.4% of those treated with celecoxib. Flexiseq was statistically superior to the placebo group, improving pain relieving effect, function and stiffness12
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Pernaton® gel contains Perna extract, essential high-molecular
NUROFEN EXPRESS Headache is currently the largest and most widely treated pain occasion in the UK and speed is the number 1 consideration for sufferers.
Nurofen Express 256mg tablets (containing sodium and ibuprofen) targets pain twice as fast as standard ibuprofen tablets, found in many supermarkets, to provide rapid effective relief from a range of pains. Tablets contain a form of ibuprofen which breaks down easily in the body. making it easier for the body to absorb into the bloodstream and so getting to the source of pain quickly.
Nurofen Express 256mg Tablets 16’s RRP £3.56. Trade Enquiries: 0500 455 456
48 - SCOTTISH PHARMACIST
glycosaminoglycans, omega 3 fatty acids, 11 minerals and 18 vital L-amino acids. It aids connective tissue and joint care. Although its mechanism of action is not fully understood, the anti-inflammatory properties of omega 3 fatty acid are thought to be responsible for its pain relieving action. Studies have shown glycosaminoglycans have a significant effect on improving skin firmness and elasticity.
Topical analgesics are often equally as effective as oral preparations but have the added advantage of lower risks of side effects, making them a great option for children.
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Emla cream can be sold for use in children prior to vaccination, and yet it rarely is. This may be due to a lack of public education on what is available for children to reduce pain.
Pernaton® gel contains Perna extract, essential high-molecular glycosaminoglycans, omega 3 fatty acids, 11 minerals and 18 vital L-amino acids. It aids connective tissue and joint care and can be used by older children, however it is not suitable for small children or infants. Although its mechanism of action is not fully understood, the anti-inflammatory properties of omega 3 fatty acid are thought to be responsible for its pain relieving action. Studies have shown glycosaminoglycans have a significant effect on improving skin firmness and elasticity.
Pain management programmes can equip patients with the knowledge and skills to cope with their pain. Self-management allows patients to stay independent and can reduce the need for future GP appointments and medication changes8
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The most recent report published in Scotland, entitled ‘Chronic Pain Services in Scotland, Where are we Now?’ provides information and advice for all Health Boards in Scotland on the management of this condition.
Dr Steve Gilbert: National Lead Clinician for Chronic Pain in Scotland comments, “Over the last 20 years, there have been a number of reports about the management of chronic pain in Scotland. The GRIPS report of 2008 noted the frustration with the lack of progress. From the information that we have collected for this latest report, we can see that some things have improved, but that much remains to be done.
Dr Steve Gilbert
“Given that pain is one of the commonest reasons for people to seek healthcare advice, I am really glad to see more primary and community care involvement, as well as the inclusion of chronic pain as a priority by the Royal College of General Practitioners. I hope this will lead to more being done in primary care.
“Chronic pain management, however, is still mostly seen as a specialty, to be managed in secondary/hospital pain clinics. To bring about real improvements, chronic pain needs to be recognised as a common condition and to involve the wider healthcare team and not just rely on treatment with medication. I believe that the Service Improvement Groups will be effective in involving colleagues in the voluntary sector and in primary care. “We need to make sure that the understanding of what to do at an early stage, when pain becomes chronic or persistent, becomes much more widely known by the public and healthcare professionals such as pharmacists, GPs and physiotherapists.
“We are working on consolidating pain management educational resources to make this a standard part of healthcare education and there are also local initiatives. Having high quality resources for patients, carers, healthcare professionals available on the
www.chronicpainscotland.org website will also help with raising awareness and knowledge.
“I believe that the future development of the Scottish Service Model for Chronic Pain (SSMCP) will help those with chronic pain to know what to do and where to find and get the best assistance in managing their pain towards better wellbeing and less suffering.”
REFERENCES 1. Wilson, E. 2009. Pain: treatment and management. 2009: Outset Publishing Ltd. 2. The British Pain Society. 2009. FAQs. [Online]. [Accessed 20/5/14]. Available online at: www.
britishpainsociety.org/media_faq.htm
. Referral to such
programmes should be considered for all patients with chronic pain10
3. The Musculoskeletal Elf, Minervation Ltd. 2012. Cost-effectiveness of self-management for chronic pain in an aging population. [online]. [Accessed 20/5/14] Available online at:
www.themusculoskeletalelf.net/cost-effectiveness-of-self-management-for-chronic-pain-in-an- aging-population/ 4. Bradford, E. 2014. NHS ‘failing’to meet targets over chronic pain care. [Online][20/5/14] Available online at:
www.bbc.co.uk/news/uk-scotland-glasgow-west-27159366 5. Healthcare Improvement Scotland. 2011. About us. [Online]. [Accessed 20/5/14] Available at:
www.healthcareimprovementscotland.org/about_us.aspx 6. Healthcare Improvement Scotland. 2014. Chronic Pain Services in Scotland: Where are we now? [Online]. [Accessed 19/5/14] Available at: file:///C:/Users/Carla/Downloads/Chronic%20 pain%20services%20in%20Scotland%20April%202014%20V3%20(1).pdf 7. Tidy, C et al. 2014. Neuropathic Pain. [Online]. [Accessed 20/5/14]. Available at:
www.patient.
co.uk/health/neuropathic-pain 8. NHS Quality Improvement Scotland. 2006. Management of Chronic Pain in Adults. [Online]. [Accessed 20/5/14]. Available at: file:///C:/Users/Carla/Downloads/PAINCHRONIC_BPS_FEB06.pdf 9. NHS Choices. 2012. Painkillers, paracetamol. [Online]. [Accessed 20/5/14] Available at: www.
nhs.uk/conditions/painkillers-paracetamol/pages/introduction.aspx 10. Health Improvement Scotland. 2013. SIGN 136: Management of Chronic Pain. [Online]. [Accessed 20/5/14]. Available online at:
www.sign.ac.uk/pdf/qrg136.pdf 11. Saarto, T. and Wiffen, PJ. 2012. Antidepressants for treating Neuropathic pain. [Online]. [Accessed 20/5/14]. Available at:
summaries.cochrane.org/CD005454/antidepressants-for- treating-neuropathic-pain 12. Conaghan P, Dickson J, Bolten W, Cevc G, Rother M. June 2013. A multicentre, randomized, placebo- and active-controlled trial comparing the efficacy and safety of topical ketoprofen in Transfersome® gel (IDEA-033) with ketoprofen-free vehicle (TDT 064) and oral celecoxib for knee pain associated with osteoarthritis. Available at:
www.flexiseq.com/row/ templates/flexiseqv3/docs/Summary_III_03_10_June_2013.pdf [Accessed 10/1/15] 13. Pernaton® Gel. Available at:
www.pernaton-uk.com/PernatonlGel.aspx [Accessed 10/1/15]
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