ANALGESICS
otc oraL and toPIcaL anaLgESIcS
aS a rEcEnt SUrvEY commISSIonEd bY mEnthoLatUm ShoWS that tWo oUt of fIvE PaIn SUffErS do not dIScUSS PaIn WIth thEIr gP, tImothY mccLUrE ShoWS hoW thIS IS a KEY arEa WhErE commUnItY PharmacY can EnSUrE PatIEntS arE rEcEIvIng thE rIght mEdIcatIon to trEat thEIr SYmPtomS.
W
orth in excess of £540 million, sales of analgesics represent approximately a
quarter of all sales in the UK over the counter (otc) market.
Such sales are hardly surprising in light of the fact that: • the british Pain Society estimates that around ten million people suffer from pain every day1 • an estimated 4.9 million work days are lost through work-related back pain annually1 • over ten million people in the UK regularly suffer headaches2 • one in seven UK adults suffer from migraines, with women more likely to be affected than men3 • twenty-five million work and school days are lost each year due to headaches and migraine³ • northern Ireland has the highest incidence of chronic pain (pain that lasts for over twelve weeks despite medication or treatment) in the UK at approximately 19 per cent of the adult population4
.
the otc analgesics sector is ever growing with more product choices coming to market. It is clearly vital for both pharmacists and otc trained pharmacy staff to be well equipped with the right knowledge and expertise to optimise sales and customer satisfaction in this area. as a pharmacist practising in a small independent pharmacy myself, I
16 - PharmacY In focUS
depend on my staff being able to competently question patients on their specific needs before either selecting an appropriate product to sell (or referring the patient to me where needed). this article looks at the evidence-based oral and topical otc analgesics that can be recommended in the treatment of common painful conditions seen in everyday community practice.
tEnSIon hEadachES this is the most common form of headache. Symptoms include a dull, non-throbbing, often bilateral generalised pain often described as a ‘tightness’ or ‘weight’ pressing down on the head. Pain is gradual in onset and tends to worsen through the day. Simple common analgesics such as paracetamol or ibuprofen should be recommended as a first-line treatment.5
many soluble and orodisperible formulations of paracetamol and ibuprofen are currently on the market. these products can provide faster analgesia owing to more rapid absorption once taken.5
Should
simple analgesia fail to control symptoms, compound analgesia (such as paracetamol or ibuprofen combined with codeine) can be recommended.
It should always be emphasised that otc products containing codeine can cause addiction and should only be used for a maximum of three days. It
is also worth noting that a recent cochrane review concluded that a dose of caffeine equivalent to a mug of coffee (100 mg) added to a standard dose of paracetamol or ibuprofen provided a small but important (five-ten per cent) increase in the proportion of patients who experience a good level of pain relief.6 Prolonged use of analgesics for headaches can make symptoms worse.
mIgraInES one in five women and one in fifteen men will develop a migraine at some time in their life.7
moderate/severe to mild/none two hours after treatment with simple analgesia, but only a quarter will be pain free within this time.5
compound analgesics offer an alternative should first-line treatment fail. migraleve is a short-term (up to three days) treatment for nausea and headache associated with a migraine attack when this is not relieved by paracetamol, ibuprofen or aspirin. this product contains codeine, paracetamol and an anti-sickness medicine called buclizine.7
Symptoms include a
unilateral throbbing pain of moderate to severe intensity that is often associated with nausea and lethargy.
Some patients may also experience visual or neurological auras.3
Like
tension headaches, simple common analgesics, such as paracetamol or ibuprofen, should be recommended as a first-line treatment.5
these
should be taken as soon as possible for maximum benefit.
aspirin is also a first-line option but in most circumstances, other non- steroidal anti-inflammatory drugs (nSaIdS) such as ibuprofen are preferred.8
as migraines are
associated with gastric stasis, soluble or orodispersible formulations will maximise analgesic absorption.
approximately 60 per cent of migraine suffers can expect a reduction in pain from
Sumatriptan is a 5ht1 agonist that is licensed for the acute relief of migraine attacks where there is a clear diagnosis of migraine. the supply of sumatriptan is associated with various product licence restrictions and the pharmacist should satisfy that these are fulfilled before selling.
dEntaL PaIn analgesics should be used prudently in dental care as a temporary measure until the cause of the pain has been dealt with. most dental pain is relieved effectively by nSaIds such as ibuprofen. Paracetamol has analgesic and antipyretic effects but no anti- inflammatory action. combination analgesic preparations containing ibuprofen or paracetamol with codeine have not been shown to provide greater relief of pain than an adequate dose of ibuprofen or paracetamol given alone.9
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