ANALGESICS >
PErIod PaIn Period pain is a normal part of the menstrual cycle usually felt as painful muscle cramps in the abdomen, which can spread to the back and thighs. the pain normally lasts 48 to 72 hours, although it can last longer. Studies have shown that nSaIds, when given orally, are effective in 80- 85 per cent of women.
a cochrane review concluded nSaIds were significantly more effective in relieving moderate to severe period pain compared to placebo, but there was little evidence of superiority of any individual nSaId. current otc nSaIds for the treatment of period pain include ibuprofen and naproxen. the latter is licensed to relieve period pain in women aged between fifteen and 50 years (feminax Ultra).
SPraInS and StraInS Sprains are caused by forcing a joint into an abnormal position that overstretches or twists ligaments. Strains involve the partial or complete tearing of muscle fibres. although varied in presentation, otc treatment for sprains and strains tends to be the same. In addition to advising rest, icing, compression and elevation of the affected area, otc analgesia can be recommended.5
Paracetamol should be offered first line, with oral nSaIds (ibuprofen) only considered 48 hours after the initial injury as inflammation is a necessary part of the healing process.10
a
recent cochrane review found no significant difference between nSaIds and paracetamol in people with sprains and strains for pain relief, swelling or return to function at seven days or over.
anaLgESIc namE Paracetamol tablets Ibuprofen tablets aspirin tablets
naproxen tablets
however, there was some evidence that those treated with nSaIds had slightly more side effects related to the stomach or intestines.11
topical
nSaIds offer an alternative to oral analgesics, with minimal adverse systemic side effects. there is strong evidence to support the use of topical diclofenac and topical ibuprofen gel in the treatment of acute soft tissue injuries like strains and sprains.12
bacK PaIn acute low back pain (acute LbP) is most often caused by a sudden injury to the muscles and ligaments supporting the back, resulting in muscle spasms or a strain or tear in the muscles and ligaments.5
often prescribed by doctors, recent studies have called the effectiveness of paracetamol into question for relieving acute LbP. Studies found that paracetamol does not produce better outcomes compared to placebo for people with acute LbP (it is uncertain if it has any effect on chronic LbP).13
cochrane reviews suggest oral nSaIds are effective for short-term symptomatic relief in patients with acute LbP without sciatica. a seven- day course of ibuprofen tablets can be recommended unless patient is contra-indicated from using nSaIds.14 there is less robust evidence to support of use of topical nSaIds such as ibuprofen and diclofenac gels in treating this condition.
oStEoarthItIS osteoarthitis (oa) is a painful, degenerative joint disease that often affects the hips, knees, neck, lower back, or small joints of the hands. Joint flexibility is reduced and the joint swells. In addition to non-
Standard otc adULt doSagE
500mg - 1000mg every four to six hours (max 4g in 24 hours) 200mg - 400mg three times daily
300mg - 900 mg every four to six hours (max 4g in 24 hours) 250mg three times daily
codeine and Paracetamol two 8mg + 500mg tablets every four to six hours tablets (co-codamol)
(max eight tablets in 24 hours) Ibuprofen gel diclofenac gel 5% - 10% gel applied three times daily
1.16% gel applied three times daily or 2.32% gel applied twice daily
tabLE 1: common otc oraL and toPIcaL anaLgESIcS doSagE and advIcE InformatIon9 18 - PharmacY In focUS Pharmacy-only deep relief Joint Pain gel 100g
the mentholatum company’s pharmacy-only deep relief Joint Pain gel is a dual action gel which can be recommended to help relieve pain from non-serious arthritis, as well as rheumatic and muscular pain. deep relief Joint Pain gel contains two pain- relieving ingredients - levomenthol and ibuprofen - plus anti-inflammatory action. cooling levomenthol acts on the nerve endings in the skin, giving an analgesic effect, while ibuprofen penetrates the skin to give targeted pain relief and help relieve inflammation at the point of pain. an in vitro study suggests that levomenthol also helps enhance the penetration of ibuprofen through the skin*. Ibuprofen helps relieve mild to moderate pain and inflammation by blocking the production of prostaglandins through its action of inhibiting cyclo-oxygenase (cox). In topical formulations it is absorbed through the skin to reduce local pain and inflammation. In the deep relief range, ibuprofen is combined with levomenthol, which produces a cooling, soothing effect, relieving pain with its counter-irritant activity – stimulating the nerves which perceive cold while depressing those which
perceive pain. * turner r. In vitro permeation investigation to assess the potential synergistic effect of the ibuprofen and levomenthol combination in delivering ibuprofen through human skin. Study
although
conducted for mentholatum by medpharm Ltd. 2011 trade contact - Laser healthcare: 01202 780558
pharmacological treatments such as exercise, paracetamol or nSaId (ibuprofen) tablets can be recommended in the management of pain in patients with hip or knee oa.15
topical therapies, namely diclofenac or ibuprofen gel, are also a first-line treatment for osteoarthritis with strong evidence supporting their use, particularly for those who find the gastrointestinal side effects of oral nSaIds intolerable.11,15
topical nSaId formulations act most effectively on more superficial sites of pain such as in osteoarthritic joints in the hands and knees. a recent cochrane review cited that approximately 60 per cent of patients with oa using a topical nSaId preparation reported reduced pain after six to twelve weeks.16
•
rEfErEncES 1 – british Pain Society. media resources.
https://www.britishpainsociety.org/media- resources/ [online] 2 – nhS choices. headaches.
http://www.nhs.uk/conditions/headache/Pages/ Introduction.aspx [online] 3 – migraine trust.
otc advISE
do not take any other products containing paracetamol take with or just after food
take with or just after food do not take any other products containing aspirin
take with or just after food do not take for more than three days at a time
do not take any other products containing paracetamol
do not take for more than three days at a time this medicine can cause addiction
do not use for longer than seven days at a time unless recommended by a doctor
do not use for longer than seven days at a time unless recommended by a doctor
https://www.migrainetrust.org/about- migraine/migraine-what-is-it/facts-figures/ [online] 4 – faculty of Pain medicine.
http://www.rcoa.ac.uk/faculty-of-pain- medicine/recruitment/northern-ireland [online] 5 – P. rutter. community Pharmacy: Symptoms, diagnosis and treatment 6 – cochrane review. caffeine as an analgesic adjuvant for acute pain in adults.
http://www.cochrane.org/cd009281/SYmPt_c affeine-as-an-analgesic-adjuvant-for-acute- pain-in-adults [online] 7 – migraleve.
http://www.migraleve.co.uk/ [online] 8 – nIcE clinical Knowledge Summaries. analgesia - mild to moderate pain.
https://cks.nice.org.uk/analgesia-mild-to- moderate-pain [online] 9 – british national formulary Issue 72 10 – nIcE clinical Knowledge Summaries. Sprains and strains.
https://cks.nice.org.uk/sprains-and-strains [online] 11 – cochrane review. oral non-steroidal anti- inflammatory drugs compared with other oral pain killers for sprains, strains and bruises.
http://www.cochrane.org/cd007789/mUSKInJ _oral-non-steroidal-anti-inflammatory-drugs- compared-other-oral-pain-killers-sprains-strains -and [online] 12 – c. argoff. mayo clinic review. topical analgesics in the management of acute and chronic pain. 13 – cochrane review. Paracetamol for low back pain.
http://www.cochrane.org/cd012230/bacK_pa racetamol-low-back-pain [online] 14 – cochrane review. non-steroidal anti- inflammatory drugs for low back pain.
http://www.cochrane.org/cd000396/bacK_no n-steroidal-anti-inflammatory-drugs-for-low- back-pain [online] 15 – SIgn guideline 136. management of chronic pain. 16 – cochrane review. can topical nSaIdS help relieve the pain of arthritis.
http://uk.cochrane.org/news/can-topical-nsaids- help-relieve-pain-arthritis [online]
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