ANALGESICS
WITH A RECENT SURVEY COMMISSIONED BY MENTHOLATUM SHOWING THAT TWO OUT OF FIVE PAIN SUFFERERS DO NOT DISCUSS PAIN WITH THEIR GP, THIS IS A KEY AREA WHERE COMMUNITY PHARMACY CAN ENSURE PATIENTS ARE RECEIVING THE RIGHT MEDICATION TO TREAT THEIR SYMPTOMS.
OTC ORAL AND TOPICAL ANALGESICS
By Timothy McClure
Worth in excess of £540 million, sales of analgesics represent approximately a quarter of all sales in the UK over the counter (OTC) market.
SOME PAINFUL FACTS:
• The British Pain Society estimate 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
• 25 million work and school days are lost each year due to headaches and migraine3
• Chronic pain (pain that lasts for over twelve weeks despite medication or treatment) affects one in every five people in Scotland4
The OTC analgesics sector is ever growing, with more product choices
16 - SCOTTISH PHARMACIST
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 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 which evidence-based oral and topical OTC analgesics 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
MIGRAINES 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 emphasized 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.
One in five women and one in fifteen men will develop a migraine at some time in their life.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% of migraine suffers can expect a reduction in pain from 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
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