ANALGESICS
thE rEcEnt hEadlInE caSE of tv PrESEntEr anthony McPartlIn (ant & dEc) haS oncE agaIn BroUght thE ISSUE of addIctIon to PrEScrIPtIon drUgS – PartIcUlarly PaInKIllErS - to thE attEntIon of thE gEnEral PUBlIc… WhIch IS Why, WhEn It coMES to PaIn, toPIcal analgESIcS May BE thE fIrSt Port of call for PatIEntS.
PaIn rElIEf
a
ccording to the 2015 global burden of disease study, chronic pain conditions are
amongst the most significant causes of suffering and disability worldwide. It has been estimated that around 20 per cent of adults in Europe and thirteen per cent of adults in the UK experience chronic pain. children aren’t immune to it either; the national Pain audit estimates that eight per cent of children in the UK also suffer from severe pain.
Unfortunately, chronic pain also comes with many associated problems, such as depression. Indeed, it’s estimated that around 49 per cent of patients in the UK, who suffer from chronic pain, also suffer from depression.
Analgesic prescribing the increasingly ageing population is also directly contributing to the increased prescribing of analgesics, including opioids. as the average age of the UK population continues to increase significantly – from 33.9 in
18 - PharMacy In focUS
vital role for topical analgesics
1974 to 40.00 in mid-2014, and with 17.6 per cent of the population now over 65, the increasing demand for pain management is in no doubt.
little wonder then that the otc analgesics sector is continuing to grow at an alarming rate, with more product choices coming to market. as a result, all parts of the UK have seen substantial increases in the prescribing of opioids over recent years, with data indicating that, in northern Ireland, analgesic use overall increased by almost ten per cent between 2010 and 2014 and by 36.4 per cent between 2004 and 2014.
Pregabalin appears to be prescribed much more readily in nI than in the rest of the UK, with the combined number of items of gabapentin and pregabalin prescribed totalling 352,000 for 2013: a 29 per cent rise in two years. Manufacturers of the drug have estimated that approximately 80 per cent of total UK pregabalin prescriptions are for the treatment of neuropathic pain.
In terms of anti-depressants for associated problems, the figures for nI are staggering, with amitriptyline items increasing between 2011-2015 by 76.2 per cent from 222,358 to 391,720 and duloxetine from 58,284 to 106,980 items – an increase of 83.5 per cent.
The use of opioids In a recent study, ‘opioids aware’, there is certainly a large body of evidence – including randomised controlled trials – that has concluded that opioids may reduce pain for some patients in the short and medium term (ie, less than twelve weeks). there is, however, a lack of consistent, good-quality evidence to support a strong clinical recommendation for the long-term use of opioids for patients with chronic pain.
In March 2017, the British Medical association also produced a paper: ‘chronic pain: supporting safer prescribing of analgesics’, in which it concluded that: ‘over recent years,
there has been a substantial increase in the prescribing of opioids, leading to significant public health concerns that the harms associated with these medications are increasing. Much of this increased prescribing is likely associated with their use for the treatment of chronic pain but, there is limited evidence to support their long-term use for most patients.’
despite an increasingly overwhelming body of evidence that oral analgesics do not work in the long term, the evidence does not, however, appear to be putting patients off reaching for otc boxes of painkillers, or from making regular trips to their gP to request prescriptions for painkillers. last year, research by Mintel showed that while three in ten (29 per cent) of otc users prefer painkillers designed for specific types of pain, more than two thirds (67 per cent) said they were happy to use general painkillers to treat any pain.
hardly surprising then that prescribing data for the entire UK indicates that >
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