ANALGESICS


the use of topical diclofenac and topical ibuprofen gel in the treatment of acute soft tissue injuries such as strains and sprains.


Back pain recent studies have called into question the effectiveness of paracetamol for relieving acute low back pain. a seven-day course of ibuprofen tablets can be recommended unless the patient is contra-indicated from using nSaIds.


a topical analgesic may not be the best choice for an extended area such as the lower back, although many patients will use topical nSaIds in this area in an attempt to get some ‘instant relief’, however fleeting that may be.


the topical analgesics market is worth a staggering £82.9 million


> the use of opioids has increased substantially in the UK; as have the number of deaths from a range of opioids. Between 2003 and 2013, the number of deaths in nI in which tramadol was mentioned on the death certificate rose from zero to 20.


deaths involving codeine also rose from two to 22 over the same period. With such alarming statistics, healthcare professionals are increasingly being advised to encourage patients to try other forms of treatment – sometimes in conjunction with low-dosage opioids in the first instance. for that reason, alternative treatments such as counselling and topical analgesics are increasingly being recommended.


Topical analgesics the topical analgesics market is worth a staggering £82.9 million, and there’s no doubt that that the segment has experienced the healthiest growth in the pain relief market at 12.2 per cent, compared to two per cent across the total pain relief market.


When it comes to pain relief, many patients will automatically reach for an opioid such as aspirin or ibuprofen. But, when the source of pain is close to the surface, then the application of a cream, spray or gel containing a painkiller may ease the


20 - PharMacy In focUS


pain and avoid some of the overall side effects of oral analgesics.


How do they work? the active ingredient in most topical analgesics is a non-steroidal anti- inflammatory drug (nSaId) such as ibuprofen, naproxen, aspirin or diclofenac. once applied to the skin, these medications target inflammation, which is the main cause of the pain and stiffness that the patient may be experiencing.


a scientific review by the cochrane collaboration, an international body of health experts, found that some prescription topical nSaIds could offer the same pain relief as the oral versions. More importantly, the topical versions avoided the side effects associated with oral nSaIds, such as fewer gastrointestinal concerns. (of course, some of the medication will still enter the bloodstream and eventually end up in the stomach, but to a much reduced level than with the oral version.)


the main reason why topical analgesics work so successfully is because they work locally and can target the pain more precisely. they can also be applied at regular intervals throughout the day – usually two to four times – to control mild to moderate pain. there are, of course, as with any form of medication, some side effects. these tend to be redness,


itching and other generalised skin irritation but, for the most part, they are generally mild. Patients must take care to wash their hands following application, as it’s vital that they don’t smear the gel or cream into their eyes, nose, or other mucous membranes.


the most common areas for successful application of topical analgesics are listed below. a general rule is that they may not be the best choice for pain relief when the pain affects a widespread or extended area, or if it affects more than one part of the patient’s body.


What is vitally important to tell patients is that they must not use topical analgesics if they’re also taking an oral nSaId – either prescription or otc – without telling their gP, as this could result in stomach bleeding.


Sprains and strains Sprains are caused by forcing a joint into an abnormal position that overstretches or twists ligaments. Paracetamol should be offered first line, with oral nSaIds such as ibuprofen only considered 48 hours after the initial injury. topical nSaIds offer an alternative, however. not only do they come with minimal adverse systemic side effects, but there is strong evidence to support


Osteoarthritis osteoarthritis is a painful, degenerative joint disease that often affects the hips, knees, lower back, neck, or small joints of the hands. topical therapies, such as diclofenac or ibuprofen gel are an effective first- line treatment, with strong evidence supporting their use, particularly for those who find that the gastrointestinal side effects of oral nSaIds intolerable. 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 osteoarthritis using a topical nSaId preparation reported reduced pain after six to twelve weeks.


Toothache/dental pain toothache occurs when the dental pulp, comprised of nerves and blood vessels, becomes inflamed. causes can include tooth decay, cracked teeth, loose or broken fillings, receding gums and periapical abscess. While many who seek treatment for toothache will opt for an oral nSaId, some patients do, however, prefer topical anaesthetics, as they act locally and quickly.


Sports injuries/muscle pain In addition to analgesic treatment, which usually consists of paracetamol and ibuprofen, patients can also derive great benefit from topical rubs, sprays and patches from the pharmacy, together with support bandages, which are available to suit every type of injury.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56