PAIN


PRESCRIPTION ADDICTION


SCOTTISH PHARMACIST EXAMINES WHETHER OPIOIDS ARE BEING PRESCRIBED AS A ‘QUICK FIX’ SOLUTION AND LOOKS AT THE VITAL ROLE THAT TOPICAL ANALGESICS PLAY IN TREATING CHRONIC PAIN.


PRESCRIPTION ADDICTION


Chronic pain conditions are amongst the most signifi cant causes of suffering and disability worldwide. An estimated 49 per cent of patients in the UK, who have chronic pain, also suffer from depression. It is also associated with poorer mental wellbeing, anxiety, job loss, impaired function and limited daily physical and social activities.¹


ARE ORAL ANALGESICS BEING OVER-PRESCRIBED?


With chronic pain so prevalent in our society, it is hardly surprising that prescriptions for opioid painkillers have increased. They have in fact doubled from twelve to 24 million in the past decade, with recent estimates suggesting that over 192,000 people could be dependent.²


With such shocking statistics, it begs the question as to whether powerful and potentially addictive opiate painkillers are being prescribed too readily by GPs. Addiction to any substance can have a potentially life-changing effect on a person’s health and wellbeing, which is why GPs should carefully consider the risks of a drug before prescribing it to a patient. A recent study by Opioids Aware concluded that opioids may reduce pain for some patients in the short and medium term (less than twelve weeks). However, there is 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.³


The relief of pain should be seen as a clinical priority, yet the prescribing of opioids is often not the most appropriate or effective treatment option for many patients with chronic pain, and can risk exposing patients to unnecessary harm. Despite the increasingly overwhelming body of evidence that oral analgesics do not work in the long term, it doesn’t 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.


Deaths from addictive painkillers have almost doubled in a decade as trends in Britain follow ‘alarming’ US patterns. The fi gures, comparing trends in the decade ending 2011, show almost 900 such deaths, compared with almost 500 in 2001.


Opioids act on different parts of the brain and nervous system, including the spinal cord. The latter receives sensations from the body before sending them to the brain. Opioids work on this area to decrease feelings of pain, even after injury.


All opioids are chemically related and interact with opioid receptors on nerve cells in the body and brain. Opioid pain relievers are generally safe when taken for a short time and as


prescribed by a GP but, because they produce euphoria in addition to pain relief, they can be misused (taken in a different way or in a larger quantity than prescribed, or taken without a doctor’s prescription). The 2016 BMA analysis report on prescribed drugs associated with dependence and withdrawal highlighted the potential that opioids, prescribed to treat chronic pain, will lead to tolerance and physical dependence, especially with prolonged treatment and at higher doses.4


WHAT IS THE VITAL ROLE THAT TOPICAL ANALGESICS PLAY IN CHRONIC PAIN RELIEF?


Tablets are often the go-to pain


relief treatment but topicals are really driving the market at the moment. The topical analgesics market is worth £82.9 million and is experiencing a healthy growth of 12.2 per cent.5


Topical analgesics were developed, in part, to provide the symptomatic benefi ts seen with oral agents but without the systemic adverse effects associated with oral analgesics.


With topicals comes variety, with products available as gels, creams, patches and sprays and there is growing evidence that they are effective. These products may have local analgesic, anesthetic, antipruritic and/or counterirritant effects. A scientifi c review by the Cochrane Collaboration,


concluded that topical non-steroidal anti-infl ammatory drugs (NSAID) could offer the same pain relief as the oral versions.6


Topical pain relief offers an attractive option for managing pain because the products are applied directly to the site of pain, providing targeted relief and carrying less risk of adverse effects. They may also be more suitable for patients on complex medication regimens, who wish to avoid taking more tablets, or who have diffi culty swallowing solid-dose forms.


Like their oral equivalents, topical analgesics, such as ibuprofen and diclofenac, reduce pain by blocking the enzyme cyclo-oxygenas, thereby inhibiting the production of pain- causing prostaglandins and reducing infl ammation.


However, while oral NSAIDs can be associated with adverse effects, such as gastric irritation and urticaria, as well as certain drug interactions, topical NSAIDs have minimal adverse systemic effects. Under advice from the GP, topical analgesics for musculoskeletal pain can be used alone or in conjunction with oral analgesics.


The factors that a pharmacist may consider when recommending a topical analgesic include dosage form, cost, ease of use and odour of product, as well as the patient’s medical history including possible allergies. As a general rule, they may


SCOTTISH PHARMACIST - 21 >


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