ADDICTION


transforming the stimuli into electrical signals, which are then conducted to the central nervous system.


Distributed throughout the body (skin, viscera, muscles, joints, meninges) they can be stimulated by mechanical, thermal or chemical stimuli. Inflammatory mediators are released from damaged tissue and can stimulate nociceptors directly. they can also act to reduce the activation threshold of nociceptors so that the stimulation required to cause activation is less.


The misuse and unnecessary prescription of opioid painkillers are issues of serious concern. We are fast becoming a society dependent on drugs for pain relief and too many people are quietly self-harming with their overprescribed opioid painkillers


> 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.7


topical analgesics were developed, in part, to provide the symptomatic benefits 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 scientific review by the cochrane collaboration concluded that topical non-steroidal anti-inflammatory drugs (nSaID) could offer the same pain relief as the oral versions.8


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 difficulty 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-


12 - PharmacY In focUS


causing prostaglandins and reducing inflammation.


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 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 the physiological response to pain? Pain stimulates pain receptors and this stimulus is transferred via specialised nerves to the spinal cord and from there to the brain. the pain stimulus is processed in the brain, which then sends an impulse down the spinal cord and via appropriate nerves which command the body to react.


nociceptors are the specialised sensory receptors responsible for the detection of noxious stimuli,


the pain sensation, however, is only one part of the nociceptive response, which may include an increase in blood pressure, an increase in heart rate and a reflexive withdrawal from the noxious stimulus. If pain cannot be alleviated, psychological factors, such as depression and anxiety, can intensify the condition.


How does the body react to pain? Pain transmission is a result of complex peripheral and central processes. It is both a sensory and emotional experience, and patients’ past experiences, fears and anxieties can play an important role. It has a biologically important protective function and the sensation of pain is a response to injury or disease, and is a result of normal physiological processes within the nociceptive system.


genetic and environmental factors contribute to sensitisation, resulting in chronic pain in some individuals even after healing has taken place. nociceptors not only signal acute pain but, when chronically sensitised, contribute to persistent pathological pain disorders from previous injury or ongoing disease.


there are many types of pain management and each of them has their own benefits, drawbacks, and limits. a common difficulty in pain management is communication.


People experiencing pain may have difficulty recognising or describing what they feel and how intense it is. the misuse and unnecessary prescription of opioid painkillers are issues of serious concern. We are fast becoming a society dependent on drugs for pain relief and too many people are quietly self-harming with their overprescribed opioid painkillers.


With such alarming statistics, those prescribing these medicines need to ensure they are not doing more harm than good. healthcare professionals are increasingly being advised to encourage patients to try other forms of treatments, such as counselling, exercise and physiotherapy.


topical analgesic therapy is nonetheless a potentially valuable strategy in the management of a variety of conditions associated with acute or chronic pain, including acute soft tissue injuries, chronic musculoskeletal pain and various neuropathic pain disorders.


References 1. northern Ireland Statistics and research agency (nISra). https://www.nisra.gov.uk /publications/drug-related-deaths-northern- ireland-information-paper 2. the Lancet. https://www.thelancet.com/pdfs /journals/lancet/PIIS0140-6736(16)31678-6.pdf 3. nhS Digital figures. 4. northern Ireland Statistics and research agency (nISra). https://www.nisra.gov.uk /publications/drug-related-deaths-northern- ireland-information-paper 5. opioids aware. https://www.rcoa.ac.uk /faculty-of-pain-medicine/opioids-aware 6. British medical association. 7. IrI Data 8. cochrane collaboration. http://www.cochrane.org/cD007400/SYmPt_t opical-nonsteroidal-anti-inflammatory-drugs- chronic-musculoskeletal-pain-adults


Ralgex Iconic topical analgesic brand, ralgex, returns to the market. ralgex muscle rub cream has strong brand recognition as a trusted muscle pain remedy, offering symptomatic relief of muscular aches and stiffness. for use before or after exercise, the effective warming ingredients increase blood flow and soothe pain. ralgex muscle rub cream offers symptomatic relief of muscular aches, pains and stiffness, including backache, lumbago and fibromyalgia and can be applied up to three times a day. ralgex muscle rub cream is suitable for adults and children aged 12 and over and retails at £3.69 for a 45g tube.


for orders contact Laneshealth sales team on 01452 507458


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