PAIN
PAIN ReMAINs ONe OF THe MAIN ReAsONs FOR PATIeNTs PReseNTING AT GP suRGeRIes. WITH PAIN AFFeCTING ANY PART OF THe BODY, THe TReATMeNTs FOR IT ARe As DIVeRse As THe CAuses. PIF TAKes A CLOseR LOOK AT…
The possibilities for PAIN P
ain affects everyone at some time or another. Whether it’s a ‘one-off’ treatment that is
required, or long-term treatment for chronic pain, there are many diverse options available.
Over-the-counter (OTC) medication This is the most common form of pain medication, with patients often attending the pharmacy for nonsteroidal anti-inflammatory drugs (NsAIDs) such as aspirin, ibuprofen and naproxen to treat pain caused by muscle aches and stiffness. Topical pain relievers are also popular.
Prescribed analgesics In the event that OTC medication doesn’t work, then the doctor may prescribe stronger medications, such as muscle relaxants, anti-anxiety drugs or anti-depressants for musculo-skeletal pain prescription NsAIDs or a short course of stronger painkillers, such as codeine or fentanyl, or acetaminophen.
The ‘analgesic ladder’ In 1986, the World Health Organisation (WHO) produced the analgesic ‘ladder’ for clinicians to use when developing treatment plans for cancer pain. Over the years, this
20 - PHARMACY IN FOCus
guideline has been adopted by clinicians throughout the world to treat not only cancer pain but any type of pain.
According to WHO, if pain occurs, there should be prompt oral administration of drugs in the following order: non-opioids (aspirin and paracetamol); then, as necessary, mild opioids (codeine); then strong opioids such as morphine, until the patient is free of pain. To calm fears and anxiety, additional drugs – ‘adjuvants’ – should be used.
To maintain freedom from pain, drugs should be given ‘by the clock’, ie, every three to six hours, rather than ‘on demand’.
Over the years, this three-step approach of administering the right drug in the right dose at the right time has proven to be 80-90 per cent effective.
There are, however, many other pain- relieving options available….
Injections Where medication – either prescribed or OTC – does not treat the pain adequately, steroid injections at the site of a joint problem can reduce swelling and inflammation.
sometimes, a group of nerves that causes pain to a specific organ or body region can be blocked with local medication. The injection of this nerve-numbing substance is called a nerve block. On occasion, however, blocks may not be possible or are too dangerous.
Another form of pain control is patient-controlled analgesia (PCA). This enables the patient to self administer a pre-measured dose of pain medicine – often infused with opioids – by pushing a button on a computerised pump. This allows
medicine to be injected intravenously, subcutaneously or into the spinal area.
Trigger point injections These are procedures which are often used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. The procedure involves a healthcare professional injecting a local anaesthetic using a small needle. The anaesthetic, which may or may not include a steroid, renders the trigger point inactive; thereby relieving the pain. In most cases a
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