Pain: don’t focus on the product

New figures suggest a third of Australians suffer from chronic pain, and many don’t have an effective plan to manage it

With the February 2018 upscheduling of codeine looming, many stakeholders are focusing on the availability of codeine and suggesting alternative treatments, says Amcal spokesperson and senior pharmacist James Neville.

But a wider focus could be of benefit to many, he says.

“Pharmacists need to understand the patient,” Mr Nevile told the AJP. “Some people get hung up on which products are available, but when you’re patient-focused the availability of codeine or whatever becomes less relevant, because you’re thinking about the patient and working with allied health professionals to find the best solution for that patient.”

Mr Nevile was commenting on new figures released by Amcal which suggest that 33% of Australians suffer from chronic pain, with 20% admitting to taking anti-inflammatories or other painkillers several times a day to try and manage their symptoms.

Almost four in 10 chronic pain sufferers claim they experience moderate-to-severe discomfort for 24 hours a day.

More than a quarter—26%—are living without an effective pain management plan, and one in 10 have decided to self-manage their pain rather than seek specialist advice.

The three most common types of pain experienced by Australians are backache, headaches and sore joints, with ibuprofen ranking high on the list of favoured pain relief treatments.

“The significant impact that chronic pain can have on a person’s life should never be underestimated,” Mr Nevile says.

“Our research showed that more than half of chronic pain sufferers frequently experience low mood due to their condition, while a quarter said it impacts their love life. It may also mean that an individual living in constant pain can’t work in their chosen career—or work at all.”

He expressed concern that people taking NSAIDs on a daily basis are at high risk of developing side effects including indigestion, stomach ulcer or undetected damage to their stomach lining and digestive tract.

Amcal has just launched its free personalised pain management plans for consumers, but Mr Nevile encouraged pharmacists more widely to consider working with their patients to find a well-rounded pain management solution.

“Our research revealed a core group of people are using them every day, or coming in for large quantities of Panadeine Forte, those sorts of things,” he said.

“We seem to be getting feedback from pharmacy that there’s an overly big focus on the medicine itself, and this idea that we need to control supply, as opposed to trying to understand the type and nature of the pain.

“I think for some patients there’s the mentality that you just want to take something, get rid of the pain and move on, but particularly with chronic pain underlying things need to be addressed, whether that’s musculoskeletal, a weigh management issue, diabetic neuropathy or something else.

“We did some work around weight management and joint pain over the last couple of years, and we showed significant improvement in joint pain scores by helping with weight management without focusing on pain.

“We’d like to see a deeper understanding from patients, but also a patient focus from pharmacy and a multidisciplinary approach to sorting them out, rather than just restricting supply.”

Pharmacy is the ideal place to initiate this approach, he says, due to its accessibility and the relationship pharmacists often have with their patients.

And the same approach applies to people who have built up a dependence on codeine, he says, particularly given it is soon to become prescription-only.

“Even for people that are ‘misusing’ this medicine, the reality is they didn’t start out want to misuse it, but it’s started because they had a clinical issue that wasn’t solved,” Mr Nevile says.

“Because it wasn’t well managed, it’s escalated to being dependent. So rather than focus on the change and the product, I think our role as pharmacists is to focus on the patient and the cause of the pain, and the symptoms they’re trying to treat.

“If we focus on that, the product becomes less important, and it’s about the right overall solution.”

The Amcal data is the second set of findings this month to show high levels of chronic pain amongst Australians.

Results from the 2017 Global Pain Index showed Australia has the highest rate of weekly body pain of 32 countries surveyed, affecting 68% of Australians.

These results also showed that one in four such sufferers would rather see a pharmacist for help than a doctor.

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