At any time one million Britons are suffering from pain that could be prevented or better managed, says a UCL School of Pharmacy and Clinical Pharmacy Association report (‘Relieving persistent pain, improving health outcomes’) that argues the case for community pharmacies to contribute more to timely and cost-effective solutions.
One example of such a solution is a pilot scheme run by the Clinical Pharmacy Association that involved 10 community pharmacies in London performing enhanced pain-related MURs over six weeks, using the painDETECT tool. Results suggest that if the scheme were rolled out nationally, pharmacists could identify about 50,000 people with undiagnosed neuropathic pain and 10,000 other cases of serious illness involving pain as a symptom. In addition, they could provide more than one million guidance sessions for pharmacy users with pain-related problems.
‘Four in five people already think they should go to their pharmacy with pain-related problems. Enhanced community pharmacy-based services could help more of us respond to pain in timely and effective ways, and reduce the prevalence of persistent pain,’ says co-author of the report, Professor David Taylor.
LloydsPharmacy has set up a pain assessment service for customers. It involves assessing a patient’s level of pain and making recommendations to help them manage it.
‘We ask patients how pain affects their lifestyle and we’ll make recommendations, such as taking medicines at a different time or trying other types of exercise if one type is difficult. We can offer aids not available from their GP – TENS machines, hot and cold packs and living aids,’ says Nitin Makadia, condition category manager and pain specialist at Celesio. ‘Our service goes beyond pain and looks at lifestyle and quality of life.’
After an initial assessment, patients come in for follow-up sessions. Some 20,000 customers have used the service to date, with a third saying they’d noticed an improvement. ‘Pain management is an area where pharmacy could get more involved – we see pain sufferers more often than other health professionals and analgesics are our number one seller.’
Chris Rose, an independent prescriber and specialist in pain management, ran a pilot scheme from his community pharmacy in Essex, focusing on pain management. He saw 21 patients with unresolved chronic pain per month for six consultations. At the end of the trial 29 per cent of patients were discharged as they’d achieved their goal of better pain control. Some 61 per cent said their pain level had improved, as well as side effects and their mobility.
‘Pharmacists see patients with chronic conditions every month to dispense their medication, have expertise in the medication and can optimise it to maximise the benefit to the patient. Pharmacists are the best placed healthcare professionals to manage the medication of patients with chronic conditions such as pain.’
Numark has run a medicines adherence programme for patients with neuropathic pain in conjunction with Pfizer’s drug Lyrica. ‘We wanted to see how we could improve medicine taking and patient understanding of pain. We have lifestyle as well as medicines advice and trained our pharmacists on how to approach the problem,’ explains Mimi Lau, director of pharmacy services. Some 118 pharmacies took part, recruiting 368 patients over three months.
‘Feedback from customers was excellent. Pain levels went from an average of 7.5 to 3.3. Everyone said the programme improved their understanding of their condition, 99 per cent felt it was valuable and 88 per cent said it improved medicines understanding. Some 90 per cent of the pharmacists said it was a worthwhile scheme.’
Numark pharmacist Bharat Pandya of Jetsol Pharmacy, Canning Town, took part. ‘Many of our patients are on medication for chronic pain – up to three in 10 prescriptions – most commonly back pain, neuralgia and arthritis. Patients who took part in our scheme said it improved understanding of their condition. We have the time to explain medicine side effects to patients and when to expect improved pain relief.’
Pharmacist David Barrett is launching an online pain clinic through his business White Pharmacy, which will involve doctors, pharmacists and nurses. The private service aims to attract 200 patients per month initially. ‘Patients will have a full medical history taken by a nurse, followed by a face-to-face online consultation with a doctor, then follow-up support from a pharmacist on medication management. A treatment plan is then developed for each patient. I think there is a need for this type of service – GPs just don’t have time and are often unsure about how to help patients with chronic pain.’
It is important to ask the customer questions to ensure you make the right recommendation, such as who is the medicine for and what are the symptoms, advises GSK.
Use visual tools with customers to help understand the type of pain, such as how it occurred and how long the customer has had the pain, suggests Charlotte Messer, a spokesperson from Reckitt Benckiser. This will help pharmacy staff to recommend ways of potentially avoiding the pain in future and speeding up recovery time.
‘It’s also important for pharmacy staff to keep their knowledge up to date and take advantage of training opportunities,’ says Lynn McGuiness at The Mentholatum Company. ‘Good signposting and information POS material help direct customers to appropriate products. We know that customers shop across the brands throughout the pain cycle, so it makes sense to display these categories of products together.’
‘Assistants should be trained to ask the customer if they need a bigger pack or signpost at the GSL fixture to let customers know there are other options behind the counter and to speak to a pharmacist or pharmacy assistant,’ says Ms Messer.
The UCL School of Pharmacy has devised eight ‘Less Pain’ questions for pharmacists to discuss with customers when talking about pain management:
The Nurofen Topicals range is being supported by a £2.5 million media campaign and Reckitt Benckiser is currently holding training seminars around the country with a headache toolkit to help facilitate conversations in pharmacy. The company has also launched a pharmacy training portal with information on how you can help customers to manage pain.
The Mentholatum Company has a new pharmacy leaflet, ‘Topical pain relief’, to show which types of product are most suitable for which stages and types of pain or minor injury. Deep Relief is being supported with a £1 million radio campaign to mid-February, targeting women with back and muscular pain.
Bipin Patel, Broadway Pharmacy, Bexleyheath ‘We give customers information on what they can and can’t take with pain relief medicine, along with all of the other necessary information. We check the contraindications and make sure they aren’t suffering with anything else. We also take a full medical history and recommend an appropriate product accordingly. Pharmacy could improve its over-the- counter sales by recommending heat patches or rubs to work alongside the analgesic product being purchased. Sometimes it’s an old-fashioned thing like a hot water bottle that does the trick. One key challenge in the category is advising people who always use one particular pain management product on a regular basis.’
Ramesh Patel, Brownes Chemist, Abbey Wood, London ‘If a customer comes in with pain we tell them that if it doesn’t subside in two or three days they need to get further medical advice. Some patients do come back to us in a few days’ time for further advice and if the pain persists we suggest they visit their GP, or dentist for tooth pain and potential infection. Many people are not registered with a dentist so we do often have customers who come in with tooth problems. Talking to patients about the pain they are suffering from is a good way to improve over-the- counter sales in this category. It is important to train staff on pain management so they understand the differences between backache pains, kidney problems and colic pains, for example.’
Nawaz Mohamed, locum pharmacist, Sheffield ‘Brand awareness is key in this category because many customers display brand loyalty, so it is important to ensure that key lines are optimally displayed. It is also essential that the pharmacy orders enough stock to meet demand in the pain management category, especially for the best-selling products and it is a good idea to have replacement brands available for any best seller that goes out of stock. One of the main challenges today is codeine addiction in the community, which can be difficult to spot. All customers purchasing codeine- containing products should be advised that they are to be used for up to three days only, and that longer-term use can actually increase pain. Staff should be trained to recognise repeat requests for codeine products.’