Pain management is recognised as a core category for community pharmacy. Yet chronic pain, in particular, is still often not being adequately addressed

Nearly 10 million Britons suffer pain almost daily, which can have a major impact on their quality of life and result in days off work. Effective selfmanagement should enable chronic pain sufferers to minimise the impact it has on their everyday lives. But according to Heather Wallace, chair of Pain Concern, recent NICE Quality Standards statements released in June indicate that for more than 7 million people in the UK with osteoarthritis, the burden of pain is still not being addressed.

“For many people with osteoarthritis, the impact on their lives is enormous and may prevent them from working, being able to participate in sport or outdoor activities or perform simple everyday tasks,” she says. “In the absence of a cure or effective pain-relief therapies, people with osteoarthritis need to be empowered with agreed effective plans to help them understand their condition and afford them some relief from their pain.”

Elvy Mardjono, senior product manager for Deep Relief Pain Relief Gel, says a recent survey for the brand revealed that six out of 10 people with painful joints had seen a doctor about their pain, but fewer than one in five had asked for advice from a pharmacist. “This suggests that joint pain is an area where pharmacy can do more – both by reviewing their joint pain fixtures and ensuring that customers know they can ask the pharmacist for advice on managing their pain once the cause has been diagnosed,” she says.

“Pharmacists can make a difference, not just by recommending OTC analgesics, but also by advising on lifestyle changes that may help. Mentholatum’s new consumer leaflet, Pain Relief Without Pills, helps consumers understand how and when to use topical pain relief products most appropriate for their needs.”

Topical relief

Topical analgesics may be an option for customers who are unable to take oral analgesics or who have problems with compliance. According to Denika Fletcher, Movelat brand manager, pharmacists need to feel confident enough to recommend the most suitable products. “Together with leading experts in the field, we have developed an easy-to-digest pharmacy refresher guide for pharmacists to help their patients manage their muscular pains, stiffness, sprains, and strains more effectively,” she says.

“The guide is designed to aid pharmacists when discussing pain and includes useful information such as defining pain, considering which OTC medicines are right for the patient, as well as ways on consulting the patient to ensure the patient’s needs are met.” Voltarol has launched the Voltarol 140mg Medicated Plaster, a medicated pain relief plaster with anti-inflammatory action, available from behind the pharmacy counter.

“Voltarol 140mg Medicated Plaster has been developed to answer a specific need, as we know there are customers looking for an antiinflammatory action when purchasing pain relief patches,” says Hannah Eckstein, Voltarol brand manager.

“The new Voltarol Medicated Plaster provides exactly that – the powerful anti-inflammatory diclofenac in a plaster format. The launch of the plaster provides pharmacists with the opportunity to recommend a ‘trade-up’ from their patients’ usual patch product,” says the brand.

James Barder, chief executive of Future Medical, believes brands need to exploit state-of-the-art delivery technologies to maintain their market share. Futura Medical has developed a “new generation” of topical pain relief with two products that target more active ingredients directly to the point of pain. Both products – TPR100 Diclofenac gel and TIB200 Ibuprofen gel – benefit from Futura’s multi-action skin permeation technology, DermaSys, designed to target pain for up to 12 hours.

Non-medicated relief

Dawn Rothwell, a pain therapist based in Saddleworth, suggests pharmacy teams should look to offer drug-free ways to help manage pain as well as the more traditional painkillers. The drug-free non-invasive Painmaster patch uses microcurrent therapy.

“It’s especially beneficial for customers suffering with chronic pain including back pain, muscular aches and pain, and continuous and occasional pain,” she says. “A microcurrent pain patch is helpful in targeting multiple areas of pain in a localised way and relieving muscle tension. It can be worn under clothing and during everyday activities and sport.”

The Futuro brand from 3M is partnering with The Miles Group to expand its range of first aid braces and supports. The range has been developed specifically to help with ailments such as arthritis, tendonitis, back pain, carpal tunnel syndrome and bursitis.

Futuro Custom Dial Products offer a personalised fit for the knee, elbow and wrist, using a dial technology system to provide targeted pain relief and easy on the go adjustment. The Futuro Night range offers support with breathable, moisture-wicking materials. The supports are ideal for those who suffer from carpal tunnel syndrome, or who have injured, arthritic, weak or post-cast wrists. Nutritional supplements may also help.

“Studies have shown that ingesting hyaluronans, either as a supplement or from food sources, improves discomfort and disability in patients with osteoarthritis of the knee,” says dietitian Dr Emma Derbyshire. “Given what we now know about hyaluronic acid, it also makes sense to try a supplement, or use a topical HA gel, such as Regenovex, to help protect and maintain joint function and mobility.”

Preventing chronic problems

Some types of pain (eg headaches) are acute, but can develop into a chronic problem if they aren’t treated effectively. Headache is an important category for pharmacy, with pharmacy teams seeing and engaging with patients daily on their treatment habits. But despite this, the majority of pharmacy staff still think only half of their patients understand the importance of correct dosing.

“Although the pharmacist is well placed to provide first-line advice on the management of the different types of headache, recent UK research (involving 2,000 adults) revealed that about half of sufferers have rarely or never sought advice from a pharmacist,” says Craig Shaw, marketing director for Nurofen.

“Treatment should be taken at the first sign of symptoms to gain relief as early as possible. Treating an acute tension-type headache may prevent prolonged sensitisation of the central nervous system, which is thought to play a key role in the development of chronic tension-type headache.” Nurofen Express has partnered with Migraine Action to launch a campaign highlighting the need for better management of headache and migraine and the role of pharmacy in facilitating change.

Migraine and Headache Awareness Week (6–12 September 2015), presents pharmacy teams with the ideal opportunity to invite customers into store to discuss headache and migraine management.

Shaheen Bhatia, Broadway Pharmacy, Bexleyheath “Pain covers a variety of conditions, so we will often sit down with the patient to try to work out the source of the pain, to judge if the problem can be dealt with in pharmacy or whether or not they need to be referred to their GP. In our area, the minor ailments scheme has conditions listed rather than medications. We can give painkillers for raised temperature and muscle pain but not for symptoms such as headaches. This is because the source of a headache has to be investigated, if it’s not just a normal headache. It’s important to make sure someone is using a suitable product. High profile advertising campaigns from the brands do help to highlight to customers what’s available. This also leads to conversations – people know the products already, and so can ask, ‘If I get this will it be good for me?’ From a business point of view, I think it makes sense to stock Tens machines and recommend them.”

 

Rena Dadra, Village Pharmacy, Harlington “This is a very important category for our pharmacy. We have a large section of pain management products, which we’ve actually just expanded further this year. The Voltarol brand and ibuprofen products sell extremely well. Patches and the hot and cold treatment options are very much in demand at the moment. We also stock Tens machines, and we have a sports section as well with the Medi-care range. Advice is definitely the main thing to get right with this one.”

 

Fiona McElrea, Whithorn Pharmacy, Whithorn “This is very important; we give out a lot of advice about pain management. A lot of people don’t know what painkillers they can take with the medication they’re already on or don’t know what they can take with other painkillers. The best sellers for us are Solpadine Plus, Nurofen Plus and generics. The advice is the main thing to get right; making sure that patients are getting the right advice and taking the medication correctly. The way that some branded products are advertised has annoyed me in the past. Companies advertise their ‘new’ product, but actually it’s the same as an older product, just repackaged, and we have to explain this to patients as it’s confusing. It happens in the coughs and colds category as well. I think that drug companies have to take responsibility for this. That’s where the category can improve, I think.”

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