Pain Management: A Pharmacist Session

Source: physio4gps
Document type: pharmacy presentation
Review status: unreviewed

Original file: Pain Management Classes - Pharmacist Presentation(1).pptx

PAIN MANAGEMENT – A PHARMACIST PERSPECTIVE

Martin Rayner + Mayoor Kerai

PCN Clinical Pharmacists

Canterbury Integrated Health

July 2023

Ground Rules + Housekeeping

Fire safety

Please ensure mobile phones are turned off/on silent

Please respect the views of others

Allow everyone the chance to speak

Confidentiality

Outline

Brief overview on chronic pain (video)

Medications for chronic pain

Side effects of pain medications

Long term harms of opioid medications (video)

Patient resources for chronic pain

Chronic Pain – Overview and Prevalence

Short term pain (acute pain) lasts days/weeks then resolves

Chronic pain (also called long-term or persistent pain) is pain that lasts more than 3 months

The problem is in the pain sensing system itself – rather than being a specific problem in the body

Common – upto 1 in 3 people in UK

Can affect in specific part of the body (e.g. back, shoulder) or throughout the whole body

It can be continuous or ‘flare up’

It can have other symptoms e.g. numbness, burning, electric shocks

Chronic pain is NOT a simple physical problem

There are lots of contributing factors – i.e. it’s complex!

All forms of pain cause distress and disability – but these are particularly prominent in chronic pain.

Medications for chronic pain

OPIOID MEDICINES e.g. morphine, tramadol, co-codamol, fentanyl, oxycodone etc.

NON-OPIOID MEDICINES:

PARACETAMOL

ANTI INFLAMMATORY DRUGS e.g. ibuprofen, naproxen

ANTIDEPRESSANTS e.g. amitriptyline, citalopram, sertraline

ANTIEPILEPTIC MEDICATIONS e.g. pregabalin, gabapentin

And more!!!

Common side effects of pain medications

ANTI-INFLAMMATORIES

Indigestion/Reflux

Nausea

Diarrhoea

Stomach ulcers/bleeding

Headaches

OPIOIDS

Nausea/Vomiting

Constipation

Dizziness

Dry mouth

Itchy skin

Drowziness

PREGABALIN/GABAPENTIN

Dizziness

Tiredness

Tremors (shaking)

Weight gain

Changes in mood

Impaired memory/concentration

ANTIDEPRESSANTS

Nausea

Dizziness

Reduced libido

Diarrhoea/Constipation

Headaches

Agitation

Long term harms of opioid medications

Along with side effects, long term use of opioids can:

Increase the risk of falls (and fractures)

Cause hormonal effects - lower sex drive, disrupt menstrual cycles and affect male/female fertility

Lower the immune system (increased risk of infections)

Lead to poorer quality sleep

Sensitize the nervous system and actually increase pain!!!

↑ Risk of accidental overdose and death

Non-medication strategies

PHYSICAL ACTIVITY (incl physio, Yoga, Tai Chi, pilates)

Cognitive Behaviour Therapy (CBT)

SLEEP HYGIENE

ACUPUNCTURE

MINDFULNESS/MEDITATION

Chronic Pain Patient Resources

https://livewellwithpain.co.uk/

https://youtu.be/bQjYkcoYze0 (Video - “Understanding Pain in less than 5 minutes)

https://youtu.be/MI1myFQPdCE (2 min Video - “Understanding Pain: Brainman stops his opioids”

Questions?

Things to print for the session for patients?

https://my.livewellwithpain.co.uk/resources/painkillers-and-me/ask-yourself-these-six-questions/ (for those taking gabapentinoids)

https://my.livewellwithpain.co.uk/resources/painkillers-and-me/the-great-opioid-side-effect-lottery/ (opioid side effects)

https://my.livewellwithpain.co.uk/wp-content/uploads/explaining-pain.pdf (Explaining Pain Leaflet)

About this document. This page reproduces a source document from the physio4gps group pain-management programme. It is transcribed from the file supplied by the programme: page and slide markers have been removed and multi-column sections reflowed, so reading order in some sections may differ from the original layout. Where text was illegible or clipped in the source this is stated in place. Identifying details are left as in the original. This is reference material, not clinical advice, and it has not been clinically reviewed.