Pain management in the community: the effects of pharmacist interventions, and consumer perceptions

<p>The International Association for the Study of Pain defines pain as an `unpleasant sensory and emotional experience associated with actual or potential tissue damage.' It is typically categorised as either acute or chronic in nature. Chronic pain is a complex condition where patients experience persistent symptoms for at least 3 to 6 months. It is one of the leading causes of disabilities across the globe. Failure to adequately manage pain potentiates the rapid decline of the physical and mental wellbeing of sufferers. It is for this reason that those experiencing pain should consult with trained healthcare professionals to mitigate these health concerns and receive evidence-based therapy. Community pharmacists are one of the most trusted healthcare professionals who routinely encounter patients experiencing pain. Although pharmacists are perceived as trustworthy advocates of healthcare, there is limited research assessing the views and practical roles of Australian community pharmacists in the holistic approach to pain management. This PhD aimed to identify whether Australian pharmacists are indeed capable of extending on their pain management services with the aim of providing positive health outcomes to their patients.</p> <p>There were several objectives of this PhD. The first study investigated the views and practices of Australian community pharmacists in pain management. Although this PhD focussed on pain management, this study also investigated fever management since most Over-the-Counter analgesics available in pharmacies also exhibit antipyretic effects. Paracetamol was the most selected medicine by pharmacists for fever cases as well as for most mild-moderate pain cases. Despite the variability in responses to the case scenarios, most pharmacists believed that fever and pain clinical resources are important tools that should be used to guide therapeutic recommendations. Pharmacists were also asked to comment on their views of the 2018 codeine up-scheduling to prescription-only medicines. Approximately half believed that this restriction in codeine supply would provide positive outcomes for their patients. However, some conveyed that this restriction limited the number of OTC analgesics available in community pharmacies, making it more difficult to offer suitable options to patients experiencing uncontrolled symptoms (e.g. migraine attack). Although most pharmacological options selected by pharmacists were attuned to the recommendations outlined in clinical resources, the findings identified opportunities to promote additional pharmacist education, upskilling and awareness of the availability of clinical resources to further optimise pain and fever management.</p> <p>The second objective of this PhD shifted the focus onto patients experiencing pain. Thus, the second study investigated the practices of Australian adults experiencing pain, and their views of community pharmacy pain management services. Most reported that their pain levels had significant impacts on their quality/functionality of life. Paracetamol was the pharmacological preference irrespective of the severity of pain experienced. Approximately one-third did not find benefit in community pharmacy pain management services, although more than half disagreed when asked whether they would rather visit a supermarket than a pharmacy for analgesics. The opportunity was taken to also examine the views of participants on the 2018 up-scheduling of codeine-containing analgesics. Although some understood the reasons behind this change, more than 40% reported that the absence of OTC codeine preparations made it more difficult to self-manage acute attacks of their pain in a timely manner. The results identified further opportunities for pharmacists to extend on their interactions with their patients beyond the dispensing of medicines and offer alternative evidence-based therapies with the aim of bridging the gaps in patients' pain management knowledge and practices while also providing more awareness of the roles and responsibilities of pharmacists in this area.</p>     <p>One of the most common types of pain experienced is low back pain (LBP). Around four in five Australian adults will experience LBP at some stage in their lives, and 50% of LBP sufferers will seek medical care by visiting a health professional such as a pharmacist. An additional objective was therefore to conduct a third study which examined the knowledge and practices of Australian community pharmacists in LBP and assessed their views regarding the use and accessibility of clinical LBP resources. Around 75% preferred NSAIDs for the management of LBP, suggesting that most pharmacists were aware of the analgesic superiority of NSAIDs over paracetamol, as outlined in clinical resources. Interestingly, around 40% reported some difficulty in accessing LBP resources, with some reporting that they were unaware of the existence of LBP clinical guidelines. The results from this study highlighted the important need to further advance the knowledge and awareness of pharmacists in LBP management, particularly in finding and accessing clinical resources.</p> <p>The results of these studies identified and raised key issues in pain management, both from the pharmacists' and the patients' perspectives. Thus, the final objective of this PhD was to target these key issues and bridge gaps in pain management knowledge and practices. The final study therefore examined the effectiveness of an Australian community pharmacist-driven intervention in chronic pain management. It involved an analgesic medication management consultation which allowed pharmacists to engage with patients and identify issues they may have with their pain management practices. This pilot study also involved pharmacists following up with participants over a three-month period, which included a phone-call and a final in-pharmacy consultation. A total of 7 pharmacists across 3 community pharmacies recruited 12 chronic pain participants for this study. Although there were no statistically significant improvements in the pain intensity scores, there were statistically significant improvements in the quality/functionality of life parameters before and after receiving this intervention (‘general physical ability,’ ‘movement’ and ‘getting out of bed’). There was a high patient as well as pharmacist satisfaction in this intervention.</p> <p>This PhD examined the position of community pharmacists in pain management. Having identified the views and practices of pharmacists as well as the self-reported practices and perspectives of Australian adults experiencing pain, the promising results obtained in this pharmacist-driven intervention study (in conjunction with the results of the previous studies) solidify the argument that Australian community pharmacists can and should hold key roles in a multidisciplinary approach to pain management and are indeed capable of providing positive health outcomes to Australians suffering from pain.</p>