pain relief

Question 1

what are the main conditions we would treat for pain in community?

Answer 1

• Musculoskeletal pain (sprains and strains)
• Low back pain
• Period pain
• Headache (see ‘Headache’)
• Dental pain (toothache)

Question 2

what are the red flags for pain?

Answer 2

• Severe and debilitating pain
• Failure to OTC treatment or overuse of painkillers
• Pain which is progressively getting worse (with or without
the use of painkillers)
• Unusual bruising (urgent referral if patient is taking
anticoagulants and there is extensive bruising)
• Patients taking medications that may interact with OTC
analgesia

Question 3

what are the red flags for back pain?

Answer 3

• Pain following trauma e.g. car accident
• New back pain in patients under 20 or over 50
• Unexplained weight loss
• Past history of malignancy
• Associated bladder or bowel symptoms

Question 4

what is the lifestyle advice for pain?

Answer 4

For sprains and strains, recommend RICE:
• Rest – to prevent pain and worsening during movement
• Ice – will alleviate the pain and is recommended for up to 48 hours in intervals
• Compression – will provide comfort and may reduce swelling but avoid constricting the
blood flow especially in the elderly, patients with diabetes, and those with peripheral
arterial disease
• Elevation – will prevent gravitational oedema

Question 5

what is the first option for pain?

Answer 5

The first option is paracetamol tablets or liquid, that is available in various strengths depending on the preparation. Generally, paracetamol is considered as a safe medication and is suitable in children, adults, elderly and pregnant woman. Caution is advised in patients with a risk of hepatotoxicity.

Question 6

who is aspirin not suitable for?

Answer 6

Some patients may benefit from using aspirin 300mg, although this is not suitable for children under 16 years of age (due to the risk of Reye’s Syndrome).

Question 7

when should you give a patient a weak opioid?

Answer 7

atients who have not responded to paracetamol or ibuprofen may need short-term treatment with a compound containing a weak opioid (e.g. codeine or dihydrocodeine with paracetamol) – however these are not routinely recommended due to the risk of addiction with opioids and patients should be referred to their GP for chronic pain.

Question 8

what should you offer patients for period pain?

Answer 8

• Naproxen, although is a POM, can be purchased OTC (as Feminax Ultra®) for the treatment of primary dysmenorrhoea in women aged 15 to 50 years
• The recommended dose is to take two 250mg GR tablets initially followed by one tablet every 6-8 hours with food

Question 9

what should you offer patients with tooth pain?

Answer 9

• Usually dealt with by dentists, however painkillers may be provided in the short-term to those suffering with dental pain and discomfort
o Patients with persistent or recurring dental pain should be referred to the dentist to identify any underlying cause e.g. infection
• Teething in babies is a common ailment seen in the pharmacy and the baby can be provided with a teething gel, that contains a mild anaesthetic to numb the area
o Paracetamol may be indicated in babies presenting with an associated fever