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CONTINUING PROFESSIONAL DEVELOPMENT
Consideration must be given not
only to pain control for Mrs PM
but also to non-pharmacological
therapies, which will help her cope
better with chronic pain, e.g. graded
exercise, stress management and goal
setting (see Table 2).3 A multifaceted
approach needs to be adopted and
any psychological and social factors,
which impact upon her mental beliefs
around pain, need to be identified and
It is important to note that chronic
pain is rarely simple with most
patients having both nociceptive
and neuropathic components.
suggested to Dr IO that he consider
adding paracetamol ,which has an
changing the citalopram to duloxetine
– an antidepressant which has some
evidence for use in CNCP (beyond the
scope of this article).
1. Rossi S, ed. Australian medicines handbook. Adelaide:
Australian Medicines Handbook; 2015.
2. NPS MedicineWise. Educational visiting card. In: Chronic
pain: opioids and beyond; 2014. At: www.nps.org.au/
3. Frieden TR, Houry D. Reducing the risks of relief - the CDC
opioid-prescribing guideline. N Engl J Med. 2016. At: www.
4. NPS Medicine Wise. Chronic pain: opioids and beyond. In:
Educational visitors site. 2015.
5. Blanch B, Pearson SA, Haber PS. An overview of the patterns
of prescription opioid use, costs and related harms in
Australia. Br J Clin Pharmacol 2014;78(5):1159–66 . At: www.
6. Chaparro LE, et al. Opioids compared to placebo or other
treatments for chronic low back pain. Cochrane Database
of Systematic Reviews 2013, Issue 8.
7. At: www.ncbi.nlm.nih.gov/pubmed/23983011
8. Analgesic Expert Group. Analgesic, version 6. Melbourne:
Therapeutic Guidelines; 2012.
9. Sivertsen B, Lallukka T, Petrie KJ. Sleep and pain sensitivity
in adults. Pain 2015;156(8):1433–9 . At: http://journals.
10. Velayudhan A, Bellingham G, Morley-Forster P. Opioid-
induced hyperalgesia. 2014. At: www.medscape.com/
11. Jammal W, Gown G. Opioid prescribing pitfalls: medicolegal
and regulatory issues. Aust Prescr 2015;38(6):198–203. At:
12. Davey A. Codeine-related deaths more than double. 2015.
13. Roxburgh A, Hall WD, Burns L, et al. Trends and characteristics
of accidental and intentional codeine overdose deaths in
Australia. Med J Aust 2015;203(7):299. At: www.mja.com.au/
14. NPS MedicineWise. Codeine-related deaths: a cause for
concern. In: MedicineWise News. 2015. At: www.nps.
15. McDonough M. Safe prescribing of opioids for persistent
non-cancer pain. Aust Prescr 2012;35(1):20–4 . At: www.
16. Chou R, Turner JA, Devine EB. The effectiveness and risks
of long-term opioid therapy for chronic pain: a systematic
review for a National Institutes of Health Pathways
to Prevention workshop. Ann Intern Med. 2015 Feb
Australian Pharmacist Continuing Professional
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The CPD section is recognised under the PSA
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can choose which articles they want to answer
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1. How is chronic pain defined?
a) Pain that has been present for
b) Pain that has been present for >6 weeks.
c) Constant daily pain lasting for 3 months
or more in the last 6 months.
d) Pain that has been present for
2. Which of these is NOT a recognised
adverse effect of an opioid?
a) Respiratory depression.
b) Dental caries.
3. If the use of an adequate dose of
opioid for 4 weeks has not shown an
improvement in patient wellbeing
and functioning, should it be
4. What is allodynia?
a) An increased response to a normally
b) A painful response to a non-painful
c) A drug to treat gout.
d) Increased pain due to opioid use.
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