Home' Australian Pharmacist : February 2013 Contents 36 Australian Pharmacist February 2013 I ©Pharmaceutical Society of Australia Ltd.
'But you have to have that
understanding as to where to lead
them on to thereafter. The policing role
[as in reporting] is important but it's a
very reactive approach. We need to be
proactive, she said.
'It's a multi-pronged approach
that is needed. As pharmacists our
understanding is very uni-dimensional
at the moment because we have
analgesics and that seems to be all we
have for pain. Chronic pain doesn't
respond to that, acute pain does. So
what can we offer? There is a lot more
we can offer and we are still at the
coalface for pain sufferers so we have to
really look at the opportunities we have
to provide better care.
'We have to navigate correctly the new
approach to chronic pain and that may
mean we may need to create those
healthcare collaborative hubs which are
encouraged in the new healthcare model.'
Professor Louisa Degenhardt of the
University of NSW said it was important to
recognise the 'many complicated clinical
issues going on with this group of people,
many of which have nothing to do with
opioids per se'.
The POINT study is the first large-
scale Australian prospective cohort
investigation to rigorously examine
opioid analgesic prescribing patterns
amongst chronic pain patients at a
population level, and their relationship
to important health outcomes and
to mortality. It will comprehensively
examine the extent to which opioid
therapy for chronic pain is associated with
pain reduction, adverse events including
side effects, quality of life, and mental and
physical health outcomes.
'One of the things we're finding is there
is a lot of co-morbidity between mental
health problems and chronic pain,'
'And so with the people we are
interviewing there are really high
levels of depressions and really high
levels of suicidal thought so there so it
understandable at times that they feel so
low, as their lives are pretty miserable.'
Professor Degenhardt said she believed
there was a need to think about
non-opioid interventions and potentially
non-medication interventions in
'I think that aspect is being overlooked
in the broader debate about opioids
because people are understandably
focussing on the group of people who are
not using opioids as intended,' she said.
'More opioids are being prescribed so
people are noticing the problem more
because there is more of it around,
'When we're looking at things like
mortality it doesn't look like there is a
greater risk of mortality for the amount
being prescribed. The mortality risks
seem to be fairly consistent given the
level of prescribing; it's just that there is
more prescribing going on.
'So it's not that doctors are all of a sudden
prescribing to risky patients who are
dying at higher rates as a result of taking
'But there are more opioids around and
people are noticing but the riskiness of
prescribing hasn't changed. That seems to
have remained steady.'
The view that a different approach
needs to be taken to pain management
was reinforced by Lesley Brydon, Chief
Executive Office of Painaustralia.
The National Pain Strategy outlines the
need to treat acute and chronic non-
cancer pain quite differently.
'Opioids are quite often a very important
part of the management of acute pain,
particularly after surgery, injury or
trauma,' she said.
'However, they have very limited role in
the potential management of chronic
non-cancer pain. They potentially have
a role in cancer pain management and
certainly have a role in palliative care.
But for the management of chronic
non-cancer pain such as arthritis, MS or
other diseases conditions or of pain of no
particular known origin, they have very
'We advocate a multi-disciplinary
approach for many people can be very
successful in managing chronic pain
without any medication at all. But for a
very few people who do not respond well
to other medications such as NSAIDs or
neuropathic drugs then the use of opioids
in closely managed conditions may be
necessary. But they are a very few people.'
Painaustralia believes other alternatives
should be adopted, usually used in
conjunction with other therapies.
Physiotherapy could be very important
and cognitive behavioural therapy could
also be very effective.
'Learning self management techniques
and how to activate the body's own pain
management mechanisms have proved to
be very effective. There's good evidence
on that,' she said.
'We strongly advocate for a
multidisciplinary approach but
acknowledge that there are some people
who need to use opioids in a controlled
and well-managed manner. However,
they should be used in conjunction with
'They should be constantly monitored
and where possible other therapies
should be integrated.
'The opioid monitoring scheme would
probably be quite useful in terms
of controlling how these drugs are
dispensed and used.
'However, they don't help the person
Ms Brydon said the overriding
consideration had to be what needed to
be done for the person in pain.
'That is, that they need to be given
help and proper advice in the first
circumstance. There is a universal need
for education and training for health
professionals about multidisciplinary
approaches to pain management,'
'We are launching an online module for
with the RACGP on pain management
which includes a comprehensive
module on the quality use of use of
opioids. We are negotiating to have that
adapted for pharmacists, nurses, clinical
psychologists, physiotherapists and other
allied health professionals.
'We think having a better understanding
of the multidisciplinary approaches will
be of enormous help to pharmacists.'
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