In the UK, almost 10 million people live with pain every day, but many are not getting the relief they need. Experts tell us how best to treat common painful problems

Pain is often dismissed as a minor inconvenience that most people just ‘put up with’. Yet it can have a major impact on people’s overall wellbeing if it’s not treated or managed correctly. And according to a survey by Reckitt Benckiser, a quarter of people who buy pain medication are dissatisfied with it, illustrating a clear need for advice and guidance from the pharmacy team.

Pain occurs for many different reasons, so it’s important that advice about pain relief is tailored to each individual customer. Pharmacy staff can help customers to manage their pain more effectively by asking them why they need over-the counter (OTC) analgesics and checking that the product they are taking, or asking for, is the right one for their needs. Here are some common questions that pharmacy customers may ask.

Do faster-acting analgesics work and how long do they last for?

When pain strikes, most people want to relieve it as quickly as possible, so it’s not surprising that faster-acting analgesics are popular, especially for acute pain such as headaches. “Liquids or soluble formulations are already dissolved, so they get absorbed more quickly and therefore work faster,” says Michael Stewart, Numark’s information pharmacist. “Some of the fast acting products contain different versions of the usual painkilling drugs, for instance ibuprofen lysine, which gets absorbed by the body more quickly. Ibuprofen’s effects typically last for six to eight hours, whilst paracetamol lasts for four to six hours.”

I have pain in one of my molars and I am waiting to see the dentist. Is there anything I can take for the pain in the meantime?

Toothache that lasts for more than a day or two always needs to be assessed by a dentist. This is in case it’s caused by decay, which can lead to an infection or abscess. An OTC analgesic can make the pain more bearable until the underlying cause is treated.

According to Karen Coates, dental advisor to the British Dental Health Foundation, it’s important to check which painkiller is most suitable for the customer. “Obviously not everyone can take ibuprofen. However, it is usually the best for dental pain because it is anti-inflammatory,” she says. “We wouldn’t recommend that people use anything topically on the gums as this can cause chemical burns.”

What is the best OTC painkiller for period pain?

Period pain strikes most women at some point but varies in severity from a dull ache to intense spasms. Most cases can be treated at home with OTC painkillers, especially the nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen. “Naproxen is an NSAID that is licensed over-the-counter only for the treatment of period pain, although there is little evidence to suggest it is any more effective than ibuprofen,” says Michael. “An OTC product containing tranexamic acid is available to treat heavy menstrual bleeding. Heavy periods can often be associated with worsened period pain, so reducing the bleeding may also reduce the pain. This is a relatively recent POM to P switch and the pharmacist should be involved in any sale.”

I normally take paracetamol for my back pain, but it doesn’t seem to be enough. Is there anything else I can take to relieve the pain?

Paracetamol is considered to be the first-line painkiller for back pain. If it fails to work, customers with back pain can be offered NSAIDs such as ibuprofen or combination painkillers containing codeine. Customers can also buy a product containing both paracetamol and ibuprofen, which claims to be more effective than taking each painkiller on its own.

“It’s important to be aware of the risks associated with NSAIDs and compound analgesia – for example, in frail elderly people or those with asthma or a history of stomach ulcers – and the important drug interactions such as diuretics or blood pressure medications,” says Dr Tom Margham, GP and primary care lead for Arthritis Research UK.

My dad keeps getting headaches despite taking tablets nearly every day to try and get rid of them. What can he do?

Taking painkillers every day, or nearly every day, can actually cause headaches called medication overuse headaches (MOH). According to NICE guidance issued in August 2013, pharmacists should provide information on the risks of MOH to all customers who are suffering from a headache.

Codeine carries the highest risk of triggering MOH, although even paracetamol and ibuprofen can cause problems. According to headache specialist Professor Anne MacGregor, MOH affects around two per cent of the population. “Women are more at risk than men, probably because they get more headaches anyway,” she says. “MOH is diagnosed in patients who experience headaches on 15 or more days per month and are treating headaches with triptans, ergots, compound analgesics or opioids on 10 or more days a month and/or simple analgesics or NSAIDs on 15 or more days a month.”

If MOH is suspected, abrupt withdrawal of the painkillers is recommended, although problems may occur if the painkillers contain potentially addictive ingredients like codeine or caffeine. If the headaches don’t improve and/or worsen, it’s essential to seek medical advice from a GP.

Taking painkillers every day, or nearly every day, can actually cause headaches called medication overuse headaches

I sprained my ankle while I was out running yesterday. What can I do to relieve the pain and be out running again as soon as possible?

According to NHS Choices, minor sprains can be managed with PRICE therapy (Protection; Rest; Ice; Compression; Elevation) and avoiding HARM (Heat; Alcohol; Running; Massage). Most healthcare professionals recommend that people don’t stop using a sprained joint because the injury will heal quicker if they keep the joint moving as much as possible. NSAIDs such as ibuprofen shouldn’t be used in the first 48 hours after an injury as they may delay the healing process.

NHS Choices recommends using ice or cold therapy for the first 48 to 72 hours after the injury, for 15 to 20 minutes every two to three hours during the day. Paracetamol can be taken to relieve any pain. “Topical treatments, such as cold gels or sprays, can provide a convenient way of providing a fast, cooling effect to the area,” says physiotherapist John Miles, head of medical and physio services at Cardiff Blues. “Heat therapy should be used 72 hours after an injury, following cold therapy.”

I work at a computer and always seem to have a sore, stiff neck at the end of the day, sometimes with a headache too. What can I do to ease the pain?

Analgesics may help with acute pain, but they shouldn’t be used as a long-term measure – it’s important to tackle the cause of the pain and stiffness. Stress and muscle tension are often triggers, so massage, heat therapy and essential oils may help by encouraging relaxation.

Stuart Palma, professional adviser to the Chartered Society of Physiotherapists, says that people are not designed to sit or stand in the same position for hours on end. “Our tissues become tight and irritable, so it’s important to take regular breaks,” he says. “It’s also essential that your workstation is set up correctly. If you are suffering from neck pain, it’s possible that your monitor may not be positioned correctly, or that your chair is not supporting your back sufficiently. You can also do a few simple exercises every hour to keep you moving; download our free leaflet from: www.csp.org.uk.”

Working at a computer all day can cause pain and stiff muscles

 

Is there something I can take to relieve the pain of my arthritis? Can I apply an analgesic cream or gel?

If a customer suffers from arthritis pain, it’s essential that they speak to their GP before using any OTC painkillers. This is to ensure that their symptoms are being properly managed.

A number of NSAIDs are available as OTC gels or creams, which can be applied directly to the affected area if the pain is localised. The 2014 NICE guidelines for osteoarthritis recommend using topical NSAIDS before resorting to the oral versions.

“Topical NSAIDs should be considered ahead of oral NSAIDs and compound analgesia for osteoarthritis, particularly of the knee and hand,” says Dr Margham. “They are safer than oral NSAIDs, as less of the active drug is absorbed into the bloodstream. This makes them useful as a safe and effective alternative form of pain relief for people at increased risk of problems such as heart attacks and strokes. The 2014 NICE guidelines for osteoarthritis also recommend hot and cold therapies alongside the core treatments of activity and exercise, access to appropriate information and weight loss (if the person is overweight or obese).”

I suffer from migraine – can I get an OTC treatment?

According to the NICE guidance on headaches in young people and adults, published in August 2013, people with migraine should be advised to take a triptan as a first-line measure with either an NSAID or paracetamol, as long as the headache is migraine and there are no contraindications.

“Sumatriptan 50mg is available without prescription from a pharmacy, if a screening questionnaire is completed and complications requiring GP input are not identified,” says Rachel Markham, spokesperson for Migraine Action. “However, it is more usual for a formal diagnosis to be made by the GP and most often for the GP to have already prescribed a triptan. The pharmacist will be best able to judge on a case-by-case basis.”

Professor MacGregor says that pharmacy customers with migraine should steer clear of codeine-containing analgesics. “Codeine aggravates the gastric shutdown that naturally occurs in migraine, further restricting the absorption of oral analgesics,” she says. “It also aggravates nausea and vomiting. Generally, the data point to ibuprofen being more effective than paracetamol. Keep it simple, but take at the right time (as early as possible), in the right dose and in the right form (soluble is better than solid tablets). Hot/cold forehead packs, and also lavender sticks are useful aids to medication.”

I get pain in my lower back and would prefer a non-drug treatment. Which is best – hot or cold therapy?

Cold products are usually recommended for acute injuries, whereas heat treatments are more suitable for chronic pain as they shouldn’t be used in the first 72 hours after an injury when inflammation is present. However, it usually boils down to personal preference.

“Both hot and cold therapy can be fantastic for simple low level back pain as they will increase the blood flow to the muscles and tissues of the spine,” says Becky Lees, physiotherapist at bac< and backpainhelp.com. “Cold is preferable if there is an acute injury accompanied by swelling, redness and heat. More muscular stiffness and pain tend to respond to heat. Both sensations may also block the pain a little and enable gentle movement to take place, which is extremely beneficial for back pain.”

Exercise is important in the management of back pain too. Research shows that regular exercise leads to less frequent and shorter episodes of back pain, with reduced pain and stiffness. “Simple measures such as massage and using a hot water bottle can be recommended,” adds Michael.