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Update: 03

Hello Again for another instalment of our updates. We had hoped that we will be reporting back from the Breaking Down Barrier conference in London (Update 2) but it appears a vast majority of the delegates were snowed in! Nevertheless we had a good wet day out in London! The conference will take place later in the year and we sure hope to be there. In the meantime, let us continue to break down barriers where ever we encounter them….

On that note we wish to describe the outcome of a branch meeting we attended recently:

We attended the Annual General Meeting (AGM) of the Southampton Branch of the RPSGB on the 9th of February 2008 (link) and the presentations by the Cathy Price (Pain Consultant at Southampton University NHS Trust-SUHT) and Emma Davies (Specialist Pharmacist – Pain Services at SUHT) was as informative as it was interesting. A number of issues stood out for us and we will now proceed to describe these:

  • Multi factorial nature of pain
Cathy Price described a number of factors which interplay to affect the perception of pain. Whilst there are clear medical pathways which results in pain, there are psychological and sociological factors which can affect the perception of pain. This may explain the inherent challenge in diagnosing severity of pain. It was interesting to hear an expert say that the notion of pain prone personality is discredited. We also find the observation that pain is generally underestimated by healthcare professionals and overestimated by families of the patient very interesting.

What can we do with these information?:

As pharmacists working in primary care, we have to be guided by what our patients are telling us about their pain. On a bad day, the pain may feel worse than usual. There is also the issue of pain threshold (amount of stimulation a person requires before feeling pain) and pain tolerance (amount of stimulation that a person is willing to tolerate). If our patients tell us they cannot tolerate the pain they are getting, then we have to support them. According to Emma, Paracetamol is a very effective baseline medicine in pain management. Our ability to manage expectation can have a great impact on pain perception. When we recommend Paracetamol (sometime perceived as a weak pain killer) we need to be able to ‘talk up’ its efficacy and relative safety. I know I will be saying to my staff that we should not use words like ‘weak’ painkiller to describe Paracetamol. Of cause if the intensity of the pain is rising, then other products can be added. Managing expectation here is equivalent to giving realistic expectation. The evidence points to the efficacy of Paracetamol (…and that is from the experts!).

  • Difference between Addiction and Dependence:
This is a minefield! As primary care professionals, we have to choose our words very carefully here.  To understand this we have to understand the difference between addiction and dependence.

Addiction:
This is a primary psychological disease. The key characteristic feature of addiction is the harmful and compulsive use of a drugs to such an extent as to produce significant adverse consequences. Cathy and Emma highlighted that it is quite uncommon to get addicted to painkillers like opioids.

Dependence:
Unlike addiction, dependency relates more to the body’s adaptation to using a drug. Stopping or discontinuation of the drug may result in withdrawal symptoms.

This is obviously a complex area of practice and we offer this way forward:

  • We should never assume that the patient in front of us, who may be a regular user of say, Co-codamol, is addicted to it. Dependent? probably but addiction rely on a complex diagnosis based on case history etc, which we may not have access to. My first step will be to educate my staff about this. Nevertheless the experts say addiction is uncommon.
  • If we suspect dependence, then we can manage it in the usual way through education and referral.
  • Relationship between the Pharmacist and the Consultant:
We thought we will describe our thoughts on what we observed about the working relationship between Cathy and Emma. In the first instant, Cathy was very keen to highlight the multidisciplinary approach to case management of patients with pain and she emphasised the role of the pharmacist in this approach. That is well and good but according to Albert Mehrabian’s commonly quoted result in this field of communication: He observed that in any face-to-face communication, word account for 7%, tone of voice 38% and body language 55%. Something remarkable stood out for us: Here are two experts, who were comfortable in their working relationship! We observed a remarkable keenness to consult each other on some controversial questions. Each adding their own perspective on the issues.

We bring this up because this is the nature of the relationship which we all hope will be replicated more consistently in primary care between pharmacists and GPs. It may have informed the recent guideline and letter sent out out to GPs and Community Pharmacists entitled ‘Improving Professional Relationships’ (link ) and ‘Guideline for GP Practices: Achieving best value from community pharmacy medicines use review'(link). It is endorsed by BMA, PSNC and NHS Employers. We of cause have copies of this documents for our members’ perusal.

As pharmacists working in a community setting, what activities have we undertaken lately to build our relationship with our local GPs. Admitely, we have to deal with a lot of GPs in the course of our practice day. Our advise is: Why don’t we just start with one GP at a time…

Bookapharmacist will like to thank Cathy Price and Emma Davies for a wonderful presentation, the drug companys’ which made the day possible and the Southampton Branch of the Royal Pharmaceutical Society. Finally, are you missing out on some of these events in Hampshire? If you are unsure of how to get your name on the Branch’s mailing list, feel free to e-mail us at info@bookapharmacist.com and we will signpost you to the right people.

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We are happy to announce to our members that we now have a copy of the Hampshire antibiotics guideline for the Community. We are reviewing it and extracting key points which we feel will be useful in practice. We will signpost you to this when we have it.

We also have the login details for the Travex website. If you are working in Hampshire and you are member, just drop us an e-mail at info@bookapharmacist.com.

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We will continue to work to bring valuable information and support to our members. If you are not yet a member or haven’t yet felt an interest in joining, we hope you will read more about the project here. We will be waiting to welcome you into our fold.

Thanks for now and have a great week.

Administrator
bookapharmacist.com

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