Pain Management with a WholeLife Pharmacist

WholeLife Pharmacy and Health are gearing up early for National Pain Week next month (24-30 July 2023), which advocates for awareness, accessibility and affordability to healthcare, services and advice for Australians living with chronic pain.¹

Our very own pharmacist and Health Services Manager Melissa Armstrong is here to share some tips on pain management.  Melissa also practices as a pharmacist consultant at a community pain program on the Gold Coast, where she assists and coordinates patients with education and self-management strategies for chronic pain.

With expert knowledge in medications, pharmacists are a great starting point for advice about your pain management, as they are readily accessible and can help with immediate pain concerns.  Pharmacists can guide you through your pain symptoms and recommend treatments needed to address any immediate concerns, especially for acute and flare-up pain.

Treating Short-term or Acute Pain

Acute pain is defined as short-term pain and is a perfectly normal response to an injury (eg. sprained ankle or headache) or a medical condition (eg. pain from an infection).  It comes on suddenly and is short-lived once the underlying cause is treated and the physical injury has healed, normally within three months.²

Simple analgesic medications such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are readily accessible over-the-counter from your pharmacy to help treat acute or short-term pain symptoms.  Paracetamol is a great allrounder for pain relief, as it has effective analgesic properties and is safe for most people.  People living with chronic pain can also be recommended to take paracetamol on a regular basis, as it can help support and compliment other pain medications as part of their longer-term treatment regime.

Anti-inflammatory medications (NSAIDs) such as ibuprofen, naproxen or diclofenac are effective for treating pain symptoms associated with inflammation such as tension and migraine headaches, or muscle strain from sport/exercise injuries or occupational activity.  If you have any pre-existing medical conditions or take regular medications, it is best to check with your pharmacist if these medications are safe for you to take.  These medications can also be found in muscle gels and rubs, which are a useful alternative for those who are unable to tolerate or take anti-inflammatory tablets.

Managing Chronic Pain

Chronic (or persistent) pain is a condition of the nervous system and is defined when your pain persists for longer than three months, even after the original injury has healed.¹  Now, this is where it can get a bit complicated, as it is not uncommon for people to experience a “mix” of types and subcategories of chronic pain, such as:

• Nociceptive pain – pain associated with tissue injury or damage (osteoarthritis, rheumatoid arthritis, pelvic pain)
• Neuropathic pain – pain associated with injury or disease of nerve tissue (sciatic pain, diabetic neuropathy, shingles pain)
• Nociplastic pain – pain that may reflect changes in the functionality of the nervous and immune systems, and where there is no clear evidence of actual tissue damage or injury (fibromyalgia, non-specific lower back pain, complex regional pain syndrome)

If any of these pain conditions or symptoms sound familiar to you or you are concerned about your pain, you should consult your doctor as soon as possible before commencing any treatments or therapies.

Unfortunately, the hard truth about chronic pain is it is unlikely that you will get back to being “pain-free”. HOWEVER, there are many ways persistent pain can be managed to maintain daily function and continue living a good quality life.  The first key step is to build a trusted health-care team, and pharmacists will play a key role to support you through your pain management journey.

Pharmacists can provide a medication review, which involves a one-on-one private consultation where you can address any concerns regarding your pain medications and collaborate with your doctor to optimise your treatment.  In these consultations, you will be given a chance to discuss any concerns about the effect of your pain medication or any adverse effects you may be experiencing and how to minimise them.  Your pharmacist can help create a Pain Medication Action Plan to help guide you through a flare-up or breakthrough pain, or to help you build confidence in managing your medications, so it doesn’t get too confusing.

Strong pain medications such as opioids are not intended for long-term treatment for chronic pain, as it may contribute to tolerance, physical and mental dependence, increased side effects (such as constipation), iron deficiency, hormone changes and sometimes increases pain with prolonged use.  It is also possible that opioids may not be addressing the actual symptoms of your condition, and there may be other medications better suited for your longer-term regime.¹  If you have been taking an opioid medication for a while, we certainly encourage you to have a discussion with your pharmacist and doctor about a possible reduction plan suitable for you and your pain condition.

Are there any natural medicines or herbal supplements I can take for my pain?

Absolutely!  There is emerging evidence supporting the use of naturally derived ingredients and supplements which have found to be helpful as supportive and adjunct therapies for pain management, including chronic pain:

• Fish Oil has been found to be effective in reducing inflammation in joint pain and stiffness in arthritic conditions, which can also help reduce the need and reliance on conventional anti-inflammatory (NSAID) medications and is safe to taken long-term and regularly.³
• Curcumin is one the active components in turmeric, which can also be helpful in reducing inflammation in osteoarthritis. Curcumin is often combined with other natural ingredients such as Boswellia and piperine (from black pepper) to enhance anti-inflammatory effects.⁴
• Magnesium is well known for relieving muscle tension and cramping, which are common symptoms in lower back pain, tension headaches and pelvic pain conditions. It can also play an important role in reducing hypersensitivity in some neuropathic pain conditions such as shingles pain, diabetic neuropathy, and fibromyalgia.⁵
• Palmitoylethanolamide (PEA) is an exciting supplement which is becoming more popular in pain management. Clinical studies have shown promising results in reducing pain (nociception), inflammation and could be helpful in reducing neuropathic (nerve pain) symptoms.⁶

It is important to remember natural and herbal medicines act similarly to conventional medicines and some may have potential interactions with your regular medications.  Ask your pharmacist if any of these ingredients would be suitable and safe for you.

What are other treatments should I consider for my pain?

The key to optimising pain is to incorporate multiple facets, tools and services available to take charge of your pain symptoms and wellbeing.  Depending on your pain, you could consider the following therapies to include in your pain management plan:

• Heat or Cold therapy – remember cold to reduce swelling (after injury) and heat to relieve muscle soreness and tension.²
• Transcutaneous electrical nerve stimulation (TENS) devices pass low-voltage electrical current across your skin to stimulate nerves to block or change perception of pain.
• Supportive braces and strapping could be used under the guidance of a physiotherapist to provide support whilst engaging in active tasks or exercise.
• Massage can help relieve soft-tissue injury and muscle tension. Acupuncture has been found to reduce pain severity and restore balance within the body.²
• Physiotherapy can provide you with stretching, strengthening exercises to help regain mobility and stability to help reduce pain. Some practitioners may also incorporate a tailored exercise plan if appropriate for your treatment.²
• Nutrition advice is also important for weight management, but where you can also explore foods to help reduce inflammation and other sensitivities.
• Counselling and mental health support is essential for chronic pain management, as unmanaged pain can often lead to emotional stress and affect a person’s mental health and wellbeing. These services allow you to explore coping strategies and breathing techniques to help reduce pain, particularly when a flare-up occurs.²

Your pharmacist can discuss these options with you during your pain medication review and can provide a letter of recommendation to your GP to consider these services as part of your overall pain management care plan.

Pain is a very individualised experience, but with a trusted healthcare team and with the right information, it can certainly be self-managed by you!  Knowledge is power and the best way to increase your knowledge is to ask your pharmacist and doctor all the questions you need answered, so that you can become your own superhero to Take Charge of your Pain!

This advice does not replace any current treatment or health advice already provided by your health practitioner.  Our pharmacists at WholeLife Pharmacy and Healthfoods are here to help and support you with your current and ongoing pain management plans.  For any treatments recommended to you, always read the label and follow the directions for use.

1. Chronic Pain Australia. Retrieved from https://chronicpainaustralia.org.au/resources/#aboutchronicpain
2. Better Health Channel – Pain and pain management in adults. Retrieved from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pain-and-pain-management-adults#types-of-pain
3. NPS Medicinewise – Fish Oil Supplements. Retrieved from https://www.nps.org.au/news/fish-oil-supplements-do-they-have-a-role-in-the-management-of-rheumatoid-arthritis
4. NCBI NLM – Curcumin: A Review of Its’ Effects on Human Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664031/
5. NCBI NLM – The role of magnesium in pain. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK507245/
6. NCBI NLM – Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094513/