5 Min
In OTC
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Pain can have a negative impact on many aspects of sufferers’ lives.1
Although effective pain management is crucial, opioid misuse can lead to dependency, which poses significant potential long-term complications.2 It can be difficult to monitor OTC co-codamol consumption; however, pharmacy teams have a fundamental responsibility to their customers to help mitigate the risk of addiction and dependence whilst helping to manage their pain effectively.
Learning Objectives
After reading this module, you will be able to:
Adapt your current practice to help you to be more mindful about suitable analgesic options when managing acute pain
Recognise your responsibility in helping to mitigate the risk of opioid addiction whilst offering appropriate pain relief
Offer self-care advice and wellbeing tips to help manage pain
SUPPORTING MOLLY
Read through the following customer scenario and consider how you would manage Molly’s pain effectively, mindfully and in line with recommended guidance.
Molly approaches the pharmacy counter and asks to purchase some co-codamol tablets whilst rubbing her sore, lower back.
Using the WWHAM framework, you establish:
WWHAM
Who: The treatment is for Molly, a 35-year-old female, who enjoys playing sports.
What: Molly is suffering from lower back pain after over-exerting herself in a game of tennis.
How long: Molly has been suffering for the last 2 days.
Action: Molly has tried paracetamol and ibuprofen separately but has not found adequate relief. Her friend told her that “co-codamol is the most effective painkiller” and she would like to try it so that she can get back to playing tennis.
Medicines/Medical conditions: Molly does not take any regular medicines or have any medical conditions. She also confirms that she is not pregnant or breastfeeding.
Click through the flashcards to explore the different options you could choose to recommend to Molly as next steps. Consider the benefits and consequences of these options.
You know that Molly has no concerns using paracetamol or ibuprofen; however, as they have not adequately relieved her pain individually, Nuromol is especially suitable for her.1 Simultaneous and faster release of ibuprofen and paracetamol leads to faster absorption of Nuromol compared to separate tablets of standard ibuprofen and paracetamol taken together.3-10
NICE does not recommend using paracetamol alone for the management of low back pain and recommends that an NSAID should be used at the lowest effective dose for the shortest period of time.11 NSAIDs can help relieve pain, reduce inflammation, and decrease stiffness
Nuromol contains a combination of paracetamol and ibuprofen in the convenience of one tablet and this combination is a potential next step recommended by NICE guidance
It is important to consider an effective, non-opioid alternative, such as Nuromol for acute moderate pain relief as this may help mitigate opioid dependence before it starts12
One NUROMOL tablet provides effective relief from acute moderate pain, equivalent to prescription-strength co-codamol up to 12 hours*13
Nuromol is not known to cause addiction10
*Codeine 30mg + paracetamol 1000mg vs 1x NUROMOL tablet
As Molly has already tried paracetamol and ibuprofen separately, without any relief, the next step (step 3) recommended by NICE guidance would be: Paracetamol should be added to ibuprofen or the weak opioid.14
However, for the management of low back pain, NICE states that the short-term use of codeine (with or without paracetamol) should only be considered if an NSAID (ibuprofen) is contraindicated, not tolerated, or is ineffective.11 However, they must also ‘consider the risk of opioid dependence, contraindications and adverse effects’.11 We know that Molly has no issues using ibuprofen
Opioid dependence can happen in as little as 2 days and the risk increases with continuous use2 - there is a responsibility to help mitigate this risk
Although co-codamol may manage Molly’s pain temporarily, the risks associated with long term use could potentially increase the requirement of NHS services in future, which could in turn contribute to increasing the burden on the NHS.
No red flags have been identified through the consultation that would require a referral to the GP at this stage. Molly should be made aware of what to look out for
By referring Molly to her GP, the risks could involve:
A delay of treatment – Molly’s pain could continue unmanaged for longer than necessary, effecting her quality of life
Unnecessary treatment – A consultation with a GP may lead to prescription medication to manage her pain, without her having tried suitable available options OTC first
Unnecessary use of NHS services – Unnecessary visits to the GP increase the burden to the NHS and may delay treatment for those who really need it
Molly should be made aware that if her symptoms are not managed by OTC medicines or if her pain worsens, she should then speak to the pharmacist or her GP.
Other points of consideration:
Molly is in pain, which is affecting her ability to play sports and enjoy herself, therefore effecting her quality of life. Pain relief should be prioritised, particularly as she may be suitable for treatment
You can always offer self-care and wellbeing advice alongside the treatment so that her pain can be managed effectively.
MOLLY'S TREATMENT CHOICE
You could advise Molly with the following information:
Co-codamol would not be the best option at this stage and it is important to avoid the potential risk of opioid dependence
Nuromol would be a better treatment option as per the recommended guidance. Especially as it is considered as effective as co-codamol13 and is non-addictive10
Self-care advice such as using heat and cold therapy and doing gentle exercises could help to relieve pain alongside the treatment15
Molly should be reminded that pain medication should be used for short-term use only10 and if her symptoms worsen or do not improve, she should speak to the pharmacist or her GP.