A community pharmacy environment that fosters teamwork ensured high levels of consumer satisfaction. This series of articles is designed for you to use as guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.
The below information, considerations and checklist provides support to enable you to run a team training session and identify opportunities for learning within the topic of Muscle and Joint Pain.
Muscle and joint pain strikes people of all ages. Broadly defined as suffering from aches, pains, and swelling, it can be a debilitating condition that affects a person’s mobility and sleep. At its worst, it can negatively affect their quality of life. The good news is that community pharmacists offer patients a plethora of oral and topical medications, as well as various supports and aids, to treat the many conditions that cause muscle and joint pain.
What is muscle and joint pain?
There are many causes for this type of pain, including injuries, poor posture, and disease. It can impact a particular area, or can also present as referred pain. Joint pain and stiffness is commonly caused by fractures, sprains and arthritis (such as rheumatoid or osteoarthritis), while muscle pain often results from impact injuries, overstretching, overuse, and strains. Injuries to the tendons that join muscle to bone are another common source of pain, as are ligament sprains, which normally result from over-stretching or the twisting of a joint.
How is this type of pain treated?
No two patients will respond in the same way to one, or a combination of muscle and joint pain relief therapies. The Irish Society of Chartered Physiotherapists lists some of the most common therapies for alleviating muscle and joint pain as manual techniques (manipulation, traction or mobilisation), soft tissue techniques (massage, trigger point therapy, and acupressure), stretching and strengthening exercises, electrotherapy, hydrotherapy, and posture therapy. According to Arthritis Research UK, prescription analgesics, steroid tablets and steroid injections may be prescribed to some patients.
What can pharmacists offer?
Patients who suffer from muscle and joint pain – whether it’s chronic or acute – are advised to treat it immediately. Various types of joint pain can be considered for management in the pharmacy setting. Aside from dispensing prescription medications, there are many over-the-counter options available to pharmacy patients.
These include:
• painkillers, such as paracetamol
• non-steroidal anti-inflammatory drugs, such as aspirin or ibuprofen tablets
• topical gels, creams, roll-ons, massage balms and patches that can be applied locally to the painful joint
• heat pads, heated rice pads or hot-water bottles
• various supports, braces, sleeves and walking aids.
Hot and cold pain relief products in the form of gels, creams, roll-on lotions and patches, can provide targeted, relief and help to relax stiff and sore muscles and joints by boosting blood flow to the affected area. Heat therapy works by improving circulation and blood flow to a particular area due to increased temperature. Increasing the temperature of the afflicted area even slightly can soothe discomfort and increase muscle flexibility. Heat therapy can relax and soothe muscles and heal damaged tissue.
Cold therapy (cryotherapy) works by reducing blood flow to a particular area, which can significantly reduce inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.
Pharmacies should stock a variety of topical products for local symptomatic pain relief, for example products containing diclofenac which can reduce inflammation and act as an analgesic. When diclofenac is applied to the skin as a gel, it is absorbed into the skin and then moves deeper into areas of the body where there is inflammation (for example, the muscle).
Using a topical product means that the total amount of diclofenac in the body remains low. This in turn means less likelihood of any side-effect to the medicine. Patients should be advised not to use diclofenac gel more than 4 times in any 24-hour period.
Consider:
The benefits of the various available OTC treatments and therapies and their indicated use
How to recognise different types of musculoskeletal pain
The limitations and benefits of OTC medicines
The importance of exercise and warm-up/cool-down techniques for everyone
Lifestyle issues that may be impacting on recovery
When to refer customers to the pharmacist
Key Points:
Check your pharmacy team are aware and understand the following key points:
Is the pharmacy team fully trained on the indications and benefits of all products for muscle and joint pain?
How are pain relief products (oral and topical) displayed in the pharmacy?
Do we make the most of the potential for linked sales (e.g. oral and topical analgesics, food supplements, complementary therapies, support bandages)
Am I up to date with the latest guidance on osteoarthritis from NICE?
Am I aware which preparations NICE recommends first-line?
Are we clear on when to use heat and when to use cold treatment in cases of joint injury?
Actions:
Ensure support staff understand the following key points:
The causes of joint pain, including the various types of injury and arthritis
What types of joint pain can be considered for management in the pharmacy
Which customers should be referred to the pharmacist
The appropriate use of hot and cold in cases of joint injury
The use of the PRICE method
The importance of not taking certain oral analgesics for longer than three days without referral
Questions to ask the customer
The role of dietary supplements (e.g. fish oils, glucosamine, chondroitin)
