It is estimated that, by the age of 40, more than 97% of Australians carry the inactive virus (varicella zoster virus) that causes shingles from a previous chickenpox infection.^1-3

Research commissioned by GSK Australia* reveals over a quarter (26 per cent) of Australians aged 50-79 do not recall previously having chickenpox and are at risk of developing shingles without being aware of this risk.4 It also showed that almost a quarter (24 pesr cent) of Australians don’t believe or understand that they can develop shingles if they’ve had chickenpox.⁴

The risk of developing shingles increases with age.⁵ As the immune system naturally weakens, and this can allow the usually inactive virus that causes shingles to reactivate.⁶ If Australians have a weakened immune system due to illness, treatments or medications, you may also be at increased risk.^1,2,5

Shingles Awareness Week aims to increase understanding of the impact of shingles and address common misconceptions surrounding shingles. Journalist Shelly Horton and AFL-legend Robert ‘Dipper’ DiPierdomenico join news presenter Deborah Knight as Shingles Awareness Week ambassadors, having experienced first-hand the pain and impact of shingles.

“I experienced shingles during a very stressful time of my life. A huge spread of tiny blisters appeared on my right inner thigh, which left me in excruciating pain, and I felt completely debilitated,” shared Shelly Horton, who is an advocate for talking about taboo health topics.

“Since my experience, many people close to me have been affected by this condition. My mum had shingles, which caused a rash across her torso. It was so painful she couldn’t even drive or sit on the couch to watch TV. She almost went to hospital because she thought it was kidney stones.

“I now know that shingles is common in people 50 and over. One of mum’s friends got shingles in her eye, which could have affected her sight. My father-in-law also had shingles at my wedding in Mexico, with a rash across his back,” recalled Ms Horton. “He was in a lot of pain and afraid of the rash being aggravated, especially during our dance. While everyone else continued celebrating, he became bed bound in the hotel room.”

Recognised as one of Hawthorn Football Club’s most prominent players, Robert ‘Dipper’ DiPierdomenico, has also experienced the painful and debilitating impact of shingles, and has cared for his partner during her shingles diagnosis.

“Compared to the pain of many of my sporting injuries, shingles was relentless. It put me out of action for nine days,” said Dipper. “I had a large, itchy, red rash suddenly appear on the left side of my body. It was so uncomfortable, I slept on a mattress in the lounge room with the air conditioning running to try and find some relief. It was horrible to experience personally, and I know some of my loved ones, like my partner and my mum, have also experienced the pain and discomfort of shingles.”

Monika Boogs, Chief Executive Officer, Painaustralia, says that the pain of shingles is often described by people as some the worst they have ever experienced.

“Shingles is often more than just a rash. The pain from shingles can disrupt sleep, mood, work and daily activities and impact quality of life. For some people, it can cause long-term issues with eyesight or chronic nerve pain leading to long-term discomfort,” said Ms Boogs.

Leading expert, Professor Tony Cunningham, Director of the Centre for Virus Research (WIMR) and Vaccine Theme Leader at Sydney Infectious Diseases Institute (SydneyID), The University of Sydney, suggests that Australians aged 50 and over should not underestimate their shingles risk even if they don’t recall having had chickenpox.

  “If you’ve had chickenpox, the virus can remain dormant in your body. Almost all Australians have had chickenpox, even if they don’t remember having it or were asymptomatic, and so are at risk of shingles as they carry the inactive virus. As you get older, there is a decline in your immune system that can leave you susceptible to the reactivation of this virus, which causes shingles,” said Professor Cunningham.

“Shingles Awareness Week is an important reminder to understand the symptoms and your risk, especially if you are aged 50 and over. Speak to your doctor to understand your risk of shingles and encourage loved ones who are older to do the same.”

To help reduce the impact on people’s lives and the disruption to everyday activities that shingles can cause, Australians aged 50 years and over should learn more about the signs, symptoms and risk factors for shingles. For more information about shingles, speak to a healthcare professional and visit knowshingles.com.au

On behalf of GSK Australia, Ipsos Healthcare conducted an online survey among 600 Australian-based consumer participants (aged 50-79 years old from the general population) who chose to take part in the survey between 17 July and 1 August 2024. Participants were all screened to match national proportions based on region, gender and working situation. Majority of respondents had one or more comorbidities, while one in three did not. The sample is not nationally representative, only indicative.

References

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“Patients are suffering unnecessarily, enduring heightened pain and distress, because the medications that typically control their symptoms are either unavailable or prohibitively expensive,” says Dr Peter Allcroft, Chair, Palliative Care Australia.

Despite repeated calls for action from the palliative care sector, Palliative Care Australia (PCA) says there has been little progress toward ensuring a stable supply of these life-changing drugs.

“A collective of 7 organisations wrote to parliamentarians in early December [2024] trying to escalate this issue after months and months of slow or no progress, people, including children are dying without adequate pain relief,” says Dr Allcroft.

‘Supply becoming increasingly uncertain’

Most of the affected medicines are vital opioid analgesics that have been used for decades to manage severe pain and other symptoms in palliative care patients.

With their supply becoming increasingly uncertain, clinicians are forced to prescribe less effective alternatives, resulting in less reliable pain relief and risking unwanted side effects.

Adding to the distress is cost, with many of the alternative medications not subsidised through the Pharmaceutical Benefits Scheme (PBS).

One of the most startling examples is hydromorphone SR, which costs the public $182 for 32mg, which a non-PBS-listed alternative is $4209 for 100 tablets.

PCA campaign to resolve the ongoing issue

As part of the ‘better access to palliative care’ campaign leading up to the federal election, PCA has launched an 11 point plan to resolve this ongoing issue.

“Our recommendations centre on establishing a national stockpile of critical medicines, fostering domestic pharmaceutical manufacturing, strengthening the PBS, and empowering the TGA,” says Dr Allcroft.

“Four hundred people die every day of a terminal illness — limited or no access to these critical medications has a ripple effect through families and communities.”

With nearly 20,000 signatures already on the campaign’s petition, advocates hope the issue will be addressed ahead of the federal election, ensuring better quality of life for those in palliative care.

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Affecting function and impeding daily activities such as getting dressed and eating, it’s said that hand OA affects 1 in 2 women and 1 in 4 men, who will experience symptoms by the time they turn 85.

Of those with hand OA, about half will have inflamed joints, which cause pain and are associated with significant joint damage.

Despite the high prevalence and disease burden, there are no effective medications.

However, relief from hand OA could be on the way for those affected by this debilitating condition, after a Monash University and Alfred Health-led study found an affordable existing drug can help.

Published in The Lancet, the paper investigated methotrexate, a low-cost, effective treatment for inflammatory joint conditions such as rheumatoid arthritis and psoriatic arthritis. It has been widely used in Australia and globally since the early 1980s.

Researchers found that methotrexate reduced symptoms in those with hand osteoarthritis (OA).

A 20mg weekly oral dose over six months had a moderate effect in reducing pain and stiffness in patients with symptomatic hand OA.

Senior author Professor Flavia Cicuttini, who heads Monash University’s Musculoskeletal Unit and is The Alfred’s Head of Rheumatology, said the study identified the role of inflammation in hand OA and the potential benefit of targeting patients who experience painful hand OA.

“In our study, as with most studies of osteoarthritis, both the placebo group and methotrexate groups’ pain improved in the first month or so,” Professor Cicuttini said.

“However, pain levels stayed the same in the placebo group but continued to decrease in the methotrexate group at three and six months, when they were still decreasing. The pain improvement in the methotrexate group was twice as much as in the placebo group.

“Based on these results, use of methotrexate can be considered in the management of hand osteoarthritis with an inflammatory pattern. This provides clinicians with a treatment option for this group, which tends to get more joint damage.”

Professor Cicuttini said in patients with hand OA and inflammation, the effects of methotrexate were present at about 3 months and by 6 months it was very clear if it worked.

“At that time patients and their doctors can decide whether to continue or stop it,” she said. “This is very similar to what we currently do with other forms of inflammatory arthritis.”

The NHMRC-funded randomised, double-blind, placebo-controlled trial of 97 people assessed whether 20mg of methotrexate weekly reduced pain and improved function compared to placebo in patients with symptomatic hand OA and synovitis (inflammation) over six months.

Participants with hand OA and MRI-detected inflammation were recruited from Melbourne, Hobart, Adelaide, and Perth.

Professor Cicuttini said the results could provide relief for people with hand OA inflammation, which was particularly common in women as they experienced menopause.

“Further trials are needed to establish whether the effect of methotrexate extends beyond six months, for how long we need to treat patients, and whether methotrexate reduces joint damage in patients with hand osteoarthritis and associated inflammation,” she said.

For more information, visit: thelancet.com/journals/lancet/article/PIIS0140-6736(23)01572-6/fulltext

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To encourage all Australians to move Voltaren is launching V-League, endorsed by the National BasketBall League (NBL). NBL legends, Dave Andersen and Adam Gibson have been recruited to captain each of the teams and are calling on Aussies to join them on court by entering a competition to take part in the first V-League face-off.

Inspired to better understand what types of pain are holding Australians back, the study identified that more than half of the time (53.2%) that Australians are in pain, they are experiencing back pain, with muscular pain representing a third of pain. This is impacting people’s daily life by preventing them from exercising (49.2%), stopping them from attending social events (13.7%) or even from spending time with family and friends (12.9%).

The data shows this trend of limiting movement is also continuing to be exacerbated for older Australians, with more than half of people (65.6%) stating that they are moving less as they get older, a habit which has been shown to increase the risk of pain and immobility over time.

Joseph Mehdawi, Voltaren ANZ Senior Marketing Lead said, Voltaren understands it’s not just about movement, it’s about providing Australians with a pain relief partner to rediscover the joy of movement.

“It is our passion for relieving pain that led us to undertake this new research, to really understand what is holding Australians back. We dug deeper into the sentiments of the Australian community around movement and pain and have noticed some alarming trends. Namely that niggling pain and discomfort is consistently holding us back from the things that bring us happiness.”

“We’re so excited to be able to create the new, V-League, platform to celebrate the joy of movement and engage directly with Australians who are experiencing discomfort. We cannot wait to see the introductory V-League game kick-off,” says Mehdawi.

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For those who suffer chronic headaches, the experience can be debilitating. Migraine & Headache Australia (MHA) asserts that nearly all those with migraine and 60 per cent of those with tension-type headache experience reductions in social activities and work capacity. Even so, says the World Health Organisation, both the general public and most healthcare professionals tend to perceive headaches as a minor or trivial complaint.

Headaches can be complex and have many possible causes. More than 200 types of headaches are recognised in the International Classification of Headache Disorders.

Symptoms

A headache is typically characterised by pain or discomfort in the head or face. It could be a throbbing, dull or sharp pain, for example. How it feels can vary and depend on the cause. Headaches also vary greatly in terms of the location of pain, how long they last and how often they occur.

Types 

Headaches Australia cites the most common primary types of headaches as being tension-type headaches, migraine, and cluster headaches.

Migraine is more than just a headache, according to the Migraine Foundation, which describes it as a chronic neurological disease.

Causes 

There are primary and secondary causes of headaches.

The primary variety has no underlying condition and is related to, for example, lifestyle factors such as stress, sleep patterns or diet.

A secondary headache is related to an underlying medical condition. This could include dental problems, eye strain or sinus congestion.

Treatment 

Understanding these causes can help with suggesting treatments. Addressing and avoiding stress would be one option, but it’s important to find effective treatment with minimal side effects.

MHA reports that paracetamol and ibuprofen used together can be effective to treat acute episodes of headaches. Aspirin has been shown to be somewhat effective for migraines. Soluble formulations may be helpful, as absorption of medicines slows down during migraines. If no success is achieved after trying these, a triptan should be considered.

According to MHA, chronic migraine is diagnosed when 15 days of headaches are experienced each month. Long-term use of painkillers to treat this can cause medication overuse headaches, which can increase the risk of a rebound headache when the medication wears off. This can lead to more frequent headaches and reduced response to medication. Because of this, MHA recommends preventive treatments for chronic headaches. These can include preventive medications, natural remedies or Botox injections.

The amount of acceptable medication that can be taken depends on the medication class. MHA says that as a rule of thumb, taking over-the-counter painkillers should be limited to three to four days a week, or one to two days a week for triptans.

Other remedies include dietary changes such as reducing processed foods, eating to ensure consistent blood sugar levels, ensuring hydration, exercising, and resting in a quiet, dark environment.

Neuromodulation is also an option, such as the Cefaly external trigeminal nerve stimulation device, available without a prescription.

Prevention

Knowing and avoiding triggers can prevent a headache. Keeping a diary to record symptoms, triggers, attacks and frequency can be helpful.

Preventive medicines are available for migraine and cluster headaches.

The most frequently recommended supplements to help include high-quality magnesium, vitamin B2 and coenzyme Q10.

A pharmacist’s role

According to MHA, a three-question screening can help indicate whether the headache is likely to be a migraine. This involves asking whether there are accompanying symptoms of nausea, or of light sensitivity, and whether the headache has restricted daily activities for a day or more. A yes answer to two or more of these can mean migraine is a likely diagnosis.

Referral to a GP may be required if no effective response is achieved with OTC triptan. Other reasons to refer to a GP include:

• More than two to four days of migraine per month.
• Older age (onset at 50 years old or later).
• Positional headache – such as when sitting, standing or bending – which often improves when lying down.
• Post-trauma.
• Medication overuse headache.

A referral to an emergency department should be made if there are systemic symptoms, such as fever, a neoplasm in medical history, or neurologic deficits or a rapid onset.

References:

1. Johns Hopkins Medicine. Health: Headache.
2. Johns Hopkins Medicine. Health. Headache. Overview
3. headacheaustralia.org.au/what-is-headache/
4. headacheaustralia.org.au/headache-management/treatment-of-headache-no-absolute-cure/
5. headacheaustralia.org.au/migraine/treatment-options/

Written by Tracey Cheung. 

This feature was originally published in the August issue of Retail Pharmacy magazine. 

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While sports injuries declined during COVID-19 due to lockdown measures and event cancellations, the number of Australians admitted to hospital for injuries sustained while playing sports has returned to pre-COVID trends.

This is according to a new report from the Australian Institute of Health and Welfare (AIHW) titled, ‘Sports injuries in Australia’.

“In response to COVID-19 lockdowns and the cancellation of many sporting activities, there was a decline in the number of sports injury hospitalisations in 2019–20, but in 2020–21, the numbers rebounded to pre-pandemic trends, increasing by 27%,” says AIHW spokesperson Dr Heather Swanston.

The AIHW shows that cycling accounted for the highest number of sports injury hospitalisations in 2020–21, with 9800 injury hospitalisations – up from 8000 in 2019–20 – an increase of 35 injury hospitalisations per week.

“Unlike many other sports, there was a rise in the number of cycling injuries in 2019–20 and 2020–21, which may reflect increased participation rates in solo sports with the onset of COVID-19 that has continued with the lifting of restrictions,” says Dr Swanston.

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One condition that farmers experience a lot, but rarely seek professional help for, is the management of chronic pain. Untreated, chronic pain can cause serious distress and diminished productivity.

Now, a team of UniSA experts are exploring what chronic pain means to Australian farmers in a move to improve the way chronic pain management strategies are delivered in rural communities.

They are currently seeking farmers who have experienced chronic pain to participate in this ground-breaking study.

Rural health expert, UniSA’s Associate Professor Kate Gunn, says the study will address a serious gap in pain management among farmers.

“Agriculture is a great industry to work in, but one of the downsides is the physical injuries that can result, which can have long-term consequences on farmers’ ability to work, and their wellbeing,” says Assoc Prof Gunn.

“Musculoskeletal disorders are very common in this group and due to the unrelenting nature of farm work, farmers often return to work without accessing best-practice treatments, and without being aware of what this means for their long-term health and wellbeing.

“We also know that farmers face multiple barriers to accessing mainstream health care services, including health professionals’ lack of understanding of their way of life.

“This new study is all about giving farmers a voice so that we can gain insight into how they perceive chronic pain, how it impacts upon their work and life, and importantly, how they would like to be assisted to manage it, in a way that fits with their preferences and lifestyles.

“This is important because there are practical things people can do for themselves and with health professional input, that research has shown really do help.”

Chronic pain is a common and complex condition characterised by persistent pain experienced on most days of the week.

In Australia, chronic pain affects almost one in five people, or 1.6 million.

Renowned neuroscientist and pain expert, UniSA’s Professor Lorimer Moseley AO, says that all Australians should have access to the knowledge, skills, and local support to prevent and overcome persistent pain.

“Chronic pain is a huge burden to society. But despite its seriousness, only a small proportion of the population receive evidence-based information and advice about how to manage this condition,” says Prof Moseley.

“The effects of chronic pain are significant. It can reduce productivity, lead to increased BMI, and substantially increase the risk of numerous other conditions such as stroke, cancer, depression, multiple sclerosis, and rheumatoid arthritis.

“Rural communities are already struggling with health services. By working with farmers, we are hoping to develop realistic, appropriate and end-user-informed ways to improve the care and management of chronic pain in rural communities.”

The research team, which includes PhD student Indika Koralegedera and Dr Gemma Skaczkowski, is now looking to connect with farmers who have experienced chronic pain and will confidentially talk about its impact on their life and work, and what they currently do to help manage it.

Text by: UniSA

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Of the more than 100 forms of arthritis, the most common are osteoarthritis, rheumatoid arthritis and gout.

Emily Thorpe, Senior Pharmacist Trainer and Assessor from the Pharmaceutical Society of Australia (PSA) says colder weather, as well as spending more time indoors and being less mobile, can cause stiffness in joints, which can be painful.

Arthritis pain can be caused by:

• Inflammation.
• Damage to joints.
• Muscle tension.

The most common symptoms are pain, stiffness, swelling, redness and warmth in a joint, and tiredness.

It may take several visits before a doctor can determine the type of arthritis because some types can be hard to diagnose in the early stages. A doctor may also refer patients to a specialist arthritis doctor for more tests.

There is no cure for osteoarthritis, and current treatment options on the market mostly address the symptoms.

Management strategies 

• Analgesia and alternatives <bold)

Arthritis Australia says some of the medications that pharmacists may discuss include:

• Analgesics such as paracetamol for pain relief.
• Non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation, joint swelling, and stiffness. NSAIDs and corticosteroids are often used to treat inflammatory forms of arthritis, such as rheumatoid arthritis. Corticosteroids can also be used to treat a single inflamed joint.

Many patients may also turn to alternatives, especially as the negative long-term side effects of analgesia are becoming more known, says Dr David Hunter, Professor of Medicine at the University of Sydney.

“These alternatives include omega-3 fatty acids, such as fish oil,” he said.

“There’s been limited effectiveness shown for commonly used supplements such as glucosamine and chondroitin. Curcumin and Boswellia have modest effects and can be worth trialling for three to four weeks, to see if an individual gains a benefit from their use.”

• Exercise 

Physical activity is one of the most effective treatments for arthritis, Arthritis Australia advises.

• Heat and cold packs

Arthritis Australia suggests using such packs, as heat relaxes muscles and stimulates blood circulation, while cold numbs the painful area and reduces swelling.

• Conserving energy 

Patients can try to protect their joints by avoiding activities that cause pain, breaking up tasks into smaller parts and getting help when they need. Other interventions Arthritis Australia states might be helpful include massage, acupuncture and relaxation techniques such as meditation.

Pain prevention 

• Keep warm and active 

Professor Hunter advises patients to stay warm and keep active every day, moving gently at home to raise their internal body warmth, walking and practising yoga.

• Nutrition

Arthritis Australia states there is very little evidence that specific foods have an effect on arthritis. However, the Arthritis Foundation[2] reports a diet containing anti-inflammatory food such as fish, nuts and seeds – for example, the Mediterranean diet – may be helpful for joint health and fighting inflammation. It’s also important to avoid weight gain, which can worsen arthritis symptoms.

Pharmacists 

“Most critically, pharmacists understand drug interactions,” Professor Hunter said. “Often, the patient will have two to three comorbidities and illnesses such as high blood pressure, diabetes, or depression, and be on several medications for these.

“If the pharmacist suspects it’s more than just acute pain, and it’s been ongoing for some time, a referral can be made to a GP.”

References 

1. arthritisaustralia.com.au/
2. arthritis.org/health-wellness/healthy-living/nutrition/anti-inflammatory/the-ultimate-arthritis-diet

This feature was originally published in the May issue of Retail Pharmacy magazine. 

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Of the growing number of Australians who experience chronic pain, around 20 per cent suffer from neuropathic pain.¹ In these individuals, up to 75 per cent report moderate to severe pain despite the use of analgesics.²

While pain is multifaceted and complex, neuroinflammation is often a key feature of neuropathic pain, and the need for effective therapeutic cover is paramount.

Mel Nash, Healthcare Practitioner Education Specialist at Metagenics, says pharmacists can play a key role in helping patients find appropriate complementary pain treatment.

“As highly trained and trusted healthcare professionals, pharmacists are considered to be more readily accessible than other community health providers,” she said.

“Over 60 per cent of pain sufferers surveyed said they would like their pharmacy or pharmacist to offer more solutions when it comes to their pain management.”³

Know your pain

The classification of nociplastic pain as a new pain descriptor was postulated in 2016.⁴

Ms Nash says that when the body’s natural responses to nerve pain and damage fail to resolve, or when the stimuli cannot be removed or adequately treated, there is:

• Increased nociceptor sensitivity.⁵
• Glial cell-mediated inflammation.⁶
• Increased pain neurotransmission.⁷
• Downregulation of opioid receptors.⁸

“Combined, these factors may lead to central sensitisation, defined as an [pain in response to non-painful stimuli] and hyperalgesia [exaggerated pain perception], a hallmark feature in nociplastic pain,⁹ and involves specific changes to the nervous system, particularly at the receptor sites,” she said.¹⁰

“There’s currently no conclusive diagnostic criteria or tests for central sensitisation. However, it’s considered likely to be present in many, if not all chronic pain cases.”

According to Ms Nash, pain researchers point out that nociplastic pain responds differently to therapies than nociceptive pain – that is, pain caused by damage to body tissue.

“There’s decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections,” she said.¹⁰

Breaking the cycle

Pain amplification occurs when neuropathic pain triggers an inflammatory process at the site of nerve injury, through the release of neuropeptides.¹¹ 

This in turn prompts the release of inflammatory mediators by local mast cells to facilitate tissue healing.¹²

However, persistent neuron damage can prolong neuroinflammation and amplify pain signalling, says Ms Nash.

This can “increase nerve excitability and decrease pain tolerance, leading to pain hypersensitivity and the pain cycle continues”.

Strategies that effectively downregulate neuroinflammation and desensitise pain sensory receptors have been identified as effective targets for neuropathic pain^{13, 14, 15, 16} and may assist in the management of chronic pain.¹⁷

Nervalgesic, part of the Ethical Nutrients Clinical range, is promoted as offering a unique combination of synergistic ingredients to address central sensitisation and downregulate pain amplification.

Available exclusively to pharmacists for recommendation to their customers in Australian pharmacies, Nervalgesic combines palmitoylethanolamide (PEA), saffron and thiamine to offer “effective pain relief”, and can be recommended alongside analgesic medications.

“Supported by clinical data, these ingredients help to downregulate both nociceptor sensitivity and glial cell activation that contribute to the chronic pain cycle, providing analgesic, anti-inflammatory and neuroprotective benefits to enhance clinical outcomes in chronic pain sufferers,” Ms Nash said.

PEA at 600mg/day has been successfully used in several human clinical trials for neuralgia and neuropathic pain to decrease symptoms and improve quality of life in conditions such as lumbosciatica^{18, 19, 20}, and back pain^{21, 22} with several studies highlighting 70 per cent improvement in subjective pain scores over three weeks. The PEA used in Nervalgesic (Levagen) is more highly bioavailable than standard PEA and thus able to be offered at convenient doses.²³

Ms Nash says chronic pain can impact the quality of life of many sufferers who are searching for adequate therapeutic cover, often in addition to their current medications or topical treatments.

“Being able to offer an adjunct therapy, such as a combination of PEA, saffron and thiamine, across the dispensary counter could provide improvements and reduction in your customers’ pain scores to help them live a happier, healthier life.”

References 

1. Henderson J, Pollack AJ, Pan Y, Miller GC. ‘Neuropathic and non-neuropathic chronic pain at GP encounters: prevalence, patient characteristics, suffering and pregabalin use’. Aust Fam Physician, 2016 Nov; 45 (11): 783-86.
2. O’Connor AB. ‘Neuropathic pain: quality of life impact, costs and cost-effectiveness of therapy’. PharmacoEconomics, 2009; 27 (2): 95-112. doi: 10.2165/00019053-200927020-00002.
3. Mishriky J, et al. ‘An investigation of the practices of Australian adults experiencing pain and their views of Australian community pharmacy pain management services’. Pharmacy (Basel), 2020 Oct 13; 8 (4): 187. doi: 10.3390/pharmacy8040187;
4. Kosek E, et al. ‘Do we need a third mechanistic descriptor for chronic pain states?’ Pain,2016; 157: 1382–86.
5. Gouin O, et al. ‘TRPV1 and TRPA1 in cutaneous neurogenic and chronic inflammation: pro-inflammatory response induced by their activation and their sensitisation’. Protein & Cell, 2017 Sep; 8 (9): 644-661. doi: 10.1007/s13238-017-0395-5
6. Ji RR, Berta T, Nedergaard M. ‘Glia and pain: is chronic pain a gliopathy?’ Pain, 2013 Dec; 154 Suppl 1 (1): S10-S28. doi: 10.1016/j.pain.2013.06.022.
7. Souza Monteiro de Araujo D, et al. ‘TRPA1 as a therapeutic target for nociceptive pain’. Expert Opin Ther Targets, 2020 Oct; 24 (10): 997-1008. doi: 10.1080/14728222.2020.1815191
8. Zheng BX, et al. ’Nerve trauma-caused downregulation of opioid receptors in primary afferent neurons: molecular mechanisms and potential managements’. Exp Neurol, 2021 Mar; 337: 113572. doi: 10.1016/expneurol, 2020.113572.
9. Fitzcharles M-A, et al. ‘Nociplastic pain: towards an understanding of prevalent pain conditions’. Lancet, 2021 May; 397 (10289): 2098-2110. doi.org/10.1016/S0140-6736(21)00392-5
10. Curatolo M, Arendt-Nielsen L, Petersen-Felix S. ‘Central hypersensitivity in chronic pain: mechanisms and clinical implications’. Phys Med Rehabil Clin N Am, 2006; 17: 287-302. doi: 10.1016/j.pmr.2005.12.010
11. D’Amico R, et al. ‘ALIAmides update: Palmitoylethanolamide and its formulations on management of peripheral neuropathic pain’. Int J Mol Sci, 2020 Jul 27; 21 (15): 5330. doi: 10.3390/ijms21155330.
12. Héron A, Dubayle D. ‘A focus on mast cells and pain’. J Neuroimmunol, 2013 Nov 15; 264 (1-2): 1-7. doi: 10.1016/j.jneuroim.2013.09.018.
13. Jara-Oseguera A, Simon SA, Rosenbaum T. ‘TRPV1: on the road to pain relief’. Curr Mol Pharmacol, 2008 Nov; 1 (3): 255-69. doi: 10.2174/1874467210801030255
14. Souza Monteiro de Araujo D, et al. ‘TRPA1 as a therapeutic target for nociceptive pain’. Expert Opin Ther Targets, 2020 Oct; 24 (10): 997-1008. doi: 10.1080/14728222.2020.1815191.
15. Moran MM. ‘TRP channels as potential drug targets’. Annu Rev Pharmacol Toxicol, 2018 Jan 6; 58: 309-30. doi: 10.1146/annurev-pharmtox-010617-052832.
16. Moran MM, Szallasi A. ‘Targeting nociceptive transient receptor potential channels to treat chronic pain: current state of the field’. Br J Pharmacol, 2018 Jun; 175 (12): 2185-2203. doi: 10.1111/bph.14044.
17. O’Connor AB. ‘Neuropathic pain: quality of life impact, costs and cost-effectiveness of therapy’. PharmacoEconomics, 2009; 27 (2): 95-112. doi: 10.2165/00019053-200927020-00002.
18. Guida G, et al. ‘Palmitoylethanolamide (Normast) in chronic neuropathic pain by compressive type lumbosciatalgia: multicentric clinical study’. DOLOR, 2010; 25 (1): 35–42
19. Keppel Hesselink JM, Kopsky DJ. ‘Palmitoylethanolamide, a neutraceutical, in nerve compression syndromes: efficacy and safety in sciatic pain and carpal tunnel syndrome’. J Pain Res, 2015 Oct 23; 8: 729-34. doi: 10.2147/JPR.S93106.
20. Domínguez CM, et al. ‘N-palmitoylethanolamide in the treatment of neuropathic pain associated with lumbosciatica’. Pain Manag, 2012 Mar; 2 (2): 119-24. doi: 10.2217/pmt.12.5
21. Paladini A, et al. ‘Palmitoylethanolamide in the treatment of failed back surgery syndrome’. Pain Res Treat, 2017: 1486010. doi: 10.1155/2017/1486010.
22. Passavanti MB, et al. ‘The beneficial use of ultra micronised palmitoylethanolamide as add-on therapy to tapentadol in the treatment of low back pain: a pilot study comparing prospective and retrospective observational arms’. BMC Anesthesiol, 2017 Dec 19; 17 (1): 171. doi: 10.1186/s12871-017-0461-9.
23. Briskey D. ‘Increased absorption of palmitoylethanolamide using a novel dispersion technology system (LipiSperse)’. J Nutraceuticals Food Sci, 2020 May; 5 (2): 3. doi: 10.36648/nutraceuticals.5.2.3.

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While there is currently no cure for OA, there are treatments that can effectively control symptoms. Last month, Retail Pharmacy explored the role of diet in arthritis management. Another lifestyle change often recommended to OA sufferers is an exercise program tailored to the individual’s condition and ability.

Exercise keeps joints and muscles healthy and flexible and prevents other health problems. But what if your patient is feeling too ‘stiff’ to get moving?

Topical gels 

Pronat Group Australia Director Peter Smith says certain products can provide temporary relief of symptoms commonly associated with mild OA or other kinds of arthritis.

“Common symptoms associated with mild arthritis include joint pain, stiffness and reduced joint mobility and flexibility,” he said.

“Products like fisiocrem Joint Ease assist arthritis sufferers by helping to promote healthy joint mobility by relieving mild joint stiffness, mild joint pain and soreness and by helping sufferers maintain joint flexibility.

“As these products assist in providing temporary pain relief, people can keep moving and participate in their everyday activities and tasks with the people they love.³

Fisiocrem Joint Ease is a discrete, low-odour topical gel that is easy to apply. The product combines the clinically demonstrated power of fisiocrem Solugel with two additional botanical actives to provide more than just pain relief, says Mr Smith.

“It has been scientifically formulated specifically for the temporary relief of symptoms of mild osteoarthritis, mild arthritis and joint pain, and is designed to provide ongoing joint comfort,” he said.

Botanical actives 

Mr Smith outlines the plant-based ingredients used in fisiocrem Joint Ease:

• Arnica Montana (also called leopard’s or wolf’s bane). “Well-established scientific evidence supports its usefulness in the healing of minor muscle injuries and bruises.”
• Calendula officinalis (also called pot or garden marigold). “It can be beneficial in relieving symptoms of soft tissue trauma and supporting body tissue regeneration and repair.”
• Hypericum perforatum (also called St John’s wort). “Well-established scientific evidence supports its use in relieving mild swelling, bruise pain and assisting in the healing of minor tissue injuries.”
• Melaleuca alternifolia (also called tea tree oil). “It can help to relieve inflammation and helps to enhance the dermal penetration of the other active constituents.”
• Menthol “Helps to relieve pain and to stimulate blood flow to the skin, it’s especially useful for relief of muscle pain and soreness.”

Boswellia Serrata gum resin extract. “Rich in Boswellic acids that are likely to be responsible for its anti-inflammatory and analgesic properties, it’s been shown to be particularly beneficial in helping to relieve symptoms of mild rheumatic disease such as joint aches and pains and stiffness, and helps to promote healthy joint function.”

Nigella sativa oil (also called black seed oil). “Well-established scientific and clinical evidence indicates that it can help to moderate the symptoms of mild arthritis/mild osteoarthritis, providing relief from aches, pains and soreness. Thymoquinone has been described as the main active constituent, and is likely responsible for its as anti-inflammatory and joint protective effects.”

Building on brand recognition 

The fisiocrem brand is well-established and has a strong reputation in the muscle pain category. As the brand extends into joint pain with fisiocrem Joint Ease, the brand will expand its marketing activities nationally and continue to support all practitioner conferences and work with key governing bodies, such as state arthritis associations.

“Fisiocrem Joint Ease has already been approved and added to most major pharmacy retailer group planograms and will be on-shelf across Australia within the coming weeks,” Mr Smith said.

“It will be promoted alongside our hero product, fisiocrem Solugel, within pharmacy catalogues and a national campaign is set to roll out in the new year.”

Monitoring joint pain 

With the growing range of OTC joint pain products available to sufferers, it’s important for pharmacy staff to remind customers to monitor their symptoms and know when to seek further treatment.

The Arthritis Foundation advises pharmacy staff to be alert for the below signs and symptoms:

• Pain, swelling or stiffness in one or more joints.

• Joints that are red or warm to the touch.
• Joint tenderness or stiffness.
• Difficulty moving a joint or undertaking daily activities.
• Joint symptoms that cause concern.

Sufferers should make an appointment with their doctor if they have any of the following:

• Joint symptoms that last three days or more.
• Several episodes of joint symptoms within a month.⁴

Always read the label and follow the directions for use. 

References 

1. arthritisnsw.org.au/about-arthritis/arthritis-statistics/#:~:text=3.9%20million%20Australians%20have%20arthritis,5.4%20million%20Australians%20with%20arthritis.
2. arthritisnsw.org.au/about-arthritis/types-of-arthritis/osteoarthritis/
3. ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=384978&agid=%28PrintDetailsPublic%29&actionid=1
4. arthritis.org/health-wellness/about-arthritis/understanding-arthritis/when-joint-pain-means-its-time

This feature was originally published in the November issue of Retail Pharmacy magazine. 

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