An investigation of the views and practices of Australian community pharmacists on pain and fever management and clinical guidelines

Steroidal Anti-Inflammatory Drugs for Oral Surgery: A Systematic Review and Meta-Analysis

Objectives

The aim of the present study was to investigate if there are differences in mitigation acute pain following oral surgery procedures within a hospital setting and regarding various medication regimens.

Materials and methods

A systematic literature search was performed between the years 2013 and 2023, including the databases PUBMED, Cochrane and Scopus, to identify the clinical trials investigating the prescription of non-steroidal (NSAID's) anti-inflammatory drugs before or after an oral surgery. A meta-analysis with meta-regression model was employed on the primary and secondary outcomes, such as pain, swelling and trismus.

Results

Thirty-six articles were included, 6 of them being retrospective and 30 prospective, with a higher proportion of women than men, at a ratio of 1.34:1 and an average age of 31.9 years. Drugs with medium duration of action demonstrated lower values for pain and swelling. Regarding these parameters, pain and swelling, propionic acid derivatives and acetic acid derivatives exhibited lower values respectively.

Conclusions

The quality of evidence was low to very low- certainty. The meta-analysis suggests that postoperative pain, swelling and trismus following oral surgery management may be effectively treated with the following drugs: NSAID medium-duration action drugs; propionic acid derivatives for lower pain levels and acetic acid derivatives for lower swelling measures; and Ibuprofen 400mg every 8h for 3 days or less.

Clinical Relevance

Anti-inflammatory and analgesic drugs are prescribed to prevent or treat dental pain. Ibuprofen 400mg was the most prescribed drug after or before an oral surgery procedure. However, the evidence is indirect and needs to be interpreted with caution.

Community Pharmacists' Knowledge and Attitudes Towards Pediatric Pain Management in Nigeria

PURPOSE

Community pharmacists (CPs) frequently attend to pediatric patients with pain but limited data exist regarding their knowledge of and attitude to effective management of pediatric pain in Nigeria. Thus, this study aimed to evaluate the knowledge of and attitude to pediatric pain management among CPs in Nigeria.

PATIENTS AND METHODS

A validated and pilot-tested questionnaire, the Community Pharmacists Survey on Pediatric Pain, was administered to 517 eligible participants at the 38th Annual National Conference of the Association of Community Pharmacists of Nigeria. Independent samples t-test and one-way analysis of variance were used for inferential statistical analyses.

RESULTS

CPs with additional higher academic qualifications and clinically related additional academic degrees had significantly higher mean knowledge scores relative to first degree only holder counterpart (t= 4.33, p< 0.05, Eta2=0.05) and those without clinically related second degrees (t= 6.34, p< 0.05, Eta2=0.27). Pain knowledge among the study cohort also varied significantly by age group, years of practicing community pharmacy, ownership structure of premises, geographical location of practice and previous exposure to pain management training (F(4370)=2.858, p=0.025, Eta2=0.03; F(3371)=3.985, p=0.008, Eta2=0.03; F(2372)=3.643, p=0.027, Eta2=0.02; F(5369)=4.497, p=0.01, Eta2=0.06; F(2372)=3.587, p=0.029, Eta2=0.02), respectively.

CONCLUSION

Community pharmacists' knowledge of and attitude to pediatric pain management in Nigeria appeared sub-optimal, and requires regular targeted educational intervention to fill the identified gaps, improve service delivery and patient outcomes.

Low back pain management - What Australian community pharmacists recommend and how this compares to current clinical guidelines

BACKGROUND

Low back pain (LBP) is a serious and debilitating condition that necessitates proper assessment and management. Community pharmacists are ideally positioned to interact with these patients and provide therapeutic recommendations in line with LBP clinical guidelines, which have changed in recent years. Understanding what therapeutic strategies pharmacists recommend and why, can provide insights into whether these recommendations are in line with current clinical resources.

OBJECTIVES

The objectives of this study were to examine community pharmacists' views, knowledge and practices in LBP management compared to current clinical guidelines; and investigate their views regarding the accessibility and use of clinical LBP resources.

METHODS

A cross-sectional study of Australian community pharmacists was conducted using a structured, self-administered, anonymous online survey. Primary outcomes assessed were pharmacists' views, practices and recommendations in low back pain of different severities, as well as views on the use and accessibility of clinical guidelines.

KEY FINDINGS

A total of 176 pharmacists completed the survey. Most recommended non-pharmacological strategies to manage mild symptoms for both adult and teenage groups, escalating to pharmacological with increasing symptom severity. Approximately 75% reported they would recommend ibuprofen over paracetamol for low back pain. Approximately 40% agreed there is difficulty in finding and accessing clinical resources and more than 40% reported being unaware that there are specific guidelines available for the management of LBP symptoms.

CONCLUSION

Results from this study highlight an important need to further improve the knowledge and awareness of pharmacists in low back pain management, including locating and accessing clinical resources.

An Investigation of the Practices of Australian Adults Experiencing Pain and Their Views of Australian Community Pharmacy Pain Management Services

Pain is a common and debilitating condition requiring appropriate assessment and management. The consequences of inadequate treatment of pain is well known; however, research investigating pain management practices and the benefits Australian community pharmacies offer in pain management are more limited. This study investigated the knowledge and practices of Australian adults experiencing pain, and their views of community pharmacy pain management services. A cross-sectional study was conducted using a pre-tested anonymous self-administered questionnaire. Participants were recruited from ten community pharmacies across metropolitan Melbourne, Australia. A total of 120 participants completed the questionnaire. Most reported that their pain interfered with their quality/functionality-of-life. Paracetamol was the pharmacological preference irrespective of pain severity experienced. Approximately 30% did not believe that visiting a community pharmacy is helpful in pain management, but many reported their pain management knowledge could be improved, yet more than 60% disagreed when asked whether they would rather visit a supermarket than their pharmacy to purchase analgesics. More than half believed that community pharmacies can and should offer more pain management services. This suggests that enhancing the involvement of community pharmacists can help bridge gaps in pain management knowledge, which may provide greater positive outcomes for patients experiencing pain symptoms.

The role of the pharmacist in low back pain management: a narrative review of practice guidelines on paracetamol vs non-steroidal anti-inflammatory drugs

Low back pain (LBP) is a common and costly condition and a leading cause of disabilities across the globe. In Australia and other countries, there has been changes in LBP management guidelines and evidence in recent years, including the use of pharmacotherapy. Inadequately treated LBP is a burden with significant health and economic impacts. Although there is some variability, non-steroidal anti-inflammatory drugs (NSAIDs) have largely replaced paracetamol as the first-choice analgesic for non-specific LBP in many international clinical guidelines, including the current Australian Therapeutic Guidelines. More recent clinical evidence also supports that targeting LBP with the use of NSAIDs can provide superior and more effective relief of LBP symptoms compared with paracetamol. Community pharmacists are one of the most accessible and frequently visited health professionals that offer vital primary healthcare services aimed to provide enhanced clinical outcomes for patients. The position of a community pharmacist is pivotal in LBP assessment and management, from both a pharmacological and non-pharmacological standpoint, including the use of clinical guidelines, yet their roles are often not fully utilized in LBP therapy. Studies investigating the community pharmacist’s views, practices, knowledge, and roles, specifically in LBP management in Australia are variable and limited. This narrative review will briefly cover the impacts of LBP, and to provide a summary on recent evidence, updates and a comparison of the Australian and international low back pain management guidelines on paracetamol vs NSAIDs in LBP, as well as pharmacists’ roles and interventions in a primary healthcare setting in this context.