1. Careful questions and everyday objects – the essential tool kit to diagnose neuropathic pain
Reflecting the updated international definition ‘neuropathic pain is caused by a lesion or disease of the somatosensory system’, the program offers education, resources and tools to help doctors distinguish neuropathic pain from other pain conditions.
Dr Andrew Boyden, medical advisor with NPS MedicineWise, says, “Neuropathic pain can be difficult to diagnose. Our program emphasises the need to take a targeted history combined with a simple sensory examination that uses readily available tools – a toothpick, cotton wool and/or a brush. Generally, this approach can be used to confidently diagnose probable neuropathic pain – and further investigations are often not necessary.”
Neuropathic pain can cause significant distress for 1 in 20 Australians and determining whether pain is neuropathic ensures those patients with the condition receive appropriate treatment and avoid unnecessary and ineffective use of pain medications for nociceptive pain. With regards to pharmacological management of neuropathic pain, the program reminds health professionals that in suitable patients, amitriptyline remains a first-line option according to Australian and international guidelines.
The program recommendations for the management of neuropathic pain note that all medications indicated for treating the condition have limitations in terms of their efficacy and that there is significant variation between individuals with regard to the extent to which they may get pain relief from their use.
Dr Boyden says, “Apart from medication use, we emphasise the importance of taking a broader approach to pain management, referring to physical activity as well psychological techniques such as cognitive behavioural therapy and meditation. This will help sufferers to understand and cope with their condition.”
Dr Boyden also notes that pregabalin isn’t useful in a diagnostic capacity, “because of the variable response people with neuropathic pain have to it”.
The program also refers to the use of pregabalin for non-neuropathic pain conditions such as back pain without a neuropathic component, where current evidence does not support its use. The Faculty of Pain Medicine (ANZCA), through the Choosing Wisely Australian initiative, has released a recommendation to avoid prescribing pregabalin or gabapentin for pain which does not fulfil the criteria of neuropathic pain.
Following PBS listing in March 2013, prescriptions of pregabalin have increased from 200,000 in 2012–13 to 3.61 million in 2016–17.
CPD points are available for GPs and nurses when an education visits on the topic ‘Neuropathic Pain: touchpoints for diagnosis and management’ are organised. Book here.
2. Chronic pain – discomfort that lasts over three months – needs GP assessment
Not-for-profit, evidence-based NPS MedicineWise is encouraging Australians who suffer pain for longer than three months to visit their general practitioner (GP) to have their condition checked.
The advice follows the launch of an NPS MedicineWise visiting program on neuropathic pain, a kind of chronic pain experienced by one in 20 Australians.
Dr Andrew Boyden, medical advisor with NPS MedicineWise, says, “If pain continues for more than three months it becomes a form of chronic pain. Working out if neuropathic pain is behind the patient’s discomfort will help them to receive the best treatment. This educational visiting program aims to help GPs with the often difficult task of distinguishing neuropathic pain from other pain conditions.”
People with neuropathic pain, sometimes known as ‘nerve pain’, can experience shooting, stabbing or burning sensations. This is caused by damage or injury to nerves from conditions such as shingles, diabetes and nerve root compression around the spine.
The visiting program reminds GPs, and in turn, their patients, that finding medicines to provide pain relief for chronic conditions can be difficult. All medicines indicated for treating neuropathic pain are limited in their efficacy and there is significant variation between individuals and the level of pain relief they receive from their use.
Dr Boyden says, “The program reminds health professionals that in suitable patients, amitriptyline remains a first-line option according to Australian and international guidelines. This can provide a point for discussion between the patient and their doctor around optimal treatment for the pain.
“Apart from medication use, we emphasise the need to take a broad approach to pain management, suggesting physical activity and psychological techniques, such as cognitive behavioural therapy and meditation. This can help patients to understand and deal more easily with their condition.”
The program also reminds GPs that pregabalin isn’t useful in a diagnostic capacity for neuropathic pain because of the variable response that people with neuropathic pain have to it. Additionally, pregabalin for non-neuropathic pain conditions such as back pain without a neuropathic component, are not recommended where current evidence does not support its use.
The Faculty of Pain Medicine (ANZCA), through the Choosing Wisely Australia initiative, has released a recommendation to avoid prescribing pregabalin or gabapentin for pain which does not fulfil the criteria of neuropathic pain.
3. NPS MedicineWise and American Express Open-air Cinemas announce winners of national short film competition
Entrants were tasked with creating a 30-second short film to win their share of $10,000, with first-place prizes awarded to talent across two categories: Australians under 18 and over the age of 18 years old.
Announced on Wednesday evening at the AMEX OAC location at Bondi Beach, ‘Keep the bugs outta the club’ took out the top prize for the 18+ category. The film features a man who is rejected from entering a pharmacy based on his overuse of antibiotics.
The film is the work of Brisbane-based cinematographer, Lucas Tomoana, who says, “It was such a fun challenge to try and communicate the message about antibiotic resistance. We wanted to produce something that was engaging, funny, relatable and delivered in a small amount of time. Humour was key for us, as people are more likely to share content they get a laugh out of. I was inspired by a lot of New Zealand ads that have gone viral recently, where they deliver important messages in a humorous and relatable way.
“One thing a lot of us can relate to is having a night out and trying to get past the bouncers into the club. The bouncers obviously want to make sure everyone’s safe and also that you don’t bring any friends that might ruin the night for everyone else”, says Tamoana.
Winners were chosen by an influential panel of judges including Director and Chief Executive Officer (CEO) of the National Institute of Dramatic Arts (NIDA), Kate Cherry, Australian GP and media personality, Dr Sam Hay, acclaimed actor and Weekend Sunrise ‘Movie Man’, Jason (Jabba) Davis, Fairfax’s Digital Entertainment Editor, Aja Styles, and CEO of NPS MedicineWise, Dr Lynn Weekes.
Judge Dr Sam Hay said ‘Keep the bugs outta the club’ was “the total package, showing a great balance between comedic timing and messaging with outstanding cinematography and editing.”
The judges were also impressed by ‘Therapeutic’, which took out first-place for the under 18 category. The film features a couple, representing an antibiotic and a bacterial infection, having a therapy session.
“Sending a message about antibiotics is exceptionally important especially in today’s age when they’re losing their strength. However, it seems that a message has more power if it is expressed through humour or a symbolic scene. Thus, we tried to find a way to send a message about antibiotics and make it fun to engage with”, says 16-year-old Therapeutic producer, Catriona Warren.
Judge Aja Styles said ‘Therapeutic’ was “brilliant and showed great creativity linking antibiotics and resistant bacteria to people. It was well shot and certainly made me laugh.”
NPS MedicineWise Chief Executive Officer Dr Lynn Weekes said that she is thrilled with the quality and imaginative structure of the winning films and their creative approach to raising awareness about antibiotic resistance.
“Antibiotic resistance is one of the biggest threats to global health and can affect anyone of any age, in any country. The competition provides an avenue for emerging Australian filmmakers to showcase their talent while shining a light on a very serious issue. Short films both remind and inspire the community to take action to preserve the power of antibiotics and combat the spread of superbugs”, said Dr Weekes.
Films were submitted from across the country by primary and high school students, amateur and professional film makers, health professionals and people whose lives have been affected by antibiotic resistance.
The winning films can be viewed on the NPS MedicineWise YouTube channel:
4. MedicineWise App updates aid transition to prescription-only codeine
The MedicineWise App – developed by independent not-for-profit NPS MedicineWise as a free medication management tool – has been updated to show low-dose codeine combination medicines now only available by prescription, following the up-scheduling of over-the-counter codeine-containing medicines in February.
Makers of low-dose (S2 and S3; Pharmacy Only) codeine combination medicines wishing to continue supplying them as S4 (Prescription Only) were required to submit applications to the Therapeutic Goods Administration (TGA) by late November 2017. The TGA has advised that all applications for newly scheduled S4 medicines received by the deadline have been processed, however some applications arrived late, delaying approval and products reaching pharmacies.
Kishen Kaurah, Mobile-enabled Consumer Products Manager with NPS MedicineWise, says, “The MedicineWise app is to provide up-to-the-minute information about all available medicines in Australia. Medicines containing low-dose codeine, which are now only available by prescription, have been updated on the app, allowing patients and doctors to search for medicines available in pharmacies simply and quickly.
“Helpful content has been added to relevant medications including videos, factsheets and updated medicines information.”
The MedicineWise app allows users to scan the barcodes on medicine packaging or search for medicines by brand name or active ingredient. When products are found, people can add these medicines to their profile and then find additional information about the medicine including Consumer Medicines Information factsheets, videos and PDF information sheets.
Mr Kaurah adds, “The MedicineWise app is a simple and secure resource that allows people to store their medicines and health information, and access accurate up-to-date information about any changes to their medicines. This information is accessible to them anytime and anywhere, which is particularly useful for sharing with their health professionals or if they are travelling.”
For an additional source of information, the TGA has published a list of all products that have been through the up-scheduling process and may be legally supplied. These products, some of which may not be currently available in pharmacies, include combinations such as:
Download the MedicineWise app: