Essay: The Pharmacy Guild Australia's Pain MedsCheck Program Analysis

This essay analyzes The Pharmacy Guild Australia's Pain MedsCheck program, initiated in 2018 to support individuals with chronic pain through community pharmacies. It examines the program's aim to improve pain management and provide doctor's support. The essay provides an argumentative analysis of the program, drawing on literature to discuss both pharmacological and non-pharmacological perspectives on chronic pain management. It covers the use of topical analgesics, the complexities of opioid use, and the importance of non-pharmacological interventions like music therapy. The essay highlights the potential for both benefits and risks associated with the program, including the potential for over-reliance on opioid medications and the importance of educating healthcare professionals. The essay concludes by emphasizing the importance of a balanced approach, incorporating both pharmacological and non-pharmacological interventions for effective chronic pain management.

Running head: ESSAY
Essay
Name of the Student
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Author Note

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Introduction
In 2018, The Pharmacy Guild Australia initiates a new trial program (Pain
MedsCheck) through the 5700 community level pharmacies in Australia in order to support
individuals with chronic pain for three months or longer. Under this program the pharmacist
will evaluate and review patient’s pain management therapy and medicine through face-to-
face conversation in order to support their clinical needs. The aim of the program is to
improve the pain management skills of the patients along with providing proper doctor’s
support. The topic holds utmost importance in the nursing practice. According to Tse and Ho
(2014) it is the duty of the nursing professionals to work on the patient’s self-management
skills for pain management and at the same time review the severity of pain for further
referral of the doctors. The following essay aims to analyse to provide an argumentative
analysis of the trial program implemented by The Pharmacy Guild Australia in association
with the Australian Medical Association (AMA). The essay will provide differing opinion in
effective management of the chronic pain from review of literature.
Chronic Pain
Pain is the major stressors for individuals irrespective of age. Chronic pain is common
among the adults who are in their advanced age and is suffering from osteoarthritis,
musculoskeletal pain, lower back pain, cancer, peripheral neuropathy and cardiovascular
problem. Apart from physiological complications (lack of proper sleep), chronic pain causes
psychological imbalance like development of negative emotions (depression and anxiety)
affecting the quality of life along impairment in conducting daily living activities (Tse & Ho,
2014).

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Figure: Symptoms Cluster of Pain
(Source: Tse & Ho, 2014)
Pharmacological and non-pharmacological perspectives of pain management
In order to study the importance of the topical analgesic in effective management of
the acute and chronic pain a systematic review was conducted (Argoff et al., 2013). The
analysis of the articles provided strong evidence towards the importance of the topical
ibuprofen and topical diclofenace obtained over-the-counter for the effective treatment of the
chronic joint-related conditions and soft tissue injuries like osteoarthritis. The review also
highlighted significant evidences that support the administration of topical lidocaine in the
treatment of diabetic neuropathy and postherpetic neuralgia. Argoff et al. (2013) also stated
in the review that there are limited evidences against the application of other topical
analgesics for the treatment of chronic and acute pain. Argoff et al. (2013) also argued that

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commonly used topical analgesics like the non-steroidal anti-inflammatory drugs are
associated with adverse systemic effects which are at times severe.
Volkow and McLellan (2016) stated that chronic pain caused by cancer is most
controversial and complex to manage. The patient’s urgency, the evidences against the
effectiveness of opioid analgesics in pain management and limited therapeutic alternatives for
pain management has generated overreliance on opioid medications. Volkow and McLellan
(2016) argued in their review that over-reliance on the opioid medication results in the
development of respiratory problems along with depression. Pain MedsCheck increase the
provision for the over or the excess use of the opioid analgesic. This might lead to the
generation of opioid-induced tolerance along with development of the physical dependence.
This is defined as a reflect counter-adaptations in the receptors of opioid and generating
intracellular signalling cascades developing addiction Opioid addiction at times lead to
medical illness and discontinuation of opioid leads to the immediate relapse of the pain. The
authors also stated that repeated and long-term use of opioid leads to the generation of
tolerance towards opioid increasing overall dosage requirement. One of the limitations of the
review is, Volkow and McLellan (2016) mainly highlighted physical dependence but failed to
highlight mental health consequences of opioid administration. In relation to the opioid
misuse, a study was conducted among the physicians in order to study their perspectives
about the administration of opioid for the management of the chronic pain (Jamison et al.,
2014). The analysis of the survey results highlighted that the younger doctors are more
concerned in using opioid for the management of pain in comparison to the primary care
healthcare professionals who are reluctant in effective management of the opioid medication.
The strength of the study is, the sample population was recruited randomly however, the
overall sample size was low and this can be considered as a limitation of the study. Thus
Jamison et al. (2014) analysis revealed that application of Pain MedsCheck without any

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proper education of the community level pharmacists will results in the generation opioid
tolerance. However, Pain MedsCheck program mainly deals with framing of the patient
centred care plan in order to achieve effective outcome. The trial program also provides
proper training modules developed in joint partnership with leaders in pain management to
educate the pharmacists and the other nursing professionals about effective management of
pain (The Pharmacy Guild of Australia, 2018).
Cooper (2013) however, questioned the easy access over-the-counter medications for
the pain management. Cooper (2013) stated that easy access of the analgesic or painkillers
through over-the-counter (OTC) increases the process of the medicalization of pain and
thereby leading to the over-use of the painkillers even under mild to moderate pain leading to
neurological complications among the mass. Cooper (2013) proposed for the proper training
of the healthcare professionals in order to educate the patients about the side-effects of the
over-use of miss-use of the analgesic. The new pharmacy program proposed by The
Pharmacy Guild of Australia (2018), promised face-to-face consultations with the patients in
order to review their medications and the use of the analgesic and subsequent referral to the
doctors. The Pain MedsCheck service also includes the provision of information in order to
seek additional support like consultation from the General Physicians or other allied
healthcare professionals for effective management of the pain.
In order to overcome the side-effects of pharmacological interventions, proper
application of the non-pharmacological interventions are crucial. The study conducted by
Gutgsell et al. (2013) highlighted that music therapy helps in reducing pain among the
palliative care patients as measure under the pain assessment score. The live music played in
music therapy helps to provide autogenic relaxation for the mood, helping to lower the
severity of pain. Such therapy is not associated with any kind of side-effects. Similar results
were demonstrated by the study conducted by Bradt et al. (2015) showed that application of

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the music therapy is effective in reducing the sensation of pain among the cancer patients.
However, the study showed that the impact of the music therapy on pain depends on the
patient’s outlook towards life, readiness to explore emotions associated with the cancer
experience. The authors stated that it is the duty of the nursing professionals to frame person-
centered music therapy for effective management of pain through non-pharmacological
interventions.
Conclusion
Thus from the above discussion it can be concluded that the implementation of the
new legislation originating from the Pharmacy Guild and Pharmaceutical Society along with
AMA for proper use of the over-the-counter medication will help to educate the healthcare
professionals to gain a detailed knowledge about the effective management of pain. However,
the easy availability of the over-the-counter medication for the pain symptom management
might lead to the medicalization of the pain symptoms. Medicalization of medication caused
overuse of the painkillers irrespective of the severity of the condition and thereby leading to
the development of the negative physiological health consequences. In order to overcome the
harmful effects of the long-term use of the painkillers, non-pharmacological interventions for
the pain management are important. Non-pharmacological interventions include use of the
music therapy with a person-centered approach. However, the healthcare professionals must
also be educated about the music therapy and its role in modulating mood swings.

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References
Argoff, C. E. (2013, February). Topical analgesics in the management of acute and chronic
pain. In Mayo Clinic Proceedings (Vol. 88, No. 2, pp. 195-205). Elsevier. Argoff, C.
E. (2013, February). Topical analgesics in the management of acute and chronic pain.
In Mayo Clinic Proceedings (Vol. 88, No. 2, pp. 195-205). Elsevier.
Bradt, J., Potvin, N., Kesslick, A., Shim, M., Radl, D., Schriver, E., ... & Komarnicky-
Kocher, L. T. (2015). The impact of music therapy versus music medicine on
psychological outcomes and pain in cancer patients: a mixed methods
study. Supportive Care in Cancer, 23(5), 1261-1271.
https://doi.org/10.1007/s00520-014-2478-7
Cooper, R. J. (2013). Over-the-counter medicine abuse–a review of the literature. Journal of
substance use, 18(2), 82-107. https://doi.org/10.3109/14659891.2011.615002
Gutgsell, K. J., Schluchter, M., Margevicius, S., DeGolia, P. A., McLaughlin, B., Harris,
M., ... & Wiencek, C. (2013). Music therapy reduces pain in palliative care patients: a
randomized controlled trial. Journal of Pain and Symptom Management, 45(5), 822-
831. https://doi.org/10.1016/j.jpainsymman.2012.05.008
Jamison, R. N., Kerry Anne Sheehan, B. A., Elizabeth Scanlan, N. P., & Ross, E. L. (2014).
Beliefs and attitudes about opioid prescribing and chronic pain management: survey
of primary care providers. Journal of opioid management, 10(6), 375-382. Retrieved
from: https://www.wmpllc.org/ojs-2.4.2/index.php/jom/article/view/115

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The Pharmacy Guild of Australia. (2018). New pharmacy program for patients with chronic
pain. Access date: 28th Feb 2019. Retrieved from: https://www.guild.org.au/news-
events/news/2018/new-pharmacy-program-for-patients-with-chronic-pain
Tse, M. M. Y., & Ho, S. S. (2014). Enhancing knowledge and attitudes in pain management:
A pain management education program for nursing home staff. Pain Management
Nursing, 15(1), 2-11. https://doi.org/10.1016/j.pmn.2012.03.009
Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain—misconceptions
and mitigation strategies. New England Journal of Medicine, 374(13), 1253-1263.
Retrieved from: https://www.nejm.org/doi/full/10.1056/NEJMra1507771