On Saturday, October 23, 2004, Dr. Shakeel Bhatti, in association with UBC Continuing Studies and the Physiotherapy Association of British Columbia (PABC), held a workshop called “The Pharmaceutical Approach to Managing Pain” at the University of British Columbia (UBC) - Point Grey campus.  Dr. Bhatti discussed how common prescription, non-prescription, anti-inflammatories and muscle relaxants work; their applications, effects, limitations, differences, side effects, contraindications; and patient adherence in the pain management process.  

Describing Pain

Dr. Bhatti described pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”  In fact, he added that pain is subjective, and the success of treatment is complicated by issues of a patient’s biological and psychological beliefs.  In addition he described the three types of acute pain: somatic, visceral, and neuropathic. 

NSAIDs

Medications commonly prescribed for somatic and visceral acute pain are NSAIDs and Opioids.  NSAIDs (Nonsteroidal Anti-Inflammatory drug) are the most widely used pain medication and play a vital role in injury recovery.   NSAIDs work by inhibiting proatogladin production, which inhibits the release of inflammatory mediators which then affects the patient’s pain perception.  NSAIDs work quickly and can be taken safely over a long period of time, but need to be taken for 3 to 5 days to maximize their effects. These drugs have a ceiling – that is, a point where if taken in excess, the drug becomes ineffective.  As for side effects, the most common side effect associated with the use of NSAIDs are gastrointestinal in nature.  The first of these drugs on the market was Aspirin; other examples of NSAIDs are Ibuprofen, Naproxen, Diclofenac, Indomethacin, and Ketoralac. 

Opiods

The second set of pain medications prescribed by physicians are Opioids.  Opioids affect the opioid receptors in the central nervous system and are highly effective for acute and chronic pain.  Side effects of these drugs, which have no ceiling, are constipation and vomiting.  Examples of Opioids are Tylenol #3, Oxycontin, Percocet and Emtec.  While these drugs are good for severe acute pain and post-surgery pain, the client needs to be weaned off the drug.  Unfortunately, fearsome opinions and personal beliefs about the dangers of using Opioids  often affect a client’s compliance in using them when prescribed by a doctor.  Dr. Bhatti discussed the difference between habitual drug use (Requiring increasing quantities for satisfaction.) and drug addiction (Compulsive use of an addictive substance, regardless of the potentially negative social, psychological, and physical consequences.). 

Rehabilitation & Fitness Professional's Role

How might Dr. Bhatti’s information be useful to a rehabilitation & fitness professional?  While physicians guide the drug therapy of the client by prescribing and educating the client about the medication, and informing the client about any side effects, and pharmacists dispense the medication and educate the client to take their medication as prescribed, the rehabilitation & fitness professional can follow up with the client to ensure they are taking the medication as prescribed by their physician and reinforce the importance of taking their prescriptions until they are completed.  In addition, rehabilitation & fitness professional can encourage clients to follow up with their physicians if they experience side effects, when they have completed their rounds of medication and if they have any concerns about the medication they are taking.

Dr. Shakeel Bhatti was an excellent presenter.  He was very knowledgeable and reinforced the treatment role that all team members play in client drug therapy.  If you ever have the opportunity to hear Dr. Shakeel Bhatti speak, I highly recommend that it.

Workshop Review written by Rick Kaselj - rkaselj@healingthroughmovement.com

On-line Resources

• RxFiles

Dr. Bhatti recommended an on-line resource which he uses on a frequent basis, RxFiles.  RxFiles was created by the Saskatoon Health Region to provide physician, pharmacist and other health care professionals with the best information on drug therapy.

http://www.rxfiles.ca/

• Bandolier

Bandolier, an independent journal about evidence-based healthcare, is written by Oxford scientists. It appears monthly and has become the premier source of evidence-based healthcare information in the UK and worldwide for both healthcare professionals and consumers.

http://www.jr2.ox.ac.uk/bandolier/index.html

• Dr. Shakeel Bhatti - Murrayville Pharmacy – Langley, BC, Canada

www.pharmacist.bc.ca

• University of British Columbia (UBC) - Continuing Studies

http://www.cstudies.ubc.ca/physio/  

• Physiotherapy Association of British Columbia (PABC)

http://www.bcphysio.org

Article written by Rick Kaselj - rkaselj@healingthroughmovement.com

 Sign-up for the Free Rehabilitation & Fitness Newsletter - www.HealingThroughMovement.com

W - (604) 532-5248      F - (604) 677-5425     info@HealingThroughMovement.com       www.HealingThroughMovement.com