Page 23 - P4403.14_V87_YOUROTC_Book DECEMBER_2023 NI PRINT Final 23

HEALTHCARE 23

Supporting patients with joint pain in community pharmacy

45 years of age and over
Patient presents with activity-limiting STEP 1
joint pain through:
PRESENTATION
Referral from
Medicines Self-selected Advice
use review other healthcare OTC product requested
professional

Patient-centred consultation STEP 2

Information gathering CONSULTATION
Usage-related pain Pain worse on resting,
improved by rest improved by usage
Morning stiffness Prolonged morning
(duration <30 mins) stiffness (duration >30
Gradual changes mins)
in symptoms Rapid worsening Support and refer STEP 3
No hot swollen joints of symptoms
No fever or unexplained Hot swollen joints Red flagged
weight loss Systemic upset Manage the patient’s acute RECOMMENDATIONS
No immediate prior injury History of trauma or cancer pain as appropriate AND REFERRAL

Manage
Pharmacist Non-pharmacist

• Signpost to Recommendation at first presentation • Refer to • Refer to
community/ GP or pharmacist
support Education/information on usage-related joint pain acute NHS
initiatives Strengthening, flexbility and aerobic exercises walk-in
• Refer to relevant Weight management if required centre
healthcare NICE additional treatments if required (e.g. thermotherapy) • Monitor
professionals (e.g. patient
• physiotherapists, First line (topical NSAIDs) progress
dietitians and Monitor patient progress
occupational
therapists)
Recommendation at second presentation

If symptoms improve If symptoms persist If symptoms worsen
STEP 4
• Review / continue • Review first line • Refer to GP
• Monitor patient • Consider second-line • Monitor patient MONITOR PATIENT
progress (paracetamol or progress PROGRESS
oral NSAIDs + PPI
• Monitor patient
progress

Recommendation at third presentation
If symptoms persist or worsen

• Review first- and second-line treatment
• Consider third line (OTC opioid, e.g. co-codamol if not on paracetamol)
• Refer to GP
• Monitor patient progress
The above recommendations assume no contraindications to therapy or no drug interactions exist. In such instances, refer patient to the appropriate healthcare professional.
NICE: National Institute for Health and Care Excellence; NSAID: non-steroidal anti-inflammatory drug; OTC: over-the-counter; PPI: proton pump inhibitor.
Cottrell E, Stanford C, Quicke J et al. Appropriate community pharmacy management and referral of patients with chronic peripheral joint pain. Pharm J 7924(302):S16–S20.
doi: 10.1211/PJ.2019.20205710

05/05/2023 15:00
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Product Size Case Buying RRP Trade POR Pip Code
Size Price/Single Offer % %
VOLTAROL
VOLTAROL Osteoarthritis P 1% 100g 100g 6 £7.89 £14.49 9% 35% 356-4010
VOLTAROL Osteoarthritis P 1% 50g 50g 6 £4.96 £8.99 8% 34% 301-3711
VOLTAROL 12 HOUR GEL P EASY OPEN 100g 6 £10.63 £19.49 9% 35% 387-6570
VOLTAROL 12 HOUR EMUGEL P 2% 30G X6 GB 30g 6 £4.63 £8.49 9% 35% 379-5309
VOLTAREN GEL BACK & MUSCLE 1.16 % 100G (No Mess) 100g 3 £8.71 £15.99 9% 35% 406-6643
VOLTAROL EMULGEL 12 HOUR 50g 6 £6.53 £11.99 9% 35% 379-5291

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