Opioids in chronic non-cancer pain
As mentioned in last month’s newsletter, CSGPN has commenced educational visits on Opioid Therapy in Chronic Pain: Use a Planned Approach. Opium has been used by man over many millennia. Indeed, fossilised poppy seeds in Europe indicate Neanderthal man using opium poppy over 30,000 years ago! Reference is made to it in a Sumerian text dated around 4000 BC. Today there is good evidence for opioid therapy in cancer and severe acute pain yet its place in chronic non-cancer pain is uncertain.

The current NPS presentation explores some of the key issues with opioid prescribing for persistent non-cancer pain. Resources provided include tools to assist pain assessment, opioid misuse, templates for patient pain management plans and diaries, and an information sheet for patients prescribed an opioid. CSGPN has also put together a laminated sheet that lists the opiods available in Australia with their trade names, presentations and approximate conversion to a morphine dose. This chart includes the new long acting formulation of hydromorphone (Jurnista).

Feedback from GPs has been very positive. GPs have discovered pain information and plan templates that they didn’t know existed! Others have appreciated information supplied on best practice guidelines for selecting an opioid and the role of patches.  The visits provide a forum to raise GP issues with opioids and explore the balance between the historical under treatment of chronic pain to the ballooning misuse of opioids.

If you would like a practice visit on this topic, please contact Beba or Cameron at CSGPN to make an appointment.

Lost in translation: medicine misunderstandings lead to further health problems
Health information can be difficult for anyone without a medical degree to understand, but for people with English as a second language it can be even more challenging – and have significant consequences.

A quarter of all Australians were born overseas, many in countries with different languages, cultures and beliefs about health and medicines. This can affect how they understand health information and medicines, for example thinking the colour of a tablet symbolises its strength, or not regarding herbal remedies as medicines.

Health professionals need to be aware many people from culturally and linguistically diverse backgrounds may not think it’s appropriate to ask a doctor or pharmacist questions or to seek clarification. They may not have access to translated information or be unable to read it, even in the language they speak. These language difficulties are often exacerbated because they don’t know what questions to ask. Many also come from cultures where asking questions of health professionals is seen as disrespectful.

As a result, people often don’t understand what their medicines are for, how and when to take them, and for how long to take them. Also, many do not know about the side effects of their medicines, and what to do if they experience one.

The problem is not confined to those with little or no English. Those with conversational English often have difficulties understanding complex medical explanations and instructions, particularly when they are unwell or in a stressful situation.

When in doubt, use an interpreter, and don’t be afraid to enlist the pharmacist’s support through an HMR. For more information about the free interpreter service available to all Australian GPs, Google: “Translating and Interpreting Service”.