The Pharmaceutical Journal
Vol 277 No 7424 p505
28 October 2006

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Pharmacy review helps patients with knee pain

Following a pharmacy review, patients with knee pain experience less discomfort in the short term, according to researchers from Keele University.

In a study, (BMJ Online First, 20 October 2006) 325 adults aged 55 years or older with knee pain were recruited from 15 general practices in North Staffordshire. Patients were randomised to receive pharmacy review, community physiotherapy sessions or an advice leaflet followed by a telephone call (control group).

The pharmacy intervention resulted in differences in the improvement of pain scores (mean difference 1.18, 95 per cent confidence interval 0.3–2.1; P=0.006) at three months compared with controls, however the difference in function score changes was not significant between the two groups.

At three months, the physiotherapy intervention led to differences in the improvement of pain scores (mean difference 1.15, 0.2–2.1; P=0.008) and function scores (3.99, 1.2–6.8; P=0.008) compared with controls.

None of the differences was sustained at six or 12 months for either intervention.

Alison Blenkinsopp, professor of the practice of pharmacy, Keele University, and one of the authors, said that the trial has demonstrated benefit from enhanced pharmacy review in the short term. “One question,” she said, “is whether periodic pharmacy review over a longer period of time might have led to a benefit that was sustained for longer.”

She added: “Patients with chronic knee pain clearly need support to help them manage their condition. Regular pharmacy review could make a valuable contribution.”

Further data from the pharmacy review arm were presented last month at the British Pharmaceutical Conference (PJ, September Supplement, pB29 (PDF 80K)); the authors will soon publish a full report, said Professor Blenkinsopp.

Another of the study contributors, Michael Phelan, pointed out that the reviews were undertaken in GP practices where the pharmacist had access to patients’ medical records. “This was important in building up a picture of the prescribing of NSAIDs, identifying risk factors and understanding which other analgesics had been tried in the past,” he said.

Mr Phelan explained that a treatment algorithm, agreed with all of the prescribers, was used to make changes to patients’ therapy. He said that about half of the patients who were taking NSAIDs were found to be unsuitable for treatment with the drugs.

Professor Blenkinsopp said that the trial was important in quantifying the outcomes from the two individual interventions. “It is, of course, possible that a combination of enhanced pharmacy review and physiotherapy might produce an additive effect,” she said.