Australian Pain Specialist Urges Pharmacists to Engage Customers on Neuropathic Pain Associated with Postherpetic Neuralgia (PHN)
Raising awareness about neuropathic pain and effective treatment options is vital for better patient outcomes, according to Australian Pain Medicine Specialist Dr Ian Thong, and pharmacy is well placed to champion change.
“There are treatments within the neuropathic pain category and opportunities associated with these treatments for community pharmacy. Whether the patient is coming in for initial advice or filling a script for a neuropathic pain treatment, pharmacists are in a good position to assist,” said Dr Thong.
“There are many types of neuropathic pain – a complex form of chronic pain that may be severe. One of these is PHN, or postherpetic neuralgia.”
PHN is a type of neuropathic pain that affects nerves in a particular area of the skin1. PHN occurs when pain persists for longer than 3 months in an area of the skin after herpes zoster reactivation (shingles)1. It is often characterised by burning, shooting, or stabbing pains2,3.
“Understanding the different treatments available on prescription or as OTC preparations is crucial as it can be confusing for patients with PHN. For example, patients may not understand that a product like VERSATIS® (a topically acting, hydrogel patch with 5% lignocaine used to treat PHN) is different to OTC creams and other preparations containing the same active ingredient4,” said Dr Thong.
“Some patients with PHN have ended up swapping out of prescribed treatments, such as dermal patches, for OTC topical creams and preparations. Pharmacists have an important role in educating patients about their prescribed treatments.
“In most cases, doctors have considered all treatment options – both prescription and OTC – and have selected the most appropriate treatment for their patient. For example, VERSATIS® patches are relatively easy to administer, and provide both pain relief and a protective barrier over the hypersensitive area of skin. This helps to reduce discomfort and rubbing against clothing for the patient4.
“At the end of the day, people with PHN are looking for simple and sustainable solutions to help keep their pain under control and reduce the interference in their lifestyle,” Dr Thong continued.
Lesley Brydon, CEO of PainaustraliaTM, said management of patients with all forms of chronic pain requires a multidisciplinary approach.
“People who experience neuropathic pain often require long-term treatment and on-going access to a healthcare professional team, including their local pharmacist. This presents an important opportunity for pharmacy to engage customers about pain and provide them with appropriate advice and treatment options,” Ms Brydon said.
VERSATIS® (lignocaine) 5% w/w, Dermal Patch is Schedule 4 and is the only lignocaine patch indicated for the symptomatic relief of neuropathic pain associated with previous herpes zoster infection (postherpetic neuralgia, PHN) in adults4,5.
VERSATIS® relieves neuropathic pain associated with PHN via a dual mode of action. Lignocaine acts on sensitised nerve fibres to reduce impulse transmission in local, damaged fibres, delivering analgesia.4,6 Additionally, the hydrogel patch provides a protective cover over the hypersensitive area of the skin and offers a soothing effect4,7.
The effectiveness of VERSATIS® in PHN is supported by several clinical studies. In one study, where the lignocaine patch was compared to treatment with pregabalin, data revealed that VERSATIS® achieved a 62% responder rate* compared to 46% with pregabalin after 4 weeks of treatment (N=88)+#8. VERSATIS® demonstrated improved tolerability compared to the systematic treatment pregabalin9. A prospective evaluation of the efficacy and safety of VERSATIS® over a 4-year period demonstrated the sustained, long-term efficacy of VERSATIS® in PHN10.
No clinically relevant interactions with other medicines have been observed in clinical studies. The most commonly reported adverse events for VERSATIS® were skin reactions4. Systemic adverse drug reactions following the appropriate use of the VERSATIS® patch are unlikely4.
Usually, between one and three VERSATIS® patches are enough to cover the PHN affected area. The patches can also be cut if the area is smaller than the size of one patch. A maximum of 3 patches can be applied simultaneously for up to 12 hours. The subsequent patch-free interval must be at least 12 hours4.
VERSATIS® is currently available through all pharmacy wholesalers and is expected to retail from $150-$160 for a pack of 30.
For more information on VERSATIS®, visit www.versatis.com.au
*Responder is defined as a reduction of at least 2 points or an absolute value of 4 or below on the 11-point NRS-3; +primary endpoint for non-inferiority was not met, results for per protocol subset; #p-value not reported.
1. Votrubec M and Thong I. Aust Fam Phys 2013; 42: 92-97.
2. Schmader KE and Dworkin RH. JPain 2008; 9 (1 Supp, 1): 3-9.
3. Dworkin RH et al. JPain 2008; 9 (1supp, 1): 37-44.
4. Versatis Approved Product Information, July 2015.
5. Data on file, Seqirus Pty Ltd, 2015.
6. Garnock-Jones KP and Keating GM. Drugs 2009; 69(15): 2149-2165.
7. Rowbotham M et al. Pain 1996; 65: 39-44.
8. Baron R et al. Curr Med Res Opin 2009; 25(7): 1663-76.
9. Rehm S et al. Curr Med Res Opin 2010; 26(7): 1607-1619.
10. Sabatowski R et al. Curr Med Res Opin 2012; 28: 1-10.