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Pain management

Revisiting opioid use in New Zealand: how does your prescribing compare?

Opioids can be effective for relieving moderate to severe acute pain but carry a significant risk of harm with longer periods... View Article

October 2023

Managing pain in the last days of life

Pain is often feared by people in the last days of life and if not adequately controlled, it can negatively impact their remaining... View Article

September 2023

Polymyalgia rheumatica (PMR) – look before you leap

Polymyalgia rheumatica (PMR) is an inflammatory rheumatological condition that causes a specific pattern of joint pain and morning... View Article

July 2023

Osteoarthritis: a focus on exercise

Three main aspects form the foundation of a management strategy for patients with osteoarthritis: education, exercise and weight... View Article

March 2023

The medicinal cannabis guide for pharmacists

The Medicinal Cannabis Scheme provides pathways for registered medical practitioners to prescribe quality medicinal cannabis products... View Article

June 2022

Acute low back pain

Low back pain is a leading contributor to disability in New Zealand; it is only rarely a life-threatening condition, but it represents... View Article

May 2022

An overview of medicinal cannabis for health practitioners

Recent regulatory changes will make medicinal cannabis much more accessible to patients. As medicinal cannabis is not a focus... View Article

March 2022

Gabapentinoids: when and how should they be prescribed?

Limited pharmacological treatment options to manage chronic non-neuropathic pain can lead to the inappropriate prescribing of... View Article

December 2021

Endometriosis: diagnosis and management

Endometriosis is characterised by the presence of endometrial-like tissue outside the uterine cavity, causing mainly cyclical... View Article

February 2021

Codeine: all formulations prescription-only

All combination codeine products will be reclassified as prescription-only medicines on 5 November, 2020. This change has been... View Article

October 2020

Codeine reclassified as a prescription-only medicine: a community pharmacy perspective

The range of analgesics available over-the-counter (OTC) in pharmacies will be reduced when all codeine-containing products are... View Article

October 2020

Understanding the role of opioids in chronic non-malignant pain

There is no evidence that opioids such as tramadol are effective for managing pain long-term, yet they continue to be prescribed... View Article

October 2018

Avoiding the triple whammy in primary care: ACE inhibitor/ARB + diuretic + NSAID

Angiotensin converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers (ARBs), diuretics and nonsteroidal anti-inflammatory... View Article

May 2018

Pain theme Peer Group Discussion

The following questions can be used as discussion points for peer groups or self-reflection of practice. The questions relate... View Article

April 2018

Prescribing gabapentin and pregabalin: upcoming subsidy changes

From 1 May, 2018, pregabalin will be available to prescribe, fully subsidised. From 1 June, 2018, prescribing restrictions will... View Article

March 2018

Prescribing tramadol appropriately

Tramadol is an atypical opioid used for moderate pain when paracetamol and/or a NSAID is not adequate. There is no evidence that... View Article

February 2018

Paracetamol dosing for children in primary care

Paracetamol dosing errors can lead to acute liver failure in children. Calculation of a paracetamol dose in children should be... View Article

February 2018

The principles of managing acute pain in primary care

The primary aim of acute pain management is to provide treatment that reduces the patient’s pain, with minimal adverse effects,... View Article

February 2018

Selected topics in acute pain management for primary care

There are a multitude of causes of acute pain, however, the approach to management will often be similar; assessment guides prescribing... View Article

February 2018

When to consider strong opioids for patients with acute pain

There are few indications for prescribing a strong opioid for acute pain in a primary care setting. If a strong opioid is required,... View Article

February 2018

Medicinal cannabinoids: current regulations for prescribing

Recent amendments have been made to regulations concerning the prescription of some medicinal cannabis products. For primary care,... View Article

February 2018

Managing pain in osteoarthritis: focus on the person

The progression of osteoarthritis varies from person to person. Functional decline and worsening of symptoms is not inevitable,... View Article

January 2018

Celecoxib: the “need to know” for safe prescribing

Celecoxib is a selective cyclo-oxygenase-2 (COX-2) inhibitor that has been fully subsidised without restriction, since 1 June,... View Article

January 2018

Methylnaltrexone is a subsidised treatment option for opioid-induced constipation in palliative care

Methylnaltrexone injections are now subsidised for the treatment of opioid-induced constipation for patients in palliative care.... View Article

January 2018

Diagnosing and managing headache in adults in primary care

A systematic approach is recommended when assessing patients with headache to rule out serious underlying conditions and to ensure... View Article

December 2017

Oxycodone prescribing: New Zealand solutions to a global problem

Inappropriate prescribing of opioids for non-cancer pain is an international problem. In this article we examine an initiative... View Article

October 2016

Diagnosis and management of axial spondyloarthritis in primary care

Ankylosing spondylitis is a relatively uncommon inflammatory cause of long-term back pain which can result in radiographic changes... View Article

August 2016

Managing patients with neuropathic pain

Neuropathic pain results from a lesion or disease affecting the somatosensory system. There are a range of causes of neuropathic... View Article

May 2016

Oxycodone Update

This report provides an update on the use of oxycodone over the 12 month period from October, 2014 – September, 2015. View Article

March 2016

Chronic pelvic pain in women

Chronic pelvic pain can cause significant disruption to the lives of the women it affects. It can arise not only from pathology... View Article

September 2015

Upfront: An avoidable death: the importance of communication in clinical care

The following treatment injury case study was prepared by the Accident Compensation Corporation (ACC) in conjunction with the... View Article

August 2015

The Year in Review - What did we learn in 2014?

In 2014 we published over 60 medical education articles in Best Practice Journal, spanning more than 450 pages. Context is crucial... View Article

February 2015

Identifying and managing addiction to opioids

The increased use of opioid analgesics in recent years, particularly oxycodone, has resulted in misuse and addiction issues associated... View Article

October 2014

Helping patients cope with chronic non-malignant pain: it’s not about opioids

The role of opioids in the management of chronic non-malignant pain is a controversial subject due to concerns over the long-term... View Article

September 2014

Investigating myalgia in patients taking statins

Muscle pain (myalgia) and weakness is experienced by up to 10% of patients taking statins. However, myalgia is commonly experienced... View Article

August 2014

Oxycodone Update

Since 2011, bpacnz has produced a series of reports and articles on appropriate use of opioids and has urged prescribers to review... View Article

August 2014

Oxycodone: how did we get here and how do we fix it?

Following on from the interview with Dr Jeremy McMinn in the last edition of Best Practice Journal, we examine in more detail... View Article

July 2014

The role of triptans in the treatment of migraine in adults

Paracetamol or a non-steroidal anti-inflammatory drug (NSAID) can be used first-line for pain relief in acute migraine. A triptan... View Article

July 2014

News Updates

Evidence that alternate dosing of paracetamol and ibuprofen in children with fever may reduce temperature: other benefits un... View Article

July 2014

Assessing diabetic peripheral neuropathy in primary care

Diabetic peripheral neuropathy is one of the most common long-term complications of diabetes. It develops in up to half of all... View Article

June 2014

Upfront: “A disaster in the making”: it’s time to take action against misuse of oxycodone

Dr Jeremy McMinn is a consultant psychiatrist and addiction specialist at Capital & Coast DHB. He is also the Co-Chair of the... View Article

June 2014

The use of analgesics in children

This report discusses the use of analgesics for the treatment of pain in children between January – December 2013. View Article

May 2014

Managing patients with renal colic in primary care: Know when to hold them

Approximately one in ten people will be affected by renal colic at some stage in their life. Patients with red flags should be... View Article

April 2014

Managing pain in children aged under 12 years

“Pain is what the patient says it is”. This definition of pain can be applied to any patient, regardless of their age. Good pain... View Article

March 2014

Non-steroidal anti-inflammatory drugs (NSAIDs): Making safer treatment choices

Non-steroidal anti-inflammatory drugs (NSAIDs) are successfully used to treat a wide range of painful conditions. However, NSAIDs... View Article

October 2013

Calcium pyrophosphate deposition disease: The arthropathy formerly known as “Pseudogout”

A number of clinical syndromes are associated with the precipitation of calcium pyrophosphate dihydrate crystals in and around... View Article

October 2013

Polymyalgia rheumatica: Look before you leap

Polymyalgia rheumatica is an inflammatory condition that causes a particular pattern of joint pain and stiffness, most commonly... View Article

June 2013

Strong opioids for pain management in adults in palliative care

Pain is estimated to be the most prevalent symptom preceding all deaths occurring in a palliative care setting. Strong opioids... View Article

December 2012

Oxycodone update

In June 2011, bpacnz produced a report on oxycodone dispensing which urged prescribers to review their use of oxycodone. Oxycodone... View Article

May 2012

Update on oxycodone: what can primary care do about the problem?

The volume of oxycodone prescribed in New Zealand is continuing to rise, despite efforts to encourage clinicians to use this medicine... View Article

May 2012

The fear of enabling; misuse of prescription medicines

Misuse of prescription opioids is increasing worldwide and many doctors are becoming reluctant to prescribe these medicines for... View Article

June 2011

Oxycodone use still increasing

Oxycodone is a strong opioid used for the treatment of moderate to severe pain in people for whom morphine is not tolerated or... View Article

June 2011

Oxycodone Prescribing

Examines oxycodone prescribing compared to that of morphine. View Article

June 2011

Snippets: Fentanyl patches

This article has been archived. If you would like access to the original article please contact: editor@bpac.org.nz View Article

December 2010

Snippets: Dextropropoxyphene & Donepezil

Donepezil to be funded on pharmaceutical schedule | Dextropropoxyphene - finding alternatives View Article

July 2010

Snippets: Gabapentin Humalog & Tramadol

Humalog, Tramadol and Gabapentin View Article

June 2010

Common issues in paediatric oral health

How to recognise and manage common oral health issues in younger children including: what to expect inside the mouth, teething... View Article

April 2010

Oxycodone: place in therapy

Oxycodone is a strong opiod and is a second line option (after Morphine) for use at step three on the WHO analgesic ladder. It... View Article

November 2009

Acute low back pain

Acute low back pain is common and most patients will fully recover within three months. Serious causes are rare and can be excluded... View Article

June 2009

Management of non-specific back pain and lumbar radicular pain

Key aspects of management include reassurance, education and encouraging the patient to remain active - adequate analgesia is... View Article

June 2009

Five-minute back examination with neurological assessment

Instructions and illustrations for performing a quick examination on a patient presenting with acute low back pain and neurological... View Article

June 2009

WHO Analgesic Ladder: Methadone - safe and effective use for chronic pain

Methadone is a strong opioid that may be suitable for people whose pain is uncontrolled with, or who are unable to tolerate, morphine.... View Article

December 2008

WHO Analgesic Ladder: which opioid to use at step two?

There are several different opioid options that can be considered at step two of the WHO analgesic ladder for chronic pain. Choice... View Article

December 2008

Symptomatic management of osteoarthritis

The key treatment of osteoarthritis is to provide information and resources that help patients to cope, including advice on exercise... View Article

October 2008

Safe Prescribing of Morphine in Primary Care

Advice from the 'Safe and Quality Use of Medicines Group'. View Article

October 2008

The problem of pain memory: persistent central sensitisation pain

Pain memory occurs when the nervous system has become up-regulated from a previous trauma or severe pain. This is a particularly... View Article

September 2008

Pharmacological management of chronic pain

Managing pain includes helping the patient understand why they have pain and creating realistic expectations for relief. Individualised... View Article

September 2008

Pharmacological management of neuropathic pain

The treatment of neuropathic pain involves a different step-wise approach. View Article

September 2008

Widened access to fentanyl patches

Fentanyl is a synthetic opioid which is available as a transdermal patch. This allows controlled delivery of the drug for up to... View Article

September 2008

Snippets: NSAIDs dextropropoxyphene and antibiotic resistance

Drug information of topical interest View Article

February 2008

Dilemmas: Recognition and treatment of pain in elderly people

Chronic pain is common in elderly people, however it is often unrecognised, treated sub-optimally or not treated at all. Regular... View Article

February 2008

Lumiracoxib linked to deaths in Australia

Medsafe have just announced that approval for lumiracoxib (Prexige) 400 mg tablets has been revoked in New Zealand. This follows... View Article

September 2007

A slow death from colchicine

Contributed by Safe and Quality Use of Medicines. View Article

September 2007

Safe use of paracetamol in children

The evidence-base for the information contained in this article is no longer current: please refer to the New Zealand Formulary... View Article

May 2007

NSAIDs and coxibs

Cardiovascular risk associated with NSAIDs and coxibsNSAIDs in the treatment of soft tissue injuries View Article

October 2006