Welcome to the latest issue of Nurse Update, provided by NPS: Better choices, Better health. Nurse Update is a digest of evidence-based information to help you improve your knowledge of medicines use and prescribing practices.

NPS actively engages with nurses to encourage a greater understanding of medicines by providing information and activities on various therapeutic programs.

In this issue

• Managing acute low back pain
• Iron deficiency anaemia
  
• New quiz to assess sleep
• Feed your competency
• NPS publications

Managing acute low back pain

Acute low back pain is extremely common, affecting 4 in 5 Australians at some point in their lives. The pain can be debilitating and people often want to know what’s causing it, but in about 85% of cases the cause is non-specific.

Doctors, pharmacists, physiotherapists and osteopaths may be sought by people to help manage their acute low back pain. Recognising this, NPS’s latest education program for health professionals looks at treatment options in acute low back pain and emphasises that in the absence of indicators of more serious problems, diagnostic imaging is usually not necessary.

Most cases of acute low back pain is are not due to any serious injury, disease or damage to the spine and do not cause lasting damage.

People have come to expect having a scan or x-ray to diagnose the problem, but they need to understand diagnostic imaging isn’t usually necessary in acute non-specific low back pain. In most cases having a scan will not change the treatment options or recovery time.

Scan and x-ray orders have increased significantly in Australia over the last decade. A review of GP activity using the BEACH dataset from 2008–09 showed nearly 1 in 10 consults led to imaging orders, generating an additional 2.7 million imaging orders than in 1999–2000. In 2008–09, 5% of diagnostic imaging related to back pain.

Needless imaging can unnecessarily expose people to radiation. Many prescribers don’t realise that a lumbar spine CT scan may deliver a dose of radiation equivalent to 165 chest x-rays.

Consider the following approaches for managing acute non-specific low back pain:

• Reassure people that acute lower back pain is common and that most people improve within a few days or weeks.
• Advise people that imaging tests are not recommended in routine evaluation of non-specific acute low back pain in the absence of indicators of a serious underlying condition.
• Consider non-medicine approaches including staying active and trying hot or cold packs for short-term relief.
• If a medicine is needed to manage the pain and enable people to stay active, encourage use of simple analgesics. Regular paracetamol is the preferred choice of analgesic given it has fewer side effects than other pharmacological options, especially if used in the longer term. Reiterate the importance of using only the recommended dose and speaking to a doctor if effective pain relief is not being achieved.
• Advise people to stay active by starting slowly and gradually building up to their normal level of daily activity. Remind them to keep moving and not spend more than 20–30 minutes sitting or lying in 1 position during the day.

A range of resources have been developed for health professionals in educating patients about managing their acute low back pain including:

• Managing your acute low back pain: symptomatic management pad
• a poster aimed at consumers to be put in surgeries, pharmacies and clinics
• online videos and content for consumers.

For more information visit www.nps.org.au/managingpain.

A consumer campaign about over-the-counter analgesics that includes managing acute low back pain will be launched in February 2011.

More information on opioid use in chronic pain is available from the health professionals section of our web site.

Iron deficiency

Iron deficiency anaemia affects people of all ages, but young women, pregnant women and children are at increased risk. While there are more than 100 oral iron replacement products available on the market, only a few contain enough iron to treat iron deficiency anaemia.

The latest NPS News discusses causes, investigation and treatment options for iron deficiency anaemia based on dose and duration, to help health professionals manage anaemia and potential side effects and drug interactions.

Establishing the cause of iron deficiency anaemia is essential to rule out serious disease like gastric or colon cancer, to ensure the right therapy is prescribed and to prevent further iron imbalance.

Likely causes of iron deficiency anaemia vary according to age, co-morbidities and medicines use. Causes may be physiologic (e.g. increased iron demand due to pregnancy) or pathologic (e.g. increased iron loss because of bleeding and decreased iron absorption because of coeliac disease). However, interpreting iron studies can be complex and expert advice may be needed.

While oral iron is first line therapy for most people with iron deficiency anaemia, it is critical that the dose and duration are adequate.

There are more than 100 oral preparations containing iron available over the counter in Australia but few contain enough iron to treat iron deficiency anaemia.

Doses also differ for adults and children, and parents should be reminded that small children can overdose on even a small amount of an iron preparation.

If oral iron causes stomach upset, it can be taken with or shortly after food. Other ways to minimise stomach upset are to start on a low dose and gradually increase as tolerated (e.g. start with alternate daily dosing then increase to daily or twice daily dosing) or to give smaller, more frequent doses (e.g. use oral liquid in divided doses).

For more information about iron deficiency anaemia read the latest NPS News.

New online quiz to assess sleep quality

The modified Pittsburgh Sleep Quality Index^© is now available via the NPS website. It allows people to assess the quality of their sleep by answering a few simple questions.

The quiz about sleep has been developed as part of the sleep program currently running for health professionals and consumers.

It includes a short questionnaire and participants are encouraged to discuss their results with their doctor.

Other program resources developed for consumers include:

• Sleep right. Sleep tight factsheet
• a sleep diary.

To take the quiz or to access the resources visit www.nps.org.au/sleep.

Feed your competency