According to the Australian War Memorial website, the 25th of April was officially named ANZAC Day in 1916. Even then it was marked by a wide variety of ceremonies and services.

Today ANZAC Day goes beyond commemorating the landing on the Gallipoli peninsula in Turkey in 1915. It is now the day we remember all Australians who served and died in all wars, conflicts and peacekeeping operations.

By the mid 1930s all the rituals we now associate with ANZAC Day were well established – dawn vigils, marches, memorial services, reunions and even two-up games. Another of these traditions is the bugle call of the Last Post. Originally part of a more elaborate routine that began in the 17th century known in the British Army as “tattoo”, the Last Post signals the day’s end.

The Last Post was eventually incorporated into funeral and memorial services as a final farewell.

The ceremonial presence of the lone piper is likely to have become a feature of Australian memorial services from the 1920s. The traditional Scottish song of mourning and remembrance, Flower of the Forest, is the tune usually played on these occasions.

Flowers and plants in their own right have come to play a part in this process of reflection and remembrance. Laurel, generally woven into a wreath, is a commemorative symbol. In the ancient Greco-Roman world, it was used to crown victors and the brave as a mark of honour.

It’s now commonplace to wear a sprig of rosemary on Anzac Day. The use of rosemary as a symbol of remembrance, dates back centuries. Since ancient times this aromatic herb was believed to have properties to improve memory. Possibly because of these supposed properties, rosemary became an emblem of both fidelity and remembrance in ancient literature and folklore.

The Flanders Poppy is another flower increasingly being used as part of Anzac Day observances. During the First World War, red poppies were seen to be among the first living plants that sprouted from the devastation of the battlefields of northern France and Belgium.

Poppies of a different kind are cultivated for their opium content and it’s a grim irony that the Taliban, fighting our forces, are being supported by funds derived from the heroin trade – that’s heroin manufactured from the plants in those vast attractive poppy fields of Afghanistan.

The narcotic pain relievers developed from the opium poppy remain one of the most valuable groups of medicines available. Unfortunately the pain experienced by our troops in war zones is often such that it can’t be managed by pain relievers alone. Post traumatic stress can be severe and long lasting.

Official recognition was given to the condition known as post-traumatic stress disorder (PTSD) in 1980 following the Vietnam War. While the majority of causes of PTSD are war related – war veterans, peace-keeping forces and refugees are all at high risk – people who are victims of national disasters may also suffer PTSD.

With the assistance of the Australian Government and the Department of Veterans Affairs, the Pharmaceutical Society has produced a fact card on Post Traumatic Stress Disorder. It’s one of a series of Cards that includes Anxiety, Depression and Sleeping Problems available at your nearest Self Care pharmacy. Phone the Pharmaceutical Society on 1300 369 772 for more information or check the Society’s website www.psa.org.au and click on “pharmacy finder”, for the location of pharmacies providing the Society’s Self Care health information.

©2010 Pharmaceutical Society of Australia

The products will still be available, but rather than being able to be self-selected from the pharmacy shelf, they will only be available after consultation with the pharmacist. Larger packs, containing more than five days’ supply, will only be available on prescription. These changes are in line with the new “scheduling” regulations introduced by the Therapeutic Goods Administration (TGA).

Pain is an important signal that our body has been damaged or stressed in some way; and so attention is required to treat or remedy that injury.

However, at best pain is unpleasant; and when it becomes severe and chronic (that is, long lasting), it can all but destroy our quality of life. Coping mechanisms often involve the use of pain relievers; and various pain relievers are available which work in different ways and are more or less suitable for different types of pain.

Apart from the sensation and the severity of pain – it can be mild or severe; and it can be sharp or dull – pain is usually described as acute pain or chronic pain.

Acute pain comes on suddenly and lasts for a limited time – perhaps just a few minutes, but maybe hours, days or weeks. It could be caused by insect bites, burns, or broken bones. When pain last longer than a few months it is described as chronic; possibly due to a medication condition such as arthritis or cancer; or it may be due to an infection or an accident.

Although some forms of chronic pain can be treated with non-prescription medicines (for example: regular paracetamol for osteoarthritis), whatever the cause, chronic pain should be managed by your doctor.

Simple, single ingredient pain relievers such as paracetamol or ibuprofen are generally effective in relieving the mild to moderate acute pain associated with headache or muscle and joint pain.

Aspirin, paracetamol or ibuprofen in combination with codeine – may be more effective for some people in relieving stronger pain: however, along with the extra benefit, codeine does carry some disadvantages. It may cause drowsiness, dizziness or constipation. And if used in high doses for long periods, it can cause dependence and withdrawal symptoms.

Interestingly codeine is not for everyone. Up to 10% of the population do not have the enzyme which is necessary to convert codeine to morphine in the body – a requirement for its pain relieving effect. And some people are what are known as “rapid metabolisers” – they change the codeine to morphine very quickly and are more likely to suffer the adverse effects.

Non-steroidal anti-inflammatory drugs (NSAIDS) are a group of pain relievers which includes aspirin, ibuprofen, naproxen and diclofenac. They may be useful for conditions where inflammation is present – conditions such as period pain or sports injuries. However, caution is needed for people especially older people with asthma, high blood pressure, heart failure, kidney disease or gastrointestinal problems (ulcer or reflux).

Most Australians use pain relievers wisely, and the TGA scheduling changes have been made to ensure as much as possible this continues to be the case. Whatever the cause of your pain, check with your pharmacist first to make sure you get the most effective product.

You can get more information about pain relievers – which ones to use and when – from the Pain Relievers fact card which is available from pharmacies around Australia providing the Pharmaceutical Society’s Self Care health information. For the nearest location phone 1 300 369 772 or log on to the website at www.psa.org.au and click on Self Care Pharmacy Finder. There are also cards on Back Pain, Headache, Arthritis and Sprains and Strains.

©2010 Pharmaceutical Society of Australia

Just like the moon watchers of 1969, Captain James Cook was looking skyward when not quite by accident, but certainly secondary to his main aim, he came across the east coast of Australia.

In 1769 Captain Cook’s primary role was to observe the transit of Venus. His ‘discovery’ the following year of what he named New South Wales led to the visit and permanent settlement of Arthur Phillip’s First Fleet 18 years later.

Philip sailed into Botany Bay just a few days before French navigator, the Comte de La Perouse. It’s debatable if the French had arrived before the British whether the Tour de France would include Australia; however, different timing of events in 1815 really would have meant our red, white and blue flag may have had a very different design.

Apparently at a critical stage during the Battle of Waterloo, Napoleon returned to his quarters to seek relief from the pain of his haemorrhoids. Whether relief was gained we don’t know, but we do know that for the ‘little general’ the battle was lost.

No time is convenient to suffer with haemorrhoids; and how many emperors today are similarly discomforted is hard to say, but Napoleon had been all day in the saddle, and any horse rider would surely say that having haemorrhoids is not much fun. The reality is, of course, having haemorrhoids is no fun for anyone – it’s a very sensitive issue in more ways than one.

Haemorrhoids are just like varicose (swollen) veins inside or around the anus. They are very common, with 80% of people estimated to have suffered with haemorrhoids at some time in their lives.

Symptoms include pain and irritation – the pain is usually a dull ache, often worse when passing a bowel motion; and the irritation is usually a burning, itching sensation. Fortunately these symptoms can generally be treated effectively with medicines, diet and attention to hygiene.

Rectal and anal discomfort can also be caused by conditions other than haemorrhoids. Therefore, if we are unsure whether haemorrhoids are actually the cause of the discomfort, we should see our doctor in the first instance.

Non-prescription topical preparations containing combinations of local anaesthetics, corticosteroids, astringents and healing agents are soothing and give at least temporary relief of symptoms – they should normally be used twice a day and after each bowel motion. However, long term relief may need some diet and lifestyle modification.

Constipation or straining to pass a bowel motion are common causes of haemorrhoids, so judicious use of laxatives can be useful in addition to an increase in fibre and fluid intake. We should also recognise that medicines (often prescribed medicines) can be a cause of constipation. Your pharmacist can advise you if this is likely to be the case.

With this in mind, paracetamol is the first choice ‘over the counter’ oral analgesic to relieve the pain of haemorrhoids. So-called compound pain relievers containing codeine should be avoided as they can also cause or aggravate constipation.

Keeping the area around the anus clean will help reduce itch and irritation. As soap can itself cause irritation to the already sensitive area, non-soapy cleansers are a better option, as are the use of flushable moist towelettes instead of toilet paper.

If you want to participate in the equestrian events at the next Olympics, perhaps cycle to the local shops, or even sit down for dinner without too much discomfort, check out the Haemorrhoids fact Card. It’s available from pharmacies around Australia providing the Pharmaceutical Society’s Self Care health information – go to www.psa.org.au and click on Self Care Pharmacy Finder. There are other relevant cards: Fibre and Bowel Health, Constipation and Pelvic Floor Exercises.

©2009 Pharmaceutical Society of Australia

This was the conclusion drawn from the results of a consumer survey presented to the Australian Pain Society Annual Scientific Meeting held in Sydney recently.

Creative Commons licensed image

In commenting on the survey results, Professor Andrew McLachlan from the Faculty of Pharmacy at the University of Sydney, said that better management of back pain would lead to better health outcomes for the individual and a less severe impact on the health care system for the community.

Back pain is an extremely common condition with 80% of Australian adults saying they have suffered back pain in the last six months; and sufferers of back pain indicate that they suffer, on average, 15 days of pain each month.

Fortunately, it is rare for back pain to be caused by a serious medical condition; and most cases get better within a few weeks. Nevertheless, if the pain is extremely troublesome or long lasting, you should see your doctor.

In treating back pain, movement is the key to success. Contrary to popular opinion, rest can be counter-productive – in fact prolonged bed rest can be harmful. Yet, according to the survey, one in eight Australians ignored recommendations to remain active.

According to Professor McLachlan there are also many misconceptions about how to get the best from pain relievers to help manage back pain. Paracetamol is generally recommended as the first choice medicine for pain relief, he said, but adequate doses are essential if benefit is to be expected.

“There is evidence of under-dosing with pain reliever medicines,” said Professor Mclachlan, “it’s as if people think they can take a couple of paracetamol tablets today and the pain will be gone for the week. We want people to be using the right medicines, in the right doses over the appropriate period of time.”

For truly effective pain relief with paracetamol the recommended adult dose is two 500mg tablets four times daily.

Back pain specialist Dr Vik Wilk, a founding member of the Australasian Faculty of Musculoskeletal Medicine, told delegates at the Pain Society Meeting that back pain sufferers should seek objective evidence based information.

“I would encourage people to consult health care professionals for advice about managing back pain. Pharmacists, GPs and physiotherapists are all good sources of advice,” he said.

The recently updated Fact Card Back Pain is one such source of relevant information. It lists the possible causes, treatment options and self help hints to avoid the recurrence of back pain. The Card is available from pharmacies around Australia providing the Pharmaceutical Society’s Self Care health information.

Muscle and ligament strains are the most common causes of back pain – and the neck and lower back are the most common sites of pain. Things that can put us more at risk of injuring back muscles and ligaments include: poor posture, heaving lifting and bending, weak muscles due to lack of exercise, sitting for long periods especially in poorly designed work areas, and poor mobility or staying in one position for too long a time.

Being overweight can increase the risk of back pain and emotional stress can increase tension in the back muscles.

To help avoid the emotional and physical stress of back pain pick up one of the Back Pain Fact Cards from your nearest Self Care pharmacy. For locations, check out the Pharmaceutical Society’s website at www.psa.org.au and click on the pharmacy finder.

©2009 Pharmaceutical Society of Australia

So National Headache and Migraine Awareness Week, 22-27 September, should have universal interest.

Of course, headache is simply a symptom of an underlying cause. And this cause needs to be identified in order to select the most effective treatment.

While the exact reason why headaches occur is still unclear, medical evidence suggests that a headache originates from the pain-sensitive blood vessels at the base of the brain.

What is clear is that there are certain factors – trigger factors – which can provoke headache. These triggers aren’t the same for everyone and at different times they may even be different for the same person. However, commonly they include stress, tension and anxiety. Headaches could be related to hormone level changes; perhaps at the time of periods, during pregnancy or while taking oral contraceptive or hormone replacement therapy. Factors as simple as delaying or missing meals, coffee withdrawal or too much alcohol can trigger headaches.

Irregular sleep problems, as in too much or too little sleep, or ‘jet lag’ associated with international travel or shift work, can also trigger headaches; as can weather or altitude changes, strong smells or fumes and stuffy smoke-filled rooms. Certain medicines can trigger headaches as well.

Just about everything you want to know about headache is available by way of the Self Care fact cards – available at pharmacies throughout Australia providing the Pharmaceutical Society’s Self Care health information. There are cards titled Pain relievers, Headache and Migraine.

Migraine is one of the four most common types of headache. The others are tension headache, sinus headache and cluster headaches. And these are all described on the fact cards; with suggestions as to the most appropriate treatment. Remember, migraine is sometimes incorrectly self diagnosed. It is not just a very bad headache. It’s a specific condition usually presenting as a severe throbbing headache, often accompanied by other symptoms such as nausea and vomiting. It is usually felt on one side of the head. Some people have warning signs (so-called aura symptoms), up to an hour before the headache starts. These might be flashing lights or a feeling of tingling or numbness.

Avoiding headaches is a better option than having to treat them when they occur. This usually involves some minor changes to lifestyle – learning to relax, keeping fit, having a regular sleep pattern and regular exercise, and being moderate with eating and drinking habits. (The Relaxation techniques fact card may be a good one to have a look at, too).

Meanwhile, a report published in the Medical Journal of Australia earlier this month suggests that some migraine sufferers may be missing out on effective prevention remedies. According to Honorary Associate Professor Richard Stark from the Alfred Hospital in Melbourne, there is strong evidence for benefit from several medicines originally developed for conditions other than migraine.

Products previously used as treatments for epilepsy, high blood pressure and depression show great promise in migraine prevention.

When medication is required to treat headache, the choices are generally between aspirin, paracetamol and ibuprofen; or perhaps one of these combined with codeine for more severe pain. The combination of paracetamol with metoclopramide (an anti-nauseant medicine) is a useful non-prescription product now available to treat migraine or “sick headache”.

Paracetamol is considered safe in recommended doses, but beware the possibility of inadvertent overdose when paracetamol from different sources is taken together; for example, when prescribed for arthritis, when purchased without prescription for headache and/or cough-cold treatments.

So when you next have a headache, check with your pharmacist first for the most appropriate treatment; and ask for the fact cards. Phone the Pharmaceutical Society on 1300 369 772 for the location of your nearest Self Care pharmacy.

©2008 Pharmaceutical Society of Australia

There’s nothing new about palliative care. In fact it’s the major effect of many of our prescriptions and non-prescription products and the concept of palliative care has been around for centuries. Medicines which provide a cure are comparatively new arrivals on our pharmacy shelves.

Perhaps it’s because we’re now living much longer these days and, therefore, there is a greater focus on palliative care – the process of providing quality of life – especially towards the end of life.

The need for pain relief as a part of palliative care would seem quite obvious, but for many reasons pain relief is neglected or not provided in an effective way.

It was about ten years ago that an article in “New Scientist” magazine drew attention to the need for a reassessment of pain relief in palliative care.

The author stated that “the magic solution that would allow the vast majority of terminally ill people to die in relative comfort is not expensive or dangerous. It is one of the oldest medicines known: morphine. But because morphine is a narcotic and associated with heroin, it has gained a reputation among the medical profession and the public as a dangerous drug.”

A decade on, most doctors and pharmacists certainly have a better understanding of the benefits of the opioid pain relievers such as morphine. However, there are still misconceptions in the minds of many patients, their families and carers.

In recent years we have seen the development of a number of variations on the old morphine mixtures – preparations which are easier to take, more palatable and less likely to cause uncomfortable side effects. There are long-acting and sustained release tablets and capsules, as well as patches and lozenges in doses which can be individually tailor-made.

Of course, opioid analgesics aren’t the only option – nor even the most appropriate one on many occasions. Simple pain relievers like paracetamol or the non-steroidal anti-inflamatories can be very effective when taken in the right dose. And medicines such as antidepressants, antiepileptics, antispasmodics and steroids – medicines not normally associated with pain relief by patients and their families – are often the drugs of choice.

People who are terminally ill will be under the care of their doctor; and the pharmacist can also provide good advice about the role of various medicines – the way they work, the appropriate dose, whether they are given routinely or just as required and also the potential for side effects and how to treat them.

There might also be the need for regular laxatives or occasional antinauseants and possibly something for dry mouth caused by the side effects of some of the medicines.

Pain is experienced by more than 50% of people with advanced cancer; but it is also often a problem with other chronic conditions. There is no valid reason why effective pain relief should not be available for all these patients.

The World Health Organisation (WHO) has a so-called Analgesic Ladder to help explain how pain relievers are best given. Your pharmacist can guide you through the steps. Ask also for the series of “pain reliever” fact cards available from pharmacies around Australia providing the Self Care health information. Phone 1 300 369 772 for the nearest location or check out the website www.psa.org.au/psc

©2008 Pharmaceutical Society of Australia