Last month, I broke the (very abstract) ‘fourth wall’ between myself and potential readers of this blog. In the traditional sense, a fourth wall, of course, is a conceptual barrier between people presenting works (normally of fiction) and their audiences, such that, not unlike a two-way mirror, actors/writers/performers proceed as though their recipients are not there. Breaking it, then, involves an active acknowledgement of the audience and some ensuing form of address. My own breach of the fourth wall involved a direct question posed on the social media platform ‘X’ (formerly known as Twitter) to gauge engagement with my PJ blogs, hosted monthly since October 2022. Of course, such a poll might not accomplish much beyond the cursory exchange that ensued, and my quiet delight that more than a quarter of those responding said they had read four or more. Nonetheless, this direct reader engagement also validated for me that writing still has a place in a world dominated by social media posts, podcasts and other forms of communication that are now the norm. Another group that no doubt takes pleasure at the prospect of the written word is the collaboration #RxWritingChallenge, hosted by the Wulling Center for Innovation & Scholarship in Pharmacy Education, which has been running since 2017. The purpose of the group is to lessen the pain of writing through a focused period, in which pharmacy writers across the world commit to write for 30 minutes each day for 14 days, twice per year, of which the last period took place from 25 March to 5 April 2024. There is no doubt merit in committing to a regular, timed period of writing, regardless of what the author is attempting to produce, perhaps even for those writing fiction. For now, though, I’ll return to my main aim, which is to provide a taste of recent papers published in the Royal Pharmaceutical Society’s research journals.
My focus this month is on studies addressing the subject of pain. If the drug development continuum is conceptualised, broadly speaking, as drug discovery, followed by pre-clinical research, clinical trials, and post-marketing surveillance and patient engagement, the first paper I reviewed sits at the earlier stages, but also makes use of marketed drugs, as follows. Published in the Journal of Pharmacy and Pharmacology, the authors examine the therapeutic potential of the flavonoid compounds fisetin and quercetin for neuropathic pain in an animal model, both alone and in combination with pregabalin or gabapentin, with the rationale being that use of the latter is marred by significant side effects, as well as limited efficacy. After inducing neuropathy in rats in the experimental group, and working up a mechanical method for measuring pain thresholds using an electronic test, the authors found both quercetin and fisetin to show antiallodynic effect at 10mg/kg and 20mg/kg doses. Even with 5mg/kg doses of these compounds, when combined with gabapentin or pregabalin, the authors report increased antiallodynic effect and for a longer duration with specific combinations. The authors thus propose quercetin and fisetin as potential agents for further research.
The second study, published in RPS Pharmacy and Pharmacology Reports, sits much further along the continuum described above. Here, the authors examine the combination of gabapentin and pregabalin in the treatment of postherpetic neuralgia in a small sample of 15 patients treated in the Central Hospital of Shaoyang, China. Arguing that there is a lack of sufficient treatments for adequate pain relief, their purpose was to collect and compare data retrospectively from the medical records of patients with postherpetic neuralgia, who were given both drugs in combination, without a washout period after monotherapy had failed. The authors report a statistically significant improvement in pain scores before and after treatment on pregabalin-gabapentin combination therapy, as well as a comparable treatment duration to that of monotherapy. One patient reported side effects on switching to combined treatment, but none discontinued therapy. Acknowledging the small scale of their work, the authors advise further investigations in due course. After accessing this paper, I was interested to read the latest National Institute for Health and Care Excellence’s clinical knowledge summaries for the initial management of a person with neuropathic pain, noting, in particular, the advice to not prescribe more than one neuropathic pain drug at the same time.
The final study I read, published in the International Journal of Pharmacy Practice, focused on pain of a different kind. Here, the authors used the ‘common-sense model’ of illness representation to explore individuals’ experiences and perceptions of migraine and its management in the UK. The common-sense model of self-regulation was proposed by the psychologist Leventhal as a theoretical framework for understanding the processes by which patients deal with illness, from becoming aware of a health threat, to creating a plan for dealing with the threat, even including their feedback on the efficacy of the plan and the progression of the threat. Returning to the earlier continuum, this final study sits furthest along, by engaging with patients to analyse their perspective to explicate medication-taking behaviours. The authors thus map their findings as cognitive representations of migraine, emotional representation, and coping/self-management behaviours. Further studies are promised to investigate the extent to which the findings from this sample of 11 participants map onto the wider population.
The main conclusion we might take from considering these papers as a whole is that, alongside the practical application of science, to care for patients in our work, there is also a continual need for research to help us move forward in the field of pharmacy and pharmaceutical care. As the profession increasingly recognises the value of research, I am delighted to leave you with news that my team at the RPS has collated a new guide on current research funding opportunities available across all categories of pharmaceutical and healthcare research as of April 2024. I hope this proves useful, leading to flourishing stories of success in due course.
