案例分享：多年痠痛，竟不是退化性關節炎
在社區藥局，常常遇到長者抱怨肩頸、關節痠痛，長年服用止痛藥或去診所打針，卻效果有限。
可以觀察到部分個案往復來回診所和藥局拿止痛藥。
大部分長者以為這只是年紀大、退化或「生活勞累」的自然現象，但真的是如此嗎?
剛好一位阿姨在藥局附近診所接受家醫科照護長達四、五年，主要因肩頸痠痛和全身節疼痛長期使用 Cox-2 抑制劑（Etoricoxib），
同時因高血脂服用 statin 類降血脂藥物。然而多年下來，症狀並未明顯改善。
在藥局領藥時，偶爾會聽到阿姨抱怨長期疼痛無法改善，有時候會買痠痛貼布去緩解。
我們藥師也會提醒阿姨是否轉往教學醫院做進一步健康檢查，
直到最近阿姨在女兒陪同下，前往醫學中心新陳代謝科進一步檢查，才被診斷為 乾燥症（Sjögren’s syndrome）。
經由專科醫師處方 類固醇與必賴克廔，不僅痠痛獲得緩解，整體生活品質也明顯改善。
藥師的角色：觀察、提醒與轉診
其實藥師可以是和長者互動的最前線，展現社區照護的價值。
藥師不僅能做到有關藥事照護，更能透過長期追蹤患者的用藥反應，發現「藥效與症狀不符」的異常。
當個案主訴症狀未緩解時，藥師的一句「也許該再檢查看看」，有時能成為改變治療方向的關鍵。
- 慢性痠痛不只來自退化乾燥症、類風濕性關節炎、紅斑性狼瘡等自體免疫疾病，常常以「痠痛」為初期表現，容易與一般退化混淆。
- 跨專業合作是照護關鍵家醫科醫師在偏鄉地區提供第一線照護，是擔任照顧民眾的家庭醫師的重責。而藥師則能在藥物追蹤與症狀觀察中補足細節，比如提供飲食衛教和運動處方。兩者合作能增加長者在服藥治療期間中的信心。
- 持續溝通，累積關鍵資訊藥師可以在長者持續拿慢性病處方藥期間適時關心「服藥後的身體變化」，對個案的調整治療方向非常重要。
給長者與家屬的提醒
如果長期服藥後，症狀仍然無法緩解，不要輕忽「可能是別的疾病」的警訊。與藥師、醫師保持良好溝通，勇於尋求第二意見，往往能避免錯過最佳治療時機。
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Case Study: Chronic Pain for Years, Surprisingly Not Osteoarthritis
At community pharmacies, it is common to encounter elderly patients complaining about neck, shoulder, and joint soreness. Many have taken painkillers for years or visited clinics for injections, but the effectiveness is limited.
It can be observed that some cases repeatedly go back and forth between clinics and pharmacies to get pain medication.
Most elderly people believe this is simply a natural phenomenon of aging, degeneration, or “life fatigue,” but is that really the case?
An aunt, for example, had been receiving family medicine care at a clinic near the pharmacy for about four to five years. Her main complaints were chronic neck and shoulder soreness and generalized joint pain. She had been using a COX-2 inhibitor (Etoricoxib) long-term.
She was also taking statins for hyperlipidemia. However, over the years, her symptoms did not significantly improve.
Occasionally, when picking up her medication at the pharmacy, the aunt would complain about the persistent pain and sometimes bought topical pain-relief patches to alleviate discomfort.
Pharmacists also reminded her about the possibility of going to a teaching hospital for a more comprehensive health examination.
It was not until recently, accompanied by her daughter, that she went to a metabolic medicine department at a medical center for further examination and was diagnosed with Sjögren’s syndrome.
Under specialist care with prescribed corticosteroids and hydroxychloroquine, not only was her pain relieved, but her overall quality of life significantly improved.
Pharmacists’ Role: Observation, Reminders, and Referral
Pharmacists can be the frontline in interactions with the elderly, demonstrating the value of community care.
They do not only provide pharmaceutical care but also monitor patients’ medication responses over time, noticing any discrepancies between drug effects and symptoms.
When a patient reports unresolved symptoms, a pharmacist’s suggestion like “perhaps it’s time to have another check-up” can sometimes be a critical turning point in redirecting treatment.
Chronic soreness can stem not only from degeneration but also from autoimmune diseases such as Sjögren’s syndrome, rheumatoid arthritis, and systemic lupus erythematosus. These conditions often initially manifest as vague soreness, which can easily be mistaken for routine aging changes.
Interprofessional Collaboration Is Key in Care
Family medicine doctors provide frontline care in rural areas and bear the heavy responsibility of being the community’s primary care providers. Pharmacists complement this by tracking medications and observing symptoms, offering dietary education and exercise prescriptions. Their collaboration enhances elderly patients’ confidence during medication therapy.
Continuous Communication and Accumulation of Critical Information
Pharmacists can timely check in on patients regarding “changes in body condition after medication” during ongoing prescription refills, which is crucial for adjusting treatment plans.
Reminders for the Elderly and Their Families
If symptoms persist despite long-term medication, do not ignore signs that “there might be another disease.” Maintain good communication with pharmacists and doctors, and be courageous in seeking second opinions—this can often prevent missing the best treatment window.