best practice:- Issue 16 Contents

Issue 16 September 2008 - Contents

Welcome to Issue 16

IN THIS EDITION OF BPJ we concentrate on the topic of chronic pain. This is one area of medicine that is rarely taught formally and many of us remain unsure about how to manage pain without causing possible harm to our patients through adverse effects such as addiction or respiratory depression.
Chronic pain is often a hidden problem. Many patients do not talk about this spontaneously and therefore pain is generally under diagnosed and under treated.

Pharmacological management of chronic pain	Select
Managing pain includes helping the patient understand why they have pain and creating realistic expectations for relief. Individualised pain scales can be used to assess the severity of pain and impact on function. Pain should be treated in a step-wise approach, moving from simple analgesia to potent opioids.
Pharmacological management of neuropathic pain	Select
The treatment of neuropathic pain involves a different step-wise approach.
The problem of pain memory: persistent central sensitisation pain	Select
Pain memory occurs when the nervous system has become up-regulated from a previous trauma or severe pain. This is a particularly difficult type of chronic pain to treat.
Prescription drug misuse: how to identify and manage drug seekers	Select
Although an increasing problem in general practice, identifying drug seekers is not always simple. GPs should routinely screen any patient who is prescribed a controlled drug. It is important not to withhold appropriate treatment when a drug seeker has genuine pain.
Medication-overuse headache: when the cure becomes the cause	Select
Medication-overuse headache is a complex disorder best described as an interaction between a therapeutic agent used excessively and a susceptible patient. Recognition of the problem is the key, followed by careful withdrawal of the overused medication.
Crohn’s disease and ulcerative colitis	Select
Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases. These conditions are usually managed in secondary care, however GPs have a role in the initial detection of disease, management of relapse and ongoing monitoring for complications and adverse effects of medication.
Short articles & Essentials	Select
Short articles Widened access to fentanyl patches. Imiquimod cream (Aldara) for genital warts and basal cell carcinoma. Essentials Upfront: The nature of our nurture: How genes and the environment work together to predict disease or behavioural outcomes. Correspondence: Folate deficiency with metformin, cultural competence, aspirin gargle for sore throat, amizide.