Essential pain management: an educational program for health care workers.

Background: Education for health care workers on pain-related topics is not always readily available, and this is especially so in low and middle income countries (LMICs). The Essential Pain Management program (EPM) has been developed to offer a simple interactive educational opportunity for health care workers in LMICs.

Methods: Following a needs analysis in Papua New Guinea, an 8 h educational program with the aims of improving pain knowledge and providing a simple pain management framework was developed.

Massive clonidine overdose during refill of an implanted drug delivery device for intrathecal analgesia: a review of inadvertent soft-tissue injection during implantable drug delivery device refills and its management.

Objectives: The study aims to highlight the potentially serious consequences of inadvertent soft-tissue injection of intrathecal drugs such as clonidine, during refills of implanted drug delivery devices, and to suggest strategies to reduce this complication.

Design: Case report and literature review were used.

Results: We report the case of a 51-year-old female with chronic arm pain who sustained a massive clonidine overdose (18,000 mcg) due to inadvertent soft-tissue injection during a refill of an implanted drug delivery device, resulting in rapid loss of consciousness and significant cardiovascular instability requiring urgent resuscitation, subsequent myocardial infarction, cardiac failure, and other significant complications.

Blood concentrations of enflurane before, during, and after hypothermic cardiopulmonary bypass.

Objective: The purpose of this study was to determine blood concentrations of enflurane delivered via a membrane oxygenator during hypothermic cardiopulmonary bypass (CPB) with changes in the input enflurane concentration and temperature and to characterize the pharmacokinetics of enflurane washout during and after CPB.

Design: Blood enflurane concentrations were measured by gas chromatography before, during, and after CPB by using mean delivered enflurane concentrations of 0.5% v/v (group 1, n = 5), 0.

The management of persistent pain.

Persistent pain is a complex mix of physical and psychological symptoms and is ideally managed by a biopsychosocial approach. Often the relative contributions of family and personal relationships, finances, work, past pain experiences and personality outweigh those of the nociceptive or neuropathic processes from which most pain originates. Recent advances in our understanding of the pathophysiology of pain may lead to improved drug treatments; however, non-drug treatments--education, lifestyle modification, exercise and reassurance--should be used routinely to improve patients' quality of life.

Management strategies for the treatment of neuropathic pain in the elderly.

Pain caused by dysfunction or damage to the peripheral or central nervous system is typified by the symptoms described by patients with painful diabetic neuropathy, post-herpetic neuralgia and central poststroke pain. All these conditions are more common in the elderly. Neuropathic pain has long been recognised as one of the more difficult types of pain to treat; however, with the current emphasis on providing a multidisciplinary assessment and approach to management, more patients will be offered relief of their symptoms and an improved quality of life.

Shearing of a peripheral nerve catheter.

We report a previously undescribed complication of peripheral nerve catheter placement. The catheter was sheared when its stylet was removed with the placement needle still in the tissues. The lost distal fragment was identified with computed tomography scanning.

Australian management strategies for oral opioid use in non-malignant pain.

Chronic non-cancer pain is a complex biopsychosocial phenomenon; as such it is unlikely that any one treatment modality will achieve relief. There is increasing availability of oral opioid preparations and an associated increased level of prescribing; consequently in 1997 the Australian Pain Society drew up some management strategies for their use. This paper reviews the principles of those strategies, stressing that oral opioids should not be used in isolation nor used to treat 'distress' often associated with chronic pain.

Outcome of intrathecal opioids in chronic non-cancer pain.

Eighty-eight patients (58 women and 30 men; mean age 53.4 years) with chronic non-cancer pain present on average for 9.8 years were evaluated following treatment with intrathecal opioids for an average duration of 36.

Retro-orbital tumour--an uncommon cause of headache in pregnancy.

Retro-orbital tumour was the cause of headache and neuropathic facial pain in a 31-year-old pregnant woman. The diagnosis had been overlooked as a result of a long history of migraine. There was exacerbation of the pain throughout the pregnancy, particularly in the third trimester.

The effect of midazolam on persistent postoperative nausea and vomiting.

The effect of intravenous midazolam on persistent postoperative nausea and vomiting (PONV) was compared to placebo in a prospective randomized double-blind study. Twenty patients aged 18 to 82 years with persistent PONV resistant to standard anti-emetics and present for greater than six hours were randomized to receive either an intravenous infusion of midazolam 1.0 mg/h or placebo.

Depth of central venous catheter insertion in adults: an audit and assessment of a technique to improve tip position.

A technique of subclavian vein catheterization is described, tailored to the individual patient, to reduce the risk of right atrial placement with central venous catheter (CVC) insertion. Using data gathered retrospectively for Quality Improvement purposes, CVC tip location was assessed. The standard technique used in our cardiac anaesthesia unit at that time was to insert all CVCs to a depth of 15 cm from the skin.

The use of oral opioids in patients with chronic non-cancer pain. Management strategies.

Background: The use of oral opioids in non-cancer pain is increasing, but it is not clear that this is improving outcomes for patients. These management strategies were developed as a consensus view between the two authors, who are both Directors of the Australian Pain Society. The strategies were subsequently reviewed and approved by the other Directors of the Society: four anaesthetists specialising in pain management, a pharmacist, a rheumatologist, two rehabilitation physicians and an occupational therapist.

Control of intractable pain in erythromelalgia by using spinal cord stimulation.

A 69-yr-old woman with severe, long-standing erythromelalgia possibly secondary to multiple deep-vein thromboses, was treated with transcutaneous electrical nerve stimulation for the burning pain in her legs and feet. Problems developed, and she was subsequently successfully managed with spinal cord stimulation. The relief was reproduced after a 6-mo period of no stimulation by reestablishing spinal cord stimulation.

Extradural abscess following local anaesthetic and steroid injection for chronic low back pain.

A case is described of extradural abscess following extradural injection of local anaesthetic and steroid for the management of chronic low back pain. The common signs and symptoms are reviewed, possible causes discussed and the association with diabetes stressed.

The effect of diclofenac and nefopam on postoperative dental pain.

Eighty-two outpatients who received general anaesthesia for surgical removal of maxillary or mandibular third molars were given either diclofenac 75 mg or nefopam 20 mg intramuscularly for postoperative pain control. They and the control group were also allowed oral paracetamol as required. The results showed that there was no significant pain relief from these single intramuscular injections.