Aust Fam Physician
-
Managing pain requires time and effort to attend to its biopsychosocial characteristics. This requires proper planning and a whole-of-practice approach. ⋯ It is helpful to have a consistent, whole-of-practice approach when a patient new to the practice presents with a compelling case for opioids. Assessing patients with chronic pain includes a full medical history and detailed examination according to a biopsychosocial approach and applying 'universal precautions' to make a misuse risk assessment. A management plan should consider a range of non-opioid modalities, with a focus on active rather than passive strategies. Integrated multidisciplinary pain services have been shown to improve pain and function outcomes for patients with complex chronic pain issues, but access is often limited. Time-limited opioid use is recommended with initial and regular monitoring, including pain and function scores, urine toxicology, compliance with regulatory surveillance systems and assessment for adverse reactions and drug related aberrant behaviours. When ceasing prescribing, opioids should be weaned slowly, except in response to violence or criminal activity.
-
Neuropathic pain is described as burning, painful, cold or electric shocks and may be associated with tingling, pins and needles, numbness or itching. ⋯ A validated diagnostic screening tool can help identify patients with neuropathic pain. A systematic approach to clinical assessment and investigation will clarify the diagnosis. Good glycaemic control is important in the prevention and management of diabetic polyneuropathy; management options include antidepressants, gabapentinoids and controlled release opioids. Pain that lasts for more than 3 months after the onset of a herpes zoster infection is called 'postherpetic neuralgia'; management options include prevention with vaccination, early antiviral treatment and gabapentinoids, tricyclic antidepressants, controlled release opioids, capsaicin cream and lignocaine patches. In trigeminal neuralgia, patients complain of severe brief episodes of pain in the distribution of one or more branches of the fifth cranial nerve; first line management is with carbamazepine. Complex regional pain syndrome is diagnosed using the Budapest Diagnostic Criteria. Few clinical trials are available to guide the treatment of complex regional pain syndrome, which includes pharmacological and surgical options.
-
The prevalence of Helicobacter pylori is thought to be about 40% in developed countries. However, rates are difficult to determine due to many cases being asymptomatic. ⋯ Migraine is the most common cause of recurrent headaches in children. Previous reports have suggested a possible association between H. pylori infection and migraine. In the case study presented, H. pylori infection may have been associated with the child's recurrent headaches. Further research is required to confirm these anecdotal findings and to provide guidance for clinicians on whether recurrent headache in childhood is an indication for testing for H. pylori infection with a (13)C-urea breath test and, if necessary, treatment with triple therapy.