Aust Fam Physician
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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.
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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.
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Renal function is an important prescribing consideration. On average, glomerular filtration rate declines by about 10 mL/min every 10 years after the age of 40. Renal impairment may cause medicines to accumulate or cause toxicity, especially if the medicine has a narrow therapeutic index. ⋯ Serum creatinine considered in isolation is not a reliable indicator of renal function. The estimated glomerular filtration rate provided in pathology reporting can alert prescribers to possible renal impairment and the need to consider dose adjustments. The Cockcroft-Gault equation should be used to adjust medicine doses. Renal function monitoring is recommended for patients using medicines that can impair renal function or cause nephrotoxicity (eg. NSAIDs, ACEIs, ARBs).
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Active surveillance, followed by delayed definitive treatment for those who develop evidence of significant cancer progression, is now a recognised management strategy for selected men with low risk prostate cancer. ⋯ A considerable proportion of men with low grade prostate cancer on biopsy may never progress to higher stage disease or develop symptoms from their cancers. These patients are suitable for active surveillance under the care of a urologist. Active surveillance involves initial stringent observation of the prostate cancer, with inclusion of monitoring biopsies rather than immediate active treatment in the form of surgery or radiotherapy. With careful selection, about 70% of men will not require any intervention for at least 5 years. Men with low grade disease should be offered active surveillance as a treatment option and provided with information about the risks and benefits of this approach.