Articles: pain-clinics.
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This audit study took place in ten outpatient pain clinics and focused on the management of low back pain and nerve-damage pain. The objective was to identify and promote appropriate changes in management. An analysis of the treatment of 1236 patients with low back pain and/or nerve-damage pain highlighted wide variations in practice. ⋯ Many changes in practice occurred after the audit intervention, with large increases in the utilisation of these three treatments. Since there is reasonable evidence to support the use of these treatments for chronic pain this represents an improvement in the process of care. The audit demonstrated that patient management can be improved by a combination of active feedback and discussions based around comparisons between centres.
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Painful swelling of the calf is a common clinical problem. Distinguishing deep venous thrombosis from pseudothrombophlebitis can be difficult Pseudothrombophlebitis syndrome has been associated with ruptured/dissecting popliteal synovial cysts, localized myositis, inflammatory pseudotumor, popliteal artery aneurysm, and ruptured gastrocnemius, popliteal and/or plantaris tendon/muscles. In this report, we describe two patients for whom magnetic resonance imaging rapidly and accurately identified the cause of pseudothrombophlebitis, thus helping to avoid further testing and unnecessary anticoagulation.
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In order to determine the degree to which the recommendations of the report of the joint working party on 'Pain after Surgery' by the Royal College of Surgeons of England and the College of Anaesthetists have been implemented, a postal survey was conducted of all hospitals in the United Kingdom where surgery is performed. The number of hospitals with a multidisciplinary acute pain service had significantly increased from 2.8% before September 1990 to 42.7% at the end of 1994. ⋯ The use of written protocols, the provision of out-of-hours cover and regular training for all staff have increased with time. Research and audit activity related to acute pain management has also improved since 1990.
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Although pain assessment is a vital preliminary step towards the satisfactory control of cancer pain, data on the prevalence of different pain syndromes are rare. In a prospective study of 2266 cancer patients, we assessed localisations, aetiologies and pathophysiological mechanisms of the pain syndromes. Thirty percent of the patients presented with 1, 39% with 2 and 31% with 3 or more distinct pain syndromes. ⋯ The main pain syndrome was also coded according to the IASP Classification of Chronic Pain. Regions and systems affected by the main pain syndrome showed large variation depending on the site of cancer origin, whereas temporal characteristics, intensity and aetiology were not markedly influenced by the cancer site. The variety of pain syndromes evaluated in our patients confirms the importance of comprehensive pain assessment prior to treatment.