Gastroprotection with NSAIDs – how can we make things happen?
Andrew Moore
pp 1-3
The National Institute for Health and Clinical Excellence (NICE) guideline on osteoarthritis (OA) is one of NICE’s better pronouncements. The advice on the use of a proton pump inhibitor (PPI) with a non-steroidal anti-inflammatory drug (NSAID) or cyclo-oxygenase-2 (COX-2) inhibitor could not be more straightforward. Nor is it news – the evidence has been available for years and various sets of guidelines have said the same for at least a decade. And yet this guideline on using a PPI with an NSAID is largely ignored. Moreover, even when a PPI is prescribed with the NSAID, many patients fail to adhere to the prescription.
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Comment: The value of guidelines
Dominic Aldington
pp 3-3
Since this issue could be accused of being guideline heavy, I thought I would start the theme in my editorial. According to Wikipedia, guidelines have been with us throughout modern clinical medicine, although searching PubMed shows 5,791 articles with the word ‘guideline’ in the title, and 30% of these were from the last three years. So, what are guidelines for? Surely to guide our decision-making, which, given the breadth and complexity of medicine, is no bad idea. Why do we read them?
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Initiatives for the safer prescribing of NSAIDs
Norman Evans
pp 4-4
It has been known for some time that there is a risk of upper gastrointestinal (GI) bleeding with aspirin, and non-steroidal anti-inflammatory drugs (NSAIDs) of all types, and that concomitant use of proton pump inhibitors (PPIs) reduces the risk. The National Institute for Health and Clinical Excellence (NICE) recommends coprescribing in all patients. NICE clinical guideline 59 even has implementation tools to assist prescribers.
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Neuropathic pain guidelines: an overview
Alia Darweish and Murli Krishna
pp 5-8
Neuropathic pain is a multidimensional entity that continues to present a challenge to medical professionals with regards to its diagnosis and management. In recent years there has been an emphasis on the use of pain descriptors to aid diagnosis, but the lack of pathognomonic terms and overlap of descriptors between neuropathic and nociceptive pain conditions means that neuropathic pain continues to be poorly recognised and undertreated.
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Commissioning pain management services
Norman Evans and Shailen Rao
pp 9-10
Pain is the most common symptom of any illness, and long-term pain can have a devastating effect on the lives of sufferers and families. Pain is a complex experience entailing physiological, sensory, affective, cognitive and behavioural components. An individual’s perception of the intensity of pain relates to the interaction of physical, psychological, cultural and spiritual factors. The management of pain, therefore, requires a multidisciplinary approach.
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What you told us about MPIP
pp 11-11
In Managing pain in practice 2.3 we ran a reader survey to help us gauge how readers are using the journal, and how helpful a resource it is for healthcare professionals who deal with pain management. The majority of respondents were hospital nurses specialising in pain, community nurse practitioners and GPs with special interest in pain. The rest comprised a mix of nurse practitioners, community nurses specialising in pain, prescribing advisers and pharmaceutical advisers.
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