Post-herpetic pain in the elderly
Helen Gaskell
pp 1-3
This article focuses on the prevention and treatment of persisting pain and associated symptoms after herpes zoster (HZ), commonly known as shingles, which can be a significant problem for many older patients. In recent years, more possible methods of dealing with this condition have become available. A typical episode of HZ includes mild malaise for several days, during which time the patient may experience abnormal sensations such as numbness, itching or burning in areas of the skin in a dermatomal distribution. The eyes can be affected and, more rarely, so can the viscera. These conditions are important, but beyond the scope of this article.
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Comment: Taking the broader approach
Dominic Aldington
pp 3-3
While reading Helen Gaskell’s latest contribution to Managing pain in practice on post-herpetic neuralgia (PHN), I was reminded of how common a problem PHN is. I recalled a couple of patients who I saw recently, the misery of their lives with PHN and, in one case, the extremes they had been to in an attempt to manage it. I was then struck by the statement that the National Institute for Health and Clinical Excellence made about the lack of support for topical agents in treating this condition. The evidence is that these agents work extremely well, but only for a very few patients. However, for those in whom they do work, the results are terrific.
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Quality of life and NSAIDinduced gastrointestinal adverse events
Jonathan Belsey
pp 4-5
The key objective in managing chronic pain is not only achieving adequate analgesia, but also optimising the ability to carry out normal activities. Achieving the first goal without the other will result in significant impairment in quality of life (QoL), despite the apparent success of the treatment. This is particularly important when managing osteoarthritis (OA) and rheumatoid arthritis, where limitation of activity may constitute the most important element of the disease for the individual patient. The situation becomes complicated when considering which treatment to use.
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Recognising and treating common sports injuries
Jonathan Greenwell
pp 6-7
With the opening ceremony of the London 2012 Olympic Games drawing ever closer, the number of people exercising is on the increase. Although exercise has significant public health benefits, there is also the risk of injury, either acute or resulting from overuse. With the recent recognition of Sport and Exercise Medicine as a specialty by the Department of Health, there has been a strong shift towards evidencebased medicine in the management of these injuries. After acute traumatic injuries, the next biggest group of injuries is tendinopathies, and this is where many of the recent advances in management have been made.
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Managing acute pain in a hospital setting
Debby Edwards
pp 8-9
The primary goals in acute pain management are to relieve pain with analgesia, resolve the causes of pain by promoting healing and/or correcting underlying problems, and to keep the side effects of analgesics to a minimum. Identical injuries do not present the same pain. All patients are individuals and one size does not fit all. Acute pain teams are often led by specialist nurses along with consultants in anaesthesia, and they routinely review patients after surgery and trauma. Staff and patient education, the development of guidelines and protocols, and audit of outcomes and complications are all key functions of the acute pain team
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How to recognise and treat common causes of foot pain: part 1
Heidi J Siddle and Philip S Helliwell
pp 10-11
Foot and ankle problems are highly prevalent in the general population, but presentation and management of these problems is often neglected. Recent evidence has demonstrated that 8% of musculoskeletal consultations in primary care involve the foot and ankle1 and most involve non-traumatic conditions. Therefore, it is important that these conditions are assessed and managed effectively. The biggest barriers to managing pain in the feet are usually time, reluctance by clinicians to remove shoes and socks, and the lack of skills needed to examine the foot and subsequently diagnose the presenting problem.
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