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‘Hey, Doc, I’ve heard there’s something new…’

Philip Cornish, FANZCA, FFPMANZCA Dept of Anaesthesia & Pain Medicine Flinders Medical Centre, South Australia. ‘Hey, Doc, I’ve heard there’s something new…’. ?Medicine is an art not a science. ?Make medicine more artful. ?Put the art back into medicine.

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‘Hey, Doc, I’ve heard there’s something new…’

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  1. Philip Cornish, FANZCA, FFPMANZCADept of Anaesthesia & Pain MedicineFlinders Medical Centre, South Australia ‘Hey, Doc, I’ve heard there’s something new…’

  2. ?Medicine is an art not a science • ?Make medicine more artful • ?Put the art back into medicine • ?Medicine is both a science and an art • ?Medicine is a science not an art • ?Practice the art of medicine • ?Transform art into science • ?Refine the art of medicine

  3. ‘The practice of medicine is an art, based on science’

  4. Pain Can Be Fun

  5. Pain as a Disease • Burden of pain largely unaddressed • Nosological status • National Pain Strategy • Funding • Training

  6. Pain as the 5th vital sign • P • BP • RR • LOC • VAS

  7. Where is the pain?...

  8. NNT – trick or treat? • = effort required to reach therapeutic target • Limitations • Point estimate • Pooled data • Overestimates efficacy • Underestimates NNH • Doesn’t usually mention NNK

  9. Zoster/PHN • Vaccination • Booster in late middle age • NNV@65 : AHZ 11 PHN 43 C/E > 60 for pain

  10. Ideas Out There • Discogenic Pain – methylene blue • Post Herpetic Neuralgia – botulinum toxin • Multiple Sclerosis – cannabis • Pre-Pain Clinic CBT – STEPS • Phantom Limb Pain – mirror therapy

  11. Q.S.T. • Psychophysiological test • C-fibre axonopathy • CRPS • Peripheral neuropathy • QST vs EMG

  12. Neuropathic Pain • Caused by injury to nociceptive nerves • Rarely treated by neurectomy

  13. Oxycodone/Naloxone • Claimed to lessen constipation • Might also lessen diversion

  14. Glial cells • ‘benign’ connective tissue • TLR-4 receptors & pronociception

  15. Opioid Passport • New style opioid contract • 4 components • Passport • Schedule 8 pass • Patient’s information sheet • Doctor’s checklist

  16. Cancer Pain • WHO ladder • Survivors • Specific treatments

  17. TAP Block • First described: • Rafi AN, Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001; 56: 1024-6 • Popularised: • O’Donnell BD, McDonnell JG, McShane AG. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. RAPM 2006; 3:91 • McDonnell JG, et al., Analgesic efficacy of transversus abdominis plane (TAP) block after abdominal surgery, a prospective randomized controlled trial. Anesth Analg 2007; 104:193-7

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