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BPJ 16 September 2008

Best Practice Journal

Pharmacological management of chronic pain

Managing pain includes helping the patient understand why they have pain and creating realistic expectations for relief. Individualised pain scales can be used to assess the severity of pain and impact on function. Pain should be treated in a step-wise approach, moving from simple analgesia to potent opioids. View Article

Pharmacological management of neuropathic pain

The treatment of neuropathic pain involves a different step-wise approach. View Article

The problem of pain memory: persistent central sensitisation pain

Pain memory occurs when the nervous system has become up-regulated from a previous trauma or severe pain. This is a particularly difficult type of chronic pain to treat. View Article

Prescription drug misuse: how to identify and manage drug seekers

Although an increasing problem in general practice, identifying drug seekers is not always simple. GPs should routinely screen any patient who is prescribed a controlled drug. It is important not to withhold appropriate treatment when a drug seeker has genuine pain. View Article

Medication-overuse headache: when the cure becomes the cause

Medication-overuse headache is a complex disorder best described as an interaction between a therapeutic agent used excessively and a susceptible patient. Recognition of the problem is the key, followed by careful withdrawal of the overused medication. View Article

Crohn’s disease and ulcerative colitis

Crohn’s disease and ulcerative colitis are chronic inflammatory bowel diseases. These conditions are usually managed in secondary care, however GPs have a role in the initial detection of disease, management of relapse and ongoing monitoring for complications and adverse effects of medication. View Article

Widened access to fentanyl patches

Fentanyl is a synthetic opioid which is available as a transdermal patch. This allows controlled delivery of the drug for up to 72 hours. View Article

Imiquimod cream (Aldara) for genital warts and basal cell carcinoma

Imiquimod enhances the immune response to viral infections and tumours by stimulating the immune system to release interferon and other cytokines. View Article

Upfront: The nature of our nurture

How genes and the environment work together to predict disease or behavioural outcomes. View Article

Correspondence: Metformin; Cultural competence; Aspirin; Amizide

View Article