Philip Cornish, FANZCA, FFPMANZCA Dept of Anaesthesia

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Philip Cornish, FANZCA, FFPMANZCADept of
Anaesthesia Pain MedicineFlinders Medical
Centre, South Australia

• Hey, Doc, Ive heard theres something new

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• ?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

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• The practice of medicine is an art, based on
  science

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Pain Can Be Fun?
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Pain as a Disease

• Burden of pain largely unaddressed
• Nosological status
• National Pain Strategy
• Funding
• Training

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Pain as the 5th vital sign

• P
• BP
• RR
• LOC
• VAS

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Where is the pain?...
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NNT trick or treat?

• effort required to reach therapeutic target
• Limitations
• Point estimate
• Pooled data
• Overestimates efficacy
• Underestimates NNH
• Doesnt usually mention NNK

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Zoster/PHN

• Vaccination
• Booster in late middle age
• NNV_at_65 AHZ 11
• PHN 43
• C/E gt 60 for pain

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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

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Q.S.T.

• Psychophysiological test
• C-fibre axonopathy
• CRPS
• Peripheral neuropathy
• QST vs EMG

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Neuropathic Pain

• Caused by injury to nociceptive nerves
• Rarely treated by neurectomy

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Oxycodone/Naloxone

• Claimed to lessen constipation
• Might also lessen diversion

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Glial cells

• benign connective tissue
• TLR-4 receptors pronociception

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Opioid Passport

• New style opioid contract
• 4 components
• Passport
• Schedule 8 pass
• Patients information sheet
• Doctors checklist

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Cancer Pain

• WHO ladder
• Survivors
• Specific treatments

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TAP Block

• First described
• Rafi AN, Abdominal field block a new approach
  via the lumbar triangle. Anaesthesia 2001 56
  1024-6
• Popularised
• ODonnell BD, McDonnell JG, McShane AG. The
  transversus abdominis plane (TAP) block in open
  retropubic prostatectomy. RAPM 2006 391
• McDonnell JG, et al., Analgesic efficacy of
  transversus abdominis plane (TAP) block after
  abdominal surgery, a prospective randomized
  controlled trial. Anesth Analg 2007 104193-7

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