Management of pain
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7390.635 (Published 22 March 2003) Cite this as: BMJ 2003;326:635
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I read this succinct and useful article. My only point is that two
drugs Gabapentin and amitryptyline are very useful in the elderly patients
with neuropathic pain -esp the peripheral type. Strangely the
anticholinergic effects do not seem to be a major concern in the doses
used.
Competing interests:
None declared
Competing interests: No competing interests
As an occupational therapist involved in the area chronic pain
management (both in research and educational endeavours), I welcome the
article by Holdcroft and Power (2003) on recent developments in the
management of pain. The review clearly explains the complexity of the
pain experience, highlights a management plan for low back pain based on
evidence, and indicates areas of future development. I particularly
applaud the emphasis on the function of the patient as being a key aim,
and the recognition that better outcomes can be obtained by a
multidisciplinary approach which has a biopsychosocial approach.
I
suggest that the World Health Organisation ICF
(www3.who.int/icf/icftemplate.cfm) provides a useful framework for
conceptualising pain and the impact which pain has upon an individual's
life. There is involvement at the level of body functions and structure,
the activity level, and the participation level of the individual, with
the individual environmental and personal factors also having relevance.
This review provides a useful starting point for better pain management.
Competing interests:
js is the lead editor of Pain a textbook for therapists, published in 2002 by Harcourt.
Competing interests: No competing interests
ALCOHOL FOR PAIN RELIEF.
This article is a valuable contribution to the subject of pain and
its management, emphasising a mechanism-based approach, new drug
development, and most important, care that is individualised, holistic and
multidisciplinary. It is unfortunate that consideration of drug therapy
appears largely focussed on opioids and makes no mention of mankind's most
venerable analgesic, ethyl alcohol.
There are several good reasons why alcohol, usually by mouth but
occasionally by the intravenous route, should be considered as a component
of the management of severe chronic pain. First, alcohol is a very potent
analgesic, as anyone who has sutured lacerations in an intoxicated patient
can affirm - local anaesthesia is commonly not required. Further, it is
possible to induce substantial analgesia with doses of alcohol that do not
induce an unwanted drunken state. Second, to many patients the central
effects of the narcotic analgesics are unfamiliar and frequently
disturbing, producing not euphoria but dysphoria and depression. As a
result, patients frequently take less aanalgesia than is required for
optimal pain control. By contrast, the effects of alcohol are familiar to
most people and are usually regarded as pleasant, tending to produce
euphoria and banish depression. Third, the ingestion of alcohol promotes
appetite, whereas narcotics frequently induce nausea and anorexia. Fourth,
alcohol is the only analgesic agent that is also a source of calories;
this enhances its value in cancer patients. Fifth, alcohol is readily
combined with narcotics as an adjuvant drug - witness the gin in Brompton
mixture. Finally, whereas many patients have strong preconceived ideas
about the evils of narcotics, profound disapproval of the taking of
alcohol is relatively uncommon, especially when it is recommended for a
medical purpose. This ancient and valuable agent should be considered as a
component of pain management.
Competing interests:
None declared
Competing interests: No competing interests