Paediatric chronic pain Publication date: Available online 26 September 2019 Source: Anaesthesia & Intensive Care Medicine Author(s): Paul M. Rolfe Abstract Chronic pain in childhood is common and if untreated may lead to significant pain-related disability, emotional disturbance and poor school attendance. Many children and adolescents are successfully managed outside of specialist paediatric pain management clinics in a wide range of clinical settings. However, some children require the expertise of a multidisciplinary pain management team in a dedicated paediatric centre. Following multidisciplinary assessment an individualized pain management plan is agreed with the family. Treatment options can be classified into pharmacological, physical and psychological therapies. The aim of treatment is to facilitate a restoration of function for the child, working with the family as a whole.

Pharmacology in the management of chronic pain Publication date: Available online 26 September 2019 Source: Anaesthesia & Intensive Care Medicine Author(s): Grace Nisbet, Arun Sehgal Abstract Pharmacological treatment can play an important role in the successful management of chronic pain and should be prescribed as part of a biopsychosocial approach. When planning a pharmacological strategy for chronic pain it is important to consider the nature and likely source of the pain. This article will summarize common pharmacological options in current clinical use for the management of chronic pain.

Self-assessment Publication date: Available online 16 September 2019 Source: Anaesthesia & Intensive Care Medicine Author(s): Viyayanand Nadella

Visceral pain Publication date: Available online 13 September 2019 Source: Anaesthesia & Intensive Care Medicine Author(s): Anu Kansal, John Hughes Abstract Pain is one of the most common symptoms that patient presents with. Visceral organs were thought to be insensitive to pain in the past, but we now know this is not true. It is more common than somatic pain and originates from the internal organs in the thorax, abdomen or pelvis. These organs are innervated by the parasympathetic (vagus and sacral parasympathetic fibres) and sympathetic (thoracolumbar sympathetic chain: T1–L2) nervous systems. The afferent and efferent fibres to the organs accompany the sympathetic nervous system. The sensory system to the gut is specialized and divided into an enteric and extrinsic nervous system. The physiology of visceral pain is poorly understood compared to somatic pain, but it is well established that peripheral and central sensitization along with dysregulation of the descending pathways plays a significant role. Pain originating from visceral organs is usually diffuse, dull aching, poorly localized and can be associated with phenomenon such as referred somatic pain, referred hyperalgesia, visceral hyperalgesia and viscero-visceral hyperalgesia. Treatment of visceral pain involves identifying and treating the cause, if identified, and the management of pain. Patient education and information plays an important part in management along with pharmacological and non-pharmacological treatments.

Critical care transfers: core principles and logistics Publication date: Available online 10 September 2019 Source: Anaesthesia & Intensive Care Medicine Author(s): Euan J. McIntosh, Chris Lochrin, Wayne Auton Abstract In the UK over 11,000 critically ill patients are transferred between hospitals each year. In addition, a significant number of critically ill patients are transferred to hospital from locations outside hospital such as rural general practice surgeries or the community. While specialist teams are available for some transfers, the majority are conducted by teams from the referring hospital. The aim of this article is to give an overview of the principles of critical care transfer, transfer platforms and the importance of a structured approach.

Chronic pain: psychological formulation and MDT working Publication date: Available online 10 September 2019 Source: Anaesthesia & Intensive Care Medicine Author(s): Jo Burrell, Louise Robinson Abstract Chronic pain is complex and often a challenge to manage. Patients’ expectations are frequently at odds with the treatment outcomes which can be a significant source of distress. Pain is best understood within the biopsychosocial model. Clinical psychologists work as part of the multidisciplinary pain team to draw together information and develop an understanding of how to support patients to live well while experiencing ongoing pain. This article presents two alternative models for formulating and providing therapy for individuals experiencing chronic pain; cognitive behaviour therapy and acceptance and commitment therapy. Psychologically informed strategies to support healthcare professionals in their interactions with people with chronic pain are presented.

Percutaneous cervical cordotomy for cancer-related pain Publication date: Available online 6 September 2019 Source: Anaesthesia & Intensive Care Medicine Author(s): Manish Gupta, Manohar L. Sharma Abstract The anatomic rationale of cordotomy involves interruption of pain fibres in the spinothalamic tract. Cordotomy is indicated in cancer patients with limited life expectancy who have severe, unilateral pain. The goal in patients with limited life expectancy should be to improve the quality of survival, which includes improving the patient's ability to interact with others, and to reduce the amount of time spent in contact with healthcare providers. Analgesic optimization alone may fail to adequately control cancer related pain. When successful, percutaneous cervical cordotomy allows significant reduction in pain medications, and reduces the need for clinic visits. Percutaneous procedures are preferred over open procedures for their lower morbidity. The percutaneous cervical cordotomy procedure is technically not simple and requires considerable skills of the physician performing the procedure.

Drugs affecting the autonomic nervous system Publication date: Available online 6 September 2019 Source: Anaesthesia & Intensive Care Medicine Author(s): Matthew Charlton, Jonathan P. Thompson Abstract The autonomic nervous system (ANS) is a complex system of nervous and humoral mechanisms that modulates the function of the autonomous or visceral organs. Autonomic control of organs aims to maintain homoeostasis in health. Many drugs used in clinical practice can have either primary or secondary effects on the function of autonomic nervous system.

Complex neuropathic pain states Publication date: Available online 6 September 2019 Source: Anaesthesia & Intensive Care Medicine Author(s): Rhian P. Lewis, Indre Kriukelyte Abstract In this article we discuss complex neuropathic pain states: diabetic peripheral neuropathic pain (DPNP), phantom limb pain (PLP), central post-stroke pain (CPSP), and complex regional pain syndrome (CRPS). Pain in these conditions can often be severe, significantly affect quality of life and be resistant to current treatment options. Multidisciplinary assessment and treatment is essential.

Physiology of patient transfer by land and air Publication date: Available online 6 September 2019 Source: Anaesthesia & Intensive Care Medicine Author(s): James J. Hale, David P. Hall, Mark J.G. Dunn Abstract Patient transfer is an important part of many patients’ journeys through the healthcare system. In the UK, the majority of transfers are undertaken by land ambulance but some are by air utilizing helicopters or fixed wing aircraft. The transfer of patients is challenging often involving unstable critically ill patients, trainee staff, time pressure, out of hours work and unfamiliar transfer equipment. Patients are exposed to a number of physical factors including acceleration and deceleration, decreased barometric pressure, noise, vibration, reduced humidity and altered ambient temperatures. These factors have a significant effect on patient physiology and it is important that clinicians understand these effects and integrate them with planning and decision making. Other challenges include staff fatigue, communication difficulties, the effects of transfer on medical equipment and the hazards of caring for patients in confined spaces for prolonged periods of time.