Aust Fam Physician
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Patient selection for repeated spinal surgery is not uniform and must be further refined. A multidisciplinary approach with careful evaluation of physical, psychological and environmental factors is ideal. Improved imaging should delineate disorders more clearly, and advances in surgical technique may improve outcome. It is likely, however, that a number of patients will continue to require long-term pain management.
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The components of a holistic pain assessment process in advanced cancer are presented. Central to the assessment and management process is recognition of different types of cancer pain, which have their own individual management emphasis. An overview of nociceptive cancer pain management is presented outlining current drugs available and the 'analgesic ladder' approach.
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Neuropathic pain is often a reason for an unfavourable response to morphine or other opioids in treating cancer pain. This type of pain is difficult to manage and may co-exist with nociceptive cancer pain. There is still a potential for opioid responsiveness, although the doses needed will be higher, and adjuvant drug therapies are best employed concurrently with opioid drugs. ⋯ Less commonly, agents such as baclofen and clonidine, and sympatholytic drugs such as prazosin can be employed for sympathetically maintained neuropathic pain (discussed in Part 3). The type of agent selected will depend on the natural history of the disease process, as well as a description of the pain--the lancinating pains tending to respond better to anticonvulsants. Non invasive neurostimulatory approaches such as transcutaneous electrical nerve stimulation (TENS) may be useful in management, and a few patients may require an invasive procedure such as dorsal column stimulation.
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Ross River fever, or epidemic arthritis, is caused by the Ross River virus and usually mild and short-lived although persisting joint symptoms can develop. This article reviews the cause, diagnosis and treatment of this sometimes debilitating disease.
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Depression in the elderly may have many presentations. Skill is required in differentiating clinical depressive conditions from mild reactive states and senile dysphoria. Screening tests are available that may assist the doctor in the diagnosis of depression. ⋯ Depression in older persons is very common, may be difficult to diagnose, is treatable and has a prognosis similar to that of middle aged or younger patients. Doctors should think depression in older patients and bear in mind possible atypical presentations. When the correct diagnosis, usually possible by taking a careful history, is followed by correct treatment, the outcome can be very rewarding for patient and doctor.