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NETWORK A national newsletter on substance misuse management in primary care
network
I S S U E 1 4 M A Y 2 0 0 6
Principles of pain
Welcome
treatment in the context
Another packed issue coinciding with the 11th National
Conference Management of Drug Users in Primary Care - indeed
much of our content is in line with conference programme.
of substance use
IN THIS ISSUE
Hmm…? Pain and opiate dependence - Read Hugh Campbell’s superb
Pain and pain management in
demystification of this confounding topic beginning page 1
and see how Dr Fixit in the guise of Dr Penny Scofield gets
people who are opiate dependent
practical on the subject on page 15
is a complex topic, sometimes
HIV update - Huge improvements in HIV treatment and
leading to uncertainty or conflict
prognosis yet increasing levels of HIV and hepatitis co-
between patient and practitioner. infection in injecting drug users. A thorough update by Dr Gary
Hugh Campbell sheds light on this
Brook (pages 4-5). Dr Fixit in the guise of Dr Ewen Stewart
confounding yet fascinating topic
complements this with some practical advice on HIV and blood
virus screening (page14).
revealing the evidence, myths and
what is currently known about effective clinical practice. Ed.
The GPwSI - is this odd hybrid heading out on a random
evolutionary path? Jim Barnard takes a look for SMMGP on
Dr Hugh Campbell MSc, MRCP, MRCGP, MBACP, Adv Dip Integrative
pages 6-7.
Psychotherapy, GP Specialist in Addictive Behaviour, RCGP Parenting and children of service users - Findings suggest
Regional Clinical Lead in Substance Misuse (SW Region).
that services are doing little to ensure that children are not
being exposed to unacceptable levels of risk at home. In fact
Introduction
service users may not even be asked about their children,
parenting needs or child related risk. Dr David Best and Victoria
My interest in this topic comes from clinical experience, and some of the Manning (page 8) highlight harm remaining hidden in this all
theoretical material described in this article formed part of a dissertation
too vulnerable child population. Anna Millington (page 9)
submitted for the MSc in Addictive Behaviour at St George’s Hospital,
presents a parent’s view on the difficulties and stigma that can
be encountered when accessing services, and the need for
London in 2005.
parents to receive proactive friendship and support from staff.
Pain is a complex experience and is particularly clinically challenging in SCAN, a network for addiction psychiatrists - With the rapid
the context of substance use and dependence, and especially so in a
development of GP work in the field, Meredith Mora highlights
Primary Care setting. 15% of those in treatment for opioid dependence
the relevance of joined up working and consensus with
addiction psychiatrists on page 10.
under my care, give pain as a reason for first heroin use, and over 40%
describe chronic pain at the present time. Interestingly, and unexpectedly,
Addicted Doctors - Dr David McCartney tackles this sensitive
there is only a small overlap between these two populations.
topic and the difficulty in identifying, confronting and supporting
colleagues. A dearth of dialogue, expertise or published
Not only can pain be challenging to treat but it can also be an obstacle to
literature is contrasted by estimates of 13,000 doctors with drug
or alcohol problems in the UK. A thought provoking read (page
detoxification, and there is little doubt that untreated pain is a risk factor
11).
for relapse.
First Contact: a new consultation model for GPs – With the
Pain concepts
time constraints of General Practice, Dr Morris Gallagher and
Dr David Julien advocate getting the basics right and getting
Pain has been defined as “an unpleasant sensory and emotional experience the patient wanting to come back (page 12-13). An excellent
associated with actual or potential tissue damage, or described in terms of
training and development model that promotes a positive and
such damage. It is subjective and each individual learns the application of
welcoming attitude as the key to good consulting behaviour.
the word through experience related to injury in early life. It is a sensation
Practice Based Commissioning – Dr Linda Harris Acting
in a part of the body, is always unpleasant, and therefore an emotional
Director of the RCGP SMU calls for GP champions to work with
experience”
(6)
. Pain may arise as a result of excitation of nociceptors
new PCTs and their new found commissioning powers (page
(sensory receptors), or can occur in the absence of nociception. 15).
Pain experience can be divided into physical, affective and functional
Usual courses and events on page
16.
components. There are several classifications of pain. These include acute
and chronic (continuous pain of moderate severity or greater for more
Enjoy the read.
than 6 months) which can be sub divided into chronic non-malignant and
Jean-Claude Barjolin
cancer-related pain. The Pain Society classifies pain as:
Editor
n Persistent pain (continuous or intermittent pain for more than 3 months,
…continued overleaf
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