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Artful Medicine: Transforming Science into an Artful Practice

Explore the fusion of art and science in medicine with innovative techniques and ideas in pain management and cancer treatment. Learn how to refine the art of medicine and put the art back into healing for a holistic approach to patient care.

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Artful Medicine: Transforming Science into an Artful Practice

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Presentation Transcript

  1. Philip Cornish, FANZCA, FFPMANZCADept of Anaesthesia & Pain MedicineFlinders Medical Centre, South Australia ‘Hey, Doc, I’ve heard there’s something new…’

  2. ?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

  3. ‘The practice of medicine is an art, based on science’

  4. Pain Can Be Fun

  5. Pain as a Disease • Burden of pain largely unaddressed • Nosological status • National Pain Strategy • Funding • Training

  6. Pain as the 5th vital sign • P • BP • RR • LOC • VAS

  7. Where is the pain?...

  8. NNT – trick or treat? • = effort required to reach therapeutic target • Limitations • Point estimate • Pooled data • Overestimates efficacy • Underestimates NNH • Doesn’t usually mention NNK

  9. Zoster/PHN • Vaccination • Booster in late middle age • NNV@65 : AHZ 11 PHN 43 C/E > 60 for pain

  10. 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

  11. Q.S.T. • Psychophysiological test • C-fibre axonopathy • CRPS • Peripheral neuropathy • QST vs EMG

  12. Neuropathic Pain • Caused by injury to nociceptive nerves • Rarely treated by neurectomy

  13. Oxycodone/Naloxone • Claimed to lessen constipation • Might also lessen diversion

  14. Glial cells • ‘benign’ connective tissue • TLR-4 receptors & pronociception

  15. Opioid Passport • New style opioid contract • 4 components • Passport • Schedule 8 pass • Patient’s information sheet • Doctor’s checklist

  16. Cancer Pain • WHO ladder • Survivors • Specific treatments

  17. TAP Block • First described: • Rafi AN, Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001; 56: 1024-6 • Popularised: • O’Donnell BD, McDonnell JG, McShane AG. The transversus abdominis plane (TAP) block in open retropubic prostatectomy. RAPM 2006; 3:91 • McDonnell JG, et al., Analgesic efficacy of transversus abdominis plane (TAP) block after abdominal surgery, a prospective randomized controlled trial. Anesth Analg 2007; 104:193-7

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