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Motor

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cortex stimulation appears to be a new and promising possibility of pain treatment, especially in cases with trigeminal neuropathy, but many problems have yet to be solved, before a clear indication could be given. chronic pain management guidelines depending on their stages (conservative or terminal). In the recovery room, however, there was a higher frequency of shivering (P less than 0.05) in the morphine group. Only minor and unimportant side effects were seen. Sublingual buprenorphine for premedication and postoperative pain relief

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in orthopaedic surgery.The effect of sublingual buprenorphine (Temgesic)

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as a premedicant and for postoperative pain relief compared with morphine/pethidine was studied in 50 patients scheduled for elective surgery of the knee joint. Twenty-five patients were given morphine intramuscularly (7.5 mg or 10 mg to females and males respectively) 1 h preoperatively.

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The remaining 5 patients with trigeminal neuropathy experienced definite pain relief varying between 60 and 90%. The first survey was conducted before the distribution of the Guideline in July, 1999 and the second was done after the

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distribution in January, 2000. To evaluate usefulness of the Guideline for

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the management of cancer pain, the same questionnaires were addressed to nurses and physicians of enrolled institutions twice. Three of them had central pain as sequelae of cerebrovascular disease. It is concluded, that buprenorphine sublingually is as good as morphine intramuscularly for premedication and therefore should

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be recommended to patients who wish to avoid injections. (6) The answers from physicians to questions about treatment of cancer pain remained unchanged between the first and

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the second survey. Emergence shivering, confusion and restlessness just after termination of the operation

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were equal in the two groups. Two patients had pain from peripheral nerve injuries. In none of them did the stimulation provide pain relief. Usefulness of the evidence-based medicine-supported cancer pain management guideline.The Japanese guidelines for the clinical practice of cancer pain management supported

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by evidence-based medicine were established by the Japanese Society for Palliative Medicine in 1999 [as their Evidence-based Medicine-supported Cancer Pain Management Guideline ]. This group received pethidine (75 mg) intramuscularly on demand postoperatively. (5) The rate of pain relief of patients staying in the ward where the guidance for dosing of morphine had been carried out was 37.5% at the first

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survey versus 47.9% at the second. (2) At the first survey the rate of pain relief in each stage of cancer patients was essentially unchanged from a previous result obtained in 1998.

(1) Morbidity of pain in cancer patients at each stage having some analgesics did not change at each survey period. During the first 24 h postoperatively the buprenorphine group was given an average of 3.8 doses compared with 2.3 in the pethidine group (P greater than 0.05). The usefulness of the Guideline for cancer pain management is partly confirmed by these results. 2001 European Federation of Chapters of the International Association for the Study of Pain..

All the patients were anaesthetized with halothane N2O/O2 after induction with thiopentone. (3) The rate of pain relief shown in the second survey tended to be higher than that shown in the first in both groups of patients.

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Twenty-five patients received buprenorphine 0.4 mg sublingually 1 h before surgery and the same dose on demand postoperatively. No significant differences were found with regard to sedation, dizziness, nausea and vomiting during the study period. Motor cortex stimulation as treatment of trigeminal neuropathic pain.A report is given on first experiences with motor

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cortex stimulation in 10 patients with different forms of neuropathic pain. For postoperative pain relief the initial dose of buprenorphine should be given intravenously. During test stimulation most patients had one or two short-lasting generalized seizures. But no one had any motor effects after permanent implantation.

The significance of the Guideline will be totally discussed by comparing its effects on nurses, pharmacists and physicians. Usefulness of the Guideline was examined by comparing the results of two surveys.