A partially inflated cuff inserted by the lateral route is a better method of insertion in children and grade 3 fibreoptic views can be associated with a significant build up of carbon dioxide in children breathing spontaneously.

Adverse childhood experiences (ACEs) increase the likelihood of reduced physical and psychological health in adulthood. Though understanding and psychological management of traumatic experiences is growing, the empirical exploration of ACEs and physical clinical outcomes remains under-represented and under-explored. This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services and clinical decision making by: (1) providing an overview of the relationship between ACEs and chronic pain; (2) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; (3) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and (4) providing practical clinical implications for pain management. Review findings demonstrated that in chronic pain, ACEs are associated with increased pain complications, pain catastrophizing and depression and the combination of these factors further heightens the risk of early treatment attrition. The pervasive detrimental impacts of the COVID-19 pandemic on ACEs and their cyclical effects on pain are discussed in the context of psychological decline during long treatment waitlists. The review highlights how people with pain can be further supported in pain services by maintaining trauma-informed practices and acknowledging the impact of ACEs on chronic pain and detrimental health outcomes. Clinicians who are ACE-informed have the potential to minimize the negative influence of ACEs on treatment outcomes, ultimately optimizing the impact of pain management services.

Chronic postsurgical pain (CPSP) is a common problem, with up to a third of patients reporting persistent or intermittent pain 1 year after common operations. A proposed definition is pain that develops after a surgical procedure, which lasts at least 2 months, and where other causes and preexisting pain have been excluded. A variety of preoperative, intraoperative, and postoperative factors are thought to contribute to the pathogenesis of CPSP. Preventive strategies include effective postsurgical acute pain management, preoperative administration of gabapentin or pregabalin continued postoperatively, and considering the necessity of the surgical procedure itself and exploring alternatives.

These data reveal that NSAIDs were still widely used as analgesics for many surgical procedures at the time of the audit. Intravenous (IV) NSAID administration is the preferred route because of its reliability and speed of onset. The results of this audit indicated significant use of IV NSAIDs (ketorolac, diclofenac and ketoprofen) not in accordance with manufacturers' recommendations, with some NSAIDs even being used in the absence of a product licence for use by the IV route. This may be due to a lack of a satisfactory licensed product. A new formulation of IV diclofenac may fulfil this currently unmet need.

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This case describes the successful addition of acupuncture to treat a patient with cervical dystonia previously managed with Botox (botulinum toxin) injections. This resulted in reduced pain and muscle spasm relief and to the authors' knowledge is the fi rst case to be reported using this treatment combination. The patient was diagnosed with the idiopathic variant of cervical dystonia and had been treated with regular Botox injections for almost a year and half. She was then referred for a course of acupuncture to manage pain and reduce excessive muscle tone. She had excellent benefi t from the acupuncture and she continued to get top-ups of acupuncture every 8-10 weeks. Requirement for Botox injections had decreased thus reducing its long-term side effects. CASE REPORTThis case report details the successful use of acupuncture in conjunction with Botox injections for the management of cervical dystonia.A 65-year-old woman presented to our clinic with an 8-year history of torticollis, mainly affecting her left side, forcing her to adopt an awkward posture. This reduced neck mobility was suffi cient to stop her driving. Figure 1 shows the patient's usual posture before acupuncture treatment. She complained of pain in her left lower cervical area. Movements were reduced and painful particularly when she attempted right lateral fl exion and rotation. This had been steadily worsening over the past few years and by 2005 she was not able to lift her head most of the time. There was no signifi cant aetiology to explain the onset of symptoms and after confi rming diagnosis of an idiopathic variant of cervical dystonia, she was referred to the neuro-rehabilitation doctor in 2005 for a course of Botox (500 units type A toxin -Dysport) injections into her left trapezius, sternocleidomastoid and splenius capitis muscles. This initially gave her excellent benefi t. After two further repeat injections she was referred in February 2006 for a course of acupuncture to manage pain and reduce excessive muscle tone.Her past history included ischaemic heart disease, refl ux oesophagitis, Figure 1 Before acupuncture treatment -simulated views. thalassaemia minor and hypertension. Her drug treatment included aspirin, clopidogrel, atenolol, baclofen, losartan, bendrofl umethiazide, simvastatin, esomeprazole and amitriptyline. ExaminationOn examination she sat with her head turned to the left and her neck in forward and lateral fl exion. All movements of her neck were restricted. Turning her head to the right, lateral rotation to the right and lateral fl exion were almost impossible. The superior and middle fi bres of her left trapezius were very fi rm, tight and tender on palpation. She also had diffuse tenderness on the left side of her neck and over the left supra scapular and infra scapular area (fi gure 2). TreatmentThe normal practice in our acupuncture clinic, dictated by time constraints, is to administer four weekly sessions of Western medical acupuncture followed by top-ups (consisting of single sessions) if the initial...

According to standard philosophical and clinical understandings, pain is an essentially mental phenomenon (typically, a kind of conscious experience). In a challenge to this standard conception, a recent burst of empirical work in experimental philosophy, such as that by Justin Sytsma and Kevin Reuter, purports to show that people ordinarily conceive of pain as an essentially bodily phenomenon—specifically, a quality of bodily disturbance. In response to this bodily view, other recent experimental studies have provided evidence that the ordinary (‘folk’) concept of pain is more complex than previously assumed: rather than tracking only bodily or only mental aspects of pain, the ordinary concept of pain can actually track either of these aspects. The polyeidic (or ‘many ideas’) analysis of the folk concept of pain, as proposed by Emma Borg et al., captures this complexity. Whereas previous empirical support for the polyeidic view has focused on the context-sensitivity of the folk concept of pain, here we discuss individual differences in people’s ‘pain priors’—namely, their standing tendencies to think of pain in relatively mind-centric or body-centric ways. We describe a preliminary empirical study and present a small number of findings, which will be explored further in future work. The results we discuss are part of a larger programme of work which seeks to integrate philosophical pain research into clinical practice. For example, we hypothesise that variations in how patients with chronic pain are thinking about pain could help predict their responses to treatment.

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