Use of pain rating scales, especially the visual analogue scale (VAS), has increased dramatically in the last decade. Consideration of the VAS in terms of its physical structure and the patient's behaviour when confronted with the scale, casts doubt on its validity. It is non-linear and prone to bias which limits its use as a serial measure of pain severity. Measuring pain intensity alone imposes further limitations. The McGill Pain Questionnaire measuring several dimensions of pain appears to be a better alternative.

The analgesic effects of high frequency transcutaneous electrical nerve stimulation (TNS), "acupuncture-like" TNS and placebo TNS were evaluated in 33 patients with rheumatoid arthritis and chronic hand pain using a randomized, double-blind, non-crossover design. An oscilloscope was employed to monitor the stimulator output in the TNS treatment groups and to provide strong suggestion and a focus of attention in the placebo treatment group. The two forms of TNS were applied at the highest intensity that could be tolerated by patients. Assessments of resting pain, joint tenderness, grip strength and grip pain were made before and after treatment. The pain and joint tenderness measurements showed high frequency TNS, "acupuncture-like" TNS and placebo TNS to be equally effective in producing analgesia of similar degree and trend over time. The grip strength measurements showed no significant change. The results obtained with placebo are probably due to the suggestion and attention effects of the visual stimulus. The implications of these results in respect to pain control pathways are discussed. Although TNS given at high intensity was shown to be no better than placebo applied with strong suggestion, this does not preclude its use as a method of pain control in rheumatoid arthritis.

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SUMMARY We report the effects of some common antirheumatic drugs on the production of catabolin from synovium and on its action on cartilage. A method is described to generate reproducible amounts of catabolin from synovial mince. Aspirin, Clozic (ICI 55 897), and gold were without effect on the catabolin system. Penicillamine at high doses enhanced the action of catabolin, while chloroquine inhibited catabolin's effect on cartilage. Prednisolone inhibited the production of catabolin without affecting its action. This inhibition was produced by very low doses of prednisolone (25 ng/ml) and was dose-dependent.

A study of post-mortem examinations performed between 1970 and 1979 at a specialist orthopaedic hospital revealed that the overall mortality rate due to pulmonary embolism was 0.23% and that pulmonary embolism was responsible for 19.1% of hospital deaths. The majority of these fatalities occurred following operation for either fractured proximal femur or total hip replacement. During the decade, 928 patients were operated upon for fractured proximal femur, none received prophylactic anticoagulation therapy and the mortality rate due to pulmonary embolism was 17.7%. However, the yearly mortality rate decreased with time and this change was attributed to earlier operation and early mobilisation. Over the same period, 3016 patients underwent total hip replacement, 20% were anticoagulated prophylactically; the mortality rate due to pulmonary embolism was 0.63%. In those patients who died of pulmonary embolism, post-mortem evidence of deep vein thrombosis was usually found, but no relationship between site of thrombosis and side of operation was observed. Pulmonary embolism was diagnosed in only a few patients although on later consideration at least a third of patients had symptoms suggestive of previous emboli. Possible improvements in diagnosis are discussed and a more rational approach to prophylactic anticoagulation suggested.