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This paper presents the results of a detailed study of the pain epidemiology and health related quality of life (HRQL) in 150 chronic non-malignant pain patients referred to a Danish multidisciplinary pain centre. Mean pain intensity was 71.6 (SD 18.5) on the VAS scale. HRQL was evaluated using the questionnaires: SF-36, HAD and PGWB. Compared with the normal population (NP) both physical, psychological and social well-being was severely reduced, and 58% were found to have a depressive or anxiety disorder. Sixty-three percent of the patients had neurogenic pain conditions. Of these, only 25% were treated with antidepressants or anticonvulsants. At referral 73% were treated with opioids. Mean opioid consumption was 64 mg of morphine per day. Patients had used the health care system five times more often than the NP (p < 0.001). The study showed that HRQL of chronic non-malignant pain patients is among the lowest observed for any medical condition.

The number of refugees around the world who have fled political or ethnic persecution has increased. An increasing proportion of these refugees are survivors of torture. Many of these suffer physical as well as psychological sequelae to torture. In trying to evaluate the torture claims of the refugees, it is important for the physician to learn about types of torture and to look for symptoms. After positional torture, in which the victims are suspended by their wrists which are tied behind their back (Palestinian hanging), severe lasting nerve, ligament, or tendon damage is seen. In this paper we present two cases of brachial plexus injury. Only sensory nerves were affected causing a neurogenic pain condition including dysaesthesia and neuralgia.

We present two cases of patients who developed local swelling and induration after continuous subcutaneous infusion of morphine. Cutaneous complications of repeated subcutaneous injections of pentazocine, meperidine, ketobemidone and methadone are well described. There are few reports of similar reactions after subcutaneous administration of morphine. Both patients were later treated with sufentanil using the subcutaneous route without any reaction. Sufentanil might be an alternative to patients who cannot tolerate morphine.

Cerebral dysfunction due to long-term treatment with opioids is a problem of increasing relevance because of the rapidly growing use of opioids. A review of psychomotor and cognitive test methods is given, including their application in patients on long-term opioid treatment. The findings of the most valid studies on cancer patients in long-term treatment with opioids are an increase in continuous reaction time and subjective sedation score regardless of the routes of administration. Studies of drug addicts in long-term treatment with opioids seem to reflect a lowering of the general level of activity. According to recent studies, patients with chronic non-malignant pain conditions are responsible for the major part of the total opioid consumption. So far, no studies of cerebral dysfunction have been performed on this group of patients. Further research should concentrate on the use of few valid psychomotor and cognitive tests and should include patients with chronic non-malignant pain conditions.

Three different post-operative pain relief schedules were investigated in a double blind study after total hip replacement. Group BS received a priming dose of buprenorphine i.m. at the time of wound closure and continued with sublingual buprenorphine every eight hours. Supplementary doses of buprenorphine i.m. could be demanded. Group B and M received a priming dose of buprenorphine and morphine respectively, and continued with sublingual placebo eight hourly. Supplementary doses of buprenorphine could be demanded by patients in Group B and supplementary doses of morphine by patients in Group M. On one occasion VAS scorings of groups BS and B were statistically significantly lower than group M, and on another occasion VAS scorings of group BS were statistically significantly lower than the other two groups. Furthermore, the number of on demand supplementary doses was statistically significantly higher in group M. It is concluded that buprenorphine administered at regular intervals as well as on demand provided better postoperative analgesia than morphine at present dose levels. In this context, only moderate advantages were obtained by administering buprenorphine at regular intervals.

A 30-year-old woman, 35 weeks pregnant, developed spontaneous rupture of the oesophagus following severe vomiting, probably caused by treatment with Ritodrin (Utopar). The symptoms, diagnosis and treatment of spontaneous oesophageal rupture are discussed.

A total of 110 accidents in slaughterhouse workers treated in the casualty department of Sønderborg Hospital during a period of one year was analysed as regards the nature of the injury, the mechanism of injury, employment of prophylactic measures, employment and the loss of income in connection with the sick leave involved. Cuts and stab lesions caused by ordinary knives constituted 72.7% and 93.7% of these were situated on the hands and forearms. Employment of prophylactic measures was not identical in the various working processes. Thus, all of the persons employed with filleting employed prophylactic equipment. In this group, the majority of injuries were on knife-hand but there were also many injuries to the protected hand. In the remainder of the production, employment of prophylactic measures was much less and the injuries here were localized electively to the hand not holding the knife. It is concluded that employment of safety knives in filleting is capable of reducing the number of injuries to the knife-hand while increased employment of five-fingered metal-net gloves and arm protectors is recommended in the remainder of the production.