Waiting in pain: a systematic investigation into the provision of persistent pain services in Australia

Abstract Objective To provide an update on Australian persistent pain services (number, structure, funding, wait times, activity). Methods An updated national search was conducted. Of those identified, 74 persistent pain services provided detailed responses between July 2016 and February 2018 (64 adult, seven pediatric, two pelvic pain, and one cancer pain). A similar structure to the original Waiting in Pain (WIP) survey was used, and participants chose online or telephone completion. Results Pediatric pain services had more than doubled but remained limited. Adult services had also increased, with a concurrent decrease in median wait times and an increase in the number of new referrals seen each year. Despite this, some lengthy wait times (≥3 years) persisted. Wait times were longest at clinics using public or combined funding models and offering pain management group programs (PMGPs). Although clinical activity had increased, medical staffing had not, suggesting that clinics were operating differently. Privately funded clinics performed more procedures than publicly funded services. Use of PMGPs had increased, but program structure remained diverse. Conclusions Specialist pain services have expanded since the original WIP survey, facilitating treatment access for many. However, wait time range suggested that the most disadvantaged individuals still experienced the longest wait times, often far exceeding the recommended 6-month maximum wait. More needs to be done. Numerous developments (e.g., National Strategic Action Plan for Pain Management, health system changes as a result of the COVID-19 pandemic) will continue to influence the delivery of pain services in Australia, and repeated analysis of service structures and wait times will optimize our health system response to the management of this condition.

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Grain Refinement in Titanium-Erbium Alloys

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100052626 ◽

1974 ◽

Vol 32 ◽

pp. 522-523

Author(s):

B. B. Rath ◽

J. E. O'Neal ◽

R. J. Lederich

Keyword(s):

Electron Microscopy ◽

Size Distribution ◽

Grain Refinement ◽

Grain Growth ◽

Volume Fraction ◽

Pure Titanium ◽

Systematic Investigation ◽

Second Phase ◽

Titanium Matrix ◽

Average Size

Addition of small amounts of erbium has a profound effect on recrystallization and grain growth in titanium. Erbium, because of its negligible solubility in titanium, precipitates in the titanium matrix as a finely dispersed second phase. The presence of this phase, depending on its average size, distribution, and volume fraction in titanium, strongly inhibits the migration of grain boundaries during recrystallization and grain growth, and thus produces ultimate grains of sub-micrometer dimensions. A systematic investigation has been conducted to study the isothermal grain growth in electrolytically pure titanium and titanium-erbium alloys (Er concentration ranging from 0-0.3 at.%) over the temperature range of 450 to 850°C by electron microscopy.

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Optical Properties of HVEM Accelerators

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100114529 ◽

1975 ◽

Vol 33 ◽

pp. 180-181

Author(s):

A. Strojnik ◽

J.W. Scholl ◽

V. Bevc

Keyword(s):

Optical Properties ◽

Electron Accelerator ◽

Systematic Investigation ◽

Electron Source ◽

High Brightness ◽

The Past ◽

Wide Range ◽

Optical Behavior

The electron accelerator, as inserted between the electron source (injector) and the imaging column of the HVEM, is usually a strong lens and should be optimized in order to ensure high brightness over a wide range of accelerating voltages and illuminating conditions. This is especially true in the case of the STEM where the brightness directly determines the highest resolution attainable. In the past, the optical behavior of accelerators was usually determined for a particular configuration. During the development of the accelerator for the Arizona 1 MEV STEM, systematic investigation was made of the major optical properties for a variety of electrode configurations, number of stages N, accelerating voltages, 1 and 10 MEV, and a range of injection voltages ϕ0 = 1, 3, 10, 30, 100, 300 kV).

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Magnitude Estimation and Cross-Modal Matching of Lingual Vibrotactile and Auditory Sensation

Journal of Speech Language and Hearing Research ◽

10.1044/jshr.3203.698 ◽

1989 ◽

Vol 32 (3) ◽

pp. 698-702 ◽

Cited By ~ 2

Author(s):

Daniel Harris ◽

Donald Fucci ◽

Linda Petrosino

Keyword(s):

Auditory Stimulus ◽

Magnitude Estimation ◽

Sensory Processing ◽

Test Site ◽

Systematic Investigation ◽

Thenar Eminence ◽

Stimulus Range ◽

Psychophysical Scaling ◽

Scaling Methods ◽

Response Biases

The present experiment was a preliminary attempt to use the psychophysical scaling methods of magnitude estimation and cross-modal matching to investigate suprathreshold judgments of lingual vibrotactile and auditory sensation magnitudes for 20 normal young adult subjects. A 250-Hz lingual vibrotactile stimulus and a 1000-Hz binaural auditory stimulus were employed. To obtain judgments for nonoral vibrotactile sensory magnitudes, the thenar eminence of the hand was also employed as a test site for 5 additional subjects. Eight stimulus intensities were presented during all experimental tasks. The results showed that the slopes of the log-log vibrotactile magnitude estimation functions decreased at higher stimulus intensity levels for both test sites. Auditory magnitude estimation functions were relatively constant throughout the stimulus range. Cross-modal matching functions for the two stimuli generally agreed with functions predicted from the magnitude estimation data, except when subjects adjusted vibration on the tongue to match auditory stimulus intensities. The results suggested that the methods of magnitude estimation and cross-modal matching may be useful for studying sensory processing in the speech production system. However, systematic investigation of response biases associated with vibrotactile-auditory psychophysical scaling tasks appears to be a prerequisite.

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Quick Reference: Chapter 1: The Musculoskeletal System: The Hand and Upper Extremity

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2000.sepoct03 ◽

2000 ◽

Vol 5 (5) ◽

pp. 4-5

Keyword(s):

Dorsal Column ◽

Persistent Pain ◽

Illness Behavior ◽

Abnormal Illness Behavior ◽

Organ Systems ◽

Spinal Cord Dorsal ◽

Objective Basis ◽

Dorsal Column Stimulation ◽

Underlying Pathology

Abstract Spinal cord (dorsal column) stimulation (SCS) and intraspinal opioids (ISO) are treatments for patients in whom abnormal illness behavior is absent but who have an objective basis for severe, persistent pain that has not been adequately relieved by other interventions. Usually, physicians prescribe these treatments in cancer pain or noncancer-related neuropathic pain settings. A survey of academic centers showed that 87% of responding centers use SCS and 84% use ISO. These treatments are performed frequently in nonacademic settings, so evaluators likely will encounter patients who were treated with SCS and ISO. Does SCS or ISO change the impairment associated with the underlying conditions for which these treatments are performed? Although the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) does not specifically address this question, the answer follows directly from the principles on which the AMA Guides impairment rating methodology is based. Specifically, “the impairment percents shown in the chapters that consider the various organ systems make allowance for the pain that may accompany the impairing condition.” Thus, impairment is neither increased due to persistent pain nor is it decreased in the absence of pain. In summary, in the absence of complications, the evaluator should rate the underlying pathology or injury without making an adjustment in the impairment for SCS or ISO.

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