Recognise neuropathic pain and initiate treatment. Describe the National Institute for Health and Care Excellence (NICE) recommendations on pharmacotherapy for neuropathic pain. Recognise future development in treatment of neuropathic pain. Arasu Rayen DA (Ind), DA (UK), FRCA, FFPMRCA, MSc (Pain Management), PG Cert Med Ed, FHEA, is a consultant in pain management at Sandwell and West Birmingham NHS Trust who has published and presented in national and international meetings on chronic pain subjects. He is a former editor of Pain News, the official newsletter of British Pain Society.

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Effective treatment for fibromyalgia (FM) is lacking and further treatment options are needed. Photobiomodulation therapy (PBMT) represents one potential treatment option. Whilst favourable findings have been reported using localised PBMT, no investigations have established the value of whole-body PBMT for the complete set of symptom domains in FM. A single-arm feasibility study was conducted in accordance to CONSORT guidelines. A non-probability sampling method was used to access individuals with FM. The primary outcome measure was identified as the Revised Fibromyalgia Impact Questionnaire (FIQR). Forty-nine participants were screened and 21 trial participants entered the trial. Nineteen participants completed the intervention (18 whole-body PBMT sessions over approximately six weeks). Descriptive statistics and qualitative analysis was undertaken to represent feasibility outcomes. Acceptability of the trial device and processes were established. Outcome measures towards efficacy data were guided by core and peripheral OMERACT domains, utilising a combination of participant-reported and performance-based outcome measures. Positive changes were observed for FM-specific quality of life, pain, tenderness, stiffness, fatigue, sleep disturbance, anxiety, depression and cognitive impairment. Patient global assessment revealed improvements at 6 weeks, with continued effect at 24 weeks. FM-specific quality of life at 24 weeks remained improved compared with baseline scores. Data for the embedded qualitative component of the trial were captured by participant-reported experience measures and audio-recorded semi-structured interviews. Findings provide evidence to support a full-scale trial and shows promise regarding potential efficacy of this novel non-invasive treatment in an FM population.

Meeting the standard for interhospital transfer of adults with severe head injury in the United Kingdom. Anaesthesia 1999; 54: 283±9. Consider position of patient to prevent ventilator-associated pneumonia We read with interest the excellent review article by Young and Ridley (Anaesthesia 1999; 54: 1183±97). It highlights the importance of aspiration