The findings of an expert panel convened to review critically how best to apply evidence-based guidelines for the treatment of acute pain in the Middle East region are presented. The panel recommended a three-step treatment protocol. Patients with mild-to-moderate levels of acute pain should be treated with paracetamol (step 1). If analgesia is insufficient after 1 -2 days, a selective cyclo-oxygenase-2 inhibitor or, if gastrointestinal safety and bleeding risk are not an issue, a non-specific nonsteroidal anti-inflammatory drug, should be used (step 2). If analgesia remains inadequate, treatment with tramadol, or paracetamol plus codeine/tramadol is recommended (step 3). Patients reporting severe pain should be referred to a pain clinic or specialist for opioid analgesic treatment. Measures of pain and functioning that have been validated in Arabic, with culturally appropriate and easy to understand descriptors, should be used. Early and aggressive acute pain management is important to reduce the risk of pain becoming chronic, especially in the presence of neuropathic features.

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HighlightsMalignant mesothelioma is a rare neoplasm of mesothelial cells.It occurs mostly in the pleura or peritoneum and less frequently in the liver.Primary intrahepatic mesothelioma is not in the WHO classification of hepatic tumors.Mesothelioma is more common in men with a mean age of 58 years.We present a rare case of primary liver malignant mesothelioma in a young female.

Highlights90% of patients are women.Different incisions allows full mobilization of the tumor.Wide excision should keep capsule intact.R0 resection should be achieved.Follow-up should be at 1–2 yearly intervals.

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