Does this case hold the answer to one of the worse types of pain in medicine--that of loin pain haematuria syndrome (LPHS)

A patient with loin pain haematuria syndrome suffering chronic throbbing pulsing pain overlaid with prolonged periods of incapacitating colic and overnight vomiting was presented 10 months following diagnosis. Ultrasound was normal. No renal or ureteral stones, or filling defects were seen on CT. At cytoscopy, bladder and urethra were normal, and bloody urine effluxed from the left ureteric orifice. The ureters were normal at diagnosis, and developed new abutting non‐penetrating calcifications by 8 months. Pain episodes of complete incapacitating intensity of 2–4 h duration were reduced to 10 min with 5 mg crushed tadalafil administered at onset. If tadalafil was delayed to after onset, the original course of agony resulted. Daily tadalafil reduced loin pain intensity, but not the exacerbations. Tadalafil efficacy may indicate that the pain exacerbations are due to spasm of ureter smooth muscle. 5 mg tadalafil taken at onset alleviated severe loin pain exacerbations in this case of loin pain haematuria syndrome.

Conspicuous by their abstinence: the limited engagement of heroin users in English and Welsh Drug Recovery Wings

Background In recent years, an abstinence-focused, ‘recovery’ agenda has emerged in UK drug policy, largely in response to the perception that many opioid users had been ‘parked indefinitely’ on Opioid Substitution Therapy (OST). The introduction of ten pilot ‘Drug Recovery Wings’ (DRWs) in 2011 represents the application of this recovery agenda to prisons. This paper describes the DRWs’ operational models, the place of opiate dependent prisoners within them, and the challenges of delivering ‘recovery’ in prison. Methods In 2013, the implementation and operational models of all ten pilot DRWs were rapidly assessed. Up to three days were spent in each DRW, undertaking semi-structured interviews with a sample of 94 DRW staff and 102 DRW residents. Interviews were fully transcribed, and coded using grounded theory. Findings from the nine adult prisons are presented here. Results Four types of DRW were identified, distinguished by their size and selection criteria. Strikingly, no mid- or large-sized units regularly supported OST recipients through detoxification. Type A were large units whose residents were mostly on OST with long criminal records and few social or personal resources. Detoxification was rare, and medication reduction slow. Type B's mid-sized DRW was developed as a psychosocial support service for OST clients seeking detoxification. However, staff struggled to find such prisoners, and detoxification again proved rare. Type C DRWs focused on abstinence from all drugs, including OST. Though OST clients were not intentionally excluded, very few applied to these wings. Only Type D DRWs, offering intensive treatment on very small wings, regularly recruited OST recipients into abstinence-focused interventions. Conclusion Prison units wishing to support OST recipients in making greater progress towards abstinence may need to be small, intensive and take a stepped approach based on preparatory motivational work and extensive preparation for release. However, concerns about post-release deaths will remain.

The Relationship between Materialistic Aspirations and Distinct Aspects of Psychological Well-being in a UK sample

The purpose of this research is to gain a deeper understanding of how materialistic aspirations are related to distinct aspects of psychological well-being. Research has consistently found a negative relationship between materialistic goals and well-being, but a review of the literature identified that the measures of well- being used in the majority of studies were measures of what Keyes (2002) describes as “subjective well-being” or “hedonic happiness”. Criticisms of these types of measures are that they fixate too much on the momentary experience of pleasure and don’t take into account what is meaningful and or what contributes to long lasting fulfilment. Very little research was found investigating the impact of materialism on “eudaimonic” well-being, which is found through doing what is worthwhile and realising ones potential and has been found to have a longer lasting impact on overall well-being (Huta & Ryan, 2010). To address this gap in the literature, a convenience sample of 113 adult subjects in the UK were recruited through Facebook and asked to respond to the Aspiration Index and the Psychological wellbeing scale. The relative importance placed on extrinsic (materialistic) and intrinsic aspirations was compared to the six dimensions of psychological well-being. In line with previous research, higher importance placed on materialistic aspirations for wealth, status and image were found to be negatively correlated with all aspects of psychological well-being. However, the strongest and only statistically significant negative correlation was between extrinsic aspirations and positive relations with others (r = -.256, p< 0.01). Positive relationships with other people form a central component of many theories of well- being and so this negative relationship may help to explain why materialistic aspirations are so consistently found to be negatively correlated to a variety of measures of well-being. Further research is needed to explore this relationship as no causation could be inferred.