Anaesthetists as pain management consultants.

Anaesthetists who manage acute and chronic pain need to be familiar with current research and practice guidelines in these areas. New local anaesthetics and new routes of administration for opioids and adjuvants may further improve our management of acute pain. The safety of epidural analgesia in combination with low molecular weight heparins and the role of the anaesthetist on the acute pain service are reviewed. Chronic pain disability is increasing, necessitating a re-evaluation of our approach to chronic pain. The limitations of nerve blocks are acknowledged and guidelines for managing chronic pain and opioids are available. Anaesthetists must recognize psychological difficulties as a significant perpetuating factor in chronic pain.