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The management of pain differs if pain is self limiting or persistent; for example, if pain is prolonged then treatment will be managed by a multidisciplinary team in a pain clinic. Pain is not just from physical disorders but also from combinations of physiological, pathological, emotional, psychological, cognitive, environmental, and social factors (fig 1). The keys to successful pain control are the mechanisms that initiate and maintain pain. Major advances in neurobiology, from molecular studies to imaging the cortex of the brain, show the complex integration of nerve cell activity and have generated a fundamental change in attitude and expectation about the control of pain.1 Now, the public and health professionals expect to control pain by using preventive and active strategies, including drugs and physical and psychosocial interventions. Fig 1 Biopsychosocial factors that interact and modulate the experience of pain The topics we have chosen result from discussions with all grades of staff involved in the management of acute and chronic pain and range from new drug development based on scientific evidence that may impact on future pain management to a holistic approach to patient care. Our searches focused on the key words “pain,” “systematic review,” “management,” and “neuropathic.” We searched Medline, the Cochrane Library, and Health Technology Assessments, and we scrutinised the BMJ and the National Institutes of Health websites as well as professionally based websites for pain, such as that of the International Association for the Study of Pain and scientific websites such as that of the National Academy of Sciences. We identified systematic reviews from the past three years from these sources and leading scientific papers. #### Recent developments A major change in pain management is a move from empirical therapies to a mechanism based approach New drug developments are targeting specific receptor subtypes Pain assessment includes qualitative sensory affective and …

Editor—The question “Why is academic medicine failing?” could be rephrased “Why is academic medicine failing women?”1 One reason is the recruitment and retention of senior female academics, and the other is the application of gender issues to medical research. The failure of academic medicine to come to terms with clinical workforce interests and population healthcare issues is exemplified by the role and aspirations of female students, potential female clinical scientists, and women as patients. Recognition of the high quality skills of female science students and their subsequent loss during early postgraduate years has led to a reappraisal of the culture of a male dominated hierarchy in universities.2 The same process has yet to be applied to medicine. What exclusions are academic medical women facing, and to what extent does this impact on the crisis in academic medicine, where men dominate and the NHS is an alternative employer? The obstacles of childrearing are very clear. It is a myth that great discoveries are made by scientists before the age of 40 years. The biological clock for women may be different; “life starts at 40 years” may be an attitude to consider. Today's female doctors are demanding improved working conditions, better equity, and less hierarchy at work. They see their female counterparts in academic medicine with fewer resources and awards, less space, and lower salaries than male doctors. A BMA working paper identifies the monitoring tools required to support equity in the workforce and considers that a fair representation of women in scientific institutions can bring benefits to academic medicine.3 If women continue to be excluded in the university system, as the evidence from science faculties suggests, academic medicine will be unable to meet the challenges of medicine in the 21st century.

Observations were made on 26 infants delivered by elective caesarean section under general anaesthesia. A standard anaesthetic technique was employed using a methohexitone, relaxant, nitrous oxide-oxygen sequence with regulated ventilation and the administration of papaveretum after clamping the umbilical cord. In 12 patients the induction dose of methohexitone was 1·4mg/kg and in 14 it was reduced to 1·0 mg/kg. There were no significant differences between the two groups in the clinical status of the mothers, in operative technique and timing, or in the value of PO2, PCO2, and pH in the umbilical cord venous blood. The infants whose mothers received the lower dose of methohexitone were in better condition, as assessed by the number needing assisted ventilation, the time taken to establish regular respiration, the Apgar score, and the “Apgar minus colour” score.

Measurements of closing volume have been made in 20 women between the 36th and 40th weeks of pregnancy. The patients were studied in the erect and supine positions and the point of airway closure was related to functional residual capacity. The results show that airway closure occurred during tidal ventilation in 10 patients in the erect position and in six patients in the supine position. These results may explain the variation found in maternal arterial oxygen tension during pregnancy.