#ANZSPM16 tweet chat: Medicinal cannabis and palliative care


In recent years scientific research into the effects of cannabinoids has been on the increase. Some would say that not-so-scientific research on the effects of cannabis has been underway for many hundreds of years, in many different countries and cultures.

Until recently I didn’t know that our own bodies produce endogenous cannabinoids, the various effects of which are still being studied. 

Two years ago, colleagues had informed me that at the Montreal Conference 2015 it was a ‘smokingly hot’ topic. The most widely studied cannabis-derived cannabinoids are Cannabidiol (CBD) and Tetrahydrocannabinol (THC.) You may have heard of some of the medications that have ‘come to market’ since then:  Continue reading

3 online events in the Palliverse this week!

PallANZ 201601

Here at Palliverse, we love online communities of practice. The monthly #PallANZ tweet chat, co-hosted by Palliverse and Palliative Care Australia, is not the only online educational opportunity that may be of interest this week. While we hope you join us for Thursday evening’s #PallANZ discussion of advance care planning, you might also like to check out the following exciting events: Continue reading

#SHCR: An inspiring, free course that will help you change health care for the better

When I first read Sonia’s post about the School for Health and Care Radicals (SHCR) a year ago, little did I know that I would be signing up for one of the most inspiring educational experiences of my ten years as a doctor, resulting in unexpected personal and professional growth.

“Anyone who wants to bring about change has to be ready to break the rules. But in health and social care, that can be really difficult. The art of rocking the boat while staying in it is something it seems no-one is ready to help you learn.” – School for Health and Care Radicals



Working on my SHCR workbook – over coffee

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NICE guidelines for end of life care

The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care in the UK.

In response to the Neuberger report and the demise of the Liverpool Care Pathway, new evidence based guidelines have been developed.

This guideline includes recommendations on:

In my state, Victoria Australia, the VEC (Victorian End of life Coordinating Program) is undertaking similar work, and plans to release a Victorian end of life care plan soon.

In Australia, we have not had the negative stories and experiences seen in the UK; because the LCP was implemented in a better way? The stories coming out of the Neuberger report were shocking: I cannot imagine any patient being denied a drink when requested “because she is on the LCP”. However the LCP has also been withdrawn locally in response to the negative findings delivered in the UK.

I will be participating in a pilot of the new end of life care plans which will replace the LCP locally. I am looking forward to seeing the final version.

Thoughts, dear reader, about the terminal care of the LCP?


Research Basics: EQUATOR, CONSORT, STROBE – what’s all that about?

EQUATOR is a good place to start if you’re struggling with writing up your research protocol or results. The EQUATOR Network (Enhancing the QUAlity and Transparency Of health Research) provides guidelines for reporting different types of health research. The EQUATOR Network is an international initiative that aims to “achieve accurate, complete, and transparent reporting of all health research studies” and includes researchers, journal editors, peer reviewers, and other relevant bodies. Continue reading

Shifting the focus of care from disease to people – heartfelt article about dying in acute hospitals

This article is going a bit viral on social media. Does it mirror your experiences? It certain does mine, having worked for a long time in consultation services in acute hospitals. There have been a number of comments and letters to the Age supporting the message of the article, written by a senior doctor about the death of his father. http://www.theage.com.au/comment/hospitals-must-shift-focus-of-endoflife-care-from-disease-to-people-20150707-gi6joz

MyPal Podcasts


Do you like technology? Innovation? Palliative care? Research? Why, these things are what @palliverse is all about – and why you/we are here in the first place!

Guess what? These things are exactly what the #MyPal podcasts from @amaranwosu are all about as well. How about that!

Check it out here and also on iTunes. Be amazed. Happy listening!

Online Pain Module – RACP eLearning

I have just been prompted to have a look at the excellent eLearning Pain Module for the RACP.  In short it is a fantastic resource that I encourage anyone with access to have a look at here.  As I understand it access to this resource is limited to fellows and trainees of the Royal Australasian College of Physicians and its administrators so my apologies to anyone not fitting that description reading this blog, as the following may come across as a bit of a tease. (Ed Correction: We have just been informed that anyone can apply for access through the site linked above – i.e. Read on, it is not a tease at all)

RACP Elearning

RACP eLearning website https://elearning.racp.edu.au/

Continue reading

Malignant Psoas Syndrome

Malignant psoas syndrome is said to be extremely rare, but I keep seeing it. Admittedly, working in the pain and palliative care service in a specialist cancer centre, if anyone was going to see it, you would think it would be my team.

I have had three patients with MPS this year and because each time it’s something that the clinical staff are not familiar with, I thought I would share a  short summary with the Palliverse.

The original description of MPS in 1990 (1) described patients with:

  1. Metastatic cancer involving the psoas major muscle either intrinsically (direct intramuscular metastasis), or extrinsically from metastatic retroperitoneal lymph- adenopathy infiltrating into the muscle.
  2. Painful flexion of the ipsilateral hip with positive psoas stretch test (‘‘reverse’’ straight leg raise) related to psoas muscle spasm or irritation.
  3. Clinical evidence of proximal (L1–L4) lumbar plexopathy with spontaneous, burning and lancinating pain associated with hyperalgesia (allodynia and hyperesthesia).
  4. Absence of osseous lumbar vertebral metastases and/or concomitant lumbar polyradiculopathy due to other causes (e.g., malignant neuraxial dissemination, chemotherapy-associated or radiation-induced neurotoxicity).

In 2010, Stevens et al wrote a helpful review (2) of MPS with a case review, mechanisms and theories. Five years ago, according to the paper, there had only been 28 cases reported in the English speaking literature.

I will leave interested readers to explore the papers themselves, but it describes polymodal pharmacotherapy (aka throw everything at it), plus some novel strategies like local anaesthetic block of psoas sheath.

What has encouraged me to put fingers to keyboards tonight though is the referral of yet another patient with psoas syndrome, plus this Japanese case series by Takase et al (3). It describes three patients with MPS who had excellent results with methadone (15-30 mg/day). Their average pain scores were reduced by an astounding 7 points with greatly improved function.

I am pretty keen to try adjuvant methadone for my new referral.

Have you seen any malignant psoas syndrome cases before?Were they recognised and treated as such? How did it go? Particularly keen to hear whether anyone has tried methadone. 



1. Stevens MJ, Gonet YM: Malignant psoas syndrome: Recognition of an oncologic entity. Australas Radiol 1990; 34:150–154.

2. Mark John Stevens, Charlotte Atkinson, and Andrew M. Broadbent. Journal of Palliative Medicine. February 2010, 13(2): 211-216. doi:10.1089/jpm.2009.0193.

3. Takase Naoto, Ikegaki Junichi, Nishimura Harumi, Yuasa Sayoko, Ito Yumiko, and Kizawa Yoshiyuki. Journal of Palliative Medicine. July 2015, 18(7): 645-652. doi:10.1089/jpm.2014.0387.

free smartphone app for GPs providing palliative care

There’s an app for that! ABC news writes that a new smartphone app can help guide GPs in management of patients approaching the end of life.

It’s free from iTunes and provided to you by the lovely chaps at Flinders University in SA.

We would love to hear from GPs or trainees  – what do you think?