Pain management

IntroductionDespite evidence of improved outcomes, people with pancreatic cancer have highly variable access to effective pain relief and palliative care. We aimed to develop evidence-based, community-informed standardised pathways to timely pain management and early palliative care for people with pancreatic cancer.Main RecommendationsUsing a multi-method, comprehensive, community engagement and evidence-informed approach, we developed pathways to standardise referral to pain management and early palliative care for people with pancreatic cancer. Community engagement included representation from multidisciplinary clinicians, community groups and people with lived experience from across regions and all Australian states. We developed two pathways: (i) a pathway for pain management for people with resectable pancreatic cancer and (ii) an integrated pathway for pain management and palliative care for people with unresectable pancreatic cancer (https://www.pancare.org.au/pancreatic-cancer-roadmap-projects/pancreatic-cancer-pathways). Clinical guidance providing practical steps and links to evidence accompany the pathways. Key elements of the pathways included:screening for pain at each encounter, comprehensive holistic assessment and management;early consideration of interventional pain management in the event of refractory pain;introduction of palliative care at time of diagnosis of metastatic or unresectable pancreatic cancer with links to suggested language to address potential community hesitancy; andrecommendation to discuss referrals for palliative care and interventional pain management at cancer multidisciplinary meetings.Changes in Management as a Result of the GuidelinesThe pathways developed have set forth best practice standards grounded in evidence and expert consensus. The extensive clinical and community engagement ensures the relevance and ownership of these pathways. Implementation of the pathways will reduce existing variation in access and enhance the quality of care for people with pancreatic cancer. Furthermore, the pathways offer an opportunity to benchmark practice within and between services.

Jennifer Philip, Melanie R. Lovell, Kylee Bellingham, Gail Garvey, Gregory B. Crawford, Nicole M. Rankin, Kara Burns, Isabel Young, Vivienne Milch, Dorothy Keefe, Katrina Anderson, James Lawson, Meinir Krishnasamy

Autism diagnoses have increased over the past decade, prompting debate on potential causes. In September 2025, US President Donald Trump claimed that paracetamol is a ‘big factor’ in autism, citing a systematic review based solely on observational studies. The review's selective reporting, methodological flaws (including applying an environmental health rather than evidence-based medicine framework) and lack of causal evidence provided weak justifications for its conclusions and have fuelled public confusion about paracetamol safety in pregnancy. This article critically appraises the review and examines how scientific uncertainty can be manipulated and amplified within broader public health domains.

David J. Tunnicliffe, Miranda Cumpston, Debra Kennedy, Margie Danchin, Armando Teixeira-Pinto

An 86-year-old man presented with acute severe neck pain, restricted neck movement and fever. The white cell count, erythrocyte sedimentation rate and C-reactive protein were all elevated. After excluding an infective aetiology, review of computed tomography images of the cervical spine (Figure) showed calcification of the transverse ligament of the atlas with crown-like density around the odontoid process. This was consistent with a diagnosis of crowned dens syndrome, an uncommon manifestation of calcium pyrophosphate dehydrate deposition disease.1,2 The patient’s symptoms were self-limiting over 1 week without the use of anti-inflammatories or corticosteroids. Figure

Matthew Jiang · Sukumar Navanathan