The condition now named complex regional pain syndrome (CRPS) has been recognised for many years, and known by many terms, although the adoption of the current taxonomy is recent. The condition typically starts with an injury to an extremity, which is often seemingly trivial, followed by immobilisation, such as an ankle sprain or Colles' fracture. However, instead of the expected resolution of symptoms, persistent pain and dysfunction develop. recent attention to its key features by international authorities should allow the diagnosis to be made with greater confidence by non-specialists. Management should be based upon general principles of neuropathic pain treatment, combined with aggressive physical rehabilitation. Many cases will resolve spontaneously, or with simple measures. For severe or resistant cases, early specialist intervention is indicated.

NICE has updated its guideline on the management of chronic heart failure. The principal changes from the 2003 guideline include more directive advice on how to improve the quality and timeliness of diagnosis. There is greater encouragement to use beta-blockers, more emphasis on rehabilitation and better access to specialist advice - particularly at the time of diagnosis, admission to hospital, and where symptoms do not respond to first-line therapy with diuretics, ACE inhibitors and beta-blockers. 'A new recommendation is that patients with stable heart failure should be offered a supervised group exercise-based rehabilitation programme designed for such patients. 

Deep periprosthetic joint infection (PJI) is one of the most feared complications of hip and knee replacement surgery as it generally requires a combination of surgical intervention(s) and prolonged antibiotic therapy. Patients with previous joint replacement have a lifetime risk of secondary PJI after other common infections. The lifetime risk has been reported to be up to 2% at 20 years after total hip arthroplasty taking into account infection from a subsequent revision procedure as well. Streptoccoccus spp. are commonly implicated in these infections. Early recognition and prompt treatment of soft tissue, dental and respiratory infections may also prevent secondary PJI. Acute haematogenous PJI should be suspected if a patient with a joint replacement develops pain in that joint after infection elsewhere. If PJI does occur in this context, optimal outcomes are achieved by early diagnosis, referral and treatment.

Infection is usually asymptomatic. Sexually active people aged under 20 in the UK are the group most likely to have a positive result if tested. This is probably because this group changes partners more frequently. However, there also appear to be immunological factors which make infection more persistent in the young. Transmission occurs through vaginal, rectal or oral sex. It can also be vertically transmitted. Untreated chlamydia infection can result in complications including pelvic inflammatory disease (potentially leading to infertility or ectopic pregnancy), sexually acquired reactive arthritis and epididymo-orchitis. There is controversy over important questions such as the likelihood of complications developing and, hence, what sort of control measures are appropriate. Some countries, for example England, have set up screening programmes while others, such as Scotland, have elected not to. [With external links to the evidence base]

Neuropathic pain is relatively common. One large European study found a prevalence of 6%. The diagnosis and treatment of long-term pain has received considerable attention recently. Long-term pain is pervasive and costly. There is an interrelationship with psychosocial problems and there are often difficulties in clarifying the diagnosis. Most treatment for long-term pain, including neuropathic pain, should be provided at the primary care level, with support as necessary from specialist services.

In England in 2008, 66% of men and 57% of women had a BMI >25 kg/m²; within this 24% of men and 25% of women were obese with a BMI >30 kg/m². The relative risk of diabetes in overweight men is 2.40 and in obese men 6.74 compared with men with a BMI in the normal range. The respective relative risks in women are 3.92 and 12.41.There is a 40% increased risk of death from cardiovascular disease for every 5 kg/m² increase in BMI above 25 kg/m². While trying to tackle obesity may seem like very hard work for little gain, having a structured approach to dealing with overweight and obese patients will make it easier to broach the subject and enable evidence-based advice to be given that will be helpful to all patients.

The simplest way to prevent passive exposure of children to tobacco smoke is to encourage and support their parents to quit smoking. For parents and other family members who will not or cannot quit smoking, the next best course of action is to make the home environment in which children live completely smoke-free. Primary care health professionals, in common with all health professionals, therefore need to engage with smoking prevention and cessation initiatives at all levels, but particularly in all contacts with individual patients who smoke, or family members who smoke. As educators, GPs and practice nurses can explore with GP and nursing trainees the importance of smoking cessation in preventing disease and improving health, an element that is barely covered in the traditional organ-based medical school curricula. [With external links to the evidence base]

Attention deficit hyperactivity disorder (ADHD) is the term most widely used to cover a group of common, chronic neurodevelopmental disorders characterised by developmentally abnormal and disabling levels of restlessness and overactivity (usually combined with impulsiveness) and/or inattention. ADHD is multifactorial in origin, with a strong genetic component and is four times more common in boys than girls. The prevalence of ADHD is at least 5% and that of the most severe form i.e. hyperkinetic disorder (HKD) 1-2%. However, a survey of services for ADHD in Scotland found that only 0.6% of children and adolescents were receiving treatment. [With external links to the evidence base]

GPs play a key role in early recognition of stroke symptoms, thus ensuring that patients receive appropriate acute treatment, early initiation of secondary prevention, lifestyle advice and referral to exercise schemes. It is becoming increasingly recognised that stroke is a chronic disease. So GPs will also be central to managing ongoing risk of recurrent stroke and identifying and managing long-term post-stroke problems.

For patients with  a chronic condition and depression the prognosis is thought to be  worse. Comorbid depression is associated with increased pain, greater functional impairment and reduced quality of life. Depressed patients may lack the confidence to self-manage their condition, increasing the risk of long-term complications.

HIV is now a treatable medical condition. In all, 77,000 people are known to be infected with HIV in the UK. However, 28% are unaware of their infection and are therefore unable to access treatment. They are also at risk of unwittingly passing the virus on to others. Many patients who present late to care have been to see their GP in the months or years leading up to their diagnosis but have never been tested for HIV. In the UK National guidelines on HIV testing have recently been published by the RCP to help improve provision and uptake of HIV testing in both primary and secondary care settings.

Palliative care is the proactive and holistic management of patients with significant illness that is unresponsive to curative treatment. The primary care team can play a vital role in palliative care. GPs will see patients at all stages of their illness, from the initial symptoms, through the early stages when although a poor prognosis has been given the patient may feel reasonably well, up to death. The aims for primary care teams are those set out in the Gold Standards Framework for palliative care.

The prevalence of shoulder disorders has been reported to range from 7 to 36% of the population accounting for 1.2% of all GP consultations. Shoulder pain has been said to be the second most common musculoskeletal complaint presenting in primary care. On average GPs are consulted approximately seven times each week for a complaint relating to the neck or upper extremity; three of these consultations will be for new complaints or new episodes. [With external links to the evidence base]