“Extreme" porn? The implications of a label

Despite its prevalence, the term ‘extreme’ has received little critical attention. ‘Extremity’ is routinely employed in ways that imply its meanings are self-evident. However, the adjective itself offers no such clarity. This article focuses on one particular use of the term – ‘extreme porn’ – in order to illustrate a broader set of concerns about the pitfalls of labelling. The label ‘extreme’ is typically employed as a substitute for engaging with the term’s supposed referents (here, pornographic content). In its contemporary usage, ‘extreme’ primarily refers to a set of context-dependent judgements rather than absolute standards or any specific properties the ‘extreme’ item is alleged to have. Concurrently then, the label ‘extreme’ carries a host of implicit values, and the presumption that the term’s meanings are ‘obvious’ obfuscates those values. In the case of ‘extreme porn’, this obfuscation is significant because it has facilitated the cultural and legal suppression of pornography

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely