Bonica’s Management of Pain, Fifth edition

 

Description:

Publisher's Note: Products purchased from 3rd Party sellers are not guaranteed by the Publisher for quality, authenticity, or access to any online entitlements included with the product. This exhaustively comprehensive edition of the classic Bonica’s Management of Pain, first published 65 years ago, expertly combines the scientific underpinnings of pain with clinical management. Completely revised, it discusses a wide variety of pain conditions—including neuropathic pain, pain due to cancer, and acute pain situations—for adults as well as children. An international group of the foremost experts provides comprehensive, current, clinically oriented coverage of the entire field. The contributors describe contemporary clinical practice and summarize the evidence that guides clinical practice.

 

 

Table of Contents:

 

PART ONE Basic Considerations

Chapter 1 Intellectual Milestones in Our Understanding and Treatment of Pain

Pain Understood as Part of a Larger Philosophy or Worldview

Mechanistic Views of Pain

19th Century—Pain as a Specific Sense

Afferent Signaling

Gate Control Theory

Treatments for Pain

Cognitive Treatment for Pain

Pharmacologic Treatment of Pain

Anatomically Specific Treatments for Pain

The Specialty of Pain Medicine

Acknowledgments

References

Chapter 2 Pain Terms and Taxonomies of Pain

Definition of Commonly Used Pain Terms

Taxonomies

Expert-Based Classifications of Pain

Classification Based on Anatomy

Classification Based on Duration

Classification Based on the Etiology of Pain

Classification Based on Body System

Classification Based on Severity

Classification Based on Functioning

Classification Based on Intensity and Functioning

Classification Based on Prognosis

Mechanism-Based Classification of Pain

Comprehensive, Multidimensional Classification of Pain: International Association for the Study of Pain Taxonomy

Comprehensive, Multidimensional Classification of Pain: Acttion-American Pain Society and Acttion-American Pain Society-American Academy of Pain Medicine

Inductive Empirically Based Classifications of Pain

Psychometric Considerations

Conclusion

References

Chapter 3 Peripheral Pain Mechanisms and Nociceptor Sensitization

Functional Characterization of Nociceptors

Identification of Putative Nociceptors

Nociceptor Characteristics

Anatomy of the Nociceptor

Stimulus Transduction

Passive Electrophysiologic Properties and the Spread of the Generator Potential

Action Potential Generation

Action Potential Propagation

Transmitter Release

Nociceptor Sensitization

Clinical Implications of Nociceptor Function

References

Chapter 4 Substrates of Spinal Cord Nociceptive Processing

Defining Nociceptive Systems

Models of Pain Processing

Methods of Neuronal Characterization

Defining Nociceptive Second-Order Neurons

Development of Sensory Systems

Targets of Primary Afferent Input

Gross Anatomy of the Spinal Cord

Spinal Laminae

Functional Characterization of Nociceptive Neurons

Classification According to Site of Projection

Targets of Axonal Projections

Intraspinal Pathways

Spinothalamic Tract

Spinoreticular and Spinomesencephalic Tracts

Postsynaptic Dorsal Column Neurons

Other Ascending Pathways

Neurochemistry of Second-Order Neurons

Neurotransmitters from Primary Afferents

Neurotransmitters from Interneurons

Neurotransmitters from Supraspinal Sources

Neurotransmitters from Glia or Unknown Sources

Other Important Receptors/Channels

What is Important to the Clinician

Acknowledgments

References

Chapter 5 Modulation of Spinal Nociceptive Processing

Spinal Cord–Based Modulatory Mechanisms

Acute Segmental Modulatory Effects

Heterosegmental Modulatory Systems

C-Fiber Wind-Up and Central Sensitization

Supraspinal Modulatory Systems

Tonic Descending Influences

Supraspinal Substrates Mediating the Descending Modulation of Pain

Summary of Supraspinal Influences

On, Off, and Neutral Cells

Triggers of Clinical Hypersensitivity

Allodynia and Hyperalgesia

Inflammation-Induced Hypersensitivity and Inhibitory Systems

Stress-Induced Analgesia and Hyperalgesia

Neuropathic Pain

Opioid-Induced Hyperalgesia

Conclusion

References

Chapter 6 Supraspinal Mechanisms of Pain and Nociception

Functional Imaging of Pain in Humans

Methodologies of Noninvasive and Invasive Functional Brain Imaging in Pain

Brainstem

Periaqueductal Gray Matter—A Key Structure of Endogenous Analgesia

Mesolimbic Dopamine System

Hypothalamus

Thalamus

The Lateral Pain System—The Sensory-Discriminative Pathway

Spinal Connections to Brainstem and Medial Thalamus—The Affective Pathway

Cortex

Sensory Areas

Limbic Areas

Vigilance, Arousal, and Attention in Pain Processing

Pain Plasticity

Summary and Conclusion

References

Chapter 7 Psychological Aspects of Pain

Cognitive Factors: Predispositions, Appraisals, Beliefs, Perceived Control, and Self-Efficacy

Predispositions

Appraisal and Beliefs

Catastrophizing and Fear-Avoidance Beliefs

Perceived Control and Self-Efficacy

Coping

Stress and Autonomic Responses: Hypothalamic-Pituitary-Adrenal Axis Dysregulation

Emotion

Anxiety

Depression

Anger and Hostility

Psychogenic Conceptualizations of Chronic Pain

Psychogenic View

Behavioral Formulations

Classical Conditioning

Operant Conditioning

Social (Observational) Learning

Gate Control Theory

Cognitive-Behavioral Perspective

Treatments Based on the Cognitive-Behavioral Perspective

Biopsychosocial, Contextual Model

Families and Family Systems Perspective

Conclusion

References

Chapter 8 Individual Differences in Pain: The Roles of Gender, Ethnicity, and Genetics

Sex and Gender Differences in Pain

Clinical Pain

Experimental Pain

Responses to Pain Treatment

Biopsychosocial Mechanisms

Ethnic Group Differences in Pain

Clinical Pain

Experimental Pain

Responses to Pain Treatment

Biopsychosocial Mechanisms

Genetic Contributions to Pain

Clinical Pain

Experimental Pain

Interactions among Individual Difference Factors

Conclusion

Acknowledgments

References

Chapter 9 Functional Neuroanatomy of the Nociceptive System

Organization of the Peripheral Nociceptive System

Peripheral Nervous System Structures of Pain Sensation

Functional Anatomy of the Central Nervous System

Dorsal Horn

Spinothalamic Tract

Thalamus

Sensory Cortex

Descending Pathways of the Central Nervous System

Central Pain

Central Pain After Spinal Cord Injury

Autonomic Nervous System

Peripheral Autonomic Nervous System

Parasympathetic Division

Cranial Parasympathetics

Sacral Parasympathetics

Sympathetic (Thoracolumbar) Division

Sensation in Visceral Organs

Autonomic Centers in the Central Nervous System

Transmission in the Peripheral Autonomic Nervous System

Physiology of the Autonomic Nervous System

Enteric Nervous System

Conclusion

References

Chapter 10 Clinical Trials

Uncontrolled Studies Paradigm

Control Groups: An Improvement over the Case Series

Randomized Allocation of Treatment and Control Groups

Other Methods for Reducing Bias in Clinical Trials

Baseline Similarity of Study Groups

Blinding

Were Groups Treated Equally Except for the Experimental Treatment?

Low Loss to Follow-Up and Intention-to-Treat Analysis

Other Issues in Clinical Trials

Measurement of Outcomes

Reporting the Results

Statistical Power

Generalizability of Results and Efficacy Versus Effectiveness

Subgroup Analyses

Effects of Funding Source

Assessment of Harms

Trial-Based Cost-Effectiveness Analysis

Alternative Study Designs

Cluster Trials

Crossover Trials

Factorial Design

New Directions in Clinical Trials

Pragmatic Trials

Enriched Enrollment Randomized Withdrawal Trials

Expertise-Based Trials

Comparative Effectiveness

Equivalence and Noninferiority Trials

Stepped Wedge Design

Bayesian Statistical Inference and Adaptive Designs

Systematic Reviews

Conclusion

References

PART TWO Economic, Political, Legal, and Ethical Considerations

Chapter 11 Transdermal Pain: A Sociocultural Perspective

What is Transdermal Pain?

Ethnicity, Race, Sex, Gender, Age: Whose Pain?

Across Cultures: Beliefs, Attitudes, Perceptions, Behaviors

Pain and Narrative: Culture, Meaning, Ethics

Beyond the Gate: Consciousness and the Limits of a Molecular Gaze

Pain and Globalization: Power, Money, Systems

Conclusion: Summary and Synthesis

Acknowledgment

References

Chapter 12 Ethical Issues in Pain Management

Pain, Suffering, and the Core Values of Health Care

The Duty to Relieve Pain and Suffering

Curative Versus Palliative Paradigms of Patient Care

The Phenomenon of Undertreated Pain

Identifying the Barriers to Pain Relief

Ethical Implications of the Barriers

Embracing a New Ethic of Pain Relief

Conclusion

References

Chapter 13 Ethical Issues in the Care of Dying Patients

Introduction

The Quest for Moral Order Amid Existential Disorder

The Contributions and Limitations of Ethical Analysis in End-of-Life Care

The Transition from Curative to Palliative and End-of-Life Care

Negotiating Treatment Preferences: The Ideal Decision-Making Process

Departures from the Ideal

Communication with Patients About Treatment Preferences Near the End of Life

Surrogate Decision Making

Assessing Decisional Capacity

Ruling Out or Eliminating Reversible Causes of Incapacity

Identifying a Surrogate

The Surrogate’s Roles and Responsibilities

A Realistic Process of Advance Care Planning

Responding to Demands for Nonbeneficial Treatment

The Ethical Basis of the Conflict

The Clinical Context of the Conflict

Differential Diagnosis of the Conflict

Physician-Assisted Death

Terminology

Ethical Considerations Along the Clinical Spectrum

Two Levels of Response: Social Policy and Clinical Care

Conclusion: Beyond the Patient–Physician Dyad

References

Chapter 14 Laws and Policies Affecting Pain Management in the United States

Introduction

Prevalence of Unrelieved Pain is a Public Health Problem

Barriers to the Safe and Effective use of Opioid Analgesics for Pain Management

Policies Governing the use of Opioid Analgesics for Pain Management

International Treaties: Establishing Balance Between Drug Control and Medical Use

US Federal Law: Preserving Balance Between Drug Control and Medical Use

The Federal Food, Drug, and Cosmetic Act

US Federal Controlled Substances Law

US State Laws: Striving for Balance Between Drug Control and Medical Use

State Pain Policy Development: An Emerging Trend

Evaluating the Quality of State Pain Policy

A Progress Report Card to Measure Changes in the Quality of State Pain Policies

The Importance of Improving State Pain Policy

Considering Additional US Policies

Taking Diversion into Account

Conclusions

References

Chapter 15 Litigation Involving Pain Management

Administrative Proceedings

In the Matter of Dileo

Hoover V Agency for Health Care Administration

Oregon Board of Medical Examiners V Bilder

Accusation of Eugene Whitney, MD

Civil Litigation

Estate of Henry James V Hillhaven Corporation

Bergman V Chin, MD, and Eden Medical Center

Tomlinson V Bayberry Care Center, et al.

Criminal Litigation

State V Naramore

Federal Criminal Prosecutions

United States V Rosen (1978)

United States V Hurwitz

United States V Mciver

Constitutional Cases

Lessons from the Litigation

References

Chapter 16 International Access to Therapeutic Opioids

Pain Relief is Part of Cancer and HIV/AIDS Control

Pain and Palliative Care

Opioids are Essential Medicines and Controlled Substances

Governments Must Ensure Adequate Opioid Availability

Disparities in Opioid Consumption

Morphine Equivalence Metric

Global Opioid Consumption Trends

Disparities in Consumption by Income Level

Regional Opioid Consumption Trends

World Health Organization Region for Africa (AFRO)

World Health Organization Region for the Americas (AMRO)

World Health Organization Region for the Eastern Mediterranean (EMRO)

World Health Organization Region for Europe (EURO)

World Health Organization Region for Southeast Asia (SEARO)

World Health Organization Regions for the Western Pacific (WPRO)

Barriers to Opioid Availability and Accessibility

Knowledge and Attitudes About Pain, Opioids, and Dependence Syndrome

Excessively Strict Laws or Regulatory Policies

Medication Distribution System Barriers

Economic Factors Including Affordability

United Nations’ Recommendations

Efforts to Address Barriers and Improve Opioid Availability and Accessibility

Conclusion

References

PART THREE Evaluation of the Pain Patient

Chapter 17 Evaluation of the Chronic Pain Patient

Introduction

General Guidelines for Assessment of Persistent Pain

Outline of a Multidimensional Assessment Questionnaire for Persistent Pain History

Summary of Some Nonproprietary Questionnaires

Other Potentially Useful Questions to Consider for Gauging Effectiveness of Therapy

Summary of Proprietary Questionnaires to Consider

The Pain History

O: Onset of Pain

P: Provocative/Palliative

Q: Quality or Character

R: Region/Radiation

S: Severity/Intensity of Pain

T: Timing of Pain

Altered Perception

Past Medical and Surgical History

Mood Assessment

Psychosocial Factors

Coping Strategies

Sleep Disorders

Cognitive Impairment

Vocational History and Current Vocational Disability

Habits

Risk of Opioid Misuse, Abuse, or Dependence

Assessment of Function

Current and Past Treatments

Current and Past Medications Including Over-the-Counter Medications

Allergies

Investigations and Consultations

Goals

Physical Examination

General Exam: Observe, Identify and Document

Site of Pain

Neurologic Exam

Bedside Method for Quantitative Sensory Testing

Caveats to Quantitative Sensory Testing Interpretation

Further Investigations or Consults

Follow-Up Visits

Conclusion

Appendix 17.1: Initial Visit Questionnaire

Appendix 17.2: Pain Diagram

Appendix 17.3: Goal Setting

Goals

Appendix 17.4: Follow-Up Questionnaire

References

Chapter 18 Electrodiagnosis in Pain Medicine

The Electrodiagnostic Laboratory

Electrodiagnostic Tests

Nerve Conduction Studies

Needle Electromyography

Application in Selected Conditions

Conclusion

References

Chapter 19 Diagnostic Imaging of Pain

Headache

Acute Headache

Chronic Headache

Intracranial Hypotension

Intracranial Hypertension (Pseudotumor Cerebri)

Facial Pain

Spinal Pain

Overview

Compression Fractures

Benign Versus Malignant; Infection/Inflammation

Discogenic Pain

Limb Pain and Magnetic Resonance Neurography

Magnetic Resonance Neurography

Thoracic Outlet Syndrome

Piriformis Syndrome

Peripheral Nerve Entrapment Syndromes

Imaging Guided Injection

Future Application of Pain Imaging

Conclusion

References

Chapter 20 Measurement of Pain

Introduction

Validity, Reliability, and Utility in the Context of Pain Assessment

How many Pain Problems should be Assessed?

Which Pain Domain(s) should be Assessed?

Recall Ratings Versus Summary Scores from Multiple Ratings using Diaries

Measuring Pain’s Domains

Measuring Pain Intensity

Measuring Pain Affect

Measuring Pain Quality

Measuring Pain’s Spatial Characteristics

Measuring Pain’s Temporal Characteristics

Measuring Pain Interference

Measuring Pain in Special Populations

Simplified Measures of Pain

Behavior Observation Measures

Summary and Conclusions

References

Chapter 21 Pain Psychology Evaluation

Psychosocial History

Early Life Experiences

Vocational History

Educational History

Current Functioning

Belief Structures

Social Support

Cultural Factors

Substance Use

Nicotine

Alcohol

Prescribed and Nonprescribed Drug Use

Psychiatric Functioning

Behavioral Observations

Depression

Anxiety

Posttraumatic Stress Disorder

Somatization

Psychological Screening for Advanced Interventional Procedures

Conclusion

References

Chapter 22 Disability Evaluation of Patients with Chronic Pain

Basic Concepts

Conceptual and Empirical Issues

Impairment and Disability

Associations between Impairment and Disability

The “Embeddedness” Problem

Practical Problems in Identifying the role of Pain in Disability Determinations

Methods for Evaluating Chronic Pain in Applicants for Disability Benefits

Evaluation Methods in the Social Security Administration

Outcomes of Social Security Administration Evaluations

Disability Evaluation and Disability Management in the Washington State Department of Labor and Industries

Washington State Department of Labor and Industries Programs to Reduce Disability

Methods Used by Washington State Department of Labor and Industries to Evaluate Injured Workers for Permanent Disability Benefits

Outcomes of Washington State Department of Labor and Industries Evaluations

Conclusion

References

Chapter 23 Multidisciplinary Assessment of Patients with Chronic Pain

Conceptual Issues

Conundrums in the Assessment of Pain

A Conceptual Model for Assessing Pain

Assessment of Medical Factors

Are there Red Flags?

Are there Risk Factors for Delayed Recovery?

Specific Evaluation Procedures

Conclusion

Assessment of Central Nervous System Sensitization

Assessment of Psychosocial Factors

Psychological Factors as Causes Versus Consequences of Chronic Pain

Elements of the Psychological Evaluation

Problem Areas to Assess

Assessing Functional Impact

Self-Report Measures of Function

Assessment of Physical Capacity

Assessment of Social Factors

Organization of Multidisciplinary Evaluations

Conclusion

References

PART FOUR Pain Conditions

Neuropathic Pain Conditions

Chapter 24 Painful Neuropathies

Pain as a Symptom of Neuropathy

The Evaluation and Diagnosis of Neuropathy

Neuropathy Classification

History, Examination, and Diagnostic Studies

Painful Neuropathies

Distal Symmetric Polyneuropathies

Other Widespread but Nonlength-Dependent Neuropathies

Painful Mononeuropathy Multiplex and Focal Neuropathic Syndromes

Sensory Neuronopathies

Treatment of Painful Neuropathies

General Principles of Therapy

Analgesia Therapy: Guidelines for Pharmacotherapy

Unresolved Questions

References

Chapter 25 Complex Regional Pain Syndrome

Epidemiology

Pathophysiology

Animal Models

Human Models

Inflammation

Immunologic Factors

Central Dysfunction

Sympathetic Dysfunction

Trophic, Dystrophic, and Nutritional Abnormalities

Motor and Movement Disorders

Immobilization and Disuse

Diagnosis

The International Association for the Study of Pain Criteria

The Budapest Criteria

Sequential Stages and Subsets of Complex Regional Pain Syndrome

Psychological Factors in Complex Regional Pain Syndrome

Treatment

The Rationale for Functional Restoration

Rehabilitation-Based Treatment Modalities

Pharmacotherapy

Psychological Interventions

Interventional Therapies

Other Therapeutic Modalities

References

Chapter 26 Phantom Pain

Epidemiology

Modulation of Phantom Pain

Pathophysiology of Phantom Pain

Prevention of Phantom Pain

Treatment of Phantom Pain

Pharmacologic Interventions

Antidepressants

Antiepileptic Drugs

Opioids

NMDA Receptor Antagonists

Calcitonin

Transient Receptor Potential Cation Channel Subfamily V Member 1 (trpv1) Modulators

Interventional Therapy

Neuromodulation

Surgical Interventions

Behavioral Medicine Interventions

Miscellaneous Treatments for Residual Limb Pain

Summary

References

Chapter 27 Herpes Zoster and Postherpetic Neuralgia

Clinical Picture and Natural History of Herpes Zoster

Prodrome

Rash

Pain

Distribution of Herpes Zoster

Clinical Variants

Diagnosis of Herpes Zoster

Laboratory Testing

Epidemiology of Herpes Zoster

Pathophysiology of Herpes Zoster and Mechanisms of Acute Pain

Complications Associated with Herpes Zoster

Ophthalmic Complications

Motor Neuropathy

Rare Neurologic Complications

Visceral Complications

Decreased Quality of Life

Treatment of Herpes Zoster

Patient Education

Antiviral Therapy

Analgesic Treatment

Corticosteroids

Neural Blockade

Complementary and Alternative Medicine

Spinal Cord Stimulation

Prevention of Herpes Zoster

Childhood Vaccination

Varicella-Zoster Immunoglobulin

Herpes Zoster Vaccination for Adults

Clinical Picture of Postherpetic Neuralgia

Diagnosis and Assessment of Postherpetic Neuralgia

Epidemiology and Natural History of Postherpetic Neuralgia

Risk Factors for Postherpetic Neuralgia

Pathophysiology of Postherpetic Neuralgia

Treatment of Postherpetic Neuralgia

Anticonvulsants: Gabapentin and Pregabalin

Antidepressant Medications

Opioid Analgesics

Tramadol

Tapentadol

Topical Therapies

Combination Therapy

N-Methyl-D-Aspartic Acid Antagonists

Other Pharmacologic Therapies

Invasive Treatments for Postherpetic Neuralgia

Psychological Interventions

Electroanalgesia

Surgical Approaches

Prevention of Postherpetic Neuralgia

Conclusions

References

Chapter 28 Central Pain States

Diagnosis

Clinical Characteristics

Clinical Assessment

Specific Central Pain Conditions

Central Poststroke Pain

Central Pain in Multiple Sclerosis

Central Pain in Spinal Cord Injury

Other Central Pain Conditions

Preclinical Models

Mechanisms

Treatment of Central Pain

Pharmacologic Treatment

Psychological and Physiotherapy Treatment

Neurosurgical Management

References

Psychological Contributions to Pain

Chapter 29 The Psychophysiology of Pain

Historical Perspective: Mind–Body Issues

Emotions: Definition and Mechanisms

What are Emotions?

Emotion in a Sociobiologic Perspective

Adaptive Functions of Emotion

Emotions and Behavior

The Central Neuroanatomy of Emotion: Limbic Structures

Peripheral Neuroanatomy of Emotion: The Autonomic Nervous System

Noxious Signaling and Central Limbic Processing

Locus Coeruleus and the Dorsal Noradrenergic Bundle

The Ventral Noradrenergic Bundle and the Hypothalamo-Pituitary-Adrenocortical Axis

Primary and Secondary Features of the Affective Dimension of Pain

Summary of the Construction and Modulation of Pain

Emotion and Cognition

The Sense of Self

Cognitive Perspective

Multiple Perspectives on the Self

Stress, Sickness, and Pain

Basic Definitions: Stress, Homeostasis, and Allostasis

Physiologic Mechanisms of Stress

Summary of the Physiologic Mechanisms of Stress

Stress and Chronic Pain

Future Directions

References

Chapter 30 Pain and Learning

Overview of the Three Major Principles of Learning

Classical Conditioning

Operant Conditioning

Observational Learning

Operant Conditioning and Pain

The Hallmark Work of Wilbert Fordyce

Operant Conditioning and Chronic Pain: The Basics

Classical Conditioning and Pain

Aversive Classical Conditioning and Pain

Classically Conditioned Fear/Avoidance and Pain

Observational Learning and Pain

Integrating Learning Principles in the Treatment of Pain

Cognitive-Behavioral Therapy and Pain

Cognitive-Behavioral Therapy as an Essential Component of a Comprehensive Interdisciplinary Approach to Pain Management

Conclusion

References

Chapter 31 Psychiatric Illness, Depression, Anxiety, and Somatic Symptom Disorder

Psychiatric Nosology and Diagnostic and Treatment Approaches

Framework for Describing Psychiatric Symptoms

Depression

Suicidal Ideation and Behavior

Which Came First, Depression or Pain?

Differential Diagnosis

Biologic Tests for Depression

Dysthymic Disorder

Epidemiology of Depression

Pain and Depression: Mechanisms of Association

Depression Treatment

Psychotherapy

Anxiety Disorders

Generalized Anxiety Disorder

Panic Disorder

Epidemiology

Treatment

Posttraumatic Stress Disorder

Diagnosis

Epidemiology of Posttraumatic Stress Disorder in Chronic Pain Patients

Posttraumatic Stress Disorder and Associations with Pain

Treatment

Personality Disorders

Epidemiology

Overview of Personality Disorders

Personality and Pain Treatment Outcome

Somatic Symptom Disorders, Illness Behavior, and Sick Role

Definitions

Overview of Somatoform Disorders and Somatic Symptom Disorders

Somatic Symptom Disorder

Conversion Disorder (Functional Neurologic Symptom Disorder)

Illness Anxiety Disorder

Conclusion: Pain and Suffering and Psychiatry

References

Chapter 32 Treatment of Pain in Patients with Addiction

Substance Use Disorder

Clinical Implications of Substance Use Disorders on Pain

Neurobiologic Overlap Between Pain and Addiction Systems

Effects of Substance Use Disorder on Pain

Effects of Opioid Use Disorder on Pain

Pain Management in Persons with Substance Use Disorder

Prevalence of Substance Use Disorders in Patients with Pain

Principles of Pain Treatment in Patients with Substance Use Disorders

Conclusions

References

Chapter 33 The Doctor–Patient Relationship in Pain Management: Dealing with Difficult Clinician–Patient Interactions

Difficult Patients and Difficult Doctor–Patient Relationships

Psychiatric and Personality Issues

Opioid Therapy

Difficult “Normal” Patients

Comorbid Medical Conditions

Substance Use Disorders

Physician Factors

Health Care System Factors

Patient Interaction Strategies

Patient-Focused Care

Communication Framework: WIPS and E’s

Clinical Scenarios

Scenario 1

Scenario 2

Scenario 3

Scenario 4

Scenario 5

Scenario 6

Scenario 7

Summary and Conclusions

Acknowledgment

References

Vascular, Cutaneous, and Musculoskeletal Pains

Chapter 34 Arthritis

Basic Considerations

Problem in Perspective

Joint Anatomy

Clinical Approach to Joint Pain

History

Physical Examination

Examination of Synovial Fluid

Clinical Considerations

Osteoarthritis

Secondary Osteoarthritis

Rheumatoid Arthritis

The Spondyloarthropathies

Reactive Arthritis

Psoriatic Arthritis

Arthritis Associated with Inflammatory Bowel Disease

Arthritis Caused by Crystals

Urate Gout

Infectious Arthritis

Polymyalgia Rheumatica

References

Chapter 35 Myofascial Pain Syndrome

Brief Historical Overview

Basic Myofascial Pain Concepts

Muscle Physiology

The Motor Endplate

Sensitization and Activation of Muscle Nociceptors

Central Sensitization

The Biochemical Milieu of Myofascial Trigger Points

pH and Muscle Pain

Neuropeptides, Inflammatory Mediators, and Tissue Injury and Pain

Catecholamines and the Autonomic Nervous System

Cytokines and Pain

Clinical Management

Trigger Point Diagnosis

Physical Examination and Diagnosis

Treatment Options

Noninvasive Treatment Options

Summary

References

Chapter 36 Fibromyalgia: A Discrete Disease or the End of the Continuum

Historical Perspective

Epidemiology

Chronic Widespread Pain

Fibromyalgia

Significance of Tender Points

Other Features of Fibromyalgia Gleaned From Epidemiologic or Observational Studies

Etiology

Animal Models of Fibromyalgia

Genetic Factors

Evidence of Central Nervous System Disturbances in Pain and Sensory Processing

Evidence of a Global Increase in Sensory Processing of Nonpainful Stimuli

Brain Imaging Studies

The Role of Neuroendocrine or Autonomic Abnormalities

The Role of Peripheral Factors in Fibromyalgia

Evidence of Abnormal Cytokines or of Immune Dysfunction in Fibromyalgia

The Role of “Small Fiber Neuropathy” in Fibromyalgia

Diagnosis

Diagnosis of Fibromyalgia

Treatment

General Approach

Pharmacologic Therapy

Neurostimulatory Therapies

Nonpharmacologic Therapies

Prognosis

Conclusion

Key Points

References

Chapter 37 Pain of Dermatologic Disorders

Basic Considerations: Anatomy and Physiology of the Skin

Clinical Disorders

Leukocytoclastic Vasculitis

Polyarteritis Nodosa

Antineutrophilic Cytoplasmic Antibodies-Associated Vasculitides: Granulomatosis with Polyangiitis (Formerly known as Wegener’s Granulomatosis)

Microscopic Polyangiitis

Eosinophilic Granulomatosis with Polyangiitis (Formerly known as Churg-Strauss Syndrome)

Rheumatoid Vasculitis

Livedoid Vasculopathy

Other Vascular Disorders

Antiphospholipid Syndrome

Warfarin (Coumadin) Skin Necrosis

Cocaine Levamisole Toxicity

Calcinosis Cutis

Calciphylaxis

Ulcers

Ischemic Ulcers

Venous Ulcers

Pyoderma Gangrenosum

Painful Infections

Necrotizing Soft Tissue Infection/Necrotizing Fasciitis

Herpes Zoster

Herpes Simplex

Erysipelas and Cellulitis

Furunculosis and Carbuncle

Erysipeloid

Inflammations

Panniculitis

Dercum Disease (Adiposa Dolorosa)

Hidradenitis Suppurativa

Inflamed Epidermal Cyst

Bullous Dermatoses with Erosions

Disorders of Connective Tissue Structure (Cartilage Disorders)

Relapsing Polychondritis

Chondrodermatitis Nodularis Helicis

Neurovascular Cutaneous Disease

Sensory Mononeuropathies

Erythromelalgia

Fabry’s Disease

Other Painful Dermatologic Disorders

Cutaneous Endometriosis

Painful Neoplasms

Acknowledgments

References

Chapter 38 Pain Due to Vascular Causes

Basic Neuroanatomic and Neurophysiologic Considerations

Vascular Pain Syndromes

Intermittent Claudication

Aortic and Other Large Artery Pain

Rest Pain, Ulcers, and Gangrene

Pain Syndromes Following Stroke

Pain Associated with Diseases Involving Small Arteries

Pain Associated with Venous Disorders

Pain Associated with Lymphatic Diseases

Pain Associated with Amputation

Differentiating Vascular from Nonvascular Pain

The Relief of Vascular Pain

Conclusion

References

Chapter 39 Pain Due to Thoracic Outlet Syndrome

Anatomy and Pathophysiology

Clinical Presentation: Symptoms and Signs

Diagnostic Tests

Differential Diagnosis

Management

Outcomes

References

Chapter 40 Pain Following Spinal Cord Injury

Extent and Impact of the Problem

Assessment and Classification of Pain Following Spinal Cord Injury

Musculoskeletal Pain

Visceral Pain

Other Nociceptive Pain

At- and Below-Level Spinal Cord Injury Pain

Other Neuropathic Pain

Psychosocial Aspects of Pain after Spinal Cord Injury

Management of Pain in People with Spinal Cord Injury

Nociceptive Pain

Visceral Pain

Other Nociceptive Pain

Other Neuropathic Pain and other Pain

At- and Below-Level Neuropathic Pain

Psychological and Environmental Management

Other Nonpharmacologic Management of Pain in People with Spinal Cord Injury

Surgical Interventions

Conclusion

References

Pain Due to Cancer

Chapter 41 Epidemiology, Prevalence, and Cancer Pain Syndromes

Epidemiology of Cancer Pain

Pain Related to Extent of Disease: The Cancer Disease Trajectory

Special Needs of Particular Age Groups: Pediatric, Young Adult, Adult, Geriatric

Special Needs of Particular Ethnic Groups: Communication Styles, Common Preferences, and Managing Taboos

Comorbidities Associated with Specific Cancers: Lung Disease, Liver Disease, Renal Disease, and Neurologic Disease

Cancer Pain and Substance Abuse

Cancer Pain in Inmates

Components of the Comprehensive Medical Evaluation of a Patient with Chronic Cancer Pain

Pain History

Definition of Pain

Definition of Suffering

Validated Assessment Tools

Types of Pain

Presenting Complaint

Details of the Pain History

Physical Examination

General Physical Examination

The Regional Pain Physical Examination

Bedside Provocative Maneuvers

Specific Bedside Provocative Maneuvers and their Role in Pain Diagnosis

Formulating a Cancer Pain Diagnosis

Syndrome Diagnosis

Pathophysiologic Diagnosis

Complementary Clinical Perspectives in the Care of Cancer Patients

The Medical Model: Pain is a Manifestation of Disease

Palliative Model: Pain is both Useless and Harmful

Rehabilitative (“Chronic Nonmalignant Pain”) Model: Focus on Dysfunctional Pain Behavior and Pain-Related Deconditioning

Anesthetic Model: Diagnostic and Therapeutic Blocks

Management of Pain in Specific Clinical Presentations

Bone Pain

Pain and Delirium

Pain and Nausea

Pain and Anorexia/Cachexia/Asthenia

Pain and Bowel Disease

Managing Cancer Pain in the Addict

Safe Prescribing Practices: Universal Precautions

Symptom Clusters

Pain at the end of Life

Cancer Pain Emergencies

Opioid Diversion at the End of Life

Conclusion

References

Chapter 42 Assessment and Diagnosis of the Cancer Patient with Pain

Issues in Assessment and Diagnosis of Cancer Pain

Pain and the Cancer Patient

Molecular Mechanism of Tumor Pain

Somatic Pain

Visceral Pain

Neuropathic Pain

Affective Processing and Suffering

Psychological Factors and the Complexities of Cancer Pain

Depression in Cancer Patients

Detecting and Assessing Depression in the Cancer Patient

Cancer-Related Fatigue

Sleep Disturbance in Cancer

Sources of Pain in the Cancer Patient

Classification of Cancer Pain by Feature

Chronicity

Intensity/Severity

Pathophysiology/Mechanisms

Tumor type and Stage of Disease

Patterns of Cancer Pain

Cancer Pain Syndromes

Bone Metastases

Characteristics of Metastatic Bone Pain

Prognosis

Sacral Insufficiency Fractures

Granulocyte Colony-Stimulating Factors–Associated Bone Pain

Visceral Pain

Mechanism

Visceral Pain Descriptions by Site

Neuropathic Pain

Neuropathic Pain Secondary to Cancer-Related Pathology in Cranial Nerves

Neuropathic Pain Secondary to Therapeutic Interventions

Oral Mucositis

Graft-Versus-Host Disease

Metastatic Epidural Spinal Cord Compression

Mechanism

Pattern of Pain

Presentation and Physical Findings

Investigations

Prognosis

Stepwise Approach to Pain Assessment

Features of Pain History

Quality of Life Assessment

General Assessment

Associated Symptoms

Laboratory and Imaging Data

Physical Examination

Diagnosis

Summary

References

Chapter 43 Cancer Pain: Principles of Management and Pharmacotherapy

Cancer Pain Management Overview

Primary Anticancer Treatment

Symptomatic Cancer Pain Management

World Health Organization Analgesic Ladder

Nonsteroidal Anti-Inflammatory Drugs

Efficacy in Cancer Pain

Acetaminophen

Opioid-Induced Bowel Dysfunction

Antiemetics

Adjuvant Analgesics

General Purpose Adjuvants

Musculoskeletal Pain Adjuvants

Neuropathic Pain Adjuvants

Bone Pain Adjuvants

Visceral Pain Adjuvants

Psychotropic Drugs

Cannabinoids

Opioid Analgesics

Selection of Opioid Therapy in Cancer Pain Management

Tolerance and Hyperalgesia

Morphine

Oxycodone

Oxymorphone

Hydromorphone

Methadone

Levorphanol

Fentanyl

Buprenorphine

Hydrocodone

Codeine

Tramadol

Tapentadol

Opioids not Recommended for Routine use in Cancer Pain Control

Opioid-Related Side Effects

Opioid Effects on Cognition, Motor Skills, and Driving Ability

Opioid Rotation in Cancer Pain

Parenteral Opioid Therapy

Intracerebroventricular Opioids

Substance Abuse in Oncology

Home Infusion Therapy

Integrative Oncology

Summary

References

Chapter 44 Interventional Pain Therapies

Intrathecal Drug Therapy

Indications

Intrathecal Drug Delivery Systems

Intrathecal Versus Epidural Drug Delivery

Implantable or Exteriorized Intrathecal Drug Delivery: Cost Analysis

Outcome Studies

Patient-Controlled Intrathecal Analgesia

Pharmacology

Contraindications and Risk Management

Complications and Side Effects

Intrathecal Therapy and Ongoing Oncologic Care

Spinal Chemoneurolysis

Spinal Chemoneurolysis Technique

Adverse Effects

Contraindications

Celiac Plexus Block

Indications

Anatomy of the Celiac Plexus

General Considerations

Adverse Effects

Celiac Plexus Block Techniques

Outcome Studies

Superior Hypogastric Plexus Block

Indications

Anatomy of the Superior Hypogastric Plexus

General Considerations

Adverse Effects

Techniques

Outcome Studies

Ganglion of Impar Block

Indications

Anatomy of the Ganglion of Impar

General Considerations

Adverse Effects

Technique

Intercostal Nerve Block

Indications

Anatomy of the Intercostal Nerves

General Considerations

Adverse Effects

Technique

Outcome Studies

Blocks of the Head and Neck

Nerve Blocks of the Trigeminal Nerve and Its Branches

Indications

Anatomy of the Trigeminal Nerve and its Branches

General Considerations

Adverse Effects

Techniques

Outcome Studies

Other Head and Neck Interventional Targets

Spinal Cord Stimulation

Vertebral Augmentation

Indications

Contraindications

Outcomes

Spinal Cord Ablation

Cordotomy

Indications

Surgical Techniques

Outcomes

Complications

Myelotomy

Indications

Surgical Technique

Percutaneous Radiofrequency Lesioning

Open Limited Myelotomy

Outcomes

Complications

Dorsal Root Entry Zone Lesioning

Image-Guided Ablation of Painful Bone Metastases

Summary

References

Chapter 45 Pain Caused by Cancer of the Head and Neck and Oral and Oropharynx

Pain Mechanisms Due to Local and Regional Cancer of the Head and Neck

Tumor-Induced Algesia

Pain Mechanisms Due to Chemotherapy and/or Radiotherapy

Pain Due to Surgery

Pain Due to Mucositis

Epidemiology

Pathogenesis

Hematopoietic Cell Transplantation

Head and Neck Radiation Therapy

Combined Radiation Therapy, Surgery, and/or Chemotherapy

Pain Assessment

Management of Oral Mucositis

Pain Management

Basic Oral Care

Bland Oral Rinses

Topical Anesthetics and Analgesics

Topical Antimicrobials

Systemic Analgesics

Anti-Infective Approaches

Hyposalivation

Biologic Response Modifiers and Cytokines

Cognitive and Behavioral Interventions

Conclusion

References

Chapter 46 Cancer-Related Bone Pain

Epidemiology Review

Pathophysiology

Evaluation of the Patient with Bone Cancer

Treatment

Cyclooxygenase-2-Specific Inhibitors

Corticosteroids

Bisphosphonates

Calcitonin

Opioids/Opiate Antagonists

Adjuvant Analgesics

N-Methyl-D-Aspartate Antagonism and α2 Agonists

Hormonal Therapy

Radionucleotides

Procedural Interventions

Associated Processes

Granulocyte Colony-Stimulating Factor Related Pain

Conclusion

References

Chapter 47 Cancer-Related Visceral Pain

Epidemiology Review

Characteristics of Visceral Pain

Anatomy and Physiology

Sensitization

Localization

Visceral Afferentation

Ascending Pathways

Visceral Pain Syndromes

Oral Mucosa

Mediastinum

Pancreas

Liver Pain

Intestinal Pain

Pelvic Pain

Adrenal Pain Syndrome

Pain Syndromes Related to Intravenous Chemotherapeutic Agents

Complex Visceral Pain Syndromes

Postradiation Visceral Pain

Postchemotherapy Visceral Pain

Treatment

N-Methyl-D-Aspartate Receptor Antagonists

Corticosteroids

Gabapentin

Short Interfering RNA Therapeutics

T-Type Calcium Channel Antagonists

AMPA/Kainate Antagonists

P38 Kinase Inhibitors

Chemokine Receptor Type 2 Antagonists

P2x Purinoceptor 3 Antagonists

Newer Opioid Derivatives for the Treatment of Chronic Pain

Procedural Interventions

Conclusion

References

Chapter 48 Radiotherapy and Chemotherapy in Cancer Pain Management

Introduction

Bone Disease

Clinical Applications of Radiation Therapy

Response of Tumors to Radiotherapy

Trachea, Bronchi, and Lungs

Pancreatic Cancer

Pelvis

Skin and Subcutaneous Tissues

Brain Metastases

Bone Metastases

Single-Fraction Radiation

Stereotactic Radiation for Nonspine Bone Metastases

Reirradiation

Pathologic Fracture

Spinal Cord Compression

Radiation Tolerance of the Spinal Cord

Clinical Management

Treatment of Diffuse Bone Metastases

Wide-Field Radiotherapy

Radiopharmaceuticals

Role of Palliative Chemotherapy

Clinical Applications

Palliative Chemotherapy

Lymphoma

Breast Cancer

Head and Neck Cancer

Ovarian Cancer

Lung Cancer

Gastrointestinal Cancers

Prostate Cancer

Decision Making About Chemotherapy

Side Effects and Complications

Endocrine Therapy

Endocrine Therapy for Relief of Cancer Pain

Bisphosphonates

Summary

References

Chapter 49 Cancer Pain in Children

Overview of Childhood Cancer

Epidemiology

Treatment

Survivorship

Pain in Children: How Does this Differ from that in Adults?

Infants–Preschool

School Age–Adolescence

Pediatric Cancer Pain

Epidemiology of Pediatric Cancer Pain

Undertreatment and Impact of Pediatric Cancer Pain

Evaluation of Pediatric Cancer Pain

History and Physical Exam

Sensory Experience—Self-Report

Sensory Experience—Observation

Emotional and Cognitive Experience

Functional and Quality of Life Assessment

Past Pain-Directed Therapies

Cancer History—Diagnosis

Cancer History—Treatments

Past Medical, Psychiatric, Social, and Spiritual History

Proxy Reports

Integrating Data in Evaluation of the Whole Child

Incorporating Technology into Assessment

Etiologies of Cancer Pain

Disease-Related Pain

Procedure-Related Pain

Treatment-Related Pain

Pain from other Etiologies

Pain in Survivorship

Management of Pain

Pharmacologic Management of Cancer-Related Pain in Children

Overview of Opioid Analgesia in Children

Adverse Effects

Dependence and Addiction

Tolerance to Opioids

“Weak” Opioid

Adjuvant Therapies for Neuropathic Pain

Physical and Psychological Therapies for Pain in the Pediatric Cancer Patient

Acupuncture

Behavioral Interventions

Hypnotherapy

Expressive Arts Therapies

Massage

Biofeedback

Botanicals

Cannabis

Magnets

Spirituality/Religiosity

Therapeutic Yoga

Palliative Care for Children with Cancer

Summary

References

Acute Pain

Chapter 50 Acute Pain Management in Children

Pain Assessment in Infants and Children

Analgesic Pharmacology in Infants and Children

Nonopioid Analgesics

Ontogeny of Prostanoid Biosynthesis and Cyclo-Oxygenases

Aspirin and Other Salicylates

Acetaminophen

Nonsteroidal Anti-Inflammatory Drugs

Ketamine

Anticonvulsants

Opioids

Ontogeny of Opioid Actions

Codeine

Tramadol

Oxycodone

Morphine

Hydromorphone

Methadone

Fentanyl

Meperidine

Opioid Administration in Infants and Children

Intermittent Intravenous Bolus Dosing

Continuous Opioid Infusions

Patient-, Nurse-, and Parent-Controlled Analgesia

Treatment of Opioid Side Effects

Local Anesthetics and Regional Anesthesia in Infants and Children

Cutaneous Analgesia

Wound Infiltration

Epidural Analgesia in Infants and Children

Drugs and Drug Dosing Used for Epidural Analgesia

Peripheral Nerve Blocks in Children

Supraclavicular

Infraclavicular

Sciatic Nerve Block

Femoral Block

Transversus Abdominis Plane Block

Painful Conditions in Pediatric Hospital Care

Cancer Pain

Pain Associated with Sickle Cell Vasoocclusive Episodes

Children with Trauma

Children with Developmental Disabilities

Conclusions

References

Chapter 51 Acute Pain in Adults

Acute and Chronic Effects of Acute Pain

Neurobiology of Acute Pain

Primary Afferents and Peripheral Nerve Neurotransmitters

Spinal Cord and Supraspinal Structures

Prevention

Preventive Analgesia

Treatment Methods

Systemic Analgesic Techniques

Nonselective Noradrenergic and Serotoninergic Medications

Intravenous Patient-Controlled Analgesia

Regional Analgesic Techniques

Peripheral Regional Analgesia

Enhanced Recovery After Surgery Pathways

Analgesia in Special Populations

War Trauma

Ambulatory Surgical Patients

Elderly Patients

Opioid-Tolerant Patients

Obesity, Obstructive Sleep Apnea, and Sleep

Gender or Sex Differences in Analgesia

Inpatient Pain Services

Long-Term Impact of Acute Pain

References

Chapter 52 Regional Anesthesia Techniques for Acute Pain Management

Continuous Epidural Analgesia

Thoracic Epidural Analgesia

Block Technique: Epidural

Subarachnoid/Intrathecal Analgesia

Technique

Clinical Subarachnoid Analgesia

Combined Spinal and Epidural

Technique of Combined Spinal Epidural

Complications and Challenges with Combined Spinal Epidural

Contraindications of Neuraxial Techniques

Sepsis, Fever, and Viral Infections

Coagulopathy, Thrombocytopenia, and Bleeding Disorders

Central Nervous System Disorders

Analgesic Adjuvants for Central and Peripheral Analgesia

Introduction

Neuraxial Opioids

Perineural Opioids

Perineural Clonidine and Dexmedetomidine

Perineural Dexamethasone

Transversus Abdominis Plane Block, Ilioinguinal Iliohypogastric Block, Rectus Sheath Block

Transversus Abdominis Plane Block

Iliohypogastric and Ilioinguinal Block

Rectus Sheath Block

Peripheral Nerve Blocks and Catheters

Interscalene Block

Indications

Landmarks

Techniques

Clinical Effects

Supraclavicular Block

Indications

Landmarks

Ultrasound Technique

Clinical Effects

Infraclavicular Block

Indications

Landmarks

Technique

Clinical Effects

Axillary Block

Indications

Landmarks

Techniques

Clinical Effects

Suprascapular and Axillary Nerve Block

Indications

Landmarks

Ultrasound Technique

Clinical Effects

Brachial Plexus Terminal Branch Blocks at the Elbow and Below

Indications

Techniques

Clinical Effects

Paravertebral Nerve Block

Indications and Landmarks

Techniques

Contraindications

Clinical Effects

Nerve Blocks of the Lumbar Plexus

Indications and Landmarks

Techniques

Complications

Clinical Effects

Femoral Block

Indications

Landmarks

Techniques

Complications

Clinical Effects

Adductor Canal Block

Indications

Clinical Effects

Technique

Complications

Fascia Iliaca Block

Indications

Techniques

Clinical Effects

Complications

Lateral Femoral Cutaneous Nerve Block

Indications and Landmarks

Techniques

Clinical Effects

Complications

Obturator Nerve

Indications and Landmarks

Techniques

Complications

Sacral Plexus-Sciatic Nerve Block

Indications

Landmarks

Techniques

Clinical Effects

Complications

Ankle Block

Indications

Techniques

Clinical Effects

Complications

Quadratus Lumborum Block

Indications

Ultrasound Technique

Clinical Effects

Complications

PECS/Serratus Anterior Plane Block

Indications

Ultrasound Technique

Clinical Effects

Complications

Complications of Peripheral Nerve Blocks

Neurologic Complications

Postsurgical Inflammatory Neuropathy

Nonneurologic Complications

Summary of Treatment of Local Anesthetic Systemic Toxicity

Summary

References

Chapter 53 Burn Pain

The Nature of Burn Pain

Psychological Factors

Generalized Treatment Paradigm for Burn Pain

Pharmacologic Approaches

Opioids

Nonopioids

Anxiolytics

Anesthetics

Pharmacologic Options for Background Pain Management

Pharmacologic Options for Procedural Pain Management

Pharmacologic Options for Postoperative Pain Management

Nonpharmacologic Approaches

Cognitive Interventions and Coping Styles

Preparatory Information

Behavioral Interventions

Hypnosis

Virtual Reality

Conclusion

Acknowledgment

References

Pain in Special Populations

Chapter 54 Persistent Pain in Children

Epidemiology of Chronic Pain in Children

Musculoskeletal Pain

Headache

Chronic Abdominal Pain

Disease- or Treatment-Related Pain

Additional Considerations

Impact of Persistent Pain on Children and Families

Clinical Evaluation of the Child with Chronic Pain

Background

History

Measurement of Pain and Functioning

Physical Evaluation

Clinical Formulation

Feedback with the Family

Treatment

General Principles of Treatment

Specific Interventions for Chronic/Persistent Pain

Specific Entities

Musculoskeletal Pain

Complex Regional Pain Syndromes

Back Pain

Headache

Functional Gastrointestinal Pain

Barriers to Care

Conclusion

References

Chapter 55 Pain in the Older Person

Overview

The Prevalence of Pain in Older Adults

Pain in the Older Person

Impact of Pain on Functioning and Quality of Life

Undertreatment of Pain in Older Persons

Change in Pain Processing and Modulation

Assessment of Pain in the Older Person

Clinical Evaluation of Pain

Nonverbal, Cognitively Impaired Older Adults

Pharmacologic Treatment of Pain in Older Persons

Pharmacokinetics and Pharmacodynamics Associated with Aging

Safe, Effective Use of Nonopioids in the Older Person

Safe, Effective Use of Opioids in the Older Person Potential Risks of Opioid Analgesics

Safe, Effective use of Adjuvants in the Older Person

Additional Treatments for Pain of Older Person

Interventional Approaches

Physical Modalities

Psychosocial Modalities

Complementary and Integrative Health

Multidisciplinary Pain Treatments

Summary

References

Chapter 56 Obstetric Pain

Historical Notes

Pain of Childbirth

Childbirth Pain Mechanisms and Pathways

Factors That Affect the Pain of Childbirth

Effects of Pain on the Mother and Fetus

Physiologic Changes of Pregnancy

Respiratory Changes

Cardiovascular Changes

Central Nervous System Changes

Pharmacokinetic Changes

Uteroplacental Unit

Nonpharmacologic Methods of Labor Analgesia

Antenatal Childbirth Education

Labor Support

Hydrotherapy

Intradermal Water Injections

Hypnosis

Transcutaneous Electrical Stimulation

Acupuncture and Acupressure

Systemic Analgesia

Inhalational Analgesia

Parenteral Opioid Analgesia

Neuraxial Analgesia

Epidural Analgesia

Combined Spinal-Epidural Analgesia

Maintenance of Epidural Analgesia

Other Central Neuraxial Techniques

Side Effects of Neuraxial Analgesia

Complications of Neuraxial Analgesia

Other Regional Analgesic Techniques

Paracervical Block

Lumbar Sympathetic Block

Pudendal Block

Perineal Infiltration

Effects of Analgesia on the Progress of Labor

Nonobstetric Drug Therapy During Pregnancy and Lactation

Drug Classification During Pregnancy and Lactation

References

Chapter 57 Pain and Sickle Cell Disease

Introduction

History

Nature of the Sickle Mutation

Classification of Sickle Cell Syndromes

Genotypes

Pathophysiology

Vaso-Occlusion

Cellular Dehydration

Adhesion to Vascular Endothelium

Inflammation and Reperfusion Injury

Genetic Markers

Other Factors

Classification of Sickle Cell Pain Syndromes

Acute Sickle Cell Pain Syndromes

The Vascular Occlusive Crisis

Acute Chest Syndrome

Acute Abdominal Pain Syndromes

Hand–Foot Syndrome (Dactylitis)

Priapism

Acute Multiorgan Failure

Chronic Sickle Cell Pain

Avascular Necrosis

Leg Ulcers

Intractable Painful Episodes

Neuropathic Pain

Management of Sickle Cell Pain

Nonpharmacologic Management of Pain

Pharmacologic Management of Pain

Curative Therapies

Conclusion

References

Chapter 58 Pain in HIV

Prevalence of Pain in HIV/AIDS

Pain in Women with HIV/AIDS

Pain in Children with HIV/AIDS

Specific Pain Syndromes in HIV/AIDS

Gastrointestinal Pain

Oropharyngeal Pain

Esophageal Pain

Abdominal Pain

Anorectal

Chest Pain Syndromes

Cardiac Pain

Pulmonary/Pleuritic Pain

Chest Wall Pain

Musculoskeletal Pain

Arthropathy

Osteoporosis

Neurologic Manifestations

Peripheral Neuropathy

Distal Symmetric Polyneuropathy

Treatment of HIV-Associated Sensory Neuropathy

Inflammatory Demyelinating Polyneuropathy

Mononeuritis Multiplex

Progressive Polyradiculopathy

Inflammatory Myopathies

Headache

Primary Headaches

Secondary Headaches

Management of Pain

Evaluation Guidelines

Pain Measurement/Assessment Tools

Multimodal Treatment Approach

Pharmacologic Treatment

Nonpharmacologic Therapies

Undertreatment of Pain

Barriers to Pain Management

Summary

References

Chapter 59 The Treatment of Chronic Pain in Patients with History of Substance Abuse

Principle of Balance

The Importance of the Definitions

Basic Science of the Disease of Addiction

Binary Concept of Pain and Addiction

Pain and Opioid Addiction—A Continuum Approach

Separating the “Motive” from “Behavior” When Dealing with Pain and Addiction

Opioids for Analgesia or Opioid-Stabilizing Effect?

Assessment Tools

Universal Precautions in Pain Medicine

The 10 Principles of Universal Precautions in Pain Medicine

Patient Triage

Treating the Pain Patient on Opioid Agonist Treatment

The Treatment of Pain and Suffering in Our Society

Conclusion

References

Chapter 60 Compliance Monitoring in Chronic Pain Management

How Communication Influences Compliance Assessment

Interpreting Aberrant Behavior

Potential Treatment Traps in Compliance Monitoring

Urine Drug Testing in Pain Medicine

Specimen Choice

Whom to Test

Frequency of Testing

Testing Strategies

Presumptive Versus Definitive Testing

Limitations of Test Interpretation

Future Considerations

References

Visceral Pain

Chapter 61 Headache

General Principles

Primary Headache Syndromes

Anatomy and Physiology

Secondary Headache

Migraine

Tension-Type Headache

Trigeminal-Autonomic Cephalalgias

Paroxysmal Hemicrania

Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing or Cranial Autonomic Activation

Other Primary Headaches

Other Important Forms of Secondary Headache

Acknowledgment

References

Chapter 62 Noncardiac Chest Pain

Epidemiology

Natural History

Pathophysiology

Gastroesophageal Reflux Disease

Linked Angina

Esophageal Dysmotility

Sustained Esophageal Contractions

Esophageal Hypersensitivity

Altered Autonomic Activity

Psychological Comorbidity

Diagnosis of Noncardiac Chest Pain

Cardiology Evaluation

Gerd-Related NCCP

Barium Esophagram

Upper Endoscopy

Ambulatory 24-hour Esophageal pH Monitoring

The Wireless pH System

The Proton Pump Inhibitor Test

Multichannel Intraluminal Impedance

Esophageal Dysmotility

Esophageal Manometry

Provocative Testing

Edrophonium (tensilon) Test

Ergonovine Stimulation Test

Pentagastrin Stimulation Test

Sensory Testing of the Esophagus

Acid Perfusion Test (bernstein Test)

Electrical Stimulation

Intraluminal Ultrasonography

Balloon Distension

Esophageal Evoked Potentials

Brain Imaging

Sensory Testing—Pitfalls in Study Design

Psychological Evaluation

Treatment

Gerd-Related NCCP

Non–Gerd-Related NCCP

Pain Modulators

Endoscopic Treatment and Surgery for NCCP

Johrei Therapy

Psychological Treatment

Future Therapy

References

Chapter 63 Abdominal, Peritoneal, and Retroperitoneal Pain

Clinical Approach to Abdominal Pain

Pain Localization and Character

Time Course

Contextual Information

Physical Examination

Diagnostic Testing in Abdominal Pain

Mechanisms of Visceral Pain

Visceral Nociception

Central Processing of Somatic and Visceral Pain

Sensitization and Visceral Hypersensitivity

Susceptibility Factors

Genetic Factors

Adverse Life Events and Stress

Psychiatric Diseases

Microbial Colonization

Biomarkers of Abdominal Pain

Treatment of Abdominal Pain

Lifestyle Modifications

Patient–Provider Relationship

Placebo Response

Opioids

Nonopioid Analgesics

Neuromodulators

Antidepressants

Psychological Therapies

Blocking Afferent Pathways

Smooth Muscle Relaxants

Acid Suppressants

Altering the Microbiome

Serotonin

Substance P

Complementary and Alternative Medicine Therapy

Conclusion

References

Chapter 64 Pelvic Pain in Females

Acute Pelvic Pain

Introduction

Overview of Assessment

Gynecologic Factors

Complications Specific to Pregnancy

Complications of Assisted Conception

Dysmenorrhea

Nonsteroidal Anti-Inflammatory Drugs

Hormonal Treatments

Surgical Treatments

Nonpharmacologic Interventions

Mittelschmerz

Chronic Pelvic Pain

Introduction

Factors Associated with Chronic Pelvic Pain

Overview of Assessment

The Importance of Visceral Hypersensitivity in Chronic Pelvic Pain

Gynecologic Factors in Chronic Pelvic Pain

Gastrointestinal Factors in Chronic Pelvic Pain

Urologic Factors in Chronic Pelvic Pain

Musculoskeletal Factors in Chronic Pelvic Pain

Neurologic Factors in Chronic Pelvic Pain

Dyspareunia

Overview

Vulval Pain Syndromes

Conclusion

References

Chapter 65 Pelvic Pain in Males

Taxonomy and Phenotyping Chronic Pelvic Pain

Classical Pathologies

Pelvic Pain Syndromes and Nonpelvic Pain Syndromes

Male-Specific Pelvic Pain Syndromes

Subclassification of the Pelvic Pain Syndromes by Organ

The Importance of Taxonomy and Phenotyping

Epidemiology

Incidence/Prevalence

Precipitating Factors

Mechanisms

Differences Between Visceral and Nonvisceral Somatic Pains

Peripheral Mechanisms

Central Mechanisms

Muscles and Pelvic Pain

Pelvic Nerves and Pain

Functional Problems and Male Pelvic Pain

Psychological Consequences of Male Pelvic Pain

Male Urogenital Pelvic Pain Syndromes—Treatment

Sex Differences and Therapies

Specific Pain Syndrome Treatments

Generic Treatment Approach

Overview and Conclusion

References

Regional Pain

Chapter 66 Cranial Neuralgias

Classical Trigeminal Neuralgia

History

Epidemiology

Etiology and Pathophysiology

Symptoms and Signs

Differential Diagnosis

Treatment

Painful Trigeminal Neuropathy

Multiple Sclerosis

Neoplasm

Herpes Zoster and Postherpetic Neuralgia

Nervus Intermedius Neuralgia

Etiology

Symptoms and Signs

Diagnosis

Treatment

Glossopharyngeal Neuralgia

Etiology

Symptoms and Signs

Diagnosis

Treatment

Vagal Neuralgia

Etiology

Symptoms and Signs

Diagnosis

Treatment

Other Terminal Branch Neuralgias

Other Cranial Neuralgia–Related Causes of Pain: Anesthesia Dolorosa

Etiology

Symptoms and Signs

Diagnosis

Treatment

Conclusion

References

Chapter 67 Facial Pain

Trigeminal and Other Cranial Nerve Neuropathic Conditions

Trigeminal Neuropathy

Glossopharyngeal Neuralgia

Nervus Intermedius Neuralgia

Odontogenic and Temporomandibular Joint Disorders

Odontogenic Pain

Temporomandibular Disorders

Chronic Headache Disorders Causing Facial Pain

Primary Headache Conditions

Secondary Headache Conditions

Medication Overuse Headache

Sinus Headaches

Head Injury Headaches

Short-Lasting, Unilateral, Neuralgiform Headache Attacks with Conjunctival Injection and Tearing

Short-Lasting, Unilateral, Neuralgiform Headache Attacks with Cranial Autonomic Features

Paroxysmal Hemicranias

Contact Point Headache

References

Chapter 68 Neck and Arm Pain

Anatomy of the Neck and Arm

Cervical Spine

Musculature of the Neck

The Vertebral Canal

Vertebral Arteries

Cervical Nerves

The Cervical and Brachial Plexus

Pectoral Girdle and Shoulder Anatomy

Epidemiology of Neck and Arm Pain

Evaluation of the Patient

History and Physical Examination

Laboratory Evaluation

Radiographic Studies

Common Causes of Neck and Arm Pain

Mechanical Neck Pain and Cervicogenic Headache

Diffuse Idiopathic Skeletal Hyperostosis

Cervical Radiculopathies

Upper Extremity Peripheral Nerve Entrapment Syndromes and Brachial Plexus Neuropathy

Lesions of the Brachial Plexus

References

Chapter 69 Chest Wall Pain

General Considerations

Anatomy of the Chest Wall

Skeletal Structures of the Chest Wall

Joints of the Chest Wall

Intercostal Spaces

Intercostal Nerves

Neoplastic Chest Wall Pain

Epidural Spinal Cord Compression

Superior Vena Cava Syndrome

Costopleural Syndrome

Nonneoplastic Chest Wall Pain

Neuropathic Pain

Chest Wall Pain of Skeletal Origin

Chest Pain and Psychological Factors

Chest Wall Pain of Cardiac Origin

Conclusion

References

Chapter 70 Lower Extremity Pain

Lumbosacral Plexopathy

Neoplasms

Radiation-Induced Plexopathy

Diabetic and Nondiabetic Lumbosacral Radiculoplexus

Abscess

Retroperitoneal Hematoma

Aneurysms

Trauma

Obstetric-Related Plexopathy

Specific Nerve Entrapment Syndromes

Lateral Femoral Cutaneous Nerve Entrapment

Femoral Nerve Entrapment

Saphenous Nerve Entrapment

Obturator Nerve Entrapment

Sciatic Nerve Entrapment

Fibular (peroneal) Nerve Entrapment

Foot Pain

Pes Planus

Pes Cavus

Plantar Fasciitis

Heel Pad Deficiency

Tarsal Tunnel Syndrome

Lisfranc Joint Instability

Posterior Tibial Tendon Insufficiency

Dorsal Foot Ganglia

Metatarsalgia

Hallux Valgus

Hallux Rigidus

Intractable Keratosis

Sesamoiditis

Gout

Interdigital (Morton’s) Neuroma

Hammertoes

Claw Toe Deformity

Hard Corn (Clavus Durum)

Soft Corn (Clavus Mollum)

Ingrown Toenail (Onychocryptosis)

References

Neck and Low Back Pain

Chapter 71 Neck Pain

Definition

Referred Pain

Cervicogenic Headache

Pursuing Diagnosis

Trauma

Acute Neck Pain

Chronic Neck Pain

Whiplash

Cervicogenic Headache

Treatment

Neck Pain

Cervicogenic Headache

Summary

References

Chapter 72 Acute Low Back Pain

Introduction

Definition

Referred Pain

Causes

Management Algorithm

Triage

Initial Management

Review

Vigilance

Reinforcement

Discussion

Conclusion

References

Chapter 73 Chronic Low Back Pain

Introduction

Definition

Referred Pain

Sources

Causes

Prevalence

Refuted Causes

Accepted Causes

Untested Causes

Assessment

Medical History

Psychosocial History

Physical Examination

Review of Previous Investigations

Provisional Diagnosis

Ancillary Investigations

Clearance

Not Indicated

Magnetic Resonance Imaging

Disk Stimulation

Sinuvertebral Nerve Blocks

Lumbar Medial Branch Blocks

Sacroiliac Joint Blocks

Sacral Lateral Branch Blocks

Treatment

General Treatments

Drug Therapy

Physical Modalities

Simple Needle Treatments

Back School

Psychological Interventions

Multidisciplinary Pain Management

Functional Restoration

Specific, Targeted Treatments

Invasive Treatments

Conclusion

References

Chapter 74 Surgery for Low Back Pain

Rationale

Effectiveness

Before Evidence-Based Medicine

Advent of Evidence-Based Medicine

Since Evidence-Based Medicine

Discussion

References

Chapter 75 Failed Back Surgery

Causes of Failed Back Surgery

Mismatch: Surgery Needed Versus Surgery Performed (“Wrong Surgery”)

Incomplete Evaluation And/or Diagnosis (“Residual Pathology”)

Complications

Technical Failure

Residual Pathology

Recurrent Pathology

New Pathology

Structural Etiologies of Failed Back Surgery

Foraminal Stenosis

Painful Disk (Discogenic Pain)

Disk Herniation

Facet Joint Pain

Sacroiliac Joint Pain

Spinal Stenosis and Axial Low Back Pain

Neuropathic Pain

Epidural Fibrosis

Deconditioning

Psychological Factors in Failed Back Surgery (“Right Patient”)

Establishing the Diagnosis

Role of the History

Time Course of Appearance of Pain

Role of Radiologic Evaluation of Failed Back Surgery

Role of Diagnostic Injections

Treatments

Nonspecific Treatments

Some of the Specific Treatments for Specific Disorders

References

Chapter 76 Psychological Screening of Candidates for Spine Surgery or Placement of Implanted Devices

Introduction

Spinal Surgery

Spinal Cord Stimulation and Intrathecal Drug Delivery Systems

Affective Disorders as Predictors of Outcome

Somatization

Pain Sensitivity

Anger

Cognitive Factors

Coping Strategies

Behavioral Factors

Early-Life Trauma and Abuse

Substance Abuse

Components of Psychological Evaluations

Validated Psychological Measures

Electronic Pain Assessment Programs

Conclusion

References

PART FIVE Methods for Symptomatic Control

Pharmacologic Therapies

Chapter 77 Rational Pharmacotherapy for Pain

Drugs are Both Underused and Overused in Pain Management

Pharmacotherapy Alone is Rarely Optimal Therapy for Chronic Pain

Every Use of Medication for Pain is an Experiment

Patient Preference: Symptom Control Versus Side Effects

Whenever Possible Treat the Cause of the Pain

Synergism and Potentiation

Outcomes Analyses of Pain Pharmacotherapy

Approved Drugs and Drugs for Nonapproved Uses

Rational Pharmacotherapy

Conclusion

References

Chapter 78 Nonsteroidal Anti-Inflammatory Drugs and Acetaminophen

Mechanism of Action

Prostaglandin Synthesis and Pharmacology

Central Sites of Action

Peripheral Sites of Action

Cox-1 and Cox-2 Selectivity

Pharmacokinetics

Absorption

Distribution

Elimination

Pathophysiologic Conditions Affecting the Kinetics of Nsaids

Specific Drugs

Salicylates

Acetic Acid Derivatives

Propionic Acid Derivatives

Oxicam Derivatives

Cox-2 Selective Nsaids

Acetaminophen

Side Effects, Warnings, and Controversies

Conclusion

Dedication

References

Chapter 79 Opioid Analgesics

Classification Based on Interactions with an Opioid Receptor

Classification Based on Opioid Agonist or Antagonist Activity

Opioid Pharmacodynamics

Cellular, Synaptic, and Circuit Level Events that Inhibit Pain Transmission

The Pharmacodynamic Effects of Opioids

Central Nervous System Opioid Effects

Analgesia

Mood Effects

Sedation

Nausea and Vomiting

Respiratory Depression

Constriction of the Pupil

Antitussive Effect

Hypothalamic Effects

Central Nervous System Excitation

Opioid Tolerance, Dependence, and Addiction

The Opioid-Tolerant Patient and Opioid-Induced Hyperalgesia

The Opioid-Dependent Patient

The Opioid-Addicted Patient with Pain

Peripheral Effects of Opioids

Effects on Smooth Muscle and the Cardiovascular System

Pruritus

Opioid Effects in Pregnancy and on the Neonate

Routes for Opioid Administration

Alternative Noninvasive Routes

Sublingual Administration

Epidural, Intrathecal, and Intraventricular Administration

Characteristics of Specific Opioids

Morphine

Hydromorphone

Methadone

Levorphanol

Oxymorphone

Oxycodone

Fentanyl

Meperidine

Codeine

Hydrocodone

Propoxyphene

Tramadol

Tapentadol

Pentazocine, Nalbuphine, and Butorphanol

Buprenorphine

Abuse-Deterrent Opioid Formulations

Selecting Among the Opioids for Clinical Use

Conclusions and Insights Into the Future of Opioids for Pain

Biased Ligands

Dedication

References

Chapter 80 Skeletal Muscle Relaxants and Analgesic Balms

Skeletal Muscle Relaxants

Mechanism of Action

Types of Skeletal Muscle Relaxants

Centrally Acting Sedative-Hypnotic Muscle Relaxants

Antihistamine Muscle Relaxant

Tricyclic Antidepressant-Like Muscle Relaxant

γ-Aminobutyric Acid Agonist Muscle Relaxants

Central α2 Agonist Muscle Relaxants

Acute Low Back Pain

Chronic Low Back Pain

Topical Analgesic Balms

Topical Counterirritants

Conclusion

References

Chapter 81 Neuropathic Pain Pharmacotherapy

Antidepressants

Tricyclic Antidepressants

Selective Serotonin and Norepinephrine Reuptake Inhibitors

Selective Serotonin Reuptake Inhibitors

Antiepileptics

Pregabalin

Gabapentin

Carbamazepine

Oxcarbazepine

Lamotrigine

Valproate

Other Anticonvulsants

Opioids

Tramadol

Tapentadol

NMDA Receptor Antagonists

Systemic Sodium Channel Blockers

Simple Analgesics

Nonsteroidal Anti-Inflammatory Agents

Topical Agents

Capsaicin

Topical Lidocaine Patches

Topical Ketamine

Cannabinoids

Drug Combinations

Future Drugs

Evidence-Based Recommendations for Drug Therapy in Neuropathic Pain

Intrathecal Drugs for Neuropathic Pain

Neuropathic Pain—Not Only Pharmacotherapy

References

Chapter 82 Local Anesthetics

Physicochemical Properties of Local Anesthetics

Molecular Structure

Chirality

Acid–Base Balance

Lipophilic–Hydrophilic Balance

Local Anesthetic Pharmacology

Pharmacodynamics

Pharmacokinetics

Regional Administration of Local Anesthetics for Pain Relief

Differential Blockade

Site of Injection

Potency, Onset, and Duration

pH Adjustment of Local Anesthetics

Vasoconstrictor Effect

Mixtures of Local Anesthetics

Special States: Pregnancy

Systemic Administration of Local Anesthetics for Pain Relief

Intravenous Lidocaine for Acute Postoperative Pain

Intravenous Lidocaine for Chronic Neuropathic Pain

Adverse Effects

Systemic Toxicity

Allergies

Methemoglobinemia

Prolonged-Duration Local Anesthetics

References

Psychological Techniques

Chapter 83 Anger and Pain

Cultural Background

Psychoanalytic Background

Current Research in Anger and Its Relation to Pain

Physiologic Mechanisms in Anger and Pain Research

Psychological Constructs in Anger and Pain Research

Anger Management Style

Measurement of Anger

State-Trait Anger Expression Inventory-2

The Targets and Reasons for Anger in Pain Sufferers

Multidimensional Anger Inventory

Novaco Anger Scale and Provocation Inventory

Anger Disorders Scale

Minnesota Multiphasic Personality Inventory-2-restructured Form

Psychotherapeutic Management

Considerations in the Selection of Psychotherapy

Behavioral and Cognitive-Behavioral Therapies

Summary

References

Chapter 84 Cognitive-Behavioral Therapy for Chronic Pain

Introduction

History and Development of Cognitive-Behavioral Therapy for Pain

Evidence for Cognitive-Behavioral Therapy for Chronic Pain

Components of Cognitive-Behavioral Therapy for Chronic Pain

Chronic Pain Psychoeducation

Relaxation Techniques

Behavioral Activation and Time-Based Pacing

Sleep Hygiene

Cognitive Restructuring

Communication Skills

Maintenance and Relapse Prevention

Third-Wave Therapies—Acceptance and Commitment Therapy

Treating Comorbid Conditions

Cognitive-Behavioral Therapy Within Interprofessional Pain Programs and Pain Rehabilitation Programs

Cognitive-Behavioral Therapy to Prevent the Transition from Acute to Chronic Pain

Summary

References

Chapter 85 Pain and Anxiety and Depression

Prevalence of Anxiety and Depressive Disorders in Chronic Pain

Impact of Anxiety and Depressive Disorders on Functioning

The Interaction of Anxiety, Depression, and Chronic Pain

The Fear-Avoidance Model

A Contextual Behavioral Approach to Anxiety and Depressive Disorders

Treatment of Anxiety and Depressive Disorders

Evidence from Pharmacologic Approaches

Evidence from Psychological Approaches

Cognitive-Behavioral Therapy for Chronic Pain: Effects on Depression and Anxiety

Developments in Cognitive Behavioral Therapy

Summary

References

Chapter 86 Hypnosis

History of Hypnosis in Pain and Symptom Control

Hypnosis by Definition

Conscious, Unconscious, and Content of Consciousness

Central Mechanisms

Central Mechanisms of Hypnosis

High and Low Hypnotizability

Central Mechanisms of Hypnotic Analgesia

Pain as a Plastic Experience

Testing Hypnotizability

Current Research and Applications of Medical Hypnosis for Pain

Efficacy and Effectiveness

Review of Research Studies According to Pain Problems or Situations

Medical Hypnosis Techniques

Principles of Preparation, Induction, and Suggestions

Common Induction Procedures

Suggestions and Imagery

Chronic Pain Management

Ericksonian Naturalistic Approaches to Pain and Symptom Management

Conclusions

References

Chapter 87 Group Therapy for Chronic Pain

Rationale and Basic Considerations of Group Treatment for Pain

Evidence for Efficacy of Group Treatment for Chronic Pain Management

Group Versus Individual Treatment

Group Cognitive-Behavioral Therapy Versus Wait-List, Treatment as Usual, or Other Group Treatments

Behavioral Versus Exercise and Physical Therapy Group Treatments

Mindfulness-Based Approaches to Pain Management

Acceptance-Based Approaches to Pain Management

Factors Affecting Psychotherapeutic Outcome

The Importance of Cognitive Change

Compliance with Homework and Skills Practice to Maintain Treatment Gains

Importance of Therapist Skill and Adequate Time with Therapist

Importance of Group Process

Advantages of Group Treatment

Efficiency and Cost-Effectiveness

Social Proximity and Support

Vicarious Learning and Modeling of Collaborative Approach

Interpersonal Group Process

Practical Issues

Open Versus Closed Groups

Length of Group

Number of Participants

Individuals Who May Be Inappropriate for Groups

Summary and Conclusions

Future Directions

Appendix 87.1: Search Strategies

References

Chapter 88 Motivating Chronic Pain Patients for Behavioral Change

Neural Mechanisms of Motivation

Concept of Readiness to Change: Transtheoretical Model of Behavior Change

Motivation Enhancement Therapy

Help Patients Recognize the Problems and Goals

Decisional Balance

Self-Motivational Statements

What Not to Do in Motivation Enhancement Therapy

Dealing with Setbacks and Resistance

Simple Reflection

Amplified Reflection

Double-Sided Reflection

Agreement with Twist

Personal Choice and Control

Shifting Focus

Research Outcomes

Volitional Approach: Implementation Intentions

Implementation Intentions: Outcomes

Conclusion

References

Physical and Other Noninterventional Therapeutic Modalities

Chapter 89 Basic Concepts in Biomechanics and Musculoskeletal Rehabilitation

Basic Considerations

Kinetic Chain Theory

Adverse Neural Tension

Neuromuscular Control

Biomechanical Considerations in the Setting of Common Physical Examination Techniques

Endurance

Biomechanical Considerations in Common Musculoskeletal Pain Syndromes

Cervicalgia

Periscapular and Thoracic Pain

Lumbar Pain

Sacroiliac and Hip Girdle Pain

Conclusion

References

Chapter 90 Pain Rehabilitation

Historical Overview: Pain Rehabilitation and Functional Restoration

History of Pain Rehabilitation

History of Functional Restoration and Work Rehabilitation

What is Pain Rehabilitation?

Stakeholders in Rehabilitation

Models of Rehabilitation

Biopsychosocial Approach Versus Biomedical Model for Pain Management

Treatment Approaches: Pain Rehabilitation

Team Building and Stakeholder Coordination

Case Management

Applying Team Values

Assessment, Goal Setting, and Progression Through Treatment

Pain Rehabilitation Principles

Rehabilitation Specialists: Activities and Conceptual Models

The Therapist’s Role: Building an Effective Therapeutic Relationship

Incorporating Behavioral Approaches in Pain Rehabilitation

Physical Therapy

Therapeutic Exercise

Exercise Prescription

Occupational Therapy

Pain Psychology

Relaxation Training

Work Rehabilitation: Work Conditioning and Work Hardening

Outcomes of Work Conditioning and Work Hardening Programs

Measuring Physical Capacity

Functional Capacity Testing

Functional Capacity Testing Utility

Role of Opioid Management in Pain Rehabilitation

Conclusion

References

Chapter 91 Assessment and Treatment of Substance Use Disorders

Assessment and Treatment of Substance Use Disorders—Addiction Medicine Perspective

Screening and Recognition

Prescription Drug Monitoring Program

Diagnostic Assessment

Monitoring During Ongoing Pain Treatment

Treatment And/or Referral

Conceptions of Opioid Use Disorder—The Pain Medicine Perspective

History of Opioid use for Chronic Pain as it Relates to Identifying Opioid use Disorder

Implications for the Identification of Opioid use Disorder

Clinical Prevention and Management of Opioid use Disorder in Patients Receiving Opioids for Chronic Pain

Conclusions: Bridging the Gap Between Addiction and Pain Medicine

References

Chapter 92 Biophysical Agents for Pain Management in Physical Therapy

Superficial Thermal Agents

Thermotherapy

Cryotherapy

Light Therapy

Laser

Monochromatic Infrared Energy

Therapeutic Ultrasound

Electrical Current

Transcutaneous Electrical Nerve Stimulation

Interferential Current

Iontophoresis

Somatosensory Desensitization

Emerging Interventions

Manual Lymphatic Drainage

Cupping

Mirror Therapy and Graded Motor Imagery

Conclusion

References

Chapter 93 Exercise Therapy for Low Back Pain

Individualized Exercise Programs

Musculoskeletal Examination for Low Back Pain

Designing Individualized Exercise Programs

Exercise Recommendations Based on the Clinical Course

Recurrent Lower Back Pain Stage of Management

Persistent Lower Back Pain Stage of Management

Relapse Management

The Application of Common Exercise Approaches for Lower Back Pain

Evidence to Support Exercise Therapy for Lower Back Pain

Evidence for Specific Exercise Approaches

Evidence for Using Classification Systems for Exercise Selection

Evidence for Global Exercise Approaches

Conclusion

References

Chapter 94 Complementary and Integrative Health

What is Complementary and Integrative Health?

The Divide

Fringe Medicine and Quackery

“Unorthodox” Medicine

Complementary and Alternative Medicine

Complementary and Integrative Health

Bridging the Divide: One Kind of Medicine

What is Different about Complementary and Alternative Medicine?

Who Uses Complementary and Integrative Health?

Categorizing Complementary and Integrative Health Therapies

Why Consider Complementary and Integrative Health Therapies in Pain Management?

Challenges of Evidence-Based Complementary and Alternative Medicine Therapies

The Complementary and Integrative Health Therapies: The Evidence

Biologically Based Therapies

Energy-Based Therapies

Conclusion

References

Implanted Electrical Stimulators

Chapter 95 Stimulation of the Peripheral Nervous System for Pain Relief

Pathophysiology and Mechanisms of Analgesia

Stimulation Technologies

Implantation Techniques

Open Surgical Placement

Percutaneous Placement with Fluoroscopic Guidance

Percutaneous Placement with Ultrasound Guidance

Placement at the Nerve Root/Dorsal Root Ganglion

Patient Selection and Preoperative Workup

Clinical Indications and Outcomes

Extremity Pain

Truncal Pain

Headache and Facial Pain

Complications

Peripheral Nerve Stimulation

Peripheral Field Stimulation

Dorsal Root Ganglion Stimulation

Conclusion and Future Directions

References

Chapter 96 Spinal Cord Stimulation

History

Basic Science of Conventional Spinal Cord Stimulation

Introduction

Neurophysiology and Neurochemistry

Basic Science of New Spinal Cord Stimulation Waveforms

High-Frequency Spinal Cord Stimulation

Burst Spinal Cord Stimulation

Moderate Changes of Conventional Spinal Cord Stimulation Parameters

Computer Modeling Studies

Conventional Spinal Cord Stimulation Mechanisms in Ischemic Pain

Peripheral Vascular Disease

Spinal Cord Stimulation for Angina Pectoris and Cardiac Disease

Mechanisms of Spinal Cord Stimulation in Visceral Abdominal Pain

Indications

Neuropathic Pain

Ischemic Pain

Visceral Pain and Dysfunction

Potential Beneficial Outcomes

Technical Goal

Clinical Goals

Prognostic Factors

Patient Selection

Technique

Screening Trial

Screening Electrode Choice

Electrode Positioning

Parameter Adjustment

Procedural Risk Reduction

Trial Duration

Removal of Trial Electrode

Device Options

Choice of Electrode

Choice of Pulse Generator

Programming a Spinal Cord Stimulation System

Patient Management

Spinal Cord Stimulation Patient Precautions

Spinal Cord Stimulation Treatment Challenges

Clinical Failure

Biologic Failure

Psychological Failure

Technical Failure

Equipment Failure

Cost-Effectiveness

Spinal Cord Stimulation Challenges

References

Chapter 97 Deep Brain and Motor Cortex Stimulation

Deep Brain Stimulation

Basic Considerations

Efficacy of Deep Brain Stimulation

Surgical Technique

Motor Cortex Stimulation

Basic Considerations

Efficacy of Motor Cortex Stimulation

Surgical Technique

Transcranial Magnetic Stimulation

Basic Considerations

Efficacy of Repetitive Transcranial Magnetic Stimulation for Pain

Conclusion

References

Interventional Pain Management

Chapter 98 Diagnostic and Therapeutic Nerve Blocks

Common Principles

Physician

Patient

Preparation

Contraindications

Complications

Procedure

Test Blocks

Prognostic Blocks

Spinal Nerve Blocks

Sympathetic Blocks

Diagnostic Blocks

Principles

Applications

Therapeutic Nerve Blocks

Conclusion

References

Chapter 99 Epidural Steroid Injections

Definition

Background

Techniques

Caudal Injections: Technique

Caudal Injections: Evidence

Caudal Injections: Adverse Events

Interlaminar Injections: Technique

Nonimage-Guided Interlaminar Technique: Evidence

Image-Guided Interlaminar Technique: Evidence

Interlaminar Technique: Adverse Events

Transforaminal Injections

Transforaminal Injections Under Fluoroscopic Guidance: Evidence

Transforaminal Injections: Determinants of Efficacy

Transforaminal Injections: Adverse Events

Transforaminal Injections Under Computed Tomography Guidance: Evidence, Adverse Events

Transforaminal Epidural Steroid Injections: Their Role in Treating the Radicular Pain Patient

References

Chapter 100 Intrathecal Drug Delivery in the Management of Pain

History of the Development of Intrathecal Drug Delivery Systems

Basic Pharmacology of Intrathecal Drug Administration

Selection of Agents for Intrathecal Drug Delivery

Specific Agents for Intrathecal Drug Delivery

Opioids

Local Anesthetics

α2-Adrenergic Agonists

Calcium Channel Antagonists

N-Methyl-D-Aspartate Receptor Antagonists

γ-Aminobutyric Acid Agonists

Gabapentin

Somatostatin and Somatostatin Analogues

Tricyclic Antidepressants

Acetylcholinesterase Inhibitors

Adenosine

Nitric Oxide

Prostaglandin Inhibitors

Calcitonin Gene-Related Peptide Antagonists

Substance P Antagonists

Patient Selection for Intrathecal Drug Delivery

Trialing Techniques for Intrathecal Drug Delivery

Implantable Pump Technology

Surgical Technique of Pump Implantation

Complications of Spinal Drug Delivery

Surgical Complications

Device-Related Complications

Pharmacologic Complications and Drug-Related Side Effects

Patient Outcomes and Intrathecal Drug Infusion

Cancer Pain

Intrathecal Drug Delivery for Chronic Noncancer Pain

Conclusion

Acknowledgment

References

Chapter 101 Intradiscal Therapies for Low Back Pain

Discogenic Pain

Pathology

Therapies

Ablation

Percutaneous Intradiscal Radiofrequency Thermocoagulation

L’disq

Chemical Therapies

Biologics

Discussion

References

Chapter 102 Neurolytic Blockade for Noncancer Pain

Introduction

Definition

Principles

History and Trends

Limitations

Chemical Neurolytic Blockade

Principles

Phenol

Alcohol

Applications

Glycerol

Cryoneurotomy

Thermal Radiofrequency

Introduction

Physics

Pathology

Physiology

Applications

Discussion

References

Surgical Approaches

Chapter 103 Surgery of the Peripheral Nervous System as a Treatment for Pain

Peripheral Neurectomy

Basic Considerations

Clinical Considerations

Indications and Outcomes for Treatment of Neuropathic Pain

Indications and Outcomes for Treatment of Nociceptive Pain

Nerve Entrapment Release

Basic Considerations

Clinical Considerations

Indications and Outcomes

Dorsal Rhizotomy and Ganglionectomy

Basic Considerations

Clinical Considerations

Indications and Outcomes

Sympathectomy

Basic Considerations

Clinical Considerations

Indications and Outcomes

Postoperative Complications

Conclusion

References

Chapter 104 The Surgical Management of Trigeminal Neuralgia

Patient Presentation

Anatomy

Pathophysiology

Evaluation for Surgery

Microvascular Decompression

Outcomes

Percutaneous Rhizotomy

Outcomes

Radiosurgery

Outcomes

Conclusions

References

Chapter 105 Ablative Neurosurgical Procedures for Chronic Pain

Dorsal Root Entry Zone Lesioning

Indications

Anatomy and Physiology

Technique

Outcomes

Cordotomy

Indications

Anatomy and Physiology

Technique

Outcomes

Cingulotomy

Indications

Anatomy and Physiology

Technique

Outcomes

Thalamotomy

Indications

Anatomy and Physiology

Techniques

Outcomes

Ablative Procedures of the Brainstem

Indications

Anatomy and Physiology

Techniques

Outcomes

Conclusion

References

PART SIX Provision of Pain Treatment

Chapter 106 Interdisciplinary Chronic Pain Management: Overview and Lessons from the Public Sector

History of Interdisciplinary Chronic Pain Management

Empirical Support for Interdisciplinary Chronic Pain Management

Theoretical Basis of the Interdisciplinary Approach

Composition of the Interdisciplinary Team and Roles of Members

The Process of Interdisciplinary Chronic Pain Management

Interdisciplinary Chronic Pain Management in Veterans Healthcare Administration: Overview of a Model System

Future Considerations for Interdisciplinary Chronic Pain Management

Conclusion

References

Chapter 107 Spine Clinics

Treatment Components

Treatment Providers

Conservative Care Gatekeepers

Pain Management

Psychology

Physical Therapy

Occupational Therapy

Spine Surgery

Chronic Pain Management Program

Potential Benefits of a Spine Specialty Clinic

Coordination of Care

Research and Education

Conclusion

References

Chapter 108 Pain Management in Primary Care

Introduction

Prevalence of Pain in the United States

Economic Implications of Chronic Pain

Chronic Pain Management: The Status Quo

Searching for Solutions

A New Approach to Chronic Pain Management

Who Treats Chronic Illness?

Why Primary Care is Involved?

Treating Chronic Pain in the Primary Care Setting—Why a Challenge?

Addressing Barriers to Care

Myths and Biases

Patient Resistance

Regulatory Scrutiny

Patient Expectations

Pain Practitioner: A Primary Care Model

Training

Collaboration with Pain Specialists

New Focus

Assessment and Evaluation During Short Visits

The 15-Minute Office Visit

Pharmacologic Treatment

Referral to an Addiction Specialist

Motivating Behavior Change in Patients with Chronic Pain

Conclusion

References

Chapter 109 Pain Management at the End of Life

Introduction

Palliative Care

Hospice

Pain Syndromes Common at the End of Life

Cancer

Noncancer Diagnoses

Pain Assessment at the end of Life

Challenges in Pain Assessment

Pain Assessment in the Cognitively Impaired

Pain Assessment in Those Unable to Communicate

Pain Measurement in Research Conducted at End of Life

Pain Management Strategies at End of Life

Routes of Drug Delivery

Intractable Pain or Unmanageable Adverse Effects of Treatment

Nonpharmacologic Techniques

Palliative Sedation

Conclusion

References

Chapter 110 Ethical Principles that Support Decision Making in Pain Management: The Case of Stopping Opioids

Background

Medical Ethics and Erikson’s Golden Rule

Trust

Mutuality

Morals and Ethics

Case Vignettes and Analysis

Case 1: Opioid-Induced Hyperalgesia

Case 2: Change in the Centers for Disease Control and Prevention Guidelines

Case 3: Opioid Prescriptions from Other Physicians Found in Check of State Drug Monitoring Program

Building Trust Through Mutuality

Dialogue

Empathy

Narrative Medicine

Conclusion

References

Chapter 111 Training Pain Specialists

The Evolution of Pain Medicine as a Subspecialty

Pain Medicine as a Primary Medical Specialty

Training in Pain Medicine in Europe

Training and Credentialing in Interventional Pain Medicine

Conclusion

Acknowledgments

References

Chapter 112 Emergencies in the Pain Clinic

The American Society of Anesthesiologists Closed Claims Project

Bleeding Complications

Infectious Complications

Local Anesthetic Systemic Toxicity

Unintended Destinations Following Local Anesthetic Administration

Vasovagal Reactions

Complications Associated with Intrathecal Drug Delivery

Opioid Withdrawal

Anaphylactic and Anaphylactoid Reactions

Catastrophic Neural Injuries and the Administration of Particulate Steroids

Conclusion

References

Chapter 113 Pain Management in the Emergency Department

The Prevalence of Pain in the Emergency Department

The Assessment of Pain in the Emergency Department

Oligoanalgesia in the Emergency Department

Pain and Opioid Abuse in the Emergency Department

Definitions

Pain and “Drug-Seeking Behavior” in the Emergency Department

Pain and Substance Abuse in the Emergency Department: A Balanced Perspective

The Example of Sickle Cell Disease

Pain Treatment and Procedural Sedation in the Emergency Department

Specific Treatment Modalities

Nonopioids

Opioids

Patient-Controlled Analgesia

Alternative Delivery Routes

Procedural Sedation and Analgesia

Evolving Emergency Department Pain Management Practice

Conclusion

References

Chapter 114 Pain Management in the Intensive Care Unit

Pain, Analgesia, and Critical Illness

Evaluation and Monitoring of Pain in the Intensive Care Unit

Managing Pain and Analgesia in the Intensive Care Unit

Pharmacologic Treatment of Pain in the Intensive Care Unit: Parenteral Opioids

Pharmacologic Treatment of Pain in the Intensive Care Unit: Adjuvant Therapy

Nonpharmacologic Management of Pain in the Intensive Care Unit

Regional Anesthetic Approaches to Pain in the Intensive Care Unit

Integrated Analgesia Management in the Intensive Care Unit

Analgosedation in the Intensive Care Unit

Analgesia as a Component of Comprehensive Bundled Intensive Care Unit Care

Pain and Analgesia at the end of Life in the Intensive Care Unit

Conclusions

Acknowledgments

References

Chapter 115 The Future of Pain Medicine: An Epilogue

References

Index

 

An aparitie	2018
Autor	Jane C. Ballantyne, Scott M. Fishman and James P. Rathmell
Dimensiuni	21.84 x 7.62 x 28.19 cm
Editura	LWW
Format	Hardcover
ISBN	9781496349033
Limba	Engleza
Nr pag	1896