Practical Management of Pain

6th Edition - February 10, 2022

Authors: Honorio Benzon, James P. Rathmell, Christopher L. Wu, Dennis Turk, Charles E. Argoff, Robert W Hurley

Editor: Andrea L Nicol

Hardback ISBN:

9 7 8 - 0 - 3 2 3 - 7 1 1 0 1 - 2

eBook ISBN:

9 7 8 - 0 - 3 2 3 - 7 1 1 0 2 - 9

For more than 30 years, Practical Management of Pain has offered expert guidance to both clinicians and trainees, covering every aspect of acute and chronic pain… Read more

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For more than 30 years, Practical Management of Pain has offered expert guidance to both clinicians and trainees, covering every aspect of acute and chronic pain medicine for adult and pediatric patients. The fully revised 6th Edition brings you fully up to date with new developments in patient evaluation, diagnosis of pain syndromes, rationales for management, treatment modalities, and much more. Edited by a team of renowned pain clinicians led by Dr. Honorio Benzon, this authoritative reference is a comprehensive, practical resource for pain diagnosis and treatment using a variety of pharmacologic and physical modalities.

Cover Image
Title Page
Copyright
Dedication
Contributors
Preface
Table of Contents
Part 1 General Considerations
1 History Is a Distillation of Rumor
Abstract
Pain and Religion
Pain and Pain Theories
Pain as a Disease
Pain in the 20th Century
Pain and the Impact of Psychology
Pain and Pain Organizations
Pain and the Hospice Movement
Pain and Palliative Care
Opioid Crisis
Key Points
Suggested Readings
References
2 Classification of Acute Pain and Chronic Pain Syndromes
Abstract
Definition of Pain
Taxonomy and Classification
International Classification of Diseases (ICD)
IASP Chronic Pain Classifications
Acute Pain
Headache Classification
New Pain Classification
Psychiatric Aspects of Chronic Pain
International Psychiatric Classifications
Key Points
Suggested Readings
References
3 Organizing an Inpatient Acute Pain Service
Abstract
The Rationale
General Principles
Identifying Service Leadership
Assessment of Need
Definition of the Service
Financing and the Business Plan
Billing and Collection
Marketing Plan
Future Service Flexibility
Conclusion
Key Points
Suggested Readings
Appendix A
Appendix B
Appendix C
Appendix D
References
4 Interdisciplinary Pain Management
Abstract
Introduction
History of Pain Rehabilitation
Continuum of Care: Pain Rehabilitation
Conclusion
Key Points
Suggested Readings
References
5 The Healthcare Policy of Pain Management
Abstract
Rationale for Pain Management Being a Healthcare Policy Priority
Corporatization of American Pain Medicine: Its Implications for Widening Pain Care Disparities
Pain Management as a Global Public Health Priority and a Human Right
The Continued Need to Achieve a More Equitable and Balanced, Worldwide Access to Analgesics and Effective Analgesia
The Need for a More Rational Strategy and Equitable Approach to Prescribing Chronic Opioids in the United States
The Need for a More Comprehensive Approach to Chronic Pain-Related Mental Health in the United States
Conclusions
Key Points
Suggested Readings
References
6 Quality Assessment, Improvement, and Patient Safety in Pain Management
What Is “Quality” in Healthcare?
Drivers of Attention to Quality in Healthcare
What Is “Quality” in Pain Management?
Quality Assessment and Measurement
Reducing Unnecessary Variation by Understanding Root Cause Analysis
Implementation Science and Toolkits
Creating a CQI Program for a Pain Practice
Summary
Strategies to Reduce and Improve Safety Events
What to do When an Adverse Event Does Occur
Conclusions
Key Points
Suggested Readings
References
7 Education, Training, and Certification in Pain Medicine
Abstract
The Evolution of Pain Medicine as a Subspecialty
Training and Credentialing in Interventional Pain Medicine
Future Directions
Key Points
Suggested Readings
References
Part 2 Basic Considerations
8 Neurophysiology of Pain: Peripheral, Spinal, Ascending, and Descending Pathways
Abstract
Introduction
Nociceptors
Spinal Cord and Spinal Trigeminal Nucleus
Ascending Pain Pathways
Modulation of Pain
Centers for Higher Processing of Nociception
Conclusion
Key Points
Suggested Readings
References
9 Neurochemistry of Nociception
Abstract
Origins of the Pain Phenotype
Primary Afferent Signaling
Dorsal Root Ganglion
Adaptive Immunity
Spinal Inhibitory Systems
Nerve Injury Initiated Signaling and Pain
Overview
Key Points
Suggested Readings
10 Neuroimaging Techniques
Abstract
Introduction
Brain Imaging of Acute Experimental Pain
Brain Imaging of Chronic Pain
Conclusion and Future Directions
Key Points
Suggested Readings
References
11 Individual Differences in Experience and Treatment of Pain: Race, Ethnicity, and Sex
Abstract
Keywords
Clarification of Terminology
Racial and Ethnic Differences in Pain
Sex and Gender Differences in Pain
Racial and Ethnic Differences in Pain Treatments Provided
Sex Differences in Pain Treatment
Racial and Ethnic Differences in Pain Treatment Outcomes
Sex Differences in Pain Treatment Outcomes
Contributing Factors to Racial, Ethnic, and Sex Disparities
Conclusion
Key Points
Suggested Readings
References
12 Communication and Clinician Relationships to Improve Care for Patients With Chronic Pain
Abstract
KEYWORDS
Introduction
Listening and Narrative Medicine
Clinician-Patient Relationships: Empathy and Therapeutic Alliance
Expectations Influence Pain
Patient-Centered, Shared Decision Making
Motivational Interviewing
Enhancing Clinician-Patient Relationships With a Collaborative Pain Care Model
Summary: Putting It Into Practice
Key Points
Suggested Readings
References
13 Pharmacogenetics in Pain Management
Abstract
Keywords
The Impact of Pharmacogenomic Research on Clinical Medicine
The Impact of Pharmacogenomics on Pain Medicine
Tricyclic Anti-depressants
Nonsteroidal Anti-inflammatory Drugs (NSAIDS)
Opioid Analgesics
Future Outlook and Conclusions
Key Points
Suggested Readings
References
14 Psychosocial and Psychiatric Aspects of Chronic Pain
Abstract
Keywords
Introduction
Historical Models
Conclusion
Key Points
Suggested Readings
References
15 Comprehensive Approach to Evaluating Patients With Chronic Pain
Abstract
Keywords
Introduction
Pain Definition
Pathophysiology of Chronic Pain
Assessing Chronic Pain
What Is the History of the Pain?
Assessment of Physical and Medical Factors
Physical Examination
Red Flag Symptoms Associated With Back Pain
Neurologic Injury
Spinal Stenosis
Musculoskeletal Sources of Pain
Risk Factors for Poorer Outcome Or Delayed Recovery
Specific Evaluation for Procedures
Diagnostic Studies
Summary
Assessment of Psychosocial Factors
Elements of the Psychological Evaluation
Brief Psychosocial Screening
Assessment of Pain
Assessment of Emotional Distress
Assessment of Substance Use and Abuse
Assessment of Beliefs, Coping, and Psychosocial Adaptation To Pain
Assessing Functional Impact
Assessment of Physical Capacity
Assessment of Social Supports
Conclusion
Key Points
Suggested Readings
References
16 Mechanism-Based Treatment and Precision Medicine
Abstract
Key words
Introduction
Current and Developing Mechanism-Based Treatments
Progress in Neuroimmune Modulation of Pain and Emerging Targets
Targeting Neuroimmune Mechanisms by Emerging Regenerative Pain Medicine
Targeting Neuroimmune Mechanism by Neuromodulation
Precision Pain Medicine
Conclusion and Perspective
Key Points
Suggested Readings
References
17 Placebo and Nocebo Effects in Clinical Trials and Clinical Practice
Abstract
Key words
The Magnitude of Placebo Analgesia
Placebo-Induced Activation of Endogenous Painkillers
Neuroimaging of Placebo Analgesia
The Reward Dopaminergic System
No Prefrontal Functions, No Placebo Effects
Nocebo Hyperalgesia
Nocebo-Induced Activation of Cholecystokinin
Neuroimaging of Negative Expectations and Nocebo Hyperalgesia
Communication Strategies
Conclusions
Key Points
Suggested Readings
References
Part 3 Clinical Evaluation and Assessment
18 History and Physical Examination of the Patient With Pain
Abstract
Keywords
General Physical Examination
Neurologic Examination
Musculoskeletal Examination
Spinal Examination
Myofascial Examination
Examination of the Extremities
Special Tests
Tests for a Nonorganic Etiology of Pain
Suggested Readings
References
19 Electromyography and Evoked Potentials
Abstract
Keywords
Electromyography
Key Points
Suggested Readings
References
20 Radiologic Assessment of Patient With Spine Pain
The Goal of Imaging
Specificity: Asymptomatic Imaging Findings
Sensitivity: Physiologic Imaging
Validity
Imaging Risk/Benefit
Imaging Recommendations
Radiographs
Advanced Imaging Modalities
Imaging of Axial Pain Generators
Imaging Correlates of Discogenic Pain
Cervical Discogenic Pain: Imaging Correlates
Imaging of Axial Pain Generators
Imaging of Radicular Pain, Radiculopathy, and Myelopathy
Unusual Manifestations of Disc Disease
Radicular Pain
Cervical Disc Herniations
Thoracic Disc Herniations
Degenerative Spondylolisthesis
Spinal Stenosis: Lumbar Neurogenic Intermittent Claudication
Thoracic Spinal Stenosis
Cervical Stenosis: Cervical Spondylotic Myelopathy (CSM)
Systemic Disease Causal of Spine/Limb Pain
Conclusion
Acknowledgments
Key Points
Suggested Readings
References
21 Biomarkers of Pain: Quantitative Sensory Testing, Conditioned Pain Modulation, Punch Skin Biopsy
Abstract
Keywords
Introduction
Quantitative Sensory Testing
Conditioned Pain Modulation
Pharmacodynamic
Skin Punch Biopsy
Summary
Key Points
Suggested Readings
References
22 Psychological and Behavioral Assessment
Abstract
Keywords
Psychological and Behavioral Assessment
Clinical Objectives
Overview of the Psychological and Behavioral Assessment Process
Domains of Functioning
Overview of Assessment Strategies
Specific Psychological and Behavioral Assessment Strategies
Pain Intensity
Pain Interference
Personality
Emotional Functioning
Pain Beliefs and Coping
Quality of Care
Conclusion
Key Points
Suggested Readings
References
23 Disability Assessment
Introduction
United States Disability and Personal injuries Compensation Systems
Models and Classification of Disablement
Measuring Disability for Compensation Purposes
American Medical Association Guides
Medicolegal Constructs and Constraints
Implications for Disability Assessment of Chronic Pain
Resources Available to the Physician Disability Examiner
Key Points
Suggested Readings
References
Part 4 Clinical Conditions: Evaluation and Treatment
24 Chronic Post-surgical Pain Syndromes: Prediction and Preventive Analgesia
Abstract
Keywords
Introduction
Definition of CPSP
Risk Factors and Prediction of CPSP
Prevention of CPSP
Analgesics
Regional Anesthesia
Future Directions
Summary
Key Points
Suggested Readings
References
25 Evaluation and Pharmacologic Treatment of Postoperative Pain
Abstract
Keywords
Evaluation of Pain Using Pain Scales
Visual Analog Scale
Numerical Rating Scale
Verbal Rating Scale
Pharmacologic Treatment of Pain
Summary
Key Points
Acknowledgments
Suggested Readings
References
26 Regional and Multimodal Treatments of Perioperative Pain
Abstract
Keywords
Introduction
Pathophysiology of Acute Postoperative Pain
Preoperative Assessment and Informed Consent
Multimodal Analgesia
Enhanced Recovery After Surgery (ERAS) Protocols
Drug Toxicity
Regional Anesthesia Techniques
Neuraxial Analgesia
Peripheral Nerve Blockade
Lower Extremity Peripheral Nerve Blocks
Upper Extremity Peripheral Nerve Blocks
Fascial Plane/Truncal Nerve Blocks
Modes of Local Anesthetic Delivery
Special Patient Populations
Conclusion
Key Points
Acknowledgments
Suggested Readings
References
27 Evaluation and Treatment of Postoperative Pain in Patients With Opioid Use Disorder
Background
Management of Opioid Use Disorder
Acute Pain Treatment Goals
Challenges of Postoperative Pain Management in Patients With Opioid Use Disorder
Evaluation of Patients With Opioid Use Disorder who Present for Surgery
Patients With OUD in Remission who Present for Surgery
Postoperative Pain Management Techniques for Patients With Opioid Use Disorder
Conclusions
Key Points
Suggested Readings
References
28 Evaluation and Treatment of Acute Pain in Children
Developmental Neurobiology of Pain
Assessment of Pediatric Acute Pain
Nonmedical Management of Pediatric Acute Pain
Pain Treatment Modalities
Conclusion
Key Points
Suggested Readings
References
29 Low Back Pain Disorders
Introduction
Lumbar Radicular Syndrome
Lumbar Herniated Disc
Lumbar Spinal Stenosis
Internal Disc Disruption
Diagnostic Studies for Low Back Pain
Symptomatic Treatments for Low Back Pain
Diagnostic Challenges in Patients WithLow Back Pain
Approach to Managing Patients WithLow Back Pain
Limitations of the Current Approach
Treatment Challenges, Prevention, and Future Directions
Key Points
Suggested Readings
References
30 Buttock and Sciatica Pain
Abstract
Keywords
Sacroiliac Joint Complex (SIJC) Pain
Coccydynia
Piriformis Syndrome
Non-Piriformis Muscle Pain
Ischial Bursitis
Summary Comments
Key Points
Suggested Readings
References
31 Facet Pain: Pathogenesis, Diagnosis, and Treatment
Abstract
Keywords
Introduction (Importance of the Problem)
Anatomy and Function
Pathophysiology
Prevalence
Diagnosis
Treatment
Complications
Guidelines or Recommendations of Best Practice
Conclusions
Key Points
Suggested Readings
References
32 Neurosurgical Approaches to Pain Management
Neuroablation
Neuromodulation
Summary
Key Points
Acknowledgment
Suggested Readings
References
33 Evaluation and Treatment of Cancer-Related Pain
Abstract
Keywords
Introduction
World Health Organization Analgesic Ladder
Acetaminophen
Nonsteroidal Anti-inflammatory Medications
Antiepileptic Drugs
Anti-depressants
Opioids
Use of Psychoactive Drugs in Oncology
The Opioid Epidemic and Cancer Pain
Intravenous Infusions for Cancer Pain
Intrathecal Therapies for Cancer Pain
Vertebral Augmentation (Vertebroplasty, Kyphoplasty)
Neurolytic Autonomic Plexus Blocks
Summary
Key Points
Suggested Readings
References
34 Evaluation and Treatment of Neuropathic Pain Syndromes
Abstract
Keywords
Introduction
Complex Regional Pain Syndrome
Postherpetic Neuralgia
Diabetic Neuropathy
HIV-Related Pain Syndromes
Chemotherapy Induced Peripheral Neuropathy
Summary
Key Points
Suggested Readings
References
35 Evaluation and Treatment of Complex Regional Pain Syndrome
Abstract
Keywords
Introduction
Pathophysiology
Epidemiology
Clinical Features
Treatment
Anti-Inflammatory Treatment
Summary
Key Points
Suggested Readings
References
36 Evaluation and Treatment of Pain in Selected Neurologic Disorders
Abstract
Pain in Selected Neurologic Disorders
Conclusion
Key Points
Suggested Readings
References
37 Chronic Widespread Pain
Abstract
Keywords
Fibromyalgia
Summary
Key Points
Acknowledgments
Suggested Readings
References
38 Headache Management
Abstract
Keywords
Introduction
Instruments and Scales in Headache
Scales that Assess Quality of Life
Scales that Assess Headache Impact and Disability
Migraine
Chronic Daily Headache
Tension-Type Headache
Cluster Headache and Other Trigeminal Autonomic Cephalgia
Chronic Paroxysmal Hemicrania
Summary
Key Points
Suggested Readings
References
39 Cervicogenic Headache, Post-meningeal Puncture Headache, and Spontaneous Intracranial Hypotension
Abstract
Keywords
CERVICOGENIC HEADACHE
Definition
Epidemiology
Pathophysiology
Summary of Cervical Nerve Anatomy5
Diagnostic Criteria
Differential Diagnosis
Investigations
Treatment
Summary
POST-MENINGEAL PUNCTURE HEADACHE
Post-Meningeal Puncture Headache
SPONTANEOUS INTRACRANIAL HYPOTENSION
Clinical Symptoms of SIH
Diagnosis of SIH
Treatment of SIH
SIH Summary
Key Points
Suggested Readings
References
40 Orofacial Pain
Abstract
Keywords
Introduction
Temporomandibular Disorders
Neurovascular Pains: Orofacial Manifestations of Primary Headache Disorders
Orofacial Pain and Worrisome Differential Diagnosis
Conclusion
Key Points
Suggested Readings
References
41 Visceral Pain
Abstract
Keywords
Introduction
Physiologic Basis of Visceral Sensation and Pain
Regional Block and Neural Ablation
Central Treatment Targets for Visceral Pain
Mechanism-Oriented Pharmacotherapy of Visceral Pain
Serotonin and Gastrointestinal Pain Management
Smooth Muscle Relaxants andVisceral Pain
Botulinum Toxin and Visceral Pain
κ-Opioids and Visceral Pain
Agents Targeting the α2δ Calcium Channel Subunit
Luminal Contents and Visceral Pain
Psychological Interventionsand Visceral Pain
Conclusion
Key Points
Suggested Readings
References
42 Pelvic Pain
Abstract
Keywords
Introduction
Causes of Pelvic Pain and Initial Evaluation
Pelvic Pain That Should Not Be Missed: Dangerous Acute Causes and Cancer
Organ-Based Causes of Pelvic Pain With Treatment
Male Urologic Problems (Including Sexual Pain)
Special Considerations
Chronification of Pain (Central and Peripheral Sensitization of Pain)
Summary
Key Points
Acknowledgments
Suggested Readings
Patient Resources
References
43 Pediatric Chronic Pain Management
Abstract
Keywords
Assessment of Chronic Pain in Children
Chronic Pain Syndromes
Pain in Terminal Illness
Conclusion
Key Points
Suggested Readings
References
44 Geriatric Pain Management
Abstract
Keywords
Introduction
Barriers to Successful Pain Management in the Older Patient
Assessing Pain in the Older Adult
Management of Pain in Older Adults
Opioids
Adjuvant Agents
Practice Recommendations
Conclusion
Key Points
Suggested Readings
References
Part 5 Pharmacologic, Psychologic, and Physical Medicine Treatments and Associated Issues
45 Managing Pain During Pregnancy and Lactation
Abstract
Use of Medications During Pregnancy
Use of Medications in the Breastfeeding Mother
Medications Commonly Used in Pain Management
Evaluation and Treatment of Pain During Pregnancy
Conclusion
Key Points
Suggested Readings
References
46 Rheumatologic Conditions
Abstract
Introduction
The Experience of Rheumatologic Pain
Why Are Rheumatologic Conditions Painful?
Assessment of Painful Rheumatologic Conditions
Pain Prognosis and Treatment Outcomes
Management
Conclusions
Key Points
Suggested Readings
Permissions and Courtesies
References
47 Pain Management in Patients With Comorbidities
Abstract
Introduction
Renal Disease
Non-opioid Medications
Opioid Medications
Liver Disease
Diabetes
Conclusion
Pain Management in Older Adults
Evaluation: Assessment and Physical Examination
Conclusion
Summary and Conclusions
Key Points
Suggested Readings
References
48 Major Opioids and Chronic Opioid Therapy
General Considerations of Opioid Administration
Selected Opioids
Rational Opioid Prescribing
Key Points
Suggested Readings
References
49 Minor Analgesics: Non-Opioid and Opioid Formulations
Abstract
Specific Drugs
Conclusion
Key Points
Suggested Readings
References
50 The U.S. Opioid Crisis and the Legal and Legislative Implications
Abstract
Introduction
Historical Perspective
Recent History
Current State
Legal Landscape
Conclusions
Key Points
Suggested Readings
References
51 Evaluation for Opioid Management: Opioid Misuse Assessment Tools and Drug Testing in Pain Management
Abstract
Background and Overview of Pain Issues
Terminology
Prevalence of Prescription Opioid Misuse and Addiction
Prescription Opioid Misuse Risk Factors
Negative Affect and Opioid Misuse
Opioid Therapy and Mood Disorder
Risk Assessment Tools
Strategies for Managing High Risk Patients
Future Considerations
Summary and Conclusions
Key Points
Suggested Readings
References
52 Pain and Addictive Disorders: Challenge and Opportunity
Abstract
Introduction
Nomenclature
Substance Use Disorder Screeners
Conclusion
Key Points
Uncited References
Suggested Readings
References
53 Anti-depressants
Introduction
SNRIs
SSRI
Noradrenaline Reuptake Inhibitors
Conclusion
Key Point
Suggested Readings
References
54 Adjunct Medications for Pain Management
Abstract
Membrane Stabilizers
Calcium Channel Modulators
Sodium Channel Blockers
GABAergic Medications
Local Anesthetics
Miscellaneous
Conclusion
Key Points
Acknowledgments
Suggested Readings
References
55 Skeletal Muscle Relaxants
Abstract
Mechanism of Action
Indications for Use
Specific Drugs By Class
Conclusion
Key Points
Suggested Readings
References
56 Cannabinoids for Pain Management
Abstract
Introduction
Definitions/Terminology
Endocannabinoid System
Cannabinoid
Mechanisms of Analgesia of Cannabinoids
Routes of Administration
Adverse Effects of Cannabinoids With Acute and Chronic Use
Contraindications to the Use of Cannabinoids
Limitations of the Current Research on Cannabinoids
Legal and Regulatory Considerations
Summary of Current Guidelines and Practical Recommendations for the Use of Medical Cannabis
Perioperative Use of Cannabis
Conclusions
Key Points
Suggested Readings
References
57 Topical Analgesics
Abstract
Background
Use of Topical Analgesics for Specific Clinical Conditions (see Box 57.1)
Conclusion
Key Points
Suggested Readings
Uncited References
References
58 Psychological Approaches in Pain Management
Abstract
Plight of Individuals With Chronic Pain
Psychological Formations of Chronic Pain
Psychogenic View
Behavioral Formulations
Gate Control Theory
Cognitive-Behavioral Perspectives
Biopsychosocial Model
Referral for Psychological Intervention
Psychological Interventions
Insight-Oriented Therapies
Behavioral Approaches
Acceptance and Commitment Therapy (ACT)
Other Psychological Techniques
Conclusions
Key Points
Suggested Readings
References
59 Evidence-Based Rehabilitation Approaches to Acute and Chronic Pain Management
Abstract
Rehabilitation Approach
Approach to Treatment
Pain Management Considerations
Specific Rehabilitation Interventions
Summary
Key Points
Suggested Readings
References
60 Physical Rehabilitation for Patients With Chronic Pain
Abstract
Patient Evaluation
Therapy for Chronic Pain
In the past week, were you able to walk a mile?
Conclusion
Key Points
Suggested Readings
References
61 The Integrative Approach to Pain Management
Abstract
Integrative Medicine: Overview
Multidimensional Perception of Pain
Integrative Medicine Modalities and Pain
Manual Medicine and the Biopsychosocial Model
Summary
Key Points
Suggested Readings
Appendix A
References
62 Patient Education and Self-Management
Abstract
Pain Self-Management: Definition and Components
Pain Self-Management in the Context of Primary Care
Key Points
Suggested Readings
References
Part 6 Neural Block and Interventional Techniques
63 Neurolytic Agents, Neuraxial Neurolysis, and Neurolysis of Sympathetic Axis for Cancer Pain
Abstract
Neurolytic Agents (Table 63.1)
Neurolytic Blocks
Conclusion
Key Points
Suggested Readings
References
64 Head and Neck Blocks
Atlanto-Axial Joint Blockade
Third Occipital Nerve Blockade
The Third Occipital Nerve and Headache Pain
Facial Pain Nerve Blockades
Sphenopalatine Ganglion Blockade
Trigeminal Nerve Blockade
Glossopharyngeal Nerve Block
Summary and Conclusions
Key Points
Suggested Readings
References
65 Interlaminar and Transforaminal Therapeutic Epidural Injections
Abstract
History
Pathophysiology
Epidural Injection Techniques
Pharmacology
Evidence-Based Medicine for Corticosteroid Epidural Injections
Contrast Media Use in Epidural Steroid Injections
Complications of Epidural Steroid Injections
Summary
Key Points
Suggested Readings
References
66 Radiofrequency Treatment
Abstract
Radiofrequency Generator System
Theoretical Aspects of Radiofrequency Treatment
Indications for Radiofrequency Treatment
Conclusions
Key Points
Suggested Readings
References
67 Pain Interventions for the Knee, Hip, and Shoulder
Abstract
Introduction
Pharmacology of Agents Utilized for Joint Injections
Joint Injection Techniques
Hip
Knee
Radiofrequency Ablation
Conclusion
Key Points
Suggested Readings
References
68 Myofascial Injections and Fascial Plane Blocks for Perioperative and Chronic Pain Management
Abstract
Overview and Pathophysiology of Myofascial Pain Syndromes
Clinical Presentation and Diagnosis of Myofascial Pain Syndromes
Treatment of Trigger Points
Piriformis Injections
Iliopsoas Injection
Truncal Blocks
Quadratus Lumborum Block
Scalene Muscle Injections for Neurogenic Thoracic Outlet Syndrome
Summary
Key Points
Suggested Readings
References
69 Minimally Invasive Procedures for Vertebral Compression Fractures
Conservative Medical Therapy
Technical Aspects
Controversies and Special Topics
Outcomes
Mortality Benefit
Complications
Post-procedure and Follow Up Care
Summary and Conclusions
Key Points
Suggested Readings
References
70 Biopsychosocial Pre-screening for Spinal Cord and Peripheral Nerve Stimulation Devices
Abstract
Overview
The Biopsychosocial Approach to Assessment
The Biopsychosocial Pre-screening Process
Summary and Conclusions
Key Points
Suggested Readings
References
71 Spinal Cord Stimulation, Peripheral Nerve Stimulation, Restorative Neurostimulation, Deep Brain Stimulation, and Motor Cortex Stimulation
Abstract
Introduction
SCS Mechanisms of Action
Spinal Cord Stimulator Trial Technique
Complications
Clinical Outcomes
Peripheral Nerve Stimulation (PNS)
Motor Cortex and Deep Brain Stimulation
Summary
Key Points
Suggested Readings
References
72 Intrathecal Drug Delivery
Patient Selection, Trialing, and Implantation
Implantation
II Intrathecal Medications
Opioids (Box 72.3)
Calcium Channel Antagonists (Box 72.4)
g-Aminobutyric Acid Agonists (Box 72.5)
Local Anesthetics
Adrenergic Agonists (Box 72.6)
Conclusion
Key Points
Suggested Readings
References
73 Radiation Safety and Radiographic Contrast Agents
Overview of Radiation Safety
Basic Radiation Physics
Minimizing Patient Radiation Exposure
Minimizing Practitioner Exposure
Optimizing Image Quality
Radiation From Interventional Pain Procedures
Overview of Radiographic Contrast Medium
Pharmacology of RCM
Adverse Reactions to RCM
Nonidiosyncratic Reactions
Hypersensitivity Reactions
Recognition and Treatment of Reactions to RCM
Prevention of Reactions to RCM
Use of Gadolinium as an Alternative to Iodinated RCM
Nephrogenic Systemic Fibrosis
Brain Deposition/Retention
Encephalopathy After Unintentional Intrathecal Gadolinium Injection
Differences Between Interventional Pain Procedures and Diagnostic MRIs and CT
Concluding Statements
Key Points
Acknowledgments
Suggested Readings
References
74 Infection and Anticoagulation Considerations in Pain Procedures
Abstract
Introduction
Infection Rates
Preoperative Risk Reduction
Intra-procedural Risk Reduction
Postoperative Risk Reduction
Infection Management
Conclusion
Introduction
Stratification of Risks
Aspirin and Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
P2Y12 Inhibitors
Vitamin K Antagonists
Heparin and LMWH
Fibrinolytic Agents
Fondaparinux and the Direct Oral Anticoagulants (DOACs)
Laboratory Tests, Reversal, and Management of Direct Oral Anticoagulants Before Emergency Surgery
Anti-depressants
Herbal Medications
New Anticoagulants Targeting CF XI
COVID-19 Induced Coagulopathy
Summary and Concluding Statements
Key Points
Suggested Readings
References
Part 7 Pain Management in Special Situations and Special Topics
75 Pain Management in Primary Care
Background and Introduction
Is Pain a Diagnosis or a Symptom?
Definitions and Types of Pain
Pain Assessment
Diagnostic Assessment
Model of Pain in Primary Care: Low Back Pain
Timing and Description of Low Back Pain
History/Physical Exam and Provocative Maneuvers
Differential Diagnosis and Indications for Consultation
Shared Decision Making
Management of Chronic Low Back Pain
Pharmacologic Therapy for Low Back Pain
General Precautions for Non-opioid Pharmacologic Therapy
Summary of Treatment Recommendations for Low Back Pain
Musculoskeletal Pain in Adults
Multimodal Therapy and Nonpharmacologic Options for Managing Pain
Pharmacologic Approach to Pain and Opioid Use
CDC Guideline for Prescribing Opioids for Chronic Pain
Decision to Refer Patients for Pain Management
Primary Care Goals for Pain Management
Key Points
Suggested Readings
References
76 Pain Management in the Emergency Department
Abstract
Prevalence and Assessment of Pain in the ED
The Problem of Balancing Undertreatment of Pain and the Risk of Addiction
Pain Treatment
Specific Treatment Modalities
Patient-Controlled Analgesia
Conclusion
Key Points
Suggested Readings
References
77 Management of Pain in Sickle Cell Disease
Abstract
Epidemiology of Vaso-occlusive Pain
Other Pain Etiologies in Sickle Cell Disease
Sickle Cell Disease Pain Management
Sickle Cell Disease Pain Management in the Inpatient Setting
Management of Perioperative Pain in Sickle Cell Disease
Management of Chronic Pain in Sickle Cell Disease: Largely Uncharted Territory
Summary
Key Points
Suggested Readings
References
78 Burn Pain
Abstract
Introduction
Epidemiology
Pathophysiology
Phases of Burn Recovery
Types of Pain in Burn Patients
Pain Management Options
Summary
Key Points
Suggested Readings
References
79 Pain Evaluation and Management in Patients With Limited Ability to Communicate Because of Dementia
Abstract
Pain Assessment Using Self-Report
Pain Assessment Using Observational Assessment Tools
Other Dimensions of the Pain Experience
A Clinical Approach to Assessment of the Older Adult With Limited Ability to Communicate Because of Dementia
A Clinical Approach to Assessment of the Older Adult With Limited Ability to Communicate Because of Dementia
Nonpharmacologic Pain Management
Pharmacologic Pain Management
Conclusions
Key Points
Suggested Readings
References
80 Disparities in Pain Care: Descriptive Epidemiology-Potential for Primary Prevention
Abstract
Background to this Chapter
Part I: Introduction
Part I: Epidemiology of Disparities in Pain Care
Part II: Factors Contributing to the Occurrence of Disparities in Pain Care
Patient Characteristics That Contribute to Disparities in Their Care
PART III: Potential for the Primary Prevention of Disparities in Pain Care
Conclusions
Key Points
Suggested Readings
References
81 Pain Management in the Critically Ill Patient
Abstract
Introduction
Prevalence of Pain in the Intensive Care Unit (ICU)
Barriers to Pain Assessment in the ICU
Barriers to Pain Treatment in the ICU
Benefits of Assessing and Treating Pain in the ICU
Methods of Pain Control in the ICU
Neuraxial Analgesia and Regional Anesthesia in the ICU
Sedation in the ICU
Conclusion
Key Points
Suggested Readings
References
82 Pain Management at the End of Life and Home Care for the Terminally Ill Patient
Abstract
Introduction
Prevalence and Causes of Pain at the End of Life
Assessing Pain and Suffering at the End of Life
Caregivers on the Front Line at the End of Life
Planning for Home Pain Management
Communication: The Cornerstone of Good Pain Management in the Home
Conclusion
Key Points
Suggested readings
References
Part 8 Research, Ethics, Healthcare Policy, and Future Directions in Pain Management
83 Clinical Trial Design Methodology and Data Analytic Strategies for Pain Outcome Studies
Abstract
Evidence-Based Medicine
The Spectrum of Outcomes Research
Experimental Versus Observational Study Designs
Healthcare Economic Evaluation
Standards for Reporting Study Design and Findings
Standardization of Pain-Related Outcome Measures
Assessing and Addressing Bias and Confounding in Clinical Research
Statistical Concepts and Methods for Pain Outcome Studies
Commonly Used Inferential Statistical Methods in Pain Research
Important Statistical Considerations and Common Pitfalls
Concluding Statements
Key Points
Suggested Readings
References
84 Outcome Domains and Measures in Acute and Chronic Pain Clinical Trials
Abstract
Selecting Outcome Measures for Use in Clinical Trials
Outcome Domains and Measures in Adult Acute Pain Trials
Outcome Domains for Adult Chronic Pain Clinical Trials
Pain
Physical Functioning
Emotional Functioning
Domains and Measures in Acute and Chronic Pediatric Pain Clinical Trials
Patient Satisfaction
Summary and Conclusions
Key Points
Suggested Readings
References
85 Ethical Issues in Pain Research
Brief Historical Overview
Ethical Issues Specific to Pain Research
Ethics of Placebos
The Ethics of Laboratory Induced Pain in Humans
Clinical Trials in Minors
Ethical Issues in Genomic Approaches to Understanding Pain
Conclusion
Key Points
Suggested Readings
References
86 Treatment Development: Directions and Areas in Need of Investigation
Abstract
Introduction
Perioperative Pain Management
Preoperative Considerations
Intraoperative Considerations
Pharmacologic Chronic Pain Management
Newer Pharmacologic Options
Non-pharmacologic Chronic Pain Management
Non-interventional Chronic Pain Management
The Value of Identifying Types of Pain and Underlying Processes
The Value of Identifying the Chronic Overlapping Pain Conditions
The Value of Understanding Central Sensitization
Digital Pain Management Resources
Expanding the Value of Symptom Tracking: Personalized Medicine Using N-of-1 Trials
Conclusions
Key Points
Suggested Readings
References
Index