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Pain Management, An Issue of Neurosurgery Clinics of North America, E-Book

Pain Management, An Issue of Neurosurgery Clinics of North America, E-Book

Ashwini Sharan

(2014)

Additional Information

Abstract

This issue provides a glimpse into how pain can be assessed and managed by several medical disciplines and approaches. It covers classical and conventional techniques as well as innovative techniques.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Pain Management\r i
Copyright\r ii
Contributors iii
Contents vii
Neurosurgery Clinics Of North America\r xi
Preface\r xiii
Basic Anatomy and Physiology of Pain Pathways 629
Key points 629
Introduction 629
Peripheral sensory system and mechanisms of sensitization 629
Dorsal root ganglia 630
Spinal cord 632
Spinothalamic pathways 632
Thalamus 634
Cortical areas 634
Descending systems 635
Summary 636
References 637
Introduction to Neuropathic Pain Syndromes 639
Key points 639
Craniofacial pain syndromes 640
Primary Headaches 640
Cranial Neuralgias 640
Other Types of Craniofacial Pain 640
Pain syndromes of the spine and spinal cord 655
Pain syndromes involving peripheral nerves 655
Discussion and summary 655
References 655
Intracranial Ablative Procedures for the Treatment of Chronic Pain 663
Key points 663
Introduction: nature of the problem 663
Diagnosis 663
Clinical outcomes and trends in the literature 663
Thalamotomy 664
Centromedial Lesions 664
Central Lateral Lesions 665
Recent Advances 665
Mesencephalic tractotomy 666
Cingulotomy 667
Summary 668
References 668
Deep Brain Stimulation for Chronic Pain 671
Key points 671
Introduction 671
Intracranial targets 672
Septal Interventions 672
IC Interventions 673
STH, VPM/Lateral Nucleus Interventions 673
CM-Pf Interventions 675
P(A)VG Interventions 675
PH Interventions 675
Motor Cortex Interventions 681
Other Areas 681
Considerations for patient selection and trial design 681
General Consideration of Pain Research 688
Specific Considerations to Chronic Stimulation for the Treatment of Pain 688
Summary 688
References 688
Motor Cortex Stimulation for Chronic Pain 693
Key points 693
Introduction 693
Indications and patient selection 694
Operative technique 694
Localization of the primary motor cortex 695
Variations in technique 695
Clinical outcomes 696
Predictors of outcome 696
Complications and concerns 696
Summary 696
References 697
Dorsal Root Entry Zone Lesion, Midline Myelotomy and Anterolateral Cordotomy 699
Key points 699
Introduction: nature of the problem 699
Clinical Anatomy of Pain Conduction in the Spinal Cord 699
Anatomy of pain pathways in the spinal cord 700
Unilateral limb pain and the DREZ 700
Unilateral limb/truncal pain and cordotomy 703
Abdominal/pelvic and bilateral lower extremity pain and midline myelotomy 704
Selection and Workup of Patients 704
Unilateral limb and plexus pain 705
Unilateral lower quadrant pain 705
Bilateral lower extremity pain or lower abdominal/pelvic pain 705
Surgical Technique 706
Preoperative measures 706
Approach laminectomy and durotomy for open procedures 706
Postoperative care 707
DREZ Lesioning 707
Lesion location and technique 708
Complications for DREZ 709
Prognosis of pain relief 709
Summary for DREZ 710
Open Cordotomy 711
Lesioning technique 711
Complications of open cordotomy 712
Prognosis of pain relief 712
Percutaneous Cordotomy 714
Lesioning technique 714
Complications of percutaneous cordotomy 715
Prognosis of pain relief 716
Midline Myelotomy 716
Lesioning technique 716
Complications 717
Prognosis for pain relief 717
Summary 718
DREZ 718
Open Cordotomy 718
Percutaneous Cordotomy 718
Midline Myelotomy 718
References 719
Percutaneous Spinal Cord Stimulation for Chronic Pain 723
Key points 723
Introduction 723
Indications 723
FBSS 724
CRPS 728
Patient selection 728
Diagnostic Evaluation 728
Nonsurgical Management 728
Drug Use or Abuse 729
Psychological Testing 730
Medical Comorbidities 730
Minimizing the Risk of Infection 731
Summary 731
References 732
Intrathecal Pain Pumps 735
Key points 735
Introduction 735
Indications 735
Patient selection 736
Techniques 737
Trialing 737
Selecting Pharmacotherapy 737
Type of Device 738
Surgical Implant 738
Outcomes 740
Cancer-Related Pain 740
Nonmalignant Chronic Pain 740
Summary 741
References 741
Microvascular Decompression for Trigeminal Neuralgia 743
Key points 743
Introduction 743
Surgical technique 743
Patient Selection 743
Establishing the diagnosis accurately 743
Age as a factor in the decision-making process 744
Significance of radiographic findings 744
Surgical Approach and Patient Positioning 744
Procedure 744
Incision 744
Craniectomy and dural opening 744
Intradural dissection and retraction 744
Intraoperative neuromonitoring 745
Petrosal veins 745
Identifying the vascular conflict and decompression of the nerve 746
Absence of vascular conflict 746
Closure 747
Complications 747
Recovery 747
Clinical outcome 747
Long-term Outcome 747
Postradiosurgery MVD 747
Comparison with Other Surgical Modalities 747
Summary 748
References 748
Percutaneous Treatments for Trigeminal Neuralgia 751
Key points 751
Introduction 751
BC 752
Procedure 752
Discussion 752
GR 755
Procedure 755
Discussion 755
RT 757
Procedure 757
Discussion 757
Summary 759
References 759
Surgical Options for Complex Craniofacial Pain 763
Key points 763
Introduction 763
Pathophysiology of complex face pain 764
Pain pathways and nodes of intervention 764
Surgical management of complex face pain 765
Peripheral Neuromodulation 765
Peripheral trigeminal nerve/field stimulation (PNS/peripheral field/nerve stimulation) 765
Clinical assessment, indications, and prerequisite for peripheral field/nerve stimulation PNS 765
Contraindications of PFNS/PNS 766
Surgical technique 766
Programming parameters 766
Review of literature 766
Sphenopalatine ganglion stimulation for headache and facial pain 767
Cervical Spinal Cord Stimulation for Craniofacial Pain 769
Trigeminal Nucleus Caudalis Dorsal Root Entry Zone Ablative Procedures for Complex Craniofacial Pain 769
Motor Cortex Stimulation for Complex Craniofacial Pain 770
Deep Brain Stimulation for Complex Craniofacial Pain 770
Summary 772
References 772
Neurolysis, Neurectomy, and Nerve Repair/Reconstruction for Chronic Pain 777
Key points 777
Introduction 777
Diagnosis 778
Therapeutic options 778
Nonoperative 778
Operative 779
Decompression/neurolysis 779
Neurectomy 781
Nerve repair/reconstruction 785
Clinical outcomes 786
Decompression 786
Neurectomy 786
Nerve Repair/Reconstruction 786
Complications and concerns 786
Summary 787
References 787
Peripheral Nerve/Field Stimulation for Chronic Pain 789
Key points 789
Introduction: nature of the problem 789
Indications 790
Surgical technique 790
Preoperative Planning 790
Inclusion criteria 790
Exclusion criteria 791
Neuropsychological evaluation 791
Trial stimulator 791
Preparation and Patient Positioning 791
Surgical Approach 791
Surgical Procedure for Percutaneous Lead Placement 791
Immediate Postoperative Care 792
Permanent stimulator 792
Surgical Approach 793
Surgical Procedure for Percutaneous Lead Placement 793
Immediate Postoperative Care 793
Rehabilitation and recovery 793
Clinical results in the literature 795
Summary 795
References 795
Chronic Pain Rehabilitation 799
Key points 799
Introduction 799
Components of IPRPs 799
Psychological factors that affect pain 800
Pain Catastrophizing 800
Mood and Affect States 800
Psychological management 800
Principles of Chronic Pain Rehabilitation 800
Behavior modification 800
Education 800
Cognitive Behavioral Therapy 801
Relaxation Training, Guided Imagery, and Biofeedback 801
Addressing Affective States 801
Pharmacologic Strategies 801
Opioids 801
Physical and Occupational Therapy 801
Occupational and Vocational Therapy 801
Summary/Discussion 801
References 801
Multimodal Treatment of Pain 803
Key points 803
Introduction 803
Patient evaluation overview 803
Pharmacologic treatment options 803
Nonsteroidal Antiinflammatory Agents 803
Acetaminophen 804
Antidepressants 804
Antiepileptics 805
Opioids 805
Nonpharmacologic treatment options 805
Physical therapy 806
Occupational therapy 806
Nutrition 807
Psychological therapies 807
Cognitive Behavioral Therapy 807
Other Psychotherapies 807
Biofeedback 807
Mindfulness Therapy 807
Adjunctive therapies 807
Tai Chi 807
Yoga 807
Combination therapies 808
Summary/Discussion 808
References 808
Nerve Blocks for Chronic Pain 809
Key points 809
Introduction 809
Diagnostic versus therapeutic nerve blocks 809
Therapeutic nerve blocks 810
Epidural Steroid Injection 810
Introduction 810
Indications 810
Efficacy 811
Procedure 811
Complications 811
Facet Joint Nerve Blocks 811
Introduction 811
Procedure 812
Transcranial Magnetic Stimulation for Chronic Pain 819
Key points 819
Introduction 819
Mechanism of action and parameters of rTMS relevant to chronic pain management 820
Safety profile of TMS 822
TMS for chronic pain 822
rTMS of M1 for Chronic Pain 823
rTMS of Other Cortical Areas for Chronic Pain 826
TMS for fibromyalgia 826
TMS for migraine 826
Summary 827
References 827
Technological Innovations in Implants Used for Pain Therapies 833
Key points 833
Introduction 833
Implanting devices 834
Electrodes 835
Anchors 836
IPGs 838
Adaptive stimulation 838
Burst stimulation 838
MRI compatibility 839
Other Advances in IPGs 839
Patient programmer 840
Electrical nerve block 840
Summary 841
Acknowledgments 841
References 841
Index 843