BOOK
Managing Chronic Pain, An Issue of Medical Clinics of North America, E-Book
(2016)
Additional Information
Book Details
Abstract
This issue of Medical Clinics of North America, Guest Edited by Charles Argoff, MD is devoted to Chronic Pain Management. Dr. Argoff has assembled a group of expert authors to review the following topics: Chronic Pain Management: An Overview of Taxonomy, Conditions Commonly Encountered, and Assessment; The Acute to Chronic Pain Transition: Can Chronic Pain Be Prevented?; What Do We Know About the Pathophysiology of Chronic Pain? Implications for Treatment Considerations; An Overview of Pharmacologic Management of Chronic Pain; An Overview of Nonmedical Treatment of Chronic Pain; Managing Chronic Headache Disorders; Managing Osteoarthritis and Other Chronic Musculoskeletal Pain Disorders; Managing Neuropathic Pain; Managing Low Back and Other Spinal Pain Disorders; Exploring the Use of Chronic Opioid Therapy for Chronic Pain: When, How and for Whom?; The Role of Invasive Pain Management Modalities in the Treatment of Chronic Pain; Multimodal Management of Chronic Pain: What is the Evidence?; Managing Chronic Pain in Special Populations; and The Future of Pain Management as a Subspecialty: Meeting the Needs of the Patients We Care For.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Managing Chronic Pain\r | i | ||
| Copyright\r | ii | ||
| PROGRAM OBJECTIVE | iii | ||
| TARGET AUDIENCE | iii | ||
| LEARNING OBJECTIVES | iii | ||
| ACCREDITATION | iii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | iii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | iv | ||
| TO ENROLL | iv | ||
| METHOD OF PARTICIPATION | iv | ||
| CME INQUIRIES/SPECIAL NEEDS | iv | ||
| MEDICAL CLINICS OF NORTH AMERICA\r | v | ||
| FORTHCOMING ISSUES | v | ||
| March 2016 | v | ||
| May 2016 | v | ||
| July 2016 | v | ||
| RECENT ISSUES | v | ||
| November 2015 | v | ||
| September 2015 | v | ||
| July 2015 | v | ||
| Contributors | vii | ||
| CONSULTING EDITORS | vii | ||
| EDITOR | vii | ||
| AUTHORS | vii | ||
| Contents | xi | ||
| Foreword: The Management of Chronic Pain: What Do We Know, What Do We Do,\rand How Should We Redesign Our Comprehensive Assessment and Treatment in\rorder to Provide for More Patient-Centered Care?\r | xi | ||
| Preface: Yes, You Can Manage Chronic Pain\r | xi | ||
| Chronic Pain Management: An Overview of Taxonomy, Conditions Commonly Encountered, and Assessment1 | xi | ||
| The Acute to Chronic Pain Transition: Can Chronic Pain Be Prevented?17 | xi | ||
| What Do We Know About the Pathophysiology of Chronic Pain? Implications for Treatment Considerations31 | xi | ||
| Biopsychosocial Approach to Assessing and Managing Patients with Chronic Pain\r | xii | ||
| Multimodal Treatment of Chronic Pain\r | xii | ||
| An Overview of Pharmacologic Management of Chronic Pain \r | xii | ||
| Exploring the Use of Chronic Opioid Therapy for Chronic Pain: When, How, and for Whom?\r | xii | ||
| The Role of Invasive Pain Management Modalities in the Treatment of Chronic Pain\r | xiii | ||
| Managing Chronic Headache Disorders\r | xiii | ||
| Managing Osteoarthritis and Other Chronic Musculoskeletal Pain Disorders\r | xiii | ||
| Managing Neuropathic Pain\r | xiii | ||
| Acute and Chronic Low Back Pain\r | xiv | ||
| Managing Chronic Pain in Special Populations with Emphasis on Pediatric, Geriatric, and Drug Abuser Populations\r | xiv | ||
| Is Platelet-Rich Plasma a Future Therapy in Pain Management?\r | xiv | ||
| Foreword :\r\rThe Management of Chronic\rPain: What Do We Know, What\rDo We Do, and How Should We\rRedesign Our Comprehensive\rAssessment and Treatment in\rorder to Provide for More\rPatient-Centered Care? | xvii | ||
| Preface: Yes, You Can Manage Chronic Pain \r | xix | ||
| Chronic Pain Management | 1 | ||
| Key points | 1 | ||
| THE EXPERIENCE OF PAIN | 2 | ||
| THE BIOLOGY OF CHRONIC PAIN | 2 | ||
| PAIN TAXONOMY | 3 | ||
| Taxonomy of Chronic Pain I: Mechanisms of Chronic Pain as a Medical Disorder | 3 | ||
| Taxonomy of Chronic Pain II: Clinical Pain Categories | 4 | ||
| Neuropathic pain | 5 | ||
| Fibromyalgia and related disorders | 5 | ||
| PAIN CATEGORIES BASED ON ORGAN SYSTEM OR REGION | 6 | ||
| Musculoskeletal Pain | 6 | ||
| Myofascial Pain | 6 | ||
| Spinal Pain | 6 | ||
| Headache | 6 | ||
| Vascular Pain | 7 | ||
| Visceral and Pelvic Pain | 7 | ||
| Cancer Pain | 7 | ||
| ASSESSMENT OF PAIN | 7 | ||
| PAIN ASSESSMENT INSTRUMENTS | 8 | ||
| Verbal Rating Scales | 8 | ||
| Numeric Rating Scales | 8 | ||
| Visual Analog Scales | 8 | ||
| QUALITATIVE SCALES, DISABILITY SCALES, AND DISCRIMINATIVE INSTRUMENTS | 10 | ||
| McGill Pain Questionnaire | 10 | ||
| Brief Pain Inventory | 10 | ||
| CATEGORY-SPECIFIC PAIN ASSESSMENT INSTRUMENTS | 10 | ||
| Oswestry Low Back Pain Questionnaire | 10 | ||
| Neuropathic Pain Assessment Tools | 10 | ||
| ASSESSING RISK AND BENEFIT OF OPIOID THERAPY | 11 | ||
| Screener and Opioid Assessment for Patients with Pain | 11 | ||
| Opioid Risk Tool | 11 | ||
| Diagnosis, Intractability, Risk, Efficacy | 11 | ||
| ASSESSMENTS OF PSYCHOLOGICAL STATE AND TRAIT IN PAIN MANAGEMENT | 11 | ||
| PUTTING IT ALL TOGETHER: A SAMPLE PAIN MANAGEMENT CONSULTATION | 12 | ||
| Chief Complaint | 12 | ||
| History of Present Illness | 12 | ||
| Past Medical History | 12 | ||
| Past Surgical History | 12 | ||
| Psychiatric History | 12 | ||
| Social History | 12 | ||
| Medications | 13 | ||
| Allergies | 13 | ||
| Focused Physical Examination | 13 | ||
| Brief Pain Inventory | 13 | ||
| McGill Pain Questionnaire | 13 | ||
| Oswestry Low Back Pain Questionnaire | 13 | ||
| Opioid Risk Tool | 13 | ||
| Medical Diagnosis | 13 | ||
| Treatment Recommendations | 13 | ||
| REFERENCES | 14 | ||
| The Acute to Chronic Pain Transition | 17 | ||
| Key points | 17 | ||
| INTRODUCTION | 17 | ||
| RISK FACTORS FOR DEVELOPMENT OF CHRONIC POSTSURGICAL PAIN | 18 | ||
| Demographic Factors | 18 | ||
| Genetic Factors | 19 | ||
| Psychosocial Factors | 19 | ||
| Disease States | 19 | ||
| Preoperative Pain | 20 | ||
| Surgical Factors | 20 | ||
| Anesthetic Factors | 20 | ||
| Acute Postoperative Pain | 21 | ||
| PREDICTION OF POSTOPERATIVE PAIN | 21 | ||
| PROPOSED MECHANISMS OF CHRONIC POSTSURGICAL PAIN | 22 | ||
| Neuroplasticity | 23 | ||
| Sensitization | 23 | ||
| N-methyl-d-aspartic acid receptors | 24 | ||
| Cyclo-oxygenase-2 | 24 | ||
| PREVENTION | 24 | ||
| THE “IDEAL” ACUTE TO PERSISTENT PAIN STUDY | 25 | ||
| FUTURE CONSIDERATIONS/SUMMARY | 26 | ||
| REFERENCES | 27 | ||
| What Do We Know About the Pathophysiology of Chronic Pain? | 31 | ||
| Key points | 31 | ||
| PAIN SIGNAL TRANSMISSIONS | 32 | ||
| INHIBITORY PATHWAYS | 32 | ||
| NOCICEPTIVE PAIN | 32 | ||
| NEUROPATHIC PAIN | 33 | ||
| NEUROPATHIC PAIN TRANSMISSION | 33 | ||
| CHALLENGES IN CHRONIC NEUROPATHIC PAIN | 34 | ||
| Cold Hyperalgesia | 34 | ||
| PERIPHERAL NERVE INJURY | 34 | ||
| WIND-UP PAIN | 35 | ||
| Presynaptic Mechanisms | 37 | ||
| CENTRAL SENSITIZATION | 37 | ||
| PATHOPHYSIOLOGY OF CENTRAL SENSITIZATION | 37 | ||
| CENTRAL SENSITIZATION AND CLINICAL PAIN PHENOTYPE | 38 | ||
| BLOCKING NERVE CONDUCTION IN PERIOPERATIVE PERIODS: PREEMPTIVE STRIKES? | 39 | ||
| PSYCHOLOGICAL FACTORS | 39 | ||
| MEDICATION MANAGEMENT OF NEUROPATHIC PAIN, CURRENT RECOMMENDATIONS | 40 | ||
| SUMMARY | 41 | ||
| REFERENCES | 41 | ||
| Biopsychosocial Approach to Assessing and Managing Patients with Chronic Pain | 43 | ||
| Key points | 43 | ||
| INTRODUCTION | 43 | ||
| CURRENT APPROACH TO PAIN TREATMENT | 44 | ||
| CHRONIC PAIN CARE IN THE PRIMARY CARE SETTING | 44 | ||
| BIOPSYCHOSOCIAL APPROACH TO PAIN | 45 | ||
| INITIAL ENCOUNTER WITH PATIENT WITH CHRONIC PAIN | 45 | ||
| BIOPSYCHOSOCIAL DIAGNOSTIC EVALUATION/INTERVIEW | 45 | ||
| Clinical Interview | 46 | ||
| Physical Examination and Diagnostic Testing | 46 | ||
| Mental Health/Substance Use Disorder Screening | 47 | ||
| BIOPSYCHOSOCIAL TREATMENT PROGRAM | 47 | ||
| Pharmacotherapy | 47 | ||
| Physical Therapy | 48 | ||
| Cognitive Behavioral Therapy | 48 | ||
| Acceptance Commitment Therapy | 49 | ||
| Barriers to Receiving Cognitive Behavioral Therapy/Acceptance Commitment Therapy | 49 | ||
| E-Health | 50 | ||
| FUTURE CONSIDERATIONS/SUMMARY | 50 | ||
| ACKNOWLEDGMENTS | 51 | ||
| REFERENCES | 51 | ||
| Multimodal Treatment of Chronic Pain | 55 | ||
| Key points | 55 | ||
| INTRODUCTION | 55 | ||
| PHARMACOLOGIC TREATMENT | 56 | ||
| THEORY BEHIND COMBINED PHARMACOLOGIC TREATMENT | 57 | ||
| STUDIED COMBINATIONS OF ANALGESIC MEDICATIONS IN COMMON PAIN CONDITIONS | 58 | ||
| Neuropathic Pain | 58 | ||
| Arthritis | 58 | ||
| Back Pain | 59 | ||
| Fibromyalgia | 59 | ||
| PSYCHOLOGICAL APPROACHES | 59 | ||
| INTERVENTIONS | 60 | ||
| INTERDISCIPLINARY PAIN REHABILITATION PROGRAMS | 61 | ||
| Fibromyalgia | 61 | ||
| Chronic Low Back Pain | 61 | ||
| COMPLEMENTARY AND ALTERNATIVE MEDICINE AND SELF-MANAGEMENT | 61 | ||
| SUMMARY | 61 | ||
| REFERENCES | 62 | ||
| An Overview of Pharmacologic Management of Chronic Pain | 65 | ||
| Key points | 65 | ||
| OVERVIEW OF THE PHARMACOLOGIC MANAGEMENT OF CHRONIC PAIN | 65 | ||
| CLASSES OF MEDICATIONS | 66 | ||
| Nonsteroidal Anti-inflammatory Drugs | 66 | ||
| OPIOIDS | 66 | ||
| ANTIDEPRESSANTS | 67 | ||
| ANTICONVULSANTS | 68 | ||
| TOPICAL AGENTS | 69 | ||
| CANNABINOIDS | 69 | ||
| BOTULINUM TOXIN | 70 | ||
| INTRATHECAL DRUG THERAPY | 71 | ||
| SUMMARY | 75 | ||
| REFERENCES | 75 | ||
| Exploring the Use of Chronic Opioid Therapy for Chronic Pain | 81 | ||
| Key points | 81 | ||
| INTRODUCTION | 82 | ||
| INITIAL EVALUATION AND ASSESSMENT | 82 | ||
| Pharmacologic Strategies: Opioid Trial | 82 | ||
| Informed consent and opioid treatment agreements | 84 | ||
| Adverse effects and risks associated with opioids | 85 | ||
| Contraindications to opioids | 86 | ||
| TREATMENT INITIATION, TITRATION, AND MAINTENANCE | 88 | ||
| Initiation | 88 | ||
| Titration | 88 | ||
| Breakthrough Pain | 88 | ||
| Opioid Rotation | 90 | ||
| REASSESSMENT AND FOLLOW-UP | 90 | ||
| MONITORING PARAMETERS | 91 | ||
| Urine Drug Tests | 92 | ||
| Prescription Drug Monitoring Program | 92 | ||
| HIGH-RISK PATIENTS AND SPECIAL POPULATIONS | 92 | ||
| High-Dose Opioids and the Morphine-Equivalent Dose | 92 | ||
| Extended-Release or Long-Acting Opioids | 92 | ||
| Neuropathy | 94 | ||
| Pharmacogenetics in Pain Management | 94 | ||
| Discontinuation of Therapy | 94 | ||
| Opioid Reversal: Naloxone | 98 | ||
| Use in Obstetrics, Gynecology, and Neonatology | 98 | ||
| SUMMARY | 98 | ||
| REFERENCES | 99 | ||
| The Role of Invasive Pain Management Modalities in the Treatment of Chronic Pain | 103 | ||
| Key points | 103 | ||
| INTRODUCTION | 103 | ||
| PROCEDURE 1: CORTICOSTEROID INJECTIONS | 104 | ||
| Facet Joint Injections | 104 | ||
| Indications | 104 | ||
| Managing Chronic Headache Disorders | 117 | ||
| Key points | 117 | ||
| INITIAL EVALUATION OF HEADACHES | 117 | ||
| FOUR COMMON SECONDARY HEADACHE DISORDERS | 119 | ||
| Subarachnoid Headache | 119 | ||
| Brain Tumor Headaches | 120 | ||
| Idiopathic Intracranial Hypertension: Pseudotumor Cerebri | 120 | ||
| Treatment for IIH | 121 | ||
| Giant Cell Ateritis (Temporal Arteritis) | 121 | ||
| Workup | 122 | ||
| Treatment | 122 | ||
| MIGRAINE MANAGEMENT | 122 | ||
| EPIDEMIOLOGY | 122 | ||
| TREATMENT | 123 | ||
| ACUTE TREATMENT | 123 | ||
| PROPHYLAXIS | 123 | ||
| INTERVENTIONAL TREATMENT | 126 | ||
| Onabotulinum Toxin A | 126 | ||
| PERIPHERAL NERVE STIMULATION FOR THE TREATMENT OF PRIMARY HEADACHES | 126 | ||
| COMPLEMENTARY THERAPY | 131 | ||
| Feverfew | 132 | ||
| MANAGEMENT OF MENSTRUAL MIGRAINES | 132 | ||
| MANAGEMENT OF MIGRAINES DURING PREGNANCY AND LACTATION | 132 | ||
| PROPHYLAXIS | 134 | ||
| EMERGENCY TREATMENT | 135 | ||
| TENSION-TYPE HEADACHE | 135 | ||
| CLUSTER HEADACHE | 137 | ||
| INPATIENT TREATMENT OF MIGRAINE, TENSION HEADACHE, AND CLUSTER AND OTHER AUTONOMIC CEPHALGIAS | 137 | ||
| REFERENCES | 140 | ||
| Managing Osteoarthritis and Other Chronic Musculoskeletal Pain Disorders | 143 | ||
| Key points | 143 | ||
| INTRODUCTION | 143 | ||
| ETIOLOGY OF OSTEOARTHRITIS | 143 | ||
| TREATMENT OPTIONS | 144 | ||
| Exercise | 144 | ||
| Weight Reduction | 144 | ||
| Physical/Occupational Therapy | 145 | ||
| PHARMACOLOGIC OPTIONS | 145 | ||
| Topical Nonsteroidal Anti-inflammatory Drugs | 145 | ||
| ALTERNATIVES | 147 | ||
| REFERENCES | 149 | ||
| Managing Neuropathic Pain | 151 | ||
| Key points | 151 | ||
| ASSESSMENT OF NEUROPATHIC PAIN | 151 | ||
| History | 152 | ||
| Physical Examination | 153 | ||
| Diagnostic Testing | 154 | ||
| MANAGEMENT | 154 | ||
| Pharmacotherapy for Neuropathic Pain | 154 | ||
| Role of pharmacotherapy as a part of multimodal therapy and treatment planning | 154 | ||
| Topical agents | 155 | ||
| Local anesthetics | 155 | ||
| Capsaicin | 157 | ||
| Topical nonsteroidal anti-inflammatory drugs and other compounded preparations | 157 | ||
| Intradermal injections | 157 | ||
| Botulinum toxin | 157 | ||
| Medications for systemic administration | 157 | ||
| Neuromodulating medications | 157 | ||
| Anticonvulsants | 158 | ||
| Antidepressants | 158 | ||
| Other medications, including those with positive limited clinical trials and clinical experience: intravenous lidocaine and ... | 158 | ||
| Opioids | 158 | ||
| Nonpharmacologic Treatment of Neuropathic Pain | 159 | ||
| Cognitive-behavioral therapy | 159 | ||
| Support groups | 160 | ||
| Physical therapy modalities and other methods of active engagement | 160 | ||
| Interventional nerve blocks for neuropathic pain | 160 | ||
| Peripheral nerve blocks for peripheral neuralgias and trigeminal neuralgia | 160 | ||
| Sympathetic nerve blocks for complex regional pain syndrome | 161 | ||
| Epidural steroid injections for radiculopathy | 161 | ||
| Potential complications | 161 | ||
| Neurolysis | 162 | ||
| Pulsed Radiofrequency Treatment of Neuropathic Noncancer Pain | 162 | ||
| Radiofrequency ablation and neurolytics for cancer pain of sympathetic ganglia | 162 | ||
| Potential complications | 162 | ||
| Spinal cord and pripheral nerve stimulation | 163 | ||
| Acute and Chronic Low Back Pain | 169 | ||
| Key points | 169 | ||
| MAGNITUDE OF THE PROBLEM | 169 | ||
| RISK AND PROGNOSTIC FACTORS | 170 | ||
| PRESENTATION | 170 | ||
| PHYSICAL EXAMINATION | 171 | ||
| IMAGING | 176 | ||
| TREATMENT | 178 | ||
| SUMMARY | 179 | ||
| REFERENCES | 179 | ||
| Managing Chronic Pain in Special Populations with Emphasis on Pediatric, Geriatric, and Drug Abuser Populations | 183 | ||
| Key points | 183 | ||
| INTRODUCTION | 183 | ||
| PEDIATRIC CHRONIC PAIN | 184 | ||
| GERIATRIC CHRONIC PAIN | 186 | ||
| SUBSTANCE ABUSERS: A SPECIAL POPULATION | 188 | ||
| GENETICS AS A FUNDAMENTAL VULNERABILITY ACROSS THE LIFESPAN | 189 | ||
| SUMMARY | 191 | ||
| REFERENCES | 191 | ||
| Is Platelet-Rich Plasma a Future Therapy in Pain Management? | 199 | ||
| Key points | 199 | ||
| INTRODUCTION | 199 | ||
| WHAT IS PLATELET-RICH PLASMA AND HOW IS IT CREATED? | 200 | ||
| Variety of Platelet-Rich Plasma End Products | 201 | ||
| Platelet-Rich Plasma Containing White Blood Cells | 202 | ||
| Platelet-Rich Plasma Activated by Exogenous Thrombin | 202 | ||
| Platelet-Rich Fibrin Matrices | 203 | ||
| Current Clinical Applications of Platelet-Rich Plasma | 203 | ||
| Platelet-Rich Plasma Injection in Lateral Epicondylitis (Tennis Elbow) | 203 | ||
| Osteoarthritis and Articular Cartilage Healing | 204 | ||
| Platelet-Rich Plasma as an Adjunct Therapy to Surgical Rotator Cuff Repair | 205 | ||
| HOW PLATELET-RICH PLASMA CAN HELP TO RELIEVE NEUROPATHIC PAIN | 205 | ||
| Clinical Evidence That Platelet-Rich Plasma Has the Potential for Relieving Neuropathic Pain | 206 | ||
| INTERVERTEBRAL DISC DEGENERATION AND THE ROLE OF PLATELET-RICH PLASMA AS A THERAPEUTIC OPTION | 206 | ||
| The Efficacy of Platelet-Rich Plasma Therapy in Intervertebral Disc Degeneration Seen Through In Vivo and In Vitro Studies | 207 | ||
| INFORMATION FOR PHYSICIANS USING PLATELET-RICH PLASMA THERAPY | 209 | ||
| Patient Disclosure, Potential Side Effects, and Costs of Treatment | 209 | ||
| FUTURE CONSIDERATION/SUMMARY | 210 | ||
| REFERENCES | 210 | ||
| Index | 219 |