BOOK
Essentials of Pain Medicine E-Book
Honorio Benzon | Srinivasa N. Raja | Scott M Fishman | Spencer S Liu | Steven P Cohen | Robert W Hurley
(2017)
Additional Information
Book Details
Abstract
Accessible, concise, and clinically focused, Essentials of Pain Medicine, 4th Edition, by Drs. Honorio T. Benzon, Srinivasa N. Raja, Scott M. Fishman, Spencer S. Liu, and Steven P. Cohen, presents a complete, full-color overview of today’s theory and practice of pain medicine and regional anesthesia. It provides practical guidance on the full range of today’s pharmacologic, interventional, neuromodulative, physiotherapeutic, and psychological management options for the evaluation, treatment, and rehabilitation of persons in pain.
- Covers all you need to know to stay up to date in practice and excel at examinations – everything from basic considerations through local anesthetics, nerve block techniques, acupuncture, cancer pain, and much more.
- Uses a practical, quick-reference format with short, easy-to-read chapters.
- Presents the management of pain for every setting where it is practiced, including the emergency room, the critical care unit, and the pain clinic.
- Features hundreds of diagrams, illustrations, summary charts and tables that clarify key information and injection techniques – now in full color for the first time.
- Includes the latest best management techniques, including joint injections, ultrasound-guided therapies, and new pharmacologic agents (such as topical analgesics).
- Discusses recent global developments regarding opioid induced hyperalgesia, addiction and substance abuse, neuromodulation and pain management, and identification of specific targets for molecular pain.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| Front Matter | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| I - Basic Considerations | 1 | ||
| 1 - Anatomy and Physiology of the Pain Signaling Process | 3 | ||
| SOMATOSENSATION, NOCICEPTION,AND PAIN | 3 | ||
| PERIPHERAL MECHANISMS | 3 | ||
| SPINAL MECHANISMS | 5 | ||
| SPINAL MODULATION | 5 | ||
| SUPRASPINAL MECHANISMS | 7 | ||
| SUPRASPINAL MODULATION OF NOCICEPTION | 9 | ||
| KEY POINTS | 9 | ||
| 2 - Neurochemistry of Somatosensory and Pain Processing | 11 | ||
| NEUROCHEMISTRY OF PAIN TRANSDUCTION | 11 | ||
| NEUROCHEMISTRY OF PAIN TRANSMISSION | 14 | ||
| SUMMARY | 19 | ||
| KEY POINTS | 19 | ||
| REFERENCES | 19 | ||
| 3 - Taxonomy: Definition of Pain Terms and Chronic Pain Syndromes | 21 | ||
| FIBROMYALGIA | 22 | ||
| PAIN OF PSYCHOLOGICAL ORIGIN | 23 | ||
| REFERENCES | 24 | ||
| II - Clinical Evaluation and Diagnostic Examinations | 25 | ||
| 4 - Physical Examination of the Patient With Pain | 27 | ||
| GENERAL OBSERVATIONS | 27 | ||
| MENTAL STATUS EXAMINATION | 27 | ||
| INSPECTION | 27 | ||
| PALPATION | 28 | ||
| RANGE OF MOTION | 29 | ||
| STRENGTH | 30 | ||
| SENSATION | 30 | ||
| REFLEXES AND COORDINATION | 32 | ||
| SPECIAL TESTS AND PROVOCATIVE TESTING | 34 | ||
| CONCLUSION | 36 | ||
| KEY POINTS | 36 | ||
| REFERENCES | 38 | ||
| 5 - Pain Assessment | 39 | ||
| INTRODUCTION | 39 | ||
| CHALLENGES OF PAIN MEASUREMENT | 39 | ||
| TYPES OF SELF-REPORT PAIN SCALES | 39 | ||
| BEHAVIORAL OBSERVATION | 42 | ||
| EXPERIMENTAL PAIN ASSESSMENT | 43 | ||
| FUNCTIONAL NEUROIMAGING | 43 | ||
| SPECIAL POPULATIONS | 43 | ||
| COGNITIVELY IMPAIRED | 44 | ||
| USING TECHNOLOGY FOR PAIN ASSESSMENT | 44 | ||
| ASSESSING PAIN CROSS-CULTURALLY | 44 | ||
| SUMMARY AND RECOMMENDATIONS | 44 | ||
| KEY POINTS | 45 | ||
| REFERENCES | 45 | ||
| 6 - Psychological Evaluation and Testing | 47 | ||
| CLINICAL INTERVIEW | 47 | ||
| STANDARDIZED TESTING | 47 | ||
| MULTIDIMENSIONAL INSTRUMENTS | 47 | ||
| PAIN-RELATED DISABILITY AND BEHAVIOR | 48 | ||
| SPECIAL TOPICS | 50 | ||
| CONCLUSION | 52 | ||
| KEY POINTS | 52 | ||
| REFERENCES | 52.e1 | ||
| 7 - Diagnostic and Statistical Manual of Mental Disorders and Pain Management | 53 | ||
| INTRODUCTION | 53 | ||
| SOMATIC SYMPTOM DISORDER | 53 | ||
| CONVERSION DISORDER (FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER) | 54 | ||
| FACTITIOUS DISORDER | 55 | ||
| MALINGERING | 55 | ||
| ACKNOWLEDGMENTS | 56 | ||
| KEY POINTS | 56 | ||
| REFERENCES | 57 | ||
| 8 - Neurophysiologic Testing for Pain | 59 | ||
| ELECTROMYOGRAPHY AND NERVE CONDUCTION STUDIES1,2 | 59 | ||
| QUANTITATIVE SENSORY TESTING5 | 63 | ||
| SHORT LATENCY SOMATOSENSORY EVOKED POTENTIALS6,7 | 64 | ||
| LASER EVOKED POTENTIALS AND CONTACT HEAT EVOKED POTENTIALS7,8 | 64 | ||
| SYMPATHETIC SKIN RESPONSE9 | 65 | ||
| QUANTITATIVE SWEAT TEST10 | 66 | ||
| NOCICEPTIVE REFLEXES8,11 | 66 | ||
| ULTRASONOGRAPHY AS A COMPLEMENTARY TECHNIQUE12,13 | 66 | ||
| KEY POINTS | 67 | ||
| REFERENCES | 67 | ||
| 9 - Anatomy, Imaging, and Common Pain-Generating Degenerative Pathologies of the Spine | 69 | ||
| ANATOMY | 69 | ||
| IMAGING OVERVIEW | 73 | ||
| DEGENERATIVE DISC DISEASE | 82 | ||
| DISC HERNIATION | 85 | ||
| FACET JOINT | 89 | ||
| INTRASPINAL FACET CYSTS | 90 | ||
| SPINAL STENOSIS | 91 | ||
| SPONDYLOLYSIS AND SPONDYLOLISTHESIS | 93 | ||
| OSTEOPOROTIC COMPRESSION FRACTURES | 93 | ||
| CONCLUSION | 95 | ||
| KEY POINTS | 95 | ||
| ACKNOWLEDGMENTS | 98 | ||
| REFERENCES | 98 | ||
| 10 - Determination of Disability | 99 | ||
| DISABILITY PROGRAMS | 100 | ||
| DISABILITY EVALUATIONS | 101 | ||
| MANAGING DISABILITY IN PAIN PRACTICES | 101 | ||
| KEY POINTS | 102 | ||
| REFERENCES | 102 | ||
| III - Perioperative Pain Management | 103 | ||
| 11 - Preventive Analgesia | 105 | ||
| TERMINOLOGY | 105 | ||
| PATHOPHYSIOLOGY OF PREVENTIVE ANALGESIA | 105 | ||
| PREVENTIVE ANALGESIA IN CLINICAL INVESTIGATIONS | 106 | ||
| CONCEPTUAL CHALLENGES OF PREVENTIVE ANALGESIA | 107 | ||
| FUTURE CONSIDERATIONS | 109 | ||
| SUMMARY | 109 | ||
| KEY POINTS | 109 | ||
| REFERENCES | 109 | ||
| 12 - Perioperative Nonopioid Infusions for Postoperative Pain Management | 111 | ||
| INTRAVENOUS KETAMINE INFUSION | 111 | ||
| INTRAVENOUS LIDOCAINE INFUSION | 112 | ||
| INTRAVENOUS NALOXONE INFUSION | 114 | ||
| MAGNESIUM INFUSION | 115 | ||
| ESMOLOL INFUSION | 115 | ||
| ALPHA-2 AGONISTS | 116 | ||
| CONCLUSION | 116 | ||
| KEY POINTS | 116 | ||
| REFERENCES | 116 | ||
| 13 - Patient-Controlled Analgesia | 117 | ||
| SAFETY AND EFFICACY OFPATIENT-CONTROLLED ANALGESIA | 117 | ||
| ADVANTAGES OF PATIENT-CONTROLLED ANALGESIA | 117 | ||
| TYPES OF PATIENT-CONTROLLED ANALGESIA | 118 | ||
| SPECIAL CONDITIONS | 120 | ||
| KEY POINTS | 122 | ||
| REFERENCES | 122 | ||
| 14 - Intrathecal Opioids for Postoperative Pain | 123 | ||
| MECHANISM OF ACTION OF INTRATHECAL OPIOIDS | 123 | ||
| ADVANTAGES OF INTRATHECAL OPIOIDS | 123 | ||
| SIDE EFFECTS OF INTRATHECAL OPIOIDS | 124 | ||
| CLINICAL USES OF INTRATHECAL OPIOIDS FOR POSTOPERATIVE ANALGESIA | 125 | ||
| ADJUVANTS TO INTRATHECAL OPIOIDS | 127 | ||
| CONCLUSION | 127 | ||
| KEY POINTS | 127 | ||
| REFERENCES | 127 | ||
| 15 - Epidural Opioids for Postoperative Pain | 129 | ||
| PHARMACOLOGY OF EPIDURAL OPIOIDS | 129 | ||
| INJECTION OF SINGLE-DOSE EPIDURAL OPIOIDS | 129 | ||
| CONTINUOUS INFUSION OF EPIDURAL OPIOIDS | 130 | ||
| SIDE EFFECTS OF EPIDURAL OPIOIDS | 130 | ||
| PATIENT OUTCOMES AND EPIDURAL MORPHINE | 131 | ||
| CONCLUSION | 133 | ||
| KEY POINTS | 133 | ||
| REFERENCES | 133 | ||
| 16 - Continuous Peripheral Nerve Blocks | 135 | ||
| INTRODUCTION | 135 | ||
| INDICATIONS FOR CONTINUOUS PERIPHERAL NERVE BLOCKS | 135 | ||
| EQUIPMENT AND TECHNIQUES | 135 | ||
| INFUSION MANAGEMENT | 137 | ||
| POTENTIAL RISKS/COMPLICATIONS | 137 | ||
| CONCLUSION | 138 | ||
| KEY POINTS | 138 | ||
| REFERENCES | 139 | ||
| 17 - Pediatric Postoperative Pain | 141 | ||
| ANATOMIC AND PHYSIOLOGIC DIFFERENCES | 141 | ||
| PAIN ASSESSMENT | 141 | ||
| NONOPIOID ANALGESICS | 142 | ||
| OPIOID ANALGESIA | 143 | ||
| SUMMARY | 146 | ||
| KEY POINTS | 146 | ||
| REFERENCES | 146 | ||
| 18 - Chronic Pain After Surgery | 147 | ||
| WHAT IS CHRONIC PAIN AFTER SURGERY? | 147 | ||
| PREVENTION OF CHRONIC PAIN AFTER SURGERY | 150 | ||
| CONCLUSION | 153 | ||
| KEY POINTS | 154 | ||
| REFERENCES | 154 | ||
| IV - Chronic Pain Syndromes | 155 | ||
| 19 - Migraine Headache and the Trigeminal Autonomic Cephalalgias | 157 | ||
| MIGRAINE HEADACHE | 157 | ||
| TRIGEMINAL AUTONOMIC CEPHALALGIAS (TAC) | 161 | ||
| KEY POINTS | 163 | ||
| REFERENCES | 163 | ||
| 20 - Tension-Type Headache, Chronic Tension-Type Headache, and Other Chronic Headache Types | 165 | ||
| EPIDEMIOLOGY | 165 | ||
| DIAGNOSIS | 165 | ||
| PATHOPHYSIOLOGY OF TENSION-TYPE HEADACHE | 166 | ||
| OTHER CHRONIC HEADACHE TYPES | 167 | ||
| KEY POINTS | 168 | ||
| REFERENCES | 168 | ||
| 21 - Postmeningeal Puncture Headache and Spontaneous Intracranial Hypotension | 169 | ||
| POSTMENINGEAL PUNCTURE HEADACHE | 169 | ||
| PATHOPHYSIOLOGY | 169 | ||
| THE ROLE OF ARACHNOID MATER IN THE PATHOGENESIS OF CEREBROSPINAL FLUID LEAK | 170 | ||
| MENINGES AND RESPONSE TO TRAUMA | 170 | ||
| DIAGNOSIS | 170 | ||
| INCIDENCE | 170 | ||
| RISK FACTORS | 171 | ||
| PREVENTION | 172 | ||
| TREATMENT | 172 | ||
| MENINGEAL PUNCTURE HEADACHE SUMMARY | 174 | ||
| SPONTANEOUS INTRACRANIAL HYPOTENSION | 174 | ||
| CLINICAL SYMPTOMS OF SPONTANEOUS INTRACRANIAL HYPOTENSION | 174 | ||
| DIAGNOSIS OF SPONTANEOUS INTRACRANIAL HYPOTENSION | 174 | ||
| TREATMENT OF SPONTANEOUS INTRACRANIAL HYPOTENSION | 175 | ||
| SPONTANEOUS INTRACRANIAL HYPOTENSION SUMMARY | 176 | ||
| KEY POINTS | 176 | ||
| POSTMENINGEAL PUNCTURE HEADACHE | 176 | ||
| SPONTANEOUS INTRACRANIAL HYPOTENSION | 176 | ||
| 22 - Cervicogenic Headache | 177 | ||
| INTRODUCTION | 177 | ||
| DIAGNOSTIC CRITERIA | 177 | ||
| ETIOLOGY | 177 | ||
| NEUROANATOMY AND NEUROPHYSIOLOGY | 177 | ||
| COMMON SOURCES OF CERVICOGENIC HEADACHE | 177 | ||
| ATLANTO-AXIAL JOINT | 177 | ||
| C2–C3 ZYGAPOPHYSIAL JOINT AND THIRD OCCIPITAL HEADACHE | 178 | ||
| THIRD OCCIPITAL NERVE NEUROLYSIS | 179 | ||
| OCCIPITAL NEURALGIA | 180 | ||
| OCCIPITAL NEUROSTIMULATION | 180 | ||
| C2 NEURALGIA | 182 | ||
| CERVICAL MYOFASCIAL PAIN | 182 | ||
| CERVICAL DISCOGENIC PAIN | 182 | ||
| SUMMARY | 182 | ||
| KEY POINTS | 182 | ||
| REFERENCES | 182 | ||
| 23 - Orofacial Pain | 183 | ||
| INTRODUCTION | 183 | ||
| ANATOMY AND PATHOPHYSIOLOGY | 183 | ||
| HEADACHE ATTRIBUTED TO DISORDER OF CRANIAL BONE | 184 | ||
| HEADACHE ATTRIBUTED TO DISORDER OF NECK | 184 | ||
| CERVICOGENIC HEADACHE | 184 | ||
| RETROPHARYNGEAL TENDONITIS | 184 | ||
| CRANIOCERVICAL DYSTONIA | 185 | ||
| HEADACHE ATTRIBUTED TO RHINOSINUSITIS | 185 | ||
| HEADACHE ATTRIBUTED TO DISORDER OF TEETH, JAWS, OR RELATED STRUCTURES | 185 | ||
| HEADACHE OR FACIAL PAIN ATTRIBUTED TO TEMPOROMANDIBULAR DISORDER | 185 | ||
| CRANIAL NEURALGIAS AND CENTRAL CAUSES OF FACIAL PAIN AND OTHER HEADACHES | 186 | ||
| TRIGEMINAL NEURALGIA | 186 | ||
| CLASSIC TRIGEMINAL NEURALGIA | 186 | ||
| Pathophysiology | 186 | ||
| Description | 187 | ||
| Diagnostic Criteria | 187 | ||
| Clinical Presentation | 187 | ||
| Management of Classic Trigeminal Neuralgia | 187 | ||
| GLOSSOPHARYNGEAL NEURALGIA | 188 | ||
| NERVUS INTERMEDIUS NEURALGIA (GENICULATE NEURALGIA, RAMSAY-HUNT SYNDROME) | 188 | ||
| SUPERIOR LARYNGEAL NEURALGIA | 188 | ||
| NASOCILIARY NEURALGIA (CHARLIN NEURALGIA) | 189 | ||
| SUPRAORBITAL NEURALGIA | 189 | ||
| OTHER TERMINAL BRANCH NEURALGIAS | 189 | ||
| OCCIPITAL NEURALGIA | 189 | ||
| OPTIC NEURITIS | 189 | ||
| OCULAR DIABETIC NEUROPATHY | 189 | ||
| HEAD OR FACIAL PAIN ATTRIBUTED TO HERPES ZOSTER | 189 | ||
| TOLOSA-HUNT SYNDROME | 190 | ||
| BURNING MOUTH SYNDROME | 190 | ||
| PERSISTENT IDIOPATHIC FACIAL PAIN (ATYPICAL FACE PAIN) | 190 | ||
| CENTRAL NEUROPATHIC FACIAL PAIN | 190 | ||
| ANESTHESIA DOLOROSA | 191 | ||
| FACIAL PAIN ATTRIBUTED TO MULTIPLE SCLEROSIS | 191 | ||
| CENTRAL POSTSTROKE PAIN | 191 | ||
| CONCLUSION | 191 | ||
| KEY POINTS | 191 | ||
| REFERENCES | 191 | ||
| 24 - Overview of Low Back Pain Disorders | 193 | ||
| EPIDEMIOLOGY | 193 | ||
| ANATOMY | 193 | ||
| SPINAL MECHANICS | 194 | ||
| PATHOPHYSIOLOGY | 194 | ||
| ETIOLOGY | 195 | ||
| RISK FACTORS | 196 | ||
| CLINICAL EVALUATION | 196 | ||
| HISTORY | 196 | ||
| PHYSICAL EXAMINATION | 197 | ||
| “RED FLAGS” IN PATIENT’S CLINICAL EVALUATION (TABLE 24.3) | 197 | ||
| DIAGNOSTIC TESTING | 198 | ||
| ELECTRODIAGNOSTIC STUDIES | 200 | ||
| PSYCHOSOCIAL TESTING | 200 | ||
| OTHER DIAGNOSTIC TESTS | 200 | ||
| MANAGEMENT | 200 | ||
| NONINVASIVE TREATMENTS | 200 | ||
| Res | 200 | ||
| Pharmacologic Therapy | 200 | ||
| Physical Therapy | 201 | ||
| Acupuncture | 202 | ||
| Spinal Manipulation | 202 | ||
| Biofeedback | 202 | ||
| MINIMALLY INVASIVE TREATMENTS | 202 | ||
| SURGICAL TREATMENTS | 202 | ||
| Spinal Decompression | 202 | ||
| Spinal Fusion | 203 | ||
| Disc Arthroplasty | 203 | ||
| CONCLUSION | 203 | ||
| KEY POINTS | 205 | ||
| REFERENCES | 205 | ||
| 25 - Myofascial Pain Syndrome | 207 | ||
| PREVALENCE | 207 | ||
| PATHOPHYSIOLOGY | 207 | ||
| DIAGNOSIS | 208 | ||
| TREATMENT | 209 | ||
| PHYSICAL MODALITIES | 209 | ||
| PHARMACOTHERAPY | 210 | ||
| TRIGGER POINT INJECTION | 211 | ||
| BOTULINUM TOXIN | 211 | ||
| CONCLUSION | 211 | ||
| KEY POINTS | 212 | ||
| REFERENCES | 212 | ||
| 26 - Fibromyalgia and Centralized Pain States | 213 | ||
| EPIDEMIOLOGY | 213 | ||
| PATHOPHYSIOLOGY | 214 | ||
| DIAGNOSIS OF FIBROMYALGIA | 215 | ||
| GENERAL TREATMENT APPROACH | 216 | ||
| PHARMACOLOGIC THERAPY | 219 | ||
| Tricyclic Antidepressants | 219 | ||
| Serotonin and Norepinephrine Reuptake Inhibitors | 219 | ||
| Anticonvulsants | 219 | ||
| Combination Therapy | 219 | ||
| Other Central Nervous System–Acting Drugs | 220 | ||
| Classic Analgesics | 220 | ||
| NEUROSTIMULATORY THERAPIES | 220 | ||
| NONPHARMACOLOGIC THERAPIES | 221 | ||
| CONCLUSION | 221 | ||
| KEY POINTS | 221 | ||
| REFERENCES | 221 | ||
| 27 - Complex Regional Pain Syndrome | 223 | ||
| EPIDEMIOLOGY | 223 | ||
| PATHOPHYSIOLOGY | 224 | ||
| PERIPHERAL/AFFERENT MECHANISMS | 224 | ||
| ALTERED CUTANEOUS INNERVATION FOLLOWING INJURY | 224 | ||
| PERIPHERAL SENSITIZATION | 225 | ||
| CENTRAL SENSITIZATION | 225 | ||
| SYMPATHETICALLY MEDIATED PAIN | 225 | ||
| INFLAMMATORY MEDIATORS | 225 | ||
| CORTICAL REORGANIZATION | 225 | ||
| CLINICAL FEATURES | 226 | ||
| DIAGNOSIS | 226 | ||
| QUANTITATIVE SENSORY TESTING | 227 | ||
| AUTONOMIC FUNCTION TESTS | 227 | ||
| TEMPERATURE MEASUREMENT | 227 | ||
| VASCULAR ABNORMALITIES | 227 | ||
| TROPHIC CHANGES | 227 | ||
| TREATMENT | 227 | ||
| PHARMACOLOGIC THERAPY | 227 | ||
| Antidepressants | 227 | ||
| Anticonvulsants | 228 | ||
| Opioids | 228 | ||
| Ketamine | 228 | ||
| Bisphosphonates | 229 | ||
| OTHER POTENTIAL THERAPIES | 230 | ||
| Naltrexone | 230 | ||
| Immunoglobulin IV | 230 | ||
| INTERVENTIONAL THERAPIES | 230 | ||
| Sympathetic Nerve Blocks | 230 | ||
| Intrathecal Baclofen | 230 | ||
| Spinal Cord Stimulation | 230 | ||
| Functional Restoration | 231 | ||
| Motor Imagery Program | 231 | ||
| Psychotherapy | 231 | ||
| KEY POINTS | 231 | ||
| REFERENCES | 231 | ||
| 28 - Herpes Zoster and Postherpetic Neuralgia | 233 | ||
| HERPES ZOSTER | 233 | ||
| EPIDEMIOLOGY OF HERPES ZOSTER | 233 | ||
| NATURAL HISTORY OF HERPES ZOSTER | 233 | ||
| TREATMENT OF HERPES ZOSTER | 233 | ||
| POSTHERPETIC NEURALGIA | 235 | ||
| EPIDEMIOLOGY AND NATURAL HISTORY | 235 | ||
| PATHOPHYSIOLOGY | 235 | ||
| TREATMENT | 236 | ||
| Lidocaine Patch 5% | 236 | ||
| Gabapentin | 236 | ||
| Pregabalin | 236 | ||
| Tricyclic Antidepressants | 236 | ||
| Opioid Analgesics | 237 | ||
| Tramadol | 237 | ||
| High-Concentration Capsaicin Patch | 237 | ||
| Sequential and Combination Pharmacologic | 238 | ||
| Alternatives to Topical and Oral Medications | 238 | ||
| KEY POINTS | 239 | ||
| REFERENCES | 239 | ||
| 29 - Postamputation Pain | 241 | ||
| DEFINITIONS AND EPIDEMIOLOGY | 241 | ||
| PHANTOM SENSATIONS | 241 | ||
| TELESCOPING | 241 | ||
| PHANTOM PAIN | 241 | ||
| SPECIAL POPULATIONS | 242 | ||
| PHANTOM PHENOMENA AFTER MASTECTOMY | 242 | ||
| WOUNDED WARRIORS | 242 | ||
| PATHOPHYSIOLOGY AND MECHANISMS OF POSTAMPUTATION PAIN | 242 | ||
| EVALUATION | 243 | ||
| TREATMENT | 244 | ||
| PHARMACOTHERAPY | 244 | ||
| PREVENTIVE ANALGESIA | 246 | ||
| PHYSICAL AND OCCUPATIONAL THERAPY | 246 | ||
| COMPLEMENTARY AND ALTERNATIVE MEDICINE THERAPIES AND MODALITIES | 246 | ||
| PSYCHOLOGICAL THERAPIES | 248 | ||
| INTERVENTIONAL THERAPIES | 248 | ||
| SURGERY | 249 | ||
| CONCLUSION | 249 | ||
| KEY POINTS | 250 | ||
| REFERENCES | 250 | ||
| 30 - Central Pain States | 251 | ||
| EPIDEMIOLOGY OF CENTRAL PAIN | 251 | ||
| TAXONOMY | 251 | ||
| PATHOPHYSIOLOGIC MECHANISMS | 252 | ||
| CLINICAL PRESENTATIONS | 254 | ||
| EXPERIMENTAL MODELS OF CENTRAL PAIN SECONDARY TO SPINAL CORD INJURY | 255 | ||
| THERAPEUTIC OPTIONS | 255 | ||
| PHARMACOTHERAPY | 255 | ||
| Antiepileptic Drugs | 256 | ||
| Opioids | 257 | ||
| Na Channel Blockers | 257 | ||
| N-Methyl-d-Aspartate Receptor Antagonists | 257 | ||
| Cannabinoids | 257 | ||
| BEHAVIORAL THERAPY | 257 | ||
| PHYSICAL AND OCCUPATIONAL THERAPY | 257 | ||
| NEUROMODULATION | 258 | ||
| OTHER INTERVENTIONAL THERAPIES | 258 | ||
| INTRATHECAL PUMPS | 258 | ||
| ABLATIVE NEUROSURGERY | 258 | ||
| FUTURE DIRECTIONS | 259 | ||
| KEY POINTS | 259 | ||
| REFERENCES | 259 | ||
| 31 - Pelvic Pain | 261 | ||
| EPIDEMIOLOGY | 261 | ||
| DEMOGRAPHICS | 261 | ||
| CANCER PAIN | 261 | ||
| PELVIC PAIN DIFFERENTIAL AND ETIOLOGY | 262 | ||
| ETIOLOGY | 262 | ||
| THEORY | 262 | ||
| VASCULAR HYPOTHESIS | 262 | ||
| ALTERATION OF STIMULI PROCESSING OR ORGAN FUNCTIONING | 262 | ||
| HISTORY AND PHYSICAL EXAM | 263 | ||
| HISTORY | 263 | ||
| PHYSICAL EXAM | 263 | ||
| Abdominal Assessment | 263 | ||
| Pelvic Assessment | 263 | ||
| Musculoskeletal Assessment | 263 | ||
| Neurologic Assessment | 263 | ||
| Psychiatric Assessment | 263 | ||
| MODALITIES OF CHRONIC PELVIC PAIN | 263 | ||
| MEDICAL TREATMENT | 264 | ||
| NONSTEROIDAL ANTIINFLAMMATORY DRUGS | 264 | ||
| ACETAMINOPHEN | 264 | ||
| OPIOIDS | 264 | ||
| ORAL CONTRACEPTIVES, GONADOTROPIN-RELEASING HORMONE ANALOGUES, DANAZOL | 264 | ||
| ANTIDEPRESSANTS | 265 | ||
| ANTICONVULSANTS | 265 | ||
| PROMISING THERAPIES | 266 | ||
| PROCEDURAL PAIN MEDICINE | 266 | ||
| INTERVENTIONAL PROCEDURES | 266 | ||
| Trigger Point Injections | 266 | ||
| Epidural Steriod and Facet Joint Injections | 267 | ||
| Peripheral Nerve Blocks | 267 | ||
| Sympathetic Blocks and Neuroablation | 268 | ||
| Superior Hypogastric Plexus Block | 268 | ||
| Inferior Hypogastric Plexus Block | 268 | ||
| Ganglion Impar Block | 268 | ||
| NEUROMODULATION AND SPINAL CORD STIMULATION | 268 | ||
| Neuromodulation | 268 | ||
| TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION | 269 | ||
| INTRATHECAL PUMP | 269 | ||
| SURGICAL TECHNIQUES | 269 | ||
| DIAGNOSTIC LAPAROSCOPY AND HYSTERECTOMY | 269 | ||
| ROBOTIC SURGERY | 269 | ||
| PRESACRAL NEURECTOMY | 269 | ||
| LAPAROSCOPIC UTERINE NERVE ABLATION | 269 | ||
| ALTERNATIVE/COMPLEMENTARY PAIN MEDICINE | 270 | ||
| PSYCHOLOGICAL THERAPY | 270 | ||
| HERBAL THERAPY AND VITAMINS | 270 | ||
| ACUPUNCTURE | 270 | ||
| OTHER MODALITIES | 270 | ||
| CONCLUSION: WHY MULTIDISCIPLINARY? | 270 | ||
| KEY POINTS | 270 | ||
| REFERENCES | 271 | ||
| 32 - Painful Peripheral Neuropathies | 273 | ||
| TERMINOLOGY AND CLASSIFICATION | 273 | ||
| EPIDEMIOLOGY | 273 | ||
| MECHANISMS OF NEUROPATHIC PAIN | 273 | ||
| PERIPHERAL | 273 | ||
| EVALUATION OF THE PATIENT WITH NEUROPATHIC PAIN | 275 | ||
| HISTORY | 275 | ||
| NEUROLOGIC EXAMINATION | 275 | ||
| ELECTRODIAGNOSTIC TESTING | 275 | ||
| SCREENING TOOLS | 276 | ||
| DIFFERENTIAL DIAGNOSIS | 276 | ||
| METABOLIC CAUSES OF PERIPHERAL POLYNEUROPATHY—DIABETES | 276 | ||
| OTHER METABOLIC CAUSES OF PAINFUL PERIPHERAL NEUROPATHY | 277 | ||
| NUTRITIONAL CAUSES OF PERIPHERAL POLYNEUROPATHY | 277 | ||
| TOXIC CAUSES OF PERIPHERAL POLYNEUROPATHY | 277 | ||
| GENETIC CAUSES OF PERIPHERAL POLYNEUROPATHY | 278 | ||
| INFECTIOUS AND INFLAMMATORY CAUSES OF PERIPHERAL POLYNEUROPATHY | 278 | ||
| IDIOPATHIC SMALL-FIBER NEUROPATHY | 279 | ||
| TREATMENT OF NEUROPATHIC PAIN | 279 | ||
| KEY POINTS | 281 | ||
| REFERENCES | 282 | ||
| 33 - Entrapment Neuropathies | 283 | ||
| CARPAL TUNNEL SYNDROME | 283 | ||
| PATHOLOGY | 283 | ||
| RISK FACTORS | 283 | ||
| SYMPTOMS | 283 | ||
| PHYSICAL FINDINGS | 285 | ||
| DIAGNOSTIC STUDIES | 286 | ||
| TREATMENT | 286 | ||
| ULNAR NEUROPATHY AT THE ELBOW | 286 | ||
| PATHOLOGY | 286 | ||
| RISK FACTORS | 286 | ||
| SYMPTOMS | 286 | ||
| PHYSICAL FINDINGS | 287 | ||
| DIAGNOSTIC STUDIES | 288 | ||
| TREATMENT | 288 | ||
| THORACIC OUTLET SYNDROME | 289 | ||
| PATHOLOGY | 289 | ||
| RISK FACTORS | 289 | ||
| SYMPTOMS | 289 | ||
| PHYSICAL FINDINGS | 290 | ||
| DIAGNOSTIC EVALUATION | 290 | ||
| TREATMENT | 290 | ||
| MERALGIA PARESTHETICA | 291 | ||
| PATHOLOGY | 291 | ||
| RISK FACTORS | 291 | ||
| SYMPTOMS | 291 | ||
| PHYSICAL FINDINGS | 291 | ||
| DIAGNOSTIC STUDIES | 292 | ||
| TREATMENT | 292 | ||
| TARSAL TUNNEL SYNDROME | 292 | ||
| PATHOLOGY | 293 | ||
| RISK FACTORS | 293 | ||
| SYMPTOMS | 293 | ||
| PHYSICAL FINDINGS | 293 | ||
| DIAGNOSTIC STUDIES | 293 | ||
| TREATMENT | 293 | ||
| MORTON’S NEUROMA | 294 | ||
| PATHOLOGY | 294 | ||
| RISK FACTORS | 294 | ||
| SYMPTOMS | 294 | ||
| PHYSICAL FINDINGS | 294 | ||
| DIAGNOSTIC STUDIES | 294 | ||
| TREATMENT | 294 | ||
| SUMMARY | 295 | ||
| KEY POINTS | 295 | ||
| ACKNOWLEDGMENTS | 295 | ||
| REFERENCES | 295 | ||
| V - Cancer Pain and Pain in Special Situations | 297 | ||
| 34 - Approach to the Management of Cancer Pain | 299 | ||
| ASSESSMENT OF CANCER PAIN | 299 | ||
| TYPE | 299 | ||
| TEMPORAL PROFILE | 299 | ||
| SEVERITY | 299 | ||
| TREATMENT OF CANCER PAIN | 300 | ||
| WORLD HEALTH ORGANIZATION THREE-STEP LADDER | 300 | ||
| COMMON ANALGESICS | 301 | ||
| ACETAMINOPHEN | 301 | ||
| NONSTEROIDAL ANTIINFLAMMATORY DRUGS (INCLUDING ACETYLSALICYLIC ACID) | 301 | ||
| OPIOIDS | 302 | ||
| OPIOIDS TO AVOID | 302 | ||
| ROUTES OF ADMINISTRATION | 302 | ||
| ACHIEVING INITIAL PAIN RELIEF | 302 | ||
| ROUTINE DOSING FOR CONSTANT PAIN | 302 | ||
| TITRATION | 303 | ||
| SUSTAINED-RELEASE PRODUCTS | 303 | ||
| ABUSE-DETERRENT FORMULATIONS | 303 | ||
| BREAKTHROUGH OR RESCUE DOSING FOR INTERMITTENT PAIN | 303 | ||
| EQUIANALGESIC DOSING | 303 | ||
| CLEARANCE/BUILDUP | 304 | ||
| OPIOID ADVERSE EFFECTS | 304 | ||
| OPIOID EXCESS/OVERDOSE | 305 | ||
| ADDICTION VERSUS TOLERANCE | 305 | ||
| ADJUVANT PAIN MEDICINES | 305 | ||
| ADDITIONAL CONSIDERATIONS | 306 | ||
| CONCLUSION | 307 | ||
| KEY POINTS | 307 | ||
| 35 - Management of Pain at End of Life | 309 | ||
| PALLIATIVE CARE AND HOSPICE | 309 | ||
| PAINFUL SYNDROMES IN CANCER AND OTHER LIFE-THREATENING ILLNESSES | 309 | ||
| CANCER | 309 | ||
| ASSESSMENT OF PAIN AT THE END OF LIFE | 310 | ||
| MEDICATION ADMINISTRATION AT END OF LIFE | 311 | ||
| COMPLEX PAIN SYNDROMES AT END OF LIFE | 312 | ||
| MALIGNANT BONE PAIN | 312 | ||
| INTRACTABLE NEUROPATHIC PAIN | 312 | ||
| MALIGNANT INTESTINAL OBSTRUCTION | 312 | ||
| OPIOID NEUROTOXICITY | 312 | ||
| OTHER SYMPTOMS COMMON AT END OF LIFE | 313 | ||
| DYSPNEA | 313 | ||
| ANXIETY | 313 | ||
| DEPRESSION | 313 | ||
| CONCLUSION | 313 | ||
| KEY POINTS | 313 | ||
| REFERENCES | 313 | ||
| 36 - Pain Management in the Emergency Department | 315 | ||
| CHRONIC PAIN | 315 | ||
| ACUTE PAIN | 315 | ||
| SPECIFIC PROBLEMS | 316 | ||
| ABDOMINAL PAIN | 316 | ||
| HEADACHE | 316 | ||
| CHEST PAIN | 318 | ||
| MUSCULOSKELETAL PAIN | 318 | ||
| PAIN MANAGEMENT IN PEDIATRICS | 318 | ||
| ANALGESIA DURING PROCEDURES | 318 | ||
| SPECIFIC AGENTS | 319 | ||
| FENTANYL AND MIDAZOLAM | 319 | ||
| KETAMINE | 319 | ||
| KETAMINE AND PROPOFOL | 320 | ||
| OTHER AGENTS | 320 | ||
| LOCAL ANESTHETICS | 320 | ||
| KEY POINTS | 321 | ||
| REFERENCES | 321 | ||
| 37 - Chronic Pain Management in Children and Adolescents | 323 | ||
| ASSESSMENT OF CHRONIC PAININ CHILDREN | 323 | ||
| INTERDISCIPLINARY APPROACH TO PEDIATRIC CHRONIC PAIN MANAGEMENT | 323 | ||
| FUNCTIONAL IMAGING OF PEDIATRIC CHRONIC PAIN STATES | 324 | ||
| FUNCTIONAL IMAGING TECHNIQUES | 324 | ||
| PEDIATRIC CHRONIC PAIN SYNDROMES | 325 | ||
| COMPLEX REGIONAL PAIN SYNDROME | 325 | ||
| EVALUATION | 327 | ||
| TREATMENT | 327 | ||
| TRICYCLIC ANTIDEPRESSANTS | 328 | ||
| ANTICONVULSANTS | 328 | ||
| SELECTIVE SEROTONIN REUPTAKE INHIBITORS AND SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS | 328 | ||
| SYSTEMIC VASODILATORS | 328 | ||
| REGIONAL ANESTHESIA AND SYMPATHETIC BLOCKS | 328 | ||
| HEADACHES IN CHILDREN | 329 | ||
| EVALUATION AND MANAGEMENT OF HEADACHE | 329 | ||
| ABDOMINAL PAIN IN CHILDREN | 330 | ||
| PEDIATRIC CANCER PAIN | 330 | ||
| CONCLUSION | 331 | ||
| KEY POINTS | 331 | ||
| REFERENCES | 331 | ||
| 38 - Sickle Cell Disease | 333 | ||
| PATHOPHYSIOLOGY | 333 | ||
| CLINICAL MANIFESTATIONS | 333 | ||
| DIFFERENTIAL DIAGNOSIS AND EVALUATION | 334 | ||
| MANAGEMENT OF ACUTE SICKLE CELL PAIN | 334 | ||
| KEYS TO SUCCESSFUL MANAGEMENT OF ACUTE SICKLE CELL DISEASE PAIN IN THE EMERGENCY DEPARTMENT | 334 | ||
| SUMMARY | 338 | ||
| KEY POINTS | 338 | ||
| REFERENCES | 338 | ||
| 39 - Pain Management During Pregnancy and Lactation | 339 | ||
| DRUGS DURING PREGNANCY | 339 | ||
| PHARMACOKINETIC CHANGES DURING PREGNANCY | 339 | ||
| TRANSFER OF DRUGS ACROSS THE PLACENTA | 339 | ||
| TERATOGENICITY | 339 | ||
| FOOD AND DRUG ADMINISTRATION RISK CLASSIFICATION | 340 | ||
| SPECIFIC DRUGS | 340 | ||
| DRUGS DURING LACTATION | 341 | ||
| AMERICAN ACADEMY OF PEDIATRICS | 341 | ||
| SPECIFIC DRUGS | 341 | ||
| IMAGING DURING PREGNANCY | 342 | ||
| PAIN SYNDROMES DURING PREGNANCY AND LACTATION | 342 | ||
| PELVIC GIRDLE PAIN AND LOW BACK PAIN | 342 | ||
| NEUROPATHIC PAIN: CARPAL TUNNEL SYNDROME | 342 | ||
| HEADACHE | 342 | ||
| KEY POINTS | 342 | ||
| REFERENCES | 343 | ||
| 40 - Pain Control in the Critically Ill Patient | 345 | ||
| ASSESSMENT | 345 | ||
| ANALGESIA | 345 | ||
| HYPNOSIS | 345 | ||
| THERAPEUTIC AGENTS | 348 | ||
| ANALGESIA | 349 | ||
| Nonopioids | 350 | ||
| Analgesic Agents: Opioids | 350 | ||
| HYPNOSIS | 351 | ||
| Hypnotic Agents: Benzodiazepines | 351 | ||
| Hypnotic Agents Propofol | 352 | ||
| Hypnotic Agents Dexmedetomidine | 352 | ||
| Hypnotic Agents: Ketamine | 353 | ||
| DELIRIUM | 353 | ||
| NEUROMUSCULAR BLOCKING AGENTS | 354 | ||
| CONCLUSION | 354 | ||
| KEY POINTS | 354 | ||
| REFERENCES | 355 | ||
| 41 - Geriatric Pain | 357 | ||
| PRESENTATION OF DISEASE/COMORBIDITY | 357 | ||
| AGING-ASSOCIATED PHYSIOLOGY AND PATHOLOGY | 357 | ||
| NERVOUS SYSTEM | 357 | ||
| MUSCULOSKELETAL | 357 | ||
| DRUG METABOLISM17 | 358 | ||
| ANALGESICS AFFECTED BY ALTERED PHARMACOKINETICS | 358 | ||
| ANALGESICS AFFECTED BY ALTERED PHARMACODYNAMICS | 359 | ||
| COMPREHENSIVE PAIN ASSESSMENT | 359 | ||
| KEY ASSESSMENT TOOLS FOR THE OLDER ADULT WITH PAIN | 359 | ||
| RED FLAGS | 360 | ||
| TREATMENT | 360 | ||
| NONPHARMACOLOGIC TREATMENT | 360 | ||
| PHARMACOLOGIC TREATMENT | 361 | ||
| TOPICAL THERAPIES | 361 | ||
| ORAL ANALGESICS | 361 | ||
| INJECTION THERAPIES | 368 | ||
| CORTICOSTEROID INJECTIONS | 368 | ||
| TRIGGER-POINT INJECTIONS | 368 | ||
| PROLOTHERAPY | 368 | ||
| FIBROMYALGIA: INTERDISCIPLINARY TREATMENT APPROACH EXAMPLE | 368 | ||
| CONCLUSION | 369 | ||
| KEY POINTS | 369 | ||
| REFERENCES | 369 | ||
| VI - Pharmacology and Pharmacologic Modalities | 371 | ||
| 42 - Major Opioids in Pain Management | 373 | ||
| RATIONALE | 373 | ||
| GUIDELINES | 373 | ||
| INITIATION OF CHRONIC OPIOID THERAPY | 374 | ||
| ADMINISTRATION | 375 | ||
| TREATMENT ENDPOINTS AND OPIOID SELECTION | 376 | ||
| SELECTED OPIOIDS | 377 | ||
| MEPERIDINE | 377 | ||
| MORPHINE | 377 | ||
| OXYCODONE | 378 | ||
| OXYMORPHONE | 378 | ||
| HYDROMORPHONE | 379 | ||
| METHADONE | 379 | ||
| BUPRENORPHINE | 381 | ||
| FENTANYL | 382 | ||
| SUFENTANIL | 384 | ||
| ALFENTANIL | 384 | ||
| REMIFENTANIL | 384 | ||
| KEY POINTS | 384 | ||
| REFERENCES | 384 | ||
| 43 - Opioids Used for Mild to Moderate Pain | 385 | ||
| SPECIFIC SHORT-ACTING OPIOIDS | 385 | ||
| OXYCODONE | 385 | ||
| HYDROCODONE | 386 | ||
| CODEINE | 386 | ||
| TRAMADOL | 386 | ||
| TAPENTADOL | 386 | ||
| CONCLUSION | 387 | ||
| KEY POINTS | 388 | ||
| REFERENCES | 388 | ||
| 44 - The Prescription Drug Abuse Epidemic and Emerging Prescribing Guidelines | 389 | ||
| EMERGING PRESCRIBING GUIDELINES | 389 | ||
| PATIENT EVALUATION AND RISK STRATIFICATION | 391 | ||
| DEVELOPMENT OF A TREATMENT PLAN AND GOALS | 391 | ||
| INFORMED CONSENT AND TREATMENT AGREEMENT | 391 | ||
| INITIATING AN OPIOID TRIAL | 391 | ||
| ONGOING MONITORING AND ADAPTING THE TREATMENT PLAN | 392 | ||
| PERIODIC DRUG TESTING | 392 | ||
| MENTAL HEALTH CONSULTATION AND REFERRAL | 392 | ||
| DISCONTINUING OPIOID THERAPY | 393 | ||
| DOCUMENTATION IN MEDICAL RECORDS | 393 | ||
| COMPLIANCE WITH CONTROLLED SUBSTANCE LAWS AND REGULATIONS | 393 | ||
| ADDITIONAL PRACTICES FOR SAFER PRESCRIBING | 393 | ||
| ACKNOWLEDGMENT | 393 | ||
| KEY POINTS | 393 | ||
| REFERENCES | 394 | ||
| 45 - Legal and Regulatory Issues in Pain Management | 395 | ||
| LAWS AND POLICIES AFFECTING PAIN MANAGEMENT | 395 | ||
| FEDERAL CONTROLLED SUBSTANCES LAWS | 395 | ||
| Assuring Medication Availability | 396 | ||
| Medical Practice Is Not Regulated | 396 | ||
| Treating Addiction Versus Treating Pain | 396 | ||
| Prescription Amount and Duration | 397 | ||
| STATE CONTROLLED SUBSTANCES AND HEALTH CARE LAWS | 397 | ||
| Evaluating the Quality of State Pain Policy | 397 | ||
| Grading the Quality of State Pain Policy | 398 | ||
| THE IMPORTANCE OF PRACTITIONERS IN IMPROVING STATE POLICY | 399 | ||
| OTHER IMPORTANT POLICIES TO CONSIDER | 399 | ||
| THE IMPORTANCE OF CONSIDERING DIVERSION | 400 | ||
| LITIGATION INVOLVING PAIN MANAGEMENT | 400 | ||
| ADMINISTRATIVE PROCEEDINGS | 400 | ||
| CIVIL LITIGATION | 401 | ||
| CRIMINAL LITIGATION | 402 | ||
| CONSTITUTIONAL CASES | 404 | ||
| CONCLUSION | 404 | ||
| KEY POINTS | 404 | ||
| REFERENCES | 404 | ||
| 46 - Urine Drug Testing in Pain Medicine | 405 | ||
| HISTORY OF URINE DRUG TESTING | 406 | ||
| BODILY SPECIMENS THAT CAN BE TESTED | 406 | ||
| URINE DRUG TESTING | 407 | ||
| THRESHOLD OF DETECTABILITY | 409 | ||
| WHY PERFORM AN IMMUNOASSAY SCREEN AND URINE DRUG TEST | 409 | ||
| WHO SHOULD GET AN IMMUNOASSAY SCREEN AND URINE DRUG TEST | 409 | ||
| WHEN TO GET AN IMMUNOASSAY SCREEN AND URINE DRUG TEST | 410 | ||
| HOW OFTEN TO GET AN IMMUNOASSAY SCREEN AND URINE DRUG TEST | 410 | ||
| WHAT IS THE EVIDENCE FOR GETTING AN IMMUNOASSAY SCREEN AND URINE DRUG TEST? | 410 | ||
| HOW TO INTERPRET AN IMMUNOASSAY SCREEN AND URINE DRUG TEST | 410 | ||
| ADULTERATION | 414 | ||
| TESTING ALCOHOL | 416 | ||
| CONCLUSION | 416 | ||
| REFERENCES | 417 | ||
| 47 - Substance Use Disorders and Detoxification | 419 | ||
| SUBSTANCE USE AND CHRONIC PAIN | 419 | ||
| RISKS OF PHARMACOLOGICAL TREATMENT FOR CHRONIC PAIN | 419 | ||
| OPIOIDS | 419 | ||
| DIAGNOSIS OF SUBSTANCE USE DISORDERS | 420 | ||
| TREATMENT OF SUBSTANCE USE DISORDERS IN PATIENTS WITH CHRONIC PAIN | 421 | ||
| LONG-TERM OPIOID THERAPY | 422 | ||
| WHY IS DETOXIFICATION NECESSARY? | 422 | ||
| OPIOID DETOXIFICATION | 422 | ||
| SETTING | 423 | ||
| AGENTS | 423 | ||
| ADJUNCTIVE AGENTS | 424 | ||
| SCHEDULE | 425 | ||
| FOLLOW-UP | 425 | ||
| BENZODIAZEPINE DETOXIFICATION | 425 | ||
| CONCLUSION | 426 | ||
| KEY POINTS | 426 | ||
| REFERENCES | 426 | ||
| 48 - Psychopharmacology for Pain Medicine | 427 | ||
| EPIDEMIOLOGY | 427 | ||
| PSYCHIATRIC NOSOLOGY | 427 | ||
| MAJOR DEPRESSION AND SUBTHRESHOLD DEPRESSION | 427 | ||
| TREATMENT | 428 | ||
| SELECTIVE SEROTONIN REUPTAKE INHIBITORS | 428 | ||
| TRICYCLIC ANTIDEPRESSANTS | 429 | ||
| SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS | 430 | ||
| OTHER ANTIDEPRESSANTS | 431 | ||
| ANXIETY DISORDERS | 431 | ||
| TREATMENT | 432 | ||
| ANTIDEPRESSANTS | 432 | ||
| BENZODIAZEPINES AND BUSPIRONE | 432 | ||
| MOOD STABILIZERS | 433 | ||
| LITHIUM | 433 | ||
| VALPROIC ACID | 433 | ||
| LAMOTRIGINE (LAMICTAL) | 433 | ||
| CARBAMAZEPINE (TEGRETOL) | 434 | ||
| OTHER ANTIEPILEPTIC DRUGS | 434 | ||
| TOPIRAMATE (TOPAMAX) | 434 | ||
| LEVETIRACETAM (KEPPRA) | 434 | ||
| NEUROLEPTIC DRUGS | 434 | ||
| TYPICAL NEUROLEPTIC DRUGS | 435 | ||
| ATYPICAL NEUROLEPTIC DRUGS | 435 | ||
| CONCLUSION | 435 | ||
| KEY POINTS | 436 | ||
| REFERENCES | 436 | ||
| 49 - Membrane Stabilizers | 437 | ||
| SODIUM CHANNEL BLOCKERS | 437 | ||
| ANTICONVULSANTS | 437 | ||
| PHENYTOIN (DILANTIN) | 437 | ||
| CARBAMAZEPINE (TEGRETOL) | 439 | ||
| OXCARBAZEPINE (TRILEPTAL) | 439 | ||
| VALPROIC ACID (DEPAKOTE) | 440 | ||
| LAMOTRIGINE (LAMICTAL) | 440 | ||
| TOPIRAMATE (TOPAMAX) | 440 | ||
| LEVETIRACETAM (KEPPRA) | 441 | ||
| LOCAL ANESTHETICS | 441 | ||
| LIDOCAINE | 441 | ||
| MEXILETINE | 441 | ||
| CALCIUM CHANNEL BLOCKERS | 441 | ||
| GABAPENTIN (NEURONTIN) | 442 | ||
| PREGABALIN (LYRICA) | 443 | ||
| ZONISAMIDE (ZONEGRAN) | 443 | ||
| ZICONOTIDE (PRIALT) | 443 | ||
| NIMODIPINE (NIMOTOP) | 444 | ||
| MAGNESIUM | 444 | ||
| KEY POINTS | 444 | ||
| REFERENCES | 444 | ||
| 50 - Recommendations for Pharmacologic Therapy of Neuropathic Pain | 445 | ||
| NEUROPATHIC PAIN—EPIDEMIOLOGYAND ASSESSMENT | 445 | ||
| CONSTRUCTING THE EVIDENCE BASE FOR RECOMMENDATIONS FOR NEUROPATHIC PAIN PHARMACOTHERAPY | 445 | ||
| PHARMACOLOGIC THERAPY OF NEUROPATHIC PAIN—SUMMARY OF EVIDENCE | 446 | ||
| DRUGS WITH STRONG GRADE RECOMMENDATION FOR USE AND RECOMMENDED AS FIRST LINE | 446 | ||
| DRUGS WITH WEAK GRADE RECOMMENDATIONS FOR USE AND RECOMMENDED AS SECOND LINE | 447 | ||
| DRUGS WITH WEAK GRADE RECOMMENDATION FOR USE AND RECOMMENDED AS THIRD LINE | 447 | ||
| DRUGS WITH INCONCLUSIVE GRADE RECOMMENDATIONS | 448 | ||
| DRUGS WITH WEAK GRADE RECOMMENDATIONS AGAINST THEIR USE | 448 | ||
| DRUGS WITH STRONG GRADE RECOMMENDATIONS AGAINST THEIR USE | 448 | ||
| OTHER TREATMENT RECOMMENDATIONS | 448 | ||
| Special Neuropathic Pain Conditions | 448 | ||
| TRIGEMINAL NEURALGIA | 448 | ||
| HEREDITARY CHANNELOPATHIES | 449 | ||
| PHARMACOLOGY OF DRUGS IMPLIED IN THE TREATMENT OF NEUROPATHIC PAIN | 449 | ||
| ANTIDEPRESSANTS | 449 | ||
| Dosing | 449 | ||
| Serotonin-Norepinephrine Reuptake Inhibitors | 450 | ||
| ANTICONVULSANTS | 450 | ||
| OTHER ANTICONVULSANTS | 451 | ||
| Lamotrigine | 452 | ||
| Topiramate | 452 | ||
| Lacosamide | 452 | ||
| Valproic Acid | 452 | ||
| Levetiracetam | 452 | ||
| TRAMADOL | 452 | ||
| OPIOIDS | 452 | ||
| TOPICAL CAPSAICIN | 453 | ||
| Capsaicin Cream | 453 | ||
| Capsaicin 8% Patch | 453 | ||
| TOPICAL LIDOCAINE | 453 | ||
| CANNABINOIDS | 454 | ||
| BOTULINUM TOXIN | 454 | ||
| N-METHYL-D-ASPARTATE RECEPTOR ANTAGONISTS | 455 | ||
| INTRAVENOUS LIDOCAINE | 455 | ||
| ORAL MEXILETINE | 455 | ||
| COMBINATION TREATMENTS | 455 | ||
| FUTURE DIRECTIONS | 455 | ||
| KEY POINTS | 456 | ||
| REFERENCES | 456 | ||
| 51 - Nonopioid Analgesics: Nonsteroidal Antiinflammatory Drugs, Cyclooxygenase-2 Inhibitors, and Acetaminophen | 457 | ||
| MECHANISM OF ACTION | 457 | ||
| PHARMACOKINETICS | 458 | ||
| ABSORPTION, DISTRIBUTION, AND ELIMINATION | 460 | ||
| Distribution | 460 | ||
| Elimination | 461 | ||
| SPECIFIC MEDICATIONS | 461 | ||
| SALICYLATES | 462 | ||
| PROPRIONIC ACID | 462 | ||
| OTHER PROPIONIC ACID DERIVATIVES | 463 | ||
| ACETIC ACID DERIVATIVES | 463 | ||
| ANTHRANILIC ACID | 464 | ||
| OXICAM | 464 | ||
| CYCLOOXYGENASE-2 INHIBITORS | 464 | ||
| ACETAMINOPHEN | 465 | ||
| SAFETY, TOXICITY, AND ADVERSE EFFECTS | 465 | ||
| GASTROINTESTINAL EFFECTS | 466 | ||
| RENAL EFFECTS | 466 | ||
| CARDIOVASCULAR EFFECTS | 466 | ||
| MEDICATION SELECTION | 467 | ||
| SUMMARY | 467 | ||
| KEY POINTS | 468 | ||
| REFERENCES | 468 | ||
| 52 - Intravenous Infusions for Refractory Cancer and Chronic Pain States | 469 | ||
| LOCAL ANESTHETIC (LIDOCAINE) | 469 | ||
| KETAMINE | 470 | ||
| BISPHOSPHONATES | 471 | ||
| IMMUNOGLOBULIN | 472 | ||
| MAGNESIUM | 472 | ||
| PHENTOLAMINE | 472 | ||
| KEY POINTS | 472 | ||
| REFERENCES | 473 | ||
| 53 - Pharmacologic Management of Myofascial Pain | 475 | ||
| MECHANISMS OF MUSCLE PAIN | 475 | ||
| PAINFUL CONDITIONS WITH MYOFASCIAL INVOLVEMENT | 475 | ||
| TENSION-TYPE HEADACHE | 475 | ||
| TEMPOROMANDIBULAR DISORDER | 475 | ||
| MYOFASCIAL PAIN SYNDROME | 475 | ||
| LOW BACK PAIN | 476 | ||
| NECK PAIN | 476 | ||
| MUSCLE CRAMPS | 476 | ||
| TREATMENT | 476 | ||
| TRICYCLIC ANTIDEPRESSANTS | 476 | ||
| ANTICONVULSANTS AND CALCIUM CHANNEL ANTAGONISTS | 477 | ||
| SKELETAL MUSCLE RELAXANTS | 477 | ||
| BENZODIAZEPINES | 479 | ||
| NONSTEROIDAL ANTIINFLAMMATORY DRUGS | 482 | ||
| BOTULINUM TOXIN | 482 | ||
| OPIOIDS | 482 | ||
| OTHER TREATMENTS | 483 | ||
| CONCLUSION | 483 | ||
| KEY POINTS | 483 | ||
| REFERENCES | 484 | ||
| 54 - Pharmacologic Management of Complex Regional Pain Syndrome | 485 | ||
| INTRAVENOUS KETAMINE | 485 | ||
| PHARMACOLOGY | 485 | ||
| MECHANISM OF ACTION | 486 | ||
| USE IN CHRONIC PAIN | 486 | ||
| SIDE EFFECTS OF KETAMINE | 487 | ||
| CENTRAL NERVOUS SYSTEM EFFECTS | 487 | ||
| CARDIOVASCULAR EFFECTS | 487 | ||
| HEPATIC EFFECTS | 491 | ||
| BISPHOSPHONATES | 491 | ||
| PHARMACOLOGY | 491 | ||
| MECHANISM OF ACTION | 491 | ||
| USE IN CHRONIC REGIONAL PAIN SYNDROME | 491 | ||
| Alendronate | 491 | ||
| Neridronate | 492 | ||
| Clodronate | 492 | ||
| Ibandronate | 492 | ||
| SIDE EFFECTS | 492 | ||
| CALCITONIN | 492 | ||
| PHARMACOLOGY | 492 | ||
| VII - Therapeutic Interventions | 521 | ||
| 57 - Ablative Neurosurgical Procedures for Treatment of Chronic Pain | 523 | ||
| GENERAL COMMENTS | 523 | ||
| DORSAL ROOT ENTRY ZONE LESIONS/CAUDALIS DORSAL ROOT ENTRY ZONE | 523 | ||
| PROCEDURE | 523 | ||
| PERIPHERAL NEURECTOMY/GANGLIONECTOMY | 525 | ||
| PROCEDURE—NEURECTOMY | 525 | ||
| VIII - Interventional Techniquesfor Pain Management | 559 | ||
| 62 - Interlaminar Epidural Steroid Injections | 561 | ||
| INTRODUCTION | 561 | ||
| TECHNIQUE | 561 | ||
| INJECTATE COMPOSITION | 562 | ||
| MECHANISM(S) OF ACTION | 563 | ||
| EFFICACY | 564 | ||
| ILESI VS. TFESI | 567 | ||
| COMPLICATIONS | 567 | ||
| GENERIC COMPLICATIONS | 567 | ||
| PROCEDURAL COMPLICATIONS | 569 | ||
| PHARMACOLOGIC COMPLICATIONS | 569 | ||
| CONCLUSION | 570 | ||
| KEY POINTS | 571 | ||
| REFERENCES | 571 | ||
| 63 - Transforaminal Epidural Steroid Injections and Selective Nerve Root Blocks | 573 | ||
| INTRODUCTION | 573 | ||
| TECHNIQUE | 573 | ||
| SELECTIVE NERVE ROOT BLOCK | 573 | ||
| ANATOMY | 575 | ||
| INJECTATE COMPOSITION AND DELIVERY | 579 | ||
| EFFICACY | 579 | ||
| COMPLICATIONS | 580 | ||
| NEUROLOGIC INJURY | 580 | ||
| OTHER COMPLICATIONS | 580 | ||
| KEY POINTS | 580 | ||
| REFERENCES | 583 | ||
| 64 - Antitumor Necrosis Factor-α Drugs and Disease-Modifying Antirheumatic Drugs for Low Back Pain | 585 | ||
| INTRODUCTION | 585 | ||
| ROLE OF INFLAMMATION IN LOW BACK PAIN | 585 | ||
| A BRIEF INTRODUCTION TO ANTIINFLAMMATORY DRUGS | 585 | ||
| ANTITUMOR NECROSIS FACTOR-Α DRUGS AND DISEASE-MODIFYING ANTIRHEUMATIC DRUGS FOR LOW BACK PAIN | 586 | ||
| ETANERCEPT | 586 | ||
| INFLIXIMAB | 586 | ||
| ADALIMUMAB | 587 | ||
| TOCILIZUMAB | 587 | ||
| EPIDURAL DMARD ADMINISTRATION FOR LOW BACK PAIN | 588 | ||
| SYSTEMIC DMARD USE FOR LOW BACK PAIN | 588 | ||
| ADVERSE EFFECTS OF DMARD USE FOR LOW BACK PAIN | 588 | ||
| CONCLUSION | 588 | ||
| KEY POINTS | 588 | ||
| REFERENCES | 589 | ||
| 65 - Facet Syndrome | 591 | ||
| ANATOMY AND FUNCTION | 591 | ||
| PATHOPHYSIOLOGY | 593 | ||
| CADAVERIC AND ANIMAL STUDIES | 593 | ||
| HUMAN STUDIES | 593 | ||
| PREVALENCE | 594 | ||
| DIAGNOSIS | 594 | ||
| HISTORY AND PHYSICAL EXAMINATION | 594 | ||
| RADIOLOGY | 595 | ||
| DIAGNOSTIC BLOCKS | 595 | ||
| FALSE-POSITIVE DIAGNOSTIC BLOCKS | 595 | ||
| FALSE-NEGATIVE BLOCKS | 596 | ||
| SELECTION CRITERIA: 50% VERSUS 80% RELIEF, SINGLE VERSUS DOUBLE MEDIAL BRANCH BLOCKS | 596 | ||
| TREATMENT | 596 | ||
| PHARMACOTHERAPY AND NONINTERVENTIONAL TREATMENT MODALITIES | 596 | ||
| INTRAARTICULAR CORTICOSTEROID INJECTIONS | 597 | ||
| RADIOFREQUENCY DENERVATION OF THE MEDIAL BRANCHES | 597 | ||
| SURGERY | 599 | ||
| COMPLICATIONS FROM MINIMALLY INVASIVE INTERVENTIONS | 600 | ||
| CONCLUSION | 600 | ||
| REFERENCES | 600 | ||
| 66 - Sacroiliac Joint Pain | 601 | ||
| ANATOMY, FUNCTION, AND INNERVATION | 601 | ||
| EPIDEMIOLOGY | 601 | ||
| ETIOLOGY | 602 | ||
| DIAGNOSIS AND PRESENTATION | 603 | ||
| HISTORY AND PHYSICAL EXAM | 603 | ||
| PAIN REFERRAL PATTERNS | 603 | ||
| RADIOLOGIC IMAGING | 605 | ||
| INJECTIONS | 605 | ||
| TREATMENT | 605 | ||
| CONSERVATIVE | 605 | ||
| INJECTIONS | 607 | ||
| NEUROABLATION | 607 | ||
| SURGICAL STABILIZATION | 609 | ||
| KEY POINTS | 610 | ||
| CRANIAL SHEAR TEST | 610 | ||
| EXTENSION TEST | 610 | ||
| FLAMINGO TEST | 610 | ||
| GAENSLEN TEST | 610 | ||
| GILLET TEST | 610 | ||
| PELVIC COMPRESSION TEST | 610 | ||
| PELVIC DISTRACTION TEST | 610 | ||
| PELVIC ROCK TEST | 610 | ||
| PATRICK TEST | 610 | ||
| SACROILIAC SHEAR TEST | 611 | ||
| THIGH THRUST TEST | 611 | ||
| REFERENCES | 611 | ||
| 67 - Piriformis Syndrome | 613 | ||
| ANATOMY OF THE PIRIFORMIS MUSCLE AND THE SCIATIC NERVE | 613 | ||
| PATHOPHYSIOLOGY, SIGNS AND SYMPTOMS, AND TREATMENT | 613 | ||
| TECHNIQUES OF PIRIFORMIS MUSCLE AND PERISCIATIC NERVE INJECTIONS | 615 | ||
| KEY POINTS | 617 | ||
| REFERENCES | 617 | ||
| 68 - Pulsed Radiofrequency, Water-Cooled Radiofrequency, and Cryoneurolysis | 619 | ||
| BACKGROUND AND TECHNIQUE | 619 | ||
| PULSED RADIOFREQUENCY | 619 | ||
| WATER-COOLED RADIOFREQUENCY | 619 | ||
| CLINICAL USES | 621 | ||
| PULSED RADIOFREQUENCY | 621 | ||
| WATER-COOLED RADIOFREQUENCY | 622 | ||
| CRYONEUROLYSIS | 622 | ||
| CLINICAL EFFICACY | 622 | ||
| PULSED RADIOFREQUENCY | 622 | ||
| Facet Syndrome | 623 | ||
| Shoulder Pain | 623 | ||
| Cervicogenic Headache | 625 | ||
| Postherpetic Neuralgia | 625 | ||
| Trigeminal Neuralgia | 625 | ||
| WATER-COOLED RADIOFREQUENCY | 625 | ||
| CLINICAL EFFICACY | 625 | ||
| CRYONEUROLYSIS | 625 | ||
| SIDE EFFECTS AND COMPLICATIONS | 626 | ||
| CONCLUSION | 626 | ||
| KEY POINTS | 626 | ||
| REFERENCES | 626 | ||
| 69 - Discography | 627 | ||
| OVERVIEW OF SPINAL PAIN | 627 | ||
| MECHANISMS OF DISCOGENIC PAIN | 627 | ||
| PREVALENCE | 628 | ||
| THE CONTROVERSY SURROUNDING DISCOGRAPHY | 629 | ||
| RATIONALE | 629 | ||
| FALSE-POSITIVE AND FALSE-NEGATIVE RESULTS | 629 | ||
| CORRELATION BETWEEN MAGNETIC RESONANCE IMAGING AND DISCOGRAPHY | 630 | ||
| EFFECT OF SURGICAL OUTCOMES | 631 | ||
| SPINAL ARTHRODESIS | 631 | ||
| DETERMINING OPERATIVE LEVELS | 631 | ||
| DISC REPLACEMENT | 632 | ||
| ALTERNATIVES TO PROVOCATION DISCOGRAPHY | 633 | ||
| INTERPRETATION | 633 | ||
| EVOKED PAIN OR ANALGESIC RESPONSE | 633 | ||
| VOLUMETRIC MEASUREMENTS | 634 | ||
| MORPHOLOGIC DISC EVALUATION | 635 | ||
| COMPLICATIONS AND DISC INJURY | 635 | ||
| SUMMARY | 637 | ||
| KEY POINTS | 637 | ||
| REFERENCES | 637 | ||
| 70 - Vertebroplasty and Kyphoplasty | 639 | ||
| INTRODUCTION | 639 | ||
| INDICATIONS | 639 | ||
| OSTEOPOROSIS | 639 | ||
| EPIDEMIOLOGICAL CHARACTERISTICS | 639 | ||
| DIAGNOSIS AND INITIAL EVALUATION | 640 | ||
| PREVENTION | 640 | ||
| OTHER FRACTURES | 640 | ||
| CONTRAINDICATIONS (TABLE 70.3) | 641 | ||
| Vertebroplasty and Kyphoplasty Technique | 641 | ||
| COMPLICATIONS45–49 (TABLE 70.4) | 642 | ||
| CLINICAL EVIDENCE FOR KYPHOPLASTY AND VERTEBROPLASTY FOR THE TREATMENT OF VERTEBRAL COMPRESSION FRACTURES | 643 | ||
| PROSPECTIVE STUDIES COMPARING VERTEBRAL AUGMENTATION TECHNIQUES AND CONSERVATIVE CARE | 643 | ||
| RANDOMIZED CONTROLLED TRIALS COMPARING VERTEBRAL AUGMENTATION TO CONSERVATIVE CARE (TABLE 70.5) | 643 | ||
| PROSPECTIVE AND RANDOMIZED STUDIES COMPARING VERTEBROPLASTY AND KYPHOPLASTY (TABLE 70.6) | 643 | ||
| SYSTEMATIC REVIEWS COMPARING VERTEBRAL AUGMENTATION TO CONSERVATIVE CARE (TABLE 70.7) | 645 | ||
| CONTROVERSIES | 645 | ||
| IMPLICATIONS | 646 | ||
| CONCLUSION | 646 | ||
| KEY POINTS | 646 | ||
| REFERENCES | 646 | ||
| 71 - Neurolytic Sympathetic Blocks | 647 | ||
| CELIAC PLEXUS BLOCK | 647 | ||
| INDICATIONS | 647 | ||
| TECHNIQUE | 647 | ||
| DRUG AND DOSING | 648 | ||
| COMPLICATIONS | 648 | ||
| IMPORTANT ASPECTS IN THE DIAGNOSIS AND MANAGEMENT OF SPECIFIC COMPLICATIONS | 648 | ||
| EFFICACY | 649 | ||
| SUPERIOR HYPOGASTRIC PLEXUS BLOCK | 650 | ||
| TECHNIQUE | 650 | ||
| COMPLICATIONS | 651 | ||
| EFFICACY | 651 | ||
| GANGLION IMPAR BLOCK | 652 | ||
| TECHNIQUE | 652 | ||
| COMPLICATIONS | 652 | ||
| CONCLUSION | 652 | ||
| KEY POINTS | 653 | ||
| REFERENCES | 653 | ||
| 72 - Central and Peripheral Neurolysis | 655 | ||
| INTRODUCTION | 655 | ||
| PATIENT SELECTION | 655 | ||
| PATIENT PREPARATION | 655 | ||
| NEUROLYTIC AGENTS | 656 | ||
| ALCOHOL | 656 | ||
| PHENOL | 657 | ||
| NEUROAXIAL NEUROLYSIS | 658 | ||
| INTRATHECAL ALCOHOL | 658 | ||
| INTRATHECAL PHENOL | 659 | ||
| EPIDURAL NEUROLYTIC BLOCK | 660 | ||
| COMPLICATIONS ASSOCIATED WITH INTRATHECAL AND EPIDURAL NEUROLYSIS | 660 | ||
| PERIPHERAL NEUROLYSIS | 661 | ||
| NEUROLYTIC INTERCOSTAL NERVE BLOCKS | 661 | ||
| OTHER NEUROLYTIC BLOCKS | 661 | ||
| ADDITIONAL TECHNIQUES OF NEUROLYSIS | 661 | ||
| KEY POINTS | 661 | ||
| REFERENCES | 661 | ||
| 73 - Spinal Cord Stimulation | 663 | ||
| INTRODUCTION | 663 | ||
| MECHANISM OF ACTION | 663 | ||
| PATIENT SELECTION AND PREOPERATIVE CONSIDERATIONS | 663 | ||
| EQUIPMENT | 664 | ||
| PROCEDURE | 665 | ||
| COMPLICATIONS | 667 | ||
| PROGRAMMING AND TECHNICAL OVERVIEW | 668 | ||
| SCS TYPES: TRADITIONAL, HIGH-FREQUENCY, AND BURST SCS | 669 | ||
| TRADITIONAL SCS | 669 | ||
| BURST SCS | 669 | ||
| HIGH-FREQUENCY SCS | 669 | ||
| DORSAL ROOT GANGLION STIMULATION | 669 | ||
| OUTCOMES: CLINICAL STUDIES OF TRADITIONAL SCS | 669 | ||
| FAILED BACK SURGERY SYNDROME | 669 | ||
| COMPLEX REGIONAL PAIN SYNDROME | 670 | ||
| PERIPHERAL ISCHEMIA AND ANGINA | 671 | ||
| CLINICAL STUDIES OF BURST SCS | 671 | ||
| CLINICAL STUDIES OF HIGH-FREQUENCY SCS | 673 | ||
| COST EFFECTIVENESS | 674 | ||
| PERIPHERAL, CORTICAL, AND DEEP BRAIN STIMULATION | 674 | ||
| RECOMMENDATIONS | 674 | ||
| KEY POINTS | 674 | ||
| REFERENCES | 675 | ||
| 74 - Peripheral Nerve Stimulation | 677 | ||
| HISTORY AND PATHOPHYSIOLOGY | 677 | ||
| EVIDENCE | 677 | ||
| TECHNICAL CONSIDERATIONS | 678 | ||
| RADIAL NERVE | 678 | ||
| ULNAR NERVE | 678 | ||
| MEDIAN NERVE | 679 | ||
| POPLITEAL AREA | 679 | ||
| COMMON PERONEAL NERVE AND POSTERIOR TIBIAL NERVE | 679 | ||
| SELECTED PERIPHERAL NERVE STIMULATION | 679 | ||
| OCCIPITAL NERVE STIMULATION FOR MIGRAINE | 679 | ||
| HYPOGLOSSAL NERVE STIMULATION FOR SLEEP APNEA | 680 | ||
| ADVERSE EVENTS | 680 | ||
| FUTURE APPLICATIONS OF PERIPHERAL NERVE STIMULATION | 680 | ||
| PERONEAL NERVE STIMULATION FOR FOOT DROP | 680 | ||
| TIBIAL NERVE STIMULATION FOR FECAL INCONTINENCE, OVERACTIVE BLADDER, AND PELVIC PAIN | 680 | ||
| CONCLUSION | 680 | ||
| KEY POINTS | 680 | ||
| 75 - Dorsal Root Ganglion Stimulation | 683 | ||
| INTRODUCTION | 683 | ||
| DORSAL ROOT GANGLION “GATEKEEPER” IN PAIN TRANSMISSION | 683 | ||
| ANATOMY OF THE DORSAL ROOT GANGLION | 683 | ||
| ROLE OF THE DORSAL ROOT GANGLION IN IMPULSE PROPAGATION | 684 | ||
| SOMATOTOPY OF THE DORSAL ROOT GANGLION | 684 | ||
| DORSAL ROOT GANGLION AS TARGET FOR THE TREATMENT OF CHRONIC PAIN | 685 | ||
| DORSAL ROOT GANGLIONECTOMY | 685 | ||
| RADIOFREQUENCY TECHNIQUES ADJACENT TO THE DORSAL ROOT GANGLION | 685 | ||
| NEUROSTIMULATION OF THE DORSAL ROOT GANGLION | 685 | ||
| IN VITRO STUDIES | 686 | ||
| DORSAL ROOT GANGLION STIMULATION IN HUMANS | 686 | ||
| TECHNICAL ASPECTS | 686 | ||
| CLINICAL RESULTS | 686 | ||
| SIDE EFFECTS AND COMPLICATIONS | 690 | ||
| DORSAL ROOT GANGLION STIMULATION IN PERSPECTIVE | 690 | ||
| KEY POINTS | 690 | ||
| REFERENCES | 692 | ||
| 76 - Implanted Drug Delivery Systems for Control of Chronic Pain | 693 | ||
| INTRODUCTION | 693 | ||
| COMPLICATIONS | 693 | ||
| MEDICATION CLASSES | 693 | ||
| OPIOIDS | 694 | ||
| CALCIUM CHANNEL BLOCKERS | 695 | ||
| LOCAL ANESTHETICS | 696 | ||
| GAMMA-AMINOBUTYRIC ACID AGONISTS | 697 | ||
| ALPHA-2 ADRENERGIC AGONISTS | 697 | ||
| CORTICOSTEROIDS | 699 | ||
| CONCLUSION | 700 | ||
| KEY POINTS | 700 | ||
| REFERENCES | 701 | ||
| 77 - Fluoroscopy and Radiation Safety | 703 | ||
| FLUOROSCOPY MACHINE | 705 | ||
| RADIATION SAFETY | 706 | ||
| RADIOBIOLOGY | 707 | ||
| MAXIMUM PERMISSIBLE DOSE | 707 | ||
| RADIATION PROTECTION OF THE PATIENT | 707 | ||
| RADIATION PROTECTION OF PERSONNEL | 709 | ||
| UNDERCOUCH AND OVERCOUCH FLUOROSCOPY | 710 | ||
| BARRIERS AND SHIELDING | 711 | ||
| Lead Aprons | 711 | ||
| Lead Rubber Gloves and Leaded Glasses | 711 | ||
| MINIMIZING AND MONITORING RADIATION | 711 | ||
| ORGANIZATION OF RADIATION PROTECTION | 712 | ||
| RADIOLOGICAL CONTRAST MEDIA | 712 | ||
| ADVERSE REACTIONS TO CONTRAST MEDIA | 713 | ||
| GADOLINIUM AS AN ALTERNATIVE TO IODINATED RADIOGRAPHIC CONTRAST MEDIA | 713 | ||
| KEY POINTS | 714 | ||
| REFERENCES | 714 | ||
| 78 - Efficacy of Interventional Procedures for Neuropathic Pain | 715 | ||
| INTRODUCTION | 715 | ||
| NEURAL BLOCKADE TECHNIQUES | 715 | ||
| THE DIAGNOSTIC VALUE OF NEURAL BLOCKADE | 715 | ||
| Radiculopathy | 716 | ||
| Peripheral Neuropathic Pain | 716 | ||
| Complex Regional Pain Syndrome | 716 | ||
| Summary: Diagnostic Value of Neural Blockade | 716 | ||
| THE THERAPEUTIC VALUE OF NEURAL BLOCKADE | 716 | ||
| Peripheral Compression or Trauma-Related Neuropathic Pain | 717 | ||
| Herpes Zoster | 717 | ||
| Postherpetic Neuralgia | 718 | ||
| Lumbosacral and Cervical Radiculopathy | 718 | ||
| Failed Back Surgery Syndrome With Prominent Radicular Symptoms | 718 | ||
| Complex Regional Pain Syndrome | 719 | ||
| Trigeminal Neuralgia and Trigeminal Neuropathy | 719 | ||
| Painful Diabetic and Other Peripheral Neuropathies | 719 | ||
| Summary: Therapeutic Value of Neural Blockade | 720 | ||
| NEURAL DESTRUCTIVE TECHNIQUES, PULSE RADIOFREQUENCY | 720 | ||
| Postherpetic Neuralgia | 720 | ||
| Cervical and Lumbosacral Radiculopathy | 721 | ||
| Sympathetically Maintained Pain | 722 | ||
| Summary | 722 | ||
| REFERENCES | 722 | ||
| IX - Other Nerve Blocks in Pain Medicine | 723 | ||
| 79 - Ultrasound-Guided Procedures for Pain Management: Spine Injections and Relevant Peripheral Nerve Blocks | 725 | ||
| INTRODUCTION | 725 | ||
| BASICS OF ULTRASOUND | 725 | ||
| AXIAL PROCEDURES | 726 | ||
| INJECTION OF THE CERVICAL FACET JOINT NERVE SUPPLY | 726 | ||
| Sonoanatomy | 726 | ||
| Indications | 726 | ||
| Technique | 726 | ||
| Pearls | 726 | ||
| INJECTION OF THE CERVICAL NERVE ROOT | 727 | ||
| Sonoanatomy | 727 | ||
| Indications | 727 | ||
| Technique | 727 | ||
| Pearls | 727 | ||
| INJECTION OF THE LUMBAR FACET JOINT NERVE SUPPLY | 727 | ||
| INDEX | 825 | ||
| A | 825 | ||
| B | 826 | ||
| C | 827 | ||
| D | 831 | ||
| E | 832 | ||
| F | 833 | ||
| G | 834 | ||
| H | 835 | ||
| I | 836 | ||
| J | 837 | ||
| K | 837 | ||
| L | 838 | ||
| M | 838 | ||
| N | 840 | ||
| O | 842 | ||
| P | 843 | ||
| Q | 846 | ||
| R | 846 | ||
| S | 847 | ||
| T | 850 | ||
| U | 851 | ||
| V | 851 | ||
| W | 852 | ||
| X | 852 | ||
| Y | 852 | ||
| Z | 852 | ||
| IBC | ES2 |