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Book Details
Abstract
For more than 30 years, the highly regarded Secrets Series® has provided students and practitioners in all areas of health care with concise, focused, and engaging resources for quick reference and exam review. Pain Management Secrets, 4th Edition, features the Secrets’ popular question-and-answer format that also includes lists, tables, and an easy-to-read style – making reference and review quick, easy, and enjoyable.
- The proven Secrets Series® format gives you the most return for your time – concise, easy to read, engaging, and highly effective.
- Covers the full range of essential topics in pain management for in-training or practicing professionals.
- Top 100 Secrets and Key Points boxes provide a fast overview of the secrets you must know for success in practice and on exams.
- Fully updated throughout, with new chapters on the latest areas in pain medicine, clear illustrations and figures, and a list of current websites that expedite study and review.
- Written and fully updated by internationally known pain medicine experts, including new editors Drs. Andrew Dubin and Julie Pilitsis.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Pain Management Secrets | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Preface | ix | ||
| Contributors | x | ||
| Acknowledgments | xiii | ||
| Dedication | xv | ||
| Top Secrets | xvi | ||
| I. Overview | 1 | ||
| 1 General Pain Definitions | 1 | ||
| 1. What is pain? | 1 | ||
| 2. What is suffering? | 1 | ||
| 3. What is the difference between impairment and disability? | 1 | ||
| 4. What is meant by “inferred pathophysiology”? | 1 | ||
| 5. What is the definition of nociception? | 1 | ||
| 6. What is a nociceptor? | 2 | ||
| 7. What is the difference between pain threshold and pain tolerance? | 2 | ||
| 8. What is allodynia? | 2 | ||
| 9. What is analgesia? | 2 | ||
| 10. What is the difference between analgesia and anesthesia? | 2 | ||
| 11. What is meant by paresthesia? | 2 | ||
| 12. What is a dysesthesia? | 2 | ||
| 13. What is hypoesthesia? | 2 | ||
| 14. What is formication? | 2 | ||
| 15. What is anesthesia dolorosa? | 2 | ||
| 16. What is meant by neuralgia? | 3 | ||
| 17. What is hyperpathia? | 3 | ||
| 18. What are algogenic substances? | 3 | ||
| 19. What is meant by sensitization? | 3 | ||
| 20. What is a “lancinating” pain? What does its presence imply? | 3 | ||
| 21. Define deafferentation. | 3 | ||
| 22. Describe the gate control theory of pain. | 3 | ||
| 23. What is meant by “breakthrough” pain? | 3 | ||
| 24. True or false: Central pain arises only when the original insult was central. | 4 | ||
| 25. What is meant by referred pain? | 4 | ||
| 26. What is phantom pain? | 4 | ||
| 27. What is meralgia paresthetica? | 4 | ||
| 28. What is the difference between primary and secondary pain syndromes? | 4 | ||
| 29. What is palliative care? | 4 | ||
| 30. What is meant by the term addiction? | 4 | ||
| 31. What is the definition of physical dependence? | 5 | ||
| 32. What is the definition of drug tolerance? | 5 | ||
| 33. What is the definition of pseudoaddiction? | 5 | ||
| Bibliography | 5 | ||
| 2 Classification of Pain | 6 | ||
| 1. List the bases for the most widely used classifications of pain. | 6 | ||
| 2. What is the neurophysiologic classification of pain? | 6 | ||
| 3. What is nociceptive pain? | 6 | ||
| 4. How do patients describe pain of somatic nociceptive origin? | 6 | ||
| 5. How do patients describe pain of visceral nociceptive origin? | 6 | ||
| 6. How do patients describe pain of neuropathic origin? | 6 | ||
| 7. Clinically, how do you distinguish between paresthesia and dysesthesia? | 7 | ||
| 8. What are examples of deafferentation pain? | 7 | ||
| 9. What is the difference between complex regional pain syndromes I and II? | 7 | ||
| 10. Describe “phantom limb” phenomena. | 7 | ||
| 11. How is the Multidimensional Pain Inventory used to classify chronic pain patients? | 7 | ||
| 12. What is meant by psychogenic pain? | 7 | ||
| 13. What is the World Health Organization ladder? | 7 | ||
| 14. What is myofascial pain syndrome? | 8 | ||
| 15. What is the advantage of classifying pain? | 8 | ||
| 16. Describe the temporal classification of pain. What is its shortcoming? | 8 | ||
| 17. How is acute pain defined? | 8 | ||
| 18. How is chronic pain defined? | 8 | ||
| 19. How is chronic pain classified in patients with cancer? | 8 | ||
| 20. What is meant by an etiologic classification? | 8 | ||
| 21. What is the basis of the regional classification of pain? | 8 | ||
| Bibliography | 9 | ||
| 3 Basic Mechanisms | 10 | ||
| 1. What are nociceptors? | 10 | ||
| 2. What properties characterize A delta and C fibers? | 10 | ||
| 3. Distinguish between first and second pain. | 10 | ||
| 4. What are some of the molecules that are unique to the nociceptor? | 10 | ||
| 5. What is NaV1.7? | 10 | ||
| 6. What are TRP channels? | 11 | ||
| 7. How are nociceptors altered by tissue injury? | 11 | ||
| 8. Where do nociceptive fibers enter the spinal cord? | 11 | ||
| 9. Where is the first synapse in the spinal cord? | 11 | ||
| 10. What is meant by a second-order neuron? | 12 | ||
| 11. What is a wide dynamic range neuron? | 12 | ||
| 12. Describe the major ascending pathways that transmit nociceptive information. | 12 | ||
| 13. What are the major neurotransmitters involved in nociception? | 12 | ||
| 14. What are the major neurotransmitters involved in antinociceptive functions? | 12 | ||
| 15. What are the clinical and investigational roles of capsaicin? | 13 | ||
| 16. What is the laminar organization of the dorsal horn of the spinal cord? | 13 | ||
| 17. What is substance P-saporin, and how might it be used to treat chronic pain? | 13 | ||
| 18. How is the spinal cord influenced by peripheral nerve injury? | 13 | ||
| 19. Provide a plausible explanation for the phenomenon of referred pain. | 14 | ||
| 20. What is neurogenic inflammation? | 14 | ||
| 21. How are substance P and calcitonin gene-related peptide implicated in the phenomenon of neurogenic inflammation? | 14 | ||
| 22. Differentiate primary and secondary hyperalgesia | 14 | ||
| 23. What is the contribution of the NMDA receptor to the production of pain? | 15 | ||
| 24. Describe the regions of the thalamus that have been implicated in the processing of nociceptive information. | 15 | ||
| 25. Is there a cortical representation of pain? | 15 | ||
| 26. What do we know about the cortical mechanism underlying the sensory and emotional components of the pain experience? | 15 | ||
| 27. What information do we have on the mechanism of placebo analgesia? | 16 | ||
| Bibliography | 16 | ||
| II. Clinical Assessment | 17 | ||
| 4 History Taking in the Patient With Pain | 17 | ||
| 1. What are the key elements in taking the clinical history of a patient with a complaint of pain? | 17 | ||
| 2. If pain is a purely subjective phenomenon, how can its intensity be measured? | 17 | ||
| 3. How should pain intensity be recorded? | 18 | ||
| 4. Can pain intensity be measured in children, the older person, and the cognitively impaired? | 18 | ||
| 5. What information can be gathered from the character of the pain? | 18 | ||
| 6. Why are the temporal characteristics of pain important? | 18 | ||
| 7. Why is the temporal course of the pain important? | 18 | ||
| 8. What is the best way to elicit the time course of a pain syndrome if the patient is having difficulty being specific? | 18 | ||
| 9. What is the importance of ascertaining exacerbating and relieving factors? | 18 | ||
| 10. A patient complains of back and leg pain but has trouble describing the exact distribution. What can you do to clarify the matter? | 19 | ||
| 11. A patient has a rather nondescript headache that is getting worse over days to weeks. What should you consider? | 19 | ||
| 12. An 80-year-old woman complains of severe pain in the chest wall after having a rash in that area. You made the diagnosis of postherpetic neuralgia and plan to use a tricyclic antidepressant. What questions should you ask in the history? | 19 | ||
| 13. What specific questions should be asked about the medical history in patients with complaint of pain? | 19 | ||
| 14. How does the family history affect a patient with pain? | 19 | ||
| 15. Is history of disability benefits of any importance? | 20 | ||
| 16. Are there any helpful clues in the history taking of a patient with ischial bursitis—“weaver’s bottom”—that help to support the diagnosis? | 20 | ||
| 17. What are some elements that could help to determine residual function? | 20 | ||
| Acknowledgment | 20 | ||
| Bibliography | 21 | ||
| Suggested Readings | 21 | ||
| 5 Physical Examination of the Patient With Pain | 22 | ||
| 1. Why does a physician, nurse practitioner, physician assistant, or other person directly evaluating and caring for patients need to do physical examination when evaluating a patient who presents with pain? | 22 | ||
| 2. What is the medial hamstring reflex, and what are its implications? | 22 | ||
| 3. What are the elements of testing lateral neck range of motion, and what is the significance of limited neck range of motion? | 22 | ||
| 4. What is a Spurling test, and what are the implications of a positive test? | 22 | ||
| 5. Under what circumstances is the chest expansion test used? | 22 | ||
| 6. What is the straight leg raising test, and what are its implications? | 23 | ||
| 7. What is a sitting root test? | 23 | ||
| 8. What is the FABER test, and how is it different from the Patrick maneuver? | 23 | ||
| 9. What is the tipped can test, and what are its implications? | 23 | ||
| 10. How is the iliopsoas muscle evaluated? | 23 | ||
| 11. What is the scarf test, and what are its implications? | 23 | ||
| 12. How is the piriformis syndrome evaluated? | 24 | ||
| 13. What is involved in the evaluation of chronic leg pain in the athlete? | 24 | ||
| 14. What are the examination differences between tender and trigger points when examining musculoskeletal system? | 24 | ||
| 15. What are the components of the abdominal examination, and what are their implications? | 24 | ||
| 16. How is the sensory examination conducted to demonstrate the presence or absence of painful neuropathy (i.e., of neuropathic pain)? | 24 | ||
| 17. How can you differentiate between an L4 and an L5 radiculopathy on physical exam? | 25 | ||
| 18. What is the most sensitive muscle on manual muscle testing to assess for an S1 radiculopathy? | 25 | ||
| Bibliography | 25 | ||
| 6 Specific Pain Measurement Tools | 26 | ||
| 1. Which major aspects or dimensions of pain and suffering must be considered when assessing pain? | 26 | ||
| 2. Describe the analog, numerical, and category scales. Which is most suitable for use with patients? | 26 | ||
| 3. What does a score obtained from the overall pain rating mean? | 26 | ||
| 4. What is the difference between a rating scale and a questionnaire? | 26 | ||
| 5. What is the Brief Pain Inventory? | 26 | ||
| 6. How is pain assessed in patients who cannot communicate verbally, such as infants and cognitively impaired or aphasic adults? | 26 | ||
| 7. What is the effect on the physician-patient relationship when giving the patient a psychologic status questionnaire? | 27 | ||
| 8. Are there assessment tools that would assist in measurement of different components of neuropathic pain? | 27 | ||
| 9. What are the two essential characteristics of a rating scale or questionnaire? | 27 | ||
| 10. What is a reliable measure? Name three types of reliability tests. | 27 | ||
| 11. What is meant by the validity of a questionnaire? | 27 | ||
| 12. What have brain imaging studies revealed about the dimensions of pain? | 27 | ||
| Bibliography | 28 | ||
| 7 Behavioral Assessment of Patients With Chronic Pain | 29 | ||
| 1. Why are psychological factors important in the evaluation of a patient experiencing pain? | 29 | ||
| 2. What is the prevalence of psychological comorbidities in patients with chronic pain? | 29 | ||
| 3. What are the recommendations for psychological assessment of patients with chronic pain? | 29 | ||
| 4. What are the barriers to psychological assessment? | 29 | ||
| 5. What are the components of a proper behavior assessment? | 29 | ||
| 6. What are the elements of a proper clinical interview? | 30 | ||
| 7. What is a somatoform disorder? | 30 | ||
| 8. What is a factitious disorder? | 30 | ||
| 9. What is a personality disorder? | 30 | ||
| 10. What is secondary gain? | 30 | ||
| 11. Why perform psychometric assessment? | 30 | ||
| 12. Why it is important to evaluate the validity of the patient’s psychological evaluation? | 30 | ||
| 13. What is the Minnesota Multiphasic Personality Inventory? | 31 | ||
| 14. What MMPI scales are the most predictive of outcomes? | 31 | ||
| 15. What other psychometric scales are frequently used to assess pain? | 31 | ||
| 16. What tools are commonly used to track functional outcomes in patients with pain? | 31 | ||
| 17. Do childhood psychological factors influence surgical outcome? | 31 | ||
| 18. What items should be explored in relation to a person’s employment? | 31 | ||
| 19. How does chronic pain affect a person’s social interactions? | 32 | ||
| 20. What types of gender-specific pain responses are there? | 32 | ||
| 21. What psychosocial factors may be predictive of worse outcome from treatment for pain? | 32 | ||
| 22. Why perform presurgical psychological assessment? | 32 | ||
| 23. Can clinicians best identify those patients with psychological comorbidities? | 32 | ||
| 24. What types of psychological risk factors influence surgical outcome? | 32 | ||
| 25. What is the effect of psychological factors on surgical outcomes? | 32 | ||
| 26. How do psychometric scales predict outcome from surgery for pain conditions? | 33 | ||
| 27. Do psychometric scales predict return to work after surgery for pain? | 33 | ||
| 28. How does psychological evaluation relate to outcome from neuromodulation for pain? | 33 | ||
| 29. What is the best way to approach referral for behavioral assessment? | 33 | ||
| Bibliography | 34 | ||
| 8 Neuroimaging in the Patient With Pain | 35 | ||
| 1. What are the main modalities used to image patients in pain and advantages and disadvantages of each? | 35 | ||
| 2. What are T1 and T2 magnetic resonance imaging sequences? | 35 | ||
| 3. Is “open” magnetic resonance imaging as good as regular magnetic resonance imaging? | 35 | ||
| 4. What are contraindications to magnetic resonance imaging? | 35 | ||
| 5. How are radiography, magnetic resonance imaging, and computed tomography complementary for the evaluation of the patient with back pain? | 36 | ||
| 6. When is computed tomography of the spine useful versus magnetic resonance imaging? | 36 | ||
| 7. How do I know which test to order? | 36 | ||
| 8. What indications require contrast? | 36 | ||
| 9. What signs help differentiate a benign and pathologic compression fracture? | 36 | ||
| 10. What types of imaging are best for suspected cranial nerve vascular compression syndromes as a cause of pain? | 37 | ||
| 11. In the patient with back pain, what are considered “red flags” for more rapid progression to advanced imaging techniques such as magnetic resonance imaging versus conservative therapy? | 37 | ||
| 12. Case: A 25-year-old male presents with severe pain after a motor vehicle accident, with point tenderness over the lower thoracic region at about T10 to T12 and leg weakness. What is the most appropriate modality for initial evaluation in the emergency department? | 37 | ||
| 13. Case: A 40-year-old female with a known history of IV drug abuse presents with fever, back pain, and urinary incontinence. What is the best modality for workup? Should contrast be used? | 37 | ||
| 14. What is functional magnetic resonance imaging and how does it work? | 37 | ||
| References | 38 | ||
| 9 Chronic Pelvic Pain | 39 | ||
| Common Presenting Complaints and Symptoms | 39 | ||
| Bibliography | 42 | ||
| III. Painful Clinical Syndromes | 43 | ||
| 10 Urgent Issues in Pain | 43 | ||
| 1. What is acute pain? | 43 | ||
| 2. What is radiculopathy? | 43 | ||
| 3. When does radiculopathy require urgent care? | 43 | ||
| 4. How can pain be medically managed? | 43 | ||
| 5. How can physical therapy be a curative treatment of radiculopathy? | 43 | ||
| 6. How effective are epidural injections in previously irresponsive patients? | 43 | ||
| 7. When is it appropriate to use selective diagnostic nerve root block in addition to magnetic resonance imaging and electromyography? | 43 | ||
| 8. What is cauda equina syndrome? | 43 | ||
| 9. What is herpes zoster or shingles? | 44 | ||
| 10. What are the initial symptoms of herpes zoster? | 44 | ||
| 11. How easily is herpes zoster treated? | 44 | ||
| 12. Why does postherpetic neuralgia occur? | 44 | ||
| 13. How are acute neuritis and postherpetic neuralgia treated? | 44 | ||
| 14. When does care for complex regional pain syndrome become urgent? | 44 | ||
| 15. What are status migraines? | 44 | ||
| 16. What are the treatment options for status migraines and refractory migraines? | 44 | ||
| Bibliography | 45 | ||
| 11 Migraine | 46 | ||
| 1. Is migraine an important public health problem? | 46 | ||
| 2. What are the phases of the migraine attack? | 46 | ||
| 3. Describe the premonitory phase. | 46 | ||
| 4. Describe the aura. | 46 | ||
| 5. How do you differentiate migraine aura from other kinds of focal episodes of neurologic dysfunction? | 46 | ||
| 6. What are the characteristics of the headache phase? | 47 | ||
| 7. What is the resolution phase? | 47 | ||
| 8. What feature or features are absolutely required to diagnose migraine? | 47 | ||
| 9. Describe considerations for diagnostic testing. | 48 | ||
| 10. What diagnostic tests are required to establish the diagnosis of migraine? | 48 | ||
| 11. Why is migraine considered a neurologic disease? | 48 | ||
| 12. Describe the mechanism of the aura. | 48 | ||
| 13. What is the substrate of migraine pain? | 49 | ||
| 14. What is the role of serotonin in migraine? | 49 | ||
| 15. What role might serotonin receptors play in migraine? | 49 | ||
| 16. What is the role of genetics in the pathophysiology of migraine? | 49 | ||
| 17. List the steps in managing migraine. | 49 | ||
| 18. How do you help patients identify their headache triggers? | 50 | ||
| 19. What other nonpharmacologic options for migraine treatment are available? | 50 | ||
| 20. Is migraine associated with psychiatric disease? | 50 | ||
| 21. Differentiate acute and preventive pharmacotherapy for migraine. | 51 | ||
| 22. What is an appropriate strategy for migraine pharmacotherapy? | 51 | ||
| 23. How do the migraine-specific acute treatments work? | 51 | ||
| 24. What triptans are available? | 51 | ||
| 25. How do the available triptans compare? | 51 | ||
| 26. How do you choose from among the acute treatment options? | 51 | ||
| 27. What is the role of triptans in acute migraine therapy? | 52 | ||
| 28. When should acute medications be given during the migraine attack? | 52 | ||
| 29. What are the contraindications for the triptans? | 52 | ||
| 30. How do you treat the nausea and vomiting of migraine? | 52 | ||
| 31. What is the role of opiates in the treatment of migraine? | 52 | ||
| 32. What is the role of transnasal butorphanol (Stadol)? | 53 | ||
| 33. Who should get preventive therapy? | 53 | ||
| 34. What are the preventive treatment choices? | 53 | ||
| 35. How do you choose from among the preventive treatment options? | 53 | ||
| 36. What are the principles of using preventive drugs? | 53 | ||
| 37. What is chronic or transformed migraine? | 55 | ||
| 38. Why is chronic migraine a formidable therapeutic challenge? | 55 | ||
| 39. How is chronic migraine treated? | 55 | ||
| 40. Who needs inpatient treatment, and why? | 55 | ||
| 41. What are the emerging treatments for migraines? | 55 | ||
| Bibliography | 56 | ||
| 12 Cluster Headache | 57 | ||
| 1. What is a cluster headache? | 57 | ||
| 2. Are cluster headaches common? Who is affected? | 57 | ||
| 3. What are the characteristics of cluster headaches? | 57 | ||
| 4. When do bouts occur? | 57 | ||
| 5. What is the explanation for periodicity of cluster headache? | 57 | ||
| 6. What is known about the pathophysiology of cluster headaches? | 58 | ||
| 7. Are cluster headaches triggered by the same things as migraine? | 58 | ||
| 8. Are there different types of cluster? | 58 | ||
| 9. How are cluster headaches diagnosed? | 59 | ||
| 10. How is cluster headache differentiated from the paroxysmal hemicranias? | 59 | ||
| 11. How do you determine whether a headache is cluster or migraine? | 59 | ||
| 12. How is cluster headache differentiated from hemicrania continua? | 60 | ||
| 13. Is it possible to prevent cluster attacks? | 60 | ||
| 14. How long should prophylactic therapy be continued? | 60 | ||
| 15. How are acute attacks treated? | 61 | ||
| 16. If these medications fail to break the attacks, what else can be done? | 61 | ||
| 17. Name a few potentially dangerous syndromes that can present with symptoms similar to cluster headache. | 61 | ||
| Bibliography | 61 | ||
| 13 Tension-Type Headache | 63 | ||
| 1. Is there a medical term for the headaches of everyday life? | 63 | ||
| 2. What is meant by “primary” and “secondary” headache? | 63 | ||
| 3. What is the approach to diagnosing tension-type headache? | 63 | ||
| 4. How is tension-type headache defined? | 63 | ||
| 5. What is the frequency of tension-type headache? | 63 | ||
| 6. Are there different types of tension-type headache? | 63 | ||
| 7. Discuss chronic tension-type headache in relation to chronic migraine | 63 | ||
| 8. What is the differential diagnosis of tension-type headache? | 64 | ||
| 9. How are tension-type headache and migraine differentiated? | 64 | ||
| 10. How are tension-type headache and sinus headache differentiated? | 64 | ||
| 11. What is the pathophysiology of tension-type headache? | 64 | ||
| 12. Is tension-type headache a genetic disorder? | 64 | ||
| 13. What are the approaches to treating tension-type headache? | 64 | ||
| 14. What are trigger factors? | 65 | ||
| 15. True or false: Caffeine can trigger a headache. | 65 | ||
| 16. What are the nonpharmacologic treatment options for episodic tension-type headache? | 65 | ||
| 17. What are the acute treatment options for episodic tension-type headache? | 65 | ||
| 18. What is rebound headache? | 65 | ||
| 19. Why is caffeine found in so many headache remedies? | 65 | ||
| 20. Do preventive medications have a role in the treatment of tension-type headache? | 65 | ||
| 21. What are the preventive treatments of choice for tension-type headache? | 66 | ||
| 22. Are the management approaches for chronic tension-type headache and episodic tension-type headache the same or different? | 66 | ||
| Bibliography | 66 | ||
| 14 The Paroxysmal Hemicranias | 67 | ||
| 1. What are the paroxysmal hemicranias? | 67 | ||
| 2. Are there different clinical variations of the paroxysmal hemicranias? | 67 | ||
| 3. What distinguishes the paroxysmal hemicranias from cluster headache? | 67 | ||
| 4. Do the paroxysmal hemicranias differ pathophysiologically from cluster headache? | 67 | ||
| 5. Does it matter whether we call these headaches clusters or paroxysmal hemicranias? | 68 | ||
| 6. Once the diagnosis of episodic or chronic paroxysmal hemicrania is established, are any further workups necessary? | 68 | ||
| 7. Once the diagnosis is established and neuroimaging is normal, how are these headaches treated? | 68 | ||
| 8. True or false: Breakthrough headaches do not occur with indomethacin therapy. | 68 | ||
| 9. If indomethacin fails to treat the headaches, what then? | 68 | ||
| 10. What is SUNCT and SUNA syndrome? | 68 | ||
| 11. How are SUNCT and SUNA treated? | 69 | ||
| Bibliography | 69 | ||
| IV. Uncommon Headache Syndromes | 71 | ||
| 15 Subarachnoid Hemorrhage | 71 | ||
| 1. How is the headache of subarachnoid hemorrhage often described? | 71 | ||
| 2. What is a sentinel headache? | 71 | ||
| 3. What is the most common cause of spontaneous subarachnoid hemorrhage? | 71 | ||
| 4. What is the prevalence of saccular aneurysms? | 71 | ||
| 5. What are possible physical examination findings in a patient with subarachnoid hemorrhage? | 71 | ||
| 6. How is the diagnosis of subarachnoid hemorrhage made? | 71 | ||
| 7. What are the criteria from the International Headache Society for subarachnoid hemorrhage? | 71 | ||
| 8. What is the pathophysiologic cause of a headache from subarachnoid hemorrhage? | 72 | ||
| 9. What are potential causes for a delayed headache in a patient with subarachnoid hemorrhage? | 73 | ||
| 10. How should the headache from subarachnoid hemorrhage be treated? | 73 | ||
| Bibliography | 73 | ||
| 16 Pain Associated with Brain Tumor | 74 | ||
| 1. What is the classic description of brain tumor headache? | 74 | ||
| 2. What was the theoretical basis for the pathophysiology of classic brain tumor headache? | 74 | ||
| 3. How commonly do patients with brain tumors have the “classic history” of a brain tumor headache? | 74 | ||
| 4. How often do brain tumor headaches determine the localization and laterality of brain tumors? | 74 | ||
| 5. If brain tumor headaches are most commonly tension like, how do you differentiate between a benign tension-type headache and a brain tumor headache? | 74 | ||
| 6. What “red flags” should prompt evaluation for a brain tumor? | 75 | ||
| 7. Name and describe circumstances under which extracerebral cancer can cause headache and/or facial pain. | 75 | ||
| 8. Is the pathology of the brain tumor important in determining the clinical presentation? | 75 | ||
| 9. What is Parinaud syndrome? | 75 | ||
| 10. What is a “ball-valve” headache? | 76 | ||
| 11. How commonly is headache the presenting complaint in patients with metastatic brain tumors? | 76 | ||
| 12. In what clinical scenarios does a brain tumor headache require urgent treatment? | 76 | ||
| 13. Which systemic tumors commonly metastasize to the brain and why do they cause headache? | 76 | ||
| 14. Under what circumstances is a brain tumor likely to produce severe headaches with little or no neurologic focality? | 76 | ||
| 15. Do primary brain tumors cause headaches? | 77 | ||
| 16. What is the preferred treatment for brain tumor headaches? | 77 | ||
| 17. What percentage of brain tumor patients experience headaches? | 77 | ||
| 18. What is pituitary apoplexy, and how do affected patients commonly present? | 77 | ||
| 19. A 60-year-old woman complains of progressive, unilateral headache and facial pain. On examination, she shows nystagmus, hearing loss, facial weakness, and ataxia. What is the likely diagnosis? | 77 | ||
| 20. A middle-aged man has progressive headaches and is found to have a frontal glioma. His headaches become worse, and he develops diplopia that is most pronounced on distant gaze and not present on near gaze. What is a likely explanation? | 77 | ||
| 21. A 60-year-old man with glioblastoma has undergone a full course of radiation therapy with some improvement. Six months later, he complains of increasing headache and increasing neurologic deficits referable to the area of the original tumor. What is the differential diagnosis? How would you differentiate between the two main possibilities? | 78 | ||
| Acknowledgment | 78 | ||
| Bibliography | 78 | ||
| 17 Headache Related to Increased or Decreased Intracranial Pressure | 79 | ||
| 1. What is the normal range for intracranial pressure and how is it measured? | 79 | ||
| 2. Describe the Monro-Kellie doctrine. | 79 | ||
| 3. Under what circumstances is the pressure measured by lumbar puncture not a true reflection of intracranial pressure? | 79 | ||
| 4. How is cerebrospinal fluid formed and reabsorbed? | 79 | ||
| 5. Why does increased or decreased intracranial pressure cause headaches? | 79 | ||
| 6. What clinical characteristics suggest headache is due to elevated intracranial pressure? | 80 | ||
| 7. What neurologic signs can be seen with diffuse increases in intracranial pressure? | 80 | ||
| 8. Describe the risks of performing lumbar puncture in patients with increased intracranial pressure. | 80 | ||
| 9. Name the elements that define “Cushing’s triad.” | 81 | ||
| 10. What is idiopathic intracranial hypertension? | 81 | ||
| 11. What are the diagnostic criteria for idiopathic intracranial hypertension? | 81 | ||
| 12. Describe the proper workup of a patient with suspected idiopathic intracranial hypertension. | 81 | ||
| 13. What are the main complications of untreated idiopathic intracranial hypertension? | 81 | ||
| 14. Describe the treatments for idiopathic intracranial hypertension. | 81 | ||
| 15. What are some mimics of idiopathic intracranial hypertension? | 81 | ||
| 16. How do brain tumors cause increased intracranial pressure? | 81 | ||
| 17. What are low-pressure headaches, and what are the clinical characteristics? | 82 | ||
| 18. Name some common causes of intracranial hypotension. | 82 | ||
| 19. How can low-pressure headache be diagnosed? | 82 | ||
| 20. Describe the treatment options for low-pressure headaches. | 82 | ||
| Acknowledgments | 82 | ||
| Bibliography | 83 | ||
| 18 Headache and Pain Syndromes Associated With Emergent and Chronic Systemic Disease | 84 | ||
| 1. How often are headaches a manifestation of systemic disease? | 84 | ||
| 2. What do patients believe is the most common systemic cause for episodic headaches? | 84 | ||
| 3. What is the most common systemic cause of headache? | 84 | ||
| 4. Describe the headache characteristics associated with Lyme disease. | 84 | ||
| 5. What exogenous substances can precipitate pain or headache? | 85 | ||
| 6. What is the typical presentation for colloid cyst headache? | 85 | ||
| 7. Describe the painful neuropathy associated with diabetes. | 85 | ||
| 8. In what degenerative diseases of the nervous system is headache or pain a common complaint? | 85 | ||
| 9. Which central nervous system vasculitides present with headache early in the course of the disease? | 86 | ||
| 10. Describe the pain patterns that are seen in systemic lupus erythematosus. | 86 | ||
| 11. How frequently is headache/pain associated with ischemic cerebrovascular disease? | 86 | ||
| Bibliography | 86 | ||
| 19 Trigeminal Neuralgia | 87 | ||
| 1. What is trigeminal neuralgia? | 87 | ||
| 2. What are common causes of trigeminal neuralgia? | 87 | ||
| 3. How is trigeminal neuralgia diagnosed? | 87 | ||
| 4. How is trigeminal neuralgia treated? | 87 | ||
| 5. How effective are medications as treatments for trigeminal neuralgia? | 87 | ||
| 6. What is microvascular decompression and when is it an appropriate treatment? | 88 | ||
| 7. What are additional procedures to treat trigeminal neuralgia? | 88 | ||
| 8. What is different about trigeminal neuralgia in multiple sclerosis? | 88 | ||
| Bibliography | 88 | ||
| 20 Glossopharyngeal and Other Facial Neuralgias | 89 | ||
| 1. What is glossopharyngeal neuralgia? | 89 | ||
| 2. How does glossopharyngeal neuralgia present? | 89 | ||
| 3. How common is glossopharyngeal neuralgia? | 89 | ||
| 4. What is the etiology of glossopharyngeal neuralgia? | 89 | ||
| 5. How is glossopharyngeal neuralgia diagnosed? | 89 | ||
| 6. What is the pharmacologic treatment for glossopharyngeal neuralgia? | 89 | ||
| 7. What are the surgical options for treatment of glossopharyngeal neuralgia? | 89 | ||
| 8. Describe the presentation and treatment of geniculate neuralgia. | 89 | ||
| 9. What is Ramsay-Hunt syndrome? | 90 | ||
| 10. What is the most common presentation of acute herpes zoster of the face? | 90 | ||
| 11. Describe the presentation and treatment of occipital neuralgia. | 90 | ||
| 12. What is Tolosa-Hunt syndrome? | 90 | ||
| 13. What is superior laryngeal neuralgia? | 90 | ||
| 14. Define sphenopalatine neuralgia. | 90 | ||
| Acknowledgments | 90 | ||
| Bibliography | 91 | ||
| 21 Acute and Chronic Low Back Pain | 92 | ||
| Acute Pain | 92 | ||
| What is a lumbar strain? | 92 | ||
| Tell me about lumbar radiculopathy? | 92 | ||
| What is spondylolysis? How must one evaluate and treat this injury? | 93 | ||
| What are common sources of spinal infection? | 93 | ||
| Tell me about epidural abscesses? | 94 | ||
| Please explain what a vertebral compression fracture is? | 94 | ||
| Chronic Pain | 94 | ||
| What is facet arthritis? | 94 | ||
| What is lumbar stenosis? How does is present? | 95 | ||
| What is sacroiliac joint dysfunction? | 95 | ||
| How does diabetic amyotrophy present? | 95 | ||
| Bibliography | 96 | ||
| 22 Acute and Chronic Neck and Arm Pain | 97 | ||
| What are certain features of the cervical spine? Tell about common injuries affecting the cervical spine? | 97 | ||
| What are common presentations of cervical radiculopathy? | 98 | ||
| Please go over some changes that may be seen on physical examination | 98 | ||
| Please go over common imaging and testing modalities for neck pain | 98 | ||
| Please go over common treatment options for neck pain | 99 | ||
| Bibliography | 99 | ||
| 23 Abdominal Pain | 101 | ||
| 1. What are the three afferent relays that mediate perception of abdominal pain? | 101 | ||
| 2. How does the perceived pain differ between the three pain pathways? | 101 | ||
| 3. Can abdominal pain be caused by extra abdominal disorders? | 101 | ||
| 4. List some of the well-recognized thoracic disorders that can present as abdominal pain. | 101 | ||
| 5. What are some diagnostic considerations in women with abdominal pain? | 101 | ||
| 6. Can the location of abdominal pain be useful in determining the etiology of the pain? | 101 | ||
| 7. List common gastrointestinal causes of pain in the right upper quadrant: | 102 | ||
| 8. What are common causes of left upper quadrant pain, and which abdominal organs are often involved? | 102 | ||
| 9. What are common causes of lower abdominal pain? What organ systems are commonly involved? | 102 | ||
| 10. What historical attributes must always be asked about when obtaining the history from a patient with abdominal pain? | 102 | ||
| 11. What is dyspepsia, and how is it classified? | 103 | ||
| 12. What is the most common organic cause of dyspepsia? | 103 | ||
| 13. What “alarm features” should be elicited in patients with dyspepsia? | 103 | ||
| 14. What tests may be used to diagnose common causes of dyspepsia? | 103 | ||
| 15. How is dyspepsia treated? | 103 | ||
| 16. Name three complications of untreated peptic ulcer disease. | 104 | ||
| 17. What complications can arise from chronic Helicobacter pylori infection? | 104 | ||
| 18. What is acute pancreatitis? How is acute pancreatitis diagnosed? | 104 | ||
| 19. What are the two most common causes of acute pancreatitis? Name some additional causes of pancreatitis. | 104 | ||
| 20. Name two physical exam findings that are characteristic of severe acute pancreatitis. | 104 | ||
| 21. What is chronic pancreatitis? How is chronic pancreatitis diagnosed? | 104 | ||
| 22. Name three differences between acute and chronic pancreatitis. | 105 | ||
| 23. How do patients with biliary pain typically describe their symptoms? | 105 | ||
| 24. Why is the commonly used term biliary colic a misnomer? | 105 | ||
| 25. What are the differences between cholelithiasis, cholecystitis, choledocholithiasis, and cholangitis? How are patients with these disorders managed? | 105 | ||
| 26. What is Charcot’s triad? Reynolds’ pentad? | 105 | ||
| 27. How is pain originating from the small bowel usually characterized? What are common causes of small bowel pain? | 105 | ||
| 28. What are the most common causes of small bowel obstruction? What mnemonic can be used to remember them? | 106 | ||
| 29. What term describes the group of gastrointestinal disorders related to inadequate blood flow? | 106 | ||
| 30. What is the difference in presentation between acute and chronic mesenteric ischemia? How is this difference explained by the underlying pathophysiology? | 106 | ||
| 31. When is treatment indicated for chronic mesenteric ischemia? Why is treatment important? | 106 | ||
| 32. What causes liver-related abdominal pain? Do patients with chronic liver disease typically have liver-related abdominal pain? | 106 | ||
| 33. What are the two subtypes of inflammatory bowel disease, and how does pain typically present in inflammatory bowel disease patients? | 107 | ||
| 34. What is irritable bowel syndrome, and how is it subcategorized? | 107 | ||
| 35. What criteria are used to diagnose irritable bowel syndrome? | 107 | ||
| 36. What treatment options are available for patients with irritable bowel syndrome? | 107 | ||
| 37. How can abdominal pain caused by disorders of the abdominal wall be distinguished from pain of intraabdominal origin? | 107 | ||
| 38. Patients who are immunocompromised by virtue of disease or immunosuppressive therapy may present with abdominal pain. What are some diagnostic considerations? | 107 | ||
| 39. What are some of the caveats about atypical presentations of abdominal pain? | 107 | ||
| Acknowledgments | 108 | ||
| Bibliography | 108 | ||
| 24 Chronic Pelvic Pain | 109 | ||
| Common Presenting Complaints and Symptoms | 109 | ||
| Bibliography | 112 | ||
| 25 Fibromyalgia and Myofascial Pain | 113 | ||
| 1. What are the chronic pain syndromes that involve muscle and fascia? | 113 | ||
| 2. Describe the myofascial pain syndrome. | 113 | ||
| 3. What is fibromyalgia? | 113 | ||
| 4. What are the latest criteria for the diagnosis of Fibromyalgia? | 113 | ||
| 5. Do all fibromyalgia patients have the same symptoms? | 114 | ||
| 6. Name syndromes that are associated with fibromyalgia. | 114 | ||
| 7. What are trigger points? | 114 | ||
| 8. What are “taut bands”? How are they associated with trigger points? | 114 | ||
| 9. Describe the prevalence and typical demographics of the fibromyalgia patient | 115 | ||
| 10. What laboratory investigations are useful in fibromyalgia? | 115 | ||
| 11. What treatments are commonly used for fibromyalgia and for myofascial pain? | 115 | ||
| 12. Describe the role of physical therapy modalities in the treatment of myofascial pain. | 115 | ||
| 13. Which medications are commonly used in the treatment of fibromyalgia and myofascial pain syndrome? | 115 | ||
| 14. What are some other interventions that have been studied for the treatment of fibromyalgia? | 115 | ||
| 15. Is exercise useful in the treatment of fibromyalgia and myofascial pain syndrome? | 116 | ||
| 16. What are the proposed pathophysiologic mechanisms for fibromyalgia? | 116 | ||
| 17. How is sleep disturbance related to fibromyalgia? | 116 | ||
| 18. What is the “spray and stretch” technique? | 116 | ||
| 19. Are there any factors that can precipitate the onset of fibromyalgia? | 117 | ||
| 20. What drugs have recently been added to the list of medications used in the symptomatic treatment of fibromyalgia? | 117 | ||
| 21. Are there any alternative therapeutic options for the treatment of myofascial syndrome? | 117 | ||
| 22. Are there any acute treatments that can be used to lessen the pain of fibromyalgia during a flare-up of this condition? | 117 | ||
| Bibliography | 117 | ||
| V. Soft-Tissue Pain Syndromes | 119 | ||
| 26 Postoperative Pain Management | 119 | ||
| 1. Discuss the pathophysiology of postoperative pain. | 119 | ||
| 2. Describe the phenomenon of peripheral and central sensitization. | 119 | ||
| 3. What are the predictors of postoperative pain? | 119 | ||
| 4. What is preventive analgesia? | 119 | ||
| 5. Describe your options using nonsteroidal antiinflammatory drugs in the perioperative period. | 119 | ||
| 6. Describe the benefit of intravenous, patient controlled (IV PCA) versus intravenous, intramuscular, and transdermal iontophoretic pain medication administration. | 120 | ||
| 7. How do local anesthetics block nerve function? | 120 | ||
| 8. What is the role of local anesthetics in postoperative pain management? | 120 | ||
| 9. Does regional analgesia influence surgical outcome? | 120 | ||
| 10. What could be examples of appropriate regional analgesia for perioperative pain management in shoulder arthroplasty, thoracotomy, inguinal hernia repair, laparotomy, hip arthroplasty, and knee arthroplasty? | 120 | ||
| 11. What does multimodal analgesia mean? What are its benefits? | 121 | ||
| 12. When should the postoperative pain management treatment start? | 121 | ||
| 13. Describe the role of ketamine in postoperative pain management. | 121 | ||
| 14. Describe the negative effects of the untreated or undertreated postoperative pain. | 121 | ||
| 15. What is the current concept of background continuous infusion with intravenous patient controlled analgesia? | 121 | ||
| 16. What are the special considerations of opioid use for postoperative pain control when using in geriatric patients? | 121 | ||
| 17. What are the special considerations of opioid use for postoperative pain control with children? | 121 | ||
| 18. Which opioid neuraxial administration has higher chances of resulting in delayed respiratory depression? Why? | 122 | ||
| 19. How would you treat opioid related pruritis? | 122 | ||
| 20. What are your options to treat opioid-induced nausea and vomiting? | 122 | ||
| 21. How would you treat opioid related constipation? | 122 | ||
| 22. How would you treat opioid-related respiratory depression in the postoperative setting? | 122 | ||
| 23. What are the specific goals of postoperative pain management after total knee arthroplasty? | 122 | ||
| 24. Is the thoracic paravertebral block superior to thoracic epidural analgesia? | 122 | ||
| 25. What is your postoperative pain management strategy treating patients with opioid tolerance due to chronic pain and chronic opioid use? | 123 | ||
| 26. What is opioid-induced hyperalgesia? | 123 | ||
| 27. How does preoperative buprenorphine treatment influence postoperative pain management strategies? | 123 | ||
| Bibliography | 123 | ||
| 27 Cancer Pain | 124 | ||
| 1. What causes pain in patients with cancer? | 124 | ||
| 2. Which common types of cancer cause inflammatory pain? | 124 | ||
| 3. What causes neuropathic pain in patients with cancer? | 124 | ||
| 4. How common is nociceptive pain in cancer? | 124 | ||
| 5. How common is neuropathic pain in patients with cancer? | 124 | ||
| 6. How does cancer treatment cause pain? | 124 | ||
| 7. Is it common for patients with cancer to have more than one painful site? | 125 | ||
| 8. Which types of malignancies are least likely to be painful? | 125 | ||
| 9. Which neuropathic pain syndromes are commonly seen in patients with cancer? | 125 | ||
| 10. What is the postthoracotomy pain syndrome? | 125 | ||
| 11. Why do women treated with radical mastectomy have a numb area just distal to the axilla on the upper part of the arm? | 125 | ||
| 12. What is the most common site for tumor infiltration of the brachial plexus? | 125 | ||
| 13. What are the clinical differences between radiation injury to the brachial plexus and tumor involvement of the plexus? | 125 | ||
| 14. Is phantom limb sensation common after amputation? | 125 | ||
| 15. What is the most common cause of lumbosacral plexopathy? | 126 | ||
| 16. What are the pain-sensitive structures in bones and joints? | 126 | ||
| 17. Do nonsteroidal antiinflammatory drugs have direct tumor effects? | 126 | ||
| 18. What are paraneoplastic syndromes and do they cause pain? | 126 | ||
| 19. What other pain syndromes occur in patients with cancer? | 126 | ||
| 20. Are opioids known to increase the risk for acute herpes zoster? Are they associated with risk for subsequent postherpetic neuralgia? | 126 | ||
| 21. Are additional symptoms common in patients with cancer who are experiencing pain? | 127 | ||
| 22. What is meant by “incident pain?” | 127 | ||
| 23. How is “incident pain” different from “breakthrough pain”? | 127 | ||
| 24. What are the oncologic emergencies that cause pain? | 127 | ||
| 25. Are there recommended guidelines or protocols for management of cancer pain? | 127 | ||
| 26. What are the initial National Comprehensive Cancer Network recommendations for cancer pain screening and assessment? | 127 | ||
| 27. Summarize the National Comprehensive Cancer Network approach to management of cancer pain that is not related to oncologic emergency. | 127 | ||
| 28. Summarize the Joint Commission Standards for Pain Management. | 128 | ||
| 29. What is “opioid tolerance”? | 128 | ||
| 30. What non-opioid analgesics are appropriate for patients with cancer pain? | 128 | ||
| 31. What complementary and alternative therapies are useful for cancer pain? | 128 | ||
| 32. What is the role for palliative care in management of patients with cancer pain? | 128 | ||
| 33. Who are the members of a palliative care interdisciplinary team? | 129 | ||
| 34. When are opioids prescribed for cancer pain? How do they work? | 129 | ||
| 35. Are long-acting opioid preparations preferred over short-acting types? | 129 | ||
| 36. Should patients with cancer who receive opioid therapy undergo the same screening and monitoring procedures as patients with chronic noncancer pain? | 129 | ||
| 37. Comment on the population of patients who have been successfully treated for cancer with respect to ongoing problems with pain. | 129 | ||
| 38. What is the role for radiation therapy in cancer pain? | 129 | ||
| 39. What other therapies are available to treat pain from bone metastasis? | 129 | ||
| 40. Are interventional procedures necessary for most patients with cancer pain? | 129 | ||
| Bibliography | 130 | ||
| 28 Pain Associated With Rheumatoid Arthritis and Osteoarthritis | 131 | ||
| Bibliography | 138 | ||
| 29 Neuropathic Pain | 140 | ||
| 1. What is neuropathic pain? | 140 | ||
| 2. What are the neuroanatomic pathways involved in pain? | 140 | ||
| 3. What are the postulated mechanisms for pathology in these pathways that lead to neuropathic pain? | 141 | ||
| 4. What are the most common neuropathic pain conditions? | 141 | ||
| 5. What clinical features suggest that a pain is neuropathic? | 141 | ||
| 6. How does one examine a person with suspected neuropathic pain? | 142 | ||
| 7. What confirmatory tests are helpful in confirming the presence of a neuropathic pain condition? | 142 | ||
| 8. How does distal symmetric painful polyneuropathy present clinically? | 143 | ||
| 9. What are the etiologies of distal symmetric painful polyneuropathy? | 143 | ||
| 10. How is small fiber neuropathy different from painful distal symmetric polyneuropathy? | 144 | ||
| 11. What is erythromelalgia? | 144 | ||
| 12. What are the evidence-based treatments of painful distal symmetric polyneuropathy and small fiber neuropathy? | 144 | ||
| 13. What is the natural history of postherpetic neuralgia? | 144 | ||
| 14. What are the evidence-based treatments of postherpetic neuralgia? | 145 | ||
| 15. What is posttraumatic neuralgia, and how is it diagnosed? | 145 | ||
| 16. What are the causes of trigeminal neuralgia? | 145 | ||
| 17. What are the evidence-based treatments of trigeminal neuralgia? | 145 | ||
| 18. What are the most common central pain syndromes? What are the evidence-based treatments of central pain syndromes? | 145 | ||
| 19. What is complex regional pain syndrome? | 145 | ||
| 20. Is complex regional pain syndrome a neuropathic pain state? | 145 | ||
| 21. How is complex regional pain syndrome diagnosed? | 146 | ||
| 22. How is complex regional pain syndrome treated? | 146 | ||
| 23. What is phantom limb pain? | 146 | ||
| 24. Is phantom limb pain a neuropathic pain state? | 146 | ||
| 25. Does neuropathic pain require multidisciplinary pain management? | 146 | ||
| Bibliography | 147 | ||
| 30 Neuropathic Pain: Specific Syndromes and Treatment | 148 | ||
| 1. What is neuropathic pain? | 148 | ||
| 2. List some other definitions I should know. | 148 | ||
| 3. How common is neuropathic pain, and who gets it? | 148 | ||
| 4. How does neuropathic pain affect quality of life? | 148 | ||
| 5. Describe some conditions that sound similar to neuropathic pain. | 148 | ||
| 6. What are common descriptors of the pain that a patient might give you when describing their possible neuropathic pain? | 148 | ||
| 7. What history may a patient with neuropathic pain report? | 148 | ||
| 8. What are common physical exam findings in patients with neuropathic pain? | 149 | ||
| 9. What is central neuropathic pain? | 149 | ||
| 10. What is peripheral neuropathic pain? | 149 | ||
| 11. What is the difference between central and peripheral neuropathic pain? | 149 | ||
| 12. What are some assessment and screening tools available specifically for neuropathic pain? | 149 | ||
| 13. Describe some diagnostic tools that may aid in diagnosis. | 149 | ||
| 14. Are any labs useful? | 149 | ||
| 15. What is small fiber peripheral neuropathy? | 150 | ||
| 16. Tell me more about diabetic peripheral neuropathy | 150 | ||
| 17. Tell me about human immunodeficiency virus–associated neuropathy. | 150 | ||
| 18. How about chemotherapy-induced peripheral neuropathies? | 151 | ||
| 19. What are some less common peripheral neuropathies? | 151 | ||
| 20. Are there any other peripheral neuropathies? | 151 | ||
| 21. True or false: surgery can lead to persistent neuropathic pain. | 151 | ||
| 22. How is trauma to nerves classified? | 151 | ||
| 23. What is a neuroma? | 151 | ||
| 24. What is a plexopathy? | 152 | ||
| 25. Explain radiculopathy. | 152 | ||
| 26. Erythromelalgia sounds interesting. What is it? | 152 | ||
| 27. That’s a lot of information about peripheral neuropathy. Tell me more about central neuropathic pain. | 152 | ||
| 28. What is postherpetic neuralgia? | 152 | ||
| 29. What is the epidemiology of postherpetic neuralgia? | 152 | ||
| 30. What are important clinical features of postherpetic neuralgia? | 153 | ||
| 31. What is an appropriate management strategy for acute zoster? | 153 | ||
| 32. What is central poststroke pain? | 153 | ||
| 33. True or false. Chronic central pain is common in patients with multiple sclerosis. | 153 | ||
| 34. Describe the central pain caused by spinal cord injury. | 153 | ||
| 35. What is known about the mechanisms of phantom limb pain? | 153 | ||
| 36. Does every patient with an amputation get phantom pain? | 154 | ||
| 37. How is phantom pain different from phantom sensation? | 154 | ||
| 38. How is phantom pain different from stump pain? | 154 | ||
| 39. What nonpharmacologic and interventional treatments should be considered in neuropathic pain? | 154 | ||
| 40. Describe some specific exercise techniques that may be useful. | 154 | ||
| 41. What medications are available for treatment of neuropathic pain? | 154 | ||
| 42. What are the US Food and Drug Administration approved medications for the treatment of neuropathic pain? | 155 | ||
| 43. Name some of the antiepileptics commonly used for neuropathic pain. | 155 | ||
| 44. Which antidepressants are most useful in neuropathic pain? | 156 | ||
| 45. Local anesthetics should help too, right? | 156 | ||
| 46. Speaking of blocking sodium channels, can mexiletine be used in neuropathic pain? | 156 | ||
| 47. True or false: Opioids are a first-line treatment for neuropathic pain. | 156 | ||
| 48. Ketamine seems to be en vogue. Are N-methyl-d-aspartate receptor antagonists useful? | 156 | ||
| 49. What is ziconotide? | 156 | ||
| 50. Is capsaicin still being used? | 157 | ||
| 51. My patient tells me they use marijuana for neuropathic pain. Is this legit? | 157 | ||
| 52. My patient is interested in over-the-counter supplements. Which ones might be helpful? | 157 | ||
| 53. Is there a role for procedural interventions in neuropathic pain? | 157 | ||
| 54. When are peripheral nerve blocks useful? | 157 | ||
| 55. Name some indications for epidural steroid injections in neuropathic pain. | 157 | ||
| 56. How useful are epidural injections for radicular pain? | 158 | ||
| 57. True or false: Epidural injections may prevent postherpetic neuralgia. | 158 | ||
| 58. When should sympathetic blocks be considered for treatment of neuropathic pain? | 158 | ||
| 59. Describe some more invasive techniques used in treatment such as spinal cord stimulation. | 158 | ||
| 60. What about intrathecal drug delivery? | 158 | ||
| 61. Anything more invasive than that? What about dorsal root entry zone lesioning and deep brain stimulation? | 159 | ||
| 62. Woah. I’m not ready to send my patient to a surgeon yet. Or should I? | 159 | ||
| 63. Are there any new treatment options in the pipeline? | 159 | ||
| Acknowledgments | 159 | ||
| References | 159 | ||
| 31 Depression and Anxiety in Chronic Pain | 160 | ||
| Introduction | 160 | ||
| 1. What is the DSM-5? What are differences between the DSM-5 and the DSM-4 as they pertain to chronic pain? | 160 | ||
| 2. What are the DSM-5 diagnostic criteria for major depressive disorder? | 161 | ||
| 3. What are the DSM-5 diagnostic criteria for depressive disorder due to another medical condition? | 161 | ||
| 4. What are the DSM-5 diagnostic criteria for somatic symptom disorder? | 161 | ||
| 5. What are the DSM-5 diagnostic criteria for psychological factors affecting other conditions? | 162 | ||
| 6. What are the DSM-5 diagnostic criteria for generalized anxiety disorder? | 162 | ||
| 7. What are the DSM-5 diagnostic criteria for anxiety disorder due to another medical condition? | 162 | ||
| 8. What is the prevalence of depression in the setting of chronic pain? | 162 | ||
| 9. What is the prevalence of anxiety in the setting of chronic pain? | 163 | ||
| 10. What is the relationship between anxiety and depression and chronic pain? | 163 | ||
| 11. How is depression diagnosed in the setting of chronic pain? | 164 | ||
| 12. What is the stress and coping model? | 164 | ||
| 13. What is pain catastrophizing? | 164 | ||
| 14. How does depression in the setting of chronic pain impact medical costs? | 165 | ||
| 15. What is the relationship between chronic pain and suicide? | 165 | ||
| What are the treatment strategies for chronic pain with co-morbid depression and/or anxiety? | 165 | ||
| Bibliography | 166 | ||
| 32 Personality Disorders in Chronic Pain | 168 | ||
| 1. What is a personality disorder? | 168 | ||
| 2. Are there types of personality disorders? | 168 | ||
| 3. Do certain personality disorders predispose patients to chronic pain? | 168 | ||
| 4. Are personalities influenced by chronic pain? | 168 | ||
| 5. Are certain personality disorders predisposed to developing problematic substance use? | 168 | ||
| 6. If a patient is “difficult,” does that mean that they have a personality disorder? | 168 | ||
| 7. How do you treat the difficult patient? | 169 | ||
| 8. Do patients with personality disorder have altered pain sensitivity? | 169 | ||
| 9. How prevalent are personality disorders in chronic pain patients? | 169 | ||
| 10. Are the goals of treatment different for pain patients with borderline personality disorder? | 169 | ||
| 11. Is there a role for medication in treating borderline personality disorder? | 169 | ||
| 12. What is the prognosis of borderline personality disorder? | 169 | ||
| 13. Is there a “right way” to interact with patients who have borderline personality disorder? | 170 | ||
| 14. What practices should be avoided in treating patients with borderline personality disorder? | 170 | ||
| 15. How prevalent are suicide attempts and completion in patients with borderline personality disorder? | 170 | ||
| 16. Are there specific guidelines for treating patients with borderline personality disorder? | 170 | ||
| 17. When is it OK to call it quits with a difficult patient? | 170 | ||
| Bibliography | 171 | ||
| 33 Substance Abuse in Chronic Pain | 172 | ||
| 1. How is chronic pain management defined in this chapter? | 172 | ||
| 2. What is addiction? | 172 | ||
| 3. List the five main characteristics of addiction. | 172 | ||
| 4. What is physical dependence? | 172 | ||
| 5. What are the symptoms of opioid intoxication? | 172 | ||
| 6. What are the symptoms of opioid withdrawal? | 173 | ||
| 7. What is opioid tolerance, and how does it relate to addiction? | 173 | ||
| 8. When is it appropriate to prescribe opioids for chronic pain management? | 173 | ||
| 9. Is addiction common, and are patients vulnerable to dependence on opioid analgesics used for chronic pain syndromes? | 173 | ||
| 10. What are the risk factors for addiction to opioid treatment for pain management? | 173 | ||
| 11. How has the landscape changed for physician liability with respect to addiction and pain management in the last 6 years? | 173 | ||
| 12. What are the newest guidelines for physicians to minimize the risk of addiction to opioids in chronic pain management? | 174 | ||
| 13. What are the newest formulations of opioids that are designed to mitigate addiction? | 174 | ||
| 14. What are some of the newer, nonopioid options for the outpatient management of chronic pain? | 174 | ||
| 15. What is the utility of written medication agreements in patients suspected of opioid abuse? | 174 | ||
| 16. What actions on the part of the patient should alert you to the possibility of “drug-seeking” behavior? | 174 | ||
| 17. What should be done if addiction is suspected? | 174 | ||
| 18. How can a practitioner actively prevent drug diversion? | 175 | ||
| 19. How common are practitioner sanctions from regulating bodies? | 175 | ||
| websites | 175 | ||
| Bibliography | 175 | ||
| VI. Special Patient Populations | 177 | ||
| 34 Pain in Children | 177 | ||
| 1. What types of pain do children experience? | 177 | ||
| 2. How do children’s pain experiences differ from those adults? | 177 | ||
| 3. What is plasticity? | 177 | ||
| 4. What myths have complicated our management of children’s pain? | 177 | ||
| 5. How do you assess infants’ pain experiences? | 178 | ||
| 6. How do you assess children’s pain experiences? | 180 | ||
| 7. How do you assess pain experiences of children with intellectual disabilities? | 181 | ||
| 8. How do you assess pain experiences of children with autism spectrum disorders? | 182 | ||
| 9. Which pain assessment tools should be incorporated into routine clinical practice? | 182 | ||
| 10. Is there a basic treatment algorithm to control children’s pain? | 183 | ||
| 11. What are the basic guidelines for selecting and administering analgesics to children with pain? | 183 | ||
| 12. Are there special dosing considerations for neonates and infants? | 184 | ||
| 13. Can patient-controlled analgesia be used by children? | 184 | ||
| 14. Can regional techniques be used for children? | 184 | ||
| 15. How do parents know which pain medications (prescription and over the counter) are safe and effective for children? | 185 | ||
| 16. How do parents know which pain complementary and alternative therapies are safe for children? | 185 | ||
| 17. What about marijuana—is it safe to use to treat children’s pain? | 185 | ||
| 18. How are cognitive therapies used to treat pain in pediatric clinical practice? | 186 | ||
| 19. What is the role of behavioral therapy in pain management for children? | 186 | ||
| 20. Which children should be referred to pediatric pain management specialists? | 186 | ||
| Bibliography | 186 | ||
| 35 Pain in the Older Patient | 188 | ||
| 1. Who is the “older patient”? | 188 | ||
| 2. Why is there a growing need for pain management in this population? | 188 | ||
| 3. What are the challenges/barriers to effective pain management in the older patient? | 188 | ||
| 4. What is the pathophysiology of pain in the older patient? | 188 | ||
| 5. How does the pain threshold change with age? | 189 | ||
| 6. What are the physiologic changes that occur in the elderly patient? | 189 | ||
| 7. What are the pharmacokinetic and pharmacodynamic changes that occur in the elderly patient? | 189 | ||
| 8. How can adverse events related to medications be prevented? | 189 | ||
| 9. What tools are available to assist prescribers when treating the elderly? | 189 | ||
| 10. What methods can be used to assess pain in the elderly? | 192 | ||
| 11. What methods can be used to assess pain in the cognitively impaired elderly? | 192 | ||
| Nonpharmacological Modalities | 192 | ||
| 12. What nonpharmacological modalities can be used for pain control? | 192 | ||
| Non-Opioids | 192 | ||
| 13. What non-opioid pharmacological agents are available for the elderly? | 192 | ||
| Adjuvants | 193 | ||
| 14. What are pharmacologic adjuvants, and which are used in the treatment of chronic pain? | 193 | ||
| Opioids | 193 | ||
| 15. What opioid pharmacologic agents are available? | 193 | ||
| 16. What are the opioid considerations for patients with hepatic and renal dysfunction? | 193 | ||
| 17. Do opioid concerns differ in the elderly? | 194 | ||
| 18. How should opioids be titrated in the elderly? | 194 | ||
| 19. How should opioid side effects be managed? | 194 | ||
| Interventional Modalities | 194 | ||
| 20. What interventional modalities are available for pain control in the older patient? | 194 | ||
| Bibliography | 195 | ||
| VII. Pharmacologic Management | 197 | ||
| 36 Topical Analgesics | 197 | ||
| Overview | 197 | ||
| 1. What is the history of topical medications as analgesics? | 197 | ||
| 2. How is a topical medication different from a transdermal drug? | 197 | ||
| 3. What are the various topical formulations available for the treatment of pain? | 197 | ||
| 4. What are the advantages and disadvantages of using topical medications? | 198 | ||
| Over-the-Counter Pain Relievers | 198 | ||
| 5. What topical analgesics are currently available in the United States without a prescription? How are they being used? | 198 | ||
| 6. What are specific examples of over-the-counter pain relievers? | 198 | ||
| Prescription Pain Relievers | 201 | ||
| 7. What are the most commonly prescribed topical analgesics in the United States? How are they used? | 201 | ||
| Future Developments | 201 | ||
| 8. What new topical analgesics are available, and what topical analgesics are now in development that may become available in the United States over the next few years? | 201 | ||
| 9. What is the role of compounded non-Food and Drug Administration-approved topical agents in the treatment of chronic pain? | 204 | ||
| Bibliography | 204 | ||
| 37 Nonsteroidal Antiinflammatory Drugs and Acetaminophen | 206 | ||
| 1. List the indications for treatment with aspirin, acetaminophen, and nonsteroidal antiinflammatory drugs. | 206 | ||
| 2. Describe the mechanism of action of the nonsteroidal antiinflammatory drugs. | 206 | ||
| 3. What are the major pharmacokinetic differences among the nonsteroidal antiinflammatory drugs? | 206 | ||
| 4. List the most common side effects associated with the traditional nonsteroidal antiinflammatory drugs. | 206 | ||
| 5. Describe the clinical presentation for acute acetaminophen overdose. | 207 | ||
| 6. What are the risks of combining nonsteroidal antiinflammatory drugs with acetaminophen? | 207 | ||
| 7. What is the risk of nephrotoxicity with nonsteroidal antiinflammatory drugs? | 207 | ||
| 8. Which groups of nonsteroidal antiinflammatory drugs are available in the United States? | 207 | ||
| 9. Which agent is considered to be the drug of choice for pain control? | 207 | ||
| 10. Describe an adequate trial of nonsteroidal antiinflammatory drugs for pain control. | 207 | ||
| 11. If one nonsteroidal antiinflammatory drug fails to provide sufficient pain relief, how should a clinician proceed? | 207 | ||
| 12. List the potential risk factors for the traditional nonsteroidal antiinflammatory drug-associated gastrointestinal toxicity. | 207 | ||
| 13. What is the role of protective therapies in association with administration of traditional nonsteroidal antiinflammatory drugs? | 208 | ||
| 14. Do the selective COX2 inhibitors have a lower risk for gastrointestinal toxicity compared to the traditional nonsteroidal antiinflammatory drugs? | 208 | ||
| 15. What are the major distinctions among the mechanisms of action of aspirin, acetaminophen, nonsteroidal antiinflammatory drugs, and the COX2 inhibitors (coxibs)? | 208 | ||
| 16. Which COX2 inhibitor(s) are currently available in the United States? | 208 | ||
| 17. What are the documented precautions with celecoxib? | 208 | ||
| 18. Discuss some cardiovascular issues associated with selective COX2 inhibitors. | 208 | ||
| 19. List the potential central nervous system side effects associated with nonsteroidal antiinflammatory drugs. | 208 | ||
| 20. What are the only parenteral nonsteroidal antiinflammatory drugs available in the United States? | 208 | ||
| Bibliography | 209 | ||
| 38 Opioid Analgesics | 210 | ||
| 1. What is the most common side effect of opioids? | 210 | ||
| 2. Is opioid-induced constipation readily treatable in the majority of patients using over-the-counter (OTC) laxatives? | 210 | ||
| 3. What is a narcotic? | 210 | ||
| 4. Are poppies the only naturally occurring source for opiates? | 210 | ||
| 5. What is the difference among a pure agonist, partial agonist, and an agonist/antagonist? | 210 | ||
| 6. Which opioids are hepatically activated or inactivated? | 211 | ||
| 7. Are extended release opioids always more dangerous than immediate release opioids? | 211 | ||
| 8. How does medicinal chemistry or structure activity relationship impact opioid tolerability? | 211 | ||
| 9. Are there any extended release opioids that can be crushed without causing harm? | 212 | ||
| 10. Are opioids useful in the treatment of neuropathic pain? | 212 | ||
| 11. Are any opioids contraindicated in opioid naïve patents? | 213 | ||
| 12. Is tapentadol a glorified tramadol? | 213 | ||
| 13. Does naloxone reverse buprenorphine? | 213 | ||
| 14. What buprenorphine products are FDA approved specifically as an analgesic? | 213 | ||
| 15. Can Suboxone and methadone be legally prescribed for pain, and if so, is this considered off-label? | 214 | ||
| 16. Is methadone considered an extended release opioid? | 214 | ||
| 17. Is there a validated and accepted schematic to determine morphine daily equivalent dose? | 214 | ||
| 18. Which opioids have the potential to prolong the QTc interval? | 215 | ||
| 19. Can tramadol and other opioids be used in combination with selective serotonin reuptake inhibitors? | 215 | ||
| 20. Which opioid should be avoided in mothers who are breastfeeding their babies? | 215 | ||
| 21. Which opioids should be avoided in the setting of renal impairment? | 215 | ||
| 22. Which opioid is contraindicated within 14 days of use of an monoamine oxidase inhibitor (MAOI)? | 215 | ||
| 23. Which opioid has a ceiling effect of accumulation of CO2? | 215 | ||
| 24. Which OTC opioid has the same opioid binding affinity as tramadol? | 216 | ||
| 25. What is the role of the NMDA receptor? Which opioids block the NMDA receptors? | 216 | ||
| 26. Is hyperalgesia a real thing? | 216 | ||
| 27. Describe “opioid rotation.” What is the rationale behind it and what is meant by dose reduction for cross-tolerance? | 216 | ||
| 28. What tools are available to risk stratify patients prior to initiating opioid therapy? | 216 | ||
| 29. What factors contribute to a patient’s risk of opioid-induced respiratory depression? | 216 | ||
| 30. Are some urine drug tests more accurate than others? What is the risk of not confirming immunoassay drug testing? | 217 | ||
| 31. What is the only immunoassay test that is not subject to false positives? | 217 | ||
| 32. What is meant by a “cut-off” in a urine drug screen? | 217 | ||
| 33. Which opioids should never test negative on an immunoassay opiate screen, and which opioids may result in a negative test, depending on dose? | 217 | ||
| Acknowledgment | 217 | ||
| Bibliography | 218 | ||
| 39 The Regulatory Landscape | 219 | ||
| 1. What are “opioids,” “opiates,” and “narcotics?” | 219 | ||
| 2. For a patient without a substance abuse history, does initiation of opioid treatment pose a risk? | 219 | ||
| 3. What is the federal legislation that governs opioid prescribing? | 219 | ||
| 4. What is the Controlled Substances Act? | 219 | ||
| 5. What is the Drug Enforcement Administration? | 219 | ||
| 6. What is the Food and Drug Administration? | 219 | ||
| 7 What is the prescription data monitoring program? | 220 | ||
| 8. How are opioids regulated in the United States? | 220 | ||
| 9. Why does the federal government regulate opioids (history)? | 220 | ||
| 10. Who called pain the fifth vital sign? | 220 | ||
| 11. How are opioids and potential drugs of abuse classified? | 220 | ||
| 12. How have federal laws impacted prescribing behavior? | 221 | ||
| 13. How have state laws impacted prescribing behavior? | 221 | ||
| 14. What are “pill mills”? | 221 | ||
| 15. What legal risks do opioid prescribers face? | 221 | ||
| 16. What is the doctrine of double effect? | 221 | ||
| 17. What certifications are required to prescribe opioids? | 221 | ||
| 18. What is the role of state medical boards? | 222 | ||
| 19. What is the Office of National Drug Control Policy? | 222 | ||
| 20. How often do prescription drug abusers obtain medications from family and friends? | 222 | ||
| 21. What are the Centers for Disease Control and Prevention’s new guidelines? | 222 | ||
| Bibliography | 222 | ||
| 40 Muscle Relaxants, Anticonvulsants as Analgesics; Antidepressants as Analgesics | 224 | ||
| 1. What is the mechanism of action of muscle relaxants? | 224 | ||
| 2. How might quinine be used as a muscle relaxant? | 224 | ||
| 3. What medications can be used to treat spasticity? | 224 | ||
| 4. Describe how baclofen might be used to treat spasticity. | 224 | ||
| 5. Describe how dantrolene might be used to treat spasticity. | 224 | ||
| 6. Describe how diazepam might be used to treat spasticity. | 224 | ||
| 7. Describe how tizanidine might be used to treat spasticity. | 225 | ||
| 8. Describe additional muscle relaxants that are commonly prescribed. | 225 | ||
| 9. Describe specific concerns of certain muscle relaxants. | 225 | ||
| 10. Describe the role of anticonvulsants (AEDS) for the treatment of chronic pain. | 225 | ||
| 11. Describe the role of gabapentin and pregabalin for the treatment of chronic pain. | 225 | ||
| 12. Describe the role of carbamazepine and oxcarbazepine for the treatment of chronic pain. | 226 | ||
| 13. Describe the role of lamotrigine for the treatment of chronic pain. | 226 | ||
| 14. Describe the role of topiramate for the treatment of chronic pain. | 226 | ||
| 15. Describe the role of lacosamide for the treatment of chronic pain. | 226 | ||
| 16. Describe the role of valproic acid for the treatment of chronic pain. | 226 | ||
| 17. Describe the role of antidepressants in the treatment of chronic pain. | 226 | ||
| 18. Describe the role of the tricyclic antidepressants in the treatment of chronic pain. | 226 | ||
| 19. Describe the role of antidepressant serotonin-norepinephrine reuptake inhibitors (SNRI) in the treatment of chronic pain. | 227 | ||
| 20. Describe the role of the atypical antidepressants in the treatment of chronic pain. | 227 | ||
| Bibliography | 227 | ||
| 41 Novel Analgesics for Acute and Chronic Pain | 228 | ||
| 1. What new and emerging therapies exist to treat acute postoperative pain? | 228 | ||
| 2. Is intravenous acetaminophen any better than oral delivery? | 228 | ||
| 3. What are the advantages of liposomal-bupivacaine over regular bupivacaine? | 228 | ||
| 4. How does the pharmacokinetics of the sufentanil sublingual tablet system differ from intravenous morphine? | 228 | ||
| 5. What are some of the emerging novel analgesics in the pipeline for chronic pain? | 229 | ||
| 6. How is nerve growth factor related to pain, and what evidence exists for its efficacy and safety? | 229 | ||
| 7. How do the angiontensin II type 2 receptors modulate pain, and what clinical evidence exists for pain modulation? | 229 | ||
| 8. What is prostatic acid phosphatase? | 230 | ||
| 9. How does sodium channel blockade reduce pain? | 230 | ||
| 10. Are there any other voltage-gated ion channels that are targets for pain modulation? | 230 | ||
| 11. What are transient receptor potential cation channels, subfamily 1, and what role do they play in pain transmission? | 230 | ||
| 12. Are there any new calcium channel modulators in the pipeline? | 230 | ||
| 13. What are some of the new ways to modulate the postsynaptic N-methyl-d-aspartate ionophore? | 231 | ||
| 14. What is the current status of the cannabinoids to treat pain? | 232 | ||
| 15. What are p38 kinase inhibitors? | 232 | ||
| 16. What are chemokine receptors, and how do they modulate pain? | 232 | ||
| 17. Are there any agents being developed specifically for visceral pain? | 232 | ||
| Bibliography | 233 | ||
| VIII. Nonpharmacologic Management | 235 | ||
| 42 Common Nerve Blocks for Headaches and Facial Pain | 235 | ||
| What are common nerve blocks that can be used for headaches or facial pain? | 235 | ||
| What are indications for the above nerve blocks? | 235 | ||
| Bibliography | 236 | ||
| 43 Nerve Blocks | 237 | ||
| What are epidural steroid injections? | 237 | ||
| What are facet joint injections? | 237 | ||
| What are sacroiliac joint injections? | 238 | ||
| What are Sympathetic nerve blocks? | 238 | ||
| What are celiac plexus blocks? | 238 | ||
| What are stellate ganglion blocks? | 238 | ||
| Bibliography | 238 | ||
| 44 Peripheral Nerve Blocks | 240 | ||
| Bibliography | 241 | ||
| 45 Intrathecal Therapy | 242 | ||
| 1. Why is intrathecal drug delivery an attractive option for the treatment of pain? | 242 | ||
| 2. What are the advantages of using intrathecal drug delivery compared to systemic drug administration? | 242 | ||
| 3. What are some disadvantages of intrathecal drug delivery? | 242 | ||
| 4. Which patients are potential candidates for intrathecal drug delivery? | 242 | ||
| 5. What drugs can be given intrathecally for the treatment of pain? | 242 | ||
| 6. What is the role of an intrathecal drug trial in considering intrathecal analgesic therapy, and how does one conduct a trial? | 243 | ||
| 7. How does one determine the starting dose and drug concentration when initiating intrathecal therapy? | 243 | ||
| 8. What are the different modes of intrathecal drug delivery? | 243 | ||
| 9. Does location of the catheter tip within the intrathecal space or mode of delivery affect the efficacy of intrathecal therapy? | 243 | ||
| 10. What side effects can occur from intrathecal analgesics? | 244 | ||
| 11. What is a catheter-tip-associated inflammatory mass or granuloma, and what is their clinical presentation? | 244 | ||
| 12. How can a diagnosis of granuloma be confirmed, and what is the treatment for it? | 244 | ||
| 13. Does intrathecal analgesic drug delivery place patients at higher risk of serious adverse events than other interventional pain procedures? | 244 | ||
| 14. What type of complications can occur with intrathecal therapy? | 244 | ||
| 15. What effect does a magnetic resonance imaging have on an intrathecal pump? | 245 | ||
| Bibliography | 245 | ||
| 46 Neurostimulation | 246 | ||
| 1. What is spinal cord stimulation? | 246 | ||
| 2. List the criteria for choosing patients who may benefit from spinal cord stimulation for treatment of pain. | 246 | ||
| 3. Which conditions traditionally respond to spinal cord stimulation? | 246 | ||
| 4. What is the mechanism of action of spinal cord stimulation? | 246 | ||
| 5. What does the patient feel during spinal cord stimulation? | 246 | ||
| 6. What types of electrodes and generators are used for spinal cord stimulation and where are the electrodes placed? | 246 | ||
| 7. Where in the spine are the electrodes placed? | 247 | ||
| 8. What are some of the complications of spinal cord stimulation for treatment of chronic pain? | 247 | ||
| 9. What is occipital nerve stimulation? | 247 | ||
| 10. What is the most common indication for delivery of pain medication via implantable pumps? | 247 | ||
| 11. What is the dorsal root entry zone operation? | 247 | ||
| 12. Can neurostimulation be used to treat trigeminal neuralgia? | 247 | ||
| bibliography | 247 | ||
| 47 Spinal Cord Stimulation in Treatment of Pain | 249 | ||
| 1. What is spinal cord stimulation? | 249 | ||
| 2. How many patients use spinal cord stimulation? | 249 | ||
| 3. What kinds of pain does spinal cord stimulation treat? | 249 | ||
| 4. Who is a candidate for spinal cord stimulation therapy? | 249 | ||
| 5. What does trial stimulation involve? | 249 | ||
| 6. How are spinal cord stimulation devices implanted? | 249 | ||
| 7. What is the mechanism of spinal cord stimulation action? | 249 | ||
| 8. Spinal cord stimulation electrical impulses have qualities such as amplitude, frequency, and pulse width. What do these mean? | 250 | ||
| Bibliography | 250 | ||
| 48 Neuroablative Procedures | 251 | ||
| 1. What are neuroablative procedures and some pain-associated conditions that are treated by neuroablative procedures? | 251 | ||
| 2. What are some types of neuroablative procedures for cancer pain? | 251 | ||
| 3. What are some types of ablative procedures for trigeminal neuralgia and their associated complications? | 251 | ||
| 4. What is a dorsal rhizotomy, what does it treat, and what is its mechanism of action? | 252 | ||
| 5. How is a dorsal rhizotomy performed and what are some possible complications? | 252 | ||
| Bibliography | 252 | ||
| 49 Pain Psychology | 253 | ||
| 1. What is pain psychology? | 253 | ||
| 2. How is psychological treatment relevant to pain management? | 253 | ||
| 3. What is the history of pain psychology? | 253 | ||
| 4. What are the qualifications of a psychologist or other mental health professional to be able to work with pain medicine? | 253 | ||
| 5. Are there different psychological symptoms and/or disorders with the different types of pain? | 254 | ||
| 6. What is the risk of not including psychological treatment in pain management? | 254 | ||
| 7. At what stage in pain management should psychological treatment (and/or other mental health treatment) be introduced? | 254 | ||
| 8. Is psychological evaluation and treatment recognized by third-party payers? | 254 | ||
| 9. What is the biopsychosocial model, and how does it inform pain treatment? | 254 | ||
| 10. What are operant learning and social learning, and how do these models of behavior relate to pain? | 255 | ||
| 11. What can psychoanalysis contribute to pain psychology? | 255 | ||
| 12. How does culture play a role in the experience of pain? | 255 | ||
| 13. What are the differences in the psychology of acute versus chronic pain? | 255 | ||
| 14. How does a person adjust to pain, and how can psychotherapy help this process? | 255 | ||
| 15. What is the difference between pain and suffering, and what is the role of suffering in pain? | 256 | ||
| 16. How does a history of abuse and trauma contribute to the onset, course, and treatment of pain? | 256 | ||
| 17. What is somatization, and how does it relate to pain? | 256 | ||
| 18. What is alexithymia, and how does it relate to pain? | 256 | ||
| 19. What is the diathesis-stress model, and how does it relate to pain? | 257 | ||
| 20. What is the diagnostic classification system used for mental disorder diagnoses of pain patients? | 257 | ||
| 21. How does a mental disorder interact with chronic pain? | 257 | ||
| 22. What are some of the mental disorders which pain patients develop? | 257 | ||
| 23. What is the difference between psychological treatments of noncancer versus cancer pain? | 257 | ||
| 24. What are the limitations of medical treatments for chronic pain? | 257 | ||
| 25. How can psychological therapies be useful in chronic pain and affect medical utilization? | 257 | ||
| 26. How can presurgical psychological screening be helpful for medical practitioners? | 258 | ||
| 27. What is the benefit of psychotherapy provided as part of a multidisciplinary team? | 258 | ||
| 28. How common is substance misuse, pharmaceutical overuse, and dependence among pain populations? | 258 | ||
| 29. How common is cognitive impairment among pain populations, and what are some of the causes? | 259 | ||
| 30. What types of psychological treatments are available for chronic pain treatment? | 259 | ||
| 31. How do you determine a patient’s suitability for a particular type of psychotherapy? | 259 | ||
| 32. What is the difference between short-term and long-term psychotherapy? | 259 | ||
| 33. What is the difference between a psychotherapist and a psychiatrist? | 260 | ||
| 34. What are the ethical issues involved in providing psychotherapy for pain populations? | 260 | ||
| 35. What is the concept of multimodal psychotherapy? | 260 | ||
| 36. What are the objectives of psychotherapeutic treatment? | 260 | ||
| Bibliography | 261 | ||
| 50 Integrated Approaches to Pain Management | 262 | ||
| How can exercise help with pain? | 262 | ||
| What are the benefits of chiropractic treatment and massage for pain? | 262 | ||
| Tell me about how mind-body treatments can help chronic pain? | 262 | ||
| Tell me about acupuncture for pain? | 263 | ||
| Bibliography | 263 | ||
| 51 Pain Clinics | 265 | ||
| How must one evaluate acute low back pain? And how about chronic low back pain? | 265 | ||
| How must one approach the management of acute pain? | 266 | ||
| What are some ways of managing chronic pain? | 266 | ||
| What is an addiction clinic? | 266 | ||
| What is a Functional Restoration Program? | 266 | ||
| Bibliography | 267 | ||
| 52 Complementary and Alternative Medicine | 268 | ||
| 1. Can we define complementary and alternative medical treatment? | 268 | ||
| 2. What is the prevalence and usage of complementary or alternative medicine therapies in the United States? | 268 | ||
| 3. What are the primary divisions of complementary or alternative medicine therapies? | 268 | ||
| 4. What is the philosophy of traditional Chinese medicine, and what are its major components? | 268 | ||
| 5. What are the primary methods and therapies of traditional Chinese medicine? | 268 | ||
| 6. How is acupuncture applied? | 269 | ||
| 7. How does acupuncture act to induce analgesia in patients? | 269 | ||
| 8. What is the stance of the National Institute of Health on the use of acupuncture? | 269 | ||
| 9. Is there a consensus on acupuncture as an effective treatment of fibromyalgia? | 269 | ||
| 10. Does evidence support the use of acupuncture for other chronic pain conditions? | 269 | ||
| 11. What concerns and contraindications should be considered when conducting acupuncture? | 269 | ||
| 12. What constitutes bioenergetic therapy? | 270 | ||
| 13. What is Ayurveda? | 270 | ||
| 14. Which bioenergy therapies are common in Western medicine? | 270 | ||
| 15. How is spinal manipulation involved in the treatment of headache and back pain? | 270 | ||
| 16. Which “mind-body” modalities are seeing use for treatment of pain? | 270 | ||
| 17. Can headache pain be treated using vitamins or supplements? | 271 | ||
| 18. Are there uses for feverfew and butterbur in treating headache? | 271 | ||
| 19. Create a partial list of drug-herb interactions to be aware of. | 271 | ||
| 20. To what scientific standard should complementary or alternative medicine therapies be held? | 271 | ||
| 21. How can clinicians best minimize patient exposure to risk from complementary or alternative medicine and their exposure to legal risk by treating using complementary or alternative medicine? | 271 | ||
| Bibliography | 272 | ||
| Index | 273 | ||
| A | 273 | ||
| B | 274 | ||
| C | 275 | ||
| D | 277 | ||
| E | 277 | ||
| F | 277 | ||
| G | 278 | ||
| H | 278 | ||
| I | 279 | ||
| J | 280 | ||
| K | 280 | ||
| L | 280 | ||
| M | 280 | ||
| N | 281 | ||
| O | 283 | ||
| P | 283 | ||
| Q | 285 | ||
| R | 286 | ||
| S | 286 | ||
| T | 287 | ||
| U | 288 | ||
| V | 288 | ||
| W | 288 | ||
| X | 288 | ||
| Y | 288 | ||
| Z | 288 | ||
| Inside Back Cover | ibc1 |