One of the most exciting developments in medicine in this century has been the discovery of opioid receptors and their pharmacology. The breadth of know- edge derived from such discovery has truly changed the practice of medicine today. The acceptance by the clinicians of the research data obtained by the basic scientist on spinal opioids is truly amazing. The clinical sequelae of the discovery of opioid receptors has been the development of the technique of intraspinal administration of opioids. In the last decade much has been written about indications, effects, and side effects of intraspinal opioids. The technique has become commonplace for cancer and postoperative pain. However, no standards of care and management of patients with spinally administered opioids have been developed. We need these standards to be developed and universally followed. The monograph was conceived to update clinicians on the applied pharma cology of spinal opioids. We were fortunate to have Drs. N. Rawal and D. Coombs agree to edit this monograph. They have been able to assemble world-renowned experts as contributing authors. It is our hope that the con tents of this book will be stimulating, informative, and useful to the reader. PREFACE Much has been written about the subject of spinal opioid analgesia, includ ing several notable reviews. We were stimulated to assemble this particular volume in this important series on pain management initiated by Dr. Raj for a number of reasons."

Back pain is one of the most common reasons cited by patients seeking medical help, and it is a leading cause of time off work and long term disability. Causes of back pain are complex and many health care professionals devote a substantial amount of their time dealing with it. The initiating event leading to back pain is often compounded by other factors leading to maladaptive behaviour and prolongation of pain. This pocketbook will summarise the current literature on management of back pain and provide evidence-based, practical guidelines for clinicians.

On 16 October 1846, an itinerant New England dentist named William T. G. Morton proved the anesthetic effect of diethyl ether in a public demonstration in the "ether dome" of the Bulfinch Building of the Massachusetts General Hospital in Boston. The patient, Gilbert Abbott, suffered no pain, and the surgeon, Dr. John C. Warren, was able to complete a suture ligature of a vas cular tumor of the jaw without the hurry that until then was so necessary. The operation proved a failure, since the tumor recurred; but the demonstration of ether's anesthetic effect was a great success. Operative pain was conquered, and surgery could advance from a crude and unscientific practice where speed was paramount, and the major body cavities could not be entered, into the unique blend of science and art that it is now. "Gentlemen, this is no hum bug," supposedly muttered Warren, perhaps the last noncontroversial assess ment of anesthesiology to be made by a surgeon. The screams of resisting patients in pain were stilled, and quiet entered the operating room for the first time. But the new science of pain relief was quickly wrapped in controversy. An argument immediately arose as to who could legitimately claim primacy for the discovery. Morton's attempt to hide the true nature of his anesthetic agent, coupled with an effort to patent the discovery, clouded his reputation and stimulated other claimants to push themselves forward."

Previously only available as part of "Stux"'" Acupuncture" "-" "Textbook and Atlas," the selector is now available in a package together with three new posters which depict the most important acupuncture points topographically. Photographs of the human skin were deliberately not used, as they do not allow the structures directly beneath the surface to be portrayed. To ensure a clear and exact representation, the bones have been drawn in the background. The selector presents the various categories of acupuncture points in tabular form, enabling the user to recognize the most important points of a meridian at a glance. An indispensable aid for every acupuncturist.

Second only to the common cold, pain is the most common reason for health care visits. It results in significant personal and social costs to individuals, and economic costs to society. Chronic pain has been estimated to cost more than 100 billion annually in the United States, and its estimated annual cost to European countries ranges from 1.1 to nearly 50 billion Euros (nearly 1.5 billion to over 60 billion dollars). In order to treat pain, clinicians need to be able to assess pain and its effects on functioning. However, 100s, if not 1000s, of different measures of pain and pain-related domains exist. Surprisingly, despite the fact that much is known about the psychometrics strengths and weaknesses of existing measures, there does not yet exist a simple pain assessment guide that describes the most useful and psychometrically sound pain measures for health care providers. This book fills this need.

Ronald Brisman, M.D. This book will discuss three areas where the The multiplicity of procedures with varying neurosurgeon may provide an important degrees of risks and benefits sometimes re contribution to the relief of intractable pain: quires a sequential approach, but always an trigeminal and other facial neuralgias, chronic individual one, matching an appropriate treat noncancer pain, and cancer pain. By one ment plan or procedure for a particular patient intervention, the neurosurgeon often may pro at a specific time in his or her illness. vide long-lasting pain relief. New techniques, The neurosurgical chapters in this book which have developed since the 1970s and represent my experience with several hundred continue to evolve, dominate the neurosur patients during a 12-year period from 1975 gical armamentarium because they are not only through 1987. I have relied heavily on the effective, but safe. These include percutaneous works of others, which have been quoted from radio frequency electrocoagulation for trigem the neurosurgical literature, but this book is inal neuralgia, spinal stimulation for chronic not meant to be encyclopedic. noncancer pain, and intraspinal morphine in At least as important as knowing when to fusion for cancer pain. operate is knowing when not to do so, and this Sometimes a procedure relieves pain but the is particularly true of the treatment of pain. pain recurs; it may be necessary to repeat the Most patients with pain do not require neuro procedure, which in the case of radiofrequency surgical intervention."

It is a pleasure to have the privilege of writing the foreword for a book edited by Dr. Francis F. Foldes. Dr. Foldes has collected in one convenient place a discussion and description of enzyme systems of use to the anesthesiologist and to those other individuals, such as undergraduate and graduate students in related basic sciences, who will profit by and can make use of this body of information. The practicing anesthesiologist and those who work in related fields have become increasingly aware of the need to understand enzyme activities which influence the uptake, distribution, and excretion of those substances that are used in the anesthetic management of surgical patients. A variety of such is obvious when one considers that such diverse substances as activities and muscle re analgesic drugs, tranquilizers, hypnotics, anesthetic agents, laxants are strongly affected by these systems and have an influence over the basic understanding of how these drugs operate and act in the body, as well as providing a safety measure so necessary to the proper conduct of clinical anesthesia. The editor and his colleagues have rendered us a great service in collecting information that deals with the basic activity of enzymes including their structure, their kinetics, and to the degree that knowledge permits, mechanism of actions."

All anesthesiologists eventually face the fear of a "near miss," when a patient's life has been put at risk. Learning from the experience is crucial to professionalism and the ongoing development of expertise. Drawing on forty-plus years of practice in major metropolitan hospitals in the United States, Norway, and South Africa, John Brock-Utne, MD presents 80 carefully selected cases that provide the basis for lessons and tips to prevent potential disaster. The cases emphasize problem-centered learning and span a broad range of topics-from an outbreak of operating room infection (could it be the anesthesia equipment?), complications of fiberoptic intubations, and problems with epidural drug pumps, to performing an urgent tracheostomy for the first time, working with an aggressive surgeon, and what to do when a patient falls off the operating table during surgery.80 true-story clinical "near misses" never before published, ideal for problem-centered learning, recommendations, references, and discussions accompany most cases, rich basis for teaching discussions both in or out of the operating room, settings include sophisticated as well as rudimentary anesthetic environments, complements the author's other case book, "Clinical Anesthesia: Near Misses and Lessons Learned" (Springer, 2008).

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Hyperbaric oxygen application has now become a useful technique for both diagnostic and therapeutic purposes in CNS, cardiovascular and respiratory diseases, as well as in soft-tissue and orthopaedic pathologies and haematologic disorders. With a specific didactic approach, supported by numerous illustrations and tables, this volume aims to present all aspects of oxygen application under pressure not only to resolve some clinical problems, but also to improve recovery or to modify a negative illness evolution. Both scientists and practitioners will find this work a useful and updated reference book.

Chronic pain is a significant health problem for many children and adolescents and is often challenging for healthcare professionals to treat. Estimated to affect approximately 15% to 30% of children, chronic and recurrent pain occurs most commonly in the pediatric population without clearly identifiable underlying physical etiology, such as pain associated with irritable bowel syndrome, headaches, musculoskeletal pain, or complex regional pain syndrome. Chronic or recurrent pain may also be associated with ongoing underlying medical conditions, such as arthritis, cancer, Crohn's disease, or sickle cell disease.
Cognitive-Behavioral Therapy for Chronic Pain in Children and Adolescents provides a practical guide for implementing cognitive-behavioral therapy (CBT) for children and their families coping with the consequences of persisting pain. The book is divided into three sections. The first section presents a brief history, theoretical foundations, and background concerning the development of CBT interventions for children with chronic pain conditions and summarizes research results on the efficacy of CBT. Chapters in the second section cover assessment and evaluation approaches, patient education, and how to structure and sequence CBT interventions with children and families. The last section of the book describes in detail each cognitive-behavioral intervention, including relaxation and cognitive skills and interventions directed at parents, sleep problems, physical activity, and school functioning. Extensive suggested dialogue and detailed instructions and handouts are included in the text and accompanying appendices to provide user-friendly therapist training materials for successful application of clinical techniques to children and families. Cognitive-Behavioral Therapyfor Chronic Pain in Children and Adolescents is an essential, evidence-based resource for pediatric and child clinical psychologists and other mental health professionals (social workers, child psychiatrists) who work with children in pain.

Pharmacists and other healthcare practitioners are on the frontlines of the fight against opioid use disorders. Through their training and direct contact with patients, they are uniquely qualified to prevent and manage misuse of opioids and other drugs. But knowing where and how to start isn't always obvious. The Pharmacist's Guide to Opioid Use Disorders provides a comprehensive resource for all aspects of this devastating epidemic, starting with a discussion of the neuroscience of substance use disorders. Edited by Merrill Norton, PharmD, ICCDP-D, a Clinical Associate Professor at the University of Georgia College of Pharmacy and a specialist in psychopharmacology and substance use disorders, it compiles the most current information, science, and best practices in one concise guide. Readers will benefit from the insights and lessons described in each chapter, as well as the clinical pearls-practice points-gleaned from the writers' medical, nursing, and pharmacy clinical practices. The Guide also provides useful information in its appendices, including references and resources and a naloxone products table.

The single best answer format of questions is invaluable in assessing a trainee's clinical skills and problem-solving abilities. It allows the trainee to demonstrate application of their knowledge to clinical practice. This book comprises six sets of practice papers. Each set contains 30 single best answer questions which cover topics including clinical anaesthesia, pain and intensive care. The questions are based on the recent changes introduced to the written part of the final FRCA examination. The best possible answer to a given clinical scenario is substantiated by a detailed explanation drawn from recent review articles and textbooks in clinical anaesthesia. These questions will enable candidates to assess their clinical knowledge and skills in problem-solving, data interpretation and decision making. This book is essential study material for candidates sitting postgraduate examinations in anaesthesia and intensive care medicine. It is not only an essential guide for trainees but also an invaluable educational resource for all anaesthetists.

A definitive, comprehensive text on the technological developments and clinical applications of this critical subject matter. Written for the entire heart surgery team, this volume covers the physiology of cardiopulmonary bypass, mechanics and components of the heart-lung machine, the conduct of cardiopulmonary bypass in cardiac surgery, non-cardiac applications of cardiopulmonary bypass, and mechanical assistance of the failing heart and lung. The authors also give special consideration to such areas as blood conservation in cardiac surgery, religions objections to blood transfusions, medical-legal aspects and cardiopulmonary bypass, as well as warm blood cardioplegia and normothermic cardiopulmonary bypass.

Managing Cancer Breakthrough Pain is a comprehensive review of cancer breakthrough pain (cBTP) and rapid-onset opioids (ROO), the only treatment approved for cBTP episodes. The book was originally commissioned due to the current rapid growth of the ROO market and the epidemic of ROO abuse. This book will review the historical background and definitions of cBTP and ROOs, assessment methods to determine types of cBTP, US- and EU-approved ROOs, case studies (which will provide practical applications of ROO treatment options), ROO abuse and screening methods, and the FDA-mandated TIRF REMS Access program (Transmucosal Immediate Release Fentanyl Risk Evaluation and Mitigation Strategies Access program). Busy healthcare professionals who have a basic understanding of cancer pain but want to learn more about cBTP and ROOs will benefit from this concise guide that will help them quickly understand the complexities of cBTP episodes and ROOs.

Chronic back pain has been and continues to be a major cause of distress (both to people with persistent pain and their significant others), disability, work loss, and a huge cost to society. Moreover, with the aging population, it is becoming even more prevalent and as a consequence is having an escalating impact upon the healthcare systems and society as a whole worldwide. A significant issue concerns understanding why, although the majority of people with acute back symptoms recover in a reasonable time, a significant minority evolve into patients with chronic pain and prolonged pain-related disability. Understanding the variables that contribute to chronicity could serve as a basis for early intervention to prevent the downward spiral. In the past 15 years, psychological and psychobiological mechanisms have been identified as important risk factors in back pain, leading to the development of early screending methods (Yellow Flag diagnostics) and new psychosocial interventions. These work by closely targeting treatment modalities to patients' needs. However, many aspects of how acute pain becomes chronic pain remain unexplained. Recent neurobiological work investigating genetic, neurophysiological, and biomechanical processes has uncovererd important mechanisms involved in chronic and acute back pain. From Acute to Chronic Back Pain examines the risk factors and mechanisms involved in the transition from acute to chronic back pain. It integrates genetic, biomechnanical neurobiological, psychophysiological, psychosocial, and socieconomic risk factors. Moreover, the text examines advances in treatment approaches based on evidence from published studies-ranging from prevention of disability to pharmacological, psychological, and rehabilitative strategies and methods. Broad in scope, and with contributions from leading authorities in their respective fields, this book is a valuable and comprehensive work for the many specialities involved with back pain - including those in the fields of clinical and health psychology, physiology, epidemiology, and pain.

Theodore H. Stanley, M. D. What's New in, Anesthesiology in 1988 contains the Refresher Course manuscripts of the presentations of the 33rd Annual Postgraduate Course in Anesthesiology which took place at the Marriott Hotel Convention Center in Salt Lake City, Utah, February 19-23, 1988. The chapters reflect new data, ideas and concepts within the general framework of most recent developments in "evaluation and monitoring cardiac function before, during and after surgery," "new anesthetics and their actions on the heart and peripheral vasculature, and other organ systems," "metabolism and elimination of anesthetics and anesthetic adjuvants," and "recent developments in the anesthetic management of patients with congenital heart disease, renal and pulmonary dysfunction, and diabetes insipidus. " In addition, there are chapters on new developments in "obstetrics," "regional anesthesia," and "anesthetic management of the newborn. " The purposes of the textbook are to 1) act as a reference for the anesthesio logists attending the meeting, and,2) serve as a vehicle to bring many of the latest concepts in anesthesiology to others within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the interests in anesthesia expressed at the conference. This book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarize the most salient points. This textbook is the sixth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City."

The First International Symposium on "Pain and Kampo (Japanese Herbal Medicine)" took place in Tokyo in October, 1992. More than 700 registrants participated, with 12 registrants from seven overseas countries. This book contains summaries of the presentations at this meeting and is published in order to provide up-to-date information to a much wider audience. In China, traditional herbal medicine has been used for more than 3000 years while in Japan, its use has been documented for more than 1000 years, albeit with some changes to the original Chinese formulations. Recently there has been a revival of interest in herbal medicines for several reasons. There is a rapid growth in the number of senior citizens who frequently require the attention of modern medicine. In particular, there has been an increase in the number of patients who suffer from chronic diseases which are difficult to treat, e.g., arteriosclerosis, Alzheimer's disease, chronic pain syndromes, etc. It has become evident that traditional Oriental herbal medicines could playa role in the management of these and other conditions.

The pain center/clinic is in the stage of transition. It has come a long way since chronic pain was a nonexistent entity and patients with difficult pain problems did not receive well-deserved attention or were lost in the busy practices of vari ous specialty clinics. Thirty-five years ahead of the rest of us, John]. Bonica was the first physician who had a clear vision of a pain center's potential. Twenty years later, in response to loud public demands for relief of chronic pain, this idea was put into practice by a number of others on a somewhat larger scale. A team of specialists from various disciplines, trained in the management of chronic pain, now offer approaches ranging from simple outpatient care to inpatient hospital ization for comprehensive care including drug detoxification, behavior modi fication, and total rehabilitation of these patients. Hospitals have entered this arena with renewed enthusiasm. The pain center/clinic is now an established, ac cepted, and expanding method of providing care for chronic pain patients. The chapters in this book are based on examples of multidisciplinary projects that deal comprehensively with management of chronic pain. Aimed primarily at the pain center/clinic in the university hospital setting, this book ranges from his torical perspectives to current pain centers with their less orthodox methods of re lieving chronic pain to the future of algology as a specialty."

Advances over the past two decades have enabled physicians to revolutionize the manner in which they can assess and manage children's pain. Thirty years ago it was thought that young children did not experience pain and therefore it was not necessary to treat it. Today professionals from a variety of disciplines have contributed data that have revolutionized medical perspectives. Technological advances now enable doctors to treat acute pain in fetuses, premature neonates, infants, toddlers, children, and adolescents with increasing precision and efficacy. Research highlighting the context of chronic pain has moved them away from a mind-body dichotomy and toward an integrated, holistic perspective that leads to substantial improvement in children's adaptive functioning as well as subjective discomfort.

This book covers these topics and is intended for anyone who provides medical care to children. Each chapter provides an overview of the problem, followed by a "hands on" description of relevant assessment and intervention strategies. The role of the primary care practitioner is highlighted, both as a front-line resource as well as a consumer of specialized pediatric pain treatment services. Each chapter ends with a summary and specific bullet points highlighting the most central elements, making for quick and easy reference.

A panel of prominent clinician-scientists comprehensively reviews the latest developments in pediatric pain management, with special emphasis on the setting in which pain is detected and managed. The authors explore the cutting-edge of children's pain care in inpatient, outpatient, palliative care, school, and residential settings, and describe alternate approaches, including complementary and alternative medicine, pain management via the internet and information technology, and pain care in developing countries.

Neurocritical care as a subspecialty has grown rapidly over the last two decades and has reached a level of distinct maturity with the advent of newer monitoring, diagnostic and therapeutic modalities in a variety of brain and spinal cord injury paradigms. Handbook of Neurocritical Care, Second Edition remains true to the operative tenet that "time is brain," and rapid diagnosis and therapeutic interventions in these challenging patients cannot be overemphasized. The second edition of this important Handbook again serves as a quick, practical reference for those involved in the care of critically ill neurological and neurosurgical patients. The care provided to this subset of critically ill patients continues to be multidisciplinary and includes care rendered from colleagues in emergency medical services, emergency medicine, neurology, neurosurgery, anesthesiology, critical care, nursing and physician assistance. Fully updated, all of the chapters again consist of easy-to-read, bulleted points followed by a list of Key Points and important references allowing for rapid access to vital information critical for fast and timely decision making. The first section covers a myriad of important general principles while the second section addresses the major diagnostic categories of neurocritical care with several new topics; these include, for example, neuroleptic malignant syndrome and malignant hyperthermia, meningitis and encephalitis, and intraventricular hemorrhage. Readers will find the algorithms, tables, and illustrations throughout the book not only useful but truly invaluable in facilitating fast and accurate decision making. Accessible and comprehensive, Handbook of Neurocritical Care, Second Edition again fills a vital need by providing readers with a succinct and practical approach to the management of critically ill neurological and neurosurgical patients.

Monitoring in Anesthesia and Perioperative Care is a practical and comprehensive resource documenting the current art and science of perioperative patient monitoring, addressing the systems-based practice issues that drive the highly regulated health care industry of the early twenty-first century. Initial chapters cover the history, medicolegal implications, validity of measurement, and education issues relating to monitoring. The core of the book addresses the many monitoring modalities, with the majority of the chapters organized in a systematic fashion to describe technical concepts, parameters monitored, evidence of utility complications, credentialing and monitoring standards, and practice guidelines. Describing each device, technique, and principle of clinical monitoring in an accessible style, Monitoring in Anesthesia and Perioperative Care is full of invaluable advice from the leading experts in the field, making it an essential tool for every anesthesiologist.

This book helps prepare anesthesiology residents for safe practice of pediatric anesthesia. It features 26 index cases, which are classic clinical scenarios - all covering a spectrum of pediatric anesthesia, neuro-anesthesia, cardiac anesthesia, regional anesthesia, and anesthesia and critical care medicine. Chapters are divided into case-based formats with each chapter containing a scenario layout, useful equipment, major teaching points for an after simulation debrief, and a learner evaluation form. This tiered education method will assist learners in working though essential team building skills, increasing their knowledge base and finally having concrete items in which to further their professional skills. Each chapter starts with a learning objective and presents the simulation case before launching into the case progression, detailing how the simulated patient's vital signs, physical exam findings, and clinical picture change over the course of the simulation. They are concluded with a master checklist of items the learner should accomplish during the course of the simulation along with a section summary and important teaching points. Pediatric and Adult Anesthesiology Simulation Education is designed to be used by both academic programs and private practice groups. It is beneficial to anesthesiology residents who are currently in training as well as those who have recently graduated and are preparing for board exams.