Collective knowledge of the origins and pharmacology of pain are evolving rapidly, providing increased hope for better pain management and a far greater quality of life for patients worldwide. However, there are few works dedicated to guiding primary care practitioners and clinical researchers through the use of adjuvant analgesics. Part of the Oxford American Pain Library, Adjuvant Analgesics provides a detailed discussion of the various classes of these drugs including antidepressants and anticonvulsants, cannabinoids, topical analgesics, and local anesthetics. Chapters cover a basic introduction to adjuvant analgesics for pain control, appropriate clinical applications of the various drug classes in the management of common pain problems, and on drug-drug interactions between adjuvant analgesics and traditional analgesics. Important pain entities such as acute postoperative, cancer-related, neuropathic pain, and fibromyalgia are addressed, filling an important gap in today's medical literature.

Written by leading authorities in the field, Chest Pain with Normal Coronary Arteries comprehensively reviews the clinical presentation and the pathogenesis of the condition, as well as its management. This book provides a practical tool for the clinician and a bank of information and new ideas for research scientists and clinical researchers interested in understanding the causes and mechanisms of chest pain with normal coronary arteries. Whether the pain be of gastroenterologic, cardiac or endocrine in origin, the book focuses on effective diagnosis, treatment and management of different pathologies in patients. Chest Pain with Normal Coronary Arteries is an essential read for all clinicians involved in managing patients with chest pain, and those that should be aware of non-cardiac chest pain.

Functional Electromyography: Provocative Maneuvers in Electrodiagnosis integrates electrophysiology further into the physical examination than ever before. It introduces the use of electrodiagnostic studies to quantify the neurological changes brought about by three provocative maneuvers commonly used in contemporary medicine. This widens the scope of electromyography while sharpening physicians' diagnostic acuity. The book presents nerve conduction velocity (NCV) and H-reflex techniques to identify common conditions that are difficult to diagnose by any other means, often using the needle exam (EMG), MRI or musculoskeletal ultrasound to verify their clinical utility. Functional electromyography successfully diagnoses some cases of thoracic outlet syndrome, nearly all cases of piriformis syndrome, and offers a method for determining whether spinal stenosis or radiculopathy is the main pain generator when both are present in a single patient, even at the same level. This is particularly valuable because the standard conservative and surgical treatments for these two conditions are opposite, in spite of the identical symptom-set they produce. The book carefully describes each technique and persuasively documents their validity in statistical series and individual case presentations. It further guides the attentive electromyographer to adapt these methods to cases beyond those presented in its pages, suggesting a safe and scientific approach to other functional maneuvers of value to the electromyographer, and methods for validating one-time measures that may aid the electromyographer in clinical situations that are neither common nor easily analyzed. Hand drawn illustrations are included alongside text developed by experts in the field. An invaluable resource for physiatrists, neurologists, orthopedic surgeons, specialists in pain management and other providers, Functional Electromyography: Provocative Maneuvers in Electrodiagnosis represents a major contribution to the field of electrodiagnosis.

Low back pain is described as a very common condition that tends to affect about 70% of the population at some point in time with varying degrees of symptom severity. Although definitions vary, sciatic pain is generally defined as back-related pain radiating to the leg (normally below the knee and into the foot and toes) and is one of the commonest variations of low back pain. Patients with sciatica typically experience a more persistent and severe type of pain, a less favorable outcome, consume more healthcare resources and have more prolonged disability and absence from work than those with low back pain alone. Managing Sciatica and Radiculopathies in Primary Care Practice provides a comprehensive, up-to-date overview of the subject and key information for primary care practitioners about low back pain in patients, including definitions and causes, current management approaches, diagnostic and treatment algorithms, as well as clinical practice guidelines.

Anesthesiology and Pain Management contains the edited presentations of the 39th Annual Postgraduate Course in Anesthesiology, February 1994. The chapters reflect new data concepts within the general framework of `pain research and basic science', and `clinical topics in pain management'. The purpose of the textbook is to serve as a vehicle to bring many of the latest concepts in anesthesiology to those who did not attend the conference, within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the current interests in anesthesia. This volume, as well as past and future volumes, reflects the rapid and continuing evolution of anesthesiology in the late twentieth century.

Imagine if the mere breeze of an air conditioner were to send you into excruciating pain. For those suffering from Complex Regional Pain Syndrome (CRPS), historically called Reflex Sympathetic Dystrophy (RSD), this crippling neuropathic pain is an unrelenting reality. With symptoms such as swelling, hypersensitivity, stiffness, burning pain, and temperature abnormalities, CRPS can develop at any time and quickly leaves its victims disabled and isolated. This book explains CRPS in an accessible style, featuring modern self-help techniques, complementary therapies, and holistic strategies for maximizing the potential for healing. Readers with CRPS will find a wealth of tips on life modifications to help better manage their condition, along with a list of "dynamite distractions" to refresh the pain-wracked mind and help them rediscover their imagination and humor. Patient testimonies on techniques for transforming the pain and discomfort of CRPS provide hope, and interviews with practitioners, including pain specialist Edward Carden and occupational therapist/neurological acupuncturist Sheri Barnes, offer insights every patient should know. There's even a chapter addressed to loved ones with advice for their difficult roles as encouragers and caregivers. CRPS remains a mysterious, poorly understood condition. This book provides the information and positive options everyone affected by CRPS needs.

The first of its kind, this book describes pediatric palliative care in more than 23 countries. Each region in the world is covered and countries included are both resource poor and rich. Authors are multidisciplinary and regarded nationally and internationally in their field. Clinicians, advocates, policymakers, funders, and researchers will learn how programs were developed and implemented in each country. Authors describe children for whom pediatric palliative care is needed and provided for in their country. When applicable, a brief history of pediatric palliative care is included noting especially policy changes and legislative acts. For example, the chapter on Poland describes how pediatric palliative care grew from the Catholic church into a national movement spearheaded by several health care workers. The Pole national spirit that brought them through a change in political regime has also been a driving force in the pediatric palliative care movement. The chapter on South Africa, for example, illustrates how a resource poor country has been able to leverage philanthropic and government funding tomake its dream of having an infrastructure of pediatric palliative care a reality. These are just a few examples of the inspiring stories that are included in this book. Readers from countries who wish to start a pediatric palliative care program, or advance an existing program, will learn valuable lessons from others who have faced similar barriers. Introduction and concluding chapters highlight the strengths and weaknesses of the modern pediatric palliative care movement."

Chronic pain is one of the most common and debilitating health care conditions, and among the most notoriously challenging to treat. Chronic non-cancer pain presents a significant burden to society in terms of lost workforce productivity and significant healthcare resource utilization and cost. Although controversies persist surrounding the use of opioid analgesics, consensus now exists among medical experts that they can be useful for carefully selected patients. Safe opioid prescribing, however, hinges on effective risk management. All clinicians who treat pain with opioids are obliged to implement therapy according to accepted principles of prescribing and to minimize the risk of misuse, abuse, addiction, and diversion through risk assessment and management strategies. Proper risk assessment allows for a care plan that is structured to optimize therapeutic outcomes while minimizing risks of potential opioid-related morbidities or problematic drug-related behaviors as effectively as possible. Opioid Management Tools and Tips provides health professionals with basic guidance, tools, and resources for identifying patients who may be at risk for opioid misuse and effective managing the risk of abuse, addiction, and diversion. This second edition contains updated guidelines on opioid selection as well as legal and regulatory resources.

Pain is a complex experience, influenced by many variables. There is currently growing interest in the influence of sex and gender on the experience of pain. The fact that there are sex differences in pain and analgesia is now a well-recognized phenomenon within the field of pain medicine. However, the specific mechanisms underlying these differences remain somewhat poorly understood. Traditionally, these sex differences in pain experience have been attributed largely to psychological, behavioral and socio-cultural variables - in particular, a perceived greater willingness on the part of women to report painful symptoms and seek medical attention. Although psychosocial factors do influence pain perception, there is now substantial evidence to support a strong role for hormonal factors mediating sex differences in pain modulation. In Pain in Women: A Clinical Guide, a renowned group of experts in pain medicine breaks new ground in the field by synthesizing and elucidating the range of biological and neurohormonal factors underlying these conditions and clarifying potential treatment options based on these factors. The initial section of this unique title introduces the topic of pain in women and its importance and then goes on to describe hormonal and myofascial considerations in this patient population. The second section addresses specific pain disorders common in women and the various treatment options for these, including rehabilitative and complementary and alternative medicine (CAM) treatments. The third and final section covers the specific populations of the pregnant/postpartum woman, issues related to breast cancer, the female athlete, menopausal considerations and the role of physical therapy in women's health. Timely and state-of-the-art, Pain in Women: A Clinical Guide is an important new reference that fills a significant need in the developing area of pain medicine.

Several new developments in the field of neuroimmunology with focus on the brain-to-immune system communication have been the incentive for this PIR volume. It covers topics such as brain-immune interactions, the impact of stress on the immune response, pain and immunosuppression, the modulation of inflammation and pain by the sympathetic nervous system, consequences of nerve injury for the immune system, neuronal mechanisms of immune cell recruitment, and the modulation of the immune response by corticotropin-releasing hormone or adenosine. The authors are a unique group of scientists who are all interested in brain-to-immune interactions; however, each from a different perspective. The volume will serve both neurobiologists and immunologists to understand the influence of the central nervous system on peripheral inflammation. Many aspects of this book will also be stimulating for researchers in the pain field.

This is a practical guide to the evidence-based diagnosis and management of orofacial pain. It covers common clinical presentations of acute and chronic orofacial pain and summarizes clinically relevant neurobiology. Because diagnosing orofacial pain can be a challenge, the book describes the appropriate history-taking methods, detailed examinations, and relevant tests that will help clinicians to work through the differential diagnosis. Effective medical, surgical, and behavioral approaches are presented, and the importance of a multimodal approach is consistently emphasized throughout the book. The target audience includes pain physicians, anesthesiologists, dentists, neurologists, nurse practitioners, and physician's assistants.

COX-2 inhibitors are important drugs with analgesic and anti-inflammatory effects. The discovery of COX-2, the evolution of drug development in this field and the implications of these developments in patient therapy are topics of this volume. This book presents both pre-clinical and clinical information and is important for clinicians interested in the latest information about this class of drugs, for researchers and for students in the field.

Numerous improvements in our understanding of the mechanisms that underlie neuropathic pain states have come from the development of animal models, most of which involve partial peripheral nerve injury. The animal models have shown that nerve injury initiates a cascade of events resulting in altered neurochemistry and molecular biology of the peripheral neurons, the dorsal root ganglion cell, and changes in neurotransmitter and receptor expression in the dorsal horn of the spinal cord. Moreover, nerve injury produces anatomical changes with functional consequences.
This volume summarises the current understanding of the pathophysiological processes in the peripheral and central nervous system that contribute to the neuropathic pain. It provides a timely review of neuropathic pain mechanisms, written by experts in the field.

Pain Management and Anesthesiology contains the presentations made at the 43rd Annual Postgraduate Course in Anesthesiology sponsored by the University of Utah and held at Snowbird, Utah, USA, February 20-24, 1998. This volume addresses recent advances in the understanding of the basic science and clinical management of pain. The textbook includes sections on recent advances in the understanding of pain signal processing, as well as reviews of the clinical management of acute, chronic, cancer-related, and pediatric pain. In addition, this text includes a discussion of the behavioral assessment and treatment of the pain patient. This textbook is the sixteenth in a continuing series documenting the proceedings of the postgraduate course.

Pain management is an essential part of clinical practice for all healthcare providers from trainees, physician assistants and nurse practitioners through to practising physicians. Problem-Based Pain Management is a collaboration between experts in anesthesiology, geriatric medicine, neurology, psychiatry and rehabilitation which presents a multidisciplinary management strategy. Over 60 chapters follow a standard, easy-to-read, quick access format on: clinical presentation, signs and symptoms, lab tests, imaging studies, differential diagnosis, pharmacotherapy, non-pharmacologic approach, interventional procedure, follow-up and prognosis. The broad spectrum of topics include headache, neck and back pain, bursitis, phantom limb pain, sickle cell disease and palliative care. Unlike other large, cumbersome texts currently available, this book serves as a quick, concise and pertinent reference in the diagnosis and management of common pain syndromes.

This volume is a result of an International Symposium on pain and neuroimmune interactions, held in Beirut, Lebanon, in May of 1999. The results of research on the neural mechanisms that relate tissue damage to pain show that the sensation of pain and suffering can be considered as part of mechanisms that involve not only sizeable areas in the brain but also simultaneous activations of the immune and the endocrine systems. Pain involves the sharing of molecular mechanisms between the nervous, immune and endocrine systems that can interact at peripheral and, ultimately, central levels. Chronic pain can then be viewed as a corollary of the imbalance in the cross-talk between these systems, which could lead to new treatment strategies. The aim of this volume is not to deal with acute pain that serves as an alarm signal, but to attempt to explain the molecular mechanisms of chronic pain considered as a multifactorial syndrome or disease.

The understanding of pain has undergone extraordinary development over the last 25 years. Half of all medical visits are initiated because of pain. The need for all clinicians and trainees to have a foundational knowledge of pain has become more critically important than ever. Not surprisingly, most books on pain medicine are almost all written by "pain management doctors," physicians who've trained in "pain medicine" and devote their lives to treating pain. However, the burden of pain extends to all doctors, not just those who treat it every day. Managing Pain: Essentials of Diagnosis and Treatment offers a fundamental guide on the diagnosis and therapy of frequently encountered pain conditions for non-pain physicians and clinicians. Written using easily-accessible language, this book first reviews the basics of opioids and other therapies, including psychotherapy and complementary modalities. The second part of the book presents clinically-relevant cases chosen to reflect those conditions most frequently encountered by primary care providers. Edited by world-renowned experts in pain medicine, with many chapters written by non-pain physicians who are experts in their respective specialties, Managing Pain: Essentials of Diagnosis and Treatment is a useful guide for the non-pain-trained healthcare provider who is on the frontlines treating chronic pain.

The second edition of the Handbook of Pain Relief in Older Adults: An Evidence-Based Approach expands on the first edition by providing a number of timely new features. Most important of these are the revised recommendations from the American Geriatrics Society on prescribing that reflect the many new agents available since the last guidelines were released in 2001. Additionally, concepts such as synergy in prescribing for older adults have been better delineated in this edition. The most salient features of the original edition have been retained and updated, including the full range of approaches for pain assessment and prevention, interventional strategies, guidance on pharmacotherapy and nonpharmacologic pain relief strategies for seniors, preventive analgesia, the role of rehabilitation in sound pain treatment, legal and public policy issues in pain care for seniors, pain management in long-term care, and even the issue of spirituality as an adjunct to pain management. The second edition also includes a new chapter on resources, which includes organizations, internet websites, and guidance on acquiring additional consultation for pain intervention. Of particular interest is an updated discussion of the effect that electronic medical records and internet-based personal health records will have on pain relief in older adults and a new chapter that serves as a resource guide for patients and caregivers trying to navigate the waters of pain relief assistance. This issue has not been addressed substantively in the pain management literature and the ramifications for older adults are particularly poignant. Comprehensive and practical, the Handbook of Pain Relief in Older Adults: An Evidence-Based Approach (Second Edition) is a comprehensive resource with targeted, practical information that will be of vital importance for all clinicians who provide care for seniors.

Millions of procedures, surgical and non-surgical, are performed around the world each year. Management of perioperative pain is of great importance to patients, and a critical management issue for physicians and other health professionals who provide perioperative care. Healthcare facilities and national accrediting organizations have established standards surrounding proper management of perioperative pain. There is now an increased burden on every hospital and training program to ensure that healthcare providers understand the essentials of pain management and are able to recognize and treat pain in a timely fashion. Poorly controlled pain leads to patient dissatisfaction and contributes to increased morbidity and mortality, such as myocardial infarction, pneumonia, and emotional effects. Proper management, including appropriate pharmacologic management and regional analgesic techniques, can improve function and shorten length of hospital stay. Patients who are undergoing procedures under sedation or anesthesia need to receive adequate pain relief with drugs or regional anesthetic techniques. In the recovery room following the procedure, the staff taking care of the patient needs to be properly trained to diagnose and treat post-procedural pain. Part of the Oxford American Pain Library, this concise, evidence-based clinical guide serves as a tool for every clinician who wishes to understand the basic mechanisms, pharmacology, invasive and noninvasive treatment modalities, guidelines and development of pain management protocols. The authors address new technologies, chronic pain issues, running an acute pain service, opioid and non-opioid pharmacology (including newly approved drugs), epidural and other regional anesthesia, and special populations such as pediatric patients, the elderly, and patients with a co-existing disease.

Opioid treatment for chronic pain has been popularized over the past few decades, and opioid usage has increased several-fold. Opioid treatment of chronic pain increased for several reasons: a sense that chronic pain had previously been undertreated; strong underwriting of medical education by drug companies anxious to sell new "designer" opioids; lifting of the stigma associated opioids, particularly as pain advocacy reestablished opioids as necessary and appropriate treatment for acute and cancer pain. What has emerged is that there are several limitations to chronic opioid treatment. What has become clear in this unfortunate history is that non-specialists were persuaded to prescribe opioids before they could possibly understand the complexity of the treatment. So great were the pressures to prescribe, from drug companies, advocates, and many well-meaning people who saw opioids as the panacea for suffering, opioids were prescribed indiscriminately. It became almost impossible to deny opioids without seeming inhumane. What we learned though, is that while carefully selected and managed opioid therapy can benefit certain patients, casual use fails in several respects. What is needed then is a vast educational effort to help clinicians understand some of the complexities of opioid therapy, and in particular, how to select patients, and subsequently manage and monitor so as to achieve continued efficacy without losing control of pain and drug use. While no one educational effort can solve the whole problem, this book aims to provide clinicians with expert opinion on how to manage certain common scenarios involving opioid management of chronic pain. It will provide the reader not only with an easy reference to the management of common clinical scenarios where opioids are involved, but also with in depth analysis of the difficult issues surrounding a treatment that is both uniquely effective and potentially harmful.

Over the last thirty years, the concern of Pain Medicine practitioners about the potential for their patients to develop a dependence on opioids has left opioid therapy as a largely underutilized treatment. While there is no simple answer to chronic pain, opioids remain the only class of drugs capable of providing relief to patients experiencing serious pain. Opioid Therapy in the 21st Century, Second Edition fills a dearth of clinical knowledge about analgesics to aid practitioners in weighing the risks versus the benefits of opioid therapy for their chronic pain patients. Part of the Oxford American Pain Library, this concise guide serves as a practical, user-friendly reference for physicians across the range of primary care and medical specialties. It includes an overview of appropriate clinical applications of opioids, covering such topics as opioid pharmacology, route selection, and individualization of therapy, as well as strategies for managing and mitigating the risk of abuse, addiction, and diversion. There are also special sections dedicated to the unique needs of pediatric, geriatric, and palliative care patient populations. This second edition discusses opioids approved for use since publication of the first edition, such as Butrans (buprenorphine patch); fentanyl patch and nasal spray; abuse resistant version of Oxycontin; and Embeda (morphine sulfate). Approved indications for older opioids as well as clinical trial information have also been updated.

This book has been written for the general health care professional, from every medical and paramedical specialization. Because pain is the most common factor driving patients to seek professional advice, it is likely that every physician, psychologist, and therapist has been clinically exposed to the difficulty and the frequent frustration of dealing with people in pain. All of them may find in this book some explanations for their puzzles and some updated information, which usually are published in specialized journals not ordinarily read by the general practitioner. Actually the book has been addressed to professionals at two different levels of general practice. At one level is the busy practitioner who treats most patients with' 'acute" pain, and who may use this information in daily practice to prevent the onset of chronic pain; a common effort from all professionals currently is needed to curb the "epidemic" of chronic pain in the United States. At another level the book has been addressed to the practitioner who may have a more intense desire to become involved in the actual management of chronic pain patients.

Rarely have the many mechanisms that might underlie neural plasticity been examined as explicitly as they are in this broad, lavishly illustrated treatment of plasticity in the somatosensory system. The reader is provided with state-of-the-art knowledge of connections at all levels of the somatosensory system. The authors examine the propensity for changes of connectivity in both the mature and developing mammal and make clear proposals regarding the mechanisms underlying these changes. Their functional significance to relevant psychophysical and neurological observations is also discussed.