Pain is unfortunately not an early symptom in neoplastic diseases. When it occurs, however, as it so often does in the advanced stages of the disease, then it can be particularly severe. Many physicians are not able to treat such pain efficiently with the standard methods familiar to them. Even in the oncological clinic, it is common for cancer patients not to receive adequate treatment of their pain; the therapeutic efforts are directed principally at the cancer, the pain often being neglected. This book fills a gap in the literature and should enhance the awareness of pain of all those who deal with cancer patients. For the patient, the symptoms of the disease are usually the direct cause of suffering, and pain is often the most severe symptom. The pain may be potentiated by knowledge of the threat posed by the cancer, or may itself considerably increase the patients existing anxiety. Thus there is a vicious circle of pain and psychological factors which will reduce the patient to a state of despair and distress. It is, therefore, obvious that efficient pain therapy is of utmost signi ficance to the patient, who will judge the doctor's ability to provide medical assistance according to the degree of pain relief achieved. The patient's quality of life will also depend critically on the relief obtained."

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.

It has been estimated that 60 million Americans suffer from pain. There has been an explosion in pain research, new pharmaceuticals, the recognition of complementary and alternative therapies, interventional techniques and surgery, professional pain societies and providers with expertise in pain management. The most common condition seen in primary care settings and in pain clinics is lower back pain. Several studies indicate that primary care providers feel ill-prepared to deal with pain issues. Back and neck pain, myofascial pain, whiplash and fibromyalgia are particularly challenging and troublesome for this group. There are multiple reasons for this discomfort, including lack of training, absence of guidelines, concerns about addiction risk and many other issues. As part of the Oxford American Pain Library, this practical handbook is designed to serve as a concise yet authoritative resource on diagnosing and treating back and neck pain. Co-authored by two primary care physicians and a nurse practitioner with extensive expertise in pain medicine and management, the book is tailored to the needs of busy health care professionals treating patients in the primary care setting, and focuses on essential clinical information for physicians, nurse practitioners, and physician assistants in family practice, and internal medicine. In addition to covering all aspects of diagnosis, treatment-both pharmacological and non-pharmacological, and ongoing management of back and neck pain, the handbook also features a section dedicated to similar conditions of myofascial pain, whiplash and fibromyalgia. In addition to covering traditional clinical areas such as pathogenesis, co-morbidities, pharmacologic and non-pharmacologic treatments, the book also presents an array of practical tools and features such as screening tools for easy diagnosis, disability assessment tools, tips on best questions to ask, useful checklists and additional patient resource information. The pocket-sized format, concise chapters, multiple charts and graphs and bulleted highlights are ideal for all providers needing a quick, easily accessible, portable reference on back and neck pain.

The number of studies on chronic and recurrent pain bears no relation to the frequency of these complaints in gynecologic practice, nor to the clinical and scientific problems that still need solving in this area. Several factors stand in the way of progress in this field, such as the strongly subjective nature of the complaints, the frequent lack of correlation between them and objective findings, and the complexity of the psychosomatic interac tions involved. Although progress in our knowledge has been much slower than we would have wished, and although we are well aware of these many gaps, it was considered useful to gather in a book what we think we have learned during 3 decades of active interest in pain patients and pain problems in gynecologic practice and 12 years of supervision of a pain clinic in the Department of Obstetrics and Gynecology of Leuven University. As there are many differences between acute pain - clinical as well as experi mental - on the one hand and chronic pain symptoms on the other, it was felt preferable to limit the scope of this book essentially to chronic and recurrent pain in gynecologic practice. When presented with a complaint of lower abdominal and/or low back pain, the gynecologist should constantly be on the lookout for nongynecologic causes, of which the most frequent will be either gastroenterologic or orthopedic and sometimes urologic. I have been fortunate in obtaining the collaboration of Dr."

Throughout the course of history it has always been noted that any ideas about brain function depended upon the highest technological model of the day. Hence, in the Greek or Roman era the ventricular system was singled out because of the devel opment of hydraulics. Early in this century we drew the analo gy between telephone circuits and the brain. Now it is popular to characterize neural function as that of a sophisticated com puter. Indeed, in many ways it may be. But, as yet, the pre pared human brain will likely prevail in the sorting out of information necessary for a proper diagnosis. In this manual, POECK has provided the ground work for such prepara Dr. tion. We all admire the clever diagnostician, and usually ascribe the skill to great intuition. Not so It is the clinician who has seen many patients, and has compiled a menu of choices. Dr. POECK is such a clinician, and he has provided us with his menu of choices. Use of these lists will likely aid the student or resident physician in coming to a proper diagnosis but, more importantly, will help train his or her mind to think in a logical and systematic way. ROBERT J. JOYNT, M.D., Ph.D."

Assessing Chronic Pain offers a unique approach to the evaluation and assessment of treatment for chronic pain patients. Rather than adhering to the criteria of any one discipline's approach to treating chronic pain, whether that of anesthesia, physical therapy, psychiatry or psychology, the editors overview a range of disciplines, and focus on the integration of those approaches to achieve what they term a "handbook," rather than a textbook, for the assessment of chronic pain from a multidisciplinary perspective. Issues confronting clinicians have been compounded by procedural problems and assessment indecision, but in Assessing Chronic Pain, Drs. Camic and Brown create a framework to guide specialists in all fields in approaching the patient suffering from chronic, non-malignant pain.

Pain is a symptom of many clinical disorders, afflicts a large proportion of the population and is largely treated by pharmacological means. However, the two main classes of drugs used are the opioids and the non-steroidal anti inflammatory drugs, drugs that have a long history. The last decade has seen remarkable advances in our understanding of some of the pharmacological bases of pain and analgesia and this book aims to reflect these rapid changes in our understanding of pain mechanisms. One impetus to these scientific advances has been dialogue and interactions between scientists and clinicians; as a result we now has a number of animal models of clinical pain states, to mimic certain aspects of clinical pathophysiological pain states. Molecular aspects of receptors and the synthesis of tools for probing receptor function have also been rapid growth areas. A number of controlled clinical studies using novel licensed drugs have also resulted from recent research, offering hope to certain patients with severe intractable pain. However, we desperately need the pharmaceutical industry to develop new drugs based on these novel targets for analgesic therapy. This book attempts to provide an overview of the important areas of the pharmacology of pain. This book, although providing an account of the pharmacology of pain transmission and its control based on the underlying anatomical organization and physiological responses, does not attempt to cover these latter two areas."

Patients with pain disorders pose many clinical challenges for the attending physician. Even experienced clinicians occasionally arrive at the point where diagnostic, work-up, treatment, or prognostic thinking becomes blocked.
Pain teaches the reader to recognize and appropriately treat a variety of pain disorders using a case study format. Divided into three section, chronic pain conditions, chronic pain and related disorders, and treatment overview, and derived from consultation requests from providers in medical practice, the cases are written in a format that encourages the reader to formulate a differential diagnosis and treatment plan for a variety of pain problems. Succinct in its presentation and logical in its layout, Pain is the perfect resource for the busy practitioner on the go.

Essentials of Pain Management is a concise, evidence-based guide that stresses a multidisciplinary approach to pain and provides a thorough review of clinical principles and procedures. Edited by faculty from Yale and Harvard Medical Schools, Essentials provides a practical approach to pain management for every type of pain management practitioner. Features: * Extensive case vignettes illustrating specific pain management challenges and solutions * Multiple-choice questions with detailed answers useful for exam preparation * In-depth discussions of palliative medicine, end-of- life care, physical therapy and acupuncture, behavioral therapy, and pediatric and elderly pain * A formulary of commonly used drugs for an easy go-to reference for every office * Special considerations for nurses and dentists From career choices in pain management to the specific drugs, procedures, and therapies that can alleviate pain, Essentials of Pain Management is a valuable resource for all pain management practitioners.

This important book fills a need in the developing area of Pain Medicine. It provides physicians with an up-to-date resource that details the current understanding about the basic science underlying the mechanism of action of the various CAM therapies used for pain. It summarizes the clinical evidence both for efficacy and safety, and finishes with practical guidelines about how such treatments could be successfully and safely integrated into a Pain practice.

From the time questions about the impact of wireless technology on public health were first raised in 1993 through the present, Wireless Technology Research, LLC (WTR) has been the largest independent surveillance and research program trying to identify and solve human health problems associated with wireless phones. In 1995 at the University "La Sapienza" of Rome, WTR sponsored the first comprehensive forum for the discussion of these issues. Papers from the 1995 State of the Science Colloquium were collected andpublished in Volume I ofthis series, Wireless Phones andHealth: Scientific Progress. This second volume assembles papers presented at WTR's Second State of the Science Colloquium in Long Beach, CA, in June 1999; it contains the most comprehensive research on the public health impact of wireless phones to date. The operating words for the proper understanding of these data are science and public health. Science is a tool for making public health decisions, but the framework in which we are operating is truly that of public health. We are looking for problems that have to do with wireless technology. We are trying to decide how this technology impacts on the public for one purpose and one purpose alone, and that purpose is to solve problems that are identified. I would like to challenge you, the reader, to suspend your parochial orientation as you consider these latest findings.

close circle of anaesthetic scientists but, with the help of computer technology, has greatly influenced the practice of the modern clinical anaesthesiologist. The efforts of anaesthesiologists, pharmaceutical companies, and the development of the internet has lead to a situation that now almost every anaesthesiologist can be in close contact to anaesthetic pharmacology computer simulation pro grams and target controlled infusion devices. These two tools allow us to in crease our understanding and improve the controllability of anaesthetic drug administration, on site, in the operating theatre. In Europe the growing enthusi asm regarding the study and practice of intravenous anaesthesia has lead to an increased output of manuscripts on this subject, the initiation of workshops on the pharmacology of anaesthetic agents and the formation of a society that embodies this spirit; the European Society for Intravenous Anaesthesia, the EuroSIVA. EuroSIVA The concept of EuroSIVA has been to provide a forum to co-ordinate, facilitate and promote high quality presentations in the area of intravenous drug admini stration. The first two meetings held in 1988 in Barcelona and 1999 in Amster dam achieved these aims. During the Barcelona and Amsterdam meetings pre senters of over 10 countries shared their knowledge with 250 and 400 partici pants, respectively. In addition to the EuroSIVA meetings the international board aims to promote education for those involved with intravenous anaes thesia."

This is the second part in a two-volume work on neuromodulation. It describes the techniques and procedures applied by direct contact with the central nervous system or cranial nerves (in order to modulate the function of neural networks) or in deeply located structures inside the nervous system (in order to alter the function on specific networks).

Pain is a common symptom, yet it is frequently underevaluated and undertreated. It is difficult to define, describe-and sometimes to prove. It's pain, and suspicions of exaggerations often add further insult to a patients' injuries. Biobehavioral Approaches to Pain translates this highly subjective experience-and its physical, psychological, social, and cultural dimensions-into practical insights key to transforming the field of pain management.

This pathbreaking volume synthesizes a rich knowledge base from across disciplines, including neurobiologic, genetic, biobehavioral, clinical, narrative, substance abuse, health services, ethical and policy perspectives, for a deeper understanding of the impact of pain on individual lives and the larger society. Its international panel of contributors highlights special issues and review best practice guidelines, from placebo effects to cancer, Whiplash Associated Disorders to pain imaging to complementary medicine, phantom limb pain to gene therapies to AIDS. Among the topics covered:

• The distinction between acute and chronic pain: is it clinically useful?
• Improving clinical assessment of patients with pain.
• Age and sex differences in pain.
• The what, how and why of the placebo and nocebo effect
• Psychosocial and partner-assisted biopsychosocial interventions for disease-related pain
• Substance abuse issues in pain treatment.
• The personal, social and economic costs of chronic pain.

Biobehavioral Approaches to Pain offers clinical and health professionals, psychologists, as well as specialists in pain management or palliative care, new directions in their ongoing dialogue with patients. Given the prevalence of pain in the general population, it should also interest researchers and students in the field of public health.

Caring for patients with fibromyalgia requires an understanding of the complex nature of this condition. Fibromyalgia: A Practical Clinical Guide is a state-of-the-art resource designed to clarify the controversy about fibromyalgia and to provide clinicians with the latest information about its pathogenesis and clinical evaluation, as well as evidence-based guidelines for effective treatment. This comprehensive title includes fully referenced, practical information on this fast-emerging field and provides useful clinical suggestions and practical office tools for effectively managing patients. The good news for fibromyalgia patients and their healthcare providers is that a wide range of medication, non-medication, and non-traditional therapies have been proven to effectively reduce some of the most problematic and disabling fibromyalgia symptoms. Brief case vignettes help describe many of the common presentations, concerns, and complexities typically seen in fibromyalgia patients. Invaluable graphic aids -- boxes, tables, and figures - are used widely to provide quick reference for the busy clinician seeking information. In addition, clinic-proven assessment and documentation tools for evaluating and monitoring fibromyalgia symptoms and severity are provided, along with handouts for patients to provide guidance on pain management techniques, including detailed exercise and relaxation technique instructions. A unique addition to the literature, Fibromyalgia: A Practical Clinical Guide is an indispensable reference for all clinicians who care for patients with fibromyalgia.

Over the past two decades attention to family issues in relation to chronic pain has been on the rise. There has been a proliferation of research and clinical literature in the field since the first major review on this topic was conducted in 1982. However, no comprehensive review book has been published. Generally speaking, the role of the family in chronic pain literature has been reported from four perspectives: (1) family factors in the etiology of chronic pain; (2) role of spouse in the perpetuation of pain behaviors; (3) impact of chronic pain on family functioning and on the health of spouse and children; and (4) family therapy for these families.

The main thrust of this book will be the issues of impact on the family and therapy. The broader literature of family issues in medical disorders will be incorporated into the body of the book to allow the reader to become familiar with some of the common problems shared by medically ill and chronic pain families and many problems that appear to be specifically associated with chronic pain. The book will offer clinical guidelines in conducting family assessment and couple and family therapy for these patients. This book will not be simply an update, but will adopt a fresh approach to this complex clinical area. The book will have 10 chapters. Each chapter will report the current state of knowledge through a comprehensive review of the most recent literature, and discuss relevant clinical issues through extensive use of case illustrations. The chapters will be designed to bring the reader up to date on the literature as well as provide clinical guidelines for practice.

International experts present in this volume advances in reconstructive neurosurgery focusing on the fields of neurotrauma and neurodegenerative disorders. The highlights include building an international strategy for risk reduction, documentating an multidisciplinary approach towards restoration of function in paraplegic spinal cord-injured patients, describing a new approach for statistical analysis in traumatic brain injury trials, describing blood flow changes in diffuse brain injury, discussing rehabilitation programs in Germany following acute brain injury, describing research data form Taiwan on neurotrauma, showing the neuropsychiatric effects from deep brain stimuation fro ovement disorders, difining the role played by imanging for deep brain stimulation targeting in mental illness, using radiosurgery in decompresssion in the treatment of trigeminal neuralgia, describing the development of radiosurgery from brain to the spine, listing new transgenic animal models of Parkinson's disease, discussing gene therapy for neuropathic pain and Parkinson's disease, and finally, discussing constrained-induced movement therapy fro stroke patients, and endovascular therapy for cerebrovenous disorders.

It has never been easy to introduce new concepts and therapeutic in-terventions into surgical practice. When attempting to do so, one is faced with the interagency of traditional dogma, which still in this era of evidence-based medicine tends to dominate the surgical thought pr- ess. This is particularly so in the area of coloproctology, where prejudice and personal opinion often influence objective analysis whenever tradition is challenged. A large body of literature on anorectal prolapse has accumulated over the years; although much is based on personal viewpoint rather than scientific evidence, it has nevertheless been passed down through the generations as ac-cepted wisdom and practice. As a consequence, it is a challenge to change the mindset of a generation of surgeons and to introduce new concepts and novel techniques which at first might appear to be a radical departure from conventional teaching. It is obviously not possible to present the basis for the develop-ment of transanal stapling techniques for anorectal prolapse in this Foreword; this is dealt with in detail elsewhere in this book. The in-terested reader will have the opportunity to share in the new and emerging concepts surrounding anorectal prolapse and to deepen their understanding of the pat- physiology and basis for surgical correction. Although hemorrhoidal disease and external rectal prolapse have been known about for centuries, the understanding of internal rectal prolapse (intussusception) and rectocele has only really advanced with the emergence of radiological imaging tech-niques, such as defecography.

about the book... Standing alone as the first definitive and comprehensive book on the subject, this guide describes the most recent studies on the brain-gut connection and psychosocial issues related to patients experiencing visceral pain. Bringing together leading experts from the top-tiers of the science, this source provides 33 engaging chapters and spans basic concepts in pharmacology, neurobiology, physiology, and psychology to provide a practical approach to the treatment of chronic pain. Examining a condition that affects up to 25% of the general U.S. population, this source is the only book on the subject to cover both clinical syndromes and neurobiology...ranges from basic mechanisms to diagnosis and clinical treatment of specific syndromes including inflammatory bowel disease, functional abdominal pain, dyspepsia, non-cardiac chest pain, and pelvic pain syndromes...analyzes the latest scientific advances including the role of functional imaging in patient care...integrates fundamental scientific concepts with a practical clinical approach...and supplies 250 figures, and more than 16 color photographs. about the editors... PANKAJ JAY PASRICHA is Chief, Division of Gastroenterology and Hepatology; Bassel and Frances Blanton Distinguished Professor of Internal Medicine; and Professor of Neuroscience and Cell Biology and Biomedical Engineering; University of Texas Medical Branch (UTMB), Galveston. Dr. Pasricha also heads the Enteric Neuromuscular Disorders and Pain Center at UTMB and has performed pioneering research in pain and motility disorders. Dr. Pasricha has served on numerous national gastroenterological committees and on panels for the National Institutes of Health. He received the M.D. degree (1982) from the All-India Institute of Medical Sciences, New Delhi, India, and post-graduate training in gastroenterology at the Johns Hopkins University Medical School in Baltimore, Maryland. WILLIAM D. WILLIS is Director, Cecil H. and

Acute Pain brings coverage of this diverse area together in a single comprehensive clinical reference, from the basic mechanisms underlying the development of acute pain, to the various treatments that can be applied to control it in different clinical settings. Much expanded in this second edition, the volume reflects the huge advances that continue to be made in acute pain management. Part One examines the basic aspects of acute pain and its management, including applied physiology and development neurobiology, the drugs commonly used in therapy, assessment, measurement and history-taking, post-operative pain management and its relationship to outcome, and preventive analgesia. Part Two reviews the techniques used for the management of acute pain. Methods of drug delivery and non-pharmacological treatments including psychological therapies in adults and children and transcutaneous electrical nerve stimulation are considered here. Part Three looks at the many clinical situations in which acute pain can arise, and the methods of treatment that may be suitable in each circumstance, whether the patient is young or old, has pain due to surgery, trauma, medical illness or childbirth, or is undergoing rehabilitation. Issues specific to the management of acute pain in the developing world are also covered here.

Whether initiated by injury or disease, induced and sustained by changes in the nervous system, or manifested by society and culture, chronic pain can change one's first-person experience of the body and the world, and ultimately impacts cognitions, emotions, and behavior. Many fine medical books address the causes and management of chronic intractable pain, but rarely do they focus on the ways that such pain creates illness and is experienced and expressed by persons in pain. Maldynia: Multidisciplinary Perspectives on the Illness of Chronic Pain is about chronic pain that has progressed to a multidimensional illness state in and of itself. Although often dismissed as such, this pain is not imaginary, but rather represents an interaction of neurobiological processes, emotional and behavioral responses, and socio-cultural effects and reactions that become enduring elements in the life and world of the pain patient, and often remain enigmatic for those who provide care. Taking a comprehensive approach that covers science, humanities, and culture, this volume emphasizes the need for researchers, clinicians, and caregivers to regard the ways in which chronic intractable pain becomes illness and affects a patient's biological, social, and psychological states, as well as his or her sense of self. Edited by neuroscientist and neuroethicist James Giordano, this book contains 17 insightful chapters representing medicine, neuroscience, psychology, philosophy, ethics, history, art, and the ministry. This exceptional volume also looks at representations of pain in and through the arts, addresses the assignation of values and meaning in pain assessment and treatment, and considers ways to conjoin the sciences and humanities so as to inform the practice of pain medicine and improve the care of those suffering the illness of chronic pain.

Chronic pain is a major cause of distress, disability, and work loss, and it is becoming increasingly prevalent through the general move towards an ageing population, which impacts dramatically upon society and health care systems worldwide. Due to improvements in health care, it is becoming more common for patients to continue living with long-term illness or disease (rather than these being terminal). Yet little attention has been paid to chronic pain as a public health problem or to the potential for its prevention, even though it can be studied and assessed using concepts and ideas from classical epidemiology.
This book takes an unusual approach in making a symptom the focus of public health research and policy. Written by leaders in the field of pain, it fills a gap in current literature by presenting chronic pain in terms of cause, impact, consequence and prevention. It presents individual conditions as examples of chronic pain, together with chapters that provide overviews on the assessment of pain and methodological issues behind population assessment.
Chronic Pain Epidemiology - From Aetiology to Public Health provides an invaluable framework and basis for thinking about chronic pain and the potential for its prevention in public health terms. It will appeal to readers from public health, epidemiology and policy perspectives, and those involved in the treatment of pain - such as pain researchers, clinicians and specialists. It will also be an invaluable resource for postgraduate students studying pain management, public health, and epidemiology.

Disease whether it is acute, chronic, or at end stage, is all too regularly accompanied by pain. Pain is often difficult to control, in malignant disease in particular, even by using appropriate medications. Anesthesiologists and pain therapists have developed new invasive therapies including nerve block, sympatholysis, and neurolysis useful for both diagnosis and pain management. To insure the efficiency and safety of these procedures, and furthermore for elaborate techniques such as vertebroplasty, cementoplasty, and radio frequency bone ablation, imaging guidance becomes mandatory. This state-of-the-art book describes the techniques elaborated by interventional radiologists in the treatment and palliation of a variety of benign and malignant painful conditions. Each chapter written by an expert in the field concentrates on a particular aspect of pain management, with emphasis on practical issues. This book will serve as an invaluable source of information for the radiologist willing to learn about new pain therapy techniques aimed at optimizing or replacing more invasive traditional methods.

Following recent guidelines set by the International Classification of Headache Disorders, this reference presents the most current diagnostic and treatment protocols for migraine and other headache conditions. Chapters are authored by internationally renowned headache clinicians and scientists, including several past presidents of the American Headache Society and the International Headache Society. User-friendly and up-to-date, this reference offers useful tables, algorithms, and diagrams that lead clinicians to effective treatments for the management of migraine and the reduction of migraine severity.

This groundbreaking new text explains and documents the scientific basis of chronic pain in Joint Hypermobility Syndrome (JHS) and other heritable disorders of connective tissue from the physiological, epidemiological, genetic and clinical viewpoints. It asks the reader to consider the possibility of JHS, identify it clinically, understand its co-morbidities, including interdependencies with Fibromyalgia and Chronic Fatigue Syndrome, while managing the condition appropriately. Hypermobility, Fibromyalgia and Chronic Pain takes a multi-specialty and multidisciplinary approach to understanding JHS and its management, drawing together expertise from a broad group of internationally-recognized authors. The book is split into two sections. Section 1 deals with the clinical manifestations of JHS and Fibromyalgia, their epidemiology and pathophysiology. Section 2 covers clinical management. Here the reader will find chapters covering pharmacotherapeutics, psychotherapy and physical therapies that address the needs of patients from childhood to adulthood. It is hoped that Hypermobility, Fibromyalgia and Chronic Pain will advance knowledge of therapies and provoke further research while stimulating interest and encouraging debate. Comprehensively relates practical therapy to the nature of the underlying pathology Covers in one single text both the scientific and practical management aspect of Joint Hypermobility Syndrome and its allied pathologies Contributions from over 30 leading international experts Multidisciplinary approach will support all health professionals working in this field