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.

Headache pain is widespread: 70% of Americans report suffering from headaches; 12% of those experience migraine pain. Aiming to supply clinicians with the information they need to care for headache patients, this second edition covers the most current information on headache classification, diagnostic procedures, and the treatment and management of chronic headache pain, including botulinum toxin for headache and zolmitriptan. The author discusses all common headache conditions: migraine, chronic migraine, status migraine, cluster and related headaches, tension headaches, sinus headaches, cervicogenic headaches, secondary headaches, and neuralgias. Part of the Oxford American Pain Library, this concise handbook aims to provide clinicians with practical information about the diagnosis and management of headache patients. Treating migraine and headache care holistically, the author includes a thorough review of both pharmacological medicines, such as anticonvulsants, antidepressants, and triptans as well as non-pharmacological alternatives, such as botanical remedies, acupuncture, and behavioral therapy. The book concludes with a collection of representative cases to help the physician integrate factual knowledge with evidence from real-life clinical situations. Compact and affordable, this volume is accessible, fact-filled, readable, and clinically pertinent.

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.

This volume on the processes of transformation of mechanical stimuli into electrical activity in various mechanoreceptors comprises the authors investigations as well as relevant literature data. It deals mainly with initial electrical processes from stimulus of the mechanoreceptor to receptor potential. For the first time the connection between passive and active ion transport and the generation of electrical potentials is considered in detail. Furthermore, data on the properties and selectivity of different types of mechanosensitive ion channels, as well as results of morphological experiments on characteristics of the mechanosensitive membrane, and the changes during the activation of primary and secondary mechanoreceptors are discussed. This comprehensive overview is of interest to molecularbiologists, neuroscientists and biophysists.

This supplement of Acta Neurochirurgica contains the proceedings of the Ninth Convention of the Academia Eurasiana Neurochirurgica held in Chateau St. Gerlach, Houthem, The Netherlands, 29 July - 1 August 1998. During this convention a three-day symposium on Neurosurgery and Medical Ethics was held. In this time of tremendous technical advancement in medicine in general and neurosurgery in particular, we are liable to lose sight of the sick patient as a human being, and the odds are that he will be the object rather than the subject of our action in the near future. It is a purpose and a task of the Academia Eurasiana Neurochirurgica to recognize this thread and to pay attention to tradition, morality and ethics in neurological surgery. The theme of this convention and the subject of the symposium met this purpose as no other. In the scientific sessions during the first day, the moral backgrounds of medical ethics in the most important cultures and religions in east and west were elucidated by invited experts in this field. A mutual respectful understanding of each other's conception of and belief in ethical principles is a growing necessity in our multicultural societies in both continents. On the second day, the ethical aspects of different fields of neurological surgery were discussed by members of the Academia. In this context, also the internationally much-discussed and much-criticized regulations on euthanasia in The Netherlands were explained.

Successful pain management is key to patient quality of life and outcomes across many fields of medicine. The Handbook of Pain Management provides an insightful and comprehensive summary, authored by a noted expert.

Concise and insightful review of an important and complicated area of medicine

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."

Psychopharmacology: A Concise Overview, 3rd Edition is an evidence-based overview of the major classes of psychiatric medications and their use in clinical practice. Clinical considerations as to when, why, and how to use each individual medication are discussed in depth, as are relevant clinical controversies and treatment caveats. Each chapter also features an updated table of individual medications and their generic and brand names, dosing information, pertinent clinical comments, black box warnings, and Food and Drug Administration indications. This overview will equip readers with an essential framework of the concepts of psychopharmacology in an accessible length and style ideal for use as either a primer or refresher text. Medical students, residents, practicing physicians, nurse practitioners and other prescribers, as well as non-prescribing mental health clinicians who need to have a functional familiarity with available pharmacotherapies, will benefit from reading this concise book.

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.

Our present understanding of the psychosocial aspects of pain in children is reviewed in this monograph by leading scientists and practitioners. The contributions are integrated within a developmental perspective to provide an introduction to the conceptual and methodological tools necessary for comprehension of new work in the field. This volume offers a survey of major new developments in the area of pediatric pain and points out the directions in which clinical work and conceptualization are moving. Children in Pain argues consistently and persuasively that both models of pain assessment, intervention techniques, and research designs must demonstrate a sophisticated appreciation for developmental considerations. Topics explored include assessment of pediatric pain; coping and adaptation in children's pain; developmental issues among infants and toddlers and among preschool and school-age children, as well as among adolescents; recurrent abdominal pain; burn injury and treatment; chronic and recurrent pain in hemophilia, juvenile rheumatoid arthritis and sickle cell disease; developmental aspects of the biobehavioral treatment of migraine in childhood; and helping children cope with painful medical procedures.

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.

Travell, Simons & Simons' Trigger Point Pain Patterns Flip Charts, Second Edition includes the iconic muscles and pain point patterns illustrations that set the standard in the field from Travell, Simons, & Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual, the definitive reference on myofascial pain, and is organized in six sections following the structure of the Clinical Considerations chapters in the manual. This spiral-bound book with a built-in easel for display and patient presentation allows for a quick clinical reference to include TrPs as part of the clinical examination. Each section contains Trigger Point (TrP) pain referral patterns that may cause or be associated with a clinical condition commonly seen in clinical practice.

Pelvic pain in the female patient is common in gynaecological practice, but the specialties of general surgery, urology and orthopaedics provide a significant number of patients and problems. These patients may suffer a multitude of symptoms, and only careful analysis and investigation of each individual problem by the doctor concerned will lead to correct diagnosis and management. The subject matter of this book lies in the practice of many specialties, and all are combined here in a coherent whole. This emphasises the close collaboration necessary between family practitioners, junior hospital staff and consultants. The authors are consultants who work together in a busy district general hospital, and their experience and collaboration is evident in the approach to the diagnosis and management of pelvic pain in the female. Emphasis is laid on the careful evaluation of history and examination and the correct interpretation of diagnostic investigations. Full details of radiology, ultrasound scanning, endoscopy, peritoneoscopy and bacteriological investigation are given. Full consultation between members of staff who have special experience in these investigative procedures is of paramount importance. Details of treatment for relief of pain are important to all doctors concerned with this aspect of clinical management. and this section will be of particular value. The blending of these specialties allows full consideration of the problems affecting the patients. Careful management leads to better treatment for the patient and better satisfaction for the doctor.

Migraine is a debilitating disorder, it is essential that it is diagnosed accurately and swiftly in patients. This book covers, in-depth, the key diagnostic criteria and treatments that pediatricians and other primary care providers must be aware of in order to treat pediatric migraine effectively.

Written by an expert on the subject of pediatric migraine/headache
A refresher for GPs and hospital doctors with practical diagnostic and treatment advice
Reviews clinical developments and guidelines, and places them into everyday clinical practice
Stresses the importance of early intervention, therapies and patient education
Concise but comprehensive"

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.

Following an introduction to the philosophical and theoreti- cal background of traditional Chinese medicine, the dia- gnostic system is presented: the Chinese system of channels and functional organs, the significance of pointsand point categories, methods of needling and moxibustion. There is a chapter on treatment based on western diagnosis.

Before the late 1970s, interest in caffeine among both the general public and the scientific community was at a relatively low level for many years, even though it was recognized that caffeine was an al most universal component of the diet. The National Coffee Associa tion was supporting a continuing program of research, some re search was being conducted by a few of the largest companies selling coffee, and an occasional university researcher became inter ested in caffeine and conducted experiments, often on effects of caf feine in very high concentration in vitro on skeletal muscle fibres or on dividing cells. Since 1978, however, there has been a mighty up surge in both public and scientific interest in caffeine. It is interest ing to note that this was prompted not by discovery of hitherto un known effects or hazards of caffeine, but by the actions of a regulatory agency, the Food & Drug Administration (FDA) of the U. S. Public Health Service. The U. S. Congress passed new laws on foods and drugs in 1958. One of the provisions was for testing of food additives to assess risk to health. As it was clearly impracticable to require immediate test ing of all additives already in use, a list was drawn up of some hun dreds of additives that were generally recognized as safe (GRAS)."

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."

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.

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."

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."

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.