Bonica's Management of Pain-5판

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authenticity, or access to any online entitlements included with the product. 
This exhaustively comprehensive edition of the classic Bonica's Management of Pain, first published 65 years ago, 
expertly combines the scientific underpinnings of pain with clinical management. 
Completely revised, it discusses a wide variety of pain conditions-including neuropathic pain, pain due to cancer, 
and acute pain situations-for adults as well as children. 
An international group of the foremost experts provides comprehensive, current, clinically oriented coverage of the 
entire field. The contributors describe contemporary clinical practice and summarize the evidence that guides clinical 
practice.



PART ONE Basic Considerations

Chapter 1 Intellectual Milestones in Our Understanding and Treatment of Pain

15.Pain Understood as Part of a Larger Philosophy or Worldview
16.Mechanistic Views of Pain
17.19th Century-pain as a Specific Sense
18.Afferent Signaling
19.Gate Control Theory
20.Treatments for Pain
21.Cognitive Treatment for Pain
22.Pharmacologic Treatment of Pain
23.Anatomically Specific Treatments for Pain
24.The Specialty of Pain Medicine
25.Acknowledgments
26.References


Chapter 2 Pain Terms and Taxonomies of Pain

28.Definition of Commonly Used Pain Terms
29.Taxonomies
30.Expert-Based Classifications of Pain
31.Classification Based on Anatomy
32.Classification Based on Duration
33.Classification Based on the Etiology of Pain
34.Classification Based on Body System
35.Classification Based on Severity
36.Classification Based on Functioning
37.Classification Based on Intensity and Functioning
38.Classification Based on Prognosis
39.Mechanism-Based Classification of Pain
40.Comprehensive, Multidimensional Classification of Pain: International Association for the Study of Pain Taxonomy
41.Comprehensive, Multidimensional Classification of Pain: Acttion-American Pain Society and Acttion-American Pain 
Society-American Academy of Pain Medicine
42.Inductive Empirically Based Classifications of Pain
43.Psychometric Considerations
44.Conclusion
45.References


Chapter 3 Peripheral Pain Mechanisms and Nociceptor Sensitization

47.Functional Characterization of Nociceptors
48.Identification of Putative Nociceptors
49.Nociceptor Characteristics
50.Anatomy of the Nociceptor
51.Stimulus Transduction
52.Passive Electrophysiologic Properties and the Spread of the Generator Potential
53.Action Potential Generation
54.Action Potential Propagation
55.Transmitter Release
56.Nociceptor Sensitization
57.Clinical Implications of Nociceptor Function
58.References


Chapter 4 Substrates of Spinal Cord Nociceptive Processing

60.Defining Nociceptive Systems
61.Models of Pain Processing
62.Methods of Neuronal Characterization
63.Defining Nociceptive Second-Order Neurons
64.Development of Sensory Systems
65.Targets of Primary Afferent Input
66.Gross Anatomy of the Spinal Cord
67.Spinal Laminae
68.Functional Characterization of Nociceptive Neurons
69.Classification According to Site of Projection
70.Targets of Axonal Projections
71.Intraspinal Pathways
72.Spinothalamic Tract
73.Spinoreticular and Spinomesencephalic Tracts
74.Postsynaptic Dorsal Column Neurons
75.Other Ascending Pathways
76.Neurochemistry of Second-Order Neurons
77.Neurotransmitters from Primary Afferents
78.Neurotransmitters from Interneurons
79.Neurotransmitters from Supraspinal Sources
80.Neurotransmitters from Glia or Unknown Sources
81.Other Important Receptors/Channels
82.What is Important to the Clinician
83.Acknowledgments
84.References


Chapter 5 Modulation of Spinal Nociceptive Processing

86.Spinal Cord-Based Modulatory Mechanisms
87.Acute Segmental Modulatory Effects
88.Heterosegmental Modulatory Systems
89.C-Fiber Wind-Up and Central Sensitization
90.Supraspinal Modulatory Systems
91.Tonic Descending Influences
92.Supraspinal Substrates Mediating the Descending Modulation of Pain
93.Summary of Supraspinal Influences
94.On, Off, and Neutral Cells
95.Triggers of Clinical Hypersensitivity
96.Allodynia and Hyperalgesia
97.Inflammation-Induced Hypersensitivity and Inhibitory Systems
98.Stress-Induced Analgesia and Hyperalgesia
99.Neuropathic Pain
100.Opioid-Induced Hyperalgesia
101.Conclusion
102.References


Chapter 6 Supraspinal Mechanisms of Pain and Nociception

104.Functional Imaging of Pain in Humans
105.Methodologies of Noninvasive and Invasive Functional Brain Imaging in Pain
106.Brainstem
107.Periaqueductal Gray Matter뾃 Key Structure of Endogenous Analgesia
108.Mesolimbic Dopamine System
109.Hypothalamus
110.Thalamus
111.The Lateral Pain System뾗he Sensory-Discriminative Pathway
112.Spinal Connections to Brainstem and Medial Thalamus뾗he Affective Pathway
113.Cortex
114.Sensory Areas
115.Limbic Areas
116.Vigilance, Arousal, and Attention in Pain Processing
117.Pain Plasticity
118.Summary and Conclusion
119.References


Chapter 7 Psychological Aspects of Pain

121.Cognitive Factors: Predispositions, Appraisals, Beliefs, Perceived Control, and Self-Efficacy
122.Predispositions
123.Appraisal and Beliefs
124.Catastrophizing and Fear-Avoidance Beliefs
125.Perceived Control and Self-Efficacy
126.Coping
127.Stress and Autonomic Responses: Hypothalamic-Pituitary-Adrenal Axis Dysregulation
128.Emotion
129.Anxiety
130.Depression
131.Anger and Hostility
132.Psychogenic Conceptualizations of Chronic Pain
133.Psychogenic View
134.Behavioral Formulations
135.Classical Conditioning
136.Operant Conditioning
137.Social (Observational) Learning
138.Gate Control Theory
139.Cognitive-Behavioral Perspective
140.Treatments Based on the Cognitive-Behavioral Perspective
141.Biopsychosocial, Contextual Model
142.Families and Family Systems Perspective
143.Conclusion
144.References


Chapter 8 Individual Differences in Pain: The Roles of Gender

146.Sex and Gender Differences in Pain
147.Clinical Pain
148.Experimental Pain
149.Responses to Pain Treatment
150.Biopsychosocial Mechanisms
151.Ethnic Group Differences in Pain
152.Clinical Pain
153.Experimental Pain
154.Responses to Pain Treatment
155.Biopsychosocial Mechanisms
156.Genetic Contributions to Pain
157.Clinical Pain
158.Experimental Pain
159.Interactions among Individual Difference Factors
160.Conclusion
161.Acknowledgments
162.References


Chapter 9 Functional Neuroanatomy of the Nociceptive System

164.Organization of the Peripheral Nociceptive System
165.Peripheral Nervous System Structures of Pain Sensation
166.Functional Anatomy of the Central Nervous System
167.Dorsal Horn
168.Spinothalamic Tract
169.Thalamus
170.Sensory Cortex
171.Descending Pathways of the Central Nervous System
172.Central Pain
173.Central Pain After Spinal Cord Injury
174.Autonomic Nervous System
175.Peripheral Autonomic Nervous System
176.Parasympathetic Division
177.Cranial Parasympathetics
178.Sacral Parasympathetics
179.Sympathetic (Thoracolumbar) Division
180.Sensation in Visceral Organs
181.Autonomic Centers in the Central Nervous System
182.Transmission in the Peripheral Autonomic Nervous System
183.Physiology of the Autonomic Nervous System
184.Enteric Nervous System
185.Conclusion
186.References


Chapter 10 Clinical Trials

188.Uncontrolled Studies Paradigm
189.Control Groups: An Improvement over the Case Series
190.Randomized Allocation of Treatment and Control Groups
191.Other Methods for Reducing Bias in Clinical Trials
192.Baseline Similarity of Study Groups
193.Blinding
194.Were Groups Treated Equally Except for the Experimental Treatment?
195.Low Loss to Follow-Up and Intention-to-Treat Analysis
196.Other Issues in Clinical Trials
197.Measurement of Outcomes
198.Reporting the Results
199.Statistical Power
200.Generalizability of Results and Efficacy Versus Effectiveness
201.Subgroup Analyses
202.Effects of Funding Source
203.Assessment of Harms
204.Trial-Based Cost-Effectiveness Analysis
205.Alternative Study Designs
206.Cluster Trials
207.Crossover Trials
208.Factorial Design
209.New Directions in Clinical Trials
210.Pragmatic Trials
211.Enriched Enrollment Randomized Withdrawal Trials
212.Expertise-Based Trials
213.Comparative Effectiveness
214.Equivalence and Noninferiority Trials
215.Stepped Wedge Design
216.Bayesian Statistical Inference and Adaptive Designs
217.Systematic Reviews
218.Conclusion
219.References


PART TWO Economic, Political, Legal, and Ethical Considerations

Chapter 11 Transdermal Pain: A Sociocultural Perspective

222.What is Transdermal Pain?
223.Ethnicity, Race, Sex, Gender, Age: Whose Pain?
224.Across Cultures: Beliefs, Attitudes, Perceptions, Behaviors
225.Pain and Narrative: Culture, Meaning, Ethics
226.Beyond the Gate: Consciousness and the Limits of a Molecular Gaze
227.Pain and Globalization: Power, Money, Systems
228.Conclusion: Summary and Synthesis
229.Acknowledgment
230.References
231.Chapter 12 Ethical Issues in Pain Management
232.Pain, Suffering, and the Core Values of Health Care
233.The Duty to Relieve Pain and Suffering
234.Curative Versus Palliative Paradigms of Patient Care
235.The Phenomenon of Undertreated Pain
236.Identifying the Barriers to Pain Relief
237.Ethical Implications of the Barriers
238.Embracing a New Ethic of Pain Relief
239.Conclusion
240.References


Chapter 13 Ethical Issues in the Care of Dying Patients

242.Introduction
243.The Quest for Moral Order Amid Existential Disorder
244.The Contributions and Limitations of Ethical Analysis in End-of-Life Care
245.The Transition from Curative to Palliative and End-of-Life Care
246.Negotiating Treatment Preferences: The Ideal Decision-Making Process
247.Departures from the Ideal
248.Communication with Patients About Treatment Preferences Near the End of Life
249.Surrogate Decision Making
250.Assessing Decisional Capacity
251.Ruling Out or Eliminating Reversible Causes of Incapacity
252.Identifying a Surrogate
253.The Surrogate뭩 Roles and Responsibilities
254.A Realistic Process of Advance Care Planning
255.Responding to Demands for Nonbeneficial Treatment
256.The Ethical Basis of the Conflict
257.The Clinical Context of the Conflict
258.Differential Diagnosis of the Conflict
259.Physician-Assisted Death
260.Terminology
261.Ethical Considerations Along the Clinical Spectrum
262.Two Levels of Response: Social Policy and Clinical Care
263.Conclusion: Beyond the Patient뻇hysician Dyad
264.References


Chapter 14 Laws and Policies Affecting Pain Management in the United States

266.Introduction
267.Prevalence of Unrelieved Pain is a Public Health Problem
268.Barriers to the Safe and Effective use of Opioid Analgesics for Pain Management
269.Policies Governing the use of Opioid Analgesics for Pain Management
270.International Treaties: Establishing Balance Between Drug Control and Medical Use
271.US Federal Law: Preserving Balance Between Drug Control and Medical Use
272.The Federal Food, Drug, and Cosmetic Act
273.US Federal Controlled Substances Law
274.US State Laws: Striving for Balance Between Drug Control and Medical Use
275.State Pain Policy Development: An Emerging Trend
276.Evaluating the Quality of State Pain Policy
277.A Progress Report Card to Measure Changes in the Quality of State Pain Policies
278.The Importance of Improving State Pain Policy
279.Considering Additional US Policies
280.Taking Diversion into Account
281.Conclusions
282.References


Chapter 15 Litigation Involving Pain Management

284.Administrative Proceedings
285.In the Matter of Dileo
286.Hoover V Agency for Health Care Administration
287.Oregon Board of Medical Examiners V Bilder
288.Accusation of Eugene Whitney, MD
289.Civil Litigation
290.Estate of Henry James V Hillhaven Corporation
291.Bergman V Chin, MD, and Eden Medical Center
292.Tomlinson V Bayberry Care Center, et al.
293.Criminal Litigation
294.State V Naramore
295.Federal Criminal Prosecutions
296.United States V Rosen (1978)
297.United States V Hurwitz
298.United States V Mciver
299.Constitutional Cases
300.Lessons from the Litigation
301.References


Chapter 16 International Access to Therapeutic Opioids

303.Pain Relief is Part of Cancer and HIV/AIDS Control
304.Pain and Palliative Care
305.Opioids are Essential Medicines and Controlled Substances
306.Governments Must Ensure Adequate Opioid Availability
307.Disparities in Opioid Consumption
308.Morphine Equivalence Metric
309.Global Opioid Consumption Trends
310.Disparities in Consumption by Income Level
311.Regional Opioid Consumption Trends
312.World Health Organization Region for Africa (AFRO)
313.World Health Organization Region for the Americas (AMRO)
314.World Health Organization Region for the Eastern Mediterranean (EMRO)
315.World Health Organization Region for Europe (EURO)
316.World Health Organization Region for Southeast Asia (SEARO)
317.World Health Organization Regions for the Western Pacific (WPRO)
318.Barriers to Opioid Availability and Accessibility
319.Knowledge and Attitudes About Pain, Opioids, and Dependence Syndrome
320.Excessively Strict Laws or Regulatory Policies
321.Medication Distribution System Barriers
322.Economic Factors Including Affordability
323.United Nations?Recommendations
324.Efforts to Address Barriers and Improve Opioid Availability and Accessibility
325.Conclusion
326.References


PART THREE Evaluation of the Pain Patient

Chapter 17 Evaluation of the Chronic Pain Patient

329.Introduction
330.General Guidelines for Assessment of Persistent Pain
331.Outline of a Multidimensional Assessment Questionnaire for Persistent Pain History
332.Summary of Some Nonproprietary Questionnaires
333.Other Potentially Useful Questions to Consider for Gauging Effectiveness of Therapy
334.Summary of Proprietary Questionnaires to Consider
335.The Pain History
336.O: Onset of Pain
337.P: Provocative/Palliative
338.Q: Quality or Character
339.R: Region/Radiation
340.S: Severity/Intensity of Pain
341.T: Timing of Pain
342.Altered Perception
343.Past Medical and Surgical History
344.Mood Assessment
345.Psychosocial Factors
346.Coping Strategies
347.Sleep Disorders
348.Cognitive Impairment
349.Vocational History and Current Vocational Disability
350.Habits
351.Risk of Opioid Misuse, Abuse, or Dependence
352.Assessment of Function
353.Current and Past Treatments
354.Current and Past Medications Including Over-the-Counter Medications
355.Allergies
356.Investigations and Consultations
357.Goals
358.Physical Examination
359.General Exam: Observe, Identify and Document
360.Site of Pain
361.Neurologic Exam
362.Bedside Method for Quantitative Sensory Testing
363.Caveats to Quantitative Sensory Testing Interpretation
364.Further Investigations or Consults
365.Follow-Up Visits
366.Conclusion
367.Appendix 17.1: Initial Visit Questionnaire
368.Appendix 17.2: Pain Diagram
369.Appendix 17.3: Goal Setting
370.Goals
371.Appendix 17.4: Follow-Up Questionnaire
372.References


Chapter 18 Electrodiagnosis in Pain Medicine

374.The Electrodiagnostic Laboratory
375.Electrodiagnostic Tests
376.Nerve Conduction Studies
377.Needle Electromyography
378.Application in Selected Conditions
379.Conclusion
380.References


Chapter 19 Diagnostic Imaging of Pain

382.Headache
383.Acute Headache
384.Chronic Headache
385.Intracranial Hypotension
386.Intracranial Hypertension (Pseudotumor Cerebri)
387.Facial Pain
388.Spinal Pain
389.Overview
390.Compression Fractures
391.Benign Versus Malignant; Infection/Inflammation
392.Discogenic Pain
393.Limb Pain and Magnetic Resonance Neurography
394.Magnetic Resonance Neurography
395.Thoracic Outlet Syndrome
396.Piriformis Syndrome
397.Peripheral Nerve Entrapment Syndromes
398.Imaging Guided Injection
399.Future Application of Pain Imaging
400.Conclusion
401.References


Chapter 20 Measurement of Pain

403.Introduction
404.Validity, Reliability, and Utility in the Context of Pain Assessment
405.How many Pain Problems should be Assessed?
406.Which Pain Domain(s) should be Assessed?
407.Recall Ratings Versus Summary Scores from Multiple Ratings using Diaries
408.Measuring Pain's Domains
409.Measuring Pain Intensity
410.Measuring Pain Affect
411.Measuring Pain Quality
412.Measuring Pain's Spatial Characteristics
413.Measuring Pain's Temporal Characteristics
414.Measuring Pain Interference
415.Measuring Pain in Special Populations
416.Simplified Measures of Pain
417.Behavior Observation Measures
418.Summary and Conclusions
419.References


Chapter 21 Pain Psychology Evaluation

421.Psychosocial History
422.Early Life Experiences
423.Vocational History
424.Educational History
425.Current Functioning
426.Belief Structures
427.Social Support
428.Cultural Factors
429.Substance Use
430.Nicotine
431.Alcohol
432.Prescribed and Nonprescribed Drug Use
433.Psychiatric Functioning
434.Behavioral Observations
435.Depression
436.Anxiety
437.Posttraumatic Stress Disorder
438.Somatization
439.Psychological Screening for Advanced Interventional Procedures
440.Conclusion
441.References


Chapter 22 Disability Evaluation of Patients with Chronic Pain

443.Basic Concepts
444.Conceptual and Empirical Issues
445.Impairment and Disability
446.Associations between Impairment and Disability
447.The Imbeddedness's Problem
448.Practical Problems in Identifying the role of Pain in Disability Determinations
449.Methods for Evaluating Chronic Pain in Applicants for Disability Benefits
450.Evaluation Methods in the Social Security Administration
451.Outcomes of Social Security Administration Evaluations
452.Disability Evaluation and Disability Management in the Washington State Department of Labor and Industries
453.Washington State Department of Labor and Industries Programs to Reduce Disability
454.Methods Used by Washington State Department of Labor and Industries to Evaluate Injured Workers for Permanent 
Disability Benefits
455.Outcomes of Washington State Department of Labor and Industries Evaluations
456.Conclusion
457.References


Chapter 23 Multidisciplinary Assessment of Patients with Chronic Pain

459.Conceptual Issues
460.Conundrums in the Assessment of Pain
461.A Conceptual Model for Assessing Pain
462.Assessment of Medical Factors
463.Are there Red Flags?
464.Are there Risk Factors for Delayed Recovery?
465.Specific Evaluation Procedures
466.Conclusion
467.Assessment of Central Nervous System Sensitization
468.Assessment of Psychosocial Factors
469.Psychological Factors as Causes Versus Consequences of Chronic Pain
470.Elements of the Psychological Evaluation
471.Problem Areas to Assess
472.Assessing Functional Impact
473.Self-Report Measures of Function
474.Assessment of Physical Capacity
475.Assessment of Social Factors
476.Organization of Multidisciplinary Evaluations
477.Conclusion
478.References


PART FOUR Pain Conditions
480.Neuropathic Pain Conditions

Chapter 24 Painful Neuropathies

482.Pain as a Symptom of Neuropathy
483.The Evaluation and Diagnosis of Neuropathy
484.Neuropathy Classification
485.History, Examination, and Diagnostic Studies
486.Painful Neuropathies
487.Distal Symmetric Polyneuropathies
488.Other Widespread but Nonlength-Dependent Neuropathies
489.Painful Mononeuropathy Multiplex and Focal Neuropathic Syndromes
490.Sensory Neuronopathies
491.Treatment of Painful Neuropathies
492.General Principles of Therapy
493.Analgesia Therapy: Guidelines for Pharmacotherapy
494.Unresolved Questions
495.References


Chapter 25 Complex Regional Pain Syndrome

497.Epidemiology
498.Pathophysiology
499.Animal Models
500.Human Models
501.Inflammation
502.Immunologic Factors
503.Central Dysfunction
504.Sympathetic Dysfunction
505.Trophic, Dystrophic, and Nutritional Abnormalities
506.Motor and Movement Disorders
507.Immobilization and Disuse
508.Diagnosis
509.The International Association for the Study of Pain Criteria
510.The Budapest Criteria
511.Sequential Stages and Subsets of Complex Regional Pain Syndrome
512.Psychological Factors in Complex Regional Pain Syndrome
513.Treatment
514.The Rationale for Functional Restoration
515.Rehabilitation-Based Treatment Modalities
516.Pharmacotherapy
517.Psychological Interventions
518.Interventional Therapies
519.Other Therapeutic Modalities
520.References


Chapter 26 Phantom Pain

522.Epidemiology
523.Modulation of Phantom Pain
524.Pathophysiology of Phantom Pain
525.Prevention of Phantom Pain
526.Treatment of Phantom Pain
527.Pharmacologic Interventions
528.Antidepressants
529.Antiepileptic Drugs
530.Opioids
531.NMDA Receptor Antagonists
532.Calcitonin
533.Transient Receptor Potential Cation Channel Subfamily V Member 1 (trpv1) Modulators
534.Interventional Therapy
535.Neuromodulation
536.Surgical Interventions
537.Behavioral Medicine Interventions
538.Miscellaneous Treatments for Residual Limb Pain
539.Summary
540.References


Chapter 27 Herpes Zoster and Postherpetic Neuralgia

542.Clinical Picture and Natural History of Herpes Zoster
543.Prodrome
544.Rash
545.Pain
546.Distribution of Herpes Zoster
547.Clinical Variants
548.Diagnosis of Herpes Zoster
549.Laboratory Testing
550.Epidemiology of Herpes Zoster
551.Pathophysiology of Herpes Zoster and Mechanisms of Acute Pain
552.Complications Associated with Herpes Zoster
553.Ophthalmic Complications
554.Motor Neuropathy
555.Rare Neurologic Complications
556.Visceral Complications
557.Decreased Quality of Life
558.Treatment of Herpes Zoster
559.Patient Education
560.Antiviral Therapy
561.Analgesic Treatment
562.Corticosteroids
563.Neural Blockade
564.Complementary and Alternative Medicine
565.Spinal Cord Stimulation
566.Prevention of Herpes Zoster
567.Childhood Vaccination
568.Varicella-Zoster Immunoglobulin
569.Herpes Zoster Vaccination for Adults
570.Clinical Picture of Postherpetic Neuralgia
571.Diagnosis and Assessment of Postherpetic Neuralgia
572.Epidemiology and Natural History of Postherpetic Neuralgia
573.Risk Factors for Postherpetic Neuralgia
574.Pathophysiology of Postherpetic Neuralgia
575.Treatment of Postherpetic Neuralgia
576.Anticonvulsants: Gabapentin and Pregabalin
577.Antidepressant Medications
578.Opioid Analgesics
579.Tramadol
580.Tapentadol
581.Topical Therapies
582.Combination Therapy
583.N-Methyl-D-Aspartic Acid Antagonists
584.Other Pharmacologic Therapies
585.Invasive Treatments for Postherpetic Neuralgia
586.Psychological Interventions
587.Electroanalgesia
588.Surgical Approaches
589.Prevention of Postherpetic Neuralgia
590.Conclusions
591.References


Chapter 28 Central Pain States

593.Diagnosis
594.Clinical Characteristics
595.Clinical Assessment
596.Specific Central Pain Conditions
597.Central Poststroke Pain
598.Central Pain in Multiple Sclerosis
599.Central Pain in Spinal Cord Injury
600.Other Central Pain Conditions
601.Preclinical Models
602.Mechanisms
603.Treatment of Central Pain
604.Pharmacologic Treatment
605.Psychological and Physiotherapy Treatment
606.Neurosurgical Management
607.References
608.Psychological Contributions to Pain


Chapter 29 The Psychophysiology of Pain

610.Historical Perspective: Mind-body Issues
611.Emotions: Definition and Mechanisms
612.What are Emotions?
613.Emotion in a Sociobiologic Perspective
614.Adaptive Functions of Emotion
615.Emotions and Behavior
616.The Central Neuroanatomy of Emotion: Limbic Structures
617.Peripheral Neuroanatomy of Emotion: The Autonomic Nervous System
618.Noxious Signaling and Central Limbic Processing
619.Locus Coeruleus and the Dorsal Noradrenergic Bundle
620.The Ventral Noradrenergic Bundle and the Hypothalamo-Pituitary-Adrenocortical Axis
621.Primary and Secondary Features of the Affective Dimension of Pain
622.Summary of the Construction and Modulation of Pain
623.Emotion and Cognition
624.The Sense of Self
625.Cognitive Perspective
626.Multiple Perspectives on the Self
627.Stress, Sickness, and Pain
628.Basic Definitions: Stress, Homeostasis, and Allostasis
629.Physiologic Mechanisms of Stress
630.Summary of the Physiologic Mechanisms of Stress
631.Stress and Chronic Pain
632.Future Directions
633.References


Chapter 30 Pain and Learning

635.Overview of the Three Major Principles of Learning
636.Classical Conditioning
637.Operant Conditioning
638.Observational Learning
639.Operant Conditioning and Pain
640.The Hallmark Work of Wilbert Fordyce
641.Operant Conditioning and Chronic Pain: The Basics
642.Classical Conditioning and Pain
643.Aversive Classical Conditioning and Pain
644.Classically Conditioned Fear/Avoidance and Pain
645.Observational Learning and Pain
646.Integrating Learning Principles in the Treatment of Pain
647.Cognitive-Behavioral Therapy and Pain
648.Cognitive-Behavioral Therapy as an Essential Component of a Comprehensive Interdisciplinary Approach to Pain 
Management
649.Conclusion
650.References


Chapter 31 Psychiatric Illness, Depression, Anxiety, and Somatic Symptom Disorder

652.Psychiatric Nosology and Diagnostic and Treatment Approaches
653.Framework for Describing Psychiatric Symptoms
654.Depression
655.Suicidal Ideation and Behavior
656.Which Came First, Depression or Pain?
657.Differential Diagnosis
658.Biologic Tests for Depression
659.Dysthymic Disorder
660.Epidemiology of Depression
661.Pain and Depression: Mechanisms of Association
662.Depression Treatment
663.Psychotherapy
664.Anxiety Disorders
665.Generalized Anxiety Disorder
666.Panic Disorder
667.Epidemiology
668.Treatment
669.Posttraumatic Stress Disorder
670.Diagnosis
671.Epidemiology of Posttraumatic Stress Disorder in Chronic Pain Patients
672.Posttraumatic Stress Disorder and Associations with Pain
673.Treatment
674.Personality Disorders
675.Epidemiology
676.Overview of Personality Disorders
677.Personality and Pain Treatment Outcome
678.Somatic Symptom Disorders, Illness Behavior, and Sick Role
679.Definitions
680.Overview of Somatoform Disorders and Somatic Symptom Disorders
681.Somatic Symptom Disorder
682.Conversion Disorder (Functional Neurologic Symptom Disorder)
683.Illness Anxiety Disorder
684.Conclusion: Pain and Suffering and Psychiatry
685.References


Chapter 32 Treatment of Pain in Patients with Addiction

687.Substance Use Disorder
688.Clinical Implications of Substance Use Disorders on Pain
689.Neurobiologic Overlap Between Pain and Addiction Systems
690.Effects of Substance Use Disorder on Pain
691.Effects of Opioid Use Disorder on Pain
692.Pain Management in Persons with Substance Use Disorder
693.Prevalence of Substance Use Disorders in Patients with Pain
694.Principles of Pain Treatment in Patients with Substance Use Disorders
695.Conclusions
696.References


Chapter 33 The Doctor-Patient Relationship in Pain Management: Dealing with Difficult Clinician-Patient 
Interactions

698.Difficult Patients and Difficult Doctor-Patient Relationships
699.Psychiatric and Personality Issues
700.Opioid Therapy
701.Difficult 밡ormal?Patients
702.Comorbid Medical Conditions
703.Substance Use Disorders
704.Physician Factors
705.Health Care System Factors
706.Patient Interaction Strategies
707.Patient-Focused Care
708.Communication Framework: WIPS and E
709.Clinical Scenarios
710.Scenario 1
711.Scenario 2
712.Scenario 3
713.Scenario 4
714.Scenario 5
715.Scenario 6
716.Scenario 7
717.Summary and Conclusions
718.Acknowledgment
719.References
720.Vascular, Cutaneous, and Musculoskeletal Pains


Chapter 34 Arthritis

722.Basic Considerations
723.Problem in Perspective
724.Joint Anatomy
725.Clinical Approach to Joint Pain
726.History
727.Physical Examination
728.Examination of Synovial Fluid
729.Clinical Considerations
730.Osteoarthritis
731.Secondary Osteoarthritis
732.Rheumatoid Arthritis
733.The Spondyloarthropathies
734.Reactive Arthritis
735.Psoriatic Arthritis
736.Arthritis Associated with Inflammatory Bowel Disease
737.Arthritis Caused by Crystals
738.Urate Gout
739.Infectious Arthritis
740.Polymyalgia Rheumatica
741.References


Chapter 35 Myofascial Pain Syndrome

743.Brief Historical Overview
744.Basic Myofascial Pain Concepts
745.Muscle Physiology
746.The Motor Endplate
747.Sensitization and Activation of Muscle Nociceptors
748.Central Sensitization
749.The Biochemical Milieu of Myofascial Trigger Points
750.pH and Muscle Pain
751.Neuropeptides, Inflammatory Mediators, and Tissue Injury and Pain
752.Catecholamines and the Autonomic Nervous System
753.Cytokines and Pain
754.Clinical Management
755.Trigger Point Diagnosis
756.Physical Examination and Diagnosis
757.Treatment Options
758.Noninvasive Treatment Options
759.Summary
760.References


Chapter 36 Fibromyalgia: A Discrete Disease or the End of the Continuum

762.Historical Perspective
763.Epidemiology
764.Chronic Widespread Pain
765.Fibromyalgia
766.Significance of Tender Points
767.Other Features of Fibromyalgia Gleaned From Epidemiologic or Observational Studies
768.Etiology
769.Animal Models of Fibromyalgia
770.Genetic Factors
771.Evidence of Central Nervous System Disturbances in Pain and Sensory Processing
772.Evidence of a Global Increase in Sensory Processing of Nonpainful Stimuli
773.Brain Imaging Studies
774.The Role of Neuroendocrine or Autonomic Abnormalities
775.The Role of Peripheral Factors in Fibromyalgia
776.Evidence of Abnormal Cytokines or of Immune Dysfunction in Fibromyalgia
777.The Role of 밪mall Fiber Neuropathy?in Fibromyalgia
778.Diagnosis
779.Diagnosis of Fibromyalgia
780.Treatment
781.General Approach
782.Pharmacologic Therapy
783.Neurostimulatory Therapies
784.Nonpharmacologic Therapies
785.Prognosis
786.Conclusion
787.Key Points
788.References


Chapter 37 Pain of Dermatologic Disorders

790.Basic Considerations: Anatomy and Physiology of the Skin
791.Clinical Disorders
792.Leukocytoclastic Vasculitis
793.Polyarteritis Nodosa
794.Antineutrophilic Cytoplasmic Antibodies-Associated Vasculitides: Granulomatosis with Polyangiitis (Formerly known 
as Wegener's Granulomatosis)
795.Microscopic Polyangiitis
796.Eosinophilic Granulomatosis with Polyangiitis (Formerly known as Churg-Strauss Syndrome)
797.Rheumatoid Vasculitis
798.Livedoid Vasculopathy
799.Other Vascular Disorders
800.Antiphospholipid Syndrome
801.Warfarin (Coumadin) Skin Necrosis
802.Cocaine Levamisole Toxicity
803.Calcinosis Cutis
804.Calciphylaxis
805.Ulcers
806.Ischemic Ulcers
807.Venous Ulcers
808.Pyoderma Gangrenosum
809.Painful Infections
810.Necrotizing Soft Tissue Infection/Necrotizing Fasciitis
811.Herpes Zoster
812.Herpes Simplex
813.Erysipelas and Cellulitis
814.Furunculosis and Carbuncle
815.Erysipeloid
816.Inflammations
817.Panniculitis
818.Dercum Disease (Adiposa Dolorosa)
819.Hidradenitis Suppurativa
820.Inflamed Epidermal Cyst
821.Bullous Dermatoses with Erosions
822.Disorders of Connective Tissue Structure (Cartilage Disorders)
823.Relapsing Polychondritis
824.Chondrodermatitis Nodularis Helicis
825.Neurovascular Cutaneous Disease
826.Sensory Mononeuropathies
827.Erythromelalgia
828.Fabry's Disease
829.Other Painful Dermatologic Disorders
830.Cutaneous Endometriosis
831.Painful Neoplasms
832.Acknowledgments
833.References


Chapter 38 Pain Due to Vascular Causes

835.Basic Neuroanatomic and Neurophysiologic Considerations
836.Vascular Pain Syndromes
837.Intermittent Claudication
838.Aortic and Other Large Artery Pain
839.Rest Pain, Ulcers, and Gangrene
840.Pain Syndromes Following Stroke
841.Pain Associated with Diseases Involving Small Arteries
842.Pain Associated with Venous Disorders
843.Pain Associated with Lymphatic Diseases
844.Pain Associated with Amputation
845.Differentiating Vascular from Nonvascular Pain
846.The Relief of Vascular Pain
847.Conclusion
848.References


Chapter 39 Pain Due to Thoracic Outlet Syndrome

850.Anatomy and Pathophysiology
851.Clinical Presentation: Symptoms and Signs
852.Diagnostic Tests
853.Differential Diagnosis
854.Management
855.Outcomes
856.References


Chapter 40 Pain Following Spinal Cord Injury

858.Extent and Impact of the Problem
859.Assessment and Classification of Pain Following Spinal Cord Injury
860.Musculoskeletal Pain
861.Visceral Pain
862.Other Nociceptive Pain
863.At- and Below-Level Spinal Cord Injury Pain
864.Other Neuropathic Pain
865.Psychosocial Aspects of Pain after Spinal Cord Injury
866.Management of Pain in People with Spinal Cord Injury
867.Nociceptive Pain
868.Visceral Pain
869.Other Nociceptive Pain
870.Other Neuropathic Pain and other Pain
871.At- and Below-Level Neuropathic Pain
872.Psychological and Environmental Management
873.Other Nonpharmacologic Management of Pain in People with Spinal Cord Injury
874.Surgical Interventions
875.Conclusion
876.References
877.Pain Due to Cancer


Chapter 41 Epidemiology, Prevalence, and Cancer Pain Syndromes

879.Epidemiology of Cancer Pain
880.Pain Related to Extent of Disease: The Cancer Disease Trajectory
881.Special Needs of Particular Age Groups: Pediatric, Young Adult, Adult, Geriatric
882.Special Needs of Particular Ethnic Groups: Communication Styles, Common Preferences, and Managing Taboos
883.Comorbidities Associated with Specific Cancers: Lung Disease, Liver Disease, Renal Disease, and Neurologic Disease
884.Cancer Pain and Substance Abuse
885.Cancer Pain in Inmates
886.Components of the Comprehensive Medical Evaluation of a Patient with Chronic Cancer Pain
887.Pain History
888.Definition of Pain
889.Definition of Suffering
890.Validated Assessment Tools
891.Types of Pain
892.Presenting Complaint
893.Details of the Pain History
894.Physical Examination
895.General Physical Examination
896.The Regional Pain Physical Examination
897.Bedside Provocative Maneuvers
898.Specific Bedside Provocative Maneuvers and their Role in Pain Diagnosis
899.Formulating a Cancer Pain Diagnosis
900.Syndrome Diagnosis
901.Pathophysiologic Diagnosis
902.Complementary Clinical Perspectives in the Care of Cancer Patients
903.The Medical Model: Pain is a Manifestation of Disease
904.Palliative Model: Pain is both Useless and Harmful
905.Rehabilitative (Ahronic Nonmalignant Pain? Model: Focus on Dysfunctional Pain Behavior and Pain-Related 
Deconditioning
906.Anesthetic Model: Diagnostic and Therapeutic Blocks
907.Management of Pain in Specific Clinical Presentations
908.Bone Pain
909.Pain and Delirium
910.Pain and Nausea
911.Pain and Anorexia/Cachexia/Asthenia
912.Pain and Bowel Disease
913.Managing Cancer Pain in the Addict
914.Safe Prescribing Practices: Universal Precautions
915.Symptom Clusters
916.Pain at the end of Life
917.Cancer Pain Emergencies
918.Opioid Diversion at the End of Life
919.Conclusion
920.References


Chapter 42 Assessment and Diagnosis of the Cancer Patient with Pain

922.Issues in Assessment and Diagnosis of Cancer Pain
923.Pain and the Cancer Patient
924.Molecular Mechanism of Tumor Pain
925.Somatic Pain
926.Visceral Pain
927.Neuropathic Pain
928.Affective Processing and Suffering
929.Psychological Factors and the Complexities of Cancer Pain
930.Depression in Cancer Patients
931.Detecting and Assessing Depression in the Cancer Patient
932.Cancer-Related Fatigue
933.Sleep Disturbance in Cancer
934.Sources of Pain in the Cancer Patient
935.Classification of Cancer Pain by Feature
936.Chronicity
937.Intensity/Severity
938.Pathophysiology/Mechanisms
939.Tumor type and Stage of Disease
940.Patterns of Cancer Pain
941.Cancer Pain Syndromes
942.Bone Metastases
943.Characteristics of Metastatic Bone Pain
944.Prognosis
945.Sacral Insufficiency Fractures
946.Granulocyte Colony-Stimulating Factors-Associated Bone Pain
947.Visceral Pain
948.Mechanism
949.Visceral Pain Descriptions by Site
950.Neuropathic Pain
951.Neuropathic Pain Secondary to Cancer-Related Pathology in Cranial Nerves
952.Neuropathic Pain Secondary to Therapeutic Interventions
953.Oral Mucositis
954.Graft-Versus-Host Disease
955.Metastatic Epidural Spinal Cord Compression
956.Mechanism
957.Pattern of Pain
958.Presentation and Physical Findings
959.Investigations
960.Prognosis
961.Stepwise Approach to Pain Assessment
962.Features of Pain History
963.Quality of Life Assessment
964.General Assessment
965.Associated Symptoms
966.Laboratory and Imaging Data
967.Physical Examination
968.Diagnosis
969.Summary
970.References


Chapter 43 Cancer Pain: Principles of Management and Pharmacotherapy

972.Cancer Pain Management Overview
973.Primary Anticancer Treatment
974.Symptomatic Cancer Pain Management
975.World Health Organization Analgesic Ladder
976.Nonsteroidal Anti-Inflammatory Drugs
977.Efficacy in Cancer Pain
978.Acetaminophen
979.Opioid-Induced Bowel Dysfunction
980.Antiemetics
981.Adjuvant Analgesics
982.General Purpose Adjuvants
983.Musculoskeletal Pain Adjuvants
984.Neuropathic Pain Adjuvants
985.Bone Pain Adjuvants
986.Visceral Pain Adjuvants
987.Psychotropic Drugs
988.Cannabinoids
989.Opioid Analgesics
990.Selection of Opioid Therapy in Cancer Pain Management
991.Tolerance and Hyperalgesia
992.Morphine
993.Oxycodone
994.Oxymorphone
995.Hydromorphone
996.Methadone
997.Levorphanol
998.Fentanyl
999.Buprenorphine
1000.Hydrocodone
1001.Codeine
1002.Tramadol
1003.Tapentadol
1004.Opioids not Recommended for Routine use in Cancer Pain Control
1005.Opioid-Related Side Effects
1006.Opioid Effects on Cognition, Motor Skills, and Driving Ability
1007.Opioid Rotation in Cancer Pain
1008.Parenteral Opioid Therapy
1009.Intracerebroventricular Opioids
1010.Substance Abuse in Oncology
1011.Home Infusion Therapy
1012.Integrative Oncology
1013.Summary
1014.References


Chapter 44 Interventional Pain Therapies

1016.Intrathecal Drug Therapy
1017.Indications
1018.Intrathecal Drug Delivery Systems
1019.Intrathecal Versus Epidural Drug Delivery
1020.Implantable or Exteriorized Intrathecal Drug Delivery: Cost Analysis
1021.Outcome Studies
1022.Patient-Controlled Intrathecal Analgesia
1023.Pharmacology
1024.Contraindications and Risk Management
1025.Complications and Side Effects
1026.Intrathecal Therapy and Ongoing Oncologic Care
1027.Spinal Chemoneurolysis
1028.Spinal Chemoneurolysis Technique
1029.Adverse Effects
1030.Contraindications
1031.Celiac Plexus Block
1032.Indications
1033.Anatomy of the Celiac Plexus
1034.General Considerations
1035.Adverse Effects
1036.Celiac Plexus Block Techniques
1037.Outcome Studies
1038.Superior Hypogastric Plexus Block
1039.Indications
1040.Anatomy of the Superior Hypogastric Plexus
1041.General Considerations
1042.Adverse Effects
1043.Techniques
1044.Outcome Studies
1045.Ganglion of Impar Block
1046.Indications
1047.Anatomy of the Ganglion of Impar
1048.General Considerations
1049.Adverse Effects
1050.Technique
1051.Intercostal Nerve Block
1052.Indications
1053.Anatomy of the Intercostal Nerves
1054.General Considerations
1055.Adverse Effects
1056.Technique
1057.Outcome Studies
1058.Blocks of the Head and Neck
1059.Nerve Blocks of the Trigeminal Nerve and Its Branches
1060.Indications
1061.Anatomy of the Trigeminal Nerve and its Branches
1062.General Considerations
1063.Adverse Effects
1064.Techniques
1065.Outcome Studies
1066.Other Head and Neck Interventional Targets
1067.Spinal Cord Stimulation
1068.Vertebral Augmentation
1069.Indications
1070.Contraindications
1071.Outcomes
1072.Spinal Cord Ablation
1073.Cordotomy
1074.Indications
1075.Surgical Techniques
1076.Outcomes
1077.Complications
1078.Myelotomy
1079.Indications
1080.Surgical Technique
1081.Percutaneous Radiofrequency Lesioning
1082.Open Limited Myelotomy
1083.Outcomes
1084.Complications
1085.Dorsal Root Entry Zone Lesioning
1086.Image-Guided Ablation of Painful Bone Metastases
1087.Summary
1088.References


Chapter 45 Pain Caused by Cancer of the Head and Neck and Oral and Oropharynx

1090.Pain Mechanisms Due to Local and Regional Cancer of the Head and Neck
1091.Tumor-Induced Algesia
1092.Pain Mechanisms Due to Chemotherapy and/or Radiotherapy
1093.Pain Due to Surgery
1094.Pain Due to Mucositis
1095.Epidemiology
1096.Pathogenesis
1097.Hematopoietic Cell Transplantation
1098.Head and Neck Radiation Therapy
1099.Combined Radiation Therapy, Surgery, and/or Chemotherapy
1100.Pain Assessment
1101.Management of Oral Mucositis
1102.Pain Management
1103.Basic Oral Care
1104.Bland Oral Rinses
1105.Topical Anesthetics and Analgesics
1106.Topical Antimicrobials
1107.Systemic Analgesics
1108.Anti-Infective Approaches
1109.Hyposalivation
1110.Biologic Response Modifiers and Cytokines
1111.Cognitive and Behavioral Interventions
1112.Conclusion
1113.References


Chapter 46 Cancer-Related Bone Pain

1115.Epidemiology Review
1116.Pathophysiology
1117.Evaluation of the Patient with Bone Cancer
1118.Treatment
1119.Cyclooxygenase-2-Specific Inhibitors
1120.Corticosteroids
1121.Bisphosphonates
1122.Calcitonin
1123.Opioids/Opiate Antagonists
1124.Adjuvant Analgesics
1125.N-Methyl-D-Aspartate Antagonism and ? Agonists
1126.Hormonal Therapy
1127.Radionucleotides
1128.Procedural Interventions
1129.Associated Processes
1130.Granulocyte Colony-Stimulating Factor Related Pain
1131.Conclusion
1132.References


Chapter 47 Cancer-Related Visceral Pain

1134.Epidemiology Review
1135.Characteristics of Visceral Pain
1136.Anatomy and Physiology
1137.Sensitization
1138.Localization
1139.Visceral Afferentation
1140.Ascending Pathways
1141.Visceral Pain Syndromes
1142.Oral Mucosa
1143.Mediastinum
1144.Pancreas
1145.Liver Pain
1146.Intestinal Pain
1147.Pelvic Pain
1148.Adrenal Pain Syndrome
1149.Pain Syndromes Related to Intravenous Chemotherapeutic Agents
1150.Complex Visceral Pain Syndromes
1151.Postradiation Visceral Pain
1152.Postchemotherapy Visceral Pain
1153.Treatment
1154.N-Methyl-D-Aspartate Receptor Antagonists
1155.Corticosteroids
1156.Gabapentin
1157.Short Interfering RNA Therapeutics
1158.T-Type Calcium Channel Antagonists
1159.AMPA/Kainate Antagonists
1160.P38 Kinase Inhibitors
1161.Chemokine Receptor Type 2 Antagonists
1162.P2x Purinoceptor 3 Antagonists
1163.Newer Opioid Derivatives for the Treatment of Chronic Pain
1164.Procedural Interventions
1165.Conclusion
1166.References


Chapter 48 Radiotherapy and Chemotherapy in Cancer Pain Management

1168.Introduction
1169.Bone Disease
1170.Clinical Applications of Radiation Therapy
1171.Response of Tumors to Radiotherapy
1172.Trachea, Bronchi, and Lungs
1173.Pancreatic Cancer
1174.Pelvis
1175.Skin and Subcutaneous Tissues
1176.Brain Metastases
1177.Bone Metastases
1178.Single-Fraction Radiation
1179.Stereotactic Radiation for Nonspine Bone Metastases
1180.Reirradiation
1181.Pathologic Fracture
1182.Spinal Cord Compression
1183.Radiation Tolerance of the Spinal Cord
1184.Clinical Management
1185.Treatment of Diffuse Bone Metastases
1186.Wide-Field Radiotherapy
1187.Radiopharmaceuticals
1188.Role of Palliative Chemotherapy
1189.Clinical Applications
1190.Palliative Chemotherapy
1191.Lymphoma
1192.Breast Cancer
1193.Head and Neck Cancer
1194.Ovarian Cancer
1195.Lung Cancer
1196.Gastrointestinal Cancers
1197.Prostate Cancer
1198.Decision Making About Chemotherapy
1199.Side Effects and Complications
1200.Endocrine Therapy
1201.Endocrine Therapy for Relief of Cancer Pain
1202.Bisphosphonates
1203.Summary
1204.References


Chapter 49 Cancer Pain in Children

1206.Overview of Childhood Cancer
1207.Epidemiology
1208.Treatment
1209.Survivorship
1210.Pain in Children: How Does this Differ from that in Adults?
1211.Infants-reschool
1212.School Age-dolescence
1213.Pediatric Cancer Pain
1214.Epidemiology of Pediatric Cancer Pain
1215.Undertreatment and Impact of Pediatric Cancer Pain
1216.Evaluation of Pediatric Cancer Pain
1217.History and Physical Exam
1218.Sensory Experience-Self-Report
1219.Sensory Experience-Abservation
1220.Emotional and Cognitive Experience
1221.Functional and Quality of Life Assessment
1222.Past Pain-Directed Therapies
1223.Cancer History-Riagnosis
1224.Cancer History-Treatments
1225.Past Medical, Psychiatric, Social, and Spiritual History
1226.Proxy Reports
1227.Integrating Data in Evaluation of the Whole Child
1228.Incorporating Technology into Assessment
1229.Etiologies of Cancer Pain
1230.Disease-Related Pain
1231.Procedure-Related Pain
1232.Treatment-Related Pain
1233.Pain from other Etiologies
1234.Pain in Survivorship
1235.Management of Pain
1236.Pharmacologic Management of Cancer-Related Pain in Children
1237.Overview of Opioid Analgesia in Children
1238.Adverse Effects
1239.Dependence and Addiction
1240.Tolerance to Opioids
1241.밯eak?Opioid
1242.Adjuvant Therapies for Neuropathic Pain
1243.Physical and Psychological Therapies for Pain in the Pediatric Cancer Patient
1244.Acupuncture
1245.Behavioral Interventions
1246.Hypnotherapy
1247.Expressive Arts Therapies
1248.Massage
1249.Biofeedback
1250.Botanicals
1251.Cannabis
1252.Magnets
1253.Spirituality/Religiosity
1254.Therapeutic Yoga
1255.Palliative Care for Children with Cancer
1256.Summary
1257.References
1258.Acute Pain


Chapter 50 Acute Pain Management in Children

1260.Pain Assessment in Infants and Children
1261.Analgesic Pharmacology in Infants and Children
1262.Nonopioid Analgesics
1263.Ontogeny of Prostanoid Biosynthesis and Cyclo-Oxygenases
1264.Aspirin and Other Salicylates
1265.Acetaminophen
1266.Nonsteroidal Anti-Inflammatory Drugs
1267.Ketamine
1268.Anticonvulsants
1269.Opioids
1270.Ontogeny of Opioid Actions
1271.Codeine
1272.Tramadol
1273.Oxycodone
1274.Morphine
1275.Hydromorphone
1276.Methadone
1277.Fentanyl
1278.Meperidine
1279.Opioid Administration in Infants and Children
1280.Intermittent Intravenous Bolus Dosing
1281.Continuous Opioid Infusions
1282.Patient-, Nurse-, and Parent-Controlled Analgesia
1283.Treatment of Opioid Side Effects
1284.Local Anesthetics and Regional Anesthesia in Infants and Children
1285.Cutaneous Analgesia
1286.Wound Infiltration
1287.Epidural Analgesia in Infants and Children
1288.Drugs and Drug Dosing Used for Epidural Analgesia
1289.Peripheral Nerve Blocks in Children
1290.Supraclavicular
1291.Infraclavicular
1292.Sciatic Nerve Block
1293.Femoral Block
1294.Transversus Abdominis Plane Block
1295.Painful Conditions in Pediatric Hospital Care
1296.Cancer Pain
1297.Pain Associated with Sickle Cell Vasoocclusive Episodes
1298.Children with Trauma
1299.Children with Developmental Disabilities
1300.Conclusions
1301.References


Chapter 51 Acute Pain in Adults

1303.Acute and Chronic Effects of Acute Pain
1304.Neurobiology of Acute Pain
1305.Primary Afferents and Peripheral Nerve Neurotransmitters
1306.Spinal Cord and Supraspinal Structures
1307.Prevention
1308.Preventive Analgesia
1309.Treatment Methods
1310.Systemic Analgesic Techniques
1311.Nonselective Noradrenergic and Serotoninergic Medications
1312.Intravenous Patient-Controlled Analgesia
1313.Regional Analgesic Techniques
1314.Peripheral Regional Analgesia
1315.Enhanced Recovery After Surgery Pathways
1316.Analgesia in Special Populations
1317.War Trauma
1318.Ambulatory Surgical Patients
1319.Elderly Patients
1320.Opioid-Tolerant Patients
1321.Obesity, Obstructive Sleep Apnea, and Sleep
1322.Gender or Sex Differences in Analgesia
1323.Inpatient Pain Services
1324.Long-Term Impact of Acute Pain
1325.References


Chapter 52 Regional Anesthesia Techniques for Acute Pain Management

1327.Continuous Epidural Analgesia
1328.Thoracic Epidural Analgesia
1329.Block Technique: Epidural
1330.Subarachnoid/Intrathecal Analgesia
1331.Technique
1332.Clinical Subarachnoid Analgesia
1333.Combined Spinal and Epidural
1334.Technique of Combined Spinal Epidural
1335.Complications and Challenges with Combined Spinal Epidural
1336.Contraindications of Neuraxial Techniques
1337.Sepsis, Fever, and Viral Infections
1338.Coagulopathy, Thrombocytopenia, and Bleeding Disorders
1339.Central Nervous System Disorders
1340.Analgesic Adjuvants for Central and Peripheral Analgesia
1341.Introduction
1342.Neuraxial Opioids
1343.Perineural Opioids
1344.Perineural Clonidine and Dexmedetomidine
1345.Perineural Dexamethasone
1346.Transversus Abdominis Plane Block, Ilioinguinal Iliohypogastric Block, Rectus Sheath Block
1347.Transversus Abdominis Plane Block
1348.Iliohypogastric and Ilioinguinal Block
1349.Rectus Sheath Block
1350.Peripheral Nerve Blocks and Catheters
1351.Interscalene Block
1352.Indications
1353.Landmarks
1354.Techniques
1355.Clinical Effects
1356.Supraclavicular Block
1357.Indications
1358.Landmarks
1359.Ultrasound Technique
1360.Clinical Effects
1361.Infraclavicular Block
1362.Indications
1363.Landmarks
1364.Technique
1365.Clinical Effects
1366.Axillary Block
1367.Indications
1368.Landmarks
1369.Techniques
1370.Clinical Effects
1371.Suprascapular and Axillary Nerve Block
1372.Indications
1373.Landmarks
1374.Ultrasound Technique
1375.Clinical Effects
1376.Brachial Plexus Terminal Branch Blocks at the Elbow and Below
1377.Indications
1378.Techniques
1379.Clinical Effects
1380.Paravertebral Nerve Block
1381.Indications and Landmarks
1382.Techniques
1383.Contraindications
1384.Clinical Effects
1385.Nerve Blocks of the Lumbar Plexus
1386.Indications and Landmarks
1387.Techniques
1388.Complications
1389.Clinical Effects
1390.Femoral Block
1391.Indications
1392.Landmarks
1393.Techniques
1394.Complications
1395.Clinical Effects
1396.Adductor Canal Block
1397.Indications
1398.Clinical Effects
1399.Technique
1400.Complications
1401.Fascia Iliaca Block
1402.Indications
1403.Techniques
1404.Clinical Effects
1405.Complications
1406.Lateral Femoral Cutaneous Nerve Block
1407.Indications and Landmarks
1408.Techniques
1409.Clinical Effects
1410.Complications
1411.Obturator Nerve
1412.Indications and Landmarks
1413.Techniques
1414.Complications
1415.Sacral Plexus-Sciatic Nerve Block
1416.Indications
1417.Landmarks
1418.Techniques
1419.Clinical Effects
1420.Complications
1421.Ankle Block
1422.Indications
1423.Techniques
1424.Clinical Effects
1425.Complications
1426.Quadratus Lumborum Block
1427.Indications
1428.Ultrasound Technique
1429.Clinical Effects
1430.Complications
1431.PECS/Serratus Anterior Plane Block
1432.Indications
1433.Ultrasound Technique
1434.Clinical Effects
1435.Complications
1436.Complications of Peripheral Nerve Blocks
1437.Neurologic Complications
1438.Postsurgical Inflammatory Neuropathy
1439.Nonneurologic Complications
1440.Summary of Treatment of Local Anesthetic Systemic Toxicity
1441.Summary
1442.References


Chapter 53 Burn Pain

1444.The Nature of Burn Pain
1445.Psychological Factors
1446.Generalized Treatment Paradigm for Burn Pain
1447.Pharmacologic Approaches
1448.Opioids
1449.Nonopioids
1450.Anxiolytics
1451.Anesthetics
1452.Pharmacologic Options for Background Pain Management
1453.Pharmacologic Options for Procedural Pain Management
1454.Pharmacologic Options for Postoperative Pain Management
1455.Nonpharmacologic Approaches
1456.Cognitive Interventions and Coping Styles
1457.Preparatory Information
1458.Behavioral Interventions
1459.Hypnosis
1460.Virtual Reality
1461.Conclusion
1462.Acknowledgment
1463.References
1464.Pain in Special Populations


Chapter 54 Persistent Pain in Children

1466.Epidemiology of Chronic Pain in Children
1467.Musculoskeletal Pain
1468.Headache
1469.Chronic Abdominal Pain
1470.Disease- or Treatment-Related Pain
1471.Additional Considerations
1472.Impact of Persistent Pain on Children and Families
1473.Clinical Evaluation of the Child with Chronic Pain
1474.Background
1475.History
1476.Measurement of Pain and Functioning
1477.Physical Evaluation
1478.Clinical Formulation
1479.Feedback with the Family
1480.Treatment
1481.General Principles of Treatment
1482.Specific Interventions for Chronic/Persistent Pain
1483.Specific Entities
1484.Musculoskeletal Pain
1485.Complex Regional Pain Syndromes
1486.Back Pain
1487.Headache
1488.Functional Gastrointestinal Pain
1489.Barriers to Care
1490.Conclusion
1491.References


Chapter 55 Pain in the Older Person

1493.Overview
1494.The Prevalence of Pain in Older Adults
1495.Pain in the Older Person
1496.Impact of Pain on Functioning and Quality of Life
1497.Undertreatment of Pain in Older Persons
1498.Change in Pain Processing and Modulation
1499.Assessment of Pain in the Older Person
1500.Clinical Evaluation of Pain
1501.Nonverbal, Cognitively Impaired Older Adults
1502.Pharmacologic Treatment of Pain in Older Persons
1503.Pharmacokinetics and Pharmacodynamics Associated with Aging
1504.Safe, Effective Use of Nonopioids in the Older Person
1505.Safe, Effective Use of Opioids in the Older Person Potential Risks of Opioid Analgesics
1506.Safe, Effective use of Adjuvants in the Older Person
1507.Additional Treatments for Pain of Older Person
1508.Interventional Approaches
1509.Physical Modalities
1510.Psychosocial Modalities
1511.Complementary and Integrative Health
1512.Multidisciplinary Pain Treatments
1513.Summary
1514.References


Chapter 56 Obstetric Pain

1516.Historical Notes
1517.Pain of Childbirth
1518.Childbirth Pain Mechanisms and Pathways
1519.Factors That Affect the Pain of Childbirth
1520.Effects of Pain on the Mother and Fetus
1521.Physiologic Changes of Pregnancy
1522.Respiratory Changes
1523.Cardiovascular Changes
1524.Central Nervous System Changes
1525.Pharmacokinetic Changes
1526.Uteroplacental Unit
1527.Nonpharmacologic Methods of Labor Analgesia
1528.Antenatal Childbirth Education
1529.Labor Support
1530.Hydrotherapy
1531.Intradermal Water Injections
1532.Hypnosis
1533.Transcutaneous Electrical Stimulation
1534.Acupuncture and Acupressure
1535.Systemic Analgesia
1536.Inhalational Analgesia
1537.Parenteral Opioid Analgesia
1538.Neuraxial Analgesia
1539.Epidural Analgesia
1540.Combined Spinal-Epidural Analgesia
1541.Maintenance of Epidural Analgesia
1542.Other Central Neuraxial Techniques
1543.Side Effects of Neuraxial Analgesia
1544.Complications of Neuraxial Analgesia
1545.Other Regional Analgesic Techniques
1546.Paracervical Block
1547.Lumbar Sympathetic Block
1548.Pudendal Block
1549.Perineal Infiltration
1550.Effects of Analgesia on the Progress of Labor
1551.Nonobstetric Drug Therapy During Pregnancy and Lactation
1552.Drug Classification During Pregnancy and Lactation
1553.References


Chapter 57 Pain and Sickle Cell Disease

1555.Introduction
1556.History
1557.Nature of the Sickle Mutation
1558.Classification of Sickle Cell Syndromes
1559.Genotypes
1560.Pathophysiology
1561.Vaso-Occlusion
1562.Cellular Dehydration
1563.Adhesion to Vascular Endothelium
1564.Inflammation and Reperfusion Injury
1565.Genetic Markers
1566.Other Factors
1567.Classification of Sickle Cell Pain Syndromes
1568.Acute Sickle Cell Pain Syndromes
1569.The Vascular Occlusive Crisis
1570.Acute Chest Syndrome
1571.Acute Abdominal Pain Syndromes
1572.Hand-Foot Syndrome (Dactylitis)
1573.Priapism
1574.Acute Multiorgan Failure
1575.Chronic Sickle Cell Pain
1576.Avascular Necrosis
1577.Leg Ulcers
1578.Intractable Painful Episodes
1579.Neuropathic Pain
1580.Management of Sickle Cell Pain
1581.Nonpharmacologic Management of Pain
1582.Pharmacologic Management of Pain
1583.Curative Therapies
1584.Conclusion
1585.References


Chapter 58 Pain in HIV

1587.Prevalence of Pain in HIV/AIDS
1588.Pain in Women with HIV/AIDS
1589.Pain in Children with HIV/AIDS
1590.Specific Pain Syndromes in HIV/AIDS
1591.Gastrointestinal Pain
1592.Oropharyngeal Pain
1593.Esophageal Pain
1594.Abdominal Pain
1595.Anorectal
1596.Chest Pain Syndromes
1597.Cardiac Pain
1598.Pulmonary/Pleuritic Pain
1599.Chest Wall Pain
1600.Musculoskeletal Pain
1601.Arthropathy
1602.Osteoporosis
1603.Neurologic Manifestations
1604.Peripheral Neuropathy
1605.Distal Symmetric Polyneuropathy
1606.Treatment of HIV-Associated Sensory Neuropathy
1607.Inflammatory Demyelinating Polyneuropathy
1608.Mononeuritis Multiplex
1609.Progressive Polyradiculopathy
1610.Inflammatory Myopathies
1611.Headache
1612.Primary Headaches
1613.Secondary Headaches
1614.Management of Pain
1615.Evaluation Guidelines
1616.Pain Measurement/Assessment Tools
1617.Multimodal Treatment Approach
1618.Pharmacologic Treatment
1619.Nonpharmacologic Therapies
1620.Undertreatment of Pain
1621.Barriers to Pain Management
1622.Summary
1623.References


Chapter 59 The Treatment of Chronic Pain in Patients with History of Substance Abuse

1625.Principle of Balance
1626.The Importance of the Definitions
1627.Basic Science of the Disease of Addiction
1628.Binary Concept of Pain and Addiction
1629.Pain and Opioid Addiction's Continuum Approach
1630.Separating the Motive's from-Behavior?When Dealing with Pain and Addiction
1631.Opioids for Analgesia or Opioid-Stabilizing Effect?
1632.Assessment Tools
1633.Universal Precautions in Pain Medicine
1634.The 10 Principles of Universal Precautions in Pain Medicine
1635.Patient Triage
1636.Treating the Pain Patient on Opioid Agonist Treatment
1637.The Treatment of Pain and Suffering in Our Society
1638.Conclusion
1639.References


Chapter 60 Compliance Monitoring in Chronic Pain Management

1641.How Communication Influences Compliance Assessment
1642.Interpreting Aberrant Behavior
1643.Potential Treatment Traps in Compliance Monitoring
1644.Urine Drug Testing in Pain Medicine
1645.Specimen Choice
1646.Whom to Test
1647.Frequency of Testing
1648.Testing Strategies
1649.Presumptive Versus Definitive Testing
1650.Limitations of Test Interpretation
1651.Future Considerations
1652.References
1653.Visceral Pain


Chapter 61 Headache

1655.General Principles
1656.Primary Headache Syndromes
1657.Anatomy and Physiology
1658.Secondary Headache
1659.Migraine
1660.Tension-Type Headache
1661.Trigeminal-Autonomic Cephalalgias
1662.Paroxysmal Hemicrania
1663.Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing or Cranial 
Autonomic Activation
1664.Other Primary Headaches
1665.Other Important Forms of Secondary Headache
1666.Acknowledgment
1667.References


Chapter 62 Noncardiac Chest Pain

1669.Epidemiology
1670.Natural History
1671.Pathophysiology
1672.Gastroesophageal Reflux Disease
1673.Linked Angina
1674.Esophageal Dysmotility
1675.Sustained Esophageal Contractions
1676.Esophageal Hypersensitivity
1677.Altered Autonomic Activity
1678.Psychological Comorbidity
1679.Diagnosis of Noncardiac Chest Pain
1680.Cardiology Evaluation
1681.Gerd-Related NCCP
1682.Barium Esophagram
1683.Upper Endoscopy
1684.Ambulatory 24-hour Esophageal pH Monitoring
1685.The Wireless pH System
1686.The Proton Pump Inhibitor Test
1687.Multichannel Intraluminal Impedance
1688.Esophageal Dysmotility
1689.Esophageal Manometry
1690.Provocative Testing
1691.Edrophonium (tensilon) Test
1692.Ergonovine Stimulation Test
1693.Pentagastrin Stimulation Test
1694.Sensory Testing of the Esophagus
1695.Acid Perfusion Test (bernstein Test)
1696.Electrical Stimulation
1697.Intraluminal Ultrasonography
1698.Balloon Distension
1699.Esophageal Evoked Potentials
1700.Brain Imaging
1701.Sensory Testing-Hitfalls in Study Design
1702.Psychological Evaluation
1703.Treatment
1704.Gerd-Related NCCP
1705.Nonerd-Related NCCP
1706.Pain Modulators
1707.Endoscopic Treatment and Surgery for NCCP
1708.Johrei Therapy
1709.Psychological Treatment
1710.Future Therapy
1711.References


Chapter 63 Abdominal, Peritoneal, and Retroperitoneal Pain

1713.Clinical Approach to Abdominal Pain
1714.Pain Localization and Character
1715.Time Course
1716.Contextual Information
1717.Physical Examination
1718.Diagnostic Testing in Abdominal Pain
1719.Mechanisms of Visceral Pain
1720.Visceral Nociception
1721.Central Processing of Somatic and Visceral Pain
1722.Sensitization and Visceral Hypersensitivity
1723.Susceptibility Factors
1724.Genetic Factors
1725.Adverse Life Events and Stress
1726.Psychiatric Diseases
1727.Microbial Colonization
1728.Biomarkers of Abdominal Pain
1729.Treatment of Abdominal Pain
1730.Lifestyle Modifications
1731.Patient-Provider Relationship
1732.Placebo Response
1733.Opioids
1734.Nonopioid Analgesics
1735.Neuromodulators
1736.Antidepressants
1737.Psychological Therapies
1738.Blocking Afferent Pathways
1739.Smooth Muscle Relaxants
1740.Acid Suppressants
1741.Altering the Microbiome
1742.Serotonin
1743.Substance P
1744.Complementary and Alternative Medicine Therapy
1745.Conclusion
1746.References


Chapter 64 Pelvic Pain in Females

1748.Acute Pelvic Pain
1749.Introduction
1750.Overview of Assessment
1751.Gynecologic Factors
1752.Complications Specific to Pregnancy
1753.Complications of Assisted Conception
1754.Dysmenorrhea
1755.Nonsteroidal Anti-Inflammatory Drugs
1756.Hormonal Treatments
1757.Surgical Treatments
1758.Nonpharmacologic Interventions
1759.Mittelschmerz
1760.Chronic Pelvic Pain
1761.Introduction
1762.Factors Associated with Chronic Pelvic Pain
1763.Overview of Assessment
1764.The Importance of Visceral Hypersensitivity in Chronic Pelvic Pain
1765.Gynecologic Factors in Chronic Pelvic Pain
1766.Gastrointestinal Factors in Chronic Pelvic Pain
1767.Urologic Factors in Chronic Pelvic Pain
1768.Musculoskeletal Factors in Chronic Pelvic Pain
1769.Neurologic Factors in Chronic Pelvic Pain
1770.Dyspareunia
1771.Overview
1772.Vulval Pain Syndromes
1773.Conclusion
1774.References


Chapter 65 Pelvic Pain in Males

1776.Taxonomy and Phenotyping Chronic Pelvic Pain
1777.Classical Pathologies
1778.Pelvic Pain Syndromes and Nonpelvic Pain Syndromes
1779.Male-Specific Pelvic Pain Syndromes
1780.Subclassification of the Pelvic Pain Syndromes by Organ
1781.The Importance of Taxonomy and Phenotyping
1782.Epidemiology
1783.Incidence/Prevalence
1784.Precipitating Factors
1785.Mechanisms
1786.Differences Between Visceral and Nonvisceral Somatic Pains
1787.Peripheral Mechanisms
1788.Central Mechanisms
1789.Muscles and Pelvic Pain
1790.Pelvic Nerves and Pain
1791.Functional Problems and Male Pelvic Pain
1792.Psychological Consequences of Male Pelvic Pain
1793.Male Urogenital Pelvic Pain Syndromes뾗reatment
1794.Sex Differences and Therapies
1795.Specific Pain Syndrome Treatments
1796.Generic Treatment Approach
1797.Overview and Conclusion
1798.References
1799.Regional Pain


Chapter 66 Cranial Neuralgias

1801.Classical Trigeminal Neuralgia
1802.History
1803.Epidemiology
1804.Etiology and Pathophysiology
1805.Symptoms and Signs
1806.Differential Diagnosis
1807.Treatment
1808.Painful Trigeminal Neuropathy
1809.Multiple Sclerosis
1810.Neoplasm
1811.Herpes Zoster and Postherpetic Neuralgia
1812.Nervus Intermedius Neuralgia
1813.Etiology
1814.Symptoms and Signs
1815.Diagnosis
1816.Treatment
1817.Glossopharyngeal Neuralgia
1818.Etiology
1819.Symptoms and Signs
1820.Diagnosis
1821.Treatment
1822.Vagal Neuralgia
1823.Etiology
1824.Symptoms and Signs
1825.Diagnosis
1826.Treatment
1827.Other Terminal Branch Neuralgias
1828.Other Cranial Neuralgia-Related Causes of Pain: Anesthesia Dolorosa
1829.Etiology
1830.Symptoms and Signs
1831.Diagnosis
1832.Treatment
1833.Conclusion
1834.References


Chapter 67 Facial Pain

1836.Trigeminal and Other Cranial Nerve Neuropathic Conditions
1837.Trigeminal Neuropathy
1838.Glossopharyngeal Neuralgia
1839.Nervus Intermedius Neuralgia
1840.Odontogenic and Temporomandibular Joint Disorders
1841.Odontogenic Pain
1842.Temporomandibular Disorders
1843.Chronic Headache Disorders Causing Facial Pain
1844.Primary Headache Conditions
1845.Secondary Headache Conditions
1846.Medication Overuse Headache
1847.Sinus Headaches
1848.Head Injury Headaches
1849.Short-Lasting, Unilateral, Neuralgiform Headache Attacks with Conjunctival Injection and Tearing
1850.Short-Lasting, Unilateral, Neuralgiform Headache Attacks with Cranial Autonomic Features
1851.Paroxysmal Hemicranias
1852.Contact Point Headache
1853.References


Chapter 68 Neck and Arm Pain

1855.Anatomy of the Neck and Arm
1856.Cervical Spine
1857.Musculature of the Neck
1858.The Vertebral Canal
1859.Vertebral Arteries
1860.Cervical Nerves
1861.The Cervical and Brachial Plexus
1862.Pectoral Girdle and Shoulder Anatomy
1863.Epidemiology of Neck and Arm Pain
1864.Evaluation of the Patient
1865.History and Physical Examination
1866.Laboratory Evaluation
1867.Radiographic Studies
1868.Common Causes of Neck and Arm Pain
1869.Mechanical Neck Pain and Cervicogenic Headache
1870.Diffuse Idiopathic Skeletal Hyperostosis
1871.Cervical Radiculopathies
1872.Upper Extremity Peripheral Nerve Entrapment Syndromes and Brachial Plexus Neuropathy
1873.Lesions of the Brachial Plexus
1874.References


Chapter 69 Chest Wall Pain

1876.General Considerations
1877.Anatomy of the Chest Wall
1878.Skeletal Structures of the Chest Wall
1879.Joints of the Chest Wall
1880.Intercostal Spaces
1881.Intercostal Nerves
1882.Neoplastic Chest Wall Pain
1883.Epidural Spinal Cord Compression
1884.Superior Vena Cava Syndrome
1885.Costopleural Syndrome
1886.Nonneoplastic Chest Wall Pain
1887.Neuropathic Pain
1888.Chest Wall Pain of Skeletal Origin
1889.Chest Pain and Psychological Factors
1890.Chest Wall Pain of Cardiac Origin
1891.Conclusion
1892.References


Chapter 70 Lower Extremity Pain

1894.Lumbosacral Plexopathy
1895.Neoplasms
1896.Radiation-Induced Plexopathy
1897.Diabetic and Nondiabetic Lumbosacral Radiculoplexus
1898.Abscess
1899.Retroperitoneal Hematoma
1900.Aneurysms
1901.Trauma
1902.Obstetric-Related Plexopathy
1903.Specific Nerve Entrapment Syndromes
1904.Lateral Femoral Cutaneous Nerve Entrapment
1905.Femoral Nerve Entrapment
1906.Saphenous Nerve Entrapment
1907.Obturator Nerve Entrapment
1908.Sciatic Nerve Entrapment
1909.Fibular (peroneal) Nerve Entrapment
1910.Foot Pain
1911.Pes Planus
1912.Pes Cavus
1913.Plantar Fasciitis
1914.Heel Pad Deficiency
1915.Tarsal Tunnel Syndrome
1916.Lisfranc Joint Instability
1917.Posterior Tibial Tendon Insufficiency
1918.Dorsal Foot Ganglia
1919.Metatarsalgia
1920.Hallux Valgus
1921.Hallux Rigidus
1922.Intractable Keratosis
1923.Sesamoiditis
1924.Gout
1925.Interdigital (Morton) Neuroma
1926.Hammertoes
1927.Claw Toe Deformity
1928.Hard Corn (Clavus Durum)
1929.Soft Corn (Clavus Mollum)
1930.Ingrown Toenail (Onychocryptosis)
1931.References
1932.Neck and Low Back Pain


Chapter 71 Neck Pain

1934.Definition
1935.Referred Pain
1936.Cervicogenic Headache
1937.Pursuing Diagnosis
1938.Trauma
1939.Acute Neck Pain
1940.Chronic Neck Pain
1941.Whiplash
1942.Cervicogenic Headache
1943.Treatment
1944.Neck Pain
1945.Cervicogenic Headache
1946.Summary
1947.References


Chapter 72 Acute Low Back Pain

1949.Introduction
1950.Definition
1951.Referred Pain
1952.Causes
1953.Management Algorithm
1954.Triage
1955.Initial Management
1956.Review
1957.Vigilance
1958.Reinforcement
1959.Discussion
1960.Conclusion
1961.References


Chapter 73 Chronic Low Back Pain

1963.Introduction
1964.Definition
1965.Referred Pain
1966.Sources
1967.Causes
1968.Prevalence
1969.Refuted Causes
1970.Accepted Causes
1971.Untested Causes
1972.Assessment
1973.Medical History
1974.Psychosocial History
1975.Physical Examination
1976.Review of Previous Investigations
1977.Provisional Diagnosis
1978.Ancillary Investigations
1979.Clearance
1980.Not Indicated
1981.Magnetic Resonance Imaging
1982.Disk Stimulation
1983.Sinuvertebral Nerve Blocks
1984.Lumbar Medial Branch Blocks
1985.Sacroiliac Joint Blocks
1986.Sacral Lateral Branch Blocks
1987.Treatment
1988.General Treatments
1989.Drug Therapy
1990.Physical Modalities
1991.Simple Needle Treatments
1992.Back School
1993.Psychological Interventions
1994.Multidisciplinary Pain Management
1995.Functional Restoration
1996.Specific, Targeted Treatments
1997.Invasive Treatments
1998.Conclusion
1999.References


Chapter 74 Surgery for Low Back Pain

2001.Rationale
2002.Effectiveness
2003.Before Evidence-Based Medicine
2004.Advent of Evidence-Based Medicine
2005.Since Evidence-Based Medicine
2006.Discussion
2007.References


Chapter 75 Failed Back Surgery

2009.Causes of Failed Back Surgery
2010.Mismatch: Surgery Needed Versus Surgery Performed (밯rong Surgery?
2011.Incomplete Evaluation And/or Diagnosis (밨esidual Pathology?
2012.Complications
2013.Technical Failure
2014.Residual Pathology
2015.Recurrent Pathology
2016.New Pathology
2017.Structural Etiologies of Failed Back Surgery
2018.Foraminal Stenosis
2019.Painful Disk (Discogenic Pain)
2020.Disk Herniation
2021.Facet Joint Pain
2022.Sacroiliac Joint Pain
2023.Spinal Stenosis and Axial Low Back Pain
2024.Neuropathic Pain
2025.Epidural Fibrosis
2026.Deconditioning
2027.Psychological Factors in Failed Back Surgery (밨ight Patient?
2028.Establishing the Diagnosis
2029.Role of the History
2030.Time Course of Appearance of Pain
2031.Role of Radiologic Evaluation of Failed Back Surgery
2032.Role of Diagnostic Injections
2033.Treatments
2034.Nonspecific Treatments
2035.Some of the Specific Treatments for Specific Disorders
2036.References


Chapter 76 Psychological Screening of Candidates for Spine Surgery or Placement of Implanted Devices

2038.Introduction
2039.Spinal Surgery
2040.Spinal Cord Stimulation and Intrathecal Drug Delivery Systems
2041.Affective Disorders as Predictors of Outcome
2042.Somatization
2043.Pain Sensitivity
2044.Anger
2045.Cognitive Factors
2046.Coping Strategies
2047.Behavioral Factors
2048.Early-Life Trauma and Abuse
2049.Substance Abuse
2050.Components of Psychological Evaluations
2051.Validated Psychological Measures
2052.Electronic Pain Assessment Programs
2053.Conclusion
2054.References


PART FIVE Methods for Symptomatic Control
2056.Pharmacologic Therapies

Chapter 77 Rational Pharmacotherapy for Pain

2058.Drugs are Both Underused and Overused in Pain Management
2059.Pharmacotherapy Alone is Rarely Optimal Therapy for Chronic Pain
2060.Every Use of Medication for Pain is an Experiment
2061.Patient Preference: Symptom Control Versus Side Effects
2062.Whenever Possible Treat the Cause of the Pain
2063.Synergism and Potentiation
2064.Outcomes Analyses of Pain Pharmacotherapy
2065.Approved Drugs and Drugs for Nonapproved Uses
2066.Rational Pharmacotherapy
2067.Conclusion
2068.References


Chapter 78 Nonsteroidal Anti-Inflammatory Drugs and Acetaminophen

2070.Mechanism of Action
2071.Prostaglandin Synthesis and Pharmacology
2072.Central Sites of Action
2073.Peripheral Sites of Action
2074.Cox-1 and Cox-2 Selectivity
2075.Pharmacokinetics
2076.Absorption
2077.Distribution
2078.Elimination
2079.Pathophysiologic Conditions Affecting the Kinetics of Nsaids
2080.Specific Drugs
2081.Salicylates
2082.Acetic Acid Derivatives
2083.Propionic Acid Derivatives
2084.Oxicam Derivatives
2085.Cox-2 Selective Nsaids
2086.Acetaminophen
2087.Side Effects, Warnings, and Controversies
2088.Conclusion
2089.Dedication
2090.References


Chapter 79 Opioid Analgesics

2092.Classification Based on Interactions with an Opioid Receptor
2093.Classification Based on Opioid Agonist or Antagonist Activity
2094.Opioid Pharmacodynamics
2095.Cellular, Synaptic, and Circuit Level Events that Inhibit Pain Transmission
2096.The Pharmacodynamic Effects of Opioids
2097.Central Nervous System Opioid Effects
2098.Analgesia
2099.Mood Effects
2100.Sedation
2101.Nausea and Vomiting
2102.Respiratory Depression
2103.Constriction of the Pupil
2104.Antitussive Effect
2105.Hypothalamic Effects
2106.Central Nervous System Excitation
2107.Opioid Tolerance, Dependence, and Addiction
2108.The Opioid-Tolerant Patient and Opioid-Induced Hyperalgesia
2109.The Opioid-Dependent Patient
2110.The Opioid-Addicted Patient with Pain
2111.Peripheral Effects of Opioids
2112.Effects on Smooth Muscle and the Cardiovascular System
2113.Pruritus
2114.Opioid Effects in Pregnancy and on the Neonate
2115.Routes for Opioid Administration
2116.Alternative Noninvasive Routes
2117.Sublingual Administration
2118.Epidural, Intrathecal, and Intraventricular Administration
2119.Characteristics of Specific Opioids
2120.Morphine
2121.Hydromorphone
2122.Methadone
2123.Levorphanol
2124.Oxymorphone
2125.Oxycodone
2126.Fentanyl
2127.Meperidine
2128.Codeine
2129.Hydrocodone
2130.Propoxyphene
2131.Tramadol
2132.Tapentadol
2133.Pentazocine, Nalbuphine, and Butorphanol
2134.Buprenorphine
2135.Abuse-Deterrent Opioid Formulations
2136.Selecting Among the Opioids for Clinical Use
2137.Conclusions and Insights Into the Future of Opioids for Pain
2138.Biased Ligands
2139.Dedication
2140.References


Chapter 80 Skeletal Muscle Relaxants and Analgesic Balms

2142.Skeletal Muscle Relaxants
2143.Mechanism of Action
2144.Types of Skeletal Muscle Relaxants
2145.Centrally Acting Sedative-Hypnotic Muscle Relaxants
2146.Antihistamine Muscle Relaxant
2147.Tricyclic Antidepressant-Like Muscle Relaxant
2148.?Aminobutyric Acid Agonist Muscle Relaxants
2149.Central Agonist Muscle Relaxants
2150.Acute Low Back Pain
2151.Chronic Low Back Pain
2152.Topical Analgesic Balms
2153.Topical Counterirritants
2154.Conclusion
2155.References


Chapter 81 Neuropathic Pain Pharmacotherapy

2157.Antidepressants
2158.Tricyclic Antidepressants
2159.Selective Serotonin and Norepinephrine Reuptake Inhibitors
2160.Selective Serotonin Reuptake Inhibitors
2161.Antiepileptics
2162.Pregabalin
2163.Gabapentin
2164.Carbamazepine
2165.Oxcarbazepine
2166.Lamotrigine
2167.Valproate
2168.Other Anticonvulsants
2169.Opioids
2170.Tramadol
2171.Tapentadol
2172.NMDA Receptor Antagonists
2173.Systemic Sodium Channel Blockers
2174.Simple Analgesics
2175.Nonsteroidal Anti-Inflammatory Agents
2176.Topical Agents
2177.Capsaicin
2178.Topical Lidocaine Patches
2179.Topical Ketamine
2180.Cannabinoids
2181.Drug Combinations
2182.Future Drugs
2183.Evidence-Based Recommendations for Drug Therapy in Neuropathic Pain
2184.Intrathecal Drugs for Neuropathic Pain
2185.Neuropathic Pain-Not Only Pharmacotherapy
2186.References


Chapter 82 Local Anesthetics

2188.Physicochemical Properties of Local Anesthetics
2189.Molecular Structure
2190.Chirality
2191.Acidase Balance
2192.Lipophilic-Hydrophilic Balance
2193.Local Anesthetic Pharmacology
2194.Pharmacodynamics
2195.Pharmacokinetics
2196.Regional Administration of Local Anesthetics for Pain Relief
2197.Differential Blockade
2198.Site of Injection
2199.Potency, Onset, and Duration
2200.pH Adjustment of Local Anesthetics
2201.Vasoconstrictor Effect
2202.Mixtures of Local Anesthetics
2203.Special States: Pregnancy
2204.Systemic Administration of Local Anesthetics for Pain Relief
2205.Intravenous Lidocaine for Acute Postoperative Pain
2206.Intravenous Lidocaine for Chronic Neuropathic Pain
2207.Adverse Effects
2208.Systemic Toxicity
2209.Allergies
2210.Methemoglobinemia
2211.Prolonged-Duration Local Anesthetics
2212.References
2213.Psychological Techniques


Chapter 83 Anger and Pain

2215.Cultural Background
2216.Psychoanalytic Background
2217.Current Research in Anger and Its Relation to Pain
2218.Physiologic Mechanisms in Anger and Pain Research
2219.Psychological Constructs in Anger and Pain Research
2220.Anger Management Style
2221.Measurement of Anger
2222.State-Trait Anger Expression Inventory-2
2223.The Targets and Reasons for Anger in Pain Sufferers
2224.Multidimensional Anger Inventory
2225.Novaco Anger Scale and Provocation Inventory
2226.Anger Disorders Scale
2227.Minnesota Multiphasic Personality Inventory-2-restructured Form
2228.Psychotherapeutic Management
2229.Considerations in the Selection of Psychotherapy
2230.Behavioral and Cognitive-Behavioral Therapies
2231.Summary
2232.References


Chapter 84 Cognitive-Behavioral Therapy for Chronic Pain

2234.Introduction
2235.History and Development of Cognitive-Behavioral Therapy for Pain
2236.Evidence for Cognitive-Behavioral Therapy for Chronic Pain
2237.Components of Cognitive-Behavioral Therapy for Chronic Pain
2238.Chronic Pain Psychoeducation
2239.Relaxation Techniques
2240.Behavioral Activation and Time-Based Pacing
2241.Sleep Hygiene
2242.Cognitive Restructuring
2243.Communication Skills
2244.Maintenance and Relapse Prevention
2245.Third-Wave Therapies-Acceptance and Commitment Therapy
2246.Treating Comorbid Conditions
2247.Cognitive-Behavioral Therapy Within Interprofessional Pain Programs and Pain Rehabilitation Programs
2248.Cognitive-Behavioral Therapy to Prevent the Transition from Acute to Chronic Pain
2249.Summary
2250.References


Chapter 85 Pain and Anxiety and Depression

2252.Prevalence of Anxiety and Depressive Disorders in Chronic Pain
2253.Impact of Anxiety and Depressive Disorders on Functioning
2254.The Interaction of Anxiety, Depression, and Chronic Pain
2255.The Fear-Avoidance Model
2256.A Contextual Behavioral Approach to Anxiety and Depressive Disorders
2257.Treatment of Anxiety and Depressive Disorders
2258.Evidence from Pharmacologic Approaches
2259.Evidence from Psychological Approaches
2260.Cognitive-Behavioral Therapy for Chronic Pain: Effects on Depression and Anxiety
2261.Developments in Cognitive Behavioral Therapy
2262.Summary
2263.References


Chapter 86 Hypnosis

2265.History of Hypnosis in Pain and Symptom Control
2266.Hypnosis by Definition
2267.Conscious, Unconscious, and Content of Consciousness
2268.Central Mechanisms
2269.Central Mechanisms of Hypnosis
2270.High and Low Hypnotizability
2271.Central Mechanisms of Hypnotic Analgesia
2272.Pain as a Plastic Experience
2273.Testing Hypnotizability
2274.Current Research and Applications of Medical Hypnosis for Pain
2275.Efficacy and Effectiveness
2276.Review of Research Studies According to Pain Problems or Situations
2277.Medical Hypnosis Techniques
2278.Principles of Preparation, Induction, and Suggestions
2279.Common Induction Procedures
2280.Suggestions and Imagery
2281.Chronic Pain Management
2282.Ericksonian Naturalistic Approaches to Pain and Symptom Management
2283.Conclusions
2284.References


Chapter 87 Group Therapy for Chronic Pain

2286.Rationale and Basic Considerations of Group Treatment for Pain
2287.Evidence for Efficacy of Group Treatment for Chronic Pain Management
2288.Group Versus Individual Treatment
2289.Group Cognitive-Behavioral Therapy Versus Wait-List, Treatment as Usual, or Other Group Treatments
2290.Behavioral Versus Exercise and Physical Therapy Group Treatments
2291.Mindfulness-Based Approaches to Pain Management
2292.Acceptance-Based Approaches to Pain Management
2293.Factors Affecting Psychotherapeutic Outcome
2294.The Importance of Cognitive Change
2295.Compliance with Homework and Skills Practice to Maintain Treatment Gains
2296.Importance of Therapist Skill and Adequate Time with Therapist
2297.Importance of Group Process
2298.Advantages of Group Treatment
2299.Efficiency and Cost-Effectiveness
2300.Social Proximity and Support
2301.Vicarious Learning and Modeling of Collaborative Approach
2302.Interpersonal Group Process
2303.Practical Issues
2304.Open Versus Closed Groups
2305.Length of Group
2306.Number of Participants
2307.Individuals Who May Be Inappropriate for Groups
2308.Summary and Conclusions
2309.Future Directions
2310.Appendix 87.1: Search Strategies
2311.References


Chapter 88 Motivating Chronic Pain Patients for Behavioral Change

2313.Neural Mechanisms of Motivation
2314.Concept of Readiness to Change: Transtheoretical Model of Behavior Change
2315.Motivation Enhancement Therapy
2316.Help Patients Recognize the Problems and Goals
2317.Decisional Balance
2318.Self-Motivational Statements
2319.What Not to Do in Motivation Enhancement Therapy
2320.Dealing with Setbacks and Resistance
2321.Simple Reflection
2322.Amplified Reflection
2323.Double-Sided Reflection
2324.Agreement with Twist
2325.Personal Choice and Control
2326.Shifting Focus
2327.Research Outcomes
2328.Volitional Approach: Implementation Intentions
2329.Implementation Intentions: Outcomes
2330.Conclusion
2331.References
2332.Physical and Other Noninterventional Therapeutic Modalities


Chapter 89 Basic Concepts in Biomechanics and Musculoskeletal Rehabilitation

2334.Basic Considerations
2335.Kinetic Chain Theory
2336.Adverse Neural Tension
2337.Neuromuscular Control
2338.Biomechanical Considerations in the Setting of Common Physical Examination Techniques
2339.Endurance
2340.Biomechanical Considerations in Common Musculoskeletal Pain Syndromes
2341.Cervicalgia
2342.Periscapular and Thoracic Pain
2343.Lumbar Pain
2344.Sacroiliac and Hip Girdle Pain
2345.Conclusion
2346.References


Chapter 90 Pain Rehabilitation

2348.Historical Overview: Pain Rehabilitation and Functional Restoration
2349.History of Pain Rehabilitation
2350.History of Functional Restoration and Work Rehabilitation
2351.What is Pain Rehabilitation?
2352.Stakeholders in Rehabilitation
2353.Models of Rehabilitation
2354.Biopsychosocial Approach Versus Biomedical Model for Pain Management
2355.Treatment Approaches: Pain Rehabilitation
2356.Team Building and Stakeholder Coordination
2357.Case Management
2358.Applying Team Values
2359.Assessment, Goal Setting, and Progression Through Treatment
2360.Pain Rehabilitation Principles
2361.Rehabilitation Specialists: Activities and Conceptual Models
2362.The Therapist's Role: Building an Effective Therapeutic Relationship
2363.Incorporating Behavioral Approaches in Pain Rehabilitation
2364.Physical Therapy
2365.Therapeutic Exercise
2366.Exercise Prescription
2367.Occupational Therapy
2368.Pain Psychology
2369.Relaxation Training
2370.Work Rehabilitation: Work Conditioning and Work Hardening
2371.Outcomes of Work Conditioning and Work Hardening Programs
2372.Measuring Physical Capacity
2373.Functional Capacity Testing
2374.Functional Capacity Testing Utility
2375.Role of Opioid Management in Pain Rehabilitation
2376.Conclusion
2377.References


Chapter 91 Assessment and Treatment of Substance Use Disorders

2379.Assessment and Treatment of Substance Use Disorders뾃ddiction Medicine Perspective
2380.Screening and Recognition
2381.Prescription Drug Monitoring Program
2382.Diagnostic Assessment
2383.Monitoring During Ongoing Pain Treatment
2384.Treatment And/or Referral
2385.Conceptions of Opioid Use Disorder-he Pain Medicine Perspective
2386.History of Opioid use for Chronic Pain as it Relates to Identifying Opioid use Disorder
2387.Implications for the Identification of Opioid use Disorder
2388.Clinical Prevention and Management of Opioid use Disorder in Patients Receiving Opioids for Chronic Pain
2389.Conclusions: Bridging the Gap Between Addiction and Pain Medicine
2390.References


Chapter 92 Biophysical Agents for Pain Management in Physical Therapy

2392.Superficial Thermal Agents
2393.Thermotherapy
2394.Cryotherapy
2395.Light Therapy
2396.Laser
2397.Monochromatic Infrared Energy
2398.Therapeutic Ultrasound
2399.Electrical Current
2400.Transcutaneous Electrical Nerve Stimulation
2401.Interferential Current
2402.Iontophoresis
2403.Somatosensory Desensitization
2404.Emerging Interventions
2405.Manual Lymphatic Drainage
2406.Cupping
2407.Mirror Therapy and Graded Motor Imagery
2408.Conclusion
2409.References


Chapter 93 Exercise Therapy for Low Back Pain

2411.Individualized Exercise Programs
2412.Musculoskeletal Examination for Low Back Pain
2413.Designing Individualized Exercise Programs
2414.Exercise Recommendations Based on the Clinical Course
2415.Recurrent Lower Back Pain Stage of Management
2416.Persistent Lower Back Pain Stage of Management
2417.Relapse Management
2418.The Application of Common Exercise Approaches for Lower Back Pain
2419.Evidence to Support Exercise Therapy for Lower Back Pain
2420.Evidence for Specific Exercise Approaches
2421.Evidence for Using Classification Systems for Exercise Selection
2422.Evidence for Global Exercise Approaches
2423.Conclusion
2424.References


Chapter 94 Complementary and Integrative Health

2426.What is Complementary and Integrative Health?
2427.The Divide
2428.Fringe Medicine and Quackery
2429.밬northodox?Medicine
2430.Complementary and Alternative Medicine
2431.Complementary and Integrative Health
2432.Bridging the Divide: One Kind of Medicine
2433.What is Different about Complementary and Alternative Medicine?
2434.Who Uses Complementary and Integrative Health?
2435.Categorizing Complementary and Integrative Health Therapies
2436.Why Consider Complementary and Integrative Health Therapies in Pain Management?
2437.Challenges of Evidence-Based Complementary and Alternative Medicine Therapies
2438.The Complementary and Integrative Health Therapies: The Evidence
2439.Biologically Based Therapies
2440.Energy-Based Therapies
2441.Conclusion
2442.References
2443.Implanted Electrical Stimulators


Chapter 95 Stimulation of the Peripheral Nervous System for Pain Relief

2445.Pathophysiology and Mechanisms of Analgesia
2446.Stimulation Technologies
2447.Implantation Techniques
2448.Open Surgical Placement
2449.Percutaneous Placement with Fluoroscopic Guidance
2450.Percutaneous Placement with Ultrasound Guidance
2451.Placement at the Nerve Root/Dorsal Root Ganglion
2452.Patient Selection and Preoperative Workup
2453.Clinical Indications and Outcomes
2454.Extremity Pain
2455.Truncal Pain
2456.Headache and Facial Pain
2457.Complications
2458.Peripheral Nerve Stimulation
2459.Peripheral Field Stimulation
2460.Dorsal Root Ganglion Stimulation
2461.Conclusion and Future Directions
2462.References


Chapter 96 Spinal Cord Stimulation

2464.History
2465.Basic Science of Conventional Spinal Cord Stimulation
2466.Introduction
2467.Neurophysiology and Neurochemistry
2468.Basic Science of New Spinal Cord Stimulation Waveforms
2469.High-Frequency Spinal Cord Stimulation
2470.Burst Spinal Cord Stimulation
2471.Moderate Changes of Conventional Spinal Cord Stimulation Parameters
2472.Computer Modeling Studies
2473.Conventional Spinal Cord Stimulation Mechanisms in Ischemic Pain
2474.Peripheral Vascular Disease
2475.Spinal Cord Stimulation for Angina Pectoris and Cardiac Disease
2476.Mechanisms of Spinal Cord Stimulation in Visceral Abdominal Pain
2477.Indications
2478.Neuropathic Pain
2479.Ischemic Pain
2480.Visceral Pain and Dysfunction
2481.Potential Beneficial Outcomes
2482.Technical Goal
2483.Clinical Goals
2484.Prognostic Factors
2485.Patient Selection
2486.Technique
2487.Screening Trial
2488.Screening Electrode Choice
2489.Electrode Positioning
2490.Parameter Adjustment
2491.Procedural Risk Reduction
2492.Trial Duration
2493.Removal of Trial Electrode
2494.Device Options
2495.Choice of Electrode
2496.Choice of Pulse Generator
2497.Programming a Spinal Cord Stimulation System
2498.Patient Management
2499.Spinal Cord Stimulation Patient Precautions
2500.Spinal Cord Stimulation Treatment Challenges
2501.Clinical Failure
2502.Biologic Failure
2503.Psychological Failure
2504.Technical Failure
2505.Equipment Failure
2506.Cost-Effectiveness
2507.Spinal Cord Stimulation Challenges
2508.References


Chapter 97 Deep Brain and Motor Cortex Stimulation

2510.Deep Brain Stimulation
2511.Basic Considerations
2512.Efficacy of Deep Brain Stimulation
2513.Surgical Technique
2514.Motor Cortex Stimulation
2515.Basic Considerations
2516.Efficacy of Motor Cortex Stimulation
2517.Surgical Technique
2518.Transcranial Magnetic Stimulation
2519.Basic Considerations
2520.Efficacy of Repetitive Transcranial Magnetic Stimulation for Pain
2521.Conclusion
2522.References
2523.Interventional Pain Management


Chapter 98 Diagnostic and Therapeutic Nerve Blocks

2525.Common Principles
2526.Physician
2527.Patient
2528.Preparation
2529.Contraindications
2530.Complications
2531.Procedure
2532.Test Blocks
2533.Prognostic Blocks
2534.Spinal Nerve Blocks
2535.Sympathetic Blocks
2536.Diagnostic Blocks
2537.Principles
2538.Applications
2539.Therapeutic Nerve Blocks
2540.Conclusion
2541.References


Chapter 99 Epidural Steroid Injections

2543.Definition
2544.Background
2545.Techniques
2546.Caudal Injections: Technique
2547.Caudal Injections: Evidence
2548.Caudal Injections: Adverse Events
2549.Interlaminar Injections: Technique
2550.Nonimage-Guided Interlaminar Technique: Evidence
2551.Image-Guided Interlaminar Technique: Evidence
2552.Interlaminar Technique: Adverse Events
2553.Transforaminal Injections
2554.Transforaminal Injections Under Fluoroscopic Guidance: Evidence
2555.Transforaminal Injections: Determinants of Efficacy
2556.Transforaminal Injections: Adverse Events
2557.Transforaminal Injections Under Computed Tomography Guidance: Evidence, Adverse Events
2558.Transforaminal Epidural Steroid Injections: Their Role in Treating the Radicular Pain Patient
2559.References


Chapter 100 Intrathecal Drug Delivery in the Management of Pain

2561.History of the Development of Intrathecal Drug Delivery Systems
2562.Basic Pharmacology of Intrathecal Drug Administration
2563.Selection of Agents for Intrathecal Drug Delivery
2564.Specific Agents for Intrathecal Drug Delivery
2565.Opioids
2566.Local Anesthetics
2567.Adrenergic Agonists
2568.Calcium Channel Antagonists
2569.N-Methyl-D-Aspartate Receptor Antagonists
2570.Aminobutyric Acid Agonists
2571.Gabapentin
2572.Somatostatin and Somatostatin Analogues
2573.Tricyclic Antidepressants
2574.Acetylcholinesterase Inhibitors
2575.Adenosine
2576.Nitric Oxide
2577.Prostaglandin Inhibitors
2578.Calcitonin Gene-Related Peptide Antagonists
2579.Substance P Antagonists
2580.Patient Selection for Intrathecal Drug Delivery
2581.Trialing Techniques for Intrathecal Drug Delivery
2582.Implantable Pump Technology
2583.Surgical Technique of Pump Implantation
2584.Complications of Spinal Drug Delivery
2585.Surgical Complications
2586.Device-Related Complications
2587.Pharmacologic Complications and Drug-Related Side Effects
2588.Patient Outcomes and Intrathecal Drug Infusion
2589.Cancer Pain
2590.Intrathecal Drug Delivery for Chronic Noncancer Pain
2591.Conclusion
2592.Acknowledgment
2593.References


Chapter 101 Intradiscal Therapies for Low Back Pain

2595.Discogenic Pain
2596.Pathology
2597.Therapies
2598.Ablation
2599.Percutaneous Intradiscal Radiofrequency Thermocoagulation
2600.L뭗isq
2601.Chemical Therapies
2602.Biologics
2603.Discussion
2604.References


Chapter 102 Neurolytic Blockade for Noncancer Pain

2606.Introduction
2607.Definition
2608.Principles
2609.History and Trends
2610.Limitations
2611.Chemical Neurolytic Blockade
2612.Principles
2613.Phenol
2614.Alcohol
2615.Applications
2616.Glycerol
2617.Cryoneurotomy
2618.Thermal Radiofrequency
2619.Introduction
2620.Physics
2621.Pathology
2622.Physiology
2623.Applications
2624.Discussion
2625.References
2626.Surgical Approaches


Chapter 103 Surgery of the Peripheral Nervous System as a Treatment for Pain

2628.Peripheral Neurectomy
2629.Basic Considerations
2630.Clinical Considerations
2631.Indications and Outcomes for Treatment of Neuropathic Pain
2632.Indications and Outcomes for Treatment of Nociceptive Pain
2633.Nerve Entrapment Release
2634.Basic Considerations
2635.Clinical Considerations
2636.Indications and Outcomes
2637.Dorsal Rhizotomy and Ganglionectomy
2638.Basic Considerations
2639.Clinical Considerations
2640.Indications and Outcomes
2641.Sympathectomy
2642.Basic Considerations
2643.Clinical Considerations
2644.Indications and Outcomes
2645.Postoperative Complications
2646.Conclusion
2647.References


Chapter 104 The Surgical Management of Trigeminal Neuralgia

2649.Patient Presentation
2650.Anatomy
2651.Pathophysiology
2652.Evaluation for Surgery
2653.Microvascular Decompression
2654.Outcomes
2655.Percutaneous Rhizotomy
2656.Outcomes
2657.Radiosurgery
2658.Outcomes
2659.Conclusions
2660.References


Chapter 105 Ablative Neurosurgical Procedures for Chronic Pain

2662.Dorsal Root Entry Zone Lesioning
2663.Indications
2664.Anatomy and Physiology
2665.Technique
2666.Outcomes
2667.Cordotomy
2668.Indications
2669.Anatomy and Physiology
2670.Technique
2671.Outcomes
2672.Cingulotomy
2673.Indications
2674.Anatomy and Physiology
2675.Technique
2676.Outcomes
2677.Thalamotomy
2678.Indications
2679.Anatomy and Physiology
2680.Techniques
2681.Outcomes
2682.Ablative Procedures of the Brainstem
2683.Indications
2684.Anatomy and Physiology
2685.Techniques
2686.Outcomes
2687.Conclusion
2688.References


PART SIX Provision of Pain Treatment

Chapter 106 Interdisciplinary Chronic Pain Management: Overview and Lessons from the Public Sector

2691.History of Interdisciplinary Chronic Pain Management
2692.Empirical Support for Interdisciplinary Chronic Pain Management
2693.Theoretical Basis of the Interdisciplinary Approach
2694.Composition of the Interdisciplinary Team and Roles of Members
2695.The Process of Interdisciplinary Chronic Pain Management
2696.Interdisciplinary Chronic Pain Management in Veterans Healthcare Administration: Overview of a Model System
2697.Future Considerations for Interdisciplinary Chronic Pain Management
2698.Conclusion
2699.References


Chapter 107 Spine Clinics

2701.Treatment Components
2702.Treatment Providers
2703.Conservative Care Gatekeepers
2704.Pain Management
2705.Psychology
2706.Physical Therapy
2707.Occupational Therapy
2708.Spine Surgery
2709.Chronic Pain Management Program
2710.Potential Benefits of a Spine Specialty Clinic
2711.Coordination of Care
2712.Research and Education
2713.Conclusion
2714.References


Chapter 108 Pain Management in Primary Care

2716.Introduction
2717.Prevalence of Pain in the United States
2718.Economic Implications of Chronic Pain
2719.Chronic Pain Management: The Status Quo
2720.Searching for Solutions
2721.A New Approach to Chronic Pain Management
2722.Who Treats Chronic Illness
2723.Why Primary Care is Involved
2724.Treating Chronic Pain in the Primary Care Setting뾚hy a Challenge?
2725.Addressing Barriers to Care
2726.Myths and Biases
2727.Patient Resistance
2728.Regulatory Scrutiny
2729.Patient Expectations
2730.Pain Practitioner: A Primary Care Model
2731.Training
2732.Collaboration with Pain Specialists
2733.New Focus
2734.Assessment and Evaluation During Short Visits
2735.The 15-Minute Office Visit
2736.Pharmacologic Treatment
2737.Referral to an Addiction Specialist
2738.Motivating Behavior Change in Patients with Chronic Pain
2739.Conclusion
2740.References


Chapter 109 Pain Management at the End of Life

2742.Introduction
2743.Palliative Care
2744.Hospice
2745.Pain Syndromes Common at the End of Life
2746.Cancer
2747.Noncancer Diagnoses
2748.Pain Assessment at the end of Life
2749.Challenges in Pain Assessment
2750.Pain Assessment in the Cognitively Impaired
2751.Pain Assessment in Those Unable to Communicate
2752.Pain Measurement in Research Conducted at End of Life
2753.Pain Management Strategies at End of Life
2754.Routes of Drug Delivery
2755.Intractable Pain or Unmanageable Adverse Effects of Treatment
2756.Nonpharmacologic Techniques
2757.Palliative Sedation
2758.Conclusion
2759.References


Chapter 110 Ethical Principles that Support Decision Making in Pain Management: The Case of Stopping 
Opioids

2761.Background
2762.Medical Ethics and Erikson's Golden Rule
2763.Trust
2764.Mutuality
2765.Morals and Ethics
2766.Case Vignettes and Analysis
2767.Case 1: Opioid-Induced Hyperalgesia
2768.Case 2: Change in the Centers for Disease Control and Prevention Guidelines
2769.Case 3: Opioid Prescriptions from Other Physicians Found in Check of State Drug Monitoring Program
2770.Building Trust Through Mutuality
2771.Dialogue
2772.Empathy
2773.Narrative Medicine
2774.Conclusion
2775.References


Chapter 111 Training Pain Specialists

2777.The Evolution of Pain Medicine as a Subspecialty
2778.Pain Medicine as a Primary Medical Specialty
2779.Training in Pain Medicine in Europe
2780.Training and Credentialing in Interventional Pain Medicine
2781.Conclusion
2782.Acknowledgments
2783.References


Chapter 112 Emergencies in the Pain Clinic

2785.The American Society of Anesthesiologists Closed Claims Project
2786.Bleeding Complications
2787.Infectious Complications
2788.Local Anesthetic Systemic Toxicity
2789.Unintended Destinations Following Local Anesthetic Administration
2790.Vasovagal Reactions
2791.Complications Associated with Intrathecal Drug Delivery
2792.Opioid Withdrawal
2793.Anaphylactic and Anaphylactoid Reactions
2794.Catastrophic Neural Injuries and the Administration of Particulate Steroids
2795.Conclusion
2796.References


Chapter 113 Pain Management in the Emergency Department

2798.The Prevalence of Pain in the Emergency Department
2799.The Assessment of Pain in the Emergency Department
2800.Oligoanalgesia in the Emergency Department
2801.Pain and Opioid Abuse in the Emergency Department
2802.Definitions
2803.Pain and 밆rug-Seeking Behavior in the Emergency Department
2804.Pain and Substance Abuse in the Emergency Department: A Balanced Perspective
2805.The Example of Sickle Cell Disease
2806.Pain Treatment and Procedural Sedation in the Emergency Department
2807.Specific Treatment Modalities
2808.Nonopioids
2809.Opioids
2810.Patient-Controlled Analgesia
2811.Alternative Delivery Routes
2812.Procedural Sedation and Analgesia
2813.Evolving Emergency Department Pain Management Practice
2814.Conclusion
2815.References


Chapter 114 Pain Management in the Intensive Care Unit

2817.Pain, Analgesia, and Critical Illness
2818.Evaluation and Monitoring of Pain in the Intensive Care Unit
2819.Managing Pain and Analgesia in the Intensive Care Unit
2820.Pharmacologic Treatment of Pain in the Intensive Care Unit: Parenteral Opioids
2821.Pharmacologic Treatment of Pain in the Intensive Care Unit: Adjuvant Therapy
2822.Nonpharmacologic Management of Pain in the Intensive Care Unit
2823.Regional Anesthetic Approaches to Pain in the Intensive Care Unit
2824.Integrated Analgesia Management in the Intensive Care Unit
2825.Analgosedation in the Intensive Care Unit
2826.Analgesia as a Component of Comprehensive Bundled Intensive Care Unit Care
2827.Pain and Analgesia at the end of Life in the Intensive Care Unit
2828.Conclusions
2829.Acknowledgments
2830.References


Chapter 115 The Future of Pain Medicine: An Epilogue

2832.References

2833.Index