Chronic Pain (eBook)

Chronic Pain 2
Title Page 3
Copyright Page 4
Series Editor’s Introduction 5
Preface 7
Contents 9
Part I: Introduction 11
Chapter 1 12
Chronic Pain and Headache Overview 12
Case History 12
Chronic Pain: Epidemiology 13
Chronic Pain Assessment Tools 15
Summary 19
References 19
Chapter 2 20
Summary of Pain Management Issues: Frequent Concerns in Treating Chronic Pain Patients 20
Do People Really Have Chronic Pain Long After They Have Recovered From an Injury? 20
Is It Unusual for Children to Report Chronic Pain? 21
Are Aches and Pain Part of the Normal Aging Process? 21
I Have Heard That You Cannot Really Treat Chronic Pain and Patients Just Need to “Learn to Live With It”. Are There Really Any Effective Treatments for Chronic Pain? 21
Are Opioids Effective for Patients With Chronic Pain, or Do They Usually Lead to Addiction? 21
Is Caring for Chronic Pain Patients Too Time-Consuming for a Busy Practice? 22
Is It Really Important to Address Chronic Pain? Is My Office Time Better Spent Focusing on “Real” Medical Problems, Like Diabetes, Heart Disease, and Hypertension? 22
Chapter 3 23
Risk Management in Chronic Pain Practice 23
Case History 23
Introduction 24
Mandate to Assess and Alleviate Pain 25
Statistics on Pain Medication Abuse 26
Regulations to Balance Pain Relief and Medication Abuse 27
Implementing Pain Management Practice Guidelines 28
Identifying Comorbidity 29
Characterizing Goal Setting 30
Evaluating Appropriateness of Opioid Analgesia 30
Requiring Patient Responsibility 32
Charting Documentation 35
Summary 41
Test Your Knowledge 41
References 42
Part II: Pathogenesis 43
Chapter 4 44
Physiology of Chronic Pain 44
Case History 44
Introduction 45
Pathophysiology of Chronic Pain 47
Long-Term Changes from Pain Exposure 49
Expected Course of Chronic Pain 50
Predictors of Chronic Pain 51
Identifying the Malingerer 52
Summary 54
Test Your Knowledge 54
References 55
Part III: Common Chronic Pain Conditions 57
Chapter 5 58
Headache 58
Case History 58
Introduction 59
Epidemiology and Impact of Chronic Headache 59
Chronic Headache Diagnoses Seen in Primary Care 59
Headache Impact and Disability 61
Evaluation of Headache Complaints 63
Headache Diagnosis 65
Headache Treatment 70
Analgesic-Overuse Headache 71
Common Primary Recurring Headaches (Migraine, Tension-Type, Post-trauma) 72
Cluster Headache 75
Headache Patterns in Women 76
Summary 78
Test Your Knowledge 78
References 79
Chapter 6 82
Neck and Upper Extremity Pain 82
Case History 82
Introduction 83
Epidemiology of Neck and Upper Extremity Pain 84
Evaluation of Neck and Upper Extremity Pain 86
Neck Pain 86
Use of Specialized Testing 89
Shoulder Pain 90
Subacromial Bursitis 91
Rotator Cuff Tendonitis 92
Hand Pain 92
De Quervain’s Tenosynovitis 93
Carpal Tunnel Syndrome 94
Treatment 95
Neck Pain 96
Cervical Radiculopathy 96
Shoulder Pain 100
Hand Pain 100
De Quervain’s Tenosynovitis 100
Carpal Tunnel Syndrome 101
Summary 101
Test Your Knowledge 102
References 103
Chapter 7 106
Back and Lower Extremity Pain 106
Case History 106
Introduction 107
Epidemiology 107
Predictors of Chronic Low Back Pain 109
Evaluation of Back and Lower Extremity Pain 112
Thoracic Pain 113
Lumbar Pain 115
Use of Specialized Testing for Back Pain 117
Selecting Candidates for Imaging Studies 118
Thoracic Spine Pain 119
Lumbar Spine Pain 119
Chronic Hip Pain 119
Chronic Knee Pain 120
Chronic Foot Pain 120
Treatment 122
Back Pain 122
Thoracic Pain 122
Lumbar Pain 123
Acute Back Pain Treatment 124
Chronic Back Pain Treatment 125
Work and Chronic Back Pain 127
Chronic Knee Pain 128
Chronic Foot Pain 128
Summary 128
Test your Knowledge 129
References 130
Chapter 8 134
Abdominal Pain 134
Case History 134
Introduction 135
Epidemiology 136
Irritable Bowel Syndrome 136
Myofascial Abdominal Wall Pain 137
Chronic Pancreatitis 139
Evaluation 139
Irritable Bowel Syndrome 140
Myofascial Pain 141
Chronic Pancreatitis 142
Psychological Factors 143
Treatment 144
Irritable Bowel Syndrome 145
Myofascial Abdominal Wall Pain 146
Chronic Pancreatitis 146
Summary 147
Test Your Knowledge 148
References 149
Chapter 9 151
Arthritis 151
Case History 151
Introduction 152
Epidemiology 153
Economic Impact of Arthritis 154
Arthritis Evaluation 154
Arthritis Diagnosis 157
Osteoarthritis 157
Rheumatoid Arthritis 160
Arthritis Treatment 163
Medications 164
Osteoarthritis 164
Rheumatoid Arthritis 164
Non-pharmacological Therapy 167
Weight Reduction 167
Exercise 168
Psychological Treatments 169
Alternative/Complementary Medicine 170
Summary 170
Test Your Knowledge 171
References 172
Chapter 10 176
Neuropathic Pain 176
Case History 176
Introduction 177
Epidemiology of Common Neuropathic Pain Syndromes 178
Diabetic Neuropathy 178
Postherpetic Neuralgia 179
Complex Regional Pain Syndrome 180
Cancer-Related Neuropathy 182
HIV-Related Neuropathy 182
Evaluation of Neuropathic Pain 182
Treatment of Neuropathic Pain 185
First-Line Therapy 185
Antiepileptic Drugs 185
Antidepressants 187
Second-Line Therapy 188
Topical Agents 188
Opioids 188
Treatment of Individual Pain Syndromes 188
Postherpetic Neuralgia 188
Complex Regional Pain Syndrome 190
Summary 191
Test Your Knowledge 191
References 192
Chapter 11 195
Myofascial Pain 195
Case History 195
Introduction 196
Epidemiology 198
Evaluation 203
Treatment 204
Physical Therapy 204
Injections 207
Pharmacological Therapy 207
Psychological Therapy 208
Summary 209
Test Your Knowledge 209
References 210
Chapter 12 212
Fibromyalgia 212
Case History 212
Introduction 213
Epidemiology 215
Psychological Comorbidity 217
Disability 218
Evaluation 219
Assessment Measures 219
Treatment 220
Pharmacological Treatment 222
Non-pharmacologic Treatments 223
Complementary and Alternative Medicine 223
Individualized, Symptom-Focused, Multidisciplinary Treatment 224
Summary 226
Test Your Knowledge 226
References 227
Chapter 13 230
Cancer Pain 230
Case History 230
Introduction 230
Epidemiology of Cancer-Related Pain 231
Cancer Pain Assessement 232
Quantifying Cancer Pain Severity 233
Cancer Pain Treatment 234
Opioids for Cancer Pain 235
Breakthrough Pain 237
Radiation 238
Interventional Therapies 239
Summary 240
Test Your Knowledge 240
References 241
Part IV: Special Groups 243
Chapter 14 244
Pediatric Pain 244
Case History 244
Introduction 245
Common Chronic Pain Syndromes in Children and Adolescents 248
Musculoskeletal Pain 249
Headache 249
Recurrent Abdominal Pain 251
Chest Pain 253
Assessment 253
Musculoskeletal Pain 254
Headache 254
Recurrent Abdominal Pain 257
Chest Pain 257
Psychosocial Factors 258
Treatment 258
Headache Therapy 259
Summary 260
Test Your Knowledge 260
References 261
Chapter 15 265
Pregnancy and Pain 265
Case History 265
Introduction 266
Common Pain Syndromes During Pregnancy 266
Headache 266
Back Pain 269
Neuropathy 270
Testing During Pregnancy 273
Treatment 274
Nonpharmacological Therapy 274
Medications During Pregnancy and Lactation 276
Summary 277
Test Your Knowledge 277
References 278
Chapter 16 282
Geriatrics and Chronic Pain 282
Case History 282
Introduction 283
Common Chronic Pain Complaints 285
Musculoskeletal Pain 285
Osteoporosis and Fractures 285
Lumbar Stenosis 286
Headache 286
Giant-Cell (Temporal) Arteritis 287
Trigeminal Neuralgia 288
Assessment Tools 288
Treatment 290
Nonpharmacological Therapy 290
Medications 291
Osteoporosis and Fractures 292
Lumbar Stenosis 292
Giant-Cell (Temporal) Arteritis 293
Trigeminal Neuralgia 295
Summary 296
Test Your Knowledge 297
References 298
Chapter 17 301
Gender and Ethnic Differences in Pain Experience 301
Case History 301
Introduction 302
Gender Differences in Pain Experience 303
Pain Perception Differs Between Genders 303
Psychological Differences in Pain Perception 305
Gender and Chronic Pain Treatment 306
Gender Differences in Seeking Treatment 306
Gender-Specific Response to Pain Therapy 306
Ethnic/Cultural Differences in Pain Experience 307
Pain Perception and Ethnicity 307
Treatment Selection and Ethnicity 309
Medications 309
Complementary and Alternative and Medicine 310
Summary 311
Test Your Knowledge 312
References 312
Part V: Chronic Pain Treatment 316
Chapter 18 317
Lifestyle and Psychological Issues 317
Introduction 318
Obesity 318
Obesity and Chronic Pain Comorbidity 318
Obesity Assessment 320
Obesity Treatment for Patients with Chronic Pain 321
Sleep 323
Sleep Disturbance and Headache 324
Treatment of Insomnia 325
Smoking 326
Prevalence of Pain Based on Smoking 326
Impact of Smoking on Chronic Pain Treatment 326
Abuse 327
Psychological Distress 329
Premorbid Psychological Factors 330
Current Psychological Factors 331
Stress 331
Depression and Anxiety 332
Primary and Secondary Gain 333
Assessment for Psychological Distress 333
Psychological Treatment 334
Treating Comorbid Psychological Symptoms 334
Psychological Treatment of Chronic Pain 334
Summary 336
Test Your Knowledge 338
References 339
Chapter 19 343
Analgesics and Opioids 343
Case History 343
Introduction 344
Selecting Pain Relief Medication 345
Non-opioid Analgesics 346
Opioid Analgesics 347
Incorporating Opioids into the Overall Management Plan 349
Opioid Abuse and Misuse 350
Determining Appropriate Dosing 351
Coanalgesics 354
Antidepressants 354
Neurostabilizing Antiepileptics 356
Muscle Relaxants 356
Topical Agents 356
Summary 356
Test Your Knowledge 357
References 358
Chapter 20 360
Managing Pain at End of Life 360
Case History 360
Introduction 361
Defining End-of-Life Care 361
Pain at End of Life 363
Assessment 365
Treatment 367
Pain Control 368
Hospice Care 369
Summary 370
Test Your Knowledge 370
References 371
Chapter 21 373
Appendices: Patient Educational Materials 373
Case Histories 373
References 375
Appendix A: Rationale Behind Pain Management 376
Appendix B: Exercise and Pain Management 380
Appendix C: Psychological Screening and Pain Management Skills 392
Appendix D: Pain Medications 396
Appendix E: Chronic Headache 397
Appendix F: Neuropathic Pain 412
Appendix G: Fibromyalgia 415
Appendix H: Pain Drawing 418
Index 419