1. Pain mechanisms and pathways.- Anatomy of the nervous system.- Sympathetic and parasympathetic systems.- Different types of pain.- Peripheral mechanisms.- Spinal and medullary dorsal horns mechanisms.- Segmental and brain stem mechanisms.- Thalamocortical mechanisms.- Experimental models.- Peripheral mechanisms of pain transmission and modulation.- Synaptic transmission of pain in the dorsal horn.- Central sensitization.- Neurotransmitters involved in pain modulation.- Development of pain behavior in the fetus and newborn.- Physiologic and behavioral pain assessment measures in infants.- Long-term consequences of neonatal pain.- 2. Research and study design.- Critical analysis of literature and evidence-based medicine.- Principles of valid clinical research.- Effects of analysis on the clinical applicability of study results.- Components of clinical trials.- Special features of study of pain.- Outcome measures in clinical studies.- Common animal models in the study of pain.- Ethics of animal experimentation.- Ethics of pain management and research.- Professionalism and quality assurance.- Placebo, Nocebo and Pain.- Use of data from epidemiologic studies of pain.- Measurement of burden in a population, including epidemiologic measures of occurrence.- Observational studies: uses and limitations.- Cohort studies: use to determine natural history and predictors of outcome.- Case control studies: uses, indications, limitations and design.- Use of risk factors to guide treatment.- 3. Assessment of Pain.- Pain as a subjective, multidimensional experience.- Introspection and measurement of subjective experience.- Measurement of pain (all scales for neonates, infants, children, adults and elderly).- Indirect pain measurement.- Dependence/tolerance/addiction/Abuse/misuse.- 4. Clinical Nerve Function Studies and Imaging.- Electrical nerve stimulation EMG/NCV.- Evoked potentials.- Quantitative sensory testing.- Skin punch biopsy.- MRI, fMRI, and MR spectroscopy.- PET scans.- EEG.- MEG.- X ray.- CT.- 5. Psychosocial and Cultural Aspects of Pain.- Pain as a biopsychological experience.- Individual differences in affective, cognitive, and behavioral responses to pain.- Coping styles.- Expectations, coping, cultural and environmental factors.- Cultural, environmental, and racial variations in experience and expression of pain.- Role of family in promoting illness and well behaviour.- Common emotional problems and psychiatric disorders associated with pain.- Sex and Gender Issues in Pain.- 6. Pharmacologic treatment of pain.- Opioids.- Antipyretic Analgesics.- Antidepressants.- Anticonvulsants.- Neuroleptic drugs.- Antihistamines.- Analeptic drugs.- Corticosteroids.- Muscle relaxants and antispasticity drugs.- NMDA antagonists.- Local anesthetics and membrane-stabilizing drugs.- Alpha 2 agonists.- Naloxone and Naltrexone.- Agonist/antagonist agents.- Ziconotide.- Marijuana.- Lidocaine infusion.- Herbal and vitamin supplements.- Fatty acids.- Capsaicin.- 7. Other methods for treatment of pain.- Cognitive and behavioral strategies.- Integration of approaches.- Stages of behavioral change and their effects.- Cognitive behavioral and self-management interventions.- Psychiatric and psychologic morbidities of chronic pain.- Psychiatric and psychological factors that impact treatment adherence and the therapeutic alliance with treatment providers.- Pharmacotherapy for treatment of comorbid conditions.- Psychotherapy for depressive disorders.- Differential diagnosis of anxiety disorders and their management.- Anger in chronic pain patients and relation to perceived pain.- Somatic complaints in chronic pain.- Role of family.- Role of patient beliefs and expectations in pain and disability.- Sleep disorders in chronic pain.- Work history and education in evaluation of chronic pain.- Peripheral stimulation techniques.- 8. Interventional Pain Management Including Nerve Blocks.- Anticoagulation.- Superficial and deep cervical plexus.- Stellate ganglion block.- Sympathetic blocks.- Brachial plexus.- Ulnar nerve.- Median nerve.- Radial nerve.- Femoral nerve.- Sciatic nerve.- Saphenous nerve.- Posterior tibial nerve.- Common peroneal nerve.- Superficial peroneal.- Deep peroneal.- Sural.- Lateral femoral cutaneous nerve.- Obturator nerve.- Ilioinguinal nerve.- Iliohypogastric nerve.- Genitofemoral nerve.- 9. Headache and Facial Pain.- Migraine headache.- Cluster headache.- Tension headache.- Other types of headache.- Botox injections.- Systematic case history.- Indications for further investigation of headache.- Physical, psychological, and social factors contributing to headache.- Occipital nerves.- Trigeminal nerve with all terminal branches.- Spheno-palatine ganglion.- Other ganglia.- Cranial nerves.- 10. Back.- Cervical Radicular Pain.- Neck Pain.- Thoracic radicular pain.- Thoracic back pain.- Lumbar Radicular Pain.- Low Back Pain.- Disc disease and discogenic pain.- PDPH.- Arachnoidtis.- Thoracic outlet syndrome.- 11. Musculoskeletal Pain.- Diagnostic labels for muscle pain.- Anatomy.- Multifactorial pathophysiology.- Common clinical characteristics.- Fibromyalgia.- Different muscle conditions.- Tendinosis and Tenditnitis.- TPIs.- TENS unit.- 12. Joints.- TMJ.- AA joint.- Sacroiliac joint.- Shoulder joint.- Elbow joint pain.- Wrist joint pain.- Hip joint pain.- Knee joint pain.- Ankle joint pain.- 13. Chest pain.- Anatomy.- Xiphodynia.- Costochondral junction, Costosternal junction and Intercosal nerve injections.- 14. Abdominal Pain.- Anatomy.- Causes and differential diagnosis.- Peripheral and central mechanisms of visceral pain modulation.- TAP block.- Celiac plexus block.- 15. Chronic Urogenital Pain.- Anatomy and epidemiology.- Clinical differentiation of gastrointestinal, urologic, gynecologic, and musculoskeletal pain.- Psychological principles in clinical assessment, explanation, and treatment.- Common causes, diagnostic evaluation, and treatment in men.- Common causes, diagnostic evaluation, and treatment in women.- Superior hypogastric plexus block.- Ganglion impar block.- 16. Surgical Pain Management.- Importance of general health status in preoperative evaluation.- Surgical lesioning of brain, brain stem, spinal cord, peripheral nerves.- Radiofrequency treatment.- Neurolysis.- Spinal cord and peripheral nerve stimulation.- Intrathecal drug delivery.- DRG stimulator.- Cordotomy.- Kyphoplast and vertebroplasty.- 17. Nerve conditions.- Complex Regional Pain Syndromes.- Phantom limb pain.- Peripheral neuropathy.- Other nerve conditions as mononeuropathy, mononeurpathy multiplex and others.- 18. Central pain.- Central pain.- 19. Cancer Pain.- Palliative care.- Hospice care.- Comprehensive evaluation of patients with cancer pain.- Principles of treatment.- Analgesic ladder approach.- Anesthetic approaches.- Surgical and interventional radiologic approaches.- Neurostimulatory approach.- Physical therapy.- Psychological approaches.- Needs of special populations.- Benefit to burden ratio.- Anorexia and cachexia associated with cancer.- 20. Pain in Pregnancy and Labor.- Factors influencing the perception of pain in pregnancy compared with the non-pregnant state.- Causes of pain and principles of pain management in pregnancy.- Mechanisms, characteristic, benefits, consequences and management of labor pain.- 21. Acute Pain.- Epidemiology of inadequate control.- Physiologic and psychologic effects.- Pharmacologic properties of major classes of drugs used for acute pain management.- Comprehensive plan for optimal perioperative pain management.- Non-pharmacologic treatment.- Clinical outcomes to be evaluated.- Tools for assessment and measurement.- Role of patient and family education.- Treatment of nonsurgical pain.- 22. Physical Medicine and Rehabilitation.- Temperature modalities.- Manipulation, mobilization, massage, traction.- Casting and splinting.- Exercise therapy.- 23. Work Rehabilitation.- Importance of early intervention and early return to work in reducing absence.- Psychosocial factors as the main determinants of disability.- Identification of obstacles to recovery.- Components of successful comprehensive rehabilitation program.- Multidisciplinary approaches for those who do not return to work within a few weeks.- Functional Capacity Evaluation.- 24. Complementary Therapies (CAM).- CAM.- 25. Clinical States: Taxonomy.- IASP classification of chronic pain syndromes.- Application and definition of pain terms.- 26. Pain in special population.- Pain in Infants, Children, and Adolescents.- Pain in older adults.- Delirium in the elderly.- Pain Issues in Individuals with Limited Ability to Communicate Due to Neurocognitive Impairments.- 27. Pain Relief in Persons with Substance use and Addictive Disorders.- Biopharmacologic and neurophysiologic basis of addiction.- Interactions between addiction and pain.- Screening for substance use disorder or addiction in patients with pain.- Principles of comprehensive approach to pain management in patients with addiction.- Pharmacologic treatment of patients with addiction.- Acute pain management of patients with active addiction or in recovery.- Analgesic response to opioids in patients with addiction.- Risks and benefits of opioid use in treatment of chronic/cancer pain in patients with substance use disorder.- Needs of special populations.- Legal, regulatory, reimbursement issues limiting access to care for patients with pain and addiction.- Treatment of withdrawal.- List of addictive drugs and their metabolites in urine.- Impact of alcohol use on pain.- 28. Pain Relief in Areas of Deprivation and Conflict.- Variability of availability and access to adequate pain treatment worldwide.- Causes of pain worldwide.- Spectrum of providers caring for patients with pain worldwide.- Limitations of education, training, and knowledge of pain and its treatment.- Research.- Inadequacy of access to drugs and palliative care in many countries.- 29. Other conditions.- Rheumatoid arthritis.- Osteoarthritis.- Osteomalacia.- Systemic lupus erythematosus.- Scleroderma.- Polymyalgia rheumatic.- Multiple sclerosis.- Post-polio syndrome.- Guillian Barre syndrome.- Ankylosing spondylitis.- Dupuytren's contractures.- Neuromas.- PHN.- Syrngomyelia.- Serotonin syndrome.- Erythromelalgia.- Restless leg syndrome.- HIV/AIDS.- Sickle cell anemia.- Vascular/Claudications.- 30. Exam taking.- Exam taking.
This concise but comprehensive guide covers common procedures in pain management necessary for daily practice, and includes topics on international pain medicine curricula, for example, the American Board of Anesthesiology, World Institute of Pain/Fellow of Interventional Pain Practice, and American Board of Pain Medicine. Treatments for pain are discussed, including nerve blocks (head, neck, back, pelvis and lower extremity). Chapters have a consistent format including high yield points for exams, and questions in the form of case studies.
Pain: A Review Guide is aimed at trainees in pain medicine all over the world. This book will also be beneficial to all practitioners who practice pain.
Alaa Abd-Elsayed completed his MBBCh and MPH at Assiut University, Assiut, Egypt in 2000 and 2006, respectively. He did an internship at Internship, Assiut University Hospitals, Assiut, Egypt and completed a Clinical research fellowship in Anesthesiology at Cleveland Clinic, Cleveland, Ohio, USA. He then moved to University of Cincinnati, Cincinnati, Ohio, USA for a further internship, residency in anesthesiology and fellowship in pain medicine. Since 2014 he has worked at UW, School of Medicine and Public Health, Madison, WI, USA, starting as Assistant Professor/Staff Anesthesiologist and now as Medical Director for the UW Pain Clinic and Director of Pain Services for UW Health.