Pain.Medicine.and.Management.Just.the.Facts

INDEX 377 Nonsteroidal anti-inflammatory drugs Oxycodone, 186. See also Opioids Percutaneous electrical nerve stimulation (NSAIDs) Oxygen inhalation, 136t (PENS), 264, 264f adverse effects, 49–51 dosage, 47t P Perimedullar block, 164 drug interactions, 51t Pace’s maneuver, 333 Perineal pain, 164t, 284 in geriatric patients, 201 Pain Peripheral nerve blocks half-lives, 47t for headache, 135t gate control theory, 285–286 agents, 102t for low back pain, 145 neuropathic. See Neuropathic pain benefits and risks, 102 for myofascial pain, 206 nociceptive. See Nociceptive pain continuous catheters, 105 pediatric doses, 50t psychiatric comorbidities, 244 lower extremity, 104, 104t for pediatric patients, 212, 212t Pain fibers, afferent, 7–8 methods, 102–103 pharmacology, 47–48 Pain medicine by neurolysis, 276–277 in pregnancy and lactation, 227 expert testimony, 370–371 for pelvic pain, 165 structure, 48, 49t medical credentials, 369–370 upper extremity, 103, 103t surgical stress response and, 51 medical records/reports, 368–369 Peripheral nerve stimulation topical, 44 peer review activity, 370 indications, 316 toxicity scores, 49t subspecialty certification examination, 1–5, outcome studies, 317–318 patient evaluation, 315–316 Norepinephrine-serotonin modulator, 249 2t technique, 316–317, 317f NSAIDs. See Nonsteroidal anti-inflammatory third parties during office visits, 369 theory, 315 Pain scales, 16–17, 17f vs. spinal cord stimulation, 316 drugs (NSAIDs) Palliative medicine, 265–265 Peripheral nerves, 19f Nucleoplasty, 356–359, 356–359f Pamidronate, 300, 301t Peripheral neuropathy Panic disorders, 251 AIDS-related, 176 O Parietal pain, abdominal, 107 clinical features, 219 Obsessive-compulsive disorder, 252 Paroxysmal neuralgia, 152 diagnosis, 219 Odontalgia, atypical, 153 Patient history, 15–16, 31–34 epidemiology, 218 Omega-3 fatty acids, 278 Patient-controlled analgesia (PCA) pathophysiology, 218–219 One-legged stork test, 338 advantages, 77 treatment, 219–220 Opioids contraindications, 78 Peristaltic pumps, 83 disadvantages, 77–78 Phalen’s test, 126 for cancer pain, 186 discontinuation, 80–81 Phase, 20 for central pain syndromes, 193–194 indications, 78 Phenoziathines, 74 for complex regional pain syndrome, 198 intravenous opioid, 78–80, 78t Phentolamine, 298–299, 298t, 301t conversion table, 188t patient education, 80t Phenytoin, 51t in epidural analgesia, 84–85 for pediatric patients, 214, 216t Phobic disorders, 251–252 for geriatric patients, 201–202 rationale, 77 Physical examination, 17–19, 18t, 19f, 19t, for headache, 140 side effect management, 80t 112–113 intrathecal, 91–93 subcutaneous opioid, 81 Physical therapy for low back pain, 145 Patient-provider interactions, 34–35 for complex regional pain syndrome, 197–198 mechanisms in humans, 73 Patrick’s test, 129, 337 for fibromyalgia syndrome, 208 for myofascial pain, 206 PCA. See Patient-controlled analgesia (PCA) Phytodolor, 280 in patient-controlled analgesia, 78t Pediatric patients Piriformis syndrome for pediatric patients, 212–213, 217t abdominal pain in, 115, 117f anatomy, 332, 332f peripheral action, 72, 72f adjuvant agents for, 213, 213t botulinum toxin injection for, 270, 335 in peripheral nerve blocks, 102t local anesthetics for, 215t, 216t diagnosis, 333, 335f pharmacology, 67–69, 68t multidisciplinary approach, 210–211 history, 331 in pregnancy and lactation, 228 nonsteroid anti-inflammatory drugs for, 212, pathogenesis, 333 receptors, 68–69, 68t rehabilitation exercises, 334t rotation, 187 212t treatment, 334–335, 334t, 335f sexual function and, 154 opioids for, 212–213, 217t Plain radiography for sickle cell pain, 236t pain assessment, 211–212, 211t, 212f in complex regional pain syndrome, 197 side effects, 187 pain factors, 211 in pain evaluation, 28–29 sites of action, 69 patient-controlled analgesia for, 214, 216t Polyradiculopathy, AIDS-related, 176 spinal action, 71, 71f undertreatment of pain in, 210 Positive sharp wave, 20 supraspinal action, 70–71, 70f, 71f Peer review, 370 Postamputation pain syndrome Oral hypoglycemic agents, 51t Pelvic examination, 113 characteristics, 221 Orchialgia, 157t, 164t Pelvic joint dysfunctions, 160 incidence, 221, 221t Orofacial pain, 41, 151–153 Pelvic pain prevention, 222 AIDS-related, 177 cryoneurolysis for, 284 risk factors, 222 cryoneurolysis for, 284–285 differential diagnosis, 161 spinal cord stimulation for, 286 Orthodromic, 20 in females, 157–159, 158t, 159t topical capsaicin for, 42 Osteoarthritis interventional blocks, 161–165 treatment, 222 acetaminophen for, 48 in males, 156–157, 157t, 159t Post-breast surgery pain, 172 chronic inflammatory, 181, 181t malignant causes, 161 Postcholecystectomy chronic pain, 223–224 evaluation, 180 neuroanatomy, 154–155 Postherpetic neuralgia lidocaine patch 5% for, 38t, 39 nonmalignant causes, 155–156, 155t, 156t eutectic mixture of local anesthetics for, 42, 43t topical capsaicin for, 41, 41t in pregnant women, 231 lidocaine patch 5% for, 38–39, 38t treatment, 181 Penile pain, 157t, 164t topical capsaicin for, 40 Oxcarbazepine, 58t Percutaneous disc compression, 355–356

378 INDEX R Shoulder pain. See Upper extremity pain Radiculopathy Sickle cell anemia Postinguinal hernia pain syndrome, 224, 283 electrodiagnostic tests, 25 causes of death, 235t epidural steroid injections for, 289–290 clinical manifestations, 234–235 Postmastectomy pain syndrome symptoms, 289t pain management, 235–236, 235–236t characteristics, 223 Radiofrequency ablation vaso-occlusive crises, 234–236, 234t incidence, 223 advantages, 310–311 Sinemet, 238t risk factors, 223 complications, 311 Sleep disturbance topical capsaicin for, 41, 41t, 223 equipment, 310 assessment, 32–33 future developments, 314–315 in fibromyalgia syndrome, 209 Poststernotomy pain syndrome, 224 for head and neck pain, 311–312 SNAP. See Sensory nerve action potential Postsurgical pain syndrome history, 309 (SNAP) indications, 311 Sodium bicarbonate, 102t criteria, 220 for neuropathic pain, 314 Sodium channel antagonists eutectic mixture of local anesthetics for, principles, 309–310 efficacy, 60–61 pulsed, 314 mechanisms of action, 59–60 42–43, 43t for spine pain, 312–314 side effects, 60t Postsympathectomy pain syndrome, Radionuclide scanning, 30 Soy, 278 Raw vegetarian diet, 278 Spasticity 224, 348 Raynaud’s phenomenon, 127 differential diagnosis, 237 Postthoracotomy pain syndrome, 171 Recruitment, 20 evaluation, 237 Reflex sympathetic dystrophy. See Complex history, 237 characteristics, 222 regional pain syndrome (CRPS) muscle groups involved, 239t cryoneurolysis for, 283 Regenerative injection therapy (RIT) quantification, 237, 238t incidence, 222, 222t anatomy, 318–319, 322f, 323f treatment, 238–239, 238t prevention, 223 contraindications, 320–321 Sphenopalatine ganglion block, 344 risk factors, 223 indications, 320 Spinal anatomy, 82f, 83t treatment, 223 mechanisms of action, 319–320 Spinal cord Posttraumatic stress disorder, 252 pathophysiology, 319 lesions, 192, 193f Postvasectomy pain syndrome, solutions used, 321 sensory cells, 8–9 225 technical considerations, 321–324, 322f, 323f syringomyelia, 192 Pregnancy Rehabilitation traumatic ischemic injury, 192 abdominal pain in, 230, 230f, 231f in low back pain, 325–330 Spinal cord stimulation acetaminophen use in, 227 in piriformis syndrome, 334, 334t implantable devices, 287, 287f anticonvulsant use in, 229 Residual limb pain, neurogenic. See indications, 303 antidepressant use in, 229 Postamputation pain syndrome mechanism of action, 285–286 benzodiazepine use in, 229 Rheumatoid arthritis, 182, 182t outcomes, 288, 303 caffeine use in, 230 Rheumatologic conditions, 179t patient selection, 286 corticosteroid use in, 228–229 RIT. See Regenerative injection therapy (RIT) system design, 286 ergot alkaloid use in, 230 Ropivacaine, 102 trial protocols, 287–288 hip pain in, 230–231 vs. peripheral nerve stimulation, 316 local anesthetics in, 228 S Spinal drug delivery. See Epidural analgesia; low back pain in, 231–233, 231f Sacroiliac joint pain, 160 Intrathecal analgesia medication use in, 226, 226t Spinal stenosis, 328. See also Low back pain migraine headache in, 233 anatomy, 336–337 Spondyloarthropathy, 181t musculoskeletal pain in, 230–231f, clinical presentation, 337 Spondylolisthesis, 328–329. See also Low back diagnosis, 128–129, 337–339 pain 230–233 treatment, 339–340, 340f Spontaneous activity, 20 neurodiagnostic imaging in, 232t Sciatic nerve block, 104 SSRIs. See Selective serotonin reuptake nonsteroidal anti-inflammatory drug use Sclerotherapy. See Regenerative injection inhibitors (SSRIs) therapy (RIT) St. John’s wort, 279 in, 227 Secondary gain, 34 Stimulants, 186t opioid use in, 228 Selective serotonin reuptake inhibitors (SSRIs) Stinchfield test, 129 pelvic pain in, 231 as analgesics, 54, 186t, 248 Stress, exam preparation and, 4 Probenecid, 51t for depression, 248 Study techniques, 3–4 Procaine, 61 dosages, 53t Substance abuse Proctalgia fugax, 159 for headache, 138 assessment, 241–242, 242t Programmable pump, 93, 95–96, 98 mechanisms of action, 53t behaviors, 241t Prolotherapy. See Regenerative injection side effects, 248 in chronic pain patients, 240, 240t therapy (RIT) tramadol and, 66 optimizing drug therapy in, 242–243, 242f Prostadynia, 157t, 164t Sensory nerve action potential (SNAP), 20 psychiatric complications, 240–241 Prostatitis, 157t, 164t Sensory testing Sucrose, 279 Psoriatic arthritis, 181t current perception threshold (CPT), 27–28 Sudomotor testing, 197 Psychodynamic psychotherapy, 250–251 mechanical, 26–27, 26t Superior hypogastric plexus block, 162–163, Psychological evaluation, 31–34 quantitative, 26–28 347–348 Psychosocial history, 16, 33–34 thermal, 26t, 27 Supraclavicular block, 103 Psychotherapeutic techniques Serotonin modulators, 249 Surgical scars, 172 for anxiety disorders, 253 Serotonin-norepinephrine reuptake inhibitors, Sympathectomy, 305 for depression, 250–251 248–249 Pudendal nerve block, 165 Pudendal nerve entrapment, 160–161 Pumps for epidural analgesia, 83 for intrathecal analgesia, 93, 97–98 Q Quinine sulfate, 75–76

INDEX 379 Sympathetic dystrophy, 171 Topical capsaicin. See Capsaicin, topical Urethral syndrome, 159t, 164t Sympathetic nerve blocks Topiramate Urine toxicology screening, 243 Urogenital pain, 156–159, 157–159t, celiac/splanchnic nerve plexus, 346–347 as analgesic, 58t cervicothoracic/stellate, 345–346 for headache, 136t 164t in complex regional pain syndrome, 197, Trachea, visceral pain, 167–168, 167t Tramadol V 198–199 benefits, 66 Valproic acid ganglion impar, 163–164, 348 dosage and administration, 64 indications, 344 drug-drug interactions, 66 as analgesic, 58t lumbar sympathetic, 162, 347 indications, 64–66 for headache, 136t by neurolysis, 277 mechanisms of action, 63 Vaso-occlusive crises, 234–236, 234t sphenopalatine ganglion, 344 pharmacology, 63–64 Venlafaxine superior hypogastric plexus, 162–163, 347–348 side effects, 64–65 as analgesic, 54–55 Symphysis pubis, 160 titration schedule, 65–66, 65t for depression, 248–249 Syringe pumps, 83 Transcutaneous electrical nerve stimulation Verapamil, 62 Systemic lupus erythematosus, 181t (TENS) Visceral pain for central pain syndromes, 194 AIDS-related, 176 T definition, 349 biochemistry, 120 TCAs. See Tricyclic antidepressants (TCAs) efficacy, 349 central sensitization, 120–121 Temporomandibular disorders, 269 mechanism and indications, 281, 349 characteristics, 107 TENS. See Transcutaneous electrical nerve procedure, 349 mediators, 121–122 Trazodone, 249 neurophysiology, 118–119, 119f, 120f stimulation (TENS) Tricyclic antidepressants (TCAs) peripheral sensitization, 121, 121f Tension myalgia. See Fibromyalgia syndrome as analgesics, 54, 186t transmission, 119–120 Tetracyclic antidepressants, 247 for complex regional pain syndrome, 198 Visual analog scale, 17f Thalamotomy, 308 for depression, 247 Vocational history, 16 Thermal sensation testing, 26t, 27 dosages, 53t Von Frey hairs, 26–27 Thermography, 197 for fibromyalgia syndrome, 208 Vulvar hyperesthesia, 158t, 164t Thigh thrust test, 338 in geriatric patients, 201 Vulvodynia, 158t, 164t Thoracic pain for headache, 136t, 138 mechanisms of action, 53t W musculoskeletal, 169–170, 170f side effects, 247 Wartenberg’s sign, 126 myofascial, 171–172 Trigeminal neuralgia, 152, 311–312 Weight loss, 278 postoperative, 172 Trigger point needling, 205–206, 205t Willow bark extract, 280 visceral, 167–169, 167t, 168f Triptans, 135t, 137t Work-related issues, 33 Thyroid supplementation, 208 World Health Organization Tiagabine, 58t U Tietze’s syndrome, 169, 170f Ultrasonography, 122 analgesic ladder for cancer pain, 184f Tinel’s test, 126 Upper extremity pain pain management guidelines, 123, 123f Tissue injury, 7 Tizanidine complex regional pain syndrome, 127–128 Y as analgesic, 75–76 compressive neuropathy, 125–126 Yin-Yang, 260, 260f for headache, 136t innervation, 19t Yoga, 281 for myofascial pain, 206 peripheral nerve block for, 103, 103t for spasticity, 238t posttrauma, 127 Z Topical analgesics. See also specific agents vasculopathy, 127 Ziconotide, 61–62 for complex regional pain syndrome, 198 Zonisamide, 58t rationale, 37