Pain Care EssentialsPub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0010
Michele L Matthews, Benjamin S Kematick
{"title":"Standard Systemic Analgesic Agents","authors":"Michele L Matthews, Benjamin S Kematick","doi":"10.1093/med/9780199768912.003.0010","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0010","url":null,"abstract":"Chapter 9 addresses drugs used for pain management. These drugs are categorized as standard systemic analgesic agents, including nonopioid and opioid analgesics, and other, neuromodulating, agents that are addressed in subsequent chapters. There is significant variability in individual response to standard systemic analgesics, and choice of therapy should foremost include patient-specific considerations balancing efficacy with tolerability. Acetaminophen is widely recommended for various acute and chronic pain syndromes and is generally considered safe when taken within therapeutic doses. Nonsteroidal anti-inflammatory drugs (NSAIDs) are versatile analgesics and are commonly utilized for general mild to moderate pain. NSAIDs are the most widely used analgesics today. Opioids are effective for severe pain, such as pain from acute trauma, postsurgical pain, and cancer pain, but require intense monitoring for side effects. All opioids cause sedation, constipation, nausea, and somnolence and can cause respiratory depression, physical dependence, and death. Opioids are available in both short-acting and extended-release or long-acting formulations. Like NSAIDs, opioids should be used at the lowest dose for the shortest duration of time when possible.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116652667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain Care EssentialsPub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0018
B. Hogans
{"title":"Extremes of Pain","authors":"B. Hogans","doi":"10.1093/med/9780199768912.003.0018","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0018","url":null,"abstract":"Chapter 17 covers the range of extreme and unusual pain-associated conditions by highlighted selected conditions that illustrate the extent of severe pain and informative aberrations in pain signaling, including congenital insensitivity. Multiple forms of severe intractable pain are addressed, including trigeminal neuralgia, postherpetic neuralgia, phantom limb pain, complex regional pain syndrome, peripheral nerve vasculitis, fibromyalgia, Ehlers-Danlos syndrome, stiff-person syndrome, endometriosis, and erythromelalgia. The preponderance of these conditions are neuropathic in nature, and all require coordinated pharmacologic and nonpharmacologic treatment. Pharmacologic therapies may include neuromodulating agents, and nonpharmacologic approaches may include clinical psychology, psychologically informed physical therapy, daily moderate exercise, stress management, sleep optimization, and mind–body approaches. These extreme pain conditions range from fairly prevalent but poorly understood (e.g., fibromyalgia) to rare but associated with specific molecular processes, as in erythromelalgia.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114371239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain Care EssentialsPub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0017
B. Hogans
{"title":"Common Chronic Pain Problems","authors":"B. Hogans","doi":"10.1093/med/9780199768912.003.0017","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0017","url":null,"abstract":"Chapter 16 addresses several common chronic pain-associated conditions. Utilizing the comprehensive, multimodal, evidence-based approach to assisting patients in planning for pain self-management, the chapter describes common chronic pain-associated conditions, including those of the head, such as chronic tension headache, temporomandibular joint disorder, and chronic migraine; the spine, such as chronic neck and low back pain; the appendicular musculoskeletal system, such as hip, knee, and shoulder pain; common neuropathic pain conditions, such as diabetic peripheral neuropathy; and common compressive neuropathies, such as carpal tunnel syndrome and ulnar neuropathy. The conditions are presented in terms of common characteristics, pathophysiologic features, and the basic approach to treatment.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122160718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain Care EssentialsPub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0004
P. Arnstein, M. Keating
{"title":"Impact of Pain on the Individual and Others","authors":"P. Arnstein, M. Keating","doi":"10.1093/med/9780199768912.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0004","url":null,"abstract":"Chapter 3 describes how pain is a powerful stressor that aids in surviving an injury and how the resultant physiologic stressors put vulnerable patients at risk for pulmonary, renal, gastrointestinal, metabolic, and psychosocial complications. The timeliness and efficacy of pain control contribute to health outcomes. Of the estimated 30% of adults who develop chronic pain, these individuals face increased risk for an impoverished, premature death. Pain is a biopsychosocial experience that undermines health, activities, and enjoyment of life. Unless assessed and treated properly, pain devalues important things in the life of the sufferer, often leading down a path to disability and despair. Pain is always a combined physical, mental, and social experience that often partially responds to properly targeted therapy. Disparities are common in the way pain is managed and may relate to factors at the patient, provider, organizational, or payer levels. Thus, healthcare professionals who interact with people experiencing pain have a duty to dampen the biopsychosocial impact of pain to help them think, feel, and do better. Given potential harm related to analgesics or invasive treatments, ethical practices involve advocating for delivering personalized treatments, with vigilant monitoring to avoid potential harm.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114645886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain Care EssentialsPub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0003
C. Renn, S. Dorsey
{"title":"Nociceptive Processing","authors":"C. Renn, S. Dorsey","doi":"10.1093/med/9780199768912.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0003","url":null,"abstract":"Chapter 2 describes the molecular events associated with pain signaling. The mechanisms associated with chemical, thermal, and mechanical pain signaling in the peripheral nerve endings are detailed. Molecular signaling mechanisms occurring in the spinal dorsal horn, including the primary afferent nociceptor, the inhibitory interneurons, and the descending on-cells and off-cells projecting from the nucleus raphe magnocellularis are described. Persistent increases in pain signaling resulting from inflammatory mediators are explained with reference to specific molecules. Signaling events at supraspinal levels, such as the thalamus, cortex, periaqueductal gray, and nucleus raphe magnus, including cannabinoids, opioids, and noradrenergic and serotonergic neurotransmitter events, are described as critical to pain pathways with relevance to potential pain therapies.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127023347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain Care EssentialsPub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0008
B. Hogans
{"title":"Diagnostic Reasoning in the Pain-Focused Encounter","authors":"B. Hogans","doi":"10.1093/med/9780199768912.003.0008","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0008","url":null,"abstract":"Chapter 7 addresses the processes and pitfalls of evaluating, reasoning about, and attending to the needs of patients with pain. This chapter builds on Chapter 6, which addressed clinical assessment, explaining in detail the process of extracting and abstracting information from the pain narrative (clinical history or interview) to lay the foundation for a problem list and differential diagnosis. The problem list and differential diagnosis are described and contrasted so that clinicians will be comfortable with both. A clinical model explains the need for patient-centered approaches to be omnipresent but balanced with an appropriate disease-centered knowledge base that is likewise informed by understanding the patient’s healthcare-related values and motivations. A balanced approach is emphasized. The process of planning for diagnostic testing, including imaging, laboratory testing, provocative maneuvers, and targeted referrals, is described. The last section of the chapter addresses the impact and nature of cognitive and affective biases that can mitigate the effectiveness of diagnostic reasoning. A coordinated strategy to limit the negative impact of diagnostic reasoning biases is presented in a memorable way. Finally, the ethics of errors and error disclosure are discussed as well as the process of error disclosure.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123234917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain Care EssentialsPub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0021
M. Martel, R. Jamison
{"title":"Opioid Misuse and Addiction Among Patients With Chronic Pain","authors":"M. Martel, R. Jamison","doi":"10.1093/med/9780199768912.003.0021","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0021","url":null,"abstract":"Chapter 20 provides an introduction to understanding the prevalence and risk factors as well as screening tools for assessing opioid misuse and addiction in patients with chronic pain. In the era of the opioid epidemic in North America and beyond, the use of prescription opioid medications to help improve function in chronic noncancer pain is frequently debated. Out of fear of iatrogenic addiction, litigation, and/or potential medication misuse, some clinicians are refusing to prescribe opioids for chronic pain. Evidence indicates that rates of opioid misuse and addiction are fairly high among chronic pain patients prescribed long-term opioid therapy, but there is consensus that opioids can be safe and effective for carefully selected and monitored patients.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114789972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain Care EssentialsPub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0020
Staja Q. Booker, K. Herr
{"title":"Pain in Older Patients","authors":"Staja Q. Booker, K. Herr","doi":"10.1093/med/9780199768912.003.0020","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0020","url":null,"abstract":"Chapter 19 discusses the complexities of pain assessment and treatment in older adults and provides best practice recommendations for comprehensive pain management. Pain in older patients is a common, yet significant quality-of-life issue necessitating accurate assessment and safe multimodal treatment. The assessment and treatment of older adults in pain pose distinct challenges and unique opportunities to provide proactive and patient-centered care for a high-risk population with complex health needs. Thus, it is important that providers are prepared to identify these challenges and implement an effective and safe pain management plan.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130951171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain Care EssentialsPub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0015
N. Zinboonyahgoon, K. Schreiber
{"title":"Acute Pain","authors":"N. Zinboonyahgoon, K. Schreiber","doi":"10.1093/med/9780199768912.003.0015","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0015","url":null,"abstract":"Chapter 14 covers the essentials of acute pain care in the hospital and procedural setting. The chapter begins with an overview of the negative physiologic impacts of uncontrolled acute pain. Based on a foundational understanding of pain pathways and nociceptive signaling, it is possible to construct an acute pain management plan incorporating nonpharmacologic, systemic, and focal pharmacologic elements for an effective multimodal treatment plan. Acute opioid management, including analgesic equivalence, is discussed in detail. Benefits, precautions, side effects, and toxicities of opioids are addressed. Naloxone administration is described in detail. Obstetric, regional, nerve blockade, and multimodal analgesia are described. Adjustments to therapy for patients with substance use disorder are addressed in detail.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134108079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain Care EssentialsPub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0014
I. Tong, R. J. Yong, B. Hogans
{"title":"Pain Emergencies and Complications of Pain Treatments","authors":"I. Tong, R. J. Yong, B. Hogans","doi":"10.1093/med/9780199768912.003.0014","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0014","url":null,"abstract":"Chapter 13 reviews some common pain-associated emergencies and also discusses some complications of pain treatments that require immediate attention. Pain is a common occurrence in emergent illness, and some complications of pain treatments require emergent management. Chest pain is an excellent example of clinical decision-making following a process of organized, rapid pain assessment and then diagnostic and treatment reasoning based on the findings and observations of the clinical assessment. Providers assessing patients for acute chest pain elicit basic pain characteristics of region, quality, severity, and timing as well as usually associated factors and then pursue testing and treatment for elements in the differential diagnosis accordingly. The chapter illustrates this same process applied to conditions of acute abdominal, limb, headache, and spine emergencies. In the second part of the chapter, emergencies arising in the context of pain treatments are discussed, including overdose and withdrawal from opioids, benzodiazepines, and other pain-active medications as well as pump and device complications.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130173914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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