Table Of ContentClinical Pain Management
Acute Pain
LEAD EDITOR
Andrew SCRiceMBBSMD FRCA
Reader inPainResearch, Department ofAnaesthetics, PainMedicineandIntensive Care
Imperial College London; andHonoraryConsultant inPainMedicine, Chelsea and
WestminsterHospital FoundationNHS Trust, London,UK
SERIES EDITORS
DouglasJustins MBBSFRCA
Fellowofthe FacultyofPainMedicine ofthe Royal College ofAnaesthetists
Consultantin PainMedicine andAnaesthesia
PainManagement Centre
StThomas’ Hospital
London,UK
TobyNewton-JohnBA(Hons)MPsych(Clin) PhD
ConsultantClinical Psychologist andProgram Director
Innervate PainProgramand
Faculty ofMedicine, University ofSydney
Australia
RichardF Howard BScMBChB FRCA
Fellowofthe FacultyofPainMedicine ofthe Royal College ofAnaesthetists
Consultantin Paediatric Anaesthesia andPain Management
Great Ormond Street Hospitalfor Children
London,UK
Christine AMiaskowski RNPhDFAAN
Professor andAssociate Deanfor Academic Affairs
Department ofPhysiologicalNursing
UCSF SchoolofNursing
SanFrancisco,CA, USA
Acute Pain
EditedbyPamelaE Macintyre, Suellen MWalker,and
David J Rowbotham
Chronic Pain
EditedbyPeter RWilson,PaulJ Watson, Jennifer AHaythornthwaite, and
TroelsSJensen
Cancer Pain
EditedbyNigel Sykes, MichaelIBennett, and
Chun-Su Yuan
Practice and Procedures
EditedbyHarald Breivik, WilliamICampbell, and
Michael KNicholas
Clinical Pain Management
Acute Pain
2nd edition
Edited by
Pamela E Macintyre BMEDSC MBBS FANZCA MHA FFPMANZCA
Consultant Anaesthetist; and Director, Acute Pain Service
Department of Anaesthesia, Pain Medicine and Hyperbaric Medicine
Royal Adelaide Hospital and University of Adelaide
Adelaide, Australia
Suellen M Walker MBBS MM(PM) MSC PHD FANZCA FFPMANZCA
Clinical Senior Lecturer in Paediatric Anaesthesia and Pain Medicine
UCL Institute of Child Health and Great Ormond Street Hospital NHS Trust
London, UK
David J Rowbotham MB CHB MD MRCP FRCA
Professor of Anaesthesia and Pain Management; and
Head, Clinical Division of Anaesthesia, Critical Care and Pain Management, University of Leicester
Leicester, UK
FirstpublishedinGreatBritainin2003
Thissecondeditionpublishedin2008by
HodderArnold,animprintofHodderEducation,
partofHachetteLivreUK,338EustonRoad,LondonNW13BH
http://www.hoddereducation.com
&2008Hodder&StoughtonLimited
Allrightsreserved.ApartfromanyusepermittedunderUKcopyrightlaw,thispublicationmayonlybe
reproduced,storedortransmitted,inanyform,orbyanymeanswithpriorpermissioninwritingofthepublishers
orinthecaseofreprographicproductioninaccordancewiththetermsoflicencesissuedbytheCopyright
LicensingAgency.IntheUnitedKingdomsuchlicencesareissuedbytheCopyrightLicensingAgency:Saffron
House,6-10KirbyStreet,LondonEC1N8TS.
HachetteLivreUK’spolicyistousepapersthatarenatural,renewable,andrecyclableproductsandmadefrom
woodgrowninsustainableforests.Theloggingandmanufacturingprocessesareexpectedtoconformtothe
environmentalregulationsofthecountryoforigin.
Whilsttheadviceandinformationinthisbookarebelievedtobetrueandaccurateatthedateofgoingtopress,
neithertheauthor[s]northepublishercanacceptanylegalresponsibilityorliabilityforanyerrorsoromissions
thatmaybemade.Inparticular,(butwithoutlimitingthegeneralityoftheprecedingdisclaimer)everyefforthas
beenmadetocheckdrugdosages;howeveritisstillpossiblethaterrorshavebeenmissed.Furthermore,dosage
schedulesareconstantlybeingrevisedandnewside-effectsrecognized.Forthesereasonsthereaderisstrongly
urgedtoconsultthedrugcompanies’printedinstructionsbeforeadministeringanyofthedrugsrecommended
inthisbook.
BritishLibraryCataloguinginPublicationData
AcataloguerecordforthisbookisavailablefromtheBritishLibrary
LibraryofCongressCataloging-in-PublicationData
AcatalogrecordforthisbookisavailablefromtheLibraryofCongress
ISBN978-0-340-94009-9(AcutePain)
ISBN978-0-340-94008-2(ChronicPain)
ISBN978-0-340-94007-5(CancerPain)
ISBN978-0-340-94006-8(PracticeandProcedures)
ISBN978-0-340-93992-5(4volset:AcutePain/ChronicPain/CancerPain/PracticeandProcedures/Webedition)
12345678910
CommissioningEditor: JoannaKoster
ProjectEditor: ZelahPengilley
ProductionController: JoannaWalker
CoverDesign: HelenTownson
Typesetin10ptMinionbyMacmillanIndia
PrintedandboundintheUKbyMPGBooks,Bodmin,Cornwall
TextprintedonFSCaccreditedmaterial
Whatdoyouthinkaboutthisbook?OranyotherHodderArnoldtitle?
Pleasevisitourwebsite:www.hoddereducation.com
Contents
Contributors vii
Series preface xi
Introduction toClinical Pain Management: Acute Pain xiii
Howto usethis book xv
Abbreviations xvii
PART I GENERAL CONSIDERATIONS 1
1a Applied physiology ofnociception 3
Pierre Beaulieu
1b Mechanisms ofinflammatory hyperalgesia 20
Suellen MWalker
2 Developmental neurobiologyofnociception 32
Suellen MWalker
3 Clinical pharmacology:opioids 53
DavidJ Rowbotham, Alcira Serrano-Gomez,and AnneHeffernan
4 Clinical pharmacology:traditional NSAIDs andselective COX-2 inhibitors 68
Stephen FJones andAidanMO’Donnell
5 Clinical pharmacology:paracetamol andcompound analgesics 84
PhilWiffen
6 Clinical pharmacology:other adjuvants 96
EvangelosTziavrangos andStephan ASchug
7 Clinical pharmacology:local anesthetics 113
JonathanMCGhieand Michael GSerpell
8 Assessment, measurement, andhistory 135
DavidAScottand WendyMMcDonald
9 Preventive analgesia andbeyond: currentstatus, evidence,and futuredirections 154
JoelKatzand HanceClarke
PART II MANAGEMENT –TECHNIQUES 199
10 Routes ofadministration 201
JeremyCashman
11 Patient-controlled analgesia 217
Pamela E MacintyreandJulia Coldrey
12 Continuousperipheral neural blockadeforacute pain 236
Kim ERusson andWilliam Harrop-Griffiths
13 Epidural andspinalanalgesia 255
SinaGrape andStephan ASchug
vi]Contents
14 Transcutaneouselectrical nerve stimulation(TENS)andacupunctureforacute pain 271
Mark IJohnson,Stephen G Oxberry, andKaren HSimpson
15 Psychological therapies – adults 291
HClareDaniel
16 Psychological interventions foracutepediatric pain 308
Christina LiossiandLindaS Franck
PART III MANAGEMENT –CLINICALSITUATIONS 325
17 Postoperative pain managementfollowing day surgery 327
GirishP Joshi
18 Acutepain management in theintensive care unit 343
RScott Simpson
19 Acutepain management in theemergencydepartment 360
Anne-Maree KellyandBarry DGunn
20 Acutepain management in fieldanddisaster situations 374
Chester CBuckenmaier III
21 Acutepain management in thedeveloping world 389
Matthew HJSizeandIain HWilson
22 Acutepain management in burns 399
John Kinsellaand Colin PRae
23 Acutepain andmedical disorders 410
EricJ Visser andCRogerGoucke
24 Acutemusculoskeletal pain 430
MiltonLCohen
25 Acutelowbackpain 444
MiltonLCohen
26 Painin pregnancy, childbirth,andthe puerperium 460
Philip Hessand PedramAleshi
27 Acutepain management in children 477
Richard FHoward
28 Acutepain management in theelderly patient 504
Pamela EMacintyre andRichard Upton
29 Acuterehabilitation ofsportinjury 526
Louise Tulloh, LeoPinczewski, andIan Power
30 The opioid-tolerant patient, includingthose withasubstance abusedisorder 539
LindyJ Roberts
31 Preventing chronicpain aftersurgery 558
William AMacrae, Alison EPowell, andJulie Bruce
Index 571
Pleasenote:ThetableofcontentsandacombinedindexforallfourvolumesintheseriescanbefoundontheClinicalPainManagement
website at:www.clinicalpainmanagement.co.uk.
Contributors
PedramAleshi MD Linda SFranckPhDRNRGNRSCNFRCPCHFAAN
Clinical Fellow Professor andChair
Harvard MedicalSchool, Department ofAnaesthesia Children’s NursingResearch,Patient Care Researchand
Beth Israel DeaconessMedicalCenter InnovationCentre, UCL Institute ofChild Health, Great Ormond
Boston, MA,USA Street Hospital forChildrenNHS Trust, London,UK
Pierre Beaulieu MDPhDFRCA CRoger GouckeMBChBFANZCAFFPMANZCA
Associate Professor Head
Department ofAnesthesiology andPharmacology, CHUM Department ofPainManagement, Sir CharlesGairdner Hospital
Montreal, Canada Nedlands, Western Australia
Julie Bruce RGNBScMScPhD SinaGrape MD
MRCSenior Research Fellow Senior Registrar
Department ofPublic Health,School ofMedicine Department ofAnaesthesia andPainMedicine
University ofAberdeen,Aberdeen, UK Royal Perth Hospital
Perth, Australia
Chester CBuckenmaierIII MD
Assistant Professor,Uniformed Services UniversityChief Barry DGunn MBBSFACEM
ArmyRegionalAnesthesiaandPainManagementInitiative Emergency Physician
WalterReed Army MedicalCenter, Washington, DC, USA WesternHealth, Footscray,Victoria, Australia
Jeremy CashmanBABScMBBSMDFRCA
William Harrop-Griffiths MAMBBSFRCA
Fellowofthe FacultyofPainMedicine ofthe
ConsultantAnaesthetist
Royal College ofAnaesthetists
Department ofAnaesthesia, StMary’s Hospital
ConsultantAnaesthetist
London,UK
StGeorge’s Hospital
London,UK Anne Heffernan MBMScMDFFARCSI
Consultant
Hance ClarkeMscMD
Department ofAnaesthesia andPainMedicine, Tallaght Hospital
Department ofAnesthesia
Dublin 24, Ireland
University ofToronto
Toronto, Canada Philip Hess MD
Assistant ProfessorofAnesthesia
Milton LCohenMBBSMDFRACPFFPMANZCA
Associate Professor Anesthesia andCritical Care
Rheumatology andPainMedicine, StVincent’sCampus, Sydney Beth Israel DeaconessMedicalCenter
Darlinghurst, NSW,Australia Boston, MA,USA
JuliaColdrey MBBS(Hons)FANZCA RichardF HowardBScMBChBFRCA
ConsultantAnaesthetist Fellowofthe FacultyofPainMedicine ofthe
Department ofAnaesthesia, HyperbaricMedicine andPain Royal College ofAnaesthetists
Medicine, Royal AdelaideHospital Consultantin Anaesthesia andPainManagement
Adelaide,Australia Great Ormond Street Hospitalfor Children
London,UK
H ClareDaniel BSc(Hons)DClinPsych
ConsultantClinical Psychologist MarkIJohnson BSc(Hons)PhD
PainManagement Centre Professor ofPain andAnalgesia,Faculty ofHealth
The National Hospitalfor NeurologyandNeurosurgery Leeds Metropolitan University; and
London,UK Leeds PalliumResearch Group, Leeds,UK
viii ]Contributors
Stephen F JonesMBBSFRCA Jonathan MCGhie MBChBFRCAFFPMANZCA
ConsultantAnaesthetist Consultantin Anaesthesia andPainMedicine
Department ofAnaesthesia, Waikato Hospital Department ofAnaesthesia, WesternInfirmary
Hamilton, NewZealand Glasgow,UK
Girish P JoshiMBBSMDFFARCSI AidanM O’Donnell BScMBChBFRCA
Professor ofAnesthesiologyandPainManagement, Director of ConsultantAnaesthetist
Perioperative Medicine andAmbulatoryAnesthesia
StJohn’sHospital, Livingston, UK
University ofTexasSouthwestern Medical Center
Dallas,Texas,USA Stephen GOxberry MBChBBScMRCP
Specialist Registrar in Palliative Medicine
JoelKatzPhD
Yorkshire Deanery,Leeds, UK
AcutePainResearch Unit,Department ofAnesthesia and
PainManagement, Toronto General Hospital and
Leo Pinczewski
Mount SinaiHospital; and
Orthopaedic Surgeon
Professor
North SydneyOrthopaedic andSportsMedicine Centre
Department ofAnesthesia,University ofToronto; and
Sydney, Australia
Professor andCanadaResearch Chair
Department ofPsychology,York University
Alison EPowell MAPhD
Toronto, ON,Canada
Health Services Researcher
Centre for PublicPolicyandManagement
Anne-MareeKellyMDMClinEDFACEM
University ofStAndrews, StAndrews, UK
Academic Head, Emergency Medicine andDirector
Joseph EinsteinCentre forEmergency Medicine Resarch
WesternHealth, Footscray IanPowerBSc(Hons)MDFRCAFFPMANZCAFANZCAFRCSEdFRCPEdin
Professor ofAnaesthesia
Victoria, Australia;and
Critical Care andPainMedicine, The UniversityofEdinburgh
Professorial Fellow
Edinburgh, UK
The University ofMelbourne,Australia
John KinsellaMBBSMDFRCA Colin P RaeMBChBFRCA(Lond)
Professor andHead ofSectionofAnaesthesia Fellowofthe FacultyofPainMedicine ofthe
PainandCritical Care Medicine Royal College ofAnaesthetists
University ofGlasgow Consultantin Anesthesia andPain Management
Glasgow Royal Infirmary Department ofAnesthesia,Glasgow Royal Infirmary
Glasgow,UK Glasgow,UK
Christina LiossiBA(Hons)MPhilMScDPsychCPsychol Lindy JRoberts MBBS(Hons)BMedSci(Hons)FANZCAFFPMANZCA
Senior Lecturerin Health Psychology Staff SpecialistandDirector AcutePainService
School ofPsychology, University ofSouthampton Departments ofAnaesthesia andPainManagement,
Southampton, UK;and Sir CharlesGairdner Hospital,Nedlands, Australia
HonoraryConsultant Clinical Psychologist
Great Ormond Street Hospitalfor ChildrenNHSTrust
David JRowbotham MBChBMDMRCPFRCA
London,UK Professor ofAnaesthesia andPain Management
University ofLeicester, Leicester, UK
PamelaEMacintyre BMedScMBBSFANZCAMHAFFPMANZCA
Director, AcutePainService,Consultant Anesthetist
Department ofAnaesthesia, HyperbaricMedicine andPain Kim ERussonMBchBFRCA
ConsultantAnaesthetist
Medicine
Rotherham General Hospital,Rotherham, UK
Royal Adelaide HospitalandUniversity ofAdelaide
Adelaide,Australia
StephanASchug MDFANZCAFFPMANZCA
William AMacrae MBChBFRCA ChairofAnaesthesiology
Consultantin PainMedicine, HonorarySenior Lecturer
School ofMedicine andPharmacology
Ninewells Hospital andMedicalSchool
Faculty ofMedicine Dentistry andHealth Sciences
Dundee, UK
University ofWestern Australia;and
WendyM McDonald RNBNGradDip(CritCare) Director ofPainMedicine
AcutePainNurse Department ofAnaesthesia andPainMedicine
Department ofAnaesthesia, StVincent’sHospital Royal Perth Hospital
Melbourne, Australia Perth, Australia
Contributors]ix
David AScott MBBSPhDFANZCAFFPMANZCA Evangelos Tziavrangos BMBSFANZCAFFPMANZCA
Associate Professor andDeputyDirector Staff Specialist
Department ofAnaesthesia, StVincent’sHospital Department ofAnaesthesia andPainMedicine
Melbourne, Australia Royal Perth Hospital
Perth, Australia
Michael GSerpellMBChBFRCA
Fellowofthe FacultyofPainMedicine ofthe
Royal College ofAnaesthetists RichardUpton BScPhD
PrincipalMedical Scientist,Senior Lecturer
ConsultantandSenior Lecturer
Royal Adelaide HospitalandUniversity ofAdelaide
University Department ofAnaesthesia, Western Infirmary
Adelaide,Australia
Glasgow,UK
Alcira Serrano-Gomez FRCA Eric J VisserMBBSFANZCAFFPMANZCA
HonoraryLecturer in Anaesthesia
PainMedicine SpecialistandAnaesthetist
University ofLeicester, Leicester, UK
Department ofAnaesthesia andPainMedicine
Royal Perth Hospital
RScott SimpsonMBBSDA(UK)FANZCAFFPMANZCAFJFICM
Western, Australia
Staff Specialist
Intensive Care Unit,The TownsvilleHospital
North Queensland, Australia Suellen M Walker MBBSMM(PM)MScPhDFANZCAFFPMANZCA
Clinical SeniorLecturer andConsultant inPaediatric Anaesthesia
KarenH Simpson MBCHBFRCA andPainMedicine
Consultantin Anaesthesia andPainMedicine
UCL Institute ofChild HealthandGreat Ormond StHospital
PainManagement Service
NHS Trust
Leeds Teaching Hospitals Trust; and
London,UK
Leeds PalliumResearch Group
Leeds, UK
Phil Wiffen MScMRPhamS
Matthew HJSize MBChBBMedSciFRCA Co-ordinating Editor
SpR in Anaesthesia Cochrane Pain andPalliative Care Group
University College Hospital NHSTrust PainRelief Unit,Churchill Hospital,Oxford, UK
London,UK
Louise Tulloh MBBSFACSP IainH Wilson MBChBFRCA
Sports Physician Consultantin Anaesthesia
North SydneyOrthopaedic andSportsMedicine Centre Royal Devon andExeterNHS Foundation Trust
Sydney, Australia Exeter, UK
Description:Acute Pain brings coverage of this diverse area together in a single, comprehensive clinical reference, from the basic mechanisms underlying the development of acute pain, to the various treatments that can be applied to control it in different clinical settings. Much expanded in this second edition