Current Therapy in Pain: Expert Consult: Online and Print

728 Pages·2008·21.92 MB·English

by  Howard S. Smith MD

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CURRENTTHERAPYINPAIN ISBN:978-1-4160-4836-7
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Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperiencebroaden
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methodanddurationofadministration,andcontraindications.Itistheresponsibilityofthepractitioner,
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andthebesttreatmentforeachindividualpatient,andtotakeallappropriatesafetyprecautions.Tothe
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ThePublisher
LibraryofCongressCataloging-in-PublicationData
Currenttherapyinpain/[editedby]HowardS.Smith.–1sted.
p.;cm.
Includesbibliographicalreferencesandindex.
ISBN978-1-4160-4836-7
1. Pain–Treatment. I.Smith,HowardS.,1956-
[DNLM:1. Pain–therapy. WL704C97582009]
RB127.C922009
616’.0472–dc22 2008008166
ExecutivePublisher:NatashaAndjelkovic
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PrintedinUnitedStatesofAmerica
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I would like to dedicate this book to the memory of my mother, Arlene; to my wife Joan, and our children, Alyssa,
Joshua, Benjamin,and Eric;and tomy father Nathan, and stepmother Priscilla.
Contributors
SalahadinAbdi,MD,PhD JosephF.Audette,MA,MD RafaelBenoliel,BDS,LDS,RCS(Eng)
Professor and Chief, University ofMiami Assistant Professor, Department of Professor and Chairman, Department of
Pain Center, Department of Physical Medicine and Rehabilitation, Oral Medicine, Faculty ofDental
Anesthesiology, Perioperative Medicine Harvard MedicalSchool, Boston, Medicine, Hadassah Hebrew University,
and PainManagement, University of Massachusetts Jerusalem, Israel
Miami Miller Schoolof Medicine, Miami, COMPLEMENTARYANDALTERNATIVE OROFACIALPAIN
Florida MEDICINEFORNONCANCERPAIN
PAINFULDIABETICPERIPHERAL KarenBjoro,PhD(c),RN
NEUROPATHY;PAININCHILDREN; MarkL.Baccei,PhD Doctoral Student,TheUniversity ofIowa,
BOTULINUMTOXINSFORTHETREATMENT Research Assistant Professor, Department IowaCity, Iowa; Nurse Researcher,
OFPAIN;EPIDURALSTEROIDINJECTIONS; ofAnesthesiology, University ofCincinnati Department ofOrthopedics, Neurology
RADIOFREQUENCYTREATMENT; CollegeofMedicine, Cincinnati, Ohio and Neurosurgery, UllevalUniversity
CRYOANALGESIAFORCHRONICPAIN PATHOPHYSIOLOGYOFPAIN Hospital, Oslo,Norway
ASSESSMENTOFPAININTHENONVERBAL
JanetAbrahm,MD Misha-MiroslavBackonja,MD AND/ORCOGNITIVELYIMPAIRED
Associate Professor ofMedicine, Harvard Professor,Department ofNeurology, OLDERADULT
Medical School; Director,Pain and Anesthesiology and Rehabilitation
Medicine, University ofWisconsin School DidierBouhassira,MD
Palliative CareProgram, Dana-Farber
Cancer Institute and Brigham and ofMedicine and PublicHealth; Professor, Universite´ de VersaillesSaint Quentin,
Women’s Hospital, andDivision Chief, Universityof Wisconsin Hospital and Versailles; Research Director, INSERM (U
Palliative Care, Dana-Farber Cancer Clinics, Madison, Wisconsin 792),Centre d’Evaluationet deTraitement
Institute, Boston, Massachusetts NEUROPATHICPAIN-DEFINITION, de laDouleur, Hoˆpital Ambroise Pare´,
PAININTHEPALLIATIVECAREPOPULATION IDENTIFICATION,ANDIMPLICATIONS Boulogne, France
FORRESEARCHANDTHERAPY BRAINIMAGINGINPAINFULSTATES:
SanjeevAgarwal,MD EXPERIMENTALANDCLINICALPAIN
ZahidH.Bajwa,MD
Assistant Professor, andDirector,
Assistant Professor ofAnesthesia and DanielBrookoff,MD,PhD
Interventional Physiatry, SUNY Downstate
Medical Center, Brooklyn, NewYork Neurology, Harvard Medical School; Director, Center for Medical Pain
STEROIDS;SYMPATHETICBLOCKADE Director,Education andClinical Pain Management, Presbyterian/St. Luke’s
Research, BethIsrael Deaconess Medical Medical Center, Denver,Colorado
PhillipJ.Albrecht,PhD Center, Boston,Massachusetts GENITOURINARYPAINSYNDROMES:
Assistant Professor, Center for HEADACHESOTHERTHANMIGRAINE; INTERSTITIALCYSTITIS,CHRONIC
Neuropharmacology and Neuroscience, TRIGEMINALNEURALGIA PROSTATITIS,PELVICFLOORDYSFUNCTION,
Albany Medical College; Integrated Tissue ANDRELATEDDISORDERS;SICKLE
Dynamics, LLC,Albany New York JeffreyR.Basford,MD,PhD CELLANEMIA
COMPLEXREGIONALPAINSYNDROME Professor ofPhysical Medicine and
PATHOPHYSIOLOGY Rehabilitation, Department ofPhysical PatriciaBruckenthal,PhD,RN,ANP-C
Medicine and Rehabilitation, Mayo Clinic, Clinical Associate Professor,Stony Brook
CatalinaApostol,MD Rochester,Minnesota University School ofNursing; Nurse
Resident inPain/Anesthesiology, TRANSCUTANEOUSELECTRICALNERVE Practitioner, Painand Headache
Department ofAnesthesiology, University STIMULATION Treatment Center, Department of
of Miami, Miami, Florida Neurology, North Shore/Long Island
BOTULINUMTOXINSFORTHETREATMENT AllisonBaum,DPT JewishHealth System, Manhasset, New
OFPAIN Spinal CordInjury Peer Mentor York
Coordinator, St. CharlesHospital and ASSESSMENTOFPAININOLDERADULTS
CharlesE.Argoff,MD Rehabilitation Center, Port Jefferson,
Professor ofNeurology, Albany Medical NewYork SeanBurgest,MD
College; Director,Comprehensive Pain PHYSICALMEDICINEAPPROACHES Medical Director, TheBurgest Clinic,
Program, Albany Medical Center, Albany, TOPAINMANAGEMENT Austin, Texas
New York FAILEDBACKSURGERYSYNDROME
NEUROPATHICPAIN-DEFINITION, JosephM.Bellapianta,MD,MS
IDENTIFICATION,ANDIMPLICATIONS Department ofOrthopaedic Surgery,
FORRESEARCHANDTHERAPY; Albany MedicalCenter, Albany, New York
HANDPAIN;FOOTPAIN
ANTIDEPRESSANTS;BOTULINUM
TOXINSFORTHETREATMENTOFPAIN
vii
viii CONTRIBUTORS
AllenL.Carl,MD DanielClayton,MD,PhD AndrewDubin,MD,MS
Professor ofOrthopaedic Surgery and Resident, Division ofNeurosurgery, Duke Associate Professor ofPhysical Medicine
Pediatrics, Albany MedicalCollege, Albany, University MedicalCenter, Durham, North and Rehabilitation, Albany Medical
New York Carolina College; Attending Physician, Albany
BACKPAIN NEUROSURGICALTREATMENTOFPAIN Medical Center Hospital; Medical Director,
Capital Region Spine, Albany,New York
JuanCata,MD StevenP.Cohen,MD POSTAMPUTATIONPAINDISORDERS;
Resident, Instituteof Anesthesiology, Associate Professor, Department of POSTSTROKEPAIN
Critical Care, andComprehensive Anesthesiology, and Directorof Medical
Pain Management, ClevelandClinic, Education, JohnsHopkins University DemetriEconomedes,DO
Cleveland, Ohio School ofMedicine, Baltimore, Maryland; Department ofOrthopaedic Surgery,
INTERPLEURALANALGESIA Director ofPainResearch and Colonel, Albany Medical Center, Albany, NewYork
United StatesArmy, WalterReedArmy HANDPAIN
BrianD.Cauley,MD,MPH
Medical Center, Washington, DC
Resident, Department ofAnesthesiology SPINALANALGESIA EliEliav,DMD,PhD
and Critical Care, Massachusetts Professor and Director,Division of
General Hospital, Harvard Medical School, AlaneB.Costanzo,MD Orofacial Pain, andSusan and Robert
Boston, Massachusetts Anesthesiology Resident, University of Carmel Endowed Chair inAlgesiology,
POSTHERPETICNEURALGIA Miami Miller School ofMedicine, Jackson University ofMedicine andDentistry of
Memorial Hospital, Miami, Florida New Jersey-New Jersey Dental School,
LucyChen,MD EPIDURALSTEROIDINJECTIONS Newark, New Jersey
Instructor, HarvardMedical School; OROFACIALPAIN
Attending Physician, Massachusetts SukdebDatta,MD,DABIPP,FIPP
General Hospital, Boston, Massachusetts Associate Professor, and Program Director, JenniferA.Elliott,MD
OPIOIDTOLERANCE,DEPENDENCE, Vanderbilt University PainMedicine Assistant Professor,Department of
ANDHYPERALGESIA Fellowship, Vanderbilt UniversityMedical Anesthesiology, University ofMissouri-
Center; Director, Vanderbilt University Kansas City SchoolofMedicine; StaffPain
JianguoCheng,MD,PhD
Interventional PainCenter, Nashville, Physician, Saint Luke’sHospital, Kansas
Staff, Department ofPain Management, Tennessee City, Missouri
Institute ofAnesthesiology, CriticalCare, EPIDURALADHESIOLYSIS PATIENT-CONTROLLEDANALGESIA;
and Comprehensive PainManagement, (cid:2)2-AGONISTS
Cleveland Clinic, Cleveland, Ohio EmilyA.Davis,MSN,ACNP
INTERPLEURALANALGESIA Division ofNeurosurgery, Duke University NasrEnany,MD
Medical Center, Durham,North Carolina Assistant Professor andAttending
PradeepChopra,MD,MHCM
SPINALCORDSTIMULATIONFORTHE Anesthesiologist, University ofCincinnati,
Assistant Professor (Clinical),Brown TREATMENTOFCHRONICINTRACTABLE Cincinnati, Ohio
Medical School, Providence, Rhode Island; PAIN;NEUROSURGICALTREATMENTOFPAIN SYMPATHETICBLOCKADE
Assistant Professor (Adjunct),Boston
University Medical Center, Boston, TimothyR.Deer,MD JonathanEpstein,MD,MA
Massachusetts President and ChiefExecutive Officer, Fellow, Obstetric Anesthesia, Mount Sinai
THORACICPAIN TheCenter for PainRelief; Clinical Medical Center, New York, NewYork
Professor, West VirginiaUniversity, TRAMADOL
PaulJ.Christo,MD,MBA
Charleston, West Virginia
Assistant Professor, JohnsHopkins EPIDEMIOLOGYOFCOMPLICATIONSIN IkeEriator,MD,MPH
University School ofMedicine; Director, INTERVENTIONALPAINMANAGEMENT Associate Professor, Universityof
Multidisciplinary PainFellowship, and Mississippi School ofMedicine; Chief,
Director, Pain Treatment Center, MartinL.DeRuyter,MD Pain Management Services, Universityof
The JohnsHopkins Hospital, Associate Professor ofAnesthesiology and Mississippi Medical Center, Jackson,
Baltimore, Maryland StaffAnesthesiologist, University ofKansas Mississippi
PELVICPAIN;POSTHERPETICNEURALGIA; Medical Center, Universityof Kansas CANCERPAINMANAGEMENT
COMPLEXREGIONALPAINSYNDROME: School ofMedicine, Kansas City,Kansas
TREATMENTAPPROACHES PERIOPERATIVEEPIDURALANALGESIA; DavidEuler,LicAc
CONTINUOUSPERIPHERALNERVE Co-Director, Continuing Medical
DanielCiampideAndrade,MD CATHETERTECHNIQUES Education Course, Harvard Medical
Universite´ de Versailles SaintQuentin, School, Boston, Massachusetts
Versailles; Clinical Fellow, INSERM (U AnthonyDragovich,MD COMPLEMENTARYANDALTERNATIVE
792), Centre d’Evaluation etdeTraitement Director, PainManagement Center, MEDICINEFORNONCANCERPAIN
de la Douleur,HoˆpitalAmbroise Pare´, Womack ArmyMedical Center, Fort
VaniaE.Fernandez,MD
Boulogne, France Bragg, North Carolina; Assistant Professor,
BRAINIMAGINGINPAINFULSTATES: Department ofAnesthesiology, Uniformed Assistant Professor ofAnesthesiology,
EXPERIMENTALANDCLINICALPAIN Services University oftheHealth Sciences, University ofMiami Schoolof Medicine;
Pain Management Fellow,Department of
Bethesda, Maryland
EliCianciolo,MD SPINALANALGESIA Anesthesiology, Perioperative Medicine
Clinical Instructor andPain Medicine and PainManagement, Jackson Memorial
Fellow, Harvard Medical School,and Hospital, Miami, Florida
Massachusetts General Hospital, Boston, PAINFULDIABETICPERIPHERAL
Massachusetts NEUROPATHY
NONSTEROIDALANTI-INFLAMMATORY
DRUGSANDCYCLOOXYGENASE-2
INHIBITORS
CONTRIBUTORS ix
RichardField,MD GregHobelmann,MD CleteA.Kushida,MD,PhD,RPSGT
Pain Fellow, Massachusetts General Postdoctoral Fellow, Division ofPain Director, Stanford University Center for
Hospital, and Harvard Medical School, Medicine, Department ofAnesthesiology Human SleepResearch; Associate
Boston, Massachusetts andCritical Care Medicine, JohnsHopkins Professor, Stanford University Medical
RADIOFREQUENCYTREATMENT UniversitySchool ofMedicine, Baltimore; Center, Stanford University Center of
PainMedicine Specialists, P.A.,Towson, Excellence forSleep Disorders, Stanford,
NannaBrixFinnerup,MD
Maryland California
Associate Research Professor, Aarhus PELVICPAIN PAINANDSLEEP
University, Aarhus, Denmark
SPINALCORDINJURY StevenH.Horowitz,MD ElizabethDemersLavelle,MD
Clinical Professor ofNeurology, University Assistant Professor,SUNY Upstate Medical
ColleenM.Fitzgerald,MD
ofVermont College ofMedicine, University, Syracuse,New York
Assistant Professor, FeinbergSchool of Burlington, Vermont; Assistant in HANDPAIN;BACKPAIN;HIPPAIN;KNEE
Medicine, Northwestern University; Neurology, Massachusetts General PAIN;FOOTPAIN;RHEUMATOIDARTHRITIS;
Medical Director, Women’s Health Hospital, Boston,Massachusetts MYOFASCIALTRIGGERPOINTS;INTRA-
Rehabilitation, Rehabilitation Institute of NEUROPATHICPAIN:ISTHEEMPEROR ARTICULARINJECTIONS
Chicago, Chicago, Illinois WEARINGCLOTHES?
FEMALEPERINEAL/PELVICPAIN:THE LoriA.Lavelle,DO
REHABILITATIONAPPROACH ChristinaK.Hynes,MD Staff Physician,Altoona Arthritis and
Clinical Instructor, Feinberg Schoolof Osteoporosis Center,Duncansville,
MarcD.Fuchs,MD
Medicine, Northwestern University; Pennsylvania
Associative Clinical Professor, Department Attending Physician, Rehabilitation RHEUMATOIDARTHRITIS;INTRA-ARTICULAR
of OrthopaedicSurgery, Albany Medical Institute ofChicago, Chicago, Illinois INJECTIONS
College, Albany,New York FEMALEPERINEAL/PELVICPAIN:THE
HIPPAIN REHABILITATIONAPPROACH WilliamF.Lavelle,MD
Assistant Professor,Department of
AimeeFurdyna,BS
KennethC.Jackson,II,PharmD Orthopaedic Surgery,SUNY Upstate
Department ofOrthopaedic Surgery,
Associate Professor, Pacific University Medical University, Syracuse,New York
Albany Medical Center, Albany, NewYork Schoolof Pharmacy; Associate Editor, HANDPAIN;BACKPAIN;HIPPAIN;KNEE
BACKPAIN
Journalof PainandPalliative Care PAIN;FOOTPAIN;RHEUMATOIDARTHRITIS;
Pharmacotherapy, Hillsboro, Oregon MYOFASCIALTRIGGERPOINTS;INTRA-
ChristineGallati,BS
OPIOIDPHARMACOTHERAPY ARTICULARINJECTIONS
Research Assistant, Pharmaceutical
Research Instituteat AlbanyCollege of ChaunceyT.Jones,MD AndrewLinn,MD
Pharamacy, Albany, NewYork
Resident, Department of Anesthesiology Clinical Fellow inAnesthesia, Harvard
PAINANDSLEEP
andCritical Care Medicine, JohnsHopkins Medical School, andBethIsrael Deaconess
UniversitySchool ofMedicine, Baltimore, Medical Center, Boston, Massachusetts
PadmaGulur,MD
Maryland TRIGEMINALNEURALGIA
Pain Specialist, Center for PainMedicine,
COMPLEXREGIONALPAINSYNDROME:
Massachusetts General Hospital;Instructor DaveLoomba,MD
TREATMENTAPPROACHES
in Anesthesia,Harvard Medical School, Assistant Professor,University of
Boston, Massachusetts DouglasKeene,MD California, Davis,Sacramento;
PAININCHILDREN
Director ofPainManagement, Department Anesthesiologist, EnloeMedical Center,
ofAnesthesia, Milton Hospital, Milton, Chico, California
PayamHadian,BA
Massachusetts; Co-founder, Boston SACROILIACJOINTPAIN
College ofArts andSciences,
PainCare, Waltham, Massachusetts
University ofRochester, Rochester, KaranMadan,MBBS,MPH
RADIOFREQUENCYTREATMENT
New York Instructor in Anaesthesia, HarvardMedical
DIAGNOSISANDTREATMENTOF
KennethL.Kirsh,PhD School; Staff, PainManagement Center,
FACET-MEDIATEDCHRONIC
Assistant Professor, Pharmacy Practice and Department ofAnesthesia, Perioperative
LOWBACKPAIN
Science, University ofKentucky; Attending and PainMedicine, Brigham andWomen’s
Clinical Psychologist, ThePain Treatment Hospital, Boston, Massachusetts
R.NormanHarden,MD
Center oftheBluegrass, Lexington, PAINANDPAINMANAGEMENTRELATEDTO
Director, Center for PainStudies, and
Kentucky HIVINFECTION
Addison Chair, Rehabilitation Institute of
POTENTIALDOCUMENTATIONTOOLSFOR
Chicago; Associate Professor, Feinberg GaganMahajan,MD
OPIOIDTHERAPY;PAININTHESUBSTANCE
School ofMedicine, Northwestern ABUSEPOPULATION Associate Professor,and Director,
University, Chicago, Illinois Fellowship inPain Medicine, University of
INTERDISCIPLINARYMANAGEMENTFOR JanKraemer,MD California, Davis,Sacramento, California
COMPLEXREGIONALPAINSYNDROME Clinical Fellow, HarvardMedical School, SACROILIACJOINTPAIN
Boston,Massachusetts
KeelaHerr,PhD,RN,FAAN,AGSF JianrenMao,MD,PhD
HEADACHESOTHERTHANMIGRAINE
Professor and Chair, Adultand Associate Professor,Harvard Medical
Gerontology, TheUniversity ofIowa MichaelA.Krieves,BS School; Attending Physician, Massachusetts
College ofNursing, IowaCity,Iowa Department ofOrthopaedic Surgery, General Hospital, Boston, Massachusetts
ASSESSMENTOFPAININTHENONVERBAL Albany MedicalCenter, Albany, New York OPIOIDTOLERANCE,DEPENDENCE,AND
AND/ORCOGNITIVELYIMPAIREDOLDER HIPPAIN;KNEEPAIN HYPERALGESIA
ADULT
x CONTRIBUTORS
JohnD.Markman,MD MilaMogilevsky,DO,PT IkeOnyedika,BS
Director, Neuromedicine Pain Resident Physician, Rehabilitation Institute Department ofOrthopaedic Surgery,
Management Center andTranslational ofChicago, Department ofPhysical Albany Medical Center, Albany, NewYork
Pain Research, Department of Medicine and Rehabilitation, Northwestern HANDPAIN
Neurosurgery, University ofRochester University, Chicago, Illinois
School ofMedicine andDentistry, PHYSICALMEDICINEAPPROACHESTOPAIN SusanElizabethOpper,MD
Rochester, New York MANAGEMENT Assistant Professor ofMedicine, University
LUMBARSPINALSTENOSIS:CURRENT of Missouri-Kansas CitySchool of
THERAPYANDFUTUREDIRECTIONS; XavierMoisset,MD Medicine; Director,Pain Management
DIAGNOSISANDTREATMENTOFFACET- Universite´ deVersailles Saint Quentin, Services, Saint Luke’sHospital, Kansas
MEDIATEDCHRONICLOWBACKPAIN Versailles; Clinical Fellow,INSERM City, Missouri
(U792), Centre d’Evaluation etde NECKPAIN
EricM.May,MD Traitement de laDouleur, Hoˆpital
Assistant Professor ofAnesthesiology, Ambroise Pare´, Boulogne, France RichardK.Osenbach,MD
University ofMissouri-Kansas City;Staff BRAINIMAGINGINPAINFULSTATES: Director, Neurosurgical Services, CapeFear
Anesthesiologist, Saint Luke’sHospital, EXPERIMENTALANDCLINICALPAIN Valley Medical Center, Fayetteville,
Kansas City, Missouri North Carolina
CONTINUOUSPERIPHERALNERVE MuhammadA.Munir,MD SPINALCORDSTIMULATIONFORTHE
CATHETERTECHNIQUES Chairman, SouthwestOhio PainInstitute, TREATMENTOFCHRONICINTRACTABLE
West Chester, Ohio PAIN;NEUROSURGICALTREATMENTOFPAIN
GaryMcCleane,MD,FFARCSI STEROIDS;NONSTEROIDAL
Consultant inPain Management,Rampark ANTI-INFLAMMATORYDRUGSAND JoshuaPal,MD
Pain Centre, Lurgan, Northern Ireland, CYCLOOXYGENASE-2INHIBITORS; Clinical Fellow, Harvard Medical School,
United Kingdom SYMPATHETICBLOCKADE Boston, Massachusetts
PAININTHEELDERLY;OPIOIDSISSUES; HEADACHESOTHERTHANMIGRAINE
ANTIEPILEPTICDRUGS;LOCAL BethB.Murinson,MS,MD,PhD
MarcoPappagallo,MD
ANESTHETICS;MUSCLERELAXANTS; Assistant Professor ofNeurology, Johns
TOPICALANALGESICAGENTS Hopkins University SchoolofMedicine; Professor, Department of Anesthesiology,
ActiveStaff, JohnsHopkins Medical Mount Sinai School ofMedicine; Director,
JamesMcLean,MDy Institutions, TheJohnsHopkins Hospital, Pain Medicine Research and Development,
Pain Fellow, Rehabilitation Institute Baltimore, Maryland Mount Sinai Medical Center, NewYork,
of Chicago; Department of AMECHANISM-BASEDAPPROACHTOPAIN New York
Physical Medicine and Rehabilitation, PHARMACOTHERAPY:TARGETINGPAIN NEUROPATHICPAIN-DEFINITION,
Feinberg School ofMedicine, MODALITIESFOROPTIMALTREATMENT IDENTIFICATION,ANDIMPLICATIONSFOR
Northwestern University, Chicago, EFFICACY RESEARCHANDTHERAPY;TRAMADOL
Illinois
PHYSICALMEDICINEAPPROACHESTOPAIN LidaNabati,MD AmarParikh
MANAGEMENT Instructor ofMedicine, Harvard Medical Research Assistant, Albany Medical
School;Attending Physician, Division of College, Albany, New York
POSTAMPUTATIONPAINDISORDERS
SangeetaR.Mehendale,MD,PhD Palliative Care, Dana-Farber Cancer
Research Associate, Department of Institute, Boston,Massachusetts
WinstonC.V.Parris,MD,FACPM
Anesthesia and Critical Care, Pritzker PAININTHEPALLIATIVECAREPOPULATION
Professor ofAnesthesiology, and Director,
School ofMedicine, Universityof Chicago,
SrdjanS.Nedeljkovic¤,MD Pain Programs, Duke University Medical
Chicago, Illinois
GASTROINTESTINALDYSFUNCTION Fellowship Director,Pain Medicine Center; Division Chief, Duke Painand
WITHOPIOIDUSE Program, and Staff, PainManagement Palliative CareCenter, Duke University
Center, Department ofAnesthesia, Hospital, Durham, North Carolina
CANCERPAINMANAGEMENT
HaroldMerskey,DM,FRCPC, Perioperative andPain Medicine, Brigham
FRCPsych andWomen’s Hospital; Assistant Professor
StevenD.Passik,PhD
Professor Emeritus ofPsychiatry, ofAnaesthesia, Harvard Medical School,
Associate Professor ofPsychiatry, Weill
University ofWestern Ontario, London, Boston, Massachusetts
College ofMedicine, Cornell University
Ontario, Canada PAINANDPAINMANAGEMENTRELATEDTO
Medical Center; Associate Attending
THETAXONOMYOFPAIN HIVINFECTION
Psychologist, Memorial SloanKettering
TobiasMoeller-Bertram,MD LisaJ.Norelli,MD,MPH,MRCPsych Cancer Center, New York, NewYork
PAININTHESUBSTANCEABUSE
Assistant Clinical Professor, Assistant Professor ofPsychiatry, Albany
POPULATION
Department ofAnesthesiology, Medical College; Director ofPsychiatry,
University ofCalifornia, San Diego, Capital District Psychiatric Center, Albany,
GiraPatel,LicAc
LaJolla, California New York
Clinical Associate, Osher Integrative Care
BOTULINUMTOXINSFORTHETREATMENT HYPNOTICANALGESIA
Center, Harvard Medical School Osher
OFPAIN
AkikoOkifuji,PhD Institute; Division for Research and
Professor ofAnesthesiology, and Attending Education in Complementary and
Integrative Medical Therapies,Arnold Pain
Psychologist, Pain Management Center,
Clinic, Beth Israel Deaconess Hospital,
University ofUtah,Salt LakeCity, Utah
PSYCHOLOGICALASPECTSOFPAIN Boston, Massachusetts
COMPLEMENTARYANDALTERNATIVE
MEDICINEFORNONCANCERPAIN
yDeceased
CONTRIBUTORS xi
EricM.Pearlman,MD,PhD ScottS.Reuben,MD ThomasT.Simopoulos,MD
Director, Pediatric Education, and Professor ofAnesthesiology and Pain Instructor in Anaesthesia, HarvardMedical
Assistant Professor ofPediatrics, Medicine, Tufts UniversitySchool of School; Director ofInterventional Pain
Mercer UniversitySchool ofMedicine; Medicine, Boston; Director, AcutePain Management, BethIsrael Deaconess
Savannah Neurology, P.C., Savannah, Service, Baystate Medical Center, Medical Center, Boston, Massachusetts
Georgia Springfield, Massachusetts FAILEDBACKSURGERYSYNDROME
MIGRAINEHEADACHES PERIOPERATIVEUSEOFCOX-2AGENTS
JeremyC.Sinkin,BA
RichardA.Pertes,DDS FrankL.Rice,PhD Department ofNeurosurgery, University of
Clinical Professor, Division ofOrofacial Professor,Center forNeuropharmacology Rochester School ofMedicine and
Pain, Universityof Medicine and Dentistry andNeuroscience, AlbanyMedical College; Dentistry, Rochester, NewYork
of NewJersey-New JerseyDental School, Integrated Tissue Dynamics, LLC, Albany, LUMBARSPINALSTENOSIS:CURRENT
Newark, New Jersey NewYork THERAPYANDFUTUREDIRECTIONS
OROFACIALPAIN COMPLEXREGIONALPAINSYNDROME
PATHOPHYSIOLOGY DavidJ.Skinner,MD
AnniePhilip,MD Assistant Professor,Departments of
Assistant Professor, Department of MelissaA.Rockford,MD Anesthesiology and PainManagement,
Anesthesiology, UniversityofRochester Assistant Professor ofAnesthesiology, Mount Sinai Schoolof Medicine; Assistant
School ofMedicine andDentistry, Universityof KansasMedical Center, Professor, MountSinai Medical Center,
Rochester, New York Universityof KansasSchool ofMedicine, New York, New York
DIAGNOSISANDTREATMENTOF KansasCity, Kansas TRAMADOL
FACET-MEDIATEDCHRONICLOW PERIOPERATIVEEPIDURALANALGESIA
BACKPAIN MichelleSkinner,MS
CarlRosati,MD Graduate Student, Department of
MarkAnthonyQuintero,MD Associate Professor ofSurgery, Albany Psychology, University ofUtah, SaltLake
Pain Management Fellow,Department of Medical College; Trauma Director, Albany City, Utah
Anesthesiology, Perioperative Medicine Medical Center, Albany,New York PSYCHOLOGICALASPECTSOFPAIN
and PainManagement, University of ABDOMINALPAIN
Miami Miller Schoolof Medicine, Jackson HowardS.Smith,MD,FACP,FACNP
Memorial Hospital, Miami, Florida MikeA.Royal,MD,JD,MBA Associate Professor ofAnesthesiology,
CRYOANALGESIAFORCHRONICPAIN Vice President, Clinical Development - Internal Medicine, Physical Medicine and
Analgesics, Cadence Pharmaceuticals, Inc., Rehabilitation, AlbanyMedical College,
LynnRader,MD SanDiego, California Academic Director ofPainManagement,
Clinical Instructor, Feinberg School of ACETAMINOPHEN Department ofAnesthesiology, Albany
Medicine, Northwestern University; Medical Center, Assistant Director of
ChristineN.Sang,MD,MPH
Attending Physician, Rehabilitation Clinical Research at ThePharmaceutical
Institute ofChicago, Chicago, Illinois Director,Translational PainResearch, Research Institute, Albany Collegeof
PHYSICALMEDICINEAPPROACHESTOPAIN Brigham and Women’s Hospital, Harvard Pharmacy, Albany,New York
MANAGEMENT Medical School,Boston, Massachusetts NEUROPATHICPAINçDEFINITION,
GLUTAMATERECEPTORANTAGONISTS
IDENTIFICATION,ANDIMPLICATIONSFOR
LakshmiRaghavan,PhD RESEARCHANDTHERAPY;POTENTIAL
NaliniSehgal,MD,FABPMR
Associate Director, Research and DOCUMENTATIONTOOLSFOROPIOID
Development, VyterisCorporation, Inc. Associate Professor, Department of THERAPY;POSTAMPUTATIONPAIN
Fair Lawn,New Jersey Orthopedics and Rehabilitation, University DISORDERS;COMPLEXREGIONALPAIN
PAININCHILDREN ofWisconsin School ofMedicine and SYNDROMEPATHOPHYSIOLOGY;PAINAND
PublicHealth; Medical Director,
SLEEP;OPIOIDSISSUES;ACETAMINOPHEN;
RakeshRamakrishnan,BS Interventional PainProgram, and Pain
ANTIDEPRESSANTS;GLUTAMATERECEPTOR
Department ofOrthopaedic Surgery, Fellowship Program Director,University of
ANTAGONISTS;BOTULINUMTOXINSFOR
Albany Medical Center, Albany, NewYork Wisconsin Hospital andClinics, Madison,
THETREATMENTOFPAIN;CRYOANALGESIA
HIPPAIN;KNEEPAIN Wisconsin
FORCHRONICPAIN
CRYOANALGESIAFORCHRONICPAIN
AlanM.Rapoport,MD
PaulE.Spurgas,MD
Clinical Professor ofNeurology, David AshutoshSharma,PhD
Associate Professor ofNeurosurgery,
Geffen School ofMedicine atUCLA, Los ChiefStrategic Officer,Vyteris, Inc., Fair
Division ofNeurosurgery, Albany Medical
Angeles, California;Founder and Director Lawn,New Jersey
Center, Albany, New York;Temple
Emeritus, TheNew EnglandCenter for PAININCHILDREN
University, Philadelphia,Pennsylvania
Headache, P.C., Stamford, Connecticut
MIGRAINEHEADACHES LeeS.Simon,MD VERTEBROPLASTYANDKYPHOPLASTY
Associate Clinical Professor ofMedicine,
StevenC.Stain,MD
RahulRastogi,MD Harvard MedicalSchool, BethIsrael
Neil Lempert Professor, andChair,
Assistant Professor, Washington University Deaconess Medical Center, Boston,
Department ofSurgery,Albany Medical
in St.Louis; Assistant Professor and Massachusetts
College; Chief ofSurgery, AlbanyMedical
Attending Anesthesiologist, Barnes-Jewish OSTEOARTHRITIS:ETIOLOGY,PATHOGENESIS,
Center Hospital, Albany, New York
Hospital, St. Louis, Missouri ANDTREATMENT
ABDOMINALPAIN
SYMPATHETICBLOCKADE
xii CONTRIBUTORS
StevenStanos,DO ChrisWarfield,BA JamesP.Wymer,MD,PhD
Assistant Professor, FeinbergSchool of Research Assistant, Arnold Pain Assistant Professor ofNeurology, Albany
Medicine, Northwestern University; Management Center, BethIsrael Deaconess Medical College; Upstate Clinical Research,
Medical Director, Rehabilitation Institute Medical Center, Boston,Massachusetts Albany, New York
of Chicago, Chicago, Illinois COGNITIVETHERAPYFORCHRONICPAIN GLUTAMATERECEPTORANTAGONISTS
PHYSICALMEDICINEAPPROACHESTOPAIN
MANAGEMENT AjayD.Wasan,MD,MSc Chun-SuYuan,MD,PhD
Assistant Professor, Harvard Medical Cyrus Tang Professor,Department of
RolandStaud,MD School;Departments ofAnesthesiology Anesthesia and Critical Care, Pritzker
Professor ofMedicine, University of andPsychiatry, Brigham and Women’s School ofMedicine, UniversityofChicago,
Florida, Gainesville, Florida Hospital, Boston, Massachusetts Chicago, Illinois
FIBROMYALGIASYNDROME ANTIDEPRESSANTS GASTROINTESTINALDYSFUNCTIONWITH
OPIOIDUSE
RichardL.Uhl,MD LynnR.Webster,MD,FACPM,FASAM
Professor ofSurgery, Albany Medical Medical Director,Lifetree Clinical Jun-MingZhang,MD,MSc
College, Albany;Adjunct Professor of Research and PainClinic, Salt LakeCity, Associate Professor andDirector of
Biomedical Engineering, Rensselaer Utah Research, Department ofAnesthesiology,
Polytechnic Institute,Troy; Chief, PAINANDSLEEP University ofCincinnati Collegeof
Orthopaedic Surgery, Albany Medical Medicine, Cincinnati, Ohio
Center Hospital,Albany, New York RichardWhipple,MD PATHOPHYSIOLOGYOFPAIN;STEROIDS;
SHOULDERPAIN;ELBOWPAIN Assistant Clinical Professor, Department of NONSTEROIDALANTI-INFLAMMATORY
Orthopaedic Surgery,Albany Medical DRUGSANDCYCLOOXYGENASE-2
MarkWallace,MD College, Albany, NewYork INHIBITORS
Professor ofClinical Anesthesiology, and HANDPAIN
Program Director,Center for Pain YiLiZhou,MD,PhD
JoshuaWootton,MDiv,PhD
Medicine, Department ofAnesthesiology, Courtesy Clinical Assistant Professor,
University ofCalifornia, San Diego,La Assistant Professor, Department of University ofFlorida; Medical Director,
Jolla, California Anaesthesia, Harvard MedicalSchool; Comprehensive PainManagement of
BOTULINUMTOXINSFORTHETREATMENT Director ofPainPsychology, Arnold Pain North Florida, Gainesville, Florida
OFPAIN Management Center, BethIsrael Deaconess DIAGNOSISANDMINIMALLYINVASIVE
Medical Center, Boston,Massachusetts TREATMENTOFLUMBARDISCOGENICPAIN
DeirdreM.Walsh,DPhil,BPhysio COGNITIVETHERAPYFORCHRONICPAIN
Professor ofRehabilitation Research,
Health and Rehabilitation Sciences
Research Institute,University ofUlster,
Newtownabbey, CountyAntrim, Northern
Ireland, United Kingdom
TRANSCUTANEOUSELECTRICALNERVE
STIMULATION
Preface
The International Association for the Study of Pain (IASP) has complaints in some patients may need therapies targeting periph-
defined pain as ‘‘an unpleasant sensory and emotional experience eral, spinal, as well as supraspinal mechanisms in efforts to fully
associated with actual or potential tissue damage, or defined in addresstheir issues.
terms of such damage’’. Donald Price in his 1999 book Despiteanexplosionofbasicsciencepainresearch,thetransla-
PsychologicalMechanismsofPainandAnalgesiabyIASPPresspro- tionoftheseadvancesintotangibleandclinicallyusefuldiagnostic
posed an alternative definition, arguing that the IASP definition andtherapeuticmeasurestoidentifyandamelioratevarioushuman
does not emphasize the experiential nature of pain. He holds that painfulconditionshaslagged.Unfortunately,despitevaliantefforts,
painisa‘somaticperceptioncontaining(1)abodilysensationwith toomanypeoplecontinuetoexistwithhorrificpainandsuffering,
qualities like those reported during tissue-damaging stimulation, some who have been helped a little, and some who have not been
(2)anexperiencedthreatassociatedwiththissensation,(3)afeeling helped at all. The field of Pain Medicine is still relatively in its
of unpleasantness or other negative emotion based on this experi- infancy,butcontinuestograduallymature.Thus,itwasheartening
enced threat’. to learn that as we approach the tail end of the ‘‘decade of pain’’;
In 1931, the French medical missionary, Dr. Albert Schweitzer Elsevierisadding thebook‘‘CurrentTherapy inPain’’toitscriti-
wrote ‘‘Pain is a more terrible lord of mankind than even death cally acclaimed ‘‘Current Therapy’’ series. Perhaps one of the best
itself’’. These words emphasize the scope of total human suffering known books in this series is Conn’s Current Therapy, which was
duetopainwhichmaydramaticallyaffectaperson’slife/qualityof initially published in 1943 and has been revised yearly since. After
life.Painremainsamongoneofthemostdebilitatingsymptomsas 65years,CurrentTherapyinPainhassurfacedineffortstodeliver
wellasoneofthemostcommonsymptomswhichpatientsreport. a source of current information on the field of pain medicine
Blair Smith and Nicole Torrance have addressed the which will be updated reasonably frequently. In keeping with
Epidemiology of Chronic Pain as a chapter in the book, the style of the series ‘‘Current Therapy in Pain’’ is clinically
Systematic Reviews in Pain Research: Methodology Refined edited oriented. However, in contrast to other Current Therapy texts,
by Henry J. McQuay, Eija Kalso, and R. Andrew Moore and pub- ‘‘Current Therapy in Pain’’ does not present all chapters without
lishedbyIASPPressin2008.Theywritethatitseemsthatuptohalf references. Although I initially set out with the intention to keep
oftheadultpopulationsuffersfromchronicpainasdefinedbythe thisformat,whichisseeninsomechapters,itbecameapparentthat
broad IASP definition and that 10-20% experience chronic pain itwouldbechallengingtohaveallthechapterswithoutreferences,
when measures of clinical significance are added to the definition. largely due to the immaturity and dynamic nature of the field of
Theyfurtherstatethattheincidenceofchronicpain(thoughdiffi- painmedicine.
cult to estimate) may be between 5% and 10% per year and is The text is organized to initially present background informa-
associated with poor health-related quality of life in all studies tion on pain —taxonomy, pathophysiology and assessment.
that measured this variable. Various treatment strategies for acute pain are then presented.
Numerouspotentialtherapeutictargetsexistwhichmaymodulate The next sections deal with a number of conditions/syndromes/
nociceptiveprocessingincluding:ionchannels,TRPchannels,ASIC issues which are painful or may interface with pain. Section IV is
channels, stretch-activated channels, signaling molecules/casades devoted to Pain in Special Populations. Finally, Sections VII
(pERK,p38MAPK proteinkinases), neurotrophins(BDNF,GDNF, through XIII deal with treatment approaches to pain (pharmaco-
NGF) inflammatory mediators, cytokines, adhesion molecules, logic, behavioral medicine, physical medicine and rehabilitation,
immune cells/glia, neurotransmitters (SP, NK1, CCK), adrenergic neuromodulation,complementaryandalternativemedicine,neuro-
receptors, purinergic receptors, toll-like receptors, and glutamate surgical,andinterventional).Thetext,althoughnotcomprehensive
receptors. Furthermore, it is not uncommon that opposing anti- ofallpain-relievingstrategies,isfelttopresentareasonablerepre-
inflammatory processes may exist for certain pro-inflammatory/ sentationofavailable therapeutic optionswhichmayhelpalleviate
pro-nociceptive processes(e.g.,acetylationofMKP-1promotesthe pain.Furthermore, because ofthedynamicnature ofpainandthe
interactionofMKP-1withitssubstratep38MAPK,whichresultsin attempt to present current information, it is not intended that all
dephosphorylationofp38MAPK).However,someofthesetargetsdo treatmentstrategiespresentedinthetextare‘‘triedandtrue’’thera-
nothaveclinicallyavailableagentstospecificallyenhanceorinhibit pieswhichhavestoodthetestoftime,butonlythattheyareormay
theirfunctionandeveniftheseagentsexisted,clinicianswouldnot beavailableoptionsforcertaincircumstances,noworinthefuture.
knowwhichagentstoutilizeforaspecificindividualpatient’spain It is hoped that the experts who contributed to this text have
complaints. presented information which may be helpful/educational to clini-
Furthermore, analgesics, modalities, neuromodulation, and cians and/or patients and that future editions continue to present
interventional techniques, etc. should not be used ‘‘in a vacuum’’, currentandusefulinformationrelatedtotheever-changingfieldof
but rather optimally in conjunction with physical medicine, beha- painmedicine.
vioralmedicine,andothertechniquesaspartofaninterdisciplinary
HOWARD S.SMITH, MD
team approach. Additionally, it is conceivable that some pain
xiii