Table Of ContentRhonda J. Moore Editor
Handbook of
Pain and
Palliative Care
Biobehavioral Approaches for the Life Course
Handbook of Pain and Palliative Care
Rhonda J. Moore
Editor
Handbook of Pain
and Palliative Care
Biobehavioral Approaches for the Life Course
Editor
Rhonda J. Moore
Department of Health and Human Services
Rockville, MD, USA
[email protected]
ISBN 978-1-4419-1650-1 (Hardcover) e-ISBN 978-1-4419-1651-8
ISBN 978-1-4614-7493-7 (Softcover)
DOI 10.1007/978-1-4419-1651-8
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This book is dedicated first and foremost
to the glory of God, the most high for his love, guidance,
refuge, faithfulness, strength, and many blessings.
Through him all things are possible. He is eternal and just.
May he continue to bless us and supply all our needs.
Foreword
“It is easier to find men who will volunteer to die than to find those who are willing to endure pain
with patience.” Julius Caesar 75 BCE
“Pain is inevitable. Suffering is optional.” Unknown
In his Foreword to the first edition of Pain and the Neurosurgeon in 1955, Sir Geoffrey Jefferson
noted: “This book is concerned with pain, not as a warning, but as an enemy to be defeated.” Wilder
Penfield addressed this further in his Foreword to the 1969 edition of this classic: “The problem is
vastly complicated by the fact that the enemy presents himself with devilish guile behind so many
masks.” He was referring to the multiplicity of human afflictions that result in pain and suffering;
concepts that can be agonizingly vague and subjectively defined. Penfield describes the physician’s
dilemma as “running through quicksand” in determining whether the patient’s pain complaints are
organic, functional, or a subtle combination of both.
A short list of acute and intractable chronic pain patterns includes phantom limb pain, arthritis,
angina, cancer pain, the many types of neuralgia, fibromyalgia, multiple classifications of headache,
and posttraumatic and postoperative pain. Renewed interest in the heterogeneity, neuroplasticity,
and neurocognitive complexity of the human brain promises rewards that can lead to new horizons
for understanding these human sensations beyond our ability to conceptualize at the present time. A
new lexicon, reflected in such terms as neuroanthropology, cognitive neurobiology, and culture-
gene-evolutionary theory, is rapidly developing.
This publication encompasses every aspect of these areas of interest at the highest levels of exper-
tise and promises to be a basic source of information for years to come. Otfrid Foerster, Penfield,
Jefferson, Leriche, Sweet, and an esteemed list of others devoted their professional lives attempting
to decipher the elusive features of pain sensory mechanisms in humans and to confront the difficulties
inherent in devising methods of treatment. Also, for centuries, suffering and pain have been master-
fully portrayed in music, literature, and art. Throughout history, scientists and creative artists alike,
devoted to the further elucidation of these universal human sensations and emotions, are entranced
and probably incredulous of the introduction of the disciplines of neuroanthropology and neuropsy-
chology as enhancements to the neurosciences. With this added perspective to neuroanatomy, neu-
roendocrinology, physiology, psychiatry, and neuropathology we may be able to further explore the
physical and even the transcendental essence of pain in many of its ramifications in the 21st century
and beyond. An entire new world of neuroscience, interpersonal neurobiology, is also emerging to
further unravel the Gordian knot of our limited understanding of “feelings, pain, and suffering”
along with humanity’s varying and unpredictable responses thereof. We are witnessing a healthy
skepticism of the so-called established markers and evidence-based facts and standards in all of
these matters. Questioning “whose evidence and on what basis were their conclusions drawn?” is a
welcomed pervading theme throughout.
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viii Foreword
Any review of the completeness of the gamut of topics in the chapter headings in this volume,
along with the stature of their authors and editors reflects a profound new evolutionary approach for
the evaluation of pain in its innumerable forms and in a vast new multicentric universe of modalities
for palliation.
Richard M. Hirshberg, M.D., FACS
White, J.C., Sweet, W.H., Pain and the Neurosurgeon: A Forty Year Experience, 1969, 2nd Edition, Charles C.
Thomas.
Preface
Chronic pain is a major cause of distress, disability, loss of work, and quality of life. A World Health
Organization (WHO) cross-continental survey, conducted in 26,000 primary care patients in fifteen
centers in Asia, Africa, Europe, and the Americas, indicated that one in five adults suffers from
chronic pain (range, 6–33%) (Verhaak et al. 1998; Smith et al. 2011; Power et al. 2007). More than
116 million Americans struggle with chronic pain each year, and associated medical charges and
lost productivity cost the nation as much as $635 billion annually (Relieving Pain in 43 America:
A Blueprint for Transforming Prevention, Care, Education, and Research. IOM Report. The National
Academies Press 2011). About 15–20% of children experience at least one episode of chronic pain.
Moreover, despite major advances many chronic pain patients still needlessly suffer due to inadequate
assessment, management, and treatment.
New paradigms for chronic pain management and symptom control have recently emerged. These
studies have begun to take a life course approach to understand the risks, onset and progression of
health and disease based on biological, behavioral, psychosocial, spiritual/existential, and environ-
mental processes that can affect the course and development of illness and disease (Power et al.
2007; Kuh and Ben-Shlomo 1997). The study of life course influences on chronic pain states is still
in its infancy (Pang et al. 2010). Nevertheless, this new paradigm emphasizes enhanced biobehav-
ioral pain and symptom assessment and management, improved communication among clinicians,
patients, and caregivers, an holistic approach to care including the “context” of care, the integration
of psychosocial, narrative, anthropological, and spiritual approaches to pain management and symp-
tom control, and increased insight into the underlying biobehavioral mechanisms of pain.
This book is designed as the beginning of a journey and a conversation about life course per-
spectives on chronic pain that will be refined over time, and expanded as this wonderful field
evolves. It is our belief that this changing paradigm can lead to a broader and better understanding
of chronic pain conditions, interventions, and treatments that will result in improved pain control
and palliative care.
The broad aim of this edited volume is to take a multidisciplinary, biobehavioral, and life course
(where applicable) approach to understanding chronic pain. By way of introduction, the contributing
authors review biopsychosocial approaches to understanding chronic pain and disability. The second
set of chapters describe issues related to communication and pain. The next set of chapters discuss
pain and palliative care assessment. The fourth set of chapters highlight biobehavioral approaches to
understanding common pain conditions, including pain in pediatric patients, pain in the older person,
pain after traumatic brain injury (TBI), pain in the battlefield injured, pain in whiplash associated dis-
order (WAD), chronic low back pain, and adult cancer-related pain. The subsequent set describe
biobehavioral mechanisms associated with chronic pain. These include stress and chronic pain, the
biobehavior of hope, temporomandibular disorder and its relationship to fibromyalgia, and pain
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