Guide to colour plates
Preface
Foreword
Michael J Cousins
About the editors
About the authors
Abbreviations
SECTION 1 THE PERSON
Introduction
Chapter 1 Pain and the front line: a general practitioner’s perspective
Roberta T Chow
Introduction
What painful conditions do GPs treat
The consultation
Pain
‘Diagnosing’ pain
Persistent pain
Evaluating pain
Training GPs in pain medicine
What about guidelines?
Costs of poor pain management
How does the person in pain feel?
Person-centred care
Complementary and alternative medicine
Conclusion
Chapter 2 Understanding the pathophysiology of pain
Philip J Sidall
Introduction
Pain types
Pain mechanisms
The periphery
The spinal cord
The brain
Pain modulation
Implications for the assessment of pain
Pathology, pain, and neuroplasticity
Putting it all together
Implications for the treatment of pain
Summary
Recommended reading
Chapter 3 Myofascial pain
Peter T Dorsher
Introduction
What is myofascial pain?
Historical perspectives
Trigger point needling
Current concepts and theories
Integrated hypothesis of trigger point formation
Neurogenic model of MPS
Diagnostic and other considerations in chronic myofascial pain
Autoimmune and neoplastic considerations
Nutrition and vitamin deficiencies
Treatment implications of the neurogenic model
Structural considerations
Neurological considerations
Exercise and chronic myofascial pain
Conclusion
Chapter 4 The management of acute pain
Ian Mowat, Elystan Hughes, and Stephan A Schug
Introduction
Definition of acute pain
Epidemiology
Consequences and implications of acute pain
Physiological implications
Psychological consequences
Progression of acute pain to chronic pain
Identifying those at risk
Assessment of pain
Systemic pharmacological management of acute pain
Systemic opioid analgesia
Systemic non-opioid/adjuvant analgesic drugs
Regional anaesthesia
Central neuraxial anaesthesia
Peripheral local or regional anaesthesia/analgesia
Multimodal analgesia
Non-pharmacological modalities
Acute pain service (APS)
Specific issues in acute pain
Burns pain
Acute neuropathic pain
Acute pain in medical settings
Recommended reading
Chapter 5 Postoperative pain
David A Scott and Pamela E Macintyre
Introduction
Understanding acute postoperative pain
Principles of management of acute postoperative pain
Communication
Multimodal analgesia
Patient assessment
Specific analgesic options
Systemic analgesics
Local anaesthetic-based techniques
The role of the acute pain service
Ongoing management after discharge
Potential risks of opioid prescription
Identification of the ‘at-risk’ patient
Choice of opioid and formulation and duration of treatment
Regulatory limitations to the prescription of opioids
Communication with the patient’s doctor
Patient information
Conclusions
Chapter 6 Transition from acute to chronic neuropathic pain: potential new players on the horizon
Joshua E Adler, Amy Hinkle, and Anne M Skoff
Chapter 7 fMRI and pain
Mark C Bicket and Paul J Christo
Introduction
Technique
Pain and nociception
Pain processing, perception, and chronic pain
Intrinsic pain modulation
The neuromatrix
fMRI and pain modulation
Pharmacological fMRI
Recommended reading
Chapter 8 Migraine and other primary headache disorders
Peter J Goadsby
General issues
Anatomy and physiology of headache
Migraine
Migraine
Management of migraine
Tension-type headaches
Clinical features
Pathophysiology
Management
Trigeminal-autonomic cephalalgias I – cluster headache
The trigeminal-autonomic cephalalgias (TACs)
Management of cluster headache
Trigeminal-autonomic cephalalgias II – paroxysmal hemicrania
Trigeminal-autonomic cephalalgias III – SUNCT/SUNA
Secondary SUNCT/SUNA and the differential diagnosis with trigeminal neuralgia
Trigeminal-autonomic cephalalgias IV – hemicrania continua
Chronic daily headache
Chronic daily headache and migraine
Management of CDH
Management of medication overuse - outpatients
Management of medication overuse – inpatient
Preventive treatments
New daily persistent headache
Clinical presentation
Primary NDPH
Recommended reading
Chapter 9 Neuropathic pain
Philip J Siddall
Introduction
Definition
Clinical features and assessment
Symptoms and history
Signs and physical examination
Other investigations
Aetiology
Prevalence
Mechanisms and pathophysiology
Peripheral mechanisms
Spinal mechanisms
Supraspinal mechanisms
Treatment
Topical preparations
Opioids
NMDA antagonists
Local anaesthetics
Antidepressants
Anticonvulsants
α adrenergic agonists
Cannabinoids
Neural blockage techniques
Stimulation techniques
Spinal drug administration
Ablative techniques
Psychological and functional approaches
Recommended reading
Chapter 10 Pain management in cancer patients
Muhammad Salman Siddiqi and Paul Glare
Introduction
Epidemiology of pain in people with cancer
Classification of cancer pain
Pain intensity
Pain pathophysiology
Onset and duration of the pain
Pain aetiology
Clinical assessment of cancer pain
Assessment of BTP
Subsequent assessment
Treatment of people with cancer pain
Non-opioids
Weak opioids
Strong opioids
Initiating treatment with strong opioids
After effective treatment with morphine has been initiated
Problems with subsequent cancer pain management
When a change to parenteral opioids is required
When side-effects are preventing escalation of the dose to an effective level
Reducing the dose
More aggressive management of side-effects
Addition of co-analgesic agents
Opioid rotation
Spinal administration of opioids and other more invasive procedures
Non-pharmacological measures including complementary therapies
Complementary therapies
Failure to adhere to pain medicine recommendations
Controversial issues in cancer pain management
Abuse potential of opioids by cancer patients
Pain management in cancer survivors
Conclusion
Chapter 11 Pain in children and adolescents
Matthew Crawford, Tamara Lang, Hsuan-Chih Lao, and David Champion
History
Pain in infants
Assessment in infants
Acute, procedural, and postoperative pain in infants
Pharmacological management of procedural and postoperative pain in infants and very young children
Non-pharmacological management of procedural pain in infants
Pain in children and adolescents
Management and assessment
Needle and procedural pain
Acute postoperative pain in children
Common recurrent and chronic pain disorders of childhood not associated with disease
Chronic pain
Management of chronic pain in children and adolescents
Future directions
Suggested websites
SECTION 2 THE SCIENCE
Introduction
Chapter 12 Opioids and their signalling mechanisms at opioid receptors
Macdonald J Christie
Opioid receptor types
Significance of opioid receptor types for pain therapeutics
µ receptor splice variants and polymorphisms
Endogenous opioid peptides
Interaction of opioid peptides with distinct opioid receptors
Potential for µ receptor agonists to selectively induce analgesia versus adverse effects
Weak versus strong opioids: potency, intrinsic efficacy, and metabolism
Intrinsic efficacy
Biased signalling at the µ receptor
Can hetero-oligomers be targeted to improve opioids?
Opioid synergism
Conclusions
Recommended reading
Chapter 13 Gates and other theories of pain
Lucy A Bee and Anthony H Dickenson
Introduction
Old versus new theories of pain
The gate control theory of pain
Gate theory in action
Chronic pain
Local circuitry gating system
Labelled lines
Descending control of spinal gates
Diffuse noxious inhibitory control
Analgesic agents
Conclusion
Chapter 14 Neuroinflammation, TNF, and pain
Kinshi Kato, Veronica I Shubayev, and Robert R Myers
Mechanisms of neuropathic pain
Axonal transport of TNFα
Glial activation
Management of neuropathic pain
Human anti-TNFα therapy
Chapter 15 Skin, neurons, neuroglia, and pain
Patricia J Armati
Introduction
Skin and pain
The epidermis
The dermis
Modality of nociceptors
Neurons and neuroglia and their signals
The neuroglia
Schwann cells
Satellite cells
The central nervous system
Microglia
Skin biopsy as a diagnostic tool
Summary
Recommended reading
SECTION 3 THE CLINICAL INTERFACE
Introduction
Chapter 16 The biopsychosocial model of chronic pain
Tony Merritt, Louise Sharpe, and Jade Hucker
Introduction
Clinicians’ roles working in the biopsychosocial model
The psychologist
Physical therapists
Medical specialists
General practitioners
Other professionals
Chapter 17 Psychological approaches to chronic pain
Tony Merritt, Louise Sharpe, and Jade Hucker
Introduction
CBT for chronic pain: an empirical overview
Efficacy of CBT for pain
Overview of outcomes for specific pain syndromes
Low back pain
Headache
Abdominal pain
Widespread pain syndromes
Rheumatoid syndromes
Neck pain
Specific components of CBT
Acceptance
Education
Relaxation strategies
Goals setting
Other skills
Managing flare-ups
Recent advances
Mindfulness-based therapies
Addressing pain-related anxiety
Attentional modulation approaches
Levels of intervention
The stepped care approach
Conclusions and summary
Recommended reading
Chapter 18 Integration of primary care into the management of chronic pain
Geoffrey Mitchell
Introduction
Specialist versus generalist management
The philosophy of primary care: person-centred care
The disease
Response to disease
The person’s context
The broader context
The power of the health professional/patient relationship
Evidence for multidisciplinary management
Establishing and running case conferences
The team to the GP
The GP goes to the team
GP-specialist case conferences facilitated by communications technology
Application to chronic pain management
The Australian Pain Management model – now
Inadequate care at the primary care level
Long waits for specialist treatment
Return to the community
Considerations for new models of care
The proposed Australian Pain Management model
Conclusion
References
Index
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