About the editors
  About the authors
  Brief table of contents
  Full table of contents




Guide to colour plates


Michael J Cousins

About the editors

About the authors




Chapter 1   Pain and the front line: a general practitioner’s perspective
Roberta T Chow
What painful conditions do GPs treat
The consultation
‘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

Chapter 2   Understanding the pathophysiology of pain
Philip J Sidall
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
Recommended reading

Chapter 3   Myofascial pain            
Peter T Dorsher
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

Chapter 4   The management of acute pain
Ian Mowat, Elystan Hughes, and Stephan A Schug
Definition of acute pain
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
Understanding acute postoperative pain
Principles of management of acute postoperative pain
         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

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
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
         Management of migraine
Tension-type headaches
         Clinical features
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
Clinical features and assessment
         Symptoms and history
         Signs and physical examination
         Other investigations
Mechanisms and pathophysiology
         Peripheral mechanisms
         Spinal mechanisms
         Supraspinal mechanisms
         Topical preparations
         NMDA antagonists
         Local anaesthetics
         α adrenergic agonists
         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
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
         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

Chapter 11   Pain in children and adolescents
Matthew Crawford, Tamara Lang, Hsuan-Chih Lao, and David Champion
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


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
Recommended reading

Chapter 13 Gates and other theories of pain
Lucy A Bee and Anthony H Dickenson
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

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
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
Skin biopsy as a diagnostic tool
         Recommended reading


Chapter 16   The biopsychosocial model of chronic pain
Tony Merritt, Louise Sharpe, and Jade Hucker
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
CBT for chronic pain: an empirical overview
Efficacy of CBT for pain
Overview of outcomes for specific pain syndromes
         Low back pain
         Abdominal pain
         Widespread pain syndromes
         Rheumatoid syndromes
         Neck pain
Specific components of CBT
         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
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












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