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1
We paid our dues: Women trade union leaders of the Caribbean. Washington, D.C: Howard University Press, 1996.
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2
Mississippi. Legislature. PEER Committee. An accountability assessment of public funds paid to selected associations for membership dues. Jackson, MS: The Committee, 2002.
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3
La paix des dupes: Un roman dans la Deuxième guerre mondiale. Paris: Éditions du Masque, 2007.
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4
Salah'eddyn, El Faleh Abdallah. Le Moyen-Orient du duel Est-Ouest à l'initiative de paix d'Israël (1950-1993): Théorie et stratégie. Paris, France: Godefroy de Bouillon, 1995.
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5
Harlamova, Yuliya. The struggle for Eurasia in the focus of transport geostrategies. ru: INFRA-M Academic Publishing LLC., 2021. http://dx.doi.org/10.12737/1243826.
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The monograph examines the problems that play an important role in the processes of constructing transport geostrategies on the Eurasian continent. In the processes of redrawing the world's spaces, the transport sphere (along with financial and information) often acts as a catalyst for modern transformations. It is emphasized that thanks to transport networks, the economy on a global scale is structured in a completely specific way. To increase the potential of any state and society (the peoples living in it), the creation of conditions for communication community (in the broadest sense) is an integral component of its sustainability. The thesis is proved that the direction of the flow of many global integration or disintegration processes corresponding to the new world conditions depends on the reliable and fast operation of transport communications. Special attention is paid to the concept of the modern Chinese state "One Belt , One Road", which the Chinese elite actively promotes in the external space. Some aspects of the economic and transport development of the Arctic region in the context of the functioning of the Northern Sea Route are considered. Due attention is paid to the special role of Central Asia in the context of these problems, as well as the implementation of the international transport project "North - South".
For students and teachers, as well as for anyone interested in economics and politics.
6
Menegatto, Marialuisa, and Adriano Zamperini, eds. Memoria Viva. Florence: Firenze University Press, 2015. http://dx.doi.org/10.36253/978-88-6655-748-7.
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‘‘Non dimenticare’ e ‘non ricordare’. Da sempre, questi due aspetti contradditori solcano la memoria autobiografica e collettiva di drammatici eventi storici, come la Shoah. Il presente volume, che ha avuto il suo momento genetico in un paio di convegni svoltisi a Pistoia e Firenze durante le celebrazioni della Giornata della Memoria nel 2014, si muove lungo questi due percorsi accidentati del fare memoria. Al centro, il lavoro di Andrea Devoto sulla memoria della deportazione politica in Toscana. Gli autori qui ospitati hanno cercato di tessere legami e segnalare nuove vie di analisi e riflessioni accompagnati dalla consapevolezza che la chiave di volta del passato sta nel presente. Per questo motivo il libro aspira a porsi come partner di dialogo all’interno delle pratiche sociali della memoria e della formazione civica dei cittadini.
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Bolles, Augusta Lynn. We Paid Our Dues: Women Trade Union Leaders of the Caribbean. Howard Univ Pr, 1997.
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9
Sobey, Christopher. Orofacial Pain. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190217518.003.0023.
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Management of orofacial pain in the general population can be a challenging and demanding undertaking due to the complex neurological anatomy and close proximity to vital structures. Differentiating various syndromes and origins of pain can prove difficult; thus, specific emphasis on establishing the correct diagnosis is of the utmost importance in formatting a successful treatment plan. The questions in this chapter delve into the presentations, physical exam findings, diagnostic testing, psychological effects, and evidence-based medical and interventional treatment algorithms of both common and less common craniofacial pain disorders. This chapter covers pathophysiology of the neurological, biomechanical, and central causes of facial pain.
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Davies, Paul. Facial pain. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0052.
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Facial pain occupies the area below the orbitomeatal line, above the neck and anterior to the pinnae. It comes in many forms and may or may not be accompanied by other symptoms. It may be acute, subacute, or chronic, arise from local pathology (e.g. dentition, parotid gland, sinus), be referred from other structures (e.g. pain behind the eye may be due to cervical spondylosis or sphenoidal sinusitis) or be part of a neurological syndrome such as trigeminal neuralgia or persistent idiopathic facial pain (previously termed atypical facial pain). There is a wide differential diagnosis. As with headache, serious causes are rare. Some benign conditions are particularly painful (trigeminal neuralgia, cluster headache) but have effective treatment.
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Huntoon, Elizabeth. Geriatric Pain. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190217518.003.0027.
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Advances in health care have provided improved longevity and daily functioning in many elderly individuals; however, the increase in longevity contributes to the complexity of caring for elderly pain patients. Many elderly pain patients are undertreated as a result of inadequate pain assessment, cognitive limitations, or physiologic processes. Therefore, it is imperative to have an awareness and understanding of how the aging process affects the body. The treatment of pain in the elderly includes a variety of pain medications that are commonly used in other age groups but must be approached with caution in older patients due to the differences caused by age-related physiologic changes as well as psychological and socioeconomic differences. The International Association for the Study of Pain has published a comprehensive review of issues related to pain in the elderly.
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Reed, Ashley, and Tariq M. Malik. Chronic Abdominal Pain in the Elderly: Ischemic Pain. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0018.
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Elderly patients with chronic abdominal pain are commonly misdiagnosed, most likely due to atypical symptom presentations. Chronic mesenteric ischemia is a rare cause of chronic abdominal pain in the elderly. Symptoms are postprandial abdominal pain, weight loss, and an abdominal bruit. The disease results from atherosclerotic plaques that reduce the bowel’s ability to increase blood flow after meals. Patients often are malnourished. Diagnosis can be made with various imaging modalities, although a computed tomography angiogram is likely needed when the syndrome is suspected. The mainstay of therapy for chronic mesenteric ischemia is surgical intervention. Interventional pain techniques, such as celiac plexus neurolysis or spinal cord stimulation, are promising adjunct treatment options.
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Banerjee, Ashis, and Clara Oliver. Anaesthetics and pain management. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198786870.003.0003.
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Emergency medicine trainees are required to complete an anaesthetic placement and obtain basic anaesthetic competencies. This chapter is not intended to provide the practical skills for delivering an anaesthetic. Instead, this chapter focuses on the theory of managing and predicting a difficult airway in the emergency department, which is more likely to appear in the short-answer (SAQ) paper. It also focuses on procedural sedation which also may appear in the SAQ paper due to its growing use in the emergency department (ED). This chapter also covers pain management, for which the Royal College of Emergency Medicine (RCEM) have introduced clinical standards. In addition, this chapter covers the use of peripheral nerve blocks such as a fascia iliaca block for neck of femur fractures. Due to the growing use of peripheral nerve blocks in the ED, such detailed knowledge is required.
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Chen, Q. Cece, and Shengping Zou. Postoperative Pain Management. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190457006.003.0016.
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Postoperative pain management is an important aspect of caring for a surgical patient as inadequate pain control can be associated with increased morbidity and mortality. Failure to effectively control postoperative pain is often due to poor communication and poorly coordinated care between the care teams, poor communication with the patient, insufficient education, unrealistic expectations, fear of complications from the pain regimen, inaccurate pain assessment, and limited effective pain treatment modalities. An effective pain management can therefore lead to improved patient comfort, satisfaction, earlier ambulation, faster recovery time, decreased hospital stay and cost of care, and reduced postoperative complications.
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Kaplan, Tamara, and Tracey Milligan. Headache and Facial Pain (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190650261.003.0003.
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The video in this chapter discusses headache and facial pain, including headaches due to another underlying cause (secondary headaches), migraine and its typical features (nausea, vomiting, photophobia, phonophobia, visual aura), trigeminal autonomic cephalgias (such as cluster headaches), and trigeminal neuralgia.
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Namerow, Norman S. Multiple Sclerosis and Pain. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199341016.003.0019.
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Pain is one of the most prevalent symptoms in persons with MS, and may also complicate other symptoms due to MS such as fatigue, impaired mobility and sleep disturbances. Thus, diagnosis and treatment of pain has become an increasingly important aspect in MS management. The epidemiology of pain in patients with multiple sclerosis is reviewed in this chapter, and a pain classification is presented. Pain syndromes are also reviewed, and appropriate treatments are described. Neuropathic pain in particular is discussed, including current views on the pathophysiology of pain production. An algorithm for medication use is presented that illustrates the utility of pharmacology with multiple agents in treating this condition.
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Wagg, Adrian, and Shashi Gadgil. Acute pain in the elderly. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199234721.003.0011.
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Physiological changes that occur with age affect the pharmacokinetics and pharmacodynamics of drugs used in acute pain management. Elderly patients are often reluctant to complain of pain and seek treatment and may sometimes be unable to express pain due to impaired cognition or language. Evidence suggests the elderly as a group that receive inadequate analgesia and are often in pain. Health care professionals are often reluctant to administer sufficient analgesia due to fear of encouraging addiction or inducing side effects. The approach to pain management in this group should follow the World Health Organization (WHO) analgesic ladder with close monitoring for potential side effects and with escalation of treatment till sufficient analgesia is achieved. Choice of drugs and the route of administration should be tailored to the individual patient and should consider the nature of their pain and any disability or co-morbidity that will affect their response to the chosen agent. Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with extreme caution, monitoring for potential gastrointestinal (GI) and renal side effects and long-term use should be avoided if possible. Opioids are effective analgesics and should not be denied to the elderly but their use should be monitored carefully and side effects such as nausea and constipation anticipated and treated.
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Vlaeyen, Johan W. S. Learning and Conditioning in Chronic Pain. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190627898.003.0004.
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This chapter highlights the ways that individuals learn to adapt to changes due to painful experiences. Learning is the observable change in behavior due to events in the internal and external environment, and it includes non-associative (habituation and sensitization) and associative learning (Pavlovian and operant conditioning). Once acquired, new knowledge representations remain stored in memory and may generalize to perceptually or functionally similar events. Moreover, these processes are not just a consequence of pain; they may also modulate the perception of pain. In contrast to the rapid acquisition of learned responses, their extinction is slow, fragile, and context-dependent, and it only occurs through inhibitory processes. The chapter reviews features of associative forms of learning in humans that contribute to pain, pain-related distress, and disability. It concludes with a discussion of promising future directions.
19
Holliday, Kate L., Wendy Thomson, and John McBeth. Genetics of chronic musculoskeletal pain. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0045.
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Chronic pain disorders are prevalent and a large burden on health care resources. Around 10% of the general population report chronic widespread pain, which is the defining feature of fibromyalgia. Fibromyalgia is a poorly understood idiopathic disorder which is also characterized by widespread tenderness and commonly occurs with comorbid mood disorders, fatigue, sleep disturbance, and cognitive dysfunction. A role for genetics in chronic pain disorders has been identified by twin studies, with heritability estimates of around 50%. Susceptibility genes for chronic pain are likely to be involved in pain processing or the psychological component of these disorders. A number of genes have been implicated in influencing how pain is perceived due to mutations causing monogenic pain disorders or an insensitivity to pain from birth. The role of common variation, however, is less well known. The findings from human candidate gene studies of musculoskeletal pain to date are discussed. However, the scope of these studies has been relatively limited in comparison to other complex conditions. Identifying susceptibility loci will help to determine the biological mechanisms involved and potentially new therapeutic targets; however, this is a challenging research area due to the subjective nature of pain and heterogeneity in the phenotype. Using more quantitative phenotypes such as experimental pain measures may prove to be a more fruitful strategy to identify susceptibility loci. Findings from these studies and other potential approaches are discussed.
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Holliday, Kate L., Wendy Thomson, John McBeth, and Nisha Nair. Genetics of chronic musculoskeletal pain. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199642489.003.0045_update_001.
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Chronic pain disorders are prevalent and a large burden on health care resources. Around 10% of the general population report chronic widespread pain, which is the defining feature of fibromyalgia. Fibromyalgia is a poorly understood idiopathic disorder which is also characterized by widespread tenderness and commonly occurs with comorbid mood disorders, fatigue, sleep disturbance, and cognitive dysfunction. A role for genetics in chronic pain disorders has been identified by twin studies, with heritability estimates of around 50%. Susceptibility genes for chronic pain are likely to be involved in pain processing or the psychological component of these disorders. A number of genes have been implicated in influencing how pain is perceived due to mutations causing monogenic pain disorders or an insensitivity to pain from birth. The role of common variation, however, is less well known. The findings from human candidate gene studies of musculoskeletal pain to date are discussed. However, the scope of these studies has been relatively limited in comparison to other complex conditions. Identifying susceptibility loci will help to determine the biological mechanisms involved and potentially new therapeutic targets; however, this is a challenging research area due to the subjective nature of pain and heterogeneity in the phenotype. Using more quantitative phenotypes such as experimental pain measures may prove to be a more fruitful strategy to identify susceptibility loci. Findings from these studies and other potential approaches are discussed.
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Singh, Bhagat, Alban Latremoliere, and Michael Costigan. Congenital insensitivity to pain. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0078.
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The landmark paper discussed in this chapter is ‘Congenital insensitivity to pain. A clinical, genetic and neurophysiological study of four children from the same family’, published by D. C. Thrush in 1973. The study of patients with congenital conditions that result in pain insensitivity has been invaluable in helping define the molecular mechanisms of sensory processing. These patients share a major defining phenotype (they feel little or no pain from birth), although they often have differing subtle symptoms which belie a host of separate conditions that we have now started to recognize with the advent of molecular genetics (e.g. loss-of-function mutations in the gene encoding Nav1.7, and mutations related to nerve growth factor (NGF)); these include congenital insensitivity to pain with anhydrosis (CIPA; thought to be due to mutations in the gene encoding the NGF receptor NTRK1) and hereditary sensory and autonomic neuropathies (HSANs) such as familial dysautonomia.
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Goff, Brandon J., Kevin B. Guthmiller, Jamie C. Clapp, William B. Lassiter, Morgan J. Baldridge, Sven M. Hochheimer, and Margaux M. Salas. Lumbar Radiculopathy and Radicular Pain. Edited by Mehul J. Desai. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199350940.003.0017.
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Lumbar radicular pain is a significant burden for patients and is one of the most common complaints presented to spine practitioners. In the young, it is most often due to acute disc herniation, but in older patients, the onset is usually multifactorial. Most cases resolve on their own, but many patients experience recurrences. This chapter reviews a continuum of treatment options, from comprehensive physical rehabilitation to surgery. Understanding the pathophysiologic process may allow a more meaningful understanding of the development of chronic neuropathic pain of the extremity. A comprehensive history and physical examination, with findings confirmed by radiologic studies as warranted, may raise red flags early in the process and will facilitate efficient treatment of the underlying issues. An interdisciplinary approach may allow for earlier improvement and suitable treatment as needed.
23
Farquhar-Smith, Paul, Pierre Beaulieu, and Sian Jaggar, eds. Landmark Papers in Pain. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.001.0001.
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Landmark Papers in Pain offers a comprehensive inventory of over 80 key studies in pain medicine from the last 100 years. Pain medicine, a relatively new specialty, has proven increasingly relevant to medical practitioners in every field. The specialism of pain has emerged over the past 50 years, largely due to the persistence of experts and new medical evidence that points to its necessity. Today, it is a distinct and integral part of global medical practice. Each paper in this book is accompanied by a concise commentary on the significance of the original findings written by an expert in pain. The reviews discuss how the papers influenced the development of the speciality and how the findings have advanced our global comprehension of pain. Together, the selected papers and reviews chart the growth of an embryonic field into the modern speciality of pain medicine. Complied by leading specialists in the field, the papers included in this book are significant for any student, researcher, clinical practitioner, or medical historian interested in pain medicine. Organized into eight distinct topics and cross-referenced by topics and author of original paper, the book is comprehensive in its coverage and easy to use. A review of the contemporary and historical research that shaped the speciality of pain, Landmark Papers in Pain is essential reading for all medical practitioners with an interest in pain medicine and pain research.
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Finnerup, Nanna Brix, and Troels Staehelin Jensen. Management issues in neuropathic pain. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0133.
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Neuropathic pain is a common complication to cancer, cancer treatment, HIV, and other conditions that may affect the somatosensory nervous system. Neuropathic pain may be present in up to 40% of cancer patients and may persist independently of the cancer and affect the quality of life in disease-free cancer survivors. Particular surgical treatment and chemotherapy may cause chronic persistent neuropathic pain in cancer survivors. The diagnosis of neuropathic pain can be challenging and requires documentation of a nervous system lesion and pain in areas of sensory changes. The pharmacological treatment may include tricyclic antidepressants, selective serotonin noradrenaline reuptake inhibitors (duloxetine or venlafaxine), calcium channel α2↓ agonists (gabapentin or pregabalin), and opioids. Topical lidocaine and capsaicin, NMDA antagonists, carbamazepine, oxcarbazepine, and cannabinoids may be indicated. Due to limited efficacy or intolerable side effects at maximal doses, combination therapy is often required and careful monitoring of effect and adverse reactions is important.
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Caballero-Manrique, Esther, and Carlos A. Pino. Head and Neck Cancer Pain. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0026.
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In the United States, there are 48,000 new cases of head and neck cancer (HNC) annually. Although HNC used to be associated mainly with smoking and drinking, it is now found in many nonsmokers and nondrinkers in their 50s due to the spread of HPV. Pain is typically present at the time of diagnosis. Treatment usually includes radiation, chemotherapy, and/or surgery, which address the mass effect and pain. Yet, patients continue to experience pain during and after treatment, because the treatment modalities can cause significant inflammation and neuropathy and can lead to central sensitization. Painful mucositis is a complication of chemotherapy and radiation treatment; it can become severe, impacting patients’ ability to speak and eat, and sometimes limiting treatment. Pain treatment for HNC is multimodal, and includes preemptive approaches to prevent neuropathy and central sensitization with antiepileptics, such as gabapentin and pregabalin. Mucositis pain is treated using a stepwise protocol.
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Daniel, Stephen H. Berkeley on God’s Knowledge of Pain. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198755685.003.0009.
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Berkeley notes that despite the fact that God does not experience pain passively or by sense as we do, he comprehends what pain is because he is omniscient and the cause of our sensations. Critics have noted, however, that if God causes our ideas of pain, he must know what pain is by modelling our sensations of pain on his own ideas; otherwise, he is a blind agent. After considering accounts by Thomas, Winkler, McCracken, Frankel, Roberts, and Pitcher, the chapter argues that, for Berkeley, God’s ‘comprehension’ of all things refers to how God knows things not as discrete, unconnected objects but as ideas that are perceivable in harmonious relations. Our experience of pain is thus due not to any divine idea but to our failure to comprehend that harmony.
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Trestman, Robert L. Psychiatric aspects of pain management. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0039.
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Chronic pain differs from acute pain in many ways. First, by definition, it has become enduring and goes beyond the expected period of healing, whether post-trauma, post-surgery, or as part of a degenerative or progressive disease. The typical time frame used for defining chronic pain is defined as pain that persists beyond a six month window. Another characteristic that distinguishes chronic from acute pain is the emotional element of perceived suffering. This component of chronic pain becomes important in the assessment and subsequent treatment of chronic pain. Chronic pain management in a correctional setting is very challenging due to a host of factors. First, the majority of people being treated have a history of substance abuse disorders. Further, as a whole, the population of incarcerated adults has a disproportionate prevalence of significant chronic medical and psychiatric conditions. Finally, access to illicit drugs is limited, if not completely eliminated in correctional settings, shifting the environmental demand characteristics to prescription medication misuse. This chapter addresses issues of the psychiatric assessment and management of chronic pain in correctional settings. Information is provided regarding the factors to be elicited in a chronic pain interview, the methods used to assess chronic pain, and the assessment factors appropriate to integrate into a management plan. The methods used to manage chronic pain, including close coordination with a treatment team, cognitive behavioral interventions, and pharmacological management are presented. Tracking treatment outcomes from a psychiatric perspective in the correctional setting are then discussed.
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Trestman, Robert L. Psychiatric aspects of pain management. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199360574.003.0039_update_001.
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Chronic pain differs from acute pain in many ways. First, by definition, it has become enduring and goes beyond the expected period of healing, whether post-trauma, post-surgery, or as part of a degenerative or progressive disease. The typical time frame used for defining chronic pain is defined as pain that persists beyond a six month window. Another characteristic that distinguishes chronic from acute pain is the emotional element of perceived suffering. This component of chronic pain becomes important in the assessment and subsequent treatment of chronic pain. Chronic pain management in a correctional setting is very challenging due to a host of factors. First, the majority of people being treated have a history of substance abuse disorders. Further, as a whole, the population of incarcerated adults has a disproportionate prevalence of significant chronic medical and psychiatric conditions. Finally, access to illicit drugs is limited, if not completely eliminated in correctional settings, shifting the environmental demand characteristics to prescription medication misuse. This chapter addresses issues of the psychiatric assessment and management of chronic pain in correctional settings. Information is provided regarding the factors to be elicited in a chronic pain interview, the methods used to assess chronic pain, and the assessment factors appropriate to integrate into a management plan. The methods used to manage chronic pain, including close coordination with a treatment team, cognitive behavioral interventions, and pharmacological management are presented. Tracking treatment outcomes from a psychiatric perspective in the correctional setting are then discussed.
29
Narouze, Samer N., ed. Multimodality Imaging Guidance in Interventional Pain Management. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.001.0001.
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Multimodality Imaging Guidance for Interventional Pain Management is a comprehensive resource covering fluoroscopy-guided procedures, ultrasound interventions, and computed tomography (CT)-guided procedures used in interventional pain management. Fluoroscopy-guided procedures have been the standard of care for many years and are widely available and affordable. Due to the lack of radiation exposure and the ability to see various soft tissue structures, ultrasound-guided interventions are more precise and safer. The benefits, disadvantages, and basic techniques of CT-guided procedures, primarily performed by radiologists, are also included in the volume. By covering all imaging modalities, Multimodality Imaging Guidance for Interventional Pain Management allows for an efficient comparison of the capabilities of each modality.
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Badiola, Ignacio, Tulsi Singh, Jiabin Liu, and Nabil Elkassabany. Acute Pain in the Opioid-Tolerant Patient. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0045.
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The number of people addicted to prescription and illicit opioids continues to increase, and many of these patients present to the hospital or pain center with acute pain issues. The matter is further complicated by the increasing number of patients with legitimately painful conditions treated with chronic opioid therapy. Typically, these patients are difficult to manage during any acute pain episode due to their opioid tolerance and opioid-induced hyperalgesia. This difficulty often leads to inadequate pain management, increased suffering, and delayed hospital discharge. Increased awareness is needed among pain management physicians and other clinicians who care for opioid-tolerant patients, yet there is a lack of evidence-based medicine regarding the optimal treatment of this population.
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Corey, John, and Kelly McQueen. Pain Relief in Areas of Deprivation and Conflict. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190217518.003.0028.
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This chapter addresses pain relief in areas of deprivation and conflict. There is variability in the causes of pain worldwide, including HIV/AIDS, torture-related pain and suffering, and war-related injuries. There is also great variability in the availability of adequate pain treatment worldwide due to limitations of education, training, knowledge of pain and its treatment, beliefs and communication about pain, and the inadequacy of access to drugs and palliative care in many countries. Research reflects the importance of extending pain care worldwide and addressing ethical and political issues surrounding pain care.
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Cohen, Jeffrey A., Justin J. Mowchun, Victoria H. Lawson, and Nathaniel M. Robbins. A 44-Year-Old Female with Buttock Pain. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190491901.003.0019.
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Sciatic neuropathy presents with buttock pain worsened by sitting on the affected side and associated with ankle and knee extension weakness. Electrodiagnostic evaluation will help to distinguish it from peroneal or tibial mononeuropathies, lumbosacral plexopathy, or lumbosacral radiculopathy. It can be difficult to distinguish from a peroneal mononeuropathy due to the preferential involvement of the peroneal division of the sciatic nerve. EMG study of the short head of the biceps femoris allows for distinction between these entities. Long-term outcome and prognosis studies are sparse although Preservation of distal lower-extremity strength may be a significant predictor earlier and/or better clinical recovery.
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Knezevic, Nebojsa Nick, Teresa M. Kusper, and Kenneth D. Candido. Chronic Low Back Pain in a Young Patient. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0023.
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Chronic low back pain (CLBP) in young adults is a great public health concern. CLBP affects individuals across all age groups with varying frequency, and it is associated with significant disability and morbidity, missed school or work, loss of productivity, and substantial health care expenditures. It can occur suddenly as a result of injury, or develop gradually due to degenerative changes in the spine. Correct diagnosis and proper management, usually involving a multidisciplinary approach, are paramount for optimal pain management. Usually, combinations of conservative management (pharmacologic and nonpharmacologic) with epidural steroid injections can achieve long-term pain relief and relapse prevention.
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Ruehlman, Linda, and Marian Wilson. Enhancing Pain Self-Management via Internet-Based Technology. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190627898.003.0015.
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This chapter focuses on internet-based pain self-management (IPSM) training for adults with chronic pain. Due to space limitations, it does not address programs directed toward children or adolescents or the burgeoning research on mobile technologies. The chapter discusses various definitions of self-management (SM) and proposes an organizing framework for the concept of SM. It examines barriers to traditional face-to-face pain SM training and the role of Internet-based training as a partial solution to the lack of care options for many. It does not reiterate the numerous excellent reviews of the efficacy of online pain SM programs. Those reviews provide support for the continued development and testing of such programs. The chapter’s focus is on the identification of strengths and weaknesses of extant technologies with an eye toward future improvements. The review of 27 IPSM programs reveals a number of important substantive and methodological issues.
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Knezevic, Nebojsa Nick, Benjamin Cantu, Ivana Knezevic, and Kenneth D. Candido. Chronic Back Pain in the Elderly: Spinal Stenosis. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0022.
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Chronic low back pain (CLBP) is a common reason for physician office visits among the elderly. Predictive factors for CLBP are female sex, social isolation, hypertension, and joint pain. In the elderly, CLBP may be related to degenerative spinal stenosis with disk degeneration and overall spondylosis. A detailed medical history and a targeted, comprehensive physical examination are the initial approaches to rule out underlying disease that requires urgent attention. Clinical and evidence-based approaches to management suggest avoiding early MRI or CT, as imaging in elderly patients has proven both impractical and uneconomical. Instead, good clinical judgment should be used for making diagnoses. Consensus on the best initial approaches for managing CLBP has not yet been achieved, and conservative therapy is suggested, varying from use of pharmacologic agents, physical therapy, electrical stimulation, and physical manipulations to epidural injections. Surgical alternatives are avoided due to confounding and multiple comorbidities in older patients.
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Chasen, Martin, and Gordon Giddings. Management issues in chronic pain following cancer therapy. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0135.
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With improved surveillance, diagnoses, and treatment of patients with cancer, an increased life expectancy, and specifically an increased number of ‘cancer cured’ patients, is noted. However, the long-term effects of the disease and treatment have a bearing on obtaining optimal physical, psychological, and cognitive functioning for cancer survivors. Pain impacts on all dimensions of quality of life and is one of the most distressing symptoms for patients. Patients often under-recognize pain and are unsure if optimum pain control is achievable. In addition, members of the interdisciplinary team often fail to assess the patient’s pain adequately, due to a lack of knowledge of the principles of pain relief and side effect management. Treatment requires an interprofessional approach that details a comprehensive assessment, with ongoing reassessment, utilizing both pharmacological and non-pharmacological measures. Empowerment of the cancer survivor, respect for survivors’ individuality and collaboration among team members are key elements of any successful strategy to optimize a patient’s quality of life.
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O’Neal, M. Angela. Ringing in the Ears and Pain in the Head. Edited by Angela O’Neal. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190609917.003.0015.
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The case illustrates the classic clinical features of a low-pressure headache. The pathophysiology results from the loss of cerebrospinal fluid (CSF). This causes sagging of the brain, stretching of the bridging veins, and venodilatation. The clinical history is of a headache that is worse in the upright position and remits when the patient is supine. Due to the connection of the perilymphatic fluid and CSF, postural tinnitus is a frequent symptom. Risk factors for low-pressure headache include those that are patient-specific: female sex, low body mass index, prior history of a low-pressure headache, and an underlying headache disorder. Operator-specific factors that decrease the risk of a postdural puncture headache (PDPH) include greater operator experience and the use of a smaller-gauge, non-cutting lumbar puncture needle. The best treatment for low-pressure headache is a blood patch with resolution in over 90% of low-pressure headaches.
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Sinton, Jamie W. Perioperative Management of the Child Following an Extremity Amputation. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0056.
Full textAbstract:
Postamputation pain is multifactorial in nature. Pain often begins prior to the surgical amputation and can be related to trauma or malignancy. Types of pain experienced include nociceptive, neuropathic, phantom, and stump. Control of pain preoperatively and acutely in the postoperative phase, may prevent the conversion from acute to chronic pain. Each patient undergoing amputation experiences nociceptive pain due to surgery, and the overwhelming majority experience neuropathic and phantom limb pain as well. Goal-targeted pain therapies can reduce pain burden perioperatively. Multimodal analgesia begins preoperatively with antineuropathic agents; continues intraoperatively with regional anesthetics, anti-inflammatories, and opioid therapy; and continues for approximately 6 weeks postoperatively with nonpharmacologic and continued pharmacologic therapy.
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Scott-Brown, Martin. Symptom control in cancer. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0329.
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Treatment in cancer is aimed at improving survival (curing where possible) and/or improving symptoms. Symptoms may be caused by the cancer itself (primary tumour, metastases, or paraneoplastic phenomenon) or by the treatments patients undergo to treat the cancer (surgery, radiotherapy, chemotherapy, hormone therapy, and biological therapy). Therefore, symptom control is one of the key roles of oncologists as they treat cancer patients. The most important part of symptom control in cancer patients is to elucidate the underlying cause of the symptom. Symptom control is most effective when the underlying cause is targeted; for example, shoulder pain may be treated most effectively by local radiotherapy if it is due to a bone metastasis in the humeral head, by dexamethasone if it is referred pain due to diaphragmatic irritation from hepatomegaly, and by amitriptyline or gabapentin if it is neuropathic pain due to cervical nerve root irritation. Covering all symptom control in cancer patients is beyond the remit of this chapter; however, it will cover the control of pain and nausea and vomiting, as these are very common symptoms in cancer patients.
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Cohen, Jeffrey A., Justin J. Mowchun, Victoria H. Lawson, and Nathaniel M. Robbins. A 61-Year-Old Male with Severe Shoulder and Cervical Pain. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190491901.003.0007.
Full textAbstract:
Severe shoulder pain in the absence of a clear orthopedic cause may be due to acute brachial plexitis. Numbness and tingling in association with weakness and muscle atrophy that cannot be accounted for by a single nerve or nerve root distribution suggests the diagnosis. Additional clues suggesting brachial plexitis include intensity of shoulder pain and antecedent events such as illness, vaccination, injury, unusual physical activity or surgery. The approach to diagnosis of plexitis/plexopathy and appropriate evaluation for etiology are discussed. Management of this condition is conservative, relating to pain control and judicious use of mobilization and strengthening with physical therapy. Prognosis is generally good with recovery of strength occurring in weeks to months.
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Lussier, David, and Russell K. Portenoy. Adjuvant analgesics. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0097.
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In the management of pain associated with serious illness, ‘adjuvant analgesics’ usually are administered in concert with opioid therapy in an effort to improve outcomes when an opioid does not provide satisfactory relief with tolerable side effects. They may be divided into categories, including multipurpose drugs, and drugs used selectively for neuropathic pain, bone pain, pain due to bowel obstruction, or musculoskeletal pain. These drugs are selected for a trial based on limited data available and clinical experience; sequential trials may be undertaken when pain is refractory. Multipurpose drugs may be considered for any type of pain. The most useful include corticosteroids and analgesic antidepressants. For neuropathic pain, conventional first-line agents are gabapentinoids, analgesic antidepressants, and corticosteroids. Corticosteroids and bisphosphonates, are used commonly for bone pain. The indications and dosing strategies for these drugs are evolving as scientific evidence and clinical experience accumulate.
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Vydyanathan, Amaresh, Allan L. Brook, Boleslav Kosharskyy, and Samer N. Narouze. Thoracic Nerve Root and Facet Injections: Computed Tomography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199908004.003.0014.
Full textAbstract:
Thoracic back pain patients present with associated radiculopathy, degenerative disc disease, spondylosis, stenosis, scoliosis, rib fractures, tumors, or after undergoing thoracic surgery. Thoracic transforaminal or selective nerve root blocks (SNRBs) may be both therapeutic and diagnostic. Therapeutic injections may include either local anesthetics for pain relief or corticosteroids for anti-inflammatory effects. The two types of pain amenable to therapeutic SNRBs include pain caused by irritation or direct pressure on a spinal nerve and pain originating from anatomic structures that are innervated by the sinuvertebral nerve. Although these blocks are traditionally performed under fluoroscopic guidance, computed tomography (CT) and CT fluoroscopy have been increasingly used to direct needle placement and have been advocated by experts due to superior visualization of the needle tip and the ability to clearly define spinal anatomy and adjacent soft-tissues.
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Zeitlin, Vladimir. Instabilities in Cylindrical Geometry: Vortices and Laboratory Flows. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198804338.003.0011.
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Vortex solutions in cyclo-geostrophic equilibrium are described and their geostrophic and ageostrophic barotropic and baroclinic instabilities are studied along the lines of Chapter 10. Special attention is paid to centrifugal instability which, as the inertial instability of jets, is due to modes trapped in the anticyclonic shear in the vortex, and has asymmetric counterparts. Saturation of this instability is shown to exhibit some specific patterns. Instabilities of intense hurricane-like vortices are analysed and shown to be sensitive to fine details of the vortex profile. Nonlinear saturation of such instabilities exhibits typical secondary meso-vortex structures, and leads to intensification of the vortex. Special attention is paid to instabilities in laboratory flows in rotating cylindrical channels. Classification of these instabilities is given, and their nature, in terms of resonances between different wave modes, is established. Rigid-lid and free-surface configuration with topography are considered and compared with experiments.
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(Editor), Michael Erdil, and O. Bruce Dickerson (Editor), eds. Cumulative Trauma Disorders: Prevention, Evaluation, and Treatment. John Wiley & Sons, 1996.
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Cohen, Jeffrey A., Justin J. Mowchun, Victoria H. Lawson, and Nathaniel M. Robbins. A 56-Year-Old Woman with Small-Fiber Neuropathy and Progressive Leg Pain and Weakness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190491901.003.0021.
Full textAbstract:
The sudden onset of leg weakness and pain may be mistaken for an acute lumbosacral radiculopathy due to a herniated disc. However, in diabetics it is also essential to consider the entity of Bruns-Farland syndrome, or diabetic lumbosacral plexopathy (DLSP). DLSP is uncommon compared with lumbosacral radiculopathy, so delays in diagnosis are the rule rather than the exception. In this chapter we present the clinical characteristics of DLSP and the key features that can help with making a prompt diagnosis. The use of nerve conduction studies and EMG for confirmation of DLSP is reviewed. Treatment options and controversies are discussed.
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Agarwal, Deepti, Ifeyinwa C. Ifeanyi, and Mercy A. Udoji. Intrathecal Drug Delivery Systems. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0030.
Full textAbstract:
Intrathecal drug delivery (ITDD), while initially intended for terminal oncology patients suffering from cancer pain, is currently widely used for chronic nonmalignant pain states. Before intrathecal drug delivery device (IDDD) implantation, patients with nonmalignant chronic pain must be screened for psychologic, behavioral, and medical etiologies for their pain, in addition to having a documented failure of maximal medical therapy and a successful intrathecal drug trial. Classes of drugs used for intrathecal therapy include opioids, local anesthetics, adrenergic agonists, and NMDA receptor agonists. Drugs currently approved by the FDA for ITDD are morphine, ziconotide, and baclofen. Complications of IDDD implantation are surgical (bleeding, infection, CSF leak, nerve injury), mechanical (due to catheter kink, shear, or disconnection), pharmacologic (overdose, incorrect pump settings, contaminated drugs), or medical (hypogonadotropic hypogonadism).
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Shaibani, Aziz. Numbness. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199898152.003.0023.
Full textAbstract:
Sensory symptoms are the most common symptoms in neuromuscular clinics, yet it is difficult to capture them in videos unless they have a very specific pattern and/or they are associated with objective loss of sensation. Distal sensory loss is a common neuropathic finding. Sensory neuropathies may also present with ataxia or severe pain. Multifocal sensory loss is usually vascular (vasculitis, diabetic amyotrophy). Intercostal pain and numbness are due to radiculopathy (diabetic, zoster, or compressive radiculopathy). Thoracic and abdominal radiculopathies are often misdiagnoses as acute coronary or abdominal emergencies respectively. The distribution of pain and the associated tingling and skin sensitivity to touch are important clues to their neuropathic nature.
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Markman, John D. Diagnostic and Clinical Scales for Peripheral Neuropathy. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0120.
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Due to the absence of a definitive pathological finding, objective biomarker, or imaging correlate, neuropathic pain syndromes may be graded as possible or probable depending on the results of neurological assessment. It is important to acknowledge the diagnostic uncertainty inherent in such a grading system based on probability in a condition for which there is no “gold standard” upon which to base validation studies. Neuropathic pain is a multidimensional entity, and specific syndromes may have distinct sensory profiles (i.e. different combinations of sensory signs and symptoms). Clinical suspicion for an underlying neuropathic mechanism increases when pain is characterized by features such as numbness, paresthesias, and allodynia and when the symptoms are generally resistant to standard over-the-counter and prescribed analgesics. In this chapter a variety pain scales are reviewed.
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Candido, Kenneth D., Tatiana Tverdohleb, and Nebojsa Nick Knezevic. Postlaminectomy Syndrome. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0024.
Full textAbstract:
Postlaminectomy syndrome is persistent or recurrent back pain after otherwise anatomically successful lumbar spine surgery. A dramatic increase in the number of low back surgeries has been observed since 1997, with an increased incidence of pain after low back surgery in the range of 5% to 74.6%. The mechanisms contributing to back pain are muscle damage during surgery, muscle spasm, and inflammation, with subsequent development of myofascial pain syndrome as well as other typical and atypical back pain generators. Diagnosis is based primarily on history and physical examination, as well as results of imaging (preoperative and postoperative). Treating postlaminectomy syndrome is challenging, due to lack of evidence-based clinical guidelines. Pharmacologic treatment in combination with interventional management sometimes is not enough, and choosing the right candidates for revision and reoperation surgery is mainly based on the surgeon’s experience and best clinical judgment. In certain circumstances, spinal cord stimulation can achieve better results than reoperation.
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Khanna, Puja. Treatment of acute gout. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0045.
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Acute gout is a common inflammatory arthritis in the adult population. Epidemiological evidence suggests that the prevalence of gout is steadily on the rise due to longevity, coexisting comorbidities, and iatrogenic causes contributing to hyperuricaemia. Acute gout usually presents as a self-limiting flare of synovitis that occurs due to deposition of monosodium urate crystals. The frequency of flares generally increases over time in patients who continue to have hyperuricaemia and their risk factors for acute gout attacks have not been adequately addressed. Effective treatment of acute gouty arthritis is primary focused on pain which is the primary symptom but must target both the pain and underlying inflammation. Acute gout is frequently treated with non-steroidal anti-inflammatory agents, colchicine, and corticosteroids. This chapter reviews the available therapies for management of acute gout and ones that have shown promising results.