Marcus Chronic Pain

A Primary Care Guide to Practical Management
2. Auflage 2009
ISBN: 978-1-60327-465-4
Verlag: Humana Press
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 444 Seiten

Reihe: Current Clinical Practice

Patients with chronic pain present a unique set of challenges to the primary care clinician. In Chronic Pain: A Primary Care Guide to Practical Management, Second Edition, leading pain specialist Dawn A. Marcus, MD, again offers practical, clear, and succinct evidence-based approaches to the diagnosis and treatment of the myriad painful conditions clinicians see in their offices every day, such as headache, back pain, arthritis, fibromyalgia, and abdominal pain. Sections addressing pain management in children, pregnant women, and seniors are also included. This new edition is designed to provide a pragmatic approach to assessing and treating the complex issues and characteristics of chronic pain patients. New chapters expand upon the evidence-based recommendations and practical office tools previously provided, with the addition of new chapters addressing risk management; pain syndromes in the shoulder, upper extremity, and lower extremity; and cancer and end-of-life pain. Chronic Pain: A Primary Care Guide to Practical Management, Second Edition provides strategies and techniques that are designed to improve the confidence with which the primary care physician can approach patients with complex pain complaints, reduce staff stress, and improve patient success.

Autoren/Hrsg.

Marcus, Dawn

Inhaltsverzeichnis

1;Chronic Pain;2
1.1;Title Page;3
1.2;Copyright Page;4
1.3;Series Editor’s Introduction;5
1.4;Preface;7
1.5;Contents;9
1.6;Part I: Introduction;11
1.6.1;Chapter 1;12
1.6.1.1;Chronic Pain and Headache Overview;12
1.6.1.1.1;Case History;12
1.6.1.1.2;Chronic Pain: Epidemiology;13
1.6.1.1.3;Chronic Pain Assessment Tools;15
1.6.1.1.4;Summary;19
1.6.1.1.5;References;19
1.6.2;Chapter 2;20
1.6.2.1;Summary of Pain Management Issues: Frequent Concerns in Treating Chronic Pain Patients;20
1.6.2.1.1;Do People Really Have Chronic Pain Long After They Have Recovered From an Injury?;20
1.6.2.1.2;Is It Unusual for Children to Report Chronic Pain?;21
1.6.2.1.3;Are Aches and Pain Part of the Normal Aging Process?;21
1.6.2.1.4;I Have Heard That You Cannot Really Treat Chronic Pain and Patients Just Need to “Learn to Live With It”. Are There Really Any Effective Treatments for Chronic Pain?;21
1.6.2.1.5;Are Opioids Effective for Patients With Chronic Pain, or Do They Usually Lead to Addiction?;21
1.6.2.1.6;Is Caring for Chronic Pain Patients Too Time-Consuming for a Busy Practice?;22
1.6.2.1.7;Is It Really Important to Address Chronic Pain? Is My Office Time Better Spent Focusing on “Real” Medical Problems, Like Diabetes, Heart Disease, and Hypertension?;22
1.6.3;Chapter 3;23
1.6.3.1;Risk Management in Chronic Pain Practice;23
1.6.3.1.1;Case History;23
1.6.3.1.2;Introduction;24
1.6.3.1.2.1;Mandate to Assess and Alleviate Pain;25
1.6.3.1.2.2;Statistics on Pain Medication Abuse;26
1.6.3.1.2.3;Regulations to Balance Pain Relief and Medication Abuse;27
1.6.3.1.3;Implementing Pain Management Practice Guidelines;28
1.6.3.1.3.1;Identifying Comorbidity;29
1.6.3.1.3.2;Characterizing Goal Setting;30
1.6.3.1.3.3;Evaluating Appropriateness of Opioid Analgesia;30
1.6.3.1.3.4;Requiring Patient Responsibility;32
1.6.3.1.3.5;Charting Documentation;35
1.6.3.1.4;Summary;41
1.6.3.1.5;Test Your Knowledge;41
1.6.3.1.6;References;42
1.7;Part II: Pathogenesis;43
1.7.1;Chapter 4;44
1.7.1.1;Physiology of Chronic Pain;44
1.7.1.1.1;Case History;44
1.7.1.1.2;Introduction;45
1.7.1.1.3;Pathophysiology of Chronic Pain;47
1.7.1.1.3.1;Long-Term Changes from Pain Exposure;49
1.7.1.1.4;Expected Course of Chronic Pain;50
1.7.1.1.5;Predictors of Chronic Pain;51
1.7.1.1.6;Identifying the Malingerer;52
1.7.1.1.7;Summary;54
1.7.1.1.8;Test Your Knowledge;54
1.7.1.1.9;References;55
1.8;Part III: Common Chronic Pain Conditions;57
1.8.1;Chapter 5;58
1.8.1.1;Headache;58
1.8.1.1.1;Case History;58
1.8.1.1.2;Introduction;59
1.8.1.1.3;Epidemiology and Impact of Chronic Headache;59
1.8.1.1.3.1;Chronic Headache Diagnoses Seen in Primary Care;59
1.8.1.1.3.2;Headache Impact and Disability;61
1.8.1.1.4;Evaluation of Headache Complaints;63
1.8.1.1.5;Headache Diagnosis;65
1.8.1.1.6;Headache Treatment;70
1.8.1.1.6.1;Analgesic-Overuse Headache;71
1.8.1.1.6.2;Common Primary Recurring Headaches (Migraine, Tension-Type, Post-trauma);72
1.8.1.1.6.3;Cluster Headache;75
1.8.1.1.6.4;Headache Patterns in Women;76
1.8.1.1.7;Summary;78
1.8.1.1.8;Test Your Knowledge;78
1.8.1.1.9;References;79
1.8.2;Chapter 6;82
1.8.2.1;Neck and Upper Extremity Pain;82
1.8.2.1.1;Case History;82
1.8.2.1.2;Introduction;83
1.8.2.1.3;Epidemiology of Neck and Upper Extremity Pain;84
1.8.2.1.4;Evaluation of Neck and Upper Extremity Pain;86
1.8.2.1.4.1;Neck Pain;86
1.8.2.1.4.1.1;Use of Specialized Testing;89
1.8.2.1.4.2;Shoulder Pain;90
1.8.2.1.4.2.1;Subacromial Bursitis;91
1.8.2.1.4.2.2;Rotator Cuff Tendonitis;92
1.8.2.1.4.3;Hand Pain;92
1.8.2.1.4.3.1;De Quervain’s Tenosynovitis;93
1.8.2.1.4.3.2;Carpal Tunnel Syndrome;94
1.8.2.1.5;Treatment;95
1.8.2.1.5.1;Neck Pain;96
1.8.2.1.5.1.1;Cervical Radiculopathy;96
1.8.2.1.5.2;Shoulder Pain;100
1.8.2.1.5.3;Hand Pain;100
1.8.2.1.5.3.1;De Quervain’s Tenosynovitis;100
1.8.2.1.5.3.2;Carpal Tunnel Syndrome;101
1.8.2.1.6;Summary;101
1.8.2.1.7;Test Your Knowledge;102
1.8.2.1.8;References;103
1.8.3;Chapter 7;106
1.8.3.1;Back and Lower Extremity Pain;106
1.8.3.1.1;Case History;106
1.8.3.1.2;Introduction;107
1.8.3.1.3;Epidemiology;107
1.8.3.1.3.1;Predictors of Chronic Low Back Pain;109
1.8.3.1.4;Evaluation of Back and Lower Extremity Pain;112
1.8.3.1.4.1;Thoracic Pain;113
1.8.3.1.4.2;Lumbar Pain;115
1.8.3.1.4.3;Use of Specialized Testing for Back Pain;117
1.8.3.1.4.3.1;Selecting Candidates for Imaging Studies;118
1.8.3.1.4.3.1.1;Thoracic Spine Pain;119
1.8.3.1.4.3.1.2;Lumbar Spine Pain;119
1.8.3.1.4.4;Chronic Hip Pain;119
1.8.3.1.4.5;Chronic Knee Pain;120
1.8.3.1.4.6;Chronic Foot Pain;120
1.8.3.1.5;Treatment;122
1.8.3.1.5.1;Back Pain;122
1.8.3.1.5.1.1;Thoracic Pain;122
1.8.3.1.5.1.2;Lumbar Pain;123
1.8.3.1.5.1.2.1;Acute Back Pain Treatment;124
1.8.3.1.5.1.2.2;Chronic Back Pain Treatment;125
1.8.3.1.5.1.2.3;Work and Chronic Back Pain;127
1.8.3.1.5.2;Chronic Knee Pain;128
1.8.3.1.5.3;Chronic Foot Pain;128
1.8.3.1.6;Summary;128
1.8.3.1.7;Test your Knowledge;129
1.8.3.1.8;References;130
1.8.4;Chapter 8;134
1.8.4.1;Abdominal Pain;134
1.8.4.1.1;Case History;134
1.8.4.1.2;Introduction;135
1.8.4.1.3;Epidemiology;136
1.8.4.1.3.1;Irritable Bowel Syndrome;136
1.8.4.1.3.2;Myofascial Abdominal Wall Pain;137
1.8.4.1.3.3;Chronic Pancreatitis;139
1.8.4.1.4;Evaluation;139
1.8.4.1.4.1;Irritable Bowel Syndrome;140
1.8.4.1.4.2;Myofascial Pain;141
1.8.4.1.4.3;Chronic Pancreatitis;142
1.8.4.1.4.4;Psychological Factors;143
1.8.4.1.5;Treatment;144
1.8.4.1.5.1;Irritable Bowel Syndrome;145
1.8.4.1.5.2;Myofascial Abdominal Wall Pain;146
1.8.4.1.5.3;Chronic Pancreatitis;146
1.8.4.1.6;Summary;147
1.8.4.1.7;Test Your Knowledge;148
1.8.4.1.8;References;149
1.8.5;Chapter 9;151
1.8.5.1;Arthritis;151
1.8.5.1.1;Case History;151
1.8.5.1.2;Introduction;152
1.8.5.1.3;Epidemiology;153
1.8.5.1.4;Economic Impact of Arthritis;154
1.8.5.2;Arthritis Evaluation;154
1.8.5.2.1;Arthritis Diagnosis;157
1.8.5.2.1.1;Osteoarthritis;157
1.8.5.2.1.2;Rheumatoid Arthritis;160
1.8.5.2.2;Arthritis Treatment;163
1.8.5.2.2.1;Medications;164
1.8.5.2.2.1.1;Osteoarthritis;164
1.8.5.2.2.1.2;Rheumatoid Arthritis;164
1.8.5.2.2.2;Non-pharmacological Therapy;167
1.8.5.2.2.2.1;Weight Reduction;167
1.8.5.2.2.2.2;Exercise;168
1.8.5.2.2.2.3;Psychological Treatments;169
1.8.5.2.2.2.4;Alternative/Complementary Medicine;170
1.8.5.2.3;Summary;170
1.8.5.2.4;Test Your Knowledge;171
1.8.5.2.5;References;172
1.8.6;Chapter 10;176
1.8.6.1;Neuropathic Pain;176
1.8.6.1.1;Case History;176
1.8.6.1.2;Introduction;177
1.8.6.1.3;Epidemiology of Common Neuropathic Pain Syndromes;178
1.8.6.1.3.1;Diabetic Neuropathy;178
1.8.6.1.3.2;Postherpetic Neuralgia;179
1.8.6.1.3.3;Complex Regional Pain Syndrome;180
1.8.6.1.3.4;Cancer-Related Neuropathy;182
1.8.6.1.3.5;HIV-Related Neuropathy;182
1.8.6.1.4;Evaluation of Neuropathic Pain;182
1.8.6.1.5;Treatment of Neuropathic Pain;185
1.8.6.1.5.1;First-Line Therapy;185
1.8.6.1.5.1.1;Antiepileptic Drugs;185
1.8.6.1.5.1.2;Antidepressants;187
1.8.6.1.5.2;Second-Line Therapy;188
1.8.6.1.5.2.1;Topical Agents;188
1.8.6.1.5.2.2;Opioids;188
1.8.6.1.5.3;Treatment of Individual Pain Syndromes;188
1.8.6.1.5.3.1;Postherpetic Neuralgia;188
1.8.6.1.5.3.2;Complex Regional Pain Syndrome;190
1.8.6.1.6;Summary;191
1.8.6.1.7;Test Your Knowledge;191
1.8.6.1.8;References;192
1.8.7;Chapter 11;195
1.8.7.1;Myofascial Pain;195
1.8.7.1.1;Case History;195
1.8.7.1.2;Introduction;196
1.8.7.1.3;Epidemiology;198
1.8.7.1.4;Evaluation;203
1.8.7.1.5;Treatment;204
1.8.7.1.5.1;Physical Therapy;204
1.8.7.1.5.2;Injections;207
1.8.7.1.5.3;Pharmacological Therapy;207
1.8.7.1.5.4;Psychological Therapy;208
1.8.7.1.6;Summary;209
1.8.7.1.7;Test Your Knowledge;209
1.8.7.1.8;References;210
1.8.8;Chapter 12;212
1.8.8.1;Fibromyalgia;212
1.8.8.2;Case History;212
1.8.8.3;Introduction;213
1.8.8.4;Epidemiology;215
1.8.8.4.1;Psychological Comorbidity;217
1.8.8.4.2;Disability;218
1.8.8.5;Evaluation;219
1.8.8.5.1;Assessment Measures;219
1.8.8.6;Treatment;220
1.8.8.6.1;Pharmacological Treatment;222
1.8.8.6.2;Non-pharmacologic Treatments;223
1.8.8.6.3;Complementary and Alternative Medicine;223
1.8.8.6.4;Individualized, Symptom-Focused, Multidisciplinary Treatment;224
1.8.8.7;Summary;226
1.8.8.8;Test Your Knowledge;226
1.8.8.9;References;227
1.8.9;Chapter 13;230
1.8.9.1;Cancer Pain;230
1.8.9.1.1;Case History;230
1.8.9.1.2;Introduction;230
1.8.9.1.3;Epidemiology of Cancer-Related Pain;231
1.8.9.1.4;Cancer Pain Assessement;232
1.8.9.1.4.1;Quantifying Cancer Pain Severity;233
1.8.9.1.5;Cancer Pain Treatment;234
1.8.9.1.5.1;Opioids for Cancer Pain;235
1.8.9.1.5.2;Breakthrough Pain;237
1.8.9.1.5.3;Radiation;238
1.8.9.1.5.4;Interventional Therapies;239
1.8.9.1.6;Summary;240
1.8.9.1.7;Test Your Knowledge;240
1.8.9.1.8;References;241
1.9;Part IV: Special Groups;243
1.9.1;Chapter 14;244
1.9.1.1;Pediatric Pain;244
1.9.1.1.1;Case History;244
1.9.1.1.2;Introduction;245
1.9.1.1.3;Common Chronic Pain Syndromes in Children and Adolescents;248
1.9.1.1.3.1;Musculoskeletal Pain;249
1.9.1.1.3.2;Headache;249
1.9.1.1.3.3;Recurrent Abdominal Pain;251
1.9.1.1.3.4;Chest Pain;253
1.9.1.1.4;Assessment;253
1.9.1.1.4.1;Musculoskeletal Pain;254
1.9.1.1.4.2;Headache;254
1.9.1.1.4.3;Recurrent Abdominal Pain;257
1.9.1.1.4.4;Chest Pain;257
1.9.1.1.4.5;Psychosocial Factors;258
1.9.1.1.5;Treatment;258
1.9.1.1.5.1;Headache Therapy;259
1.9.1.1.6;Summary;260
1.9.1.1.7;Test Your Knowledge;260
1.9.1.1.8;References;261
1.9.2;Chapter 15;265
1.9.2.1;Pregnancy and Pain;265
1.9.2.1.1;Case History;265
1.9.2.1.2;Introduction;266
1.9.2.1.3;Common Pain Syndromes During Pregnancy;266
1.9.2.1.3.1;Headache;266
1.9.2.1.3.2;Back Pain;269
1.9.2.1.3.3;Neuropathy;270
1.9.2.1.4;Testing During Pregnancy;273
1.9.2.1.5;Treatment;274
1.9.2.1.5.1;Nonpharmacological Therapy;274
1.9.2.1.5.2;Medications During Pregnancy and Lactation;276
1.9.2.1.6;Summary;277
1.9.2.1.7;Test Your Knowledge;277
1.9.2.1.8;References;278
1.9.3;Chapter 16;282
1.9.3.1;Geriatrics and Chronic Pain;282
1.9.3.1.1;Case History;282
1.9.3.1.2;Introduction;283
1.9.3.1.3;Common Chronic Pain Complaints;285
1.9.3.1.3.1;Musculoskeletal Pain;285
1.9.3.1.3.1.1;Osteoporosis and Fractures;285
1.9.3.1.3.1.2;Lumbar Stenosis;286
1.9.3.1.3.2;Headache;286
1.9.3.1.3.2.1;Giant-Cell (Temporal) Arteritis;287
1.9.3.1.3.2.2;Trigeminal Neuralgia;288
1.9.3.1.3.2.3;Assessment Tools;288
1.9.3.1.4;Treatment;290
1.9.3.1.4.1;Nonpharmacological Therapy;290
1.9.3.1.4.2;Medications;291
1.9.3.1.4.3;Osteoporosis and Fractures;292
1.9.3.1.4.4;Lumbar Stenosis;292
1.9.3.1.4.5;Giant-Cell (Temporal) Arteritis;293
1.9.3.1.4.6;Trigeminal Neuralgia;295
1.9.3.1.5;Summary;296
1.9.3.1.6;Test Your Knowledge;297
1.9.3.1.7;References;298
1.9.4;Chapter 17;301
1.9.4.1;Gender and Ethnic Differences in Pain Experience;301
1.9.4.1.1;Case History;301
1.9.4.1.2;Introduction;302
1.9.4.1.3;Gender Differences in Pain Experience;303
1.9.4.1.3.1;Pain Perception Differs Between Genders;303
1.9.4.1.3.2;Psychological Differences in Pain Perception;305
1.9.4.1.3.3;Gender and Chronic Pain Treatment;306
1.9.4.1.3.3.1;Gender Differences in Seeking Treatment;306
1.9.4.1.3.3.2;Gender-Specific Response to Pain Therapy;306
1.9.4.1.4;Ethnic/Cultural Differences in Pain Experience;307
1.9.4.1.4.1;Pain Perception and Ethnicity;307
1.9.4.1.4.2;Treatment Selection and Ethnicity;309
1.9.4.1.4.2.1;Medications;309
1.9.4.1.4.2.2;Complementary and Alternative and Medicine;310
1.9.4.1.5;Summary;311
1.9.4.1.6;Test Your Knowledge;312
1.9.4.1.7;References;312
1.10;Part V: Chronic Pain Treatment;316
1.10.1;Chapter 18;317
1.10.1.1;Lifestyle and Psychological Issues;317
1.10.1.1.1;Introduction;318
1.10.1.1.2;Obesity;318
1.10.1.1.2.1;Obesity and Chronic Pain Comorbidity;318
1.10.1.1.2.2;Obesity Assessment;320
1.10.1.1.2.3;Obesity Treatment for Patients with Chronic Pain;321
1.10.1.1.3;Sleep;323
1.10.1.1.3.1;Sleep Disturbance and Headache;324
1.10.1.1.3.2;Treatment of Insomnia;325
1.10.1.1.4;Smoking;326
1.10.1.1.4.1;Prevalence of Pain Based on Smoking;326
1.10.1.1.4.2;Impact of Smoking on Chronic Pain Treatment;326
1.10.1.1.5;Abuse;327
1.10.1.1.6;Psychological Distress;329
1.10.1.1.6.1;Premorbid Psychological Factors;330
1.10.1.1.6.2;Current Psychological Factors;331
1.10.1.1.7;Stress;331
1.10.1.1.8;Depression and Anxiety;332
1.10.1.1.9;Primary and Secondary Gain;333
1.10.1.1.9.1;Assessment for Psychological Distress;333
1.10.1.1.9.2;Psychological Treatment;334
1.10.1.1.10;Treating Comorbid Psychological Symptoms;334
1.10.1.1.11;Psychological Treatment of Chronic Pain;334
1.10.1.1.12;Summary;336
1.10.1.1.13;Test Your Knowledge;338
1.10.1.1.14;References;339
1.10.2;Chapter 19;343
1.10.2.1;Analgesics and Opioids;343
1.10.2.1.1;Case History;343
1.10.2.1.2;Introduction;344
1.10.2.1.3;Selecting Pain Relief Medication;345
1.10.2.1.3.1;Non-opioid Analgesics;346
1.10.2.1.3.2;Opioid Analgesics;347
1.10.2.1.4;Incorporating Opioids into the Overall Management Plan;349
1.10.2.1.5;Opioid Abuse and Misuse;350
1.10.2.1.6;Determining Appropriate Dosing;351
1.10.2.1.6.1;Coanalgesics;354
1.10.2.1.7;Antidepressants;354
1.10.2.1.8;Neurostabilizing Antiepileptics;356
1.10.2.1.9;Muscle Relaxants;356
1.10.2.1.10;Topical Agents;356
1.10.2.1.11;Summary;356
1.10.2.1.12;Test Your Knowledge;357
1.10.2.1.13;References;358
1.10.3;Chapter 20;360
1.10.3.1;Managing Pain at End of Life;360
1.10.3.1.1;Case History;360
1.10.3.1.2;Introduction;361
1.10.3.1.3;Defining End-of-Life Care;361
1.10.3.1.3.1;Pain at End of Life;363
1.10.3.1.4;Assessment;365
1.10.3.1.5;Treatment;367
1.10.3.1.5.1;Pain Control;368
1.10.3.1.5.2;Hospice Care;369
1.10.3.1.6;Summary;370
1.10.3.1.7;Test Your Knowledge;370
1.10.3.1.8;References;371
1.10.4;Chapter 21;373
1.10.4.1;Appendices: Patient Educational Materials;373
1.10.4.1.1;Case Histories;373
1.10.4.1.2;References;375
1.11;Appendix A: Rationale Behind Pain Management;376
1.12;Appendix B: Exercise and Pain Management;380
1.13;Appendix C: Psychological Screening and Pain Management Skills;392
1.14;Appendix D: Pain Medications;396
1.15;Appendix E: Chronic Headache;397
1.16;Appendix F: Neuropathic Pain;412
1.17;Appendix G: Fibromyalgia;415
1.18;Appendix H: Pain Drawing;418
1.19;Index;419