Case13.1 A 58-year-old Asian-American male with no other significant past medical history presents to the clinic with acute herpes zoster in the left T4 dermatome. The patient endorsed severe localized pain and tactile allodynia associated with a vesicular eruption. After…
Introduction In March 1927, Dr. Francis Peabody, Harvard Medical School educator and Boston surgeon, published a seminal article in the Journal of the American Medical Association with the oft-quoted maxim, “One of the essential qualities of the clinician is interest…
Though the experience of pain is nearly universal, the experience and burden of pain vary across race, ethnicity, sex, and gender. This chapter will discuss the disparities in the experience and burden of pain and variability in responses to treatment across…
Introduction Pain, defined as the conscious subjective experience associated with real or potential tissue damage, is a product of coordinated activity across large portions of the brain. In contrast, the concept of nociception refers to the objective neural processes triggered…
Origins of the Pain Phenotype For heuristic purposes, we can distinguish the three mechanistically distinct sources of a pain state: (1) high intensity stimulation, (2) local tissue injury and products released secondary to injury and inflammation, and (3) injury to…
Introduction The neural circuits that are responsible for pain and the reactions to pain can be termed the pain system, or perhaps more appropriately, the pain systems . The pain systems include (1) peripheral neurons with a set of peripheral…
The Evolution of Pain Medicine as a Subspecialty As medical knowledge expands, there is a natural progression toward specialization. No physician can become an expert in every field, yet there is discomfort with this inevitable narrowing of focus. The urge…
This chapter covers challenges in defining, measuring, and improving quality in pain management as well as patient safety issues. These are in some cases distinct and in others inextricably interrelated. They are each debated on national and international levels, and…
Rationale for Pain Management Being a Healthcare Policy Priority Chronic pain is a major cause of suffering, disability, lost productivity, and diminished quality of life across the entire life span and around the world. The global burden of chronic pain…
“Chronic pain is a complex biopsychosocial phenomenon that may interfere with many aspects of a person’s life—ability to work, personal relationships, and both physical and mental health”. The National Pain Strategy “Pain for me, arrives as a complete package, and…