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Geriatric Pain Management

Key Points Evidence-based approaches to assessment and management can help older adults thrive and have a good quality of life. A wide range of validated tools are available to assess pain in older adults, including individuals with cognitive impairment. A multimodal, comprehensive approach to pain management is imperative. Providers need to be aware of and work to address barriers that often occur in assessing and managing…

Pediatric Chronic Pain Management

~ Chronic pain is a significant yet underreported problem in the pediatric population, with a prevalence of up to 25%–45%. It has psychological, emotional, and social implications for both the child and the family. Common pain related functional issues include sleep problems, inability to pursue hobbies, eating difficulties, school absence, and inability to interact with friends. The potential for such consequences to negatively impact a child’s…

Pelvic Pain

Introduction Approximately 10% of people in the United States are living with pelvic pain. Many pain specialists, experts in their fields and adept at managing boundaries of care, decline referrals for pelvic pain. Nevertheless, the pain specialist skilled at differential diagnosis and collaboration is best positioned to impact the outcome in these patients. In this chapter, we outline the differential diagnosis, discuss workup and evaluation, and…

Visceral Pain

Introduction Chronic visceral pain is common. Abdominal pain is among the main reasons for physician visits, with more than 12 million consultations each year in the United States. Patients with visceral pain present unique challenges as the pain is often poorly localized, associated with strong autonomic reactions and changes in visceral function. Pain management, in turn, may further alter visceral function, with opioid effects on the…

Orofacial Pain

Key Points Pains that involve the face, head, and neck are very common in clinical practice. These painful conditions are often unique and deserving of special attention. The common descriptive terms for orofacial pain symptoms are frequently misleading. To avoid confusion, pain clinicians should be familiar with the International Headache Society’s Diagnostic Criteria for Head and Neck Disorders, the ICOP, and the diagnostic criteria for TMD.…

Cervicogenic Headache, Post-meningeal Puncture Headache, and Spontaneous Intracranial Hypotension

Cervicogenic Headache Definition The International Headache Society (IHS) defines cervicogenic headache as “Headache caused by a disorder of the cervical spine and its component bony, disc and/or soft tissue elements, usually but not invariably accompanied by neck pain.” Epidemiology The incidence of cervicogenic headache is 2% when using the IHS criteria and up to 4% when using the Cervicogenic Headache International Study Group (CHISG) criteria. Furthermore,…

Headache Management

Introduction Headache has plagued humans since the beginning of recorded time. It is one of the most common medical complaints and accounts for more than 18 million outpatient visits per year in the United States. More than 1% of physician’s office visits and emergency department visits are primarily for headaches. , In 1988 the International Headache Society (IHS) published a formal classification system for the diagnosis…

Chronic Widespread Pain

~ Chronic widespread pain presents challenges to patients, clinicians, and researchers in diagnosing and treating its complex manifestations. Chronic widespread pain is a broad category of heterogeneous, centrally mediated pain conditions. While recent advances in understanding centrally mediated pain have improved its mechanistic understanding, consistently applying clinical diagnosis and treatment remains challenging. The unifying theme for these disorders is pain and sensory hyper-responsiveness, which can be…

Evaluation and Treatment of Pain in Selected Neurologic Disorders

Pain in Selected Neurologic Disorders Although chronic pain may be the defining feature of certain neurologic disorders, physicians often focus on treatments aimed at addressing the primary neurologic condition. As most comorbidities may come from pain associated with the condition, it should be addressed early during treatment. Chronic pain is a three-dimensional process consisting of biologic, psychological, and social components. All three interact dynamically and affect…

Evaluation and Treatment of Complex Regional Pain Syndrome

Introduction As defined by the International Association for the Study of Pain (IASP), complex regional pain syndrome (CRPS) is a collection of locally painful conditions following trauma, usually manifesting distally and exceeding the clinical course of the original trauma in severity and duration, often resulting in a significant impairment of motor skills, and is characterized by a variable progression over time. CRPS can develop as a…

Evaluation and Treatment of Neuropathic Pain Syndromes

Introduction Neuropathic pain comprises a wide range of heterogeneous conditions. Various types of neuropathic pain may have distinct pathophysiologic causes and different clinical signs and symptoms. Despite the diversity of conditions classified as “neuropathic pain,” many potentially share common underlying mechanisms of nociception, including neuronal hyperexcitability, but others may not. This may, in part, explain why certain analgesic agents are relatively effective for a wide range…

Evaluation and Treatment of Cancer-Related Pain

Introduction Cancer is a disease process that results when cellular changes cause uncontrolled growth and division of cells. It continues to be a major health problem and is the second leading cause of death in the United States. The three most prevalent cancers in 2019 were prostate, colon, and rectum, and melanoma of the skin among males, and breast, uterine corpus, and colon and rectum among…

Neurosurgical Approaches to Pain Management

Neurosurgeons have a long history of surgical treatment for pain, particularly cancer pain. The notion that sectioning pain pathways could achieve pain control was first introduced by Spiller and Martin in 1912, and was followed by the development of a whole array of surgical procedures aimed at interrupting ascending pain signals throughout different parts of the central nervous system. Two major approaches are used when targeting…

Facet Pain: Pathogenesis, Diagnosis, and Treatment

Introduction (Importance of the Problem) Low back pain (LBP) and neck pain represent two of the five leading causes of medical disability worldwide. More than 75% of patients reporting spine pain are between 18 and 65 years old, thereby adding to the burden through lost productivity and wages. Although the prevalence of LBP varies greatly throughout the literature, some lifetime prevalence estimates are as high as…

Buttock and Sciatica Pain

## Buttock pain can originate from a heterogeneous collection of pathologic conditions. Similar to low back pain, the precise diagnosis and treatment of pain in this region can be challenging. This chapter focuses on pain largely experienced in the buttock region and originates below the lumbosacral junction. Pain generators can be intrinsic to the buttock region, such as the sacroiliac joint complex (SIJC), coccyx, piriformis muscle…

Low Back Pain Disorders

Introduction Musculoskeletal disorders are a common source of pain and disability globally and are ubiquitous in industrialized nations; among them, low back pain (LBP) is the most common. Second only to respiratory tract infections, LBP is the most frequent reason for outpatient doctor visits and, as it often affects the young and the employed, is the most common cause of work related disability. The rising expenditures…

Evaluation and Treatment of Acute Pain in Children

Recognition and treatment of acute pain is a vital component of pediatric medicine. , Adequate pain control is necessary to prevent adverse neurohormonal and developmental changes in response to painful stimuli. Fortunately, advances in pharmacologic therapy and regional anesthesia techniques have helped expand the scope of pediatric acute pain management. In addition, the establishment of pediatric acute pain services has played an important role in ensuring…

Evaluation and Treatment of Postoperative Pain in Patients With Opioid Use Disorder

Background Because of the dramatic increase in the number of opioid related deaths since 1999, the opioid epidemic was declared a “public health emergency” in the United States on October 26, 2017. The opioid abuse epidemic arose in part from a lack of acknowledgment about the high addiction potential of opioids along with aggressive widespread pharmaceutical company marketing of prescription opioids for both acute and chronic…

Regional and Multimodal Treatments of Perioperative Pain

Introduction According to the American Society of Anesthesiologists (ASA) practice guidelines, acute pain in the perioperative setting is defined as the presence of pain in a surgical patient after a procedure. The United States Institute of Medicine reported that despite advancements in perioperative pain control, 80% of patients who have surgery report postoperative pain, and 88% of these patients grade their severity as moderate, severe, or…

Evaluation and Pharmacologic Treatment of Postoperative Pain

Pain after a surgical procedure is inevitable. However, as stated by Haruki Murakami, “Suffering is optional.” Management of postoperative pain has come a full circle. The Joint Commission recognized the underassessment and undertreatment of pain in 2000 and introduced the concept of pain as the fifth vital sign. However, the emphasis of The Joint Commission on the use of opioids for pain control has been criticized…