Key Topics in Chronic Pain (2nd edition) by Chris J. Glynn

545978462c8c561-261x361.jpg Author Chris J. Glynn
Isbn 9781859960387
File size 1.24MB
Year 2002
Pages 269
Language English
File format PDF
Category medicine


KEY TOPICS IN CHRONIC PAIN SECOND EDITION The KEY TOPICS Series Advisors: T.M.Craft Department of Anaesthesia and Intensive Care, Royal United Hospital, Bath, UK C.S.Garrard Intensive Therapy Unit, John Radcliffe Hospital, Oxford, UK P.M.Upton Department of Anaesthesia, Royal Cornwall Hospital, Treliske, Truro, UK Accident and Emergency Medicine, Second Edition Anaesthesia, Clinical Aspects, Third Edition Cardiovascular Medicine Chronic Pain, Second Edition Critical Care Evidence-Based Medicine Gastroenterology General Surgery Neonatology Neurology Obstetrics and Gynaecology, Second Edition Oncology Ophthalmology, Second Edition Oral and Maxillofacial Surgery Orthopaedic Surgery Orthopaedic Trauma Surgery Otolaryngology, Second Edition Paediatrics, Second Edition Psychiatry Renal M Medicine Respiratory Medicine iii Thoracic Surgery Trauma Forthcoming titles include: Acute Poisoning Cardiac Surgery Cardio-Respiratory Physiotherapy Clinical Research and Statistics Urology KEY TOPICS IN CHRONIC PAIN SECOND EDITION Kate M.Grady BSc, MB, BS, FRCA Consultant in Anaesthesia and Chronic Pain Management, South Manchester University Hospitals NHS Trust, Manchester, UK Andrew M.Severn MA, MB, FRCA Consultant in Anaesthesia and Chronic Pain Management, Royal Lancaster Infirmary, Lancaster, UK Paul R.Eldridge MA, MChir, FRCS Consultant Neurosurgeon, Walton Centre for Neurology and Neurosurgery, Liverpool, UK Consultant Editor Chris J.Glynn MB, BS, DCH, FRCA, MSc Churchill Hospital, Oxford, UK © BIOS Scientific Publishers Limited, 2002 First published 1997 (ISBN 1 85996 076 6 (Print Edition)) This edition published in the Taylor & Francis e-Library, 2005. “To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to” Reprinted 1999 Second Edition 2002 (ISBN 1 85996 038 3 (Print Edition)) Reprinted 2002, (twice) All rights reserved. No part of this book may be reproduced or transmitted, in any form or by any means, without permission. A CIP catalogue record for this book is available from the British Library. ISBN 0-203-45032-9 Master e-book ISBN ISBN 0-203-45893-1 (Adobe eReader Format) ISBN 1 85996 038 3 (Print Edition) BIOS Scientific Publishers Ltd 9 Newtec Place, Magdalen Road, Oxford OX4 1RE, UK Tel. +44 (0)1865 726286. Fax +44 (0)1865 246823 World Wide Web home page: Distributed exclusively in the United States, its dependent territories, Canada, Mexico, Central and South America, and the Caribbean by Springer-Verlag New York Inc, 175 Fifth Avenue, New York, USA, by arrangement with BIOS Scientific Publishers Ltd, 9 Newtec Place, Magdalen Road, Oxford OX4 1RE, UK. Important Note from the Publisher The information contained within this book was obtained by BIOS Scientific Publishers Ltd from sources believed by us to be reliable. However, while every effort has been made to ensure its accuracy, no responsibility for loss or injury whatsoever occasioned to any person acting or refraining from action as a result of information contained herein can be accepted by the authors or publishers. The reader should remember that medicine is a constantly evolving science and while the authors and publishers have ensured that all dosages, applications and practices are based on current indications, there may be specific practices which differ between communities. You should always follow the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which you are practising. Production Editor: Nadine Séveno CONTENTS Abbreviations ix Preface to the second edition xi Preface to the first edition Names of medical substances xiii xv Introduction—What is the pain clinic? 1 Assessment of evidence—Evidence in decision-makinga 6 Assessment of evidence—Evidence-based medicine and the science of reviewing researcha 11 Assessment of evidence—Expressing and interpreting the results of researcha 17 Assessment of chronic pain—History 19 Assessment of chronic pain—Examination 22 Assessment of chronic pain—Psychosocialb 28 Back pain—Medical managementb 32 Back pain—Injectionsb 39 Back pain—Surgery 44 Burns 52 Cancer—Intrathecal and epidural infusions 55 Cancer—Nerve blocks 60 Cancer—Opioid drugs 63 Cancer—Other drugs 68 Chest pain 71 Complex regional pain syndromes 76 Depression and pain 82 vii Facial pain 86 Gastrointestinal pain 90 Headache 93 Immunodeficiency disease and pain 101 Multiple sclerosis 104 Musculoskeletal pain syndromesb 109 Neck pain 24 Neuralgia and peripheral neuropathy 120 Neuralgia—trigeminal and glossopharyngeal 124 Neuropathic pain—an overview 131 Nociceptive pain—an overview 136 Osteoarthritis 141 Osteoporosis 143 Pelvic and vulval pain 146 Post-amputation pain 152 Post-herpetic neuralgia 156 Pregnancy 160 Scars, neuromata, post-surgical pain 168 Spinal cord injury 174 Stroke 177 Sympathetic nervous system and pain 180 Therapy—Antiarrhythmics 183 Therapy—Anticonvulsants 185 Therapy—Antidepressants 188 Therapy—Anti-inflammatory drugs 191 Therapy—Botulinum toxin 195 Therapy—Cannabinoids 198 Therapy—Capsaicin 201 Therapy—Ketamine and other NMDA antagonists 203 viii Therapy—Nerve blocks: autonomic 206 Therapy—Nerve blocks: somatic and lesion techniques 210 Therapy—Neurosurgical techniques 214 Therapy—Opioids in chronic painb 221 Therapy—Physicalb 226 Therapy—Psychological 229 Therapy—Spinalcord and brain stimulation 232 Therapy—TENS, acupuncture and laser stimulation 242 Index 247 Contributed by A.F.Smith (FRCA, MRCP), Consultant Anaesthetist, Royal Lancaster Infirmary, Lancaster, UK. b Includes contribution from B.Tait (FRACP, FFPM), Consultant Physician, Avenue Consultancy, Christchurch, New Zealand. a ABBREVIATIONS AIDS AVM CABG CGRP CNS COXIBs CPPWOP CPSP CRPS CSF CT DMARD DREZ DSM EBM ESR GABA HAD HRT IASP IBS ICD LLLT MS MVD NGF NMDA acquired immune deficiency syndrome arteriovenous malformation coronary artery bypass graft calcitonin gene-related peptide central nervous system cyclo-oxygenase II inhibitors chronic pelvic pain without obvious pathology central post-stroke pain complex regional pain syndromes cerebrospinal fluid computed tomography disease-modifying antirheumatic drugs dorsal root entry zone Diagnostic and Statistical Manual evidence-based medicine erythrocyte sedimentation rate γ-amino butyric acid hospital anxiety and depression index hormone replacement therapy International Association for the Study of Pain irritable bowel syndrome International Classification of Disease low-level laser therapy multiple sclerosis microvascular decompression nerve growth factor N-methyl-D-aspartic acid x NNH NNT NSAIDs PHN PVD RCT SIP SLR SMP SSRI TCA TENS TGN THC VSCC WHO number needed to harm number needed to treat nonsteroidal anti-inflammatory drugs post-herpetic neuralgia peripheral vascular disease randomized controlled trial sympathetically independent pain straight leg raise sympathetically maintained pain serotonin specific re-uptake inhibitors tricyclic antidepressants transcutaneous electrical nerve stimulation trigeminal neuralgia tetrahydrocannabinol voltage-sensitive calcium channels World Health Organization PREFACE TO THE SECOND EDITION Four years after the publication of Key Topics in Chronic Pain it is time to ask what has changed. When we considered the invitation, the opportunity to modernize a few chapters was tempting, but we did not anticipate a complete revision. The science of evidence-based medicine is evolving. Four years ago a few systematic reviews were easy to acquire, and relevant randomized controlled trials could be numbered. Now there are hundreds of each and we have had to be selective in choosing those which we believe are relevant to practice. We have therefore removed many references to randomized controlled trials in favour of systematic reviews. We have asked an expert to steer us through the conflicting principles of evidence-based medicine to allow us to publish treatments according to the quality of evidence afforded. At the same time we have kept an ear out for the respected colleagues who have valuable advice to offer on managing difficult problems. We have used the term ‘it is reported that’ or ‘it is claimed that’ for anecdotal, case report and uncontrolled observations, and the term ‘it is shown that’ or ‘it is proven’ for controlled trials. The last edition was designed specifically for the needs of postgraduate trainees in anaesthesia. This edition, we hope, will introduce the subject in a real way to other doctors, of all specialties and grades, and to nurses, therapists, psychologists and alternative practitioners. The management of chronic pain is the science and art of rehabilitation. We believe that this concept sets apart legitimate approaches, by whomever they are practised, from less valuable treatments. There is pressure from all sides to respect opinions from a variety of sources, both ‘conventional’ and ‘alternative’. It is not the function of this book to judge the various contenders for a rightful place in multidisciplinary practice, but it can at least set some rules by which practice can be judged. Chronic pain remains a growing subspecialty, and its coexistence with the discipline of acute pain management is a relationship we are keen to promote. Hence the reader will find chapters on burn pain and pain during pregnancy, in the hope that a handy reference to taxing ‘acute pain’ problems will be available here. xii The relationship between doctors, managers and their political masters has changed irrevocably in four years, and we have therefore made reference to this and the relationship of the pain clinician to the local community. By strange coincidence the day the manuscript was delivered to the publishers was also the day that Professor Patrick Wall died (8th of August 2001). Patrick Wall was a major influence on the philosophy of this book. His seminal 1965 paper with Ronald Melzack which described the ‘gate control’ theory of pain is an example of his influence. His direct personal encouragement of one of the authors and the opinions which he so eloquently expressed at scientific meetings and which have found their way into the text is another. We hope that in some measure through the text the spirit of Patrick Wall’s challenging approach to the problems of patients with pain will be passed on to another generation of clinicians. Our trainees have been at the forefront of our minds when writing this, and we are pleased to see many moving on to consultant posts around the world. We could not have started without the encouragement of Sara and Frank, and are privileged to welcome Paul Eldridge, a neurosurgeon, as an author. Andrew Smith, who is Editor of the Cochrane Anaesthesia Review Group, and Barrie Tait, a rehabilitation specialist, have contributed to the text. We also acknowledge the support of Jai Kulkarni, Michael Sharpe, Wendy Makin and Charles Cox for commenting on the manuscripts and Chris Glynn for his help in pulling the project together. Andrew Severn, Kathryn Grady PREFACE TO THE FIRST EDITION This latest volume in the Key Topics series aims to provide the health professional with up-to-date information about a range of issues in the management of chronic pain. It is not a substitute for the larger texts, nor is it an attempt to provide a comprehensive reference to palliative care or painful rheumatological and neurological conditions. It is a working manual of the common problems of management of the chronic pain sufferer, the patient in whom investigations have excluded treatable disease. The book is designed for specialist registrars, general practitioners, psychologists, nurses and physiotherapists. It is written by two hospital consultants responsible for running Pain Clinics in general hospitals, with two chapters provided by a colleague in a neurosurgical centre. What is chronic pain? A definition that describes a chronic condition as a long-standing acute condition is inadequate. Tissues involved in chronic inflammation, for example, can be distinguished microscopically from those with acute inflammation by changes of regeneration and repair. Once a condition becomes chronic, secondary changes make for an immediate situation in which management involves treating complications of the condition rather than the condition itself. Thus it is with chronic pain. Chronic pain is not a symptom of an illness. It is an illness. It has its own symptoms, signs and complications. The professional caring for the chronic pain sufferer looks for complications of chronic pain and attempts to treat these. The original cause of the chronic pain may be irrelevant. If there is a possible cure the professional is advised to ascertain the degree to which the complications of chronic pain have become apparent: the complications themselves may seriously limit the benefit that might otherwise be obtained from treatment of the pain. This book The opening chapters explain the terms with which the professional should be familiar, and some of the practical problems encountered in Pain Clinic practice. xiv They should be read as an introduction. Elsewhere the book is arranged according to topics in alphabetical order, in the format familiar to readers of the series. Cross-reference may be made to other chapters. The chapters on cancer pain are kept together. We have attempted to organize our topics so that evidence-based medicine is afforded high priority. Yet we accept that much of our practice, and that of those with whom we meet regularly to share clinical problems, is based on precedent and experience. Our sources include comments made by colleagues in lectures at national and international meetings, and informally. It is impossible to acknowledge all of these sources. The book is dedicated to our trainees and those other professionals who have laboured with us to build up our respective practices. In particular we acknowledge the support of Chris Glynn, Sara Severn, Frank Grady, Alan Severn and Barrie Tait. Andrew Severn, Kathryn Grady Names of Medical Substances In accordance with directive 92/27/EEC, this book adheres to the following guidelines on naming of medicinal substances (rINN, Recommended International Non-proprietary Name; BAN, British Approved Name). List 1—Both names to appear UK Name rINN 1adrenaline epinephrine tetracaine bendroflumethiazide trihexyphenidyl chlorphenamine dicycloverine dosulepin formoterol fludroxycortide furosemide hydroxycarbamide lidocaine levomepromazine methylthioninium chloride mitoxantrone chlormethine acenocoumarol norepinephrine pentoxyifylline procaine benzylpenicillin calcitonin (salmon) moxisylyte levothyroxine sodium alimemazine amethocaine bendrofluazide benzhexol chlorpheniramine dicyclomine dothiepin eformoterol flurandrenolone frusemide hydroxyurea lignocaine methotrimeprazine methylene blue mitozantrone mustine nicoumalone ‘noradrenaline oxypentifylline procaine penicillin salcatonin thymoxamine thyroxine sodium trimeprazine xvi List 2—rINN to appear exclusively Former BAN rINN/new BAN amoxycillin amphetamine amylobarbitone amylobarbitone sodium beclomethasone benorylate busulphan butobarbitone carticaine cephalexin cephamandole nafate cephazolin cephradine chloral betaine chlorbutol chlormethiazole chlorathalidone cholecalciferol cholestyramine clomiphene colistin sulphomethate sodium corticotrophin cysteamine danthron desoxymethasone dexamphetamine dibromopropamidine dienoestrol dimethicone(s) dimethyl sulphoxide doxycycline hydrochloride (hemihydrate hemiethanolate) ethancrynic acid ethamsylate ethinyloestradiol ethynodiol flumethasone flupenthixol amoxicillin amfetamine amobarbital amobarbital sodium beclometasone benorilate busulfan butobarbital articane cefalexin cefamandole nafate cefazolin cefradine cloral betaine chlorobutanol clomethiazole chlortalidone colecalciferol colestyramine clomifene colistimethate sodium corticotropin mercaptamine dantron desoximetasone dexamfetamine dibrompropamidine dienestrol dimeticone dimethyl sulfoxide doxycycline hyclate etacrynic acid etamsylate ethinylestradiol etynodiol flumetasone flupentixol xvii Former BAN rINN/new BAN gestronol guaiphenesin gestonorone guaifenesin hexachlorophane hexamine hippurate hydroxyprogesterone hexanoate indomethacin lysuride methyl cysteine methylphenobarbitone oestradiol oestriol oestrone oxethazaine pentaerythritol tetranitrate phenobarbitone pipothiazine polyhexanide potassium cloazepate pramoxine prothionamide quinalbarbitone riboflavine sodium calciumedetate sodium cromoglycate sodium ironedetate sodium picosulphate sorbitan monostearate stilboestrol sulphacetamide sulphadiazine sulphadimidine sulphaguanadine 1In hexachlorophene methenamine hippurate hydroxyprogesterone caproate indometacin lisuride mecysteine methylphenobarbital estradiol estriol estrone oxetacaine pentaerithrityl tetranitrate phenobarbital pipotiazine polihexanide dipotassium clorazepate pramocaine protionamide secobarbital riboflavin sodium calcium edetate sodium cromoglicate sodium feredetate sodium picosulfate sorbitan stearate diethylstilbestrol sulfacetamide sulfadiazine sulfadimidine sulfaguanadine common with the BP, precedence will continue to be given to the terms adrenaline and noradrenaline. xviii sulphamethoxazole sulphasalazine sulphathiazole sulphinpyrazone tetracosactrin thiabendazole thioguanine thiopentone urofollitrophin sulfamethoxazole sulfasalazine sulfathiazole sulfinpyrazone tetracosactide tiabendazole tioguanine thiopental urofollitropin INTRODUCTION—WHAT IS THE PAIN CLINIC? Andrew Severn, Kate Grady Scope of the pain clinic Chronic pain patients are a diverse group of patients, and there is no one recognized medical specialty that can truly claim the responsibility for managing pain. Historically the major impetus for the establishment of specialist pain clinics was cancer pain and the development of techniques for nerve destruction. However, improvement in medical management and nursing care of cancer patients has in most cases superseded the need for techniques that prompted such specialist interest. The focus of attention of many pain clinics has thus become one of managing a condition that is usefully called a chronic pain syndrome, rather than the symptomatic treatment of pain symptoms. The general hospital pain clinic manages cancer pain, nerve injury pain, chronic back problems and peripheral vascular disease. Its involvement may be for technical service reasons, such as a sympathectomy to improve blood flow to the ischaemic limb, or it may take the lead role in managing the complex medical and psychosocial problem called the chronic pain syndrome. The Royal College of Anaesthetists recognizes the specialty of ‘pain management’ and is responsible for the training of anaesthesia specialists and the recognition of consultant anaesthetist posts. The Pain Society, affiliated to the Association of Anaesthetists of Great Britain and Ireland is the UK chapter of the International Association for the Study of Pain (IASP). The membership of the Pain Society and IASP is interdisciplinary. Pain as a disease The chronic pain syndrome is the end result of a variety of pathological and psychological mechanisms that may have included, at some stage, tissue or nerve damage, and in which symptoms have failed to resolve with healing or repair. It is helpful to consider the chronic pain syndrome as a disease in its own right. Chronic pain syndrome has its own symptomatology, signs and natural history that can be recognized in many patients irrespective of the primary source of the symptoms of pain. The management of the chronic pain syndrome requires the

Author Chris J. Glynn Isbn 9781859960387 File size 1.24MB Year 2002 Pages 269 Language English File format PDF Category Medicine Book Description: FacebookTwitterGoogle+TumblrDiggMySpaceShare Key Topics in Chronic Pain is designed to help the professional understand the working of the chronic pain clinic, its patients and its treatments. Separate chapters describe the various clinical pain syndromes commonly encountered and their management. Emphasis is placed on the management of conditions as recommended by randomised controlled trials. Key Topics in Chronic Pain is invaluable for professionals and for students preparing for the FRCA examinations.     Download (1.24MB) Understanding Chronic Fatigue Syndrome Fibromyalgia Syndrome, 2nd Edition Clinician’s Guide to Chronic Headache and Facial Pain The Concise Book Of Trigger Points (2nd Edition) Pain Medicine Pocketpedia Load more posts

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