Pub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0009
B. Hogans
Chapter 8 focuses on the recent enhancements to clinical processes that improve the patient–provider experience and increase successful long-term outcomes. Professionalism has at times been criticized as not being genuine, but clinical care is like an Olympic sport, it takes a lot of training to become effortless and natural. By actively incorporating essential components of the biopsychosocial model, patient-centered care, interprofessional collaboration, motivational interviewing, the stages of change model, healthcare ethics, and model strategies from clinical psychology, it is possible to engage in more successful and satisfying outcomes with patients. Because most chronic problems are not truly best served by a series of injections or surgeries, we need to increase knowledge of, motivation toward, and competence in the range of chronic condition management approaches that are evidence-based, safe, and effective in clinical practice.
{"title":"Professionalism in Pain Care","authors":"B. Hogans","doi":"10.1093/med/9780199768912.003.0009","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0009","url":null,"abstract":"Chapter 8 focuses on the recent enhancements to clinical processes that improve the patient–provider experience and increase successful long-term outcomes. Professionalism has at times been criticized as not being genuine, but clinical care is like an Olympic sport, it takes a lot of training to become effortless and natural. By actively incorporating essential components of the biopsychosocial model, patient-centered care, interprofessional collaboration, motivational interviewing, the stages of change model, healthcare ethics, and model strategies from clinical psychology, it is possible to engage in more successful and satisfying outcomes with patients. Because most chronic problems are not truly best served by a series of injections or surgeries, we need to increase knowledge of, motivation toward, and competence in the range of chronic condition management approaches that are evidence-based, safe, and effective in clinical practice.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125085884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0019
T. Rappold, M. DiGiusto, M. Suleman
Chapter 18 covers the basics of pediatric pain management. Pediatric pain is a significant public health problem leading to lost days of school, increased use of the healthcare system, and multifactorial impact on all aspects of a child’s life. Pediatric patients present special clinical challenges because of variabilities in metabolism, susceptibility to disease and side effects, ability to communicate, developmental stage, coping skills, and support systems. This chapter serves as an introduction to the main features of pediatric pain management and reviews pain assessment, common causes of pain both acute and chronic, and basic nonpharmacologic and pharmacologic strategies in patients ranging from neonates to adolescents.
{"title":"Basics of Pediatric Pain Management","authors":"T. Rappold, M. DiGiusto, M. Suleman","doi":"10.1093/med/9780199768912.003.0019","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0019","url":null,"abstract":"Chapter 18 covers the basics of pediatric pain management. Pediatric pain is a significant public health problem leading to lost days of school, increased use of the healthcare system, and multifactorial impact on all aspects of a child’s life. Pediatric patients present special clinical challenges because of variabilities in metabolism, susceptibility to disease and side effects, ability to communicate, developmental stage, coping skills, and support systems. This chapter serves as an introduction to the main features of pediatric pain management and reviews pain assessment, common causes of pain both acute and chronic, and basic nonpharmacologic and pharmacologic strategies in patients ranging from neonates to adolescents.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125876587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0013
M. González-Fernández, K. Wright, B. Abrams, A. Yao, A. Noles, B. Hogans
Chapter 12 introduces a broad range of considerations, alternatives, and coordination of nonpharmacologic pain management. Rehabilitation approaches to pain include somatic, biopsychosocial, and changes in neurochemical pathways in response to exercise, psychological interventions, and other therapeutic aspects. Rehabilitation occurs after injury, trauma, disease, or dysfunction leads to pain and the need for functional restoration. Prehabilitation is now being used in anticipation of planned procedures to reduce the impact of decreased activity in the operative setting and to increase the likelihood of successful return to function. Complementary and alternative therapies are often incorporated into rehabilitative pain management plans. In the process of providing clinical care for patients with persistent or disabling pain-associated conditions, questions of impairment, disability, and pending legal action may arise, and these are discussed. Applications in outpatient pain care address the coordination of pharmacologic and nonpharmacologic approaches and the challenges of planning and organizing effective evidence-based pain self-management plans in the outpatient setting.
{"title":"Rehabilitation Approaches to Pain and Applications in Outpatient Practice","authors":"M. González-Fernández, K. Wright, B. Abrams, A. Yao, A. Noles, B. Hogans","doi":"10.1093/med/9780199768912.003.0013","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0013","url":null,"abstract":"Chapter 12 introduces a broad range of considerations, alternatives, and coordination of nonpharmacologic pain management. Rehabilitation approaches to pain include somatic, biopsychosocial, and changes in neurochemical pathways in response to exercise, psychological interventions, and other therapeutic aspects. Rehabilitation occurs after injury, trauma, disease, or dysfunction leads to pain and the need for functional restoration. Prehabilitation is now being used in anticipation of planned procedures to reduce the impact of decreased activity in the operative setting and to increase the likelihood of successful return to function. Complementary and alternative therapies are often incorporated into rehabilitative pain management plans. In the process of providing clinical care for patients with persistent or disabling pain-associated conditions, questions of impairment, disability, and pending legal action may arise, and these are discussed. Applications in outpatient pain care address the coordination of pharmacologic and nonpharmacologic approaches and the challenges of planning and organizing effective evidence-based pain self-management plans in the outpatient setting.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127000802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0006
Valerie Jackson
Chapter 5 covers the foundations of pain clinical care in the biopsychosocial model, demonstrates how this model is applied in psychological assessment and treatment planning for patients with chronic pain, and introduces the reader to the foundational concepts in pain psychology and the major categories of psychological treatments for pain. The biopsychosocial model is examined and explained in detail with application to the case scenario that opens the chapter. The assessment of patients with chronic pain is described, and the benefits and potential risks of psychological assessment are characterized. Pain psychology concepts, including pain catastrophizing, pain anxiety, and passive coping, are explained. The major treatment paradigms, including psychoeducation, cognitive behavioral therapy (CBT), acceptance commitment therapy, relaxation strategies, mindfulness-based therapies, biofeedback, and treatment responses, are described in detail. An application of CBT is presented, explaining to the reader the process of feeding forward through automatic thoughts, feelings, and behaviors and illustrating how this is changed positively by CBT to reduce the negative impacts of chronic pain on thoughts, feelings, and behaviors, leading ultimately to less pain and less pain interference. Pain psychology is introduced in this chapter in the context of collaborative interprofessional care models.
{"title":"Pain Psychology","authors":"Valerie Jackson","doi":"10.1093/med/9780199768912.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0006","url":null,"abstract":"Chapter 5 covers the foundations of pain clinical care in the biopsychosocial model, demonstrates how this model is applied in psychological assessment and treatment planning for patients with chronic pain, and introduces the reader to the foundational concepts in pain psychology and the major categories of psychological treatments for pain. The biopsychosocial model is examined and explained in detail with application to the case scenario that opens the chapter. The assessment of patients with chronic pain is described, and the benefits and potential risks of psychological assessment are characterized. Pain psychology concepts, including pain catastrophizing, pain anxiety, and passive coping, are explained. The major treatment paradigms, including psychoeducation, cognitive behavioral therapy (CBT), acceptance commitment therapy, relaxation strategies, mindfulness-based therapies, biofeedback, and treatment responses, are described in detail. An application of CBT is presented, explaining to the reader the process of feeding forward through automatic thoughts, feelings, and behaviors and illustrating how this is changed positively by CBT to reduce the negative impacts of chronic pain on thoughts, feelings, and behaviors, leading ultimately to less pain and less pain interference. Pain psychology is introduced in this chapter in the context of collaborative interprofessional care models.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128990212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0011
B. Hogans
Chapter 10 explores the variety and mechanisms of medications used for chronic and neuropathic pain. In patients with chronic and neuropathic pain, these medications can and do serve as the primary medication with efficacy. To call these agents “adjuvant” is, therefore, incorrect, despite longstanding custom. The neuromodulating medications discussed here include pain-active anticonvulsants, including gabapentinoids, pain-active antidepressants, local anesthetics, and other neuroactive agents. The medications are divided based on drug class and mechanism in order to facilitate rational combination of medications from different classes when treating patients with neuropathic or chronic pain that does not respond sufficiently to a single agent.
{"title":"Neuromodulating Agents","authors":"B. Hogans","doi":"10.1093/med/9780199768912.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0011","url":null,"abstract":"Chapter 10 explores the variety and mechanisms of medications used for chronic and neuropathic pain. In patients with chronic and neuropathic pain, these medications can and do serve as the primary medication with efficacy. To call these agents “adjuvant” is, therefore, incorrect, despite longstanding custom. The neuromodulating medications discussed here include pain-active anticonvulsants, including gabapentinoids, pain-active antidepressants, local anesthetics, and other neuroactive agents. The medications are divided based on drug class and mechanism in order to facilitate rational combination of medications from different classes when treating patients with neuropathic or chronic pain that does not respond sufficiently to a single agent.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131890066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0007
B. Hogans
Chapter 6 addresses the clinical assessment of patients with pain, including the pain-focused clinical interview (history of present illness), the patient’s illness narrative, boundary issues and precautions in examining patients with pain, and details of the basic pain-focused examination. Additionally, specific maneuvers for evaluation of common pain-associated conditions are described, including palpating for trigger points, palpation of the spine, straight leg raise testing, evaluations for radiculopathy, sacroiliac dysfunction, peripheral neuropathy, neuromas, and headache. The chapter applies the principles of patient-centered medicine, the structured clinical interview, the therapeutic alliance, and trauma-informed care to provide the health professions trainee with a useful introduction to the pain-focused clinical interview and examination.
{"title":"Clinical Assessment of Pain","authors":"B. Hogans","doi":"10.1093/med/9780199768912.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0007","url":null,"abstract":"Chapter 6 addresses the clinical assessment of patients with pain, including the pain-focused clinical interview (history of present illness), the patient’s illness narrative, boundary issues and precautions in examining patients with pain, and details of the basic pain-focused examination. Additionally, specific maneuvers for evaluation of common pain-associated conditions are described, including palpating for trigger points, palpation of the spine, straight leg raise testing, evaluations for radiculopathy, sacroiliac dysfunction, peripheral neuropathy, neuromas, and headache. The chapter applies the principles of patient-centered medicine, the structured clinical interview, the therapeutic alliance, and trauma-informed care to provide the health professions trainee with a useful introduction to the pain-focused clinical interview and examination.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"2015 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127618532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0012
M. Young, A. Rubens, Antje M Barreveld
Chapter 11 describes many of the most common interventional and surgical procedures performed in the field of chronic pain medicine. They are discussed in a cranial to caudal pattern, and this is done not only for logical arrangement but also to highlight the breadth of procedures that are utilized in practice. Interventional and surgical pain management techniques using image or landmark guidance may provide diagnostic and therapeutic relief for patients suffering from pain. Performed by formally trained and experienced proceduralists, interventions, in conjunction with other multimodal strategies such as medications, physical therapy, and behavioral therapies, can be useful techniques for helping patients achieve improved function and pain relief. Benefits may be short or longer term, depending on the interventional strategy utilized. Indications, evidence, and risks must be considered when choosing the most appropriate interventional options for a patient.
{"title":"Interventional Techniques and Surgical Management of Pain","authors":"M. Young, A. Rubens, Antje M Barreveld","doi":"10.1093/med/9780199768912.003.0012","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0012","url":null,"abstract":"Chapter 11 describes many of the most common interventional and surgical procedures performed in the field of chronic pain medicine. They are discussed in a cranial to caudal pattern, and this is done not only for logical arrangement but also to highlight the breadth of procedures that are utilized in practice. Interventional and surgical pain management techniques using image or landmark guidance may provide diagnostic and therapeutic relief for patients suffering from pain. Performed by formally trained and experienced proceduralists, interventions, in conjunction with other multimodal strategies such as medications, physical therapy, and behavioral therapies, can be useful techniques for helping patients achieve improved function and pain relief. Benefits may be short or longer term, depending on the interventional strategy utilized. Indications, evidence, and risks must be considered when choosing the most appropriate interventional options for a patient.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115766070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0016
B. Hogans
Chapter 15 addresses conditions that require prompt evaluation but are not generally in the group of conditions that are true emergencies. Included in this chapter are acute migraine, other severe nonemergent headaches, facial pain, severe low back pain, acute severe neuropathies such as shingles and diabetic amyotrophy, abdominal pain, and acutely painful muscle conditions requiring prompt attention, such as myositis and rhabdomyolysis. The differential diagnosis of headache with visual impairment is reviewed, as is the differential diagnosis of facial pain. Strategies for the evaluation, diagnosis, and treatment of atypical focal pains that can represent unusual presentations of common problems as well as uncommon conditions are discussed.
{"title":"Urgent Pain Problems","authors":"B. Hogans","doi":"10.1093/med/9780199768912.003.0016","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0016","url":null,"abstract":"Chapter 15 addresses conditions that require prompt evaluation but are not generally in the group of conditions that are true emergencies. Included in this chapter are acute migraine, other severe nonemergent headaches, facial pain, severe low back pain, acute severe neuropathies such as shingles and diabetic amyotrophy, abdominal pain, and acutely painful muscle conditions requiring prompt attention, such as myositis and rhabdomyolysis. The differential diagnosis of headache with visual impairment is reviewed, as is the differential diagnosis of facial pain. Strategies for the evaluation, diagnosis, and treatment of atypical focal pains that can represent unusual presentations of common problems as well as uncommon conditions are discussed.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116463016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-01DOI: 10.1093/med/9780199768912.003.0005
Christopher R. Abrecht, B. Hogans, Antje M Barreveld
Chapter 4 describes the terminology and assessment of pain and addresses the need for a fundamental “language of pain.” Because pain is so prevalent and because clinical decision-making in acute care settings relies heavily on rapid and reliable pain appraisal, it is essential to understand the properties of commonly used tools for assessing pain and evaluating responses to pain treatments. The tools appropriate for pain assessment vary across the life span, and administration of age-appropriate instruments for pain assessment is a foundational clinical skill in pain care. The historical origins of pain appraisal are discussed with relevance to current practice. This chapter also introduces the concept of the basic classification of pain according mechanism class: specifically, pain as nociceptive, neuropathic, and inflammatory. Additional pain terminology is introduced, such as the terms hyperalgesia and allodynia; excerpted terms from the formal International Association for the Study of Pain taxonomy are referenced.
{"title":"Pain Appraisal","authors":"Christopher R. Abrecht, B. Hogans, Antje M Barreveld","doi":"10.1093/med/9780199768912.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780199768912.003.0005","url":null,"abstract":"Chapter 4 describes the terminology and assessment of pain and addresses the need for a fundamental “language of pain.” Because pain is so prevalent and because clinical decision-making in acute care settings relies heavily on rapid and reliable pain appraisal, it is essential to understand the properties of commonly used tools for assessing pain and evaluating responses to pain treatments. The tools appropriate for pain assessment vary across the life span, and administration of age-appropriate instruments for pain assessment is a foundational clinical skill in pain care. The historical origins of pain appraisal are discussed with relevance to current practice. This chapter also introduces the concept of the basic classification of pain according mechanism class: specifically, pain as nociceptive, neuropathic, and inflammatory. Additional pain terminology is introduced, such as the terms hyperalgesia and allodynia; excerpted terms from the formal International Association for the Study of Pain taxonomy are referenced.","PeriodicalId":126639,"journal":{"name":"Pain Care Essentials","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115581617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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