Pain Management, 2nd edition: Expert Consult – Online and Print by Steven D. Waldman, MD, JD (Elsevier Saunders)
Pain Management allows clinicians to get the expert, evidence-based guidance they need to diagnose pain.
Regarded as the premiere clinical reference in its field, Pain Management, 2nd Edition, edited by noted pain authority Steven Waldman, provides comprehensive, practical, highly visual guidance to help readers apply the most recent evidence-based advances in pain management. This popular text has been updated with 13 new chapters that include the latest information on interventional and ultrasound-guided techniques, and acute regional pain nerve blocks. A user-friendly format with lavish illustrations and complete online access enable readers to access trusted guidance quickly and apply the information easily to bring effective pain relief to patients. Author Waldman, MD, JD, is Clinical Professor of Anesthesiology, Professor of Medical Humanities and Bioethics, University of Missouri-Kansas City School of Medicine, Kansas City.
Pain Management enables readers to:
It is hard to believe that 5 years have passed since the publication of the first edition of Pain Management. Even at that time, when we had no knowledge of where electronic publishing would be in 2011, the conventional wisdom was that large, comprehensive textbooks were dinosaurs and that the future of medical books would be in smaller, more manageable, more specialized texts. Fortunately, this bit of conventional wisdom was off the mark. The first edition of Pain Management was published and has established itself as a popular reference among pain management practitioners across a variety of specialties.
Pain Management contains 184 chapters. Sections and their parts include:
I. The Basic Science of Pain
II. The Evaluation of the Patient in Pain
III. Generalized Pain Syndromes Encountered in Clinical Practice
IV. Regional Pain Syndromes
V. Specific Treatment Modalities for Pain and Symptom Management
Chapter One of Pain Management, Pain and Psychopathology, provides a conceptual framework for understanding pain in the human. According to that material, pains that do not conform to present day anatomic and neurophysiologic knowledge are often attributed to psychological dysfunction.
There are many pains whose cause is not known. If a diligent search has been made in the periphery and no cause is found, we have seen that clinicians act as though there was only one alternative. They blame faulty thinking, which for many classically thinking doctors is the same thing as saying that there is no cause and even no disease. They ignore a century's work on disorders of the spinal cord and brainstem and target the mind.... These are the doctors who repeat again and again to a Second World War amputee in pain that there is nothing wrong with him and that it is all in his head.
According to Katz and Melzack, this view of the role of psychological generation in pain persists to this day notwithstanding evidence to the contrary. Psychopathology has been proposed to underlie phantom limb pain, dyspareunia, orofacial pain, and a host of others including pelvic pain, abdominal pain, chest pain, and headache. However, the complexity of the pain transmission circuitry means that many pains that defy our current understanding will ultimately be explained without having to resort to a psychopathologic etiology. Pain that is ‘nonanatomic’ in distribution, spread of pain to noninjured territory, pain that is said to be out of proportion to the degree of injury, and pain in the absence of injury have all, at one time or another, been used as evidence to support the idea that psychological disturbance underlies the pain. Yet each of these features of supposed psychopathology can now be explained by neurophysiologic mechanisms that involve an interplay between peripheral and central neural activity.
Taken together, the novel mechanisms that explain some of the most puzzling pain symptoms must keep us mindful that emotional distress and psychological disturbance in our patients are not at the root of the pain. Attributing pain to a psychological disturbance is damaging to the patient and provider alike; it poisons the patient-provider relationship by introducing an element of mutual distrust and implicit (and at times, explicit) blame. It is devastating to the patient, who feels at fault, disbelieved, and alone.
Chapter one of Pain Management concludes with The Multiple Determinants of Pain.
The neuromatrix theory of pain proposes that the neurosignature for pain experience is determined by the synaptic architecture of the neuromatrix, which is produced by genetic and sensory influences. The neurosignature pattern is also modulated by sensory inputs and by cognitive events, such as psychological stress. Furthermore, stressors, physical as well as psychological, act on stress regulation systems, which may produce lesions of muscle, bone, and nerve tissue and thereby contribute to the neurosignature patterns that give rise to chronic pain. In short, the neuromatrix, as a result of homeostasis regulation patterns that have failed, may produce the destructive conditions that give rise to many of the chronic pains that so far have been resistant to treatments developed primarily to manage pains that are triggered by sensory inputs. The stress regulation system, with its complex, delicately balanced interactions, is an integral part of the multiple contributions that give rise to chronic pain.
The neuromatrix theory guides us away from the Cartesian concept of pain as a sensation produced by injury or other tissue disease and toward the concept of pain as a multidimensional experience produced by multiple influences. These influences range from the existing synaptic architecture of the neuromatrix to influences from within the body and from other areas in the brain. Genetic influences on synaptic architecture may determine – or predispose to – the development of chronic pain syndromes.
Multiple inputs act on the neuromatrix programs and contribute to the output neurosignature. They include the following: (1) sensory inputs (cutaneous, visceral, and other somatic receptors); (2) visual and other sensory inputs that influence the cognitive interpretation of the situation; (3) phasic and tonic cognitive and emotional inputs from other areas of the brain; (4) intrinsic neural inhibitory modulation inherent in all brain function; and (5) the activity of the body's stress regulation systems, including cytokines as well as the endocrine, autonomic, immune, and opioid systems. We have traveled a long way from the psychophysical concept that seeks a simple one-to-one relationship between injury and pain. We now have a theoretical framework in which a genetically determined template for the body-self is modulated by the powerful stress system and the cognitive functions of the brain, in addition to the traditional sensory inputs.
State of the art, completely updated in this 2nd edition, Pain Management allows clinicians to effectively diagnose and manage pain with procedurally focused, evidence-based guidance from a noted authority. The user-friendly format with lavish illustrations and complete online access enables readers to access trusted guidance quickly and apply the information easily to bring effective pain relief to patients.
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