THÔNG TIN TÀI LIỆU
CORE TOPICS IN PAIN
Core Topics in Pain provides a comprehensive, easy-to-read introduction to this multi-faceted topic. It covers a wide
range of issues from the underlying neurobiology, through pain assessment in animals and humans, diagnostic strate-
gies, clinical presentations, pain syndromes, to the many treatment options (for example, physical therapies, drug ther-
apies, psychosocial care) and the evidence base for each of these. Written and edited by experts of international renown,
the many concise but comprehensive chapters provide the reader with an up-to-date guide to all aspects of pain.
It is an essential book for anaesthetic trainees and is also an invaluable first reference for surgical and nursing staff,
ICU professionals, operating department practitioners, physiotherapists, psychologists, healthcare managers and
researchers with a need for an overview of the key aspects of the topic.
CORE TOPICS IN PAIN
Edited by
Anita Holdcroft
Department of Anaesthetics and Intensive Care
Imperial College London
Chelsea and Westminster Campus
Fulham Road
London SW10 9NH, UK
Siân Jaggar
The Royal Brompton Hospital
Sydney Street
London SW3 6NP, UK
cambridge university press
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Cambridge University Press
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isbn-13 978-0-511-13261-2
© Cambridge University Press 2005
2005
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Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xiii
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
General abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii
Basic science abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xix
PART 1BASIC SCIENCE 1
1.Overview ofpain pathways . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
S.I. Jaggar
2.Peripheral mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
W. Cafferty
3.Central mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
D. Bennett
4.Pharmacogenomics and pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
J. Riley, M. Maze & K. Welsh
5.Peripheral and central sensitization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
K. Carpenter & A. Dickenson
6.Inflammation and pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
W.P. Farquhar-Smith & B.J. Kerr
7.Nerve damage and its relationship to neuropathic pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .43
N.B. Finnerup & T.S. Jensen
8.Receptor mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
E.E. Johnson & D.G. Lambert
PART 2PAIN ASSESSMENT 63
Section 2aPain measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65
9.Measurement ofpain in animals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
B.J. Kerr, P. Farquhar-Smith & P.H. Patterson
10.Pain measurement in humans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
R.B. Fillingim
Section 2bDiagnostic strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79
11.Principles ofpain evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81
S.I. Jaggar & A. Holdcroft
12.Pain history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
A. Holdcroft
13.Psychological assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .89
E. Keogh
CONTENTS
PART 3PAIN IN THE CLINICAL SETTING 95
Section 3aClinical presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .97
14.Epidemiology ofpain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
W.A. Macrae
15.Pain progression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
B.J. Collett
16.Analgesia in the intensive care unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .109
U. Waheed
17.The chronic pain patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117
A. Howarth
18.Post-operative pain management in day case surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
T. Schreyer & O.H.G. Wilder-Smith
Section 3bPain syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127
19.Myofascial/musculoskeletal pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129
G. Carli & G. Biasi
20.Neuropathic pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .137
M. Hanna, A. Holdcroft & S.I. Jaggar
21.Visceral nociception and pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
K.J. Berkley
22.The management oflow back pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151
C. Price
23.Cancer pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
S. Lund & S. Cox
24.Post-operative pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
T. Kirwan
25.Complex regional pain syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
M.G. Serpell
26.Uncommon pain syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .177
A.P. Baranowski
27.Pain in children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183
R.F. Howard
28.Pain in the elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191
A. Holdcroft, M. Platt & S.I. Jaggar
29.Gender and pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195
A. Baranowski & A. Holdcroft
PART 4THE ROLE OF EVIDENCE IN PAIN MANAGEMENT 201
30.Clinical trials for the evaluation ofanalgesic efficacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203
L.A. Skoglund
31.Evidence base for clinical practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209
H.J. McQuay
PART 5TREATMENT OF PAIN 215
Section 5aGeneral Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .217
32.Overview oftreatment ofchronic pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219
C. Pither
vi CONTENTS
33.Multidisciplinary pain management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223
A. Howarth
Section 5bPhysical treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227
34.Physiotherapy management ofpain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
M. Thacker & L. Gifford
35.Regional nerve blocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
A. Hartle & S.I. Jaggar
36.Principles oftranscutaneous electrical nerve stimulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241
A. Howarth
37.Acupuncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .247
J. Filshie & R. Zarnegar
38.Neurosurgery for the reliefofchronic pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
J.B. Miles
Section 5cPharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261
39.Routes, formulations and drug combinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .263
L.A. Skoglund
40.Opioids and codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269
L. Bromley
41.Non-steroidal anti-inflammatory agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .277
J. Cashman & A. Holdcroft
42. Antidepressants, anticonvulsants, local anaesthetics, antiarrhythmics and
calcium channel antagonists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .281
C.F. Stannard
43.Cannabinoids and other agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .287
S.I. Jaggar & A. Holdcroft
Section 5dPsychosocial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291
44.Psychological management ofchronic pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .293
T. Newton-John
45.Psychiatric disorders and pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .299
S. Tyrer & A. Wigham
46.Chronic pain and addiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .305
D. Gourlay
47.The role ofthe family in children’s pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .311
A. Kent
48.Palliative care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .317
S. Lund & S. Cox
PART 6SUMMARIES 323
49.Ethical standards and guidelines in pain management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .325
A. Holdcroft
50.What is a clinical guideline? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .329
T. Kirwan
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .335
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .337
CONTENTS vii
Baranowski P. Andrew
Bennett Dave
Berkley J. Karen
Biasi Giovanni
Bromley Lesley
Cafferty Will
Carli Giancarlo
Carpenter Kate
Cashman Jeremy
Collett J. Beverly
Cox Sarah
Dickenson Anthony
Farquhar-Smith W. Paul
Fillingim B. Roger
Filshie Jacqueline
Finnerup B. Nanna
Gifford Louis
Gourlay Doug
Hanna Magdi
Hartle Andrew
Holdcroft Anita
Howard F. Richard
Howarth Amanda
Jaggar I Sian
Jensen S. Troels
Johnson E. Emma
Kent Alixe
Keogh Edmund
Kerr J. Bradley
Kirwan Trottie
Lund Samantha
Lambert G. David
Maze Mervyn
McQuay J. Henry
Macrae A. William
Miles B. John
Newton-John Toby
Patterson H. Paul
Pither Charles
Platt Michael
Price Cathy
Riley Julia
Schreyer T.
Serpell G. Mick
Skoglund Lassa
Stannard Cathy
Thacker Mick
Tyrer Stephen
Waheed Umeer
Welsh Ken
Wigham Ann
Wilder-Smith Oliver Hamilton Gottwaldt
Zarnegar Roxaneh
CONTRIBUTORS
The driving force for this book comes from our patients, rarely those who complied with our therapies, but par-
ticularly those who only partly responded, those who received complete pain relief as a marvel, and those who
were so consumed with anger that major barriers had to be broken down before healing could begin. In practic-
ing pain therapy questions inevitably arise for which we have no easy answers, but over time it is possible to plan
research to investigate and test theories. This book is written not to extol the science per se but rather to seek to
identify where further exploration is warranted, because we have no simple answers and the breadth of factors
that influence pain sensations and therapies is great.
The original publishers with whom we entered into a contract were Greenwich Medical, well known for their
concise cutting edge anaesthesia textbooks. We concurred with this format, expecting a low cost no frills approach.
Nevertheless we have attempted to provide the information needed to reach a postgraduate diploma standard. We
hope that the breadth of subjects distilled into this small volume will be a treasured resource for pain management
teams.
As far as possible we have attempted to format each chapter into an overall style. Some authors have resisted,
you the readers are our judges. Since writing or editing a book offers little recompense to those involved we hope
that the rewards are felt by your patients.
Anita Holdcroft and Siân Jaggar
PREFACE
[...]... management Many other professional groups are developing curricula for training in pain management The International Association for the Study of Pain (IASP) has been at the forefront in promoting education in pain management If you are interested in pain then please join IASP and also join the British Pain Society, a Chapter of IASP The provision of effective pain relief for all patients should be a prime... Reduced pain behaviour in models of chronic neuropathic and in ammatory pain Inhibition at the segmental level of the spinal cord and diffuse noxious inhibitory control The perception of pain in one part of the body can be reduced by application of a noxious stimulus to another body region The idea that pain inhibits pain has been used as the rationale behind therapeutic strategies employing counter... Interestingly, a more cognitively demanding task produces a greater reduction in perceived pain intensity Most levels of the CNS are thought to be involved in the attentional modulation of pain Activation in the PAG is significantly increased during a condition in which subjects are distracted from pain The level of PAG activity is predictive of the reduction in pain intensity produced by distraction Attention... amino butyric acid Guanylyl cyclase Guanosine diphosphate Glial derived nerve growth factor G-protein – through which many receptors link to intracellular events Guanosine triphosphate Hydrogen ions – important in ammatory mediator Histamine receptor type 1 Histamine receptor type 2 Interleukin 1 Interleukin 2 Inositol triphosphate – important intracellular messenger Inositol (1,4,5) triphosphate International... emission tomography Prostaglandin E2 – main pain producing prostanoid Phospholipase A2 – important intracellular messenger Protein kinase A – important intracellular messenger Protein kinase C Phospholipase C – important intracellular messenger Phospholipase A2 Another name for SNS (also known as Nav 1.8) Rostroventral medulla Sympathetic independent pain Sympathetic mediated pain Sensory nerve-specific sodium... activity in low-threshold, myelinated 1° afferents would decrease the response of DH projection neurones to nociceptive input (from unmyelinated afferents) Although there has been controversy over the exact neural substrates involved, the ‘gate control’ theory revolutionized thinking regarding pain mechanisms Pain is not the inevitable consequence of activation of a specific pain pathway beginning at... leads to increased excitability of projection neurones within the DH, C-fibre Modulation of pain processing at the level of the spinal cord The dorsal horn (DH) of the spinal cord is an important area for integration of multiple inputs, including primary (1°) sensory neurones and local interneurone networks, as well as descending control from supraspinal centres Pain can be modulated depending upon... theory of pain proposes that activity in low-threshold myelinated afferents can reduce the response of DH projection neurones to C-fibre nociceptor input An inhibitory interneurone is spontaneously active and normally inhibits the DH projection neurone reducing the intensity of pain This interneurone is activated by myelinated (A-fibre) low-threshold afferents (responding to innocuous pressure) and inhibited... cancer The range of topics dealt with in this book bear testament to the ubiquity of pain and the way in which pain impinges itself into virtually every realm of medical practice The cost of unrelieved pain can be measured in psychological, physiological and socio-economic terms Governments around the world are developing awareness that pain and disability can be very expensive and that pain management strategies... resulting in activation of descending pain- modulating pathways Other neurotransmitter systems are also involved 5-HT and norepinephrine are transmitters found in the projection neurones from the brain stem (RVM and pons) to DH Direct application of 5-HT or norepinephrine to the spinal cord results in analgesia, while destruction of these neurones blocks the action of systemically administered morphine . chronic pain and pain in patients with cancer. The range of topics
dealt with in this book bear testament to the ubiquity of pain and the way in which pain.
CORE TOPICS IN PAIN
Core Topics in Pain provides a comprehensive, easy-to-read introduction to this multi-faceted topic.
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