Pain Care Essentials

It may come as something of a surprise that pain, the most prevalent symptom in clinical practice, is not always addressed specifically in health professions training. Approximately one in six Americans lives with chronic pain in addition to the millions that experience acute pain each day. Half of older adults live with chronic pain-associated conditions, and about half of all healthcare visits are initiated because of pain. Despite this, reports indicate that the vast majority of health professions schools in the United States do not teach required courses on pain, and the total amount of content pertaining to pain is a fraction of a percent of the total. Almost certainly, the lack of education in coordinated, comprehensive, compassionate care for pain-associated conditions contributed to pervasive opioid over-prescribing and the ensuing wave of addiction and deaths that swept the country in the first part of this century. This book is our response to the pain care crisis - it is designed to prepare young clinicians to assess and treat a wide variety of pain conditions in a manner that balances competence and compassion, incorporating coordinated elements of pharmacological and non-pharmacological therapies.

Designed to be read during or after pre-licensure training, e.g. medical, nursing, pharmacy school, and to inspire students to learn more about painful conditions, this book is unique in its clinical focus and the level of detail that is included. This book aims to improve pain care, most especially if used alongside a formal pain care course as part of pre-licensure training, whether spread over four years or condensed into a shorter period. Through engagement in the interprofessional curriculum planning process, the content of the book has been shaped to align with the International Association for the Study of Pain (IASP) interprofessional pain curriculum vision and to focus on the primary questions of: What is pain? How is pain assessed? How is pain managed? How does clinical context influence pain?

Table of Contents

Introduction
Part I: The Multidimensionality of Pain: neurobiology, scope, and impact
1. Pain pathways: Structural organization and development
2. Nociceptive processing: Neurochemistry and neurophysiology
3. The Impact of pain: Epidemiology, economic burden, cultural influences and ethics
4. The Appraisal of pain: measurement, classification, and nomenclature
5. The Spectrum of pain experience: Pain psychophysics, pain behavior, influence of gender, impact of cognitions and affect, role of functional status
Part II: Clinical Skills in the Assessment and Care of Pain
6. Clinical assessment of pain: the pain narrative, focused examination and clinical stance
7. Diagnostic reasoning in the pain-focused encounter
8. Professionalism in pain care: empathy and compassion, decision-making, behavior change and difficult conversations, ethical standards, pain self-management
Part III: Pain Treatments and Approaches to Management
9. Pharmacological treatments I - Standard systemic analgesic agents: NSAIDs, acetaminophen, steroids, opioids
10. Pharmacological treatments II - Neuromodulating agents: Anti-depressants, anti-convulsants, topical agents
11. Interventional and surgical management of pain
12. Rehabilitational approaches to Pain and applications in outpatient practice; Gonzalez-Fernandez
Part IV: Pain Care in Clinical Context
13. Pain Emergencies and life-threatening complications of pain treatments
14. Acute pain; Peri-operative, trauma-related, and obstetric pain
15. Urgent pain problems (migraine, acute LBP, etc)
16. Common chronic pain-associated conditions (neck pain, chronic LBP, neuropathy)
17. The Extremes of pain: CRPS, trigeminal neuralgia, congenital insensitivity to pain
18. Pediatric Pain
19. Pain in older patients
20. Pain, addiction, and psychiatric illness
Appendices
I. Examination template
II. Chemical Structure of commonly used pain medications
III. Comparison Table: Features of commonly used pain medications Dosing
IV. Adjustments in treatment for liver and renal failure
V. Opioid conversion table
VI. Back pain diagnosis flow diagram
VII. Evidence-based basic recommendations to prevent or reduce chronic pain

Edited by Beth B. Hogans, Associate Professor; Director of Pain Education, Department of Neurology, Johns Hopkins School of Medicine, and Edited by Antje M. Barreveld, Clinical Fellow in Anaesthesia, Brigham and Women's Hospital

Dr. Beth B. Hogans, M.D., Ph.D. holds board certifications