Assessment and Multimodal Management of Pain an Integrative Approach

Front Cover
Mini Title
Assessment and Multimodal Management of Pain: An Integrative Approach
Copyright
Dedication
Reviewers
Contributors
Foreword
Acknowledgments
Contents
Half Title
Chapter 1 The Evolution of Pain Assessment and Multimodal Analgesia as an Integrative Pain Management Approach
Incidence and Prevalence of Pain
Historical Perspective of Multimodal Pain Management
Growth in Pain Research
Early National Efforts to Address Pain
Pain Assessment as the Foundation of Multimodal Analgesia
Evolution of an Integrative Multimodal Approach for Pain Management (Multimodal Analgesia) (Multimodal Treatment)
Early Support for Multimodal Analgesia
The Increase in Opioid Prescribing
Rise in Opioid-Related Complications
Resurgence of Support for Integrative, Multimodal, Opioid-Sparing Approaches
Drivers for Integrative, Multimodal, Opioid-Sparing Approaches
Professional Organizations
Centers for Disease Control and Prevention Guidelines
The Joint Commission
Enhanced Recovery After Surgery Society Guidelines
Institute of Medicine Report
National Pain Strategy
Future Challenges and Opportunities for Multimodal Analgesia Within an Integrative Approach
References
Chapter 2 Importance of Multimodal Pain Management
Physiologic Complications of Unrelieved Pain
Psychosocial Implications of Unrelieved Pain
Anxiety
Depression
Agitation
Role of Multimodal Analgesia in the Perioperative Setting
Role of Multimodal Analgesia in the Management of Chronic Pain
Ethical Considerations
Ethical Principles
Autonomy
Beneficence
Nonmaleficence
Doctrine of Double Effect
Justice
Veracity
Fidelity
Clinical Application
Key Points
Case Scenario
References
Chapter 3 Physiology of Pain
Theories of Pain
Gate Control Theory of Pain
The Neuromatrix Theory of Pain
Gain Control Theory
Other Models
Biopsychosocial Model
Fear Avoidance Model
Classifications of Pain
Classification Based on Duration
Classification Based on Mechanism
Nociceptive Pain
Neuropathic Pain
Mixed Pain States
Pain Physiology and Pathophysiology
Physiologic Processing of Pain
Transduction
Transmission
Perception
Modulation
Abnormal Processing of Pain: Neuropathic Pain and Hypersensitization
Peripheral Mechanisms and Neuropathic Pain
Central Mechanisms and Neuropathic Pain
Neuroinflammation and Immune System
Special Conditions
Central Pain
Chronic Regional Pain Syndrome
Key Points
Case Scenario
References
Chapter 4 Barriers to Effective Pain Management
Patient Barriers
Misconceptions
The Meaning of Pain
Culture and Beliefs
Clinical Application
Past Experiences With Pain
Patient Expectations of Pain and Pain Control
Fear
Fear of Side Effects
Fear of Substance Abuse or Misuse
Fear of Appearing To Be Drug Seeking
Health Care Literacy
Family
Access Issues
Finances
Transportation
Residential Area
Provider Barriers
Culture
Perception
Education
Clinician Experience
Golden Rule Versus Platinum Rule
System Barriers to Effective Pain Management
Culture of the Organization
Continuing Education of Clinicians
Time
Insurance Coverage
Opportunities
Key Points
Case Scenario
References
Chapter 5 Introduction to Pain Assessment
Importance of Pain Assessment
Classification of Pain
Differentiation of Acute From Chronic Pain
Assessment of Pain Mechanisms
Roles of the Health Team in Pain Assessment
Timing and Frequency of Pain Assessment
Discrepancies in Pain Assessment
Hierarchy of Pain Assessment: Assessing Pain in Patients Who Cannot Self-Report
Key Points
Case Scenario
References
Chapter 6 Pain Assessment in Cognitively Intact Adults
Accurate Pain Assessment
Pain Assessment
Mnemonics for use in Pain Assessment
Components of a Comprehensive Pain Assessment
Physiologic and Sensory Aspects of Pain Assessment
Location
Intensity
Onset and Duration (Temporal Aspects)
Quality
Aggravating and Alleviating Factors
Effects of Pain
Pain Affect
Psychosocial
Cognition
Mental Status
Sociocultural Factors
Health Literacy
Environmental Factors
Context of Care
Pertinent History
Medical History
Mental Health History
Substance Use Disorder Risk and History
Patient Goal
Conducting the Pain Assessment
Assessment of Acute Pain
Assessment of Chronic Pain
Tools for Assessing Pain
Clinically Important Changes
Unidimensional Pain Assessment Tools
Numeric Rating Scale
Visual Analogue Scale
Verbal Descriptor Scales
Wong-Baker FACES Pain Rating Scale
FACES Pain Scale (Revised)
Iowa Pain Thermometer
Colored Analogue Scale
Multidimensional Pain Assessment Tools
Clinically Aligned Pain Assessment Tool
The Defense and Veterans Pain Rating Scale 2.0
McGill Pain Questionnaire
Brief Pain Inventory
PEG Scale
Functional Pain Scale
Chronic Pain Grade Scale
Short-Form 36 Bodily Pain Scale
Neuropathic Pain Assessment
Leeds Assessment of Neuropathic Symptoms and Signs
Neuropathic Pain Questionnaire
Breakthrough Pain Assessment
Alberta Breakthrough Pain Assessment Tool for Cancer Patients
Breakthrough Pain Assessment Tool
Italian Questionnaire for Breakthrough Pain
Key Points
Case Scenario
References
Appendix 6-1
Translations of the Numeric Rating Scale
Appendix 6-2
Translations of Wong-Baker FACES Pain Rating Scale
Chapter 7 Pain Assessment of Patients Who Cannot Self-Report Pain
Pain Assessment of Patients Who Cannot Self-Report Pain
Pain Assessment in Critically Ill Adults Who Cannot Self-Report Pain
Pain Assessment and Intervention Notation Algorithm
Nonverbal Pain Assessment Tool
Adult Nonverbal Pain Score
Behavioral Pain Scale
The Critical Care Pain Observation Tool
Patients With Delirium Who Cannot Self-Report Pain
Patients With Dementia Who Cannot Self-Report Pain
Pain Assessment Checklist for Seniors With Limited Ability to Communicate
Pain Assessment in Advanced Dementia
The Checklist of Nonverbal Pain Indicators (CNPI)
Patients With Intellectual Disabilities Who Cannot Self-Report Pain
The Revised Faces, Legs, Activity, Cries, Consolability Scale
The Individualized Numeric Rating Scale
The Non-Communicating Adult Pain Checklist
Patients at the End of Life Who Cannot Self-Report Pain
The Multidimensional Objective Pain Assessment Tool
The Pain Assessment in Advanced Dementia Tool
Newer Trends in Pain Assessment for Patients Who Cannot Self-Report Pain
Bispectral Index
Pupillary Reflex as a Physiologic Measure
The Nociception Level Index
Cautions
Key Points
Case Scenario
References
Chapter 8 Assessment of Factors Affecting Pain and Affected by Pain
Sleep
Insomnia Disorder
Assessment of Sleep Quality
Treatment of Sleep Disorders
Obstructive Sleep Apnea
Assessment of Sleep Apnea
Anxiety and Depression
Anxiety
Anxiety Sensitivity
Discomfort Intolerance
Pain Anxiety
Pain Catastrophizing
Assessment of Anxiety
Depression
Assessment of Depression
Suicide Ideation
Family Assessment
Financial Assessment
Key Points
Case Scenario
References
Chapter 9 Basic Concepts Involved with Administration of Analgesic Medications
Patient Considerations
Age
Genetics
Route Selection
Oral Route
Transmucosal Route
Sublingual, Buccal, and Intranasal
Rectal Route
Gastrointestinal Stomal Route
Vaginal Route
Intravenous Route
Subcutaneous Route
Intramuscular Route
Topical
Intraarticular and Periarticular Injections
Transdermal
Neuraxial and Peripheral Nerve Routes
Analgesic Dosing Considerations
Equianalgesic Dosing
Around-the-Clock Dosing
Awakening Patients for Analgesic Administration
Dosing to Pain Intensity Using Numbers or Word Descriptors
Range Orders
Therapeutic Duplication
Key Points
Case Scenario
References
Chapter 10 Nonopioid Analgesic Medications
Aspirin and Nonsteroidal Antiinflammatory Drugs
History
Pharmacologic Effects
Aspirin
NSAIDs
Indications for Use
Aspirin
NSAIDs
Adverse Effects
Bleeding and Gastrointestinal Adverse Effects
Cardiovascular Adverse Effects
Renal Adverse Effects
Blood Pressure Adverse Effects
Cognitive Adverse Effects
Hepatic Adverse Effects
FDA Warnings
Safety Summary
Nanopharmacology
Dosing and Formulations
Oral
Parenteral
Topical Salicylates and NSAIDs
Other NSAID Routes
Ophthalmic Route
Intranasal Route
Monitoring Patients Receiving NSAID Therapy
Use in Special Populations
Older Adults
Patients With End-Stage Renal Disease
Surgical Patients
Patients Who Have Undergone Bariatric Surgery
Orthopedic Patients
Acetaminophen
History
Pharmacologic Effects
Indications for Use
Routes, Formulations, and Dosing
Adverse Effects
Hepatotoxicity
Treatment of Hepatotoxicity
FDA Warnings
Monitoring of Patients
Use in Special Populations
Older Adults
Patients With Liver Disease
Patients With Impaired Renal Function
Multimodal Use of Nonopioid Analgesics
Key Points
Case Scenario
References
Chapter 11 Opioid Analgesics
Section 1
Opioid Pharmacology
Background
Opioid Receptors
Discovery
Nomenclature
Opioid Receptor Signaling
Factors Affecting Drug Response
Pharmacodynamics
Pharmacokinetics
Absorption
Distribution
Metabolism
Drug-Drug Interactions: Phase I Metabolism
Drug-Drug Interactions: Phase II Metabolism
Clearance
Renal Excretion
Pharmacogenomics
Opioid Classes
Phenanthrenes
Phenylpiperadines
Diphenylheptane
Methadone
Phenylpropylamines
TraMADol
Tapentadol
Benzomorphans
Key Points
Section 2
Opioid Selection
Indications and Use of Opioids
Formulations
Opioid-Related Labeling and Safety Practices
Adverse Effects
Assessment and Monitoring of Patients on Opioid Therapy
Morphine
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Codeine
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Adverse Effects
FentaNYL
Parenteral FentaNYL
Indications and Uses
Pharmacologic Considerations
Other Considerations
Transmucosal FentaNYL
Indications and Uses
Pharmacologic Considerations
Other Considerations
Transdermal FentaNYL
Indications and Uses
Pharmacologic Considerations
Other Considerations
HYDROcodone
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
Benzhydrocodone
HYDROmorphone
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Meperidine
Indications and Uses
Adverse Effects
Methadone
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
Drug-Drug Interactions
Levorphanol
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
OxyCODONE
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
OxyMORphone
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
Other Mu Opioid Analgesics
Alfentanil
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
Remifentanil
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
SUFentanil
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
Dual-Mechanism Analgesics
TraMADol
Indications and Uses
Pharmacologic Considerations
Other Considerations
Tapentadol
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
Partial Mu Agonist
Buprenorphine
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
Mixed Agonist-Antagonist Opioids
Opioid Antagonists
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
Naloxone
Indications and Uses
Routes and Formulations
Pharmacologic Considerations
Other Considerations
Key Points
Section 3
Opioid Dosing Practices
Initiation of Opioid Therapy
Titration of Short-Acting Opioid Dose
Titration of Short-Acting Opioids in Patients With Severe Acute Pain
Use of Modified-Release Opioids
Titration of Modified-Release Opioid
Continuous Intravenous Opioid Infusions
Opioid Rotation or Switch
Rotating From Other Opioids to Methadone
Buprenorphine
Tapering and Discontinuing Opioid Therapy
Opioid Safety in the Community
Key Points
Case Scenario
References
Chapter 12 Common Unintended Effects of Opioids
Constipation
Assessment of Opioid-Induced Constipation
Prevention and Management of Opioid-Induced Constipation
Pharmacologic Management
Nonpharmacologic Management
Xerostomia (Dry Mouth)
Assessment
Prevention and Management
Opioid-Induced Nausea and Vomiting
Assessment
Prevention and Management
Pharmacologic Management
Nonpharmacologic Management
Pruritus
Assessment
Prevention and Management of Opioid-Induced Pruritus
Other Prevention and Management Considerations
Urinary Retention
Assessment for Urinary Retention
Prevention and Management of Opioid-Related Urinary Retention
Hypogonadism
Assessment
Prevention and Management of Opioid-Induced Hypogonadism
Sedation
Assessment
Prevention and Management
Myoclonus
Assessment
Prevention and Management
Opioid-Induced Hyperalgesia
Prevention
Physical Dependence on Opioids
Assessment
Prevention and Management
Opioid Tolerance
Immune Suppressing Effect of Opioids
Key Points
Case Scenario
References
Chapter 13 Preventing Opioid-Induced Advancing Sedation and Respiratory Depression
Opioids and Respiratory Function
Normal Respiratory Physiology and the Effect of Opioids
Advancing Sedation and Opioid-Induced Respiratory Depression
Incidence
Overview of Current Recommendations
Identification of the Risk Factors
Nonmodifiable Risk Factors
Obstructive Sleep Apnea
Screening for Obstructive Sleep Apnea
Screening for Obesity Hypoventilation Syndrome
Risk Factors Associated With Naloxone Administration
Modifiable Risk Factors
Timing of Care and Assessments
Communication Within the Health Care Team
Health Care Team and Institutional Policies and Procedures
Associated Pharmacologic Factors
Formulations of Opioid Medications and Risks
Mechanisms of Delivery of Opioid Medications and Risks
Clinician Boluses
Continuous Intravenous Infusion
Intravenous Patient-Controlled Analgesia
Neuraxial Analgesia
Epidural Analgesia
Peripheral Regional Analgesia
Wound Infiltration Analgesia
Periarticular Injections
Delivery Systems
Combining Classes of Medications and Their Synergistic Effects
Strategizing to Improve Safety for Patients at Risk
Assessing the Patient for Risk
Subjective Assessment of Risk
Objective Assessment of Risk
Detection Using Electronic Monitoring Devices
Monitoring the Patient
Procedures for Intermittent Nursing Assessment for All Patients on Opioids: Level of Sedation
Pasero Opioid Sedation Scale
Michigan Opioid Safety Score
Richmond Sedation Scale
Procedures for Intermittent Nursing Assessment for All Patients on Opioids: Respiratory Status
Continuous Electronic Monitoring
Pulse Oximetry
Respiratory Rate
Capnography
Minute Ventilation
Interventions After Assessment
Summary
Key Points
Case Scenario
Acknowledgments
References
Chapter 14 Opioid Use Disorder
Substance Use Disorder and Opioid Use Disorder
Pathophysiology of Substance Use Disorder
Terminology Related to Substance Use Disorder
Ethical Challenges to the Treatment of Pain in Patients With Comorbid Opioid Use Disorder
Caring for Patients With Pain and Opioid Use Disorder
Clinical Challenges of Treating Pain With Comorbid Opioid Use Disorder
Risk Factors for Development of Opioid Use Disorder
Treatment of Opioid Use Disorder
Methadone
Buprenorphine
Naltrexone
Pain and Opioid Use Disorder: Acute Care Setting
Screening for Opioid Use Disorder in the Acute Care Setting
Acute Pain Management of the Patient With Active Opioid Use Disorder Who Is Not in Active Treatment
Acute Pain Management for Patients on Medication-Assisted Treatment
Acute Pain Management for Patients on Methadone Maintenance Therapy
Acute Pain Management for Patients on Buprenorphine Therapy
Acute Pain Management for Patients on Naltrexone
Acute Pain Management for Patients With Opioid Use Disorder in Recovery Without Medication-Assisted Treatment
Acute Pain Management: Special Considerations
Discharge Planning for Patients With Opioid Use Disorder
Chronic Pain Management in Patients With Opioid Use Disorder
Chronic Pain Management for Patients With Opioid Use Disorder on Medication-Assisted Treatment: Special Considerations
Methadone Maintenance Therapy
Buprenorphine Therapy
Naltrexone Therapy
Chronic Pain Management for Patients in Recovery Without the Use of Medication-Assisted Treatment
Chronic Pain Management for Patients With Active Opioid Use Disorder Who Are Not in Recovery
Strategies to Reduce Risk
Universal Precautions
Opioid Selection
Designing a Safe Treatment Plan
Overdose Prevention
Additional Considerations
Key Points
Case Scenario
References
Chapter 15 Coanalgesic Medications
Medication Selection
Gabapentinoids
Mechanism of Action
Indications and Uses
Gabapentinoids and Neuropathic Pain
Gabapentinoids and Perioperative Pain
Gabapentinoids and Prevention of Chronic Postsurgical Neuropathic Pain
Pharmacokinetics
Dosing and Routes
Adverse Effects
Monitoring of Patients
Antidepressants
Tricyclic Antidepressants
Mechanism of Action
Indications and Uses
Pharmacokinetics
Dosing Selection
Adverse Effects
Monitoring of Patients
Serotonin Norepinephrine Reuptake Inhibitors
Mechanism of Action
Indications and Uses
DULoxetine
Venlafaxine
Milnacipran
SNRIs and Pain-Related Research
Pharmacokinetics
Dosing and Routes
Adverse Effects
Monitoring of Patients
Alpha-Adrenergic Receptor Agonists
Mechanism of Action
Indications and Uses
CloNIDine
TiZANidine
Dexmedetomidine
Pharmacokinetics
Dosing and Routes
CloNIDine
TiZANidine
Dexmedetomidine
Adverse Effects
CloNIDine
TiZANidine
Dexmedetomidine
Monitoring of Patients
Corticosteroids
Mechanism of Action
Indications and Uses
Dosing and Routes
Adverse Effects
Monitoring of Patients
N-Methyl-d-Aspartate Receptor Antagonists
Dextromethorphan
Mechanism of Action
Indications and Uses
Pharmacokinetics
Dosing and Routes
Adverse Effects
Monitoring of Patients
Ketamine
Mechanism of Action
Indications and Uses
Acute Pain
Chronic Pain
Pharmacokinetics
Dosing and Routes
Adverse Effects
Monitoring of Patients
Magnesium
Mechanism of Action
Indications and Uses
Dosing and Routes
Adverse Effects
Monitoring of Patients
Sodium Channel Blockers: Lidocaine and Mexiletine
Lidocaine
Mechanism of Action
Indications and Uses
Dosing and Routes
Adverse Effects
Monitoring of Patients
Mexiletine
Indications and Uses
Dosing and Routes
Adverse Effects
Monitoring of Patients
Muscle Relaxants
Baclofen for Spasticity From Upper Motor Neuron Syndromes
Mechanism of Action
Indications and Uses
Dosing and Routes
Adverse Effects
Monitoring of Patients
Skeletal Muscle Relaxants for Muscular Pain and Spasms From Musculoskeletal Conditions
Mechanism of Action
Indications and Uses for Skeletal Muscle Relaxants for Peripheral Conditions
Dosing and Routes
Adverse Effects
Monitoring of Patients
Dronabinol, Nabilone, and Cannabidiol
Mechanism of Action
Indications and Uses
Dosing and Routes
Adverse Effects
Monitoring of Patients
Other Coanalgesic Medications
Key Points
Case Scenario
References
Chapter 16 Topical Analgesics for the Management of Acute and Chronic Pain
Benefits of Topical Analgesics
Types of Topical Analgesics
Counter-irritants
Capsaicin
Capsaicin Application, Dosing, and Monitoring
Salicylates
Menthol
Local Anesthetics
Lidocaine
Lidocaine Application, Dosing, and Monitoring
Nonsteroidal Antiinflammatory Drugs
Diclofenac
Diclofenac Application, Dosing, and Monitoring
Compound Analgesics
Ketamine
Amitriptyline
Ketamine and Amitriptyline Combination
CloNIDine
Gabapentin
Baclofen
Opioids
Key Points
Case Scenario
References
Chapter 17 Patient-Controlled Analgesia
General Concepts
Advantages of Use
Indications for Use
Optimize Safety Within the Patient-Controlled Analgesia Process
Clinician Education
General Concepts
Equipment-Related Education
PCA by Proxy
Patient and Family Education
Appropriate Prescription
Patient Selection
Cognitive Factors to Consider
Psychological Factors to Consider
Physiologic Factors to Consider
Prescription Components
Modes of Administration
Medications Administered
Medications Frequently Administered by PCA
Mu Agonist Opioids
Local Anesthetics
Medications Not Frequently Administered by PCA
CloNIDine
Neostigmine
Ketamine
Dexmedetomidine
Technical Components of Prescription
Medication Concentration
Clinician Rescue Dose and Loading Dose
Bolus Dose or Demand Dose
Lockout Interval
Hourly Maximum
Basal or Continuous Infusion Rate
Routes of Administration
Intravenous Route
Epidural Route
Regional Route
Subcutaneous Route
Transdermal Route
Oral or Enteral Route
Intranasal Route
Sublingual Route
Inhalation Route
Patient Assessment and Monitoring to Optimize Safety
Respiratory Assessment
Sedation Assessment
Monitoring With Equipment
Pulse Oximetry
Capnography
Evaluating Equipment to Optimize Patient Safety
Infusion Tubing
Authorized Agent–Controlled Analgesia
Family-Controlled or Caregiver-Controlled Analgesia
Nurse-Controlled Analgesia
Key Points
Case Scenario
References
Chapter 18 Regional Analgesia, Local Infiltration, and Pain Management
Neuraxial Analgesia
Principles of Neuraxial Analgesia
Neuraxial Anatomy
Vertebral Column
Spinal Nerves
Neuraxial Analgesic Interventions
Neuraxial Analgesia
Beneficial Effects of Neuraxial Analgesia
Contraindications to Neuraxial Analgesia
Neuraxial Analgesia Techniques
Spinal (Subarachnoid or Intrathecal) Analgesia
Epidural Analgesia
Thoracic Epidural Analgesia
Lumbar Epidural Analgesia
Combined Spinal-Epidural
Caudal Anesthesia
Medications Used In Neuraxial Analgesia
Basic Pharmacology of Neuraxial Opioid Analgesics
Bioavailability
Solubility
Equianalgesic Dose Conversions
Distribution
Selected Opioid Analgesics
Morphine
Extended-Release Epidural Morphine
HYDROmorphone
FentaNYL
SUFentanil
Local Anesthetics
Mechanism of Action
Effects of Local Anesthetics
Effects on Sensation and Motor Activity
Vasodilatation
Basic Chemical Structure
Physiologic and Chemical Activity
Absorption and Distribution
Metabolism and Excretion of Local Anesthetics
Local Anesthetic Choices
Multimodal Analgesia Using Neuraxial Opioids and Local Anesthetics
Coanalgesic Medications Used in Neuraxial Analgesia
Epinephrine
Alpha 2 -Adrenergic Agonists (CloNIDine and Dexmedetomidine)
Administration of Neuraxial Medications
Continuous Infusion
Clinician-Administered Intermittent Bolus
Patient-Controlled Epidural Analgesia
Programmed Intermittent Epidural Bolus
Unintended Effects of Neuraxial Analgesics
Neuraxial Opioid Adverse Effects
Unintended Effects of Neuraxial Local Anesthetics
Allergic Reaction
Local Anesthetic Neurotoxicity
Local Anesthetic Systemic Toxicity
Risk Factors for LAST
Signs and Symptoms of LAST
Strategies to Reduce Risks for LAST
Treatment of LAST
Cardiovascular Unintended Effects
Hypotension
Bradycardia
Urinary Retention
Motor Block
Other Potential Complications Related to Neuraxial Analgesia
Procedure-Related Complications
Ineffective, Partial, or Incomplete Neuraxial Analgesia
Dural Puncture and Postdural Puncture Headache
Signs and Symptoms of PDPH
Treatment of PDPH
Direct Needle Trauma
Epidural Catheter–Related Complications
Epidural Catheter Migration
Signs and Symptoms of Epidural Catheter Migration
Neurologic Complications Associated With Neuraxial Analgesia
Injection or Infusion of Neurotoxic Agents
Infection
Risk Factors for Neuraxial Infection
Strategies to Reduce Risk for Neuraxial Infection
Signs and Symptoms of Neuraxial Infection
Treatment of Neuraxial Infection
Epidural Hematoma
Risk Factors for Epidural Hematoma
Signs and Symptoms of Epidural Hematoma
Diagnosis of Epidural Hematoma
Treatment of Epidural Hematoma
Regional Analgesia
Overview of Truncal and Peripheral Regional Analgesia
Peripheral Nerve Block Interventions
Beneficial Effects of Peripheral Nerve Blocks
Contraindications and Risks Associated With Peripheral Nerve Blocks
Medications for Peripheral Nerve Blocks
Administration of Peripheral Nerve Block Medications
Management of Peripheral Nerve Block Catheters and Infusions
Peripheral Nerve Blocks: Truncal Approaches
Paravertebral Block
Anatomy
Indications
Technique
Considerations
Erector Spinae Plane
Indications
Technique
Considerations
Pectoralis
Indications
Technique
Considerations
Transversus Abdominis Plane
Indications
Technique
Considerations
Quadratus Lumborum
Indications
Technique
Considerations
Peripheral Nerve Blocks: Extremity Approaches
Interscalene Nerve Block
Indications
Interscalene Anatomy
Technique
Considerations
Complications
Supraclavicular
Indications
Technique
Considerations
Infraclavicular
Indications
Technique
Considerations
Axillary
Indications
Technique
Considerations
Femoral
Indications
Technique
Considerations
Fascia Iliaca
Indications
Technique
Considerations
Adductor Canal
Indications
Technique
Considerations
Sciatic Nerve Block
Indications
Technique
Considerations
Ankle Block
Indications
Technique
Considerations
Regional Analgesia Infusion Systems
Tapering and Discontinuing Regional Analgesia Catheters
Catheter Removal
Preventing and Managing Regional Analgesia Infusion System Complications
Minimizing Errors in Administration of Regional Anesthesia
Local Infiltration Analgesia
Additional Analgesic Procedures Involving Use of Local Anesthetics
Key Points
Case Scenario
References
Chapter 19 Interventional Approaches
Anatomy of the Central Nervous System
Spinal Pain
Diagnostic Imaging
Spinal Injections
Epidural Corticosteroid Injections
Indications
Contraindications
Research
Facet Injections
Medial Branch Blocks
Neurotomy
Contraindications
Complications
Facet Injections
Complications of Radiofrequency Ablation
Postprocedure Care
Research
Vertebral Body Augmentation
Contraindications
Complications
Postprocedure Care
Research
Implantable Therapies
Spinal Cord Stimulators
Devices
Patient Selection
SCS Trial
SCS Device Implantation
Contraindications
Precautions
Complications
Postimplantation Care
Research
Intrathecal Drug Delivery System
Indications
Patient Selection
Devices
Intrathecal Medications
IDDS Trial
Permanent Implantation
Contraindications
Complications
Postprocedure Care
Research
Key Points
Case Scenario
Acknowledgement
References
Chapter 20 Exercise and Movement
Fear of Pain With Movement
Fear of Pain
Fear-Avoidance Model
Assessment of Fear of Pain With Movement
Treatment of Fear of Pain With Movement
Exercise-Induced Hypoalgesia
Movement
Movement When Recovering With Acute Pain
Paleo Movement
Movement With Chronic Pain
The Feldenkrais Method
Dance Movement Therapy
Connection Dance
Biodanza
Exercise
Isometric Exercise
Pilates Exercise
Land Aerobic Exercise
Aquatic Exercise
Strengthening Exercises
Goldfish Exercise
Tai Chi
Yoga
Physical Therapy
Therapeutic Exercise
Mechanical Modalities
Passive Therapies
Electrotherapeutic Modalities
Patient Education for All Exercise and Movement
Key Points
Case Scenario
References
Chapter 21 Distraction and Relaxation
Distraction
Types of Distraction
Evidence and Indications for Pain Management
Humor
Evidence and Indications for Pain Management
Cautions
Art, Coloring, Drawing, and Doodling
Evidence and Indications for Pain Management
Electronic Games
Evidence and Indications for Pain Management
Cautions
Virtual Reality and Immersion or Immersive Virtual Reality
Evidence and Indications for Pain Management
Relaxation
Breathing Activities
Types of Relaxation Breathing
Diaphragmatic Breathing
Abdominal Breathing
Yogic Breathing or Pranayama
Alternate Nostril Breathing
Square Breathing
Lamaze Breathing
Evidence and Indications for Pain Management
Cautions
Progressive Muscle Relaxation
Evidence and Indications for Pain Management
Cautions
Music Therapy
Music Therapy as a Profession
Music Therapy and Multimodal Pain Management
Indications Using Music for Pain Control
Evidence and Indications for Pain Management
Concerns, Cautions, and Contraindications
Animal-Assisted Therapy
Definitions
Animal-Assisted Therapy
Animal-Assisted Activity
Indications for Animal-Assisted Therapy and Animal-Assisted Activity
Evidence and Indications for Pain Management
Cautions
Guided Imagery
Evidence and Indications for Pain Management
Cautions and Contraindications
Autogenic Training
Evidence and Indications for Pain Management
Contraindications
Key Points
Case Scenario
References
Chapter 22 Cognitive-Behavioral and Psychotherapeutic Interventions as Components of Multimodal Analgesic Pain Management
Integrative, Interdisciplinary, and Multimodal Pain Treatment
Interdisciplinary Pain Rehabilitation or Functional Restoration Programs
Cognitive-Behavioral Therapy
Goal Setting
Identifying Maladaptive Thinking
Cognitive Restructuring
Problem-Solving
Behavioral Activation (Graded Behavioral Activation)
Exposure Therapy (Graded Exposure Therapy)
Coping Skill Development
Coping With Trigger Factors
Relapse Prevention and Maintenance of Skills
Evidence Supporting Cognitive-Behavioral Therapy for Pain Management
Cautions and Contraindications
The Activating Event Belief Consequence Model
Evidence for Pain Management
Acceptance and Commitment Therapy
Evidence for Pain Management
Biofeedback (Applied Psychophysiology)
Evidence for Pain Management
Mindfulness-Based Stress Management and Mindfulness-Based Cognitive Therapy
Evidence for Pain Management
Psychoeducation
Evidence for Pain Management
Key Points
Case Scenario
References
Chapter 23 Energy Healing Therapies or Biofield Therapies as Components of Multimodal Analgesic Pain Management
Reiki
Indications
Evidence for Pain Management
Cautions
Therapeutic Touch
Evidence for Pain Management
Cautions
Healing Touch
Evidence for Pain Management
Cautions
Acupuncture
Evidence for Pain Management
Caution
Auricular Acupuncture
Evidence for Pain Management
Caution
Acupressure
Evidence for Pain Management
Caution
Key Points
Case Scenario
References
Chapter 24 Manual Therapies for Pain Management
Manual Therapy
Osteopathy, Osteopathy Manual Medicine, or Osteopathic Manipulative Therapy
Evidence for Pain Management
Research
Craniosacral Therapy
Evidence for Pain Management
Cautions
Massage Therapy
Evidence for Pain Management
Cautions
Reflexology
Evidence for Pain Management
Cautions
Chiropractic Practice
Evidence for Pain Management
Cautions
Myofascial Trigger Point Therapy
Evidence for Pain Management
Cautions
Muscle Energy Technique
Evidence for Pain Management
Cautions
Fascial Distortion Model
Evidence for Pain Management
Cautions
Key Points
Case Scenario
Acknowledgments
References
Chapter 25 Spirituality as a Component of Multimodal Pain Management
Spirituality
Prayer
Evidence for Pain Management
Cautions
Meditation
Centering Prayer (Spiritual Meditation)
Evidence for Pain Management
Kabbalah (Qabalah)
Evidence for Pain Management
Loving Kindness Meditation
Evidence for Pain Management
Mindfulness Meditation
Reflective Walking, Labyrinth Walking, and Movement Meditation
Evidence for Pain Management
Ridhwan School Diamond Approach
Evidence for Pain Management
Self-Realization Fellowship
Evidence for Pain Management
Tibetan Buddhist Meditation
Evidence for Pain Management
Transcendental Meditation
Evidence for Pain Management
Zen Buddhism/Ch’an
Evidence for Pain Management
General Cautions and Precautions Regarding Meditation
Key Points
Case Scenario
References
Chapter 26 Natural Products: Supplements, Botanicals, Vitamins, and Minerals as a Component of Multimodal Pain Management
Dietary Supplements
Botanicals and Herbs
Cannabis (Cannabis sativa, Cannabis indica, and Cannabis indica)
Evidence for Pain Management
Cautions and Contraindications
Contraindications
Potential Interactions With Medications
Cat’s Claw (Uncaria tomentosa)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Cayenne (Capsicum frutescens)
Devil’s Claw (Harpagophytum procumbens, Harpagophytum zeyheri)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Feverfew (Tanacetum parthenium L.)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Frankincense or Olibanum (Boswellia serrata)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Ginger (Zingiber officinale Roscoe)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Turmeric (Curcuma longa or Curcuma domestica)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Willow Bark (Salicis cortex) and White Willow Bark (Salix alba)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Other Herbs and Botanicals Used for Pain Management
Brazilian arnica (Solidago chilensis)
Butterbur (Petasites hybridus)
Comfrey (Symphytum officinale L.)
Ginseng (Panax ginseng)
Myrrh (Commiphora molmol)
St. John’s Wort (Hypericum perforatum)
Pharmaconutrients: Nutritional Modulators of Pain
Avocado and Soybean Unsaponifiables (Persea gratissma and Glycine max) (Piascledine)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Bromelain (Ananas comosus) (Pineapple Plant)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Flavocoxid
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Green Tea (Camellia sinensis)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Honey
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Supplements
Acetyl-l-Carnitine
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Coenzyme Q10 (Ubiquinone-10)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions with Medications
Glucosamine Hydrochloride or Sulfate and Chondroitin Sulfate
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Hyaluronic Acid
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Lactic Acid–Producing Bacteria (Lactobacillus acidophilus, casei, fermentum, gasseri, johnsonii, paracasei, plantarum, reu ...
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Magnesium
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Methylsulfonylmethane
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Omega-3 Polyunsaturated Fatty Acids (Eicosapentaenoic Acid and Docosahexaenoic Acid)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Vitamins
B Vitamins
Vitamin B1 (Thiamine)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Vitamin B2 (Riboflavin)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Vitamin B6 (Pyridoxine, Pyridoxal, and Pyridoxamine)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Vitamin B9 (Folate or Folic Acid)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
B12 (Cyanocobalamin or Cobalamin)
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Vitamin B Complex and Combinations
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Vitamin D
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Vitamin E
Evidence for Pain Management
Cautions
Contraindications
Potential Interactions With Medications
Key Points
Case Scenario
References
Chapter 27 Additional Nonpharmacologic Interventions as Components of Multimodal Pain Management
Aromatherapy
Evidence for Pain Management
Cautions
Caring, Empathy, and Compassion by Caregivers
Evidence for Pain Management
Cautions
Crossing Hands and/or Arms Over the Midline
Evidence for Pain Management
Cautions
Dietary Choices
Antiinflammatory Diet
Evidence for Pain Management
Cautions
Ketogenic Diet
Evidence for Pain Management
Cautions
Environmental Modifications
Lighting
Sound
Temperature
Position
Evidence for Pain Management
Caution
Hypnosis
Evidence for Pain Management
Caution
Mirror Therapy or Mirror Visual Feedback Therapy
Evidence for Pain Management
Mirror Visual Feedback Therapy and Other Chronic Pain Conditions
Virtual Reality Mirror Visual Feedback Therapy
Mirror Visual Feedback Therapy in Home Settings
Mirror Visual Feedback Therapy and Referred Sensations
Cautions for Using Mirror Visual Feedback Therapy
Obesity and Weight Management
Evidence for Pain Management
Cautions
Static Magnet Therapy
Evidence for Pain Management
Cautions
Temperature Modalities
Therapeutic Superficial Heat
Evidence for Pain Management
Cautions
Contraindications
Therapeutic Cold, Ice, Cryotherapy
Evidence for Pain Management
Cautions
Contraindications
Alternating or Contrasting Temperature Therapy
Evidence for Pain Management
Cautions
Valsalva Maneuver
Evidence for Pain Management
Cautions
Contraindications
Key Points
Case Scenario
References
Chapter 28 Improving Institutional Commitment for Effective Multimodal Pain Management
Organizational Commitment to Quality and Pain Management
Customer Satisfaction
Patient Safety
Clinical Care
Organizational Initiatives to Support Quality of Safe and Effective Multimodal Pain Management
Interdisciplinary Pain Oversight Committee
Medication Safety Committee
Opioid Risk Initiatives and Safety Interventions
Naloxone Availability
Quality Improvement
Plan-Do-Study-Act
Lean Methodology
A3 Methodology
A3: Pitfalls
Clinical Research Programs
Clinical Nursing Efforts to Support Organizational Initiatives
Nursing Shared Governance
Pain Resource Nurse Program
Education of Clinicians
Future Opportunities for Improvement
Innovation
Resources for Guiding Improvements in Institutional Commitment to Safe and Effective Pain Management
Key Points
Case Scenario
References
Appendix: Terminology
Index