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MANAGING PAIN This page intentionally left blank MANAGING PAIN Essentials of Diagnosis and Treatment Edited by Chad M. Brummett, MD ASSISTANT PROFESSOR OF ANESTHESIOLOGY DIRECTOR, PAIN RESEARCH DEPARTMENT OF ANESTHESIOLOGY UNIVERSITY OF MICHIGAN ANN ARBOR, MICHIGAN AND Steven P. Cohen, MD PROFESSOR OF ANESTHESIOLOGY JOHNS HOPKINS SCHOOL OF MEDICINE, BALTIMORE, MD & UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES, BETHESDA, MD DIRECTOR OF PAIN RESEARCH, WALTER REED NATIONAL MILITARY MEDICAL CENTER, BETHESDA, MD CHIEF, ANESTHESIA & OPERATIVE SERVICES, 48 TH COMBAT SUPPORT HOSPITAL, FORT MEADE, MD COLONEL, US ARMY RESERVE 1 3 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trademark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Oxford University Press 2013 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. The publisher and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material. Library of Congress Cataloging-in-Publication Data Managing pain : essentials of diagnosis and treatment/[edited by] Chad M. Brummett, Steven P. Cohen. p. ; cm. Includes bibliographical references and index. ISBN 978–0–19–985943–6 (alk. paper)—ISBN 978–0–19–993149–1 (alk. paper)— ISBN 978–0–19–997829–8 (alk. paper) I. Brummett, Chad M. II. Cohen, Steven P. (Steven Paul), 1963– [DNLM: 1. Pain Management. 2. Pain—diagnosis. 3. Pain—drug therapy. WL 704.6] LC Classification not assigned 616′.0472—dc23 2012030925 ISBN 978–0–19–985943–6 9 8 7 6 5 4 3 2 1 Printed in the United States of America on acid-free paper F r o m C h a d To my wife Kate and my children Christopher and Annabelle for their love, patience and understanding. To my mother Anita for her unwavering love and support, and to my father Jack for teaching me integrity, hard work and dedication. To my many mentors, collaborators, clinical colleagues, trainees, and students who continue to push me to ask clinically important questions and make it possible to seek the answers. Special thanks to my chairman Kevin Tremper for taking a chance on me. From Steve To my wife Karen, and my children Berklee, Zared and Seff rah, for their patience and understanding during the many hours I spent writ- ing and editing this book. To my mother Harriet, and in memory of my father Allen, who guided me onto a path of inquiry and knowledge. To my mentors, and physician and nurse colleagues at Johns Hopkins, the 48th Combat Support Hospital, and Walter Reed, including my research nurse Connie, whose collective feedback and assistance have made me a bett er doctor. To all of the trainees I’ve collaborated with over the years at Johns Hopkins and Walter Reed, whose questions have kept me att uned to the need for bett er research and books such as this. To all my patients, especially the wounded service members, who have entrusted their care to me. This page intentionally left blank ACKNOWLEDGMENTS “Th e authors gratefully acknowledge Andrea Seils and Rebecca Suzan from Oxford University Press for their support, guidance and assistance throughout the production process. We would also like to extend our most genuine thanks to the authors for delivering high-quality, clinically oriented chapters in a timely fashion. Finally, we are indebted to our departments for their patience and and assistance in helping us bring this project to fruition.” This page intentionally left blank CONTENTS Preface xiii Contributors xvii PART ONE PHARMACOLOGIC PAIN THERAPIES 1. Opioids 3 Lucy Chen, Steven P. Cohen, and Jianren Mao 2. NSAIDs and Adjunctive Pain Medications 35 Howard S. Smith, Kalyna Apkarian, and Charles E. Argoff 3. Phytomedicines for the Treatment of Pain 66 Julia Vlachojannis and Sigrun Chrubasik PART TWO NON-PHARMACOLOGIC PAIN THERAPIES 4. Behavioral Interventions for Chronic Pain: Exercise and Cognitive-Behavioral Th erapy 91 David A. Williams and Aft on L. Hassett 5. Complementary and Alternative Medical Th erapies for Pain 105 Richard E. Harris and Suzanna M. Zick ix CONTENTS PART THREE ADDITIONAL CONSIDERATIONS IN THE PAIN PATIENT 6. Management of Addiction in the Pain Patient 145 Caleb Kroll and Glenn Treisman 7. A Circular Conundrum: Sleep Disruption Worsens Pain and Pain Medications Disrupt Sleep 164 Michael Sternberg, Helen A. Baghdoyan, and Ralph Lydic PART FOUR CASE-BASED PAIN CHAPTERS 8. Low Back Pain 183 Steven P. Cohen, Artemus Flagg, and Julie H. Y. Huang 9. Neck and Upper Extremity Pain 212 Tomas Kucera and Robert W. Hurley 10. Osteoarthritis 231 Kristine Phillips 11. Neuropathies: DPN, HIV, Idiopathic 247 Christina M. Ulane and Th omas H. Brannagan III 12. Chronic Post-surgical Pain 268 Chad M. Brummett and Srinivas Chiravuri 13. Herpes Zoster and Postherpetic Neuralgia 287 Julie H. Y. Huang, Andrei D. Sdrulla, and Mark Wallace 14. Complex Regional Pain Syndrome 317 Salim M. Hayek and Henry E. Vucetic 15. Primary Headache 336 Wade Cooper 16. Non-cardiac Chest Pain 359 Sharon X. H. Hu and Guy D. Eslick x CONTENTS 17. Chronic Functional Abdominal Pain 387 Roy Dekel and Ami D. Sperber 18. Pelvic Pain 408 Sawsan As-Sanie, Mark Hoff man, and Devon Shuchman 19. Central Pain Syndromes 430 Brian G. Wilhelmi and Srinivasa N. Raja 20. Fibromyalgia and Other Central Pain States 454 Daniel J. Clauw Index 473 xi This page intentionally left blank PREFACE Pain is a fascinating subject that aff ects nearly everyone at some time. To fi nd proof of this, one need only open up a newspaper, read a mag- azine, or turn on the TV set. Our knowledge about the mechanisms and treatment of pain is growing so rapidly that much of the material published only a few years ago is now obsolete. It is such an impor- tant topic that people whose lives it consumes will sometimes go to incredible lengths to learn about it and try to eradicate it. Yet there is still so much misinformation and confl icting data out there that it is sometimes diffi cult to know the right course of action. Th e reason we know this is that we see it every day. In the most recent Institute of Medicine report on pain, it was estimated that more than 100 million Americans live with chronic pain. Pain is the leading cause of disability in the world, and the second most common reason people visit healthcare providers. It should therefore come as no surprise that there are countless books available to doctors and patients alike focused on pain medicine, with more and more being published every month. Th ese books are almost all writt en by “pain management doctors,” physicians who have trained in “pain medicine,” and they are virtually all targeted to xiii PREFACE a “pain management” audience. However, the burden of pain extends to all doctors, not just those who treat it every day. We both have been asked to edit books many times, and for the most part we have declined nearly all off ers. Raising children, run- ning a clinical practice, and overseeing clinical trials can be very time consuming. Why, then, did we accept this assignment? Because we both felt there was—and still is—a strong need for a book designed to assist frontline healthcare providers with one of the most challeng- ing problems in medicine: how to eff ectively treat chronic pain. Th is book is one of the few that caters to non-pain practitioners, designed to include not just primary care doctors but non-pain spe- cialty physicians and ancillary healthcare providers.