Guide to Pain Management in Low-Resource Settings
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Guide to Pain Management in Low-Resource Settings Edited by Andreas Kopf and Nilesh B. Patel INTERNATIONAL ASSOCIATION FOR THE STUDY OF PAIN® Guide to Pain Management in Low-Resource Settings Educational material written for general distribution to health care providers by a multidisciplinary and multinational team of authors Editors Andreas Kopf, MD Department of Anesthesiology Charité Medical University Berlin, Germany Nilesh B. Patel, PhD Department of Medical Physiology University of Nairobi Nairobi, Kenya IASP® • SEATTLE © 2010 IASP® International Association for the Study of Pain® All rights reserved. Th is material may be used for educational and training purposes with proper citation of the source. Not for sale or commercial use. Timely topics in pain research and treatment have been selected for publication, but the information provided and opinions expressed have not involved any verifi cation of the fi ndings, conclusions, and opinions by IASP®. Th us, opinions expressed in Guide to Pain Management in Low-Resource Settings do not necessarily refl ect those of IASP or of the Offi cers and Councilors. No responsibility is assumed by IASP for any injury and/or damage to persons or property as a matter of product liability, neg- ligence, or from any use of any methods, products, instruction, or ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent verifi cation of diagnoses and drug dosages. Th e mention of specifi c pharmaceutical products and any medical procedure does not imply endorsement or recommendation by the editors, authors, or IASP in favor of other medical products or procedures that are not covered in the text. Errors and omissions are expected. Supported by an educational grant from the International Association for the Study of Pain A preliminary version of this text was printed in 2009 Contents Foreword vii Introduction ix Basics 1. History, Defi nitions, and Contemporary Viewpoints 3 Wilfried Witte and Christoph Stein 2. Obstacles to Pain Management in Low-Resource Settings 9 Olaitan A Soyannwo 3. Physiology of Pain 13 Nilesh B. Patel 4. Psychological Factors in Chronic Pain 19 Harald C. Traue, Lucia Jerg-Bretzke, Michael Pfi ngsten, and Vladimir Hrabal 5. Ethnocultural and Sex Infl uences in Pain 27 Angela Mailis-Gagnon 6. Pharmacology of Analgesics (Excluding Opioids) 33 Kay Brune 7. Opioids in Pain Medicine 39 Michael Schäfer 8. Principles of Palliative Care 47 Lukas Radbruch and Julia Downing 9. Complementary Th erapies for Pain Management 59 Barrie Cassileth and Jyothirmai Gubili Physical and Psychological Patient Evaluation 10. Pain History and Pain Assessment 67 Richard A. Powell, Julia Downing, Henry Ddungu, and Faith N. Mwangi-Powell 11. Physical Examination: Neurology 79 Paul Kioy and Andreas Kopf 12. Physical Examination: Orthopedics 87 Richard Fisher 13. Psychological Evaluation of the Patient with Chronic Pain 93 Claudia Schulz-Gibbins Management of Acute Pain 14. Pain Management after Major Surgery 103 Frank Boni 15. Acute Trauma and Preoperative Pain 115 O. Aisuodionoe-Shadrach 16. Pain Management in Ambulatory/Day Surgery 119 Andrew Amata 17. Pharmacological Management of Pain in Obstetrics 123 Katarina Jankovic iii iv Contents Management of Cancer Pain 18. Abdominal Cancer, Constipation, and Anorexia 137 Andreas Kopf 19. Osseous Metastasis with Incident Pain 147 M. Omar Tawfi k 20. Lung Cancer with Plexopathy 155 Rainer Sabatowski and Hans J. Gerbershagen 21. Lung Cancer with Breathing Problems 163 Th omas Jehser 22. Hematologic Cancer with Nausea and Vomiting 169 Justin Baker, Paul Ribeiro, and Javier Kane Management of Neuropathic Pain 23. Painful Diabetic Neuropathy 179 Gaman Mohammed 24. Management of Postherpetic Neuralgia 183 Maged El-Ansary 25. Central Neuropathic Pain 189 Maija Haanpää and Aki Hietaharju 26. Th e Management of Pain in Adults and Children Living with HIV/AIDS 195 Glenda E. Gray, Fatima Laher, and Erica Lazarus Management of Chronic Noncancer Pain 27. Chronic Nonspecifi c Back Pain 207 Mathew O.B. Olaogun and Andreas Kopf 28. Headache 213 Arnaud Fumal and Jean Schoenen 29. Rheumatic Pain 221 Ferydoun Davatchi Diffi cult Th erapeutic Situations and Techniques 30. Dysmenorrhea, Pelvic Pain, and Endometriosis 229 Susan Evans 31. Pain Management Considerations in Pregnancy and Breastfeeding 235 Michael Paech 32. Pain in Sickle Cell Disease 245 Paula Tanabe and Knox H. Todd 33. Complex Regional Pain Syndrome 249 Andreas Schwarzer and Christoph Maier 34. Pain Management in Children 255 Dilip Pawar and Lars Garten 35. Pain in Old Age and Dementia 269 Andreas Kopf 36. Breakthrough Pain, the Pain Emergency, and Incident Pain 277 Gona Ali and Andreas Kopf 37. Pain Management in the Intensive Care Unit 283 Josephine M. Th orp and Sabu James 38. Diagnostic and Prognostic Nerve Blocks 293 Steven D. Waldman Contents v 39. Post-Dural Puncture Headache 299 Winfried Meissner 40. Cytoreductive Radiation Th erapy 303 Lutz Moser 41. Th e Role of Acupuncture in Pain Management 307 Natalia Samoilova and Andreas Kopf Planning and Organizing Pain Management 42. Setting up a Pain Management Program 317 M.R. Rajagopal 43. Resources for Ensuring Opioid Availability 321 David E. Joranson 44. Setting up Guidelines for Local Requirements 329 Uriah Guevara-Lopez and and Alfredo Covarrubias-Gomez Pearls of Wisdom 45. Techniques for Commonly Used Nerve Blocks 337 Corrie Avenant 46. Psychological Pearls in Pain Management 341 Claudia Schulz-Gibbins 47. Clinical Physiology Pearls 345 Rolf-Detlef Treede 48. Herbal and Other Supplements 349 Joel Gagnier 49. Profi les, Doses, and Side Eff ects of Drugs Commonly Used in Pain Management 351 Barbara Schlisio Appendix Glossary 359 Andreas Kopf Foreword Th e belief that pain treatment is a human right has been therefore, that 91% said that lack of education was the accepted by many for a long time, but in 2004 the state- main barrier to good pain management in their part of ment that “the relief of pain should be a human right” the world. was felt to be of suffi cient importance for it to be pub- It is clear that in many developing countries, re- lished following the launch of the fi rst Global Campaign lief of pain is not a priority, and that concern with infec- Against Pain in Geneva in 2004 by the International tious diseases such as malaria, tuberculosis, and above Association of Pain (IASP), the European Federation all HIV/AIDS takes precedence. In fact, 75% of those of Chapters of the IASP (EFIC), and the World Health who responded to the IASP survey considered a lack of Organization (WHO). Unfortunately, however, a large government priorities for pain management as the sec- number of those who suff er pain, and especially the ond most common barrier to good treatment. Almost as people of developing countries, do not receive treat- many reported that a fear of addiction to opioids among ment for acute and, more especially, chronic pain. doctors, nurses, and health providers was a barrier to Th ere are various reasons for this problem, the availability and use of those drugs, although, in fact, which include a lack of adequately trained health pro- such fear is primarily a consequence of poor education. fessionals, the unavailability of drugs, especially opi- Th e production of this manual is timely because oids, and a fear of using opioids because there is an it will fi ll a major gap in the knowledge of those who erroneous belief that inevitably the use of these drugs deal with people in pain in developing countries. It cov- will cause addiction. Th e fi rst major step in improv- ers the basic science of pain, and perhaps uniquely, the ing services for pain patients is to provide an educated rationale for the use of natural medicines. It also pro- workforce in developing countries—not only doctors vides background knowledge and advice on the man- and nurses, but district offi cers and other health work- agement of the major painful disorders occurring in de- ers. A survey by IASP in 2007 revealed that among its veloping countries, including the two major scourges of members in developing countries, very few believed the present time—cancer and HIV/AIDS. they had received an adequate education in the under- Th is is a book that should be available to all standing and management of pain as undergraduates. who are responsible for providing treatment for pain, In most regions of the world, less than half had been whether acute or chronic, and whether they work in trained in pain management, even though it was a sig- cities, towns, or in a much more rural settings, because nifi cant part of their daily work. It is not surprising, all will fi nd it an invaluable aid to their practice. Professor Sir Michael Bond Glasgow, Scotland August 2009 vii Introduction Pain is widely undertreated, causing suff ering and fi - provide confi dence in clinical decision-making, im- nancial loss to individuals and to society. It is believed proving practical skills and attitudes to care. that health care of all patients should include assess- Information on pain and pain management is ment of pain and its impact on the patient, specifi c ef- crucial. All health care workers will see patients suf- forts by health care professionals to control pain, and fering from pain. Pain is the main reason for seeking the development of programs to generate experts in medical help. Th us, any physician, nurse, or other clini- pain management. Additionally, clinical and basic sci- cal worker needs to have basic knowledge about the ence research is to be encouraged to provide better pathophysiology of pain and should be able to use at care in the future. Th e aim of these eff orts is to ensure least simple fi rst-line treatments.