index

A Acetaminophen—cont’d AACPI, 2 nonsteroidal antiinflammatory drugs versus, 104 Abdominal pain overdose of, 151–152 cancer-related, 534t pregnancy and, 611, 613 Crohn’s disease and, 597–598 preparations of, 148t Absorption, drug as rectal suppository, 150t elderly and, 687, 688 safety of, 110 intraspinal local anesthetics and, 228 side effects of, 134–136 of opioid, 167–169, 168f tension headache and, 558 rectal, 204 Acetic acid derivative, 139t Abstinence syndrome, 609, 616–617 Acetylsalicylic acid; see also Aspirin nalbuphine causing, 614 infant and, 654 Abuse migraine and, 554t elder, 706 Acquired immunodeficiency syndrome, 564–568, 566f substance, 428–462; see also Addiction peripheral neuropathy and, 576 Accountability for pain management, 3–4, 730, 733 Action potential Accreditation, 730, 733 definition of, 16 Acetaminophen nociception and, 19t antihistamines with, 150 transduction of pain and, 18 aspirin with, 148–149 Action stage of drug treatment, 448 breast feeding and, 623 Action sites, analgesic, 106–107f caffeine with, 316 Acupuncture for fibromyalgia, 549 clinical considerations for, 108–110 Acute pain model combination drugs with, 116–117, 134 adaptation versus, 43–45 definition of, 130 correction of, 45–46 dosage of, 139t Acute pain services, 11 for child, 143t Acute versus chronic pain, 493–494; see also Pain entries frequency, 139–140t, 140–141 Adaptation model, 43–46 guidelines for, 142 Addiction opioid equivalent, 133t challenges of, 462 titration of, 141 definition of, 36, 50–51, 162, 429, 433–436 elderly and, 690 discussing with patient and family, 275–276t equianalgesic dosage of, 133t drugs of abuse and, 432–433, 432t, 433t hemophilia and, 599 elderly and, 705–706 indications for, 131–134 family’s fear of, 10 infant and, 653–654 infant and, 631 mechanism of action of, 130 as label, 51, 53–54 nonprescription formulations of, 148t memory of pain and, 30 misconceptions about, 52–53t, 276t, 430t, 439–440 t after a page number indicates a table, box, or form; f after a page misinterpretation of, 173–174 number indicates an illustration. models of, 431–432, 431t

758 INDEX 759

Addiction—cont’d Adjuvant analgesics—cont’d to opioid, 173–174 general considerations in, 303–306 undertreatment of pain and, 9 guidelines for use, 342–344t pain management in, 450–462, 455t, 460t indications for, 316–317 chronic pain and, 461–462, 477 local anesthetics as, 316 clinical principles in, 453–454 for malignant bone pain, 325t inpatient, 454–456, 461t for malignant bowel obstruction, 327t naltrexone and, 460–461 methylphenidate as, 314–315 outpatient, 456, 458 misconceptions about, 303t overlap between, 452–453 neuroleptics as, 316–317, 332–334 recovery from addiction and, 459–460 NMDA receptor blockers as, 317 patient information about, 275–276t pain mechanism affected by, 108 patient placement and, 451, 451t patient information about, 340, 345–353t phenomenology of, 436–440 pediatric dosing, 341t response documentation, 459t pregnancy and, 614–615 treatment of, 440–450 reflex sympathetic dystrophy and, 583 characteristics of, 441 temporomandibular dysfunction and, 590 cognitive-behavioral, 445–446 titration of, 122 commonalties in, 446 Administration of analgesic; see Route of administration; detoxification and, 441–442 specific route drugs used in, 442t, 443–445 Administrative rules on pain management, 738 referral for, 446–450 Admission assessment of pain, 58–59, 59t residential, 446 Adrenocorticotropic hormone, pain and, 24 twelve-step, 442–443 Adult protective services, 706 written agreement for, 754–755 Adverse drug effects Adenocard; see Adenosine elderly and, 689 Adenoscan; see Adenosine fetal, 621 Adenosine, 339 HIV and, 566–567 Adenosine triphosphate, 22 infant and, 655 Adhesive, tissue, 395 Advil; see Ibuprofen Adjuvant analgesics, 105f, 302–353 Afferent neuron, 16 for acute pain, 335–340 Age alcohol as, 334–335 elderly and, 674–706; see also Elderly patient

alpha2-adrenergic agonists as, 313–314 infant and, 629–669; see also Infant antidepressants as, 306–311, 306t; see also Antidepressants opioid and, 192 antihistamines as, 334 pain assessment and, 57 benzodiazepines as; see Benzodiazepine shingles and, 561 breast feeding and, 623–624 Agency for Health Care Policy and Research caffeine as, 315–316 clinical practice guidelines of, 7, 43–44 cannabinoids as, 334 education of clinicians and, 89 in children, 340, 341t low back pain and, 600 for chronic pain nondrug pain treatment and, 423 bone, 324–326, 325t patient education materials of, 274 classes of, 305t quality improvement and, 713 lancinating, 320–324 undertreatment of pain and, 2 multipurpose drugs for, 306–317 Aggregation, platelet, 138, 144 musculoskeletal, 327–328, 327t Agitation in alcohol withdrawal, 457 neuropathic, 317–320, 317t, 328–332 Agonist, mu; see Mu agonist classifications, 304t Agonist-antagonist major, 305t buprenorphine, 188 clinical considerations for, 112–113 butorphanol, 188–189 cocaine as, 316 characteristics of, 188–190 combination analgesics with, 116 clinical considerations for, 112 comparison of, 114f, 115 combination analgesics with, 116 corticosteroids as, 311–313 comparison of, 114 definition of, 104, 162 definition of, 162, 363 dextroamphetamine as, 314–315 dezocine, 189 dosage of, 341–344t examples of, 109t elderly and, 695–698 intranasal administration of, 203 examples of, 109t labor and delivery and, 618 760 INDEX

Agonist-antagonist—cont’d American Pain Society—cont’d mild pain and, 191 clinical practice guidelines of, 7 misconceptions about, 163t definition of pain and, 16 mu agonist with, 112 education of clinicians and, 89 nalbuphine, 189 founding of, 11 opioid receptor sites and, 166 home page, 747f pentazocine, 189–190 pain care committee and, 715 pruritus and, 265–266 patient-controlled analgesia, 249 Agreement, written, 751–752 quality improvement and, 713 AHCPR; see Agency for Health Care Policy and Research unknown cause of pain and, 47 AIDS, 564–568, 566f web site of, 747f peripheral neuropathy and, 576 American Society of Addiction Medicine, 461 Alcohol addiction, 432t American Society of Clinical Oncology, 6 CAGE questionnaire about, 705 American Society of Pain Management Nurses, 517 elderly and, 705–706 certification and, 11, 13 pharmacologic effects and, 432 founding of, 11 psychiatric disorders with, 436–437, 436t, 437t placebo and, 55–56 treatment of, 445 Amethocaine, 376 withdrawal assessment and, 457t Amitriptyline, 305t, 306t Alcohol as adjuvant analgesic, 334–335 as adjuvant analgesic, 306 Alcoholics Anonymous, 442–443, 442t breast feeding and, 623–624 Aleve; see Naproxen for child, 341t Algorithm for infant care, 662–663f dosage of, 343t Alka-Seltzer, 148t elderly and, 696–697, 699t Allergy fibromyalgia and, 548 aspirin, 144 indications for, 310 intraspinal local anesthetics and, 228 tension headache and, 555t nonsteroidal antiinflammatory drug and, 110 Amphetamine, 193 opioids and, 193 Amputation, 257–258 Allodynia, 302 pain after, 603–604 definition of, 16 phantom limb pain after herpes zoster and, 562 in elderly, 694

Alpha2-adrenergic agonist previous acute pain and, 30–31 clonidine; see Clonidine Anacin, 149t examples of, 305t Anafranil; see Clomipramine indications and dosages of, 342t Analgesia; see also Analgesics neuropathic pain and, 321t balanced; see Balanced analgesia

Alpha1-blocker for postmastectomy pain, 604 conscious, 382–384t Alzheimer’s disease, 675 epidural; see Epidural analgesia Ambulatory surgery, 145 intraspinal; see Intraspinal analgesia Amerge; see Naratriptan masking diagnostic information with, 47 Americaine; see Benzocaine optimization of, 122–123 American Academy of Head, Facial and Neck Pain, and overview of, 103–128 TMJ Orthopedics, 516 patient-controlled; see Patient-controlled analgesia American Academy of Hospice and Palliative Medicine, 13 preemptive; see Preemptive analgesia American Academy of Pain Medicine, 11 principles of, 121–123 American Academy of Physical Medicine and Rehabilitation, 516 procedures requiring, 365t American Alliance of Cancer Pain Initiatives, 2, 11 Analgesics American Amputee Foundation, 516 action sites, 106–107f American Board of Internal Medicine, 6 adjuvant; see Adjuvant analgesic American Board of Pain Medicine, 516 “Andrew-Robert survey” and, 38t,40 American Burn Association, 527 assessment of, 38t American Chiropractic Association, 516 combined; see Combination analgesics American Chronic Pain Association, 516 combining, 105t, 116t American College of Emergency Physicians differential diagnosis, 172t clinical practice guidelines of, 7 formulary guide, 737t unknown cause of pain and, 47 by infusion; see also Infusion American Foundation for Pain Research, 516 flow sheet for, 79–80t, 83–86t American Pain Society, 516–517 groups and subgroups, 105t, 109t acute pain model and, 43–44 comparisons of, 114t INDEX 761

Analgesics—cont’d Anticonvulsants—cont’d list of, 125t indications and dosages of, 342t nonopioid, 129–159; see also Acetaminophen; Nonsteroidal lamotrigine and, 322 antiinflammatory drug mechanism of, 322 nonprescription, 148–149t migraine and, 555t nurses response to survey, 40t neuropathic pain and, 321t opioid; see Opioid analgesic peripheral neuropathy and, 578 pregnancy misconceptions, 610t phenytoin and, 321–322 patient controlled, 754t pregnancy and, 615 outpatient opioids, 755t temporomandibular dysfunction and, 590 topical, 331t; see also Topical agents valproic acid and, 322 use of, 38t Antidepressants during pregnancy, childbirth, postpartum, and breast action sites of, 309f feeding, 608–625 analgesics, 306t Analgesic ceiling adjuvant, 306t definition of, 104, 130, 162, 363 action sites, 309f elderly and, 690 breast feeding and, 623–624 Analgesic groups, 104–128 for child, 341t Analgesic ladder, WHO, 115–119, 117f for chronic pain, 306–311 Anaprox; see Naproxen adverse effects of, 308–310 “Andrew-Robert” survey, 38t,40t amitriptyline and, 306 nurses’ expectations about pain and, 44 clomipramine and, 307 Anecdotal evidence, 302 desipramine and, 307 Anemia, sickle cell, 585–588 dosage of, 310–311 Anesthesia doxepin and, 307 action sites, 319f imipramine and, 306–307 circumcision and, 636–637 indications for, 310 epidural; see Epidural analgesia mechanism of action of, 308 general, 386–389, 387t monitoring of, 311 local; see Local anesthetic newer, 307 low back pain and, 600 nortriptyline and, 307 nerve block records and, 511–512t selection of, 310 Aneurysm, aortic, 26 elderly and, 696–697, 699t Angiography, back pain from, 391 fibromyalgia and, 548 Animal, companion, for relaxation, 421 herpes zoster and, 562 Ankylosing spondylitis, 595–596 misconceptions about, 303t Antacid neuropathic pain and, 317, 317t, 321t misconceptions about, 131t osteoporosis and, 575 prevention of ulcers and, 137 pregnancy and, 614–615 Antagonist, 162 temporomandibular dysfunction and, 590 opiod, inappropriate use, 269 tricyclic Antenatal period, 609 in elderly, 696–697 Anterior deltoid trigger point, 571f examples of, 306 Antiarrhythmic agent for temporomandibular dysfunction, 590 indications and dosages of, 343t Anticholinergic agent modulation of pain and, 23 antidepressants as, 308 opioids and, 193 elderly and, 695, 697 peripheral neuropathy and, 578 malignant bowel obstruction and, 327, 327t postmastectomy pain and, 604 opioids and, 193 tension headache and, 555t Anticonvulsants Antidiuretic hormone, 24 action sites, 319f Antihistamine adverse effects of, 322–324 as adjuvant analgesic, 334 breast feeding and, 624 elderly and, 695 carbazepine and, 321 nonopioids with, 150 clonazepam and, 322 opioids and, 193 dosage for, 324 Antiinflammatory drug, nonsteroidal, 129–159; see also elderly and, 697 Non-steroidal antiinflammatory drug examples of, 305t Antiparkinsonian drug, 193 gabapentin and, 322 Antipyretic, 144; see also Aspirin; Nonsteroidal antiinflamma- herpes zoster and, 562 tory drug 762 INDEX

Antisocial personality, 436 Assessment—cont’d Antiviral agent failure to attain, 36–38 herpes zoster and, 563 of headache, 550, 552 HIV and, 565 herpes zoster and, 562 Anxiety initial, 58–62, 60f,61f alcohol addiction and, 436 institutional needs, 724–726 withdrawal from, 457 lack of accountability for pain and, 3–4 burn injury and, 529t low back pain and, 599–600 as cause of pain, 48–49 misconceptions affecting, 37t, 39–58 chronic pain and, 500 addiction and, 50–54 definition of, 468 authority about pain and, 39–42 reducing, 390t clinician’s expectations and, 44–46 Aortic aneurysm, 26 implications of, 56–58 APAP, 138t, 148t, 150t know versus unknown cause of pain and, 46–50 Aphthous ulcer in HIV, 566–567 pain threshold and, 42 Appliance for temporomandibular dysfunction, 590 pain tolerance and, 42–43 Arachnoiditis, 596 placebos and, 54–56 Around the clock dosing, 175 responses to pain and, 43–44 cognitively impaired elderly and, 704 multiple sclerosis and, 602 rescue dose and, 244–246 myofascial pain syndrome and, 569–570 Arteritis, temporal, 695–696 ongoing, 97t Artery, coronary, bypass of, 694 pain management and, 720–730 Arthriten, 149t physiologic responses, 43–45, 95t Arthritis, 523–527, 524f, 525f postmastectomy pain and, 604 alternative treatment for, 690t postthoracotomy pain and, 606 in child, 143t of procedural pain, 366–367 Arthritis Foundation Aspirin Free, 148t spinal cord injury and, 607 Arthropan; see Choline salicylate tools for, 58–89 Artificial saliva, 602 breakthrough pain and, 75, 78 ASA; see Aspirin communication strategies and, 84, 86, 89 Aseptic necrosis, 539 flow sheets and, 78–84, 85 Aspirin initial, 59–62, 60–61f, 60–61t acetaminophen with, 148–149 neuropathic pain scale, 75, 76–77 allergy or intolerance to, 144 nursing admission, 58–59 bleeding and, 135, 138 pain rating scales and, 62–75 buffered, 149 teaching to use, 67–75, 74t dosage of, 139t Association for Applied Psychophysiology and for child, 143t Biofeedback, 517 equianalgesic dosage of, 133t ATC dosing, 175 indications for, 131 cognitively impaired elderly and, 704 infant and, 654 rescue dose and, 244–246 nonprescription formulations of, 148–149t Atenolol, migraine and, 555t overdose of, 150–151, 152 Atherosclerosis, 696 pediatric dosage of, 143t Ativan; see Lorazepam renal function and, 136 Atraumatic suturing, 395 topical, 332 Atrophic stage of reflex sympathetic dystrophy, 582 Aspirin Free Maximum Strength, 148t Audit, medical record pain management, 727 Aspirin Free Pain Relief, 148t Auditory disturbance in alcohol withdrawal, 457 Assessment, 36–99, 123 Aura, migraine, 552 addiction and, 461 Aventyl; see Nortriptyline admission, 58–59, 59t of analgesic history, 124t, 125t B arachnoiditis and, 596 Back pain, 599–600 behavioral responses, 43–45, 95t alternative treatment for, 690t challenges in, 89, 92–99 angiography causing, 391 chronic pain and, 477–486, 492–493, 508–509 arachnoiditis and, 596 complexities of, 36–39 chronic, 473–474 Crohn’s disease and, 598 failed back syndrome and, 496 elderly and, 686–687 osteoporosis causing, 573 epidural anesthesia, 230–231t pregnancy causing, 615–616 INDEX 763

Back pain—cont’d Benzodiazepines—cont’d psychiatric setting and, 475–476 as nonanalgesic, 113 Background pain with burn injury, 529t opioid with, 499 Baclofen, 305t pregnancy and, 615 indications and dosages of, 343t procedural analgesia with, 380, 381 modulation of pain and, 23 misconceptions about, 364t multiple sclerosis and, 603 for procedural sedation, 385–386t overview of, 324 Beta-blocker for migraine, 555t, 556 Bacteriostatic saline, 370 Bethanechol Balanced analgesia elderly and, 697 characteristics of, 174–175 side effects of, 308 clinical application of, 120, 120t Bier block, 584 concept of, 174–175 Biliary spasm, opioids causing, 265 definition of, 162 Bill of rights for patients with pain, 13 explanation of, 119–121 Binding perioperative, 144–145 opioid receptor sites and, 108 Barbiturate for procedural analgesia, 381, 386 protein, in elderly, 688 Barriers Bioavailability to assessment, 37t definition of, 162 to drug treatment, 449 intraspinal anesthesia and, 220–222 to pain management improvement, 714 of opioids, 167–169 questionnaire, 93t Biphosphonate, 325, 325t to treatment, 37t Bipolar disorder, 436 Barriers Questionnaire, 89, 92, 93 Birth; see Labor and delivery Bathing, contrast, 411 Black market for drugs, 438–439 Bayer Select Aspirin-Free Headache, 149t Bleeding BC preparation, 149t angiography and, 391 Beck Depression Inventory, 519 nonsteroidal antiinflammatory drugs causing, 138, 144 Bedrest, osteoporosis and, 574 gastrointestinal, 136, 137, 145–146 Behaviors at operative site, 145–146 addictive; see Addiction perioperative, 145–146 drug-seeking, 52–53t, 429 Bleeding time addiction versus, 434–435 aspirin and, 135, 137 elderly and, 686–687 nonsteroidal antiinflammatory drugs and, 138, 145 indicative of pain, 95t Block memory of pain and, 30 nerve; see Nerve block pain paravertebral sympathetic ganglion, 583–584 description of, 95 Blood disorder expectations about, 44–46 hemophilia and, 598–599 impaired communication and, 95, 98 sickle cell disease, 585–588 in infant, 633–634, 633f, 649 Blood Behavioral method of treatment -brain barrier, 162 drug abuse and, 442t, 445–446 patch, 232 infant and, 658–659 vessels, in migraine, 553 for procedural pain management, 389–390 Board, state medical, 9–10 Benzocaine Board of Registered Nursing, 6 for procedural pain, 369t Body surface area in burn injury, 527 topical, 371–372 Boluses, 211 Benzodiazepines cesarean section and, 622–623 addiction to, 433 elderly and, 693 as adjuvant analgesic, 335 intraspinal, 220, 221 adverse effects of, 381 intermittent, 221t alcohol withdrawal and, 458 titration of dose and, 247 common, 495t Bones detoxification protocol, 458t aseptic necrosis of, 539 elderly and, 698 cancer-related pain in, 109t, 113, 324–326, 325t, 533t examples of, 327t indomethacin affecting formation of, 147 infant and, 655 malignant, 325t equisedating doses, 656t osteoporosis and, 572–576 labor and delivery and, 618–619 Bowel obstruction, 326–327, 327t 764 INDEX

Brace for osteoporosis, 575 Butorphanol nasal spray, 112 Brachial plexus Bypass surgery, coronary artery, 694 cancer-related pain and, 535t radiation fibrosis of, 540t C Brain Cafergot; see Ergotamine addiction and, 432 Caffeine dopamine pathway in, 434 as adjuvant analgesic, 315–316 migraine and, 553 beverages containing, 151t opioid receptors in, 165–166 breast feeding and, 624 pain perception and, 22 indications and dosages of, 344 Brand names of nonopioid drugs, 138t nonsteroidal antiinflammatory drugs with, 149–150, 149t Braxton Hicks contraction, 616 CAGE questionnaire, 705 Breakthrough pain Calan; see Verapamil burn injury causing, 529t Calcitonin fentanyl for, 202–203 bone pain and, 325, 325t opioids for, 175 indications and dosages of, 344 rating scale for, 75, 78 neuropathic pain and, 321t, 330 selection of analgesic for, 121 osteoporosis and, 574 Breast Calcium-channel blocker postmastectomy pain and, 604 cluster headache and, 556t postpartum pain and, 622 migraine and, 555t Breast cancer, 532t Cancer pain initiatives, 11 age and, 678t Cancer-related pain, 531–543, 532t, 533t Breast feeding, 610, 623–624 adjuvant analgesics for, 109t, 113 acetaminophen during, 623 bone pain and, 324–326, 325t adjuvant analgesics during, 623–624 bowel obstruction and, 326–327, 327t nonsteroidal antiinflammatory drugs during, 142 Brompton’s cocktail for, 316 opioid analgesics during, 623 characteristics of, 532–537 Breathing technique cost of, 4 labor and delivery and, 617 death statistics, 532t for relaxation, 419–420 description of, 531–532 Brief Pain Inventory, 61, 62 elderly and, 678–679, 678t cultural differences and, 98 family’s attitude toward, 10 Bromo-Seltzer, 148t intraspinal sufentanil for, 227 Brompton’s cocktail, 316 intravenous opioid for, 211 Buccal administration of opioids, 195t, 201 management of, 539–542 Buffered aspirin, 149 mucositis and, 601–602 gastric injury and, 137 musculoskeletal tumor, 533t Bupivacaine neuropathic, 535–536t breast feeding and, 623 noncancer pain versus, 47–48 dosage of, 369t nondrug treatment of, 401, 405 elderly and, 694 oxycodone for, 243 injectable, 368 patient-controlled analgesia for, 249 intraspinal, 228 postchemotherapy, 538–539t labor and delivery and, 618, 620 postradiation, 540t for procedural pain, 369t postsurgical, 537t Buprenorphine procedures and treatment causing, 537–540, 537–540t characteristics of, 188 rescue analgesia for, 247–248 equianalgesic doses of, 242t resources for, 542 labor and delivery and, 112, 618 sites of, 532t opioid receptor sites and, 166 spinal cord compression as, 339–340 Bupropion, 306t stomal administration of opioid in, 205–206 Burns viscera involvement, 534t depth of, 528f WHO analgesic ladder for, 115–119 management pathway of acute care, 529t Cannabinoid, 334 pain, 527–531, 528f Capaisin, 305t Bursitis, 690t adverse effects of, 332 Butorphanol Carbamazepine, 305t characteristics of, 188–189 adverse effects of, 322–323 labor and delivery and, 618 for child, 341t INDEX 765

Carbamazepine—cont’d Cessation of opioid therapy, 270–271 indications and dosages of, 342t Cetacaine, 371–372 neuropathic pain and, 321t Chart overview of, 321 equianalgesic, for opioids, 174, 240–243 Carcinoma; see Cancer-related pain graphic vital sign, 735 Cardiac disease in elderly, 698 Checklist, patient teaching, 273 Cardiac surgery Chemical dependence, 429 in elderly, 678t Chemical irritation, wound pain and, 592–593 in infant, 662 Chemotherapy, 538t-539t Cardiotoxicity of antidepressants, 309–310 Chest surgery Cardiovascular system in elderly, 678t antidepressants in elderly and, 697 pain of, 605–606 Ehlers-Danlos syndrome and, 543 Chest trauma, 26 harmful effects of pain on, 25–26 Chest wall tumor, 533t local anesthetic in elderly and, 698 Child Caregivers adjuvant analgesics for, 340 for elderly, 684, 685t, 686 clonidine for, 336 report of patient’s pain, 39–40 dosage of, 341t Carisoprodol, 305t, 327, 328 aspirin avoided in, 143t elderly and, 700 bupivacaine for, 237–238, 368 musculoskeletal pain and, 327t cancer-related pain in, 537 Case report, 302 conscious sedation in, 382–385t Catabolism, 16 epidural analgesia in, 236–239 Catheters local anesthetic toxicity in, 368 in child, 237 nondrug pain treatment for, 421, 422 epidural, 218f, 221t nonsteroidal antiinflammatory drug for, location of, 248 142–144, 143t patient education about, 366 opioid for removal of, 82, 236t intravenous, 211, 213 patient placement, 218f rectal administration of, 205 spinal, 214–216, 232–233 pain behavior in, 46 intraspinal displacement and migration, 233t patient-controlled analgesia in, 253, 255t urethral, 372 rectal administration in, 150t Catheritization, atraumatic urethral, 372t refrigerant spray for, 377 Causalgia, 581–584 topical anesthetic for, 372 Cause and effect diagram, 722f–723f Childbirth, 617–623; see also Labor and delivery Ceftriaxone with lidocaine, 371 Chloral hydrate Ceiling analgesia, 104, 162 infant and, 655 for acetaminophen, 141 procedural analgesia with, 386 definition of, 130 Chlordiazepoxide, 698, 699t elderly and, 690 Chloroform in topical agent, 332 for opioid-nonopioid combination drugs, 134 Chlorpromazine Celiac plexus neurolytic block for pancreatitis, 581 for migraine, 554t Cell, natural killer, 29 procedural analgesia with, 380 Central nervous system; see also Brain; Neurologic disorder Chlorzoxazone, 305t, 700 nonsteroidal antiinflammatory drugs affecting, 138 musculoskeletal pain and, 327t opioid receptors in, 165–166 Chocolate, caffeine in, 150 opioid withdrawal in infant and, 632 Choline magnesium trisalicylate Centrally generated pain bleeding disorder and, 138, 144 classification of, 19t dosage of, 139t definition of, 16 for child, 143t Cerebrospinal fluid patient information sheet on, 155–156 dural puncture and, 232 Choline salicylate intraspinal anesthesia and, 214, 221–222 dosage of, 139t Certification of pain specialists, 11–12 equianalgesic, 133t Cervical trigger point, 571f opioid equivalent, 133t Cervical vertebral tumor, 533t, 536t trade name of, 138t Cesarean section, 621 Chronic fatigue immune deficiency syndrome, 597 clonidine for, 336 Chronic fatigue syndrome, 597 pain after, 622–623 Chronic illness problem inventory, 519 766 INDEX

Chronic pain, 467–520, 490–505 Cimetidine—cont’d acute care setting and, 473–475 nonsteroidal antiinflammatory drugs and, 131t acute pain versus, 493–494 ulcer prevention and, 137 addiction and, 461–462 Circumcision, 371, 636–639 treatment center for, 477 EMLA for, 376 adjuvant analgesic for, 109t, 112–113 memory of pain in, 30 admission assessment and, 492–493 City of Hope Medical Center, 4–5, 274 antidepressants for, 310 Classic migraine, 552 assessment of, 477–487 Clearance, drug of bone, 109t, 113, 324–326, 325t, 533t of intraspinal local anesthetics, 228 breakthrough, 175; see also Breakthrough pain of opioid, 169–170 cancer-related; see Cancer-related pain Clinical pathway, 679–680, 738–739 challenges of, 472–473 Clinical practice guideline, 5, 7t in child, 143t; see also Child Clinical scoring system for pain in infant, 641 combination analgesics for, 116 Clinical trial, types of, 302 cost of, 472 Clinician; see Health care professional definition of, 17, 468, 471 Clodronate, 325 drug management in, 494–499 Clomipramine, 305t, 306t education about, 494 as adjuvant analgesic, 307 elderly and, 679 indications and dosages of, 343t in infant, 640 Clonazepam, 305t intraspinal administration and, 219f adverse effects of, 323 long-term planning in, 505 characteristics of, 335 management techniques for, 505, 510 indications and dosages of, 342t misconceptions about, 469–470t, 471 as muscle relaxant, 327, 328 nerve blocks for, 510–513 musculoskeletal pain and, 327t nonmalignant neuropathic pain and, 321t activity changes, 509f overview of, 322 anesthesia nerve block, 511–512t Clonidine, 305t differential blocks, 510t for crescendo pain, 336 examples, 472t dosage of, 314, 342t medication, 489t epidural, 229, 231, 315t opioid therapy, 498t herpes zoster and, 562 patient assessment, 486t indications for, 314, 342t patient care, 491t intraspinal, 229, 231 patient daily plan, 506t mechanism of, 313–314 patient future plan, 507t neuropathic pain and, 321t patient questionnaire, 478–485t peripheral neuropathy and, 579 psycyiatric disorders, 476t for regional anesthesia, 337t return visit survey, 508t Clorazepate, 698 severity of, 509f Cluster headache, 558–559, 558f treatment, 489t drugs for, 555t–556 treatment goals, 488t Coagulation, 598–599 nonsteroidal antiinflammatory drugs for, 133–134, 138, 140, 142 nonsteroidal antiinflammatory drugs and, 135; see also opioid analgesics for, 492 Bleeding written agreements about, 753–754 vascular surgery and, 25–26 osteoporosis and, 574–575 Cocaine placebos and, 492 addiction to, 432t, 433 polypharmacy in, 304 as adjuvant analgesic, 316 prevalence of, 471–472 in topical mixtures, 373 previous acute pain and, 30 Cocktail, Brompton’s, 316 psychiatric settings and, 475–477 Codeine psychosocial considerations in, 499–503 characteristics of, 179t, 181 referral for treatment of, 513, 516–520 in combination drug, 117, 134 rehabilitation and, 487–490, 503, 505 equianalgesic dosage of, 133t, 241t respect for individual and, 491–492 infant and, 655 selection of analgesic for, 121 nebulized, 203 suicide risk and, 487 pregnancy and, 614 Cimetidine transdermal fentanyl and, 209t elderly and, 699t Coerced drug treatment, 446 INDEX 767

Cognitive impairment Constipation effects of pain and, 28–29 burn injury and, 529t elderly and, 675, 686–687, 701–705 elderly and, 695 nonsteroidal antiinflammatory drugs and, 135 antidepressants and, 697 pain assessment and, 94 opioids causing, 262t Cognitive-behavioral intervention Containment of infant, 659 cancer-related pain and, 541 Contemplation stage of drug treatment, 447t, 448 chronic pain and, 500–501 Contingency-based drug therapy, 446 drug abuse and, 442t, 445–446 Continuous dysesthesia, 302 procedural pain management and, 389–390 adjuvant analgesics for, 317 Cold, 406–411, 409f Continuous infusion, 244; see also Infusion arthritis and, 526 intraspinal, 220 herpes zoster and, 562 in opioid naive patient, 250–251 injection site pain and, 394–395 Continuous quality improvement, 713–715; see also Quality pain reduction with, 390 improvement) patient and, 410t, 411t Contract Colon cancer, 532t definition of, 751–752 age and, 678t for opioid use, 499 Combination analgesics Contraction brands and dosages, 149t Braxton Hicks, 616 chronic pain and, 496 opioid affecting, 619 epidural, 694 postpartum, 622 examples of, 116–117 Contrast bathing, 411 ketamine and morphine, 338 Controlled study, 302 labor and delivery and, 618 Controlled-release formulation in rescue analgesia, 121 mild pain and, 191 Conversion chart, equianalgesic; see Equianalgesic dosage misconceptions about, 105t Cope, 149t nonsteroidal antiinflammatory, 132, 149t Coping response, 404–405 opioid and nonopioid, 134 addiction and, 438 prevention of NSAID-induced ulcers and, 137 chronic pain and, 501–503 procedural analgesia with, 380 Coping Strategies Questionnaire, 519 rationale for, 109–110, 115 Cord, spinal; see Spinal cord WHO analgesic ladder and, 115–119 Coronary artery bypass surgery, 694 Combined spinal-epidural anesthesia, 231 Corticosteroid COMFORT Scale, 649, 650 as adjuvant analgesic, 311–313 Commission on Accreditation of Rehabilitation Facilities, 517 for bone pain, 325t, 326 Committee, pain care, 713, 715–737; see also Pain care breast feeding and, 624 committee cancer-related pain and, 538t, 541 Committee on Pain of the American Society of Addiction cluster headache and, 556t Medicine, 461 elderly and, 697–698 Communication examples of, 305t aids to, 128 fibromyalgia and, 549 chronic pain treatment and, 488, 490 malignant bowel obstruction and, 327, 327t impaired, 92, 94–95, 98–99 migraine and, 555t nurse-physician, 92t pregnancy and, 615 pain assessment and, 84, 86, 89 respiratory effects and, 26 Companion animal for relaxation, 421 transduction of pain and, 18 Compazine; see Prochlorperazine Cost Complex regional pain syndrome, 581–584 of chronic pain, 471–472 Compliance of drug treatment, 441f opioids and, 193–194 of nonsteroidal antiinflammatory drugs, 141 patient education for, 123, 124 of opioids, 194 Compression, spinal cord of unrelieved pain, 4 cancer-related, 539 Counterirritation, 390 corticosteroids for, 312, 313, 339–340 COX-1, 130 Confusion COX-2, 130 dementia versus, 704t Cramping, fibromyalgia and, 547–548 elderly and, 675, 701–705 Cream, EMLA; see EMLA Conscious sedation, 382–385t Creatinine clearance, 170t Consent, informed, 365 Crescendo pain, 335–340 768 INDEX

CRIES neonatal pain scale, 642, 644t, 650 Depakote; see Divalproex;Valproic acid Criminal model of addiction, 431, 438–439 Dependence Crisis, sickle cell, 585–588 addiction versus, 434 Criterion, 712 definition of, 50, 162, 429 Critically ill infant, 661 HIV and, 567 Crohn’s and Colitis Foundation of America, 517 in infant, 631 Crohn’s disease, 597–598 psychologic, 50, 173–174 Cross-tolerance of opioids, 172 substance, 429 methadone and, 185–186 Depolarization Crying by infant definition of, 16 opioid withdrawal and, 632 transduction of pain and, 18 pain and, 633, 633f Depression CSEA; see Combined spinal-epidural anesthesia alcohol addiction and, 436 Cultural factors in pain assessment, 57, 98–99 as cause of pain, 48–49 Cumulation of opioid, 169–170 chronic pain and, 499 Curriculum guidelines for pain management, 5 definition of, 468 Cushingoid appearance, 312 respiratory; see Respiratory depression Cutaneous stimulation, 390, 405–412 Dermal anesthesia, iontophoresis for, 377–378 heat and cold for, 406–411 Dermatomes, 217f sites for, 406f definition of, 363 vibration as, 411–412 herpes zoster and, 562 Cyclandelate, 699t intraspinal anesthesia and, 221–222 Cyclobenzaprine, 305t Desipramine, 305t, 306t elderly and, 700 as adjuvant analgesic, 307 fibromyalgia and, 548 breast feeding and, 623–624 as muscle relaxant, 327, 328 for child, 341t musculoskeletal pain and, 327t dosage of, 343t Cyclone for mucositis, 602 indications for, 310, 343t Cyclooxygenase, 132f patient education about, 346–347t nonsteroidal antiinflammatory drugs and, 130 Desyrel; see Trazodone Cyclooxygenase inhibitor, 130, 132f Determination stage of drug treatment, 448 Detoxification, 441–442 D alcohol, 458 Dalgan; see Dezocine opioid, 459t Dalmane; see Flurazepam protocols, 456t, 458t, 459t Darvon; see Propoxyphene Dexamethasone, 305t Data cluster headache and, 556t definition of, 712 high- and low-dose, 313 pain management, 720–730 indications and dosages of, 343t qualify improvement, 721t migraine and, 555t Deafferentation pain, 19t, 302 spinal cord compression and, 339–340 Death, pain causing, 17 Dexedrine; see Dextroamphetamine Debilitation, 675, 700–701 Dexmedotomidine, 305t Decadrone; see Dexamethasone Dextroamphetamine, 305t Deep breathing, 419–420 as adjuvant analgesic, 314–315 Delirium for child, 341t definition of, 675 indications and dosages of, 344 opioids causing, 263t morphine with, 339 meperidine, 183–184 Dextromethorphan, 305t Delivery, drug; see Route of administration; specific route neuropathic pain and, 321t, 328–330 Delta opioid receptor site, 166 Dezocine Delta-9-tetrahydrocannabinol, 334 characteristics of, 189 Deltoid injection site, 394f equianalgesic doses of, 242t Deltoid trigger point, 571f DHE, migraine and, 554t Dementia, 687 Diagnostic and Statistical Manual of Mental Disorders aging and, 702 drug dependence and, 435 confusion versus, 704t psychogenic pain and, 49 definition of, 675 substance abuse and, 435 Demerol; see Meperidine Diarrhea in HIV infection, 567 Depakene; see Valproic acid INDEX 769

Diary Dopamine pathway, 434f headache, 551 Dopamine receptor, 333 pain relief, 200 Dorsal column stimulation, 584 Diatheses, bleeding, 138 Dorsogluteal injection site, 393f Diazepam Dosage elderly and, 698, 699t, 700 for anticonvulsant, 324 equisedating doses of, 656t of antidepressant, 310–311 morphine with, 335 ATC dosing and, 175 as muscle relaxant, 327, 328 ceiling; see Ceiling analgesia musculoskeletal pain and, 327t for elderly, 695 opioid with, 499 epidural analgesia in child and, 238 pregnancy and, 615 equianalgesic procedural analgesia and, 381, 385t for infant, 655 Diclofenac for nonopioids, 133t cost of, 141, 142 for opioids, 174, 240–243 dosage of, 139t phenobarbital and, 458 perioperative, 145–146 of local anesthetic, 320 Diet in Crohn’s disease, 598 of nonsteroidal antiinflammatory drugs Diflunisal adverse effects and, 147–148 antipyretic effect of, 144 examples of, 139t cost of, 141, 142 nurse-activated dosing and, 177 dosage of, 139t opioid Dihydroergotamine in opioid-naive patient, 250, 252t cluster headache and, 555t rectal, 204–205 medication withdrawal and, 559 starting, 240–246 migraine and, 554t tolerance and, 171–173 Dilantin; see Phenytoin patient-controlled analgesia and, 175–177; see also Patient- Dilaudid; see Hydromorphone controlled analgesia Diphenhydramine, 695 phenobarbital withdrawal equivalents, 458 Diphosphonate, 325; see also Biphosphonate PRN dosing and, 175 Diprivan; see Propofol rescue dose and, 244–246 Discharge from hospital switching opioids and, 257 chronic pain and, 505 titration of; see Titration of dose subcutaneous continuous infusion and, 212 Double blind study, 302 Discomfort, reducing, 390t Doxepin, 305t, 306t Disease model of addiction, 431–432 as adjuvant analgesic, 307 Displacement, catheter, 233 indications and dosages of, 343t Distraction, 412–417 tension headache and, 555t benefits and limitations, 413t D-Penicillamine, arthritis and, 526 for brief pain episodes, 414t DPT for procedural analgesia, 380 indications for, 413–414 Dressing labor and delivery and, 617 epidural analgesia in child and, 237 music for, 415t wound, 593–594 picture descriptions for, 417t Drug Enforcement Agency, 431 procedural pain management and, 389–390 Drug tolerance, addiction versus, 433–434 sing and tap rhythm for, 415t Drug-receptor interaction, 165–166, 165f, 166t, 167t strategies for, 414–417 absorption, 168f Distress, reducing, 390t Drugs Distress Scale for Ventilated Newborn Infants (DSVNI), addictive classes, 432t 645–647, 646t, 650 effects of abuse, 433t new scoring system, 647t Drug-seeking behavior, 50–52, 429 Distribution of drug in elderly, 687, 688 addiction versus, 434–435 Divalproex, 305t Drug treatment indications and dosages of, 342t major models, 442t Documentation twelve steps, 433t of infusion, 78–82 Dry mouth, 308–309 opioid and, 272 DSM-IV, 36 for outpatient, 82, 84 DSVNI; see Distress Scale for Ventilated Newborn Infants Dolobid; see Diflunisal Duraclon; see Clonidine Dolophine; see Methadone Duragesic; see Fentanyl 770 INDEX

Dural puncture, 232 Elderly patients—cont’d Dyclone; see Dyclonine hydrochloride alcohol abuse in, 705–706 Dyclonine hydrochloride, topical, 372 assessment of, 686–687 Dysesthesias cancer-related pain in, 678–679 continuous, 302, 317t caregiver role, 685t elderly and, 698 probability of invasive, 678t lancinating, 321t care settings for, 679–686 paroxysmal, 321t chronic nonmalignant pain in, 679 Dysesthetic pain syndrome, 606 confusion, 704t Dyspnea, nebulized opioid and, 203 cognitive impairment in, 701–705 Dystocia, 609 frail and debilitated, 700–701 Dystrophy, reflex sympathetic, 581–584, 582f inappropriate medication use in, 692–693, 699–700, 699t mental state of, 703t E memory impairment in, 705 Education, patient misconceptions about, 675–676t acetaminophen and, 152 nondrug pain treatment in, 700 about adjuvant analgesics, 346–353 nonmalignant conditions, 679t desipramine and, 346–347 nonopioid analgesics for, 689–691 gabapentin and, 350–351 nonsteroidal antiinflammatory drugs in mexiletine and, 352–353 adverse effects of, 689t nortriptyline and, 348–349 alternative approaches, 690t cancer-related pain and, 541 central nervous system effects, 138 chronic pain and, 494, 504, 506–507 dosages, 142 cold and heat and, 410 ketorolac, 146 materials, 274t long-term use, 689t for “new” pain relievers, 345 opioid analgesics for, 691–695 nondrug treatment and, 405 physical abuse of, 706 nonsteroidal antiinflammatory drugs and, 152 physiologic changes in, 687–689 about opioid analgesic, 272–292 polypharmacy in, 698–699 addiction and, 275–276 resources for, 684–685t checklist for, 273 shingles and, 561–562 fentanyl patch and, 277–278 surgery types, 678t hydromorphone and, 279–280 Electric stimulator for multiple sclerosis, 603 morphine and, 281–286 Electromyography for peripheral neuropathy, 577 oxycodone and, 287–290 Elimination of drug in elderly, 687, 688–689 patient-controlled, 291–292 Emergency department resources for, 274 cancer patient and, 542 pain care committee’s role in, 737 chronic pain and, 473–474 pain management guidelines and, 123, 125, 126–127 Ehlers-Danlos syndrome and, 545 pain rating scales and, 67f,74 frequent use of, 51, 52, 53 procedural pain management and, 365–366 nondrug pain treatment and, 423 resource materials, 274t sickle cell disease and, 587 subcutaneous continuous infusion and, 212 Emergency treatment of respiratory depression in infant, 655 Education, professional EMLA, 305t lack of, 4–5 as adjuvant analgesic, 331 need for, 10 adverse effects of, 332 pain care committee and, 730, 734, 736–737 characteristics of, 373–377 resources for, 6–8t circumcision and, 637 Efficacy guidelines for, 375t definition of, 162 for infant, 656–657, 664–665 of opioid, 170–171 lidocaine, 375t Ehlers-Danlos syndrome, 543–545 prilocaine, 375t distribution of chronic pain, 544f for procedural pain, 369t Elavil; see Amitriptyline Empathy in drug treatment, 449 Elderly patients, 674–706 Endocrine effects of pain, 23–25 abuse of, 706 Endogenous opioid acute pain in, 677–678 composition and function of, 165 adjuvant analgesics for, 695–698 definition of, 16 age classifications for, 677 modulation of pain and, 22–23 over age 100, 677f Endorphin, 17t, 164t INDEX 771

End-stage renal disease, 135–136 Episiotomy pain, 622 Enkephalin Equanil; see Meprobamate misconceptions about, 17t, 164t Equianalgesic dosage modulation of pain and, 22–23 for infant, 655 Enteric-coated aspirin, 149 for nonopioids, 133t gastric injury and, 137 for opioids, 174, 240–243, 241–243t Enterocolitis, necrotizing, 660 phenobarbital and, 458 Enzyme Ergotamine metabolites and, 169 cluster headache and, 555t nonsteroidal antiinflammatory drugs and, 130 migraine and, 553, 554t Epidural analgesia, 213–239 withdrawal from, 559 benefits of, 4 Esophageal ulcer in HIV infection, 567 bioavailability and, 220–222 Estrogen replacement therapy, 575 breast feeding and, 623 Ethanol as adjuvant analgesic, 334–335 cancer-related pain and, 541 Ethical issues of placebo use, 55 catheter for, 218f Etodolac documentation about, 82 brand name of, 138 location of, 248 cost of, 141 removal of, 236 dosage of, 140, 140t cesarean section and, 622–623 renal effects of, 138 characteristics of drugs for, 195t ETOH, addiction to, 432 in child, 236–239 Eutectic mixture of local anesthetics; see EMLA clonidine for, 229, 231, 315, 336, 337t Excedrin Aspirin Free, 148t cognitive function and, 29 Excedrin Extra Strength, 149t combined, 231 Exercise complications of, 232–236 chronic pain and, 503, 505 drug delivery and, 214–220 fibromyalgia and, 549 effectiveness of, 25 osteoporosis and, 575 elderly and, 694 Extrapyramidal effect of neuroleptics, 333 cognitive impairment and, 701–702 Extremely-low-birth-weight infant, 627 fentanyl and, 225 Extremity gastrointestinal function and, 27–28 arthritis pain and, 523–525, 524f, 525t guidelines for, 215 elderly and, 679t hydromorphone and, 225–227 reflex sympathetic dystrophy and, 581–584 hypercoagulability and, 25–26 Eye immune system and, 29 anesthesia for, 372–373 ketamine for, 338 cluster headache and, 558 labor and delivery and, 620 Ehlers-Danlos syndrome and, 543 local anesthetics and, 227–229 surgery on, 678t muscle protein synthesis and, 25 zoster ophthalmicus and, 562 methadone and, 227 misconceptions about, 214t F morphine and, 222, 224–225 Faces pain rating scale, 63, 64–65f,67 in opioid-tolerant patient, 260–261 cultural differences and, 98 pancreatitis and, 581 Facial Action Coding System, 641 patient education about, 366 Facial expression of pain in infant, 633f, 634f patient selection for, 215 Facial pain, temporomandibular, 588–592, 589f patient-controlled; see Patient-controlled analgesia Facility, pain pediatric dosage and care, 238t classification of, 514 preemptive, 120–121 inceased numbers of, 10–11 respiratory effects and, 26 Factitious disorder, 36 side effect reduction, 254–255t Failed back syndrome, 496 spinal anatomy and, 213–214 Family switching to intravenous analgesia from, 257–258 addiction and, 275–276t, 438 unwanted effects of, 230–231 as barrier to pain management, 10 Epidural spinal cord compression, 539 elderly and, 684, 686 Epinephrine of infant, 668 local anesthetic toxicity and, 368 information for, 126–127t modulation of pain and, 23 nondrug treatment and, 402 in topical mixtures, 373, 374t pain rating scales and, 67f,74 772 INDEX

Family-controlled analgesia, 177 Flow sheet for pain management, 78–86 Fatigue, chronic, 597 Fluid therapy during labor and delivery, 621 Feedback in drug treatment, 449 Flumazenil, 381 Felbamate, 322 procedural analgesia with, 385t adverse effects of, 323 Fluoxetine, 305t Feldene; see Piroxicam as adjuvant analgesic, 307 Femoral head, aseptic necrosis of, 539 indications and dosage of, 343t Fenamate, 139t Fluphenazine, 305t Fenoprofen, 139t Flurazepam, 698, 699t Fentanyl Flurbiprofen, 139t absorption pathway, 207f FMS; see Fibromyalgia characteristics of, 181–182 Food and Drug Administration pregnancy risk classifica- dosage, 209t tions, 609–610, 611 elderly and, 691 Formulary analgesic reference guide, 737t cognitively impaired, 702 Fox Chase Cancer Center, 274 equianalgesic doses of, 241t Fracture infant and, 654t, 655, 667 osteoporosis and, 573f, 574 intraspinal, 222, 223, 225 rib, fentanyl for, 26 labor and delivery and, 619 Frail elderly, 700–701 mental status and, 267 “Frequent flyer,” 51, 52, 53 nebulized, 203 Full agonist; see Mu agonist for opioid-naive adult, 225t oral transmucosal, 201–203, 202f, 207f, 209t G for procedural pain, 378, 379t GABA agonist; see Baclofen as rescue analgesic, 245, 245t GABAergic drug, 305t overdose of, 269 Gabapentin, 305t patient information about, 277–278 adverse effects of, 323 patient-controlled analgesia with for child, 341t in child, 255t dosage of, 324, 342t in opioid naive patient, 252t elderly and, 697 preemptive analgesia with, 120–121 indications for, 342t pregnancy and, 614 neuropathic pain and, 321t procedural analgesia with, 379t overview of, 322 rib fracture and, 26 patient education about, 350–351t solubility of, 169 reflex sympathetic dystrophy and, 583 switching from, 257–258 trial of, 324 to morphine, 208t Gain, secondary, 41–42 transdermal, 206–209, 207f Gallium nitrate, 325 Fetal heart rate, 621 for bone pain, 325, 326 Fetus Gamma-aminobutyric acid, 22–23 drug effects on, 609–615 Ganglion blockade, 583–584 pain in, 635–636 Gastrointestinal bleeding in elderly, 689–690 Fever in HIV infection, 567 Gastrointestinal disorder Fiber, nerve, 577 corticosteroid and, 312, 698–699 Fibromyalgia, 545–550 Crohn’s disease and, 597–598 alternative treatment for, 690t Ehlers-Danlos syndrome and, 543 assessment of, 548 elderly and, 679t, 689–690, 698–699 classification criteria, 547t harmful effects of pain on, 27–28 description of, 545–547 malignant bowel obstruction and, 326–327 pain management in, 547–549 nonsteroidal antiinflammatory drugs and, 130, 135, 136–137 tender points, 546f perioperative bleeding and, 145–146 Fibrosis, radiation, 540t opioid withdrawal in infant and, 632 Fifth vital sign, 3, 731,735f opioids causing, 261, 262–263t Fiorinal, tension headache and, 557 pancreatitis and, 579–581 First pass effect of opioids, 167 Gastrointestinal surgery in elderly, 678t Flare Gastroprotective therapy, 137 of pain, in fibromyalgia, 547–548 Gel pack, cold, 409f of rheumatoid arthritis, 524–525 Gender Flecainide, 318 pain assessment and, 57 Flexeril; see Cyclobenzaprine pain in infant and, 649–650 INDEX 773

General anesthesia, procedural, 386–389 Health care professional—cont’d Generic name of nonopioid drugs, 138t nurse—cont’d Genetic disorder, sickle cell disease as, 585–588 role of, 125, 128 Genitourinary system, effects of pain on, 27 undertreatment of pain and, 4–5, 9–10 Gingival administration of opioids, 201 Heart Glucocorticoid; see Corticosteroid antidepressant effects on, 309–310 Glucose-6-phosphate dehydrogenase deficiency, 376 elderly and, 698 Glutamate in pain transmission, 22 Heart surgery Gold salts for arthritis, 526 elderly and, 679t Goody’s Extra Strength, 149t in infant, 662 Gout, 690t Heartburn in pregnancy, 616 GR90291, 190 Heat, 406–411 Graphic rating scale, 62–63 arthritis and, 526 Graphic vital signs record, 735 contrast bathing, 411t Gross motor movement in infant, 634 fibromyalgia and, 549 Group drug therapy, 446 patient use of, 410t Growth hormone, 24 Hematologic disorder, 135, 138 Guanethidine, 584 perioperative, 145–146 Hematoma, epidural, 234–236 H Hemodynamics Half-life clonidine and, 336 definition of, 162 epidural local anesthetics and, 231 of opioid, 169–170 Hemoglobin Hallucination, opioids causing, 263t elderly and, 690 Hallucinogen, 432t, 433 sickle cell disease and, 585 Haloperidol in elderly, 702 Hemophilia, 598–599 Handheld vibrator, 411–412 HIV infection in, 599 Harmful effects of pain, 3–4, 23–32, 24t nonsteroidal antiinflammatory drugs and, 138, 144

H2-blocker, 131t Hepatic impairment ulcer prevention and, 137 acetaminophen causing, 134–135, 151–152 Head and neck pain tramadol and, 191 elderly and, 679t Heroin, 432t mucositis and, 601–602 addiction to, 9, 51, 53, 433 myofascial, 571f Herpes zoster, 561–564 Headache, 550–560 chronic pain and, 31 alcohol withdrawal and, 457 elderly and, 696 assessment of, 550, 552 Hip replacement, 252 breast feeding and, 624 Histamine blocker caffeine-containing analgesics and, 150 elderly and, 699 cluster, 555–556t, 557–559 nonsteroidal antiinflammatory drugs and, 131t description of, 550 ulcer prevention and, 137 diagnosis of, 552f, 557f, 558f Histoacryl blue, 395 diary about, 551t History, analgesic, 123, 124 gel pack for, 409f HIV; see Human immunodeficiency virus medications for, 554–556t peripheral neuropathy in, 576 migraine, 552–556 Home care in child, 143t for cancer patient, 542 nonsteroidal antiinflammatory drugs for, 132 Ehlers-Danlos syndrome and, 545 postdural puncture, 232 for elderly, 683–686 pregnancy and, 615 sickle cell disease and, 587 rebound, 559t Hormone tension-type, 555t, 557–558 osteoporosis and, 575 Health care professional pain and, 24 expectations about pain of, 44–46 Hospice care, 681 infant and, 661–663, 668 creation of, 10–11 nondrug treatment and, 402–403 Hospice nurse certification, 13 nurse Hospitalization certification of, 11, 13 of elderly, 679–681 expectations about pain of, 44 musculoskeletal effects of, 28 pain resource, 5 5HT1 receptor, 553 774 INDEX

Human immunodeficiency virus (HIV) infection, 564–568 Ileus as stress response, 27–28 pain sources and locations, 566f Illegal drug, 438–439 peripheral neuropathy and, 576 Illness Behavior Questionnaire, 519 Humoral head, aseptic necrosis of, 539 Imipramine, 305t, 306t Hurricane; see Benzocaine as adjuvant analgesic, 306–307 Hydrocodone, 116, 134 for child, 341t characteristics of, 179t, 182 indications and dosages of, 343t in combination Imitrex, Sumatriptan fixed, 116–117 Immune deficiency opioid-nonopioid, 134 chronic fatigue and, 597 equianalgesic dosage of, 133t, 240, 241t, 243 fatigue and, 597 as fixed combination, 116–117 HIV infection and, 597 pregnancy and, 614 Immune system effects of pain, 29–30 Hydromorphone Immunization, 638–639, 638t as addictive drug, 432t Immunocompetence, 29 bioavailability of, 169 Implantation of electric stimulator, 603 characteristics of, 179t, 182–183 Incisional pain, 409f elderly and, 691 Indicator, 712 equianalgesic doses of, 241t Indinavir, 567 intraspinal, 223, 225–226 Individualization of analgesic regimen, 121–123 mental status change and, 267 Indocin; see Indomethacin nebulized, 203 Indomethacin for opioid-naive adult, 225t, 252t bone formation and, 147 patient information about, 279–280 dosage of, 139t patient-controlled analgesia with, 252t, 265 pediatric, 143t, 654 cardiovascular effects of, 25 elderly and, 699t in child, 255t Infants, 629–669 sickle cell disease and, 587 abstinence syndrome in, 609 solubility of, 169 anesthesia dosage, 657t transdermal fentanyl and, 209t assessment of, 639–640, 649–651 Hydrophilic, 162 circumcision in, 371, 636–637 Hyperalgesia, 429 consequences of pain in, 631–635 Hypercoagulation as stress response, 25 definition of pain in, 628 Hypersensitivity, aspirin, 144 developmental care, 658t, Hypnosis for burn pain, 531 EMLA in, 376 Hypnotic infusion rates, 654t as addictive drug, 432t measurement of, 640–649 elderly and, 699t memory of pain in, 30 Hypotension misconceptions about, 627t, 628–631 antidepressants and, 308 opioid weaning flowsheet, 632t in elderly, 697 operational definitions, 648t labor and, 621 pain during birth in, 635–636 Hypoxemia, in elderly, 701 pain management in Hytrin; see Terazocin algorithm for, 662f–663f CRIES measurement score, 646t I DSVNI, 646t, 647t Iatrogenic risk, 474 distress scale for ventilated facial expressions, 633f Ibupren; see Ibuprofen guidelines, 664–667t Ibuprofen health care professional’s role in, 661–663, 668 caffeine with, 316 immunizations, 638t for child, 143t multidimensional assessment, 650t in combination drugs, 134 multidimensional measures, 650t dosage of, 139t, 143t minimizing, 661t elderly and, 690 nonpharmacologic, 658–661 gastrointestinal side effects of, 136–137 parents’ role in, 667 overdose of, 152 pharmacologic, 651–658, 656t, 657t patient information sheet for, 153–154t PIPP, 645t tension headache and, 557–558 protocol for, 664–667 Ibu-Tab; see Ibuprofen unidimensional measures, 643t INDEX 775

Infants—cont’d Institutional barriers to pain management, 713 preterm, 609, 637–638 Institutional commitment to pain management, 715–738; see interventions, 662–663t also Pain management procedural pain in, 638–639 Institutional needs assessment tool, 724–726 respiratory depression, 655t Insulin, 24 silent cry, 634f Intensity of pain undertreatment of pain in, 628–631 initial assessment of, 59 Infection opioid analgesic and, 191–192 human immunodeficiency virus, 564–568, 566f, 576 Interaction intraspinal analgesia and, 234, 235t drug-receptor, 165–166, 165f, 166t, 167t Lyme disease and, 600–601 opioid, 192–193 masking of, 144 Intercostal nerve, 535t opportunistic, 567 Interdisciplinary pain care committee, 713, 715–737; see also varicella-zoster, 561–564, 561f Pain care committee Inflammation International Association for the Study of Pain, 5 arachnoiditis and, 596 classifications of pain facilities, 514 arthritis causing, 523–525, 524f, 525t clinical practice guidelines of, 7 Crohn’s disease and, 597–598 education resources of, 6 mucositis and, 601–602 founding of, 11 pancreatic, 579–581 infants and, 628 wound pain and, 592–593 malingering and, 41 Inflammatory mediator, 130 International Headache Society, 550, 552 Information, patient/family, 126–127t Internet resources, 745–750 Informed consent, 365 Interstitial Cystitis Association, 517 Infusion Interviewing, motivational, 446–450 flow sheet for, 78–82 Intestine, Crohn’s disease of, 597–598 intraspinal, 220; see also Intraspinal analgesia Intolerance, aspirin, 144 lidocaine in, 339, 370–371 Intraarterial opioid administration, 196t local anesthetic, 317, 320 Intracerebroventricular administration, 196t needle placement, 211f Intracranial pressure, corticosteroids for, 312 of neurotoxic agent, 233 Intractable migraine, 556 opioid, 211 Intractable pain treatment act, 9 in opioid naive patient, 250–251 Intramuscular administration subcutaneous continuous, 211t, 212–213t avoidance of, 121 remifentanil, 190 inappropriate, 54 Inhalation, nitrous oxide, 388–389 of opioid, 209–210 Initial pain assessment, 59–62 reducing pain of, 391–394 Injections Z-track, 391, 392 fibromyalgia and, 549 Intranasal administration, 195t, 203 intramuscular, technique for, 391, 392–395f, 394–395 definition of, 162 local anesthetic, 368–371 effectiveness of, 25 low back pain and, 600 midazolam and, 381 nerve block; see Nerve block Intraoral appliance for temporomandibular dysfunction, 590 of neurotoxic agent, 233 Intrapleural analgesia for pancreatitis, 581 osteoporosis and, 575 Intraspinal analgesia, 213–239; see also Epidural analgesia painful, 370–371 bioavailability and, 220–222 reducing discomfort, 392t catheter removal and, 236 trigger point, 570 in child, 236–239 Injury clonidine and, 229, 231 infant and, 638–639 combined, 231 needle or catheter, 233 complications of, 232–236 spinal cord, 606–607 drug delivery and, 214–220 wound pain and, 592–595 for elderly, 693–694 Innovar for labor and delivery, 618 fentanyl and, 225 Inpatient guidelines for, 215 drug treatment and, 454–456, 461t hydromorphone and, 225–227 Ehlers-Danlos syndrome and, 545 labor and delivery and, 619–621 oral patient-controlled analgesia for, 199 local anesthetics and, 227–229 sickle cell disease and, 587 methadone and, 227 776 INDEX

Intraspinal analgesia—cont’d Ketorolac—cont’d morphine and, 222, 224–225 preoperative use of, 133, 144 spinal anatomy and, 213–214, 216–217f procedural analgesia with, 380–381 use of, 215t renal function and, 146–147 Intrathecal administration, 196t, 213–239; see also Intraspinal for surgical patient, 147 analgesia in terminally ill patient, 134 for labor and delivery, 619–620 Kidney damage from acetaminophen, 135–136 Intravenous administration; see also Infusion Kindling effect, 433–434 lidocaine, 338–339 Klonopin; see Clonazepam of opioid, 195t, 211, 213 Knee replacement, 694 cancer-related pain and, 541 methadone and, 186 L oral analgesia after, 258–259 LAAM, 443–445 oxymorphone and, 187 Label for procedural pain, 378, 379t chronic pain and, 492 needle placement, 211f Labeling patient-controlled; see Patient-controlled analgesia addiction as, 51–52 remifentanil and, 190 Labor and delivery, 609–623 Invirase; see Saquinavir benzodiazepines in, 618–619 Involution of uterus, 609 buprenorphine avoided in, 112 Ion, transduction of pain and, 18 clonidine for, 336 Iontophoresis, 377–378 controversies regarding, 621 Irritation, gastrointestinal, 136 epidural meperidine ion, 226 Isometheptene, 554t lidocaine for, 370 Isoptin; see Verapamil local anesthetics in, 618 Isoxsuprine, 699t nondrug methods during, 617–618 opioids in, 619 J pain in infants during, 635–636 Jaw pain, 588–592 parenteral pain relief during, 619 JCAHO; see Joint Commission on Accreditation of Health- patterns of labor pain, 617 care Organizations postpartum pain and, 621–622 Joint regional techniques during, 619–621 arthritis of, 523–525, 524f, 525t Laceration, atraumatic suturing of, 395 elderly and, 679t Lactation, 623–624 temporomandibular, 588–591 AAP classifications, 623t Joint Commission on Accreditation of Healthcare Organiza- Ladder, WHO analgesic, 115–119, 117f tions (JCAHO), 3, 730, 733 cancer-related pain and, 539, 541 Journals on pain management, 5, 8, 738 Lamotrigine, 305t, 322 adverse effects of, 323 K Lancinating pain, 302 Kangaroo care, 660 adjuvant analgesics for, 109t, 320–324 Kappa opioid receptor site, 166 anticonvulsants for, 697 Ketamine, 305t herpes zoster and, 562 for crescendo pain, 336–338 Legal issues with placebo use, 55 neuropathic pain and, 321t, 328–330 LET, 373, 374 procedural analgesia with, 386–387, 387t Levator scapulae trigger point, 571f Ketoprofen Levo-alpha-acetylmethadol, 443–445 dosage of, 139t Levo-Dromoran; see Levorphanol overdose of, 152 Levorphanol Ketorolac characteristics of, 179t, 183 for acute pain, 132 elderly and, 692 adverse effects of, 146t, 147 equianalgesic doses of, 241t for child, 143t, 144 Library, pain management, 738 dosage of, 139t, 143t Lidocaine elderly and, 690–691 buffered, 370, 371t oral administration of, 145 bupivacaine with, 368 parenteral administration of, 133, 144 burn injury and, 530–531 in child, 144 circumcision and, 636–637 perioperative use of, 146 cluster headache and, 559 for postoperative pain, 145 elderly and, 698 INDEX 777

Lidocaine—cont’d Loracet, 134 in EMLA; see EMLA Lorazepam infant and, 656 burn injury and, 529t injectable, 368–371 equisedating doses of, 656t intraspinal, 228 infant and, 655 labor and delivery and, 618 procedural analgesia and, 381, 385t migraine and, 555t Lortab; see Hydrocodone neuropathic pain and, 318 Low back pain, 599–600 parenteral, 338–339 Low-birth-weight infant, 627 for procedural pain, 369t LSD, addiction to, 433 topical, 331–332, 372 Ludiomil; see Maprotiline in topical mixtures, 373, 374t, 375t Lumbar epidural analgesia, 222 Lifestyle in pain assessment, 58 labor and delivery and, 620 Ligament, round, 615 Lumbar plexus pain, cancer-related, 535t Limb pain, phantom, 603–604 Lumbosacral plexus, radiation fibrosis of, 540t Limbitrol; see Chlordiazepoxide Lumbosacral vertebral tumor, 536t Lioesal; see Baclofen Lung cancer, 532t Lipid solubility of opioids, 169 age and, 678t Lipophilic, definition of, 162 Lyme disease, 600–601 Lipophilic opioid pregnancy and, 614 M transmucosal, 201 Magnesium, migraine and, 553 Listening, active, 416f Magnesium salicylate Lithium for cluster headache, 556t bleeding disorder and, 144 Liver dosage of, 139t acetaminophen and, 134–135, 151–152 opioid equivalent, 133t opioid analgesia and, 192 nonprescription brands of, 151t Local anesthetic; see also Lidocaine Maintenance stage of drug treatment, 448 as adjuvant analgesic, 316 Major histocompatibility complex in Crohn’s disease, 597 adverse effects of, 318–319 Malignancy, 531–543; see also Cancer-related pain for child, 239, 341t Malignant bowel obstruction, 326–327, 327t elderly and, 694, 699t Malingering, 36, 41 epidural Maprotiline, 305t, 306t, 307 in child, 239 Marcaine; see Bupivacaine muscle protein synthesis and, 25 Marijuana addiction, 432t, 433 unwanted effects of, 230–231, 230t Masking of infection, 144 eutectic mixture of; see EMLA Massage, 420–421 examples of, 305t fibromyalgia and, 549 gastrointestinal function and, 27 Mastectomy, 604 guidelines, 367t, 369–370t Maternal hypotension in labor, 621 indications and dosages of, 344 Maternal-placental-fetal drug transfer, 610–611, 613f infant and, 656 Maximally Discriminative Facial Coding System, 641 intraspinal, 227–229 Mayday Pain Resource Center, 6 labor and delivery and, 618, 620 McGill Pain Questionnaire, 75, 577 low back pain and, 600 Measurement of pain in infant, 639–651, 643t, 650t mechanism of action of, 318 Mechanical ventilation, weaning from, 271–272 neuropathic pain and, 317–320 Meclofenamate, 139t parenteral, 338–339 Meclomen; see Meclofenamate perioperative/postoperative, 145 Mediator, inflammatory, 130 pregnancy and, 614 Medical model of addiction, 431–432 procedural pain and, 367–378 Medical record pain management audit, 727 guidelines for, 367t Medication, patient information about, 277–292t injectable, 368, 370–371 Mefenamic acid, 139t iontophoresis and, 377–378 Membrane potential, resting, 18 topical, 371–377 Memory loss, 705 toxicity of, 368 Memory of pain in infant, 630–631 Location of pain, 59 Meningoencephalitis, 562 Lodine; see Etodolac Menopause, osteoporosis and, 575 Long-term care facility, 681–683 Mental disorder, psychogenic pain in, 48–50 selection of, 682–683t 778 INDEX

Mental status Methylsergide aging and, 702–704, 704t cluster headache and, 556t alcohol withdrawal and, 457 migraine and, 555t Mini-Mental State examination and, 702, 703 Metoclopramide opioids causing change in, 263t, 266–267 mechanism of action of, 333 pain effects on, 28–29 migraine and, 554t Mepergan, 618 rebound headache and, 559 Meperidine Mexiletine, 305t breast feeding and, 623 adverse effects of, 318–319 characteristics of, 179t, 183–185 for child, 341t elderly and, 692–693 elderly and, 698 equianalgesic dosages of, 133t, 241t herpes zoster and, 562 intraspinal, 223, 226–227 indications and dosages of, 344 labor and delivery and, 618 neuropathic pain and, 318, 321t misconceptions about, 184t patient education about, 352–353t pancreatitis and, 581 peripheral neuropathy and, 579 patient-controlled analgesia with, 252t Mexitil; see Mexiletine pregnancy and, 614 M3G, 180–181, 181t procedural analgesia with, 379t, 380 M6G, 180–181, 181t sickle cell disease and, 587 Midazolam switching from, 255–256 equisedating doses of, 656t Mepivacaine, intraspinal, 228 infant and, 655 Meprobamate in elderly, 699t morphine with, 335 Mescaline addiction, 433 procedural analgesia and, 381, 385t Meta-analysis double blind study, 302 Midrin, 554t Metabolic disorder Migraine headache, 552–556, 552f fibromyalgia and, 547 breast feeding and, 624 opioid withdrawal in infant and, 632 in child, 143t Metabolic effects of pain, 23–25 Migration, catheter, 233 Metabolism in elderly, 687, 688 Millon Clinical Multiaxial Inventory, 519 Metabolite Miltown; see Meprobamate definition of, 162 Mini-mental state, 703 opioid, 169 Minipress; see Prazosin of morphine, 691 Minnesota Multiphasic Personality Inventory-2, 519 pregnancy and, 614 Misoprostol of remifentanil, 190 elderly and, 690 Methadone nonsteroidal antiinflammatory drugs and, 131t addiction and, 432t, 433, 443–445 ulcer prevention and, 137 cancer-related pain and, 541 Mitochondria in fibromyalgia, 547 characteristics of, 179t, 185–186 Modified Behavioral Pain Scale, 641 elderly and, 692 Modulation of pain, 16, 19t equianalgesic doses of, 242t antidepressants and, 309f intraspinal, 227 definition of, 106f morphine versus, 186 illustration of, 21, 107f, 319 oral administration of, 185, 185t local anesthetics and, 319f pregnancy and, 614 process of, 22–23 transmucosal of, 201 Monitoring Methemoglobinemia, EMLA and, 332, 376 of antidepressant therapy, 311 Methocarbamol, 305t by pain care committee, 733–734 elderly and, 700 Monoamine oxidase inhibitor, 183 as muscle relaxant, 327, 328 Mononeuropathy, 19t Methotrimeprazine, 305t Moral model of addiction, 431 dosage of, 334 Morbidity, 16 indications and dosages of, 344 Morphine Methylphenidate, 305t addiction to, 432t, 433 as adjuvant analgesic, 314–315 benzodiazepines with, 335 for child, 341t blood levels of, 181t indications and dosages of, 344 buccal administration of, 201 Methylprednisolone, 305t burn injury and, 529t, 530 cancer-related pain and, 541 INDEX 779

Morphine—cont’d Mu agonist—cont’d characteristics of, 179t, 180–181 oxycodone, 186–187 dextroamphetamine with, 339 oxymorphone, 187 in elderly, 691 propoxyphene, 187–188 cognitively impaired, 701, 702 titration of, 122 equianalgesic doses of, 241t Mu opioid receptor site, 166 gastrointestinal function and, 27–28 Mucosa, gastric, 136 immune system and, 29 Mucositis, 601–602 infant and, 654–655, 654t, 666 Multidimensional Pain Inventory, 519 intraspinal, 222–225 Multidimensional pain measure for infant, 642–649, 650, 651t intravenous administration of, 211 Multidisciplinary pain care program for elderly, 680–681 ketamine with, 338 Multigravida, 609 mental status change and, 267 Multimodal, continuous analgesia; see Balanced analgesia metabolites of, 169 Multiple sclerosis, 602–603 methadone versus, 186 charting example, 492t nebulized, 203 Muscle, temporomandibular dysfunction and, 588–592 for opioid-naive adult, 225t Muscle protein synthesis, 25 oral, 197–198 Muscle relaxant patient information about, 281–286t elderly and, 700 patient-controlled analgesia with examples of, 305t, 327 in child, 255 misconceptions about, 303t in opioid naive patient, 252t osteoporosis and, 574 postoperative, 250–251 Musculoskeletal system pregnancy and, 614 adjuvant analgesics for, 327t procedural analgesia with, 379t Ehlers-Danlos syndrome and, 543–545 sickle cell disease and, 587 fibromyalgia and, 545–550 switching from, 256–257 gel pack for injury to, 409f transdermal fentanyl and, 208–209, 209t harmful effects of pain on, 27–28 transmucosal administration of, 201 postpolio syndrome, 604–605 Morphine-3-glucuronide, 691 tumor of, 533t Morphine-6-glucuronide, 691 Music Morphine-like drug; see Mu agonist active listening, 416f Mortality, 16 for distraction, 391t, 415, 416f Motivational approaches to drug treatment, 448–450 in procedural pain management, 390 Motivational interviewing, 446–450 for relaxation, 421 Motor deficit with epidural local anesthetics, 230t Myelopathy, radiation, 540t Motor vehicular accident by elderly, 698 Myocardial ischemia, 694 Motrin; see Ibuprofen Myoclonus, opioids causing, 266 Mouth Myofascial pain, 489 mucositis and, 601–602 syndrome, 568–572, 569t temporomandibular dysfunction and, 588–592 trigger points, 571f Movement pain in infant and, 634 N wound pain and, 593 Nabumetone MPS, 548 bleeding disorder and, 144 Mu agonist; see also Individual drug dosage of, 140, 140t agonist-antagonist with, 112 Nalbuphine characteristics of, 178–180, 180t characteristics of, 189 codeine, 181 equianalgesic doses of, 242t combination analgesics with, 116 labor and delivery and, 618 comparison of, 113–114 pregnancy and, 614 definition of, 104, 162 Nalfon; see Fenoprofen examples of, 109t Nalmefene fentanyl, 181–182 opioid overdose and, 269 hydrocodone, 182 procedural analgesia with, 379t, 380 hydromorphone, 182–183 Naloxone levorphanol, 183 administration of, 269, 270t meperidine, 183–185 cancer-related pain and, 541–542 methadone, 185–186 inappropriate use, 269 morphine, 180–181 opioid overdose and, 269, 270 780 INDEX

Naloxone—cont’d Nerve block—cont’d procedural analgesia with, 379t, 380 in infants, 657t Naltrexone, 460–461 intraspinal opioid versus, 25 Naprosyn; see Naproxen local anesthetic for, 367–378; see also Local anesthetic Naproxen osteoporosis and, 575 dosage of, 139t pudendal, 621 for child, 143t subarachnoid space, 619–620 overdose of, 152 Nerve block clinic, 11 Naratriptan for migraine, 554t Nerve fiber, 577 Narcotic, definition of, 104, 162, 429; see also Opioid analgesic Nerve root, arachnoiditis and, 596 Naropin; see Ropivacaine Neuralgia Nasal spray, 112 definition of, 16, 302 National Association of Orthopaedic Nurses, 55 postherpetic, 561–564, 561f National Hospice Organization, 11 Neuraxial opioid, 621 National Institute of Arthritis, Musculoskeletal and Skin Dis- Neurochemical disorder, 547 eases Information Clearinghouse, 517 Neuroleptic, 332–334 National Institute of Drug Abuse, 430 as adjuvant analgesic, 316–317 National Institutes of Health, 274 adverse effects of, 333 National Neurofibromatosis Foundation, Inc., 517 examples of, 305t National Vulvodynia Association, 517 indications for, 334 Natural childbirth, 609 mechanism of action of, 333 Natural killer cell, 29 Neuroleptic malignant syndrome, 333 Nausea and vomiting Neurologic disorder alcohol withdrawal and, 457 Ehlers-Danlos syndrome and, 543 elderly and, 695 Lyme disease and, 601 ergotamine withdrawal and, 559 migraine and, 553 migraine and, 553 multiple sclerosis and, 602–603 opioids causing, 261, 262–265, 262t–263t reflex sympathetic dystrophy and, 581–584 Nebulized opioid, 195t, 203 Neurolytic block, celiac plexus, 581 Neck pain, myofascial, 571f Neuron, afferent, 16 Necrosis, aseptic, 539 Neuronal “wind-up,” 23 Necrotizing enterocolitis, 660 Neurontin; see Gabapentin Needle Neuropathic pain, 19t, intraspinal, 214–220, 218f adjuvant analgesics for, 109t, 113 complications of, 233 anticonvulsants and, 321–324 subcutaneous infusion, 211t antidepressants and, 310, 317, 317t Needs assessment tool, 724–726 lancinating pain and, 320–324, 321t Nefazodone, 305t, 306t local anesthetics and, 317–320 Neglect of elderly, 706 baclofen for, 324 Nelfinavir, 567 burn injury and, 530 Nembutal; see Pentobarbital cancer-related, 537, 538t, 541 Neonatal abstinence syndrome, 616–617, 631–632 characteristics of, 23 Neonatal Facial Coding System, 641 classification of, 19t Neonatal Infant Pain Scale, 644–645, 650 definition of, 16, 162, 675 Neonatal intensive care unit, 637–638 in elderly, 696, 699t Neonatal period, 627 anticonvulsants for, 697 Neonate; see also Infant herpes zoster and, 563 abstinence syndrome in, 616–617 HIV and, 567 definition of, 627 lidocaine for, 338–339 EMLA in, 376–377 n-methyl-D-aspartate receptor blockers for, 328–330 fentanyl in, 654t peripheral, 16, 576–579, 577f long-term effects of pain in, 634–635 rating scale for, 75, 76–77 memory of pain in, 30 wound, 592 morphine in, 654t Neurophysiologic adaptation in addiction, 452 surgery in, opioid for, 24–25 Neuropsychologic toxicity of corticosteroid, 312 Nerve block Neurotensin, 23 cancer-related pain and, 541 Neurotoxic agent, injection of, 233 chronic pain and, 510, 511 prevention of intraspinal, 234t clonidine, 337t Neurotransmitter herpes zoster and, 563 opioid receptors and, 165–166 INDEX 781

Neurotransmitter—cont’d Nonopioid analgesics—cont’d transmission of pain and, 22 infant and, 653–654 Newborn; see Infant; Neonate mechanism of action of, 130 Nifedipine, 305t misconceptions about, 131t Nipple pain, 622 opioid combined with; see Combination analgesic Nitrous oxide pain mechanism affected by, 108 burn injury and, 529t perioperative/postoperative, 145 procedural analgesia with, 387t, 388–389 polypharmacy and, 304 NMDA; see N-methyl-D-aspartate selection of, 142t NMDA receptor antagonist, 305t side effects, 134–138, 135t as adjuvant analgesic, 317t titration of, 122 neuropathic pain and, 321t, 328–330 trade and generic names of, 138t N-methyl-D-aspartate Nonprescription drug; see Over-the-counter drug as adjuvant analgesic, 317t Nonsteroidal antiinflammatory drugs (NSAIDs) definition of, 302 for acute versus chronic pain, 138 transmission of pain and, 22 adverse effects of, 145–148 Nociceptive pain, 18–23 analgesic action, 132f cancer-related, 533, 537, 541 analgesic history and, 140 classification of, 19t ankylosing spondylitis and, 596 definition of, 16 antipyretic effect of, 144 elderly and, 696 arthritis and, 526 intraspinal anesthesia and, 222 aspirin allergy and, 144 modulation of, 21f, 22–23 bleeding disorder and, 144 nonsteroidal antiinflammatory drugs and, 130 for bone pain, 326 perception of, 21f,22 breast feeding and, 142, 623 transduction of, 18, 21f,22 for child, 142–144 transmission of, 20t, 21–22, 21f choice of, 110 wound, 592–593, 593t, 594 clinical considerations for, 108–110 Nociceptor, 16, 162 combination analgesics with, 116 Nondrug pain treatments, 399–425 cost of, 141 burn injury and, 530–531 definition of, 104, 130 for child, 421, 422t dosages, 139–140t for childbirth, 617 frequency of, 140–141 in clinical practice, 421–425 guidelines for, 142 cutaneous stimulation as, 405–417; see also Cutaneous titration of, 141–142 stimulation drug combinations with, 148–150 distraction as, 412–417 elderly and, 689–691, 695, 698, 699t for elderly, 700 alternative approaches, 690t for infant, 658–661 cognitively impaired, 704 misconceptions about, 401t long-term use, 689t relaxation as, 417–421 examples of, 109t role of, 400–405 fibromyalgia and, 548–549 selection of, 404t gastrointestinal function and, 27 Nonmalignant pain hemophilia and, 599 cancer pain versus, 47–48 indications for, 108–110, 131–134, 133t chronic; see Chronic pain infant and, 654 Nonnarcotic; see Nonopioid analgesic mechanism of action of, 130 Nonnutritive sucking, 659 migraine and, 554t Nonopioid analgesics, 105f; see also Acetaminophen; Aspirin; misconceptions about, 131t Nonsteroidal antiinflammatory drugs nonprescription, 148–150, 151t caffeine with, 316 overdose of, 150–152 in children, 142–148, 143t patient/family teaching about, 152, 153–158, 157–158t clinical considerations for, 108–110 perioperative, 144–148, 146t comparison of, 114t metabolic response and, 24 definition of, 104, 130 pregnancy and, 142, 611, 613 dosing information, 133t, 138, 139–140t, 140–143, 142t procedural analgesia with, 380–381 for children, 143t response to, 140 elderly and, 689–691 routes of administration for, 110, 141 generic and brand names, 138t side effects of, 134–138 indications for, 131–134, 133t temporomandibular dysfunction and, 590 782 INDEX

Nonsteroidal antiinflammatory drugs (NSAIDs)—cont’d Opinion leader, 712, 716 transduction of pain and, 18 Opioid analgesics, 105f, 161–293 Norepinephrine, 368 for acute pain, 178t Norflex; see Orphenadrine addiction to; see Addiction Normeperidine, 226 adverse effects, 146t Norpramin; see Desipramine antidepressant with, 308 Norpropoxyphene, 169, 180t, 187, 192 around the clock dosing of, 175 North American Chronic Pain Association of Canada, 517 in cognitively impaired elderly, 704 Nortriptyline, 305t, 306t rescue dose and, 244–246 as adjuvant analgesic, 307 arthritis and, 526 breast feeding and, 623–624 breast feeding and, 623 for child, 341t cancer-related pain and, 541; see also Cancer-related pain indications and dosages of, 343t cessation of therapy with, 270–271 patient education about, 348–349t characteristics of intraspinal, 223–224t side effects of, 308 in child, 143t–144t tension headache and, 555t for chronic pain, 178t, 496–499 Noxious stimulus, 16 classification of, 165 NSAIDs; see Nonsteroidal antiinflammatory drugs in combination; see Combination analgesic Nubain; see Nalbuphine comparison of, 113–114, 114t Nulliparity, 609 definition of, 36, 130, 162, 363, 429 Numby Stuff, 377–378 detoxification and, 459t Numerical rating scale, 63f, 65–75 documentation for, 272, 273 cultural differences and, 98 dosages, 133t definition of, 36 starting, 244t examples of, 68f–73f rescue, 245t Numorphan; see Oxymorphone elderly and, 691–695, 694, 699t Nuprin; see Ibuprofen cognitively impaired, 701 Nurse endogenous certification of, 11, 13 composition and function of, 165 expectations about pain of, 44 definition of, 16 pain resource, 5 modulation of pain and, 22–23 role of, 125, 128 equianalgesic dosage of, 133t, 174, 240–243 Nurse-activated dosing, 177 examples of, 109t Nurse-based patient-controlled analgesia program, 742–743 fibromyalgia and, 549 Nursing admission assessment, 58 herpes zoster and, 562–563 Nursing home, 675, 681–683 HIV and, 565, 567 immune system and, 29–30 O infant and, 654–656, 654t Obesity, respiratory complications and, 26 weaning flowsheet, 632t Obsessive compulsive disorder, 436 intraspinal characteristics, 223–224t Obstetrics/gynecology labor and delivery and, 618, 619–620 Ehlers-Danlos syndrome and, 543 mechanism of action of, 165–166 pregnancy and; see Labor and delivery; Pregnancy misconceptions about, 163–164t Obstruction, bowel, 326–327, 327t infant and, 631 Occlusal therapy, 591 potency and, 170 Occupational therapy in arthritis, 526 mu agonist characteristics, 179–180t Octreotide newer, 190–191 malignant bowel obstruction and, 327, 327t nonsteroidal antiinflammatory drug with, 131t, 132, 149t pancreatitis and, 581 oral administration of; see Oral administration, of opioid Ocular procedure, 372–373 osteoporosis and, 574–575 Office of National Drug Control Policy, 431 outpatient, 755t Ointment, local anesthetic, 332 pain Older Americans Act, 706 mechanism affected by, 108 Oncology Nursing Society treatment definitions, 462t education resources of, 6 pancreatitis and, 581 placebo and, 55, 56 patient education about, 272–292; see also Education, patient On-line computerized database, 612 patient-controlled, 249–255; see also Patient-controlled Operative site bleeding, 146 analgesia Ophthalmic procedure, 372–373 perioperative, 145 Opiate, definition of, 104; see also Opioid analgesic metabolic response and, 24–25 INDEX 783

Opioid analgesics—cont’d Opioid analgesics—cont’d peripheral neuropathy and, 578–579 undertreatment of pain and, 9 pharmacology of, 166–174 unwarranted withholding of, 271–272; see also Undertreat- absorption and metabolism and, 168 ment of pain addiction and, 173; see also Addiction withdrawal of, 494–496 equianalgesia and, 174 written agreement about, 753–755 equivalent products, 197t Opioid antagonists, 162, 363; see also Naloxone pharmacokinetics of, 167–170 inappropriate use of, 269–270 pharmadynamics of, 170–174 Opioid dose-sparing effect, 130 physical dependence and, 173 Opioid-naive patient potency and efficacy and, 170–171 epidural analgesia in, 225 tolerance and, 169–173 infusion and, 81, 251 polypharmacy and, 304–306 patient-controlled analgesia for, 250, 252t pregnancy and, 613–614 respiratory depression in, 145, 268–269 PRN dosing of, 175 tolerant versus, 172–173 for procedural pain, 378–380, 399t Opioid receptors, 165–166, 165f, 166f, 167t receptors; see Opioid receptors Opioid treatment, long term, 490–499, 498t rectal administration of, 205t Oral administration as rescue analgesia, 134 clonidine, 336 respiratory effects and, 26 of cocaine, 316 routes of administration of, 195–196t of local anesthetic, 317–320 intranasal, 203 for child, 341t intraspinal, 213–239; see also Epidural analgesia; In- of opioid, 194–201 traspinal analgesia; Intrathecal administration disadvantages of, 196 nebulized, 203 formulations for, 196–199 oral, 194–203; see also Oral administration intravenous analgesia and, 258–259 parenteral, 209–213; see also Intramuscular administration; methadone, 185 Intravenous administration; Subcutaneous administration patient-controlled, 199–200 rectal, 204–205 postoperative pain and, 201 stomal, 205–206, 206t transdermal fentanyl and, 209t transdermal, 206–209 transmucosal, 201–203 selection guidelines for as optimal route, 121 agonist-antagonist and, 188–190; see also Agonist-antagonist tramadol and, 190 mu agonist and, 178–188; see also Mu agonist Oral transmucosal fentanyl citrate, 202f, 207f, 209t new drugs and, 190–191 for procedural pain, 378, 379t patient characteristics in, 191–194 as rescue analgesic, 245t route of administration and, 239–240 Organ failure, 192 starting dose and, 240–246 Organizations, professional, 12t sickle cell disease and, 585, 587 acronyms for, 2 side effects of, 261–270 growth of, 11 alternatives for, 256t Orphenadrine, 305t biliary spasm as, 265 as muscle relaxant, 327, 328 constipation as, 262 musculoskeletal pain and, 327t epidural analgesia and, 254t–255t nonopioids with, 150 mental status changes as, 263, 267–268 Orthodontic therapy, 591 myoclonus as, 266–267 Orthopedic surgery, 678t nausea and vomiting as, 261, 263, 264–265 Orthostatic hypotension, antidepressant and, 308 options for, 256t in elderly, 697 preventing and managing, 263–264t Orudis; see Ketoprofen prevention, 262–264t Osteoarthritis, 523–527 pruritus as, 263, 265–266 affected joints, 525f respiratory depression as, 268–270 alternative treatment for, 690t sedation as, 267–268 joint characteristics, 524f urinary retention as, 266 oxycodone for, 692 switching of, 257t Osteoporosis, 572–576 from epidural to intravenous, 257–259 assessment of, 573–574 from multiple drugs to single, 259–260 definition of, 572–573 from one route to another, 257–259 fracture sites in, 573f to another opioid, 253, 255–257 pain characteristics of, 573 temporomandibular dysfunction and, 590 pain management of, 574–575 784 INDEX

Osteoporosis—cont’d Pain—cont’d posture in, 574f centrally generated Osteoporosis and Related bone Diseases National Resource classification of, 19t Center, 518 definition of, 16 OTFC; see Oral transmucosal fentanyl citrate chronic; see Chronic pain Oucher rating scale, 63 classification by inferred pathology, 19t Outpatient clinician’s expectations about, 44–46 chronic pain and, 505 conditions causing, 522–607 drug treatment and, 451t, 456, 458 ankylosing spondylitis, 595–596 patient information for, 752, 755 arachnoiditis, 596 Overdose burn, 527–531 of nonsteroidal antiinflammatory drugs, 150–152 chronic fatigue syndrome, 597 opioid, 269 Crohn’s disease, 597–598 Over-the-counter drug Ehlers-Danlos syndrome, 543–545 arthritis and, 526 fibromyalgia syndrome, 545–550 list of, 125 headache, 550–560 nonopioid, 148–150, 148t–149t, 150t hemophilia, 598–599 rebound headache from, 559 herpes zoster, 561–564 Oxaprozin human immunodeficiency virus infection, 564–568 brand name of, 138t low back pain, 599–600 dosages of, 139t Lyme disease, 600–601 Oxazepam, 656t mastectomy, 537t, 604 Oxicam, 139t mucositis, 601–602 Oxycodone multiple sclerosis, 602–603 characteristics of, 180t, 186–187 myofascial pain syndrome, 568–572 elderly and, 692 osteoporosis, 572–576 equianalgesic doses of, 133t, 242t pancreatitis, 579–581 fixed combination with, 117 peripheral neuropathy, 576–579 oral, 198–199 phantom limb, 603–604 patient information about, 287–290 poliomyelitis, 604–605 pregnancy and, 614 reflex sympathetic dystrophy, 581–584 switching from, 259, 260 sickle cell disease, 585–588 transdermal fentanyl and, 209t spinal cord injury, 606–607 Oxygen temporomandibular joint disorder, 588–591 cluster headache and, 559 thoracotomy, 537t, 605–606 cognitive impairment in elderly and, 701 wound pain, 592–595 headache and, 556–557 control record, 87–88t sickle cell disease and, 585 crescendo, 335–340 thermoregulation and, 26 deafferentation, 302 Oxymorphone definition of, 16–17 characteristics of, 180t, 187 denial of, 89, 92 equianalgesic doses of, 242t documentation of responses, 459t facilities, 10–11, 514, 514t P harmful effects of, 23–32, 24t Pacing, by patient, 504t on cardiovascular system, 25–26 Pain on cognitive function, 28–29 addiction and, 429–430, 452; see also Addiction on development, 30 anatomy and physiology of, 18–23 on endocrine and metabolic system, 23–25 assessment of, 36–99; see also Assessment on future pain, 30–31 tool, 60f,60t on gastrointestinal system, 27–28 back on genitourinary system, 27 angiography and, 391 on immune system, 29–30 chronic, 473–474 on musculoskeletal system, 27–28 psychiatric setting and, 475–476 on quality of life, 31–32 breakthrough; see Breakthrough pain on respiratory system, 26–27 care committee; see Pain care committee in infant, 629–669; see also Infant cancer-related, 531–543; see also Cancer-related pain intensity, 95t cause, known versus unknown, 46–50 inventory, 61f,61t center, 514 known versus unknown cause of, 46–48 INDEX 785

Pain—cont’d Pain management—cont’d Knowledge and attitude survey, 728t barriers to—cont’d management; see Pain management health care professionals as, 4–10 mechanism of, 16–32 institutional, 713 misconceptions about, 17t lack of accountability and, 3–4 nonopioids and, 108 patient and family as, 10 myofascial, 489 information gathering for, 515t neuropathic; see Neuropathic pain institutional commitment to, 715–743 nociceptive, 18–23, 19t; see also Nociceptive pain administrative rules and, 738 nondrug treatment of, 399–425; see also Nondrug pain assessment standards, 734t treatment cause and effect diagram, 722–723f nonmalignant; see Chronic pain clinical pathways and, 738–739 pathology, inferred, 19t knowledge and attitude survey, 728t perception, 16 library, 738t in elderly, 675 need for change and, 720–730 physiology of, resources about, 17 needs assessment tool, 724–726t in pregnancy, 615–616 nurse-based PCA programs and, 742–743 procedural, 362–395; see also Procedural pain management pain care committee and, 715–720, 730–737 psychogenic, 36, 49–50 pain resource nurse programs and, 742 rating scales; see Pain rating scales pain services and, 739–740 relief diary, 200 patient questionnaire, 729t report, 90–91t quick reference guide, 736t resource nurse (PRN), 5, 741t, 742 role model programs and, 740–742 dosing, 175 misconceptions about, 712–713, 712t response, acute pain model of, 43–46 patient questionnaire about, 729 screen, 96t patient teaching checklist, 273t services, 739–740 program for, 515 creation of, 11 progress in, 10–13 somatic, 19t quality improvement, 713–715, 714–715t, 716t subjectivity of, 5, 9 data analysis tools, 721f supratentorial, 49–50 teaching checklist, 273 sympathetically maintained, 330 team approach to, 89t tabetic, 302 in terminally ill, 272 threshold, 42 Pain rating scales; see also Assessment, tool tolerance, high versus low, 42–43 definition of, 36 transmission of, 16, 19t, 20–21f, 22–23 faces, 64–65f,67f of antidepressant, 309f failure to obtain, 36, 38 definition of, 106f for infant, 639–649 illustration of, 21, 107f neuropathy, 76–77t for local anesthetics, 319f preferred, 37 process of, 22 selecting, 66t types of, 17–18, 19t teaching use of, 74t definitions of, 16 translations of, 68–73f treatment approaches to, 18 Palliation, local anesthetics for, 320 undertreatment of; see Undertreatment of pain Pamelor; see Nortriptyline visceral, 19t Pamidronate, 325 Pain care committee, 713, 715–737 Panadol, 148t composition of, 716–717 Pancreatitis, 579–581 data collection by, 720–730 autodigestion, 580f establishment of, 715–716 pain mechanisms, 580t ground rules for, 718t Paracervical block, 621 leadership of, 717 Parafon Forte; see Chlorzoxazone mission statement of, 717–718, 718t Paranoia, opioids causing, 263t problems with, 718–720 Paravertebral sympathetic ganglion blockade, 583–584 resources for, 717t Parent of infant, 668 responsibilities of, 730–737 Parenteral administration; see also specific routes Pain management, 711–742 of ketamine, 337–338 audit of, 727 of ketorolac, 133 barriers to, 2–10 in child, 144 786 INDEX

Parenteral administration—cont’d Patient-controlled analgesia—cont’d of ketorolac—cont’d titration of dose and, 246 postoperative, 145 unconventional use of, 177 of lidocaine, 338–339 written agreement for, 754–755 of local anesthetic, 317–320 Patient’s bill of rights, 13t of nonsteroidal antiinflammatory drug, 131t Paxil; see Paroxetine of opioid, 209–213 PCA; see Patient–controlled analgesia labor and delivery and, 619, 621 P4502D6, 181n of phenytoin, 339 Pediatric patient; see Child Paresthesia, 162, 302 Pediodicals, clinical, 738 Parkland burn pain management pathway, 529t, 530 Pemoline, 305t Paroxetine, 306t, 307 Penile block for circumcision, 376 indications and dosages of, 343t Pentamorphone, 190 Paroxysmal Pentazocine definition of, 302 characteristics of, 189–190 sweats in alcohol withdrawal, 457 elderly and, 693, 699t Patch equianalgesic dosage of, 133t, 242t blood, 232 mild pain and, 191 fentanyl, 277–278 Pentobarbital local anesthetic, 332 in elderly, 699t transdermal, 207–209 Peptic ulcer Patients corticosteroid causing, 312 assistance program for, 194 in elderly, 698–699 as barrier to pain management, 10 elderly and, 689 education; see Education, patient Perception of pain educational materials, 274t antidepressants and, 309f information for, 126–127t definition of, 16, 106f pain relief diary, 200t in elderly, 675 report of pain by, 38–40 local anesthetics and, 319f rights of, 13t process of, 22 surveying of, 721, 729, 730 Percocet, 116, 134 Patient-controlled analgesia (PCA), 175–177, 211, 248–253 Percogesic Coated, 148t for acute pain, 754t Perinatal period, 609 appropriateness of, 176–177 definition of, 627 breast feeding and, 623 Periodicals, clinical, 5, 8t, 738 burn injury and, 529t Perioperative analgesia cardiovascular effects and, 25 gastrointestinal function and, 28 with continuous infusion, 251–252 nonsteroidal antiinflammatory drugs for, 133, 144–148 dosage calculation for, 122, 250t adverse effects of, 145–148, 145—148, 146t pediatric, 255t effectiveness of, 144–145 for elderly, 693 opioid, 24–25 cognitively impaired, 702 Peripheral nerve block; see Nerve block epidural, 220, 224–227, 225t Peripheral nerve in infant, 635 hydromorphone for, 265 Peripheral neuropathy, 16, 576–579 initiation in PACU, 252–253 assessment of, 577 intraspinal, 220, 224–226 cancer-related, 538t IV use, 176t, 291–292t description of, 576–577, 577f lidocaine for, 339 pain management of, 577–579 nurse-based program for, 742–743 Peripheral vascular disease, 696 opioid-naive adult ranges, 252t Peripherally generated pain, 19t oral, 199–200, 199t Perphenazine, 699t patient information about, 291–292 Persistent vegetative state, 94–95 patient selection for, 176–177 Phantom limb pain, 603–604 pediatric, 253, 255t in elderly, 694 procedural, 388 previous acute pain and, 30 pump use, 177t, 249t Pharmacodynamics in infant, 652–653 respiratory effects and, 26 Pharmacokinetics side effect reduction, 254–255t HIV and, 567 starting prescription for, 250–252, 250t infant and, 652–653 subcutaneous continuous infusion and, 210–213 of opioids, 167–170 INDEX 787

Pharmacology of opioid analgesic, 166–174; see also Opioid Placebo(s)—cont’d analgesic, pharmacology of misconceptions about, 54–55 equivalent products, 197t recommendations about, 55–56 Pharmacotherapy for drug abuse, 442t, 443 transdermal fentanyl and, 209 Phenacetin use of, 56t,57t liver toxicity of, 135 Placenta, 610 renal failure caused by, 135 Plasma protein, 169 Phenergan, 380 Platelet, 110, 138, 144 Phenobarbital Plexus alcohol, 458 brachial opioids and, 193 cancer-related pain in, 535t Phenothiazine, 113 radiation fibrosis of, 540t opioids and, 193 celiac, 581 Phenoxybenzamine, 305t lumbar, 535t Phentolamine, 584 lumbosacral, 540t Phenylbutazone, 699t sacral, 536t Phenyltoloxamine citrate, 150 Policy on placebo use, 56 Phenytoin, 305t Poliomyelitis, 604–605 adverse effects of, 323 Polymyalgia rheumatica, 696 for child, 341t Polyneuropathy for crescendo pain, 339 definition of, 19t indications and dosages of, 342t in elderly, 696 for lancinating pain, 324 Polypharmacy; see also Combination analgesia neuropathic pain and, 321t adjuvant analgesics and, 304 opioids and, 193 in elderly, 698–699 overview of, 321–322 HIV and, 567 parenteral, 339 misconceptions about, 105t Physical abuse of elderly, 706 Ponstel; see Mefenamic acid Physical appearance in pain assessment, 57 Positioning of infant, 658–659 in infant, 633f, 634f Postchemotherapy pain, 538t–539t Physical dependence Postdural puncture headache, 232 addiction versus, 434 Posterior deltoid trigger point, 571f definition of, 50, 162, 429 Postherpetic neuralgia, 31, 561–564, 561f, 562 opioid and, 173 in elderly, 696 Physical rehabilitation Postmastectomy pain, 537t, 604 chronic pain and, 503, 505 Postnatal age, 649 postoperative, 740 Postoperative pain Physical therapy cesarean section, 622–623 ankylosing spondylitis and, 595–596 in child, 143t, 144 arthritis and, 526 dextroamphetamine for, 339 chronic pain and, 503, 505 in elderly, 680, 690–691 Ehlers-Danlos syndrome and, 545 cognitively impaired, 701 fibromyalgia and, 549 nonsteroidal antiinflammatory drugs for, 133, 143t reflex sympathetic dystrophy and, 583 opioid and, 191–192 temporomandibular dysfunction and, 591 oral analgesics for, 201 Physiologic response to pain, 95 patient-controlled analgesia for, 250–251, 252–253 acute pain model and, 45 preemptive analgesia and, 120–121 Physiology of pain, resources about, 17 rehabilitation program for, 680, 740 Pimozide, 305t transdermal fentanyl for, 209 dosages of, 344 Postpartum pain, 621–623 indications for, 334, 344 Postpolio pain, 604–605 neuropathic pain and, 321t Postradiation pain, 540t Pinch-grasp injection technique, 395f Postthoracotomy pain, 605–606 PIPP; see Premature Infant Pain Profile Posttraumatic stress, 468 Piroxicam, 139t burn injury and, 529t, 531 Placebo(s) Posture, stooped, 574f chronic pain and, 492 Potency controlled trial, 302 definition of, 162 definition of, 36 of opioid, 170–171 EMLA versus, 376 methadone, 186 788 INDEX

Potential Preterm infants, 609—cont’d action pain in, 637–638 definition of, 16 behavior, 635 transduction of pain and, 18 management guidelines, 664–667t resting, 16, 18 PIPP, 645t Prazosin, 305t Prilocaine postmastectomy pain and, 604 circumcision and, 637 Preceptorships, 740, 741t in EMLA; see EMLA Precontemplation stage of drug treatment, 447–448, 447t eutectic mixture, 375t Prednisone, 305t Primary afferent neuron, 16 breast feeding and, 624 Primigravida, 609 cluster headache and, 556t Primipara, 609 migraine and, 555t Pruritus, 265–266 Preemptive analgesia use of antagonists and agonist-antagonists, 265–266 advantages of, 120–121 Privileging system, 712 characteristics of, 174–175 PRN; see Pain resource nurses for child, 143t–144 Procaine concept of, 174–175 elderly and, 698 definition of, 162, 363 infusion of, 339 nonsteroidal antiinflammatory drugs for, 133, 145 Procedural pain management, 363–395 Pregnancy, 609–623 angiography and, 390 acetaminophen and, 611, 613 assessment in, 366–367 adjuvant analgesic in, 614–615 barbiturates for, 381, 386 analgesics barriers to, 363 opioid, 613–614 benzodiazepines for, 381, 385t references and resources, 611–612t burn injury and, 529t use during, 610t, 611–615 cancer treatment and, 537, 537t–539t back pain in, 615–616 chloral hydrate, 386 Braxton Hicks contractions in, 616 conscious sedation, 382–378 childbirth pain management and, 617–621 general anesthetics for, 386–389 FDA risk classification, 609–610, 611t goals of, 365 headache in, 615 informed consent and, 365 lactation classifications, 623t intramuscular injection and, 391–395 maternal-placental-fetal drug transfer and, 610–611, 613f iontophoresis, 377–378 misconceptions related to analgesic use, 610 local anesthetics for, 367–378; see also Local anesthetic nonsteroidal antiinflammatory drugs and, 142 misconceptions about, 364t pain management resources, 611t need for, 363–365, 365t postpartum pain and, 621–623 nondrug approaches to, 389–390 pyrosis in, 616 opioids for, 378—381 round ligament pain in, 615 patient education and, 365–366 sickle cell disease and, 616 refrigerant sprays, 377 substance abuse and, 616–617 suturing and, 395 Premature Infant Pain Profile (PIPP), 642, 645t, 650; see also wound and, 593 Infants; Preterm infants Process, definition of, 712 Preoperative analgesia, nonsteroidal antiinflammatory drugs Prochlorperazine, migraine and, 554t for, 145 Professional education, resources for, 6–7t Preoperative medication, nonsteroidal antiinflammatory Professional organization drugs for, 133 acronyms for, 2 Prescribing of opioid analgesics, 751–755 focus on pain, 12t Prescription analgesic, list of, 125 growth of, 11 Pressure Promethazine, 695 on injection site, 394 Prophylaxis intracranial, corticosteroids for, 312 migraine and, 553, 556 wound pain and, 593 for NSAID-induced ulcer, 137 Preterm infants, 609; see also Infants for perioperative/postoperative pain; see Preemptive analgesia CRIES score, 644t Propofol definition of, 627 patient-controlled analgesia with, 388 intensive care interventions, 662–663f procedural analgesia with, 387–388, 387t minimizing pain in, 661 Propoxyphene opioid in, 655 characteristics of, 187–188 INDEX 789

Propoxyphene—cont’d Quality of life, 31–32 elderly and, 693, 699t Quality of pain, 59 equianalgesic dosage of, 133t, 242t Quantitative sensory testing, 577 pregnancy and, 614 Questionnaire Propranolol, 305t barriers, 89, 92, 93 migraine and, 555t, 556 CAGE, 705 Proprioceptive receptor, 592 chronic pain and, 478–487 Proprionic acid derivative, 139t; see Ibuprofen; Ketoprofen; coping strategies, 519 Naproxen McGill pain, 577 Proproxyphene, 180t patient, 729 Prostaglandin Quick reference guide for pain management, 736 nonsteroidal antiinflammatory drugs and, 130, 136 transduction of pain and, 18 R Prostate cancer, 532t Race and culture in pain assessment, 57 age and, 678t Radiation fibrosis, 540t Protease inhibitor, 567 Radionuclide for malignant bone pain, 325t, 326 Protein binding Randomized study, 302 in elderly, 688, 690 Ranitidine opioids and, 169 in elderly, 699t Protein synthesis, muscle, 25 NSAID-induced ulcers and, 137 Protocol for infant, 664–667 Rash, herpes zoster, 562 Proxy pain rating, 95 Rating scale for pain, 62–75; see also Pain rating scale Prozac; see Fluoxetine Rebound headache, 559 Pruritus, opioids causing, 263t, 265–266 Receptors, opioid, 165–166, 165f, 166t, 167t Pseudoaddiction, 51, 173–174 intraspinal anesthesia and, 222 Pseudorheumatism, steroid, 312 Recovery from addiction, 446, 459–460 Psilocybin, 433 Rectal administration Psychiatric disorders of acetaminophen, 150t with alcohol addiction, 436–437, 436t, 437t in child, 143t, 150t nonmalignant pain and, 476t of nonsteroidal antiinflammatory drug, 131t Psychiatric setting, 475–476 of opioids, 195t, 204–205, 205t Psychogenic pain, 36, 49–50 Rectal cancer, 532t Psychologic dependence, 51, 173–174 age and, 678t Psychologic factors Reference guide chronic pain and, 499 formulary analgesic, 737 fibromyalgia and, 546–547 for pain management, 736 herpes zoster and, 562 Referral Lyme disease and, 601 chronic pain and, 513, 516 reflex sympathetic dystrophy and, 583 for drug treatment, 450, 451t Psychostimulant, 314–317 Referred pain, 568–572 for child, 341t Reflex sympathetic dystrophy, 581–584 examples of, 305t in elderly, 697 Pudendal nerve block, 621 typical, 582f Pumps Refrigerant spray, 377 external, 219f Refusal of pain treatment, 89, 92 implantable, 219f Regional anesthesia in infant, 656 for patient-controlled analgesia, 175–177, 249; see also Pa- Regional blockade tient-controlled analgesia labor and delivery and, 619 Puncture, dural, 232 reflex sympathetic dystrophy and, 584 Pyranocarboxylic acid, 139t, 140t Reglan; see Metoclopramide Pyrosis, pregnancy and, 616 Regulation, federal, 9–10 Rehabilitation Q chronic pain and, 487–490, 503, 505 Quality assurance, 712 postoperative, 740 Quality improvement, 713–715, 721f Relafen; see Nabumetone data analysis tools, 721f, 722–723f Relapse in drug treatment, 436–438, 448 data collection, 720–730 Relaxation technique, 417–421 definition of, 712 characteristics of, 419 guidelines, 716 chronic pain and, 500–501 pain care committee and, 715, 733–734 deep breathing, 420t 790 INDEX

Relaxation technique—cont’d Ropivacaine imagining, 420t in elderly, 694 indications for, 418–419 injectable, 368 labor and delivery and, 617 intraspinal, 228 massage as, 420–421, 421t for procedural pain, 369t music, 391t Round ligament pain, 615 patient involvement in, 419–421 Route of administration, 131t, 194, 195–196t research about, 418 adjuvant analgesic and, 113 Remifentanil benzodiazepines and, 381 characteristics of, 190 bioavailability of drug and, 169 metabolism of, 192 buccal, 195t, 201 Renal function for elderly, 693–694 acetaminophen and, 135–136 epidural, 213–239 ketorolac and, 146–147 individualization of regimen and, 121 nonsteroidal antiinflammatory drugs and, 138 infusion; see Infusion opioid analgesia and, 192 intraarterial, 196t tramadol and, 191 intracerebroventricular, 196t Repolarization, 16 intramuscular; see Intramuscular administration Rescue analgesic intranasal, 195t, 203 dosage calculation for, 122, 244–246 definition of, 162 nonopioids versus opioids as, 134 effectiveness of, 25 selection of, 121 midazolam and, 381 Research, terminology related to, 302 intrathecal, 196t, 213–239 Residential drug treatment, 442t, 446 for labor and delivery, 619–620 Respiratory depression, 264t, 267, 268–270 intraspinal, 213–239 elderly and, 695 intravenous; see Intravenous administration fear of, 9 nebulized, 203 infant and, 655t for nonsteroidal antiinflammatory drugs, 110, 141 labor and delivery and, 619 oral, 194–201 misconceptions about, 163t oral transmucosal, 201–203 naloxone for, 269 patient’s resistance to, 54 in opioid-naive patient, 145 for procedural pain, 378 procedural analgesia and, 378, 380 rectal, 204–205, 205t Respiratory effects of pain, 26–27 reducing pain in, 391–394 Respiratory rate, infusion and, 81 stomal, 205–206 Responsiveness subcutaneous, 195t, 210–211, 211t, 212 to adjuvant analgesic, 304 sublingual, 195t, 201 to opioid, 171 switching of, 257–260 Resting potential, 16 systemic, 302 Restraint of infant, 659 transdermal, 206–209 Retention, urinary, 266 transmucosal; see Transmucosal administration of opioid epidural analgesia in child and, 239 vaginal, 206 Revex; see Nalmefene Rufen; see Ibuprofen Rhenium-186, 325, 326 Rule, administrative, 738 Rheumatoid arthritis, 523–525 affected joints, 525f S alternative treatment for, 690t Sacral plexus, 536t joint characteristics, 524f Saddle block, 619 Rhinoplasty, gel pack for, 409f Salicylate Rib fracture, fentanyl for, 26 dosage of, 139t Rib pain, cancer-related, 535t overdose of, 152 Rid-a-Pain with Codeine, 149t Saline, bacteriostatic, 370 Rightss, of patients with pain, 13, 13t Saliva, artificial, 602 Rimadyl; see Carprofen Salsalate Ritalin; see Methylphenidate bleeding disorder and, 144 Ritonavir, 567 dosage of, 139t Robaxin; see Methocarbamol Samarium-153, 325, 326 Role model program, 740–742 Sandostatin; see Octreotide Romazicon; see Flumazenil Sansert; see Methylsergide Saquinavir, 567 INDEX 791

Scaleni trigger point, 571f Side effects, of opioids analgesics—cont’d Schizophrenia, alcohol addiction and, 436 urinary retention as, 266 Sclerosis, multiple, 602–603 Silent cry, 634f Scopolamine, 327 Simple descriptor rating scale, 63 Secobarbital, 699t numerical scale versus, 65 Seconal; see Secobarbital Sinequan; see Doxepin Secondary gain, 41–42 Single blind study, 302 Sedation Skin conscious, 382–384t burn injury to, 527–531 elderly and, 695 cutaneous stimulation and, 390, 405–412 infusion and, 81 heat and cold for, 406–411 levels of, 267 sites in, 406f misconceptions about, 364 vibration as, 411–412 opioids causing, 193, 267–268 Ehlers-Danlos syndrome and, 543 procedural analgesia and, 378, 380, 381–386 shingles and, 561–564 procedures requiring, 365t wound pain and, 592–595 scale, 267t Skin-to-skin intervention, 660–661 Sedatives Sleep disorder addiction to, 432t, 433 burn injury and, 529t alcohol withdrawal and, 458 chronic pain and, 500 detoxification protocols, 458t in cognitively impaired elderly, 701 elderly and, 699t pain effects on, 29 infant and, 655 severe pain and, 46 Seizure, tramadol and, 191 wound pain and, 592 Selective serotonin reuptake inhibitor Sodium bicarbonate for infant, 665–666 as adjuvant analgesic, 307, 310 Sodium ion in transduction of pain, 18 elderly and, 697 Sodium salicylate, 133t fibromyalgia and, 548 Solubility peripheral neuropathy and, 578 intraspinal anesthesia and, 220–222 pregnancy and, 614 of opioids, 169 sexual dysfunction caused by, 309 Soma; see Carisoprodol side effects of, 308 Somatic pain, 16 Sensorcaine; see Bupivacaine cancer-related, 533 Sensory deficit with epidural anesthesia, 230t definition of, 19t Sensory testing, quantitative, 577 Somatization, 468 Sequential trial, 162, 302 Somatoform disorder, 36, 49 Serotonin, 23 Spasm Serotonin antagonist, 555t fibromyalgia and, 547–548 Serotonin-receptor agonist, 553 pain causing, 28 Sertraline, 305t, 306t Specialist, certification of, 11–12 indications and dosages of, 343t Sphincter of Oddi, 581 Sex hormone in osteoporosis, 575 Spinal analgesia; see also Epidural analgesia; Intraspinal Sexual dysfunction with antidepressant, 309 analgesia Shingles, 561–564, 561f clonidine, 337t chronic pain and, 31 labor and delivery and, 619–620 Shooting pain; see Lancinating pain Spinal cord Sickle cell disease, 585–588 compression of pain examples, 586f cancer-related, 539 pregnancy and, 616 corticosteroids for, 312, 313, 339–340 Sickness Impact Profile, 519 injury to, 606–607 Side effects, of opioids analgesics, 261–270 neuropathic pain and, 23 biliary spasm as, 265 pain in infants and, 635 constipation as, 262 tumor of, 536t mental status changes as, 263, 267–268 Spinal nerve, dermatomes and, 217f myoclonus as, 266–267 Spine; see also Back pain nausea and vomiting as, 261, 263, 264–265 anatomy of, 213–214, 216t options for, 256t ankylosing spondylitis and, 595–596 pruritus as, 263, 265–266 arachnoiditis and, 596 respiratory depression as, 268–270 elderly and, 679t sedation as, 267–268 osteoporosis and, 574 792 INDEX

Spine—cont’d Substance abuse, 428–462; see also Addiction tumor of, 533t costs, 441f vertical column, 216f diagnostic criteria for, 435t, 436t Splinting, 594 motivational tasks, 447t Spray patient placement, 451t nasal, 112 pregnancy and, 616–617 refrigerant, 377 Substance P, 22 Spray and stretch technique for myofascial pain syndrome, 570 Sucking, nonnutritive, 659 Stadol; see Butorphanol Sucralfate, 137 Stanback, 149t Sucrose for infant, 659–660 Stanback AF Extra-Strength, 148t Sufentanil Standard intranasal, 203 for assessment, treatment, and documentation, 730, 734t intraspinal, 224, 227 definition of, 712 for opioid-naive adult, 225t State medical board, 9–10 pregnancy and, 614 Status migraine, 556 solubility of, 169 Steady state of opioid, 169–170 Suicide, risk assessment, 487, 487t Steroid; see Corticosteroid Sulindac, 139t Stiffness, fibromyalgia and, 548 Sumatriptan Stigma of addiction, 51, 53 breast feeding and, 624 Stimulation cluster headache and, 555t cutaneous, 390, 405–412 migraine and, 553 heat and cold for, 406–411 Superficial heat and cold, 406–411 sites in, 406f Superior vena cava syndrome, 312, 313, 339 vibration as, 411–412 Support group, 686 dorsal column, 584 Suppository; see Rectal administration electric, in multiple sclerosis, 603 Supraspinal injection, 162 Stimulus, noxious, 16 Supraspinatus trigger point, 571f Stocking-glove distribution of pain, 577f Supratentorial pain, 36, 49–50 Stomach disorder, 136–137 Surgery; see also Perioperative analgesia; Postoperative pain Stomal administration of opioid, 205–206, 206t ambulatory, 145 Stomatitis, 601–602 ankylosing spondylitis and, 596 Stress, 23–32 arthritis and, 526 chronic pain and, 501–503 gel pack for incisional pain, 409f harmful effects of, 23–32 in infant, 24–25, 639, 662, 663f on cardiovascular system, 25–26 low back pain and, 600 on cognitive function, 28–29 multiple sclerosis and, 603 developmental effects of, 30 postmastectomy pain and, 604 on endocrine and metabolic system, 23–25 reflex sympathetic dystrophy and, 584 in future, 30–31 temporomandibular dysfunction and, 591 on gastrointestinal system, 27–28 Survey on genitourinary system, 27 “Andrew-Robert,” 38t, 39–40, 40t,44 on immune system, 29–30 chronic pain and, 508 on musculoskeletal system, 27–28 pain knowledge and attitude, 729 on quality of life, 31–32 Suturing, atraumatic, 395 on respiratory system, 26–27 Swaddling of infant, 659 hypercoagulation and, 25 Sweats with alcohol withdrawal, 457 infant and, 635 Sympathetic blockade, 584 posttraumatic, 468 Sympathetic dystrophy, reflex, 581–584, 582f Stroke, pain after, 696 Sympathetically maintained pain, 19t, 330 Strontium chloride-89, 325, 326 Symptom Checklist-90R, 519 Stump pain in elderly, 694 Synapse, 16 Subacute overdose, 269 Systemic drug, 302 Subarachnoid space, 213–214 Subarachnoid space block, 619–620 T Subcutaneous administration of opioid, 195t, 210–211, Tabetic pain, 302 211t, 212 TAC, 373 Sublimaze; see Fentanyl Tachycardia, 694 Sublingual administration of opioids, 195t, 201 Tactile disturbance in alcohol withdrawal, 457 Suboccipital trigger point, 571f Talwin; see Pentazocine INDEX 793

Tapering of opioid, 270–271, 494–496 Tolerance—cont’d Teaching; see Education entries drug—cont’d Tegretol; see Carbamazepine misconceptions about, 163t Temporal arteritis, 695–696 opioid, 171–173 Temporomandibular joint disorder, 588–591 switching of drug in, 253–257 sources and sites of pain, 589f pain, high versus low, 42–43 Tempra, 148t Tolmetin, 139t Tenderness in fibromyalgia, 547 Tonocard; see Tocainide Tendinitis, 690t Tool, assessment, 58–99; see also Assessment, tools for Tenormin; see Atenolol Topical agent, 331–332, 331t Tension headache, 555t, 557–558 adjuvant, 305t Teratogenesis, 609 antiinflammatory, 331 opioids and, 614 burn injury and, 530–531 Terazocin, 604 capsaicin, 331 Term infant; see also Infant herpes zoster and, 562 definition of, 627 infant and, 656–657 pain behavior in, 634 local anesthetic, 331–332, 371–377 Terminally ill patient mucositis and, 602 antidepressants for, 310 neuropathic pain and, 321t HIV and, 565 osteoporosis and, 575 nebulized opioid for, 203 peripheral neuropathy and, 578 opioid for, 272 refrigerant spray and, 377 pain assessment in, 94 Toradol; see Ketorolac Terminology, 756–757 Total body surface area, 527 about agreements, 751–752 Total knee replacement, 694 Testosterone, 24 Total quality management, 713, 714–715t Tetracaine, 371–372, 373, 374t Toxicity Tetrahydrocannabinol, 334 corticosteroid, 312 Thermoregulation, 26 in elderly, 697–698 Thoracic epidural analgesia, 222 epidural local anesthetics and, 230t Thoracic surgery local anesthetic, 318, 368 in elderly, 678t elderly and, 698 pain of, 605–606 of topical agent, 332 Thoracic trauma, 26 Toxicology, urine, 446 Thoracic vertebral tumor, 536t Trade name of nonopioid drugs, 138t Thorazine; see Chlorpromazine Tramadol Throat, gel pack for, 409f characteristics of, 190–191 Tick-borne disease, 600–601 elderly and, 692 Tissue adhesive, 395 Transcutaneous electrical nerve stimulation Titration of dose for elderly, 700 for acetaminophen, 141 reflex sympathetic dystrophy and, 583 definition of, 36 Transdermal administration of opioid, individualization of regimen and, 121–122 206–209 for nonsteroidal antiinflammatory drugs, 141 Transduction, 16, 18, 22 of opioid, 246–249 of antidepressant, 309f for elderly, 695 definition of, 106f patient-controlled analgesia, 253 illustration of, 21, 107f Tizanidine, 305t, 342t for local anesthetics, 319f TLC, 373 nonsteroidal antiinflammatory drugs and, 130 Tocainide, 305t Transmission of pain, 16, 19t elderly and, 698 of antidepressant, 309f indications and dosages of, 344 definition of, 106f neuropathic pain and, 318, 321t illustration of, 21, 107f Tofanil; see Imipramine for local anesthetics, 319f Tolerance process of, 22 drug Transmucosal administration of opioid addiction versus, 433–434 buccal, 201 definition of, 50, 162, 429 characteristics of, 195t epidural analgesia and, 260–261 of fentanyl, 202f, 207f, 209t methadone and, 185–186 characteristics of, 202–203 794 INDEX

Transmucosal administration of opioid—cont’d Urinary retention—cont’d of fentanyl—cont’d epidural analgesia and, 230t for procedural pain, 378, 379t in child, 239 as rescue analgesic, 245 Urine toxicology, 446 gingival, 201 Urologic surgery in elderly, 678t for procedural pain, 378 Uterine contraction, postpartum, 622 sublingual, 201 Uterus Trauma cesarean section and, 622–623 infant and, 638–639 involution of, 609 needle or catheter, 233 spinal cord, 606–607 V wound pain and, 592–595 Vaginal administration Trazodone, 305t, 306t, 307 of opioid, 206 Treatment, misconceptions affecting, 37t of opioids, 195t Tremor in alcohol withdrawal, 457 Valium; see Diazepam Trial, clinical, types of, 302 Valproate Triavil, 699t indications and dosages of, 342t Tricyclic antidepressant; see Antidepressant neuropathic pain and, 321t Trigeminal Neuralgia Association, 518 Valproic acid, 305t Trigger for migraine, 553 adverse effects of, 323 Trigger point, 569, 570, 571f for child, 341t in fibromyalgia cluster headache and, 556t identification of, 546 migraine and, 555t injection of, 549 overview of, 322 Trilisate; see Choline magnesium trisalicylate Vanquish, 149t Trimester of pregnancy, 609 Varicella-zoster virus, 561–564, 561f Trunk pain in elderly, 679t VAS; see Visual analog scale Tumor, 531–543; see also Cancer-related pain Vascular disease in elderly, 696 Twelve-step program of drug treatment, 442–443, 442t Vascular surgery Tylenol; see Acetaminophen in elderly, 678t Tylenol 3, 117, 134 hypercoagulability and, 25–26 Tylox, 117, 134 Vastis lateralis injection site, 393f Vena cava syndrome, superior, 312 U corticosteroids for, 312, 313, 339 Ulcer Venlafaxine, 305t, 306t aphthous, HIV and, 566–567 Venous ulcer, 592 corticosteroid causing, 312 Ventilation, mechanical, weaning from, 271–272 in elderly, 689, 698–699 Ventrogluteal injection site, 392f nonsteroidal antiinflammatory drugs causing, 136, 137 Veracept; see Nelfinavir reducing risk of, 110 Verapamil venous, 592 cluster headache and, 556t Unconscious patient, pain assessment in, 94 migraine and, 555t Undertreatment of pain Versed; see Midazolam in chronic nonmalignant pain, 271 Vertebral column, anatomy of, 213–214, 216f circumcision and, 636–639 Vertebral fracture, 574 diagnosis of cause of pain and, 47 Vertebral tumor, 536t in elderly, 676–677 Very-low-birth-weight infant, 627 health care professional and, 4–5, 9–10 Vicodin, 117, 134 education for, 734, 736–737 Vicoprofen, 134 in infants, 628–631 Video tapes pain management, 738 nurses’ expectations about pain of, 44 Viracept; see Nelfinavir postoperative, in child, 144 Viral infection in terminally ill patient, 272 HIV, 564–568, 566f weaning from mechanical ventilation and, 271–272 peripheral neuropathy in, 576 Unidimensional pain measures in infants, 640–642, 643t varicella-zoster, 561–564, 561f UNIPACS, 6 Visceral pain, 16 Unrelieved pain, 3–4, 23–32, 24t cancer-related, 534t Urecholine; see Bethanechol definition of, 19t Urethral catheterization, atraumatic, 372t Visual analog scale (VAS), 62 Urinary retention, 266 definition of, 36 INDEX 795

Visual analog scale (VAS)—cont’d Williams & Wilkins Complete Library on Pain, 6 horizontal, 62f Wisconsin Cancer Pain Initiative, 6, 11, 274 numerical scale versus, 65–66 Withdrawal Visual disturbance in alcohol withdrawal, 457 alcohol, 457 Vital sign chronic pain and, 494–496 fifth, 3 corticosteroid, 312 graphic record of, 735 infant and, 631 infant and, 633 Withholding of treatment; see also Undertreatment of pain Vitamin D, osteoporosis and, 575 in chronic nonmalignant pain, 271 Vomiting opioid, 271–272 alcohol withdrawal and, 457 in terminally ill patient, 272 elderly and, 695 weaning from mechanical ventilation and, 271–272 ergotamine withdrawal and, 559 Wong-Baker faces pain rating scale, 63, 66, 67 migraine and, 553 cultural differences and, 98 opioids causing, 261, 262t–263t World Health Organization analgesic ladder, 115–119, 117f, 539, 541 W Cancer Pain Relief published by, 5 Weaning clinical practice guidelines of, 7 from mechanical ventilation, 271–272 Wound pain, 592–595, 593t from morphine in burn injury, 530 Written agreement, 751–755 from opioid in infant, 632 Web sites Z for addiction treatment, 462–463 Zantac; see Ranitidine health-related, 749–750t Zogmig; see Zolmitriptan Whipple procedure, 258–259 Zolmitriptan, 554t WHO analgesic ladder, 115–119, 117f, 539, 541 Zoster ophthalmicus, 562 Wigraine; see Ergotamine Z-track method of intramuscular injection, 391–394, 394f