Oxford Handbook of Pain Management Published and forthcoming Oxford Handbooks Oxford Handbook for the Foundation Programme 2e Oxford Handbook of Acute Medicine 2e Oxford Handbook of Anaesthesia 2e Oxford Handbook of Applied Dental Sciences Oxford Handbook of Cardiology Oxford Handbook of Clinical and Laboratory Investigation 2e Oxford Handbook of Clinical Dentistry 4e Oxford Handbook of Clinical Diagnosis 2e Oxford Handbook of Clinical Examination and Practical Skills Oxford Handbook of Clinical Haematology 3e Oxford Handbook of Clinical Immunology and Allergy 2e Oxford Handbook of Clinical Medicine - Mini Edition 8e Oxford Handbook of Clinical Medicine 8e Oxford Handbook of Clinical Pharmacy Oxford Handbook of Clinical Rehabilitation 2e Oxford Handbook of Clinical Specialties 8e Oxford Handbook of Clinical Surgery 3e Oxford Handbook of Complementary Medicine Oxford Handbook of Critical Care 3e Oxford Handbook of Dental Patient Care 2e Oxford Handbook of Dialysis 3e Oxford Handbook of Emergency Medicine 3e Oxford Handbook of Endocrinology and Diabetes 2e Oxford Handbook of ENT and Head and Neck Surgery Oxford Handbook of Expedition and Wilderness Medicine Oxford Handbook of Gastroenterology & Hepatology Oxford Handbook of General Practice 3e Oxford Handbook of Genitourinary Medicine, HIV and AIDS 2e Oxford Handbook of Geriatric Medicine Oxford Handbook of Infectious Diseases and Microbiology Oxford Handbook of Key Clinical Evidence Oxford Handbook of Medical Sciences Oxford Handbook of Neonatology Oxford Handbook of Nephrology and Hypertension Oxford Handbook of Neurology Oxford Handbook of Nutrition and Dietetics Oxford Handbook of Obstetrics and Gynaecology 2e Oxford Handbook of Occupational Health Oxford Handbook of Oncology 3e Oxford Handbook of Ophthalmology Oxford Handbook of Paediatrics Oxford Handbook of Palliative Care 2e Oxford Handbook of Practical Drug Therapy Oxford Handbook of Pre-Hospital Care Oxford Handbook of Psychiatry 2e Oxford Handbook of Public Health Practice 2e Oxford Handbook of Reproductive Medicine & Family Planning Oxford Handbook of Respiratory Medicine 2e Oxford Handbook of Rheumatology 2e Oxford Handbook of Sport and Exercise Medicine Oxford Handbook of Tropical Medicine 3e Oxford Handbook of Urology 2e Oxford Handbook of Pain Management Edited by Peter Brook Consultant in Pain Management Pain Management Service Bristol Royal Infi rmary Bristol UK Jayne Connell Principal Clinical Psychologist Bristol Royal Infi rmary Bristol UK Tony Pickering Wellcome Senior Clinical Research Fellow and Honorary Consultant Senior Lecturer in Anaesthesia School of Physiology & Pharmacology, University of Bristol, Bristol 1 1 Great Clarendon Street, Oxford OX2 6DP . 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No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging-in-Publication-Data Data available Typeset by Glyph International, Bangalore, India Printed in China on acid-free paper through Asia Pacifi c Offset ISBN 978–0–19–929814–3 10 9 8 7 6 5 4 3 2 1 Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. v Foreword The prevalence of pain in the population is high and management may often be defi cient, achieving an unsatisfactory outcome in terms of both inadequate pain relief and adverse events. Basic scientists have developed a wealth of knowledge of pain mechanisms and possible modalities that may modify these to achieve relief of pain. However, it remains frustrating that translation from laboratory experimentation to human therapy leaves many potential treatments wanting. In part, the relative failure of putative treatments results from the complex biopsychosocial aetiology of pain, of suffering and of interpersonal response differences in humans. Thus effective clinical management of pain requires skilled assessment of each patient, often by a multidisciplinary team, good communication, evidence based knowledge and experience. Papers reporting scientifi c advances and results of therapeutic trials, as well as systematic reviews, provide tools for management of pain. These tools require skilled application by a broad range of experienced practitioners to achieve optimal results for patients. An essential resource is an up to date textbook written by experienced scientists and clinicians which may also be used as a ‘bench book’. To be effective, such a volume must be broad ranging, clearly written and offer excellent indexing and bibliography. The Oxford Handbook of Pain Management provides just such a resource. Robert W. Johnson, MD.,FRCA.,FFPMRCA. University of Bristol, UK. This page intentionally left blank vii Preface Pain remains an all too common feature of our lives and its alleviation represents a ‘Grand’ challenge for healthcare practitioners. Although we have limited diagnostic tools, imperfect treatment options and fl awed structures for their delivery there is much that can be achieved through multidisciplinary and holistic practices which can achieve the best out- comes in the treatment of both acute and chronic pain. This book stemmed from our mutual perception that too few people working in healthcare were privy to the broad range of approaches that were useful in the management of pain. There will never be enough pain specialists and practitioners to meet the needs of all the patients who suffer in this way, thus for this knowledge to be effective it must be disseminated beyond ‘centres of excellence’ down to the shopfl oor. As we have noted, effective pain management often requires a multidisciplinary approach yet the time spent learning about pain in medical school and nursing, physiotherapy, and clinical psychology training is limited and is often limited to a narrow perspective. So it seemed appropriate that we should attempt to collect and share current knowledge about the management of pain from a broad range of viewpoints to support new clinicians, and other colleagues across the world. We felt that to be most useful this information source needed to be concise, to be quick and accessible, something that could sit in a pocket or on a nearby shelf. It is intended to be a pointer to good practice, giving key, immediate guidance. Practitioners have cannot hope to craft effective management plans based on the avalanche of information pouring daily through their letter boxes and in trays, rather they need distilled wisdom from a range of sources. In an attempt to meet this need we conceived the Oxford Handbook of Pain Management . In places this book provides more than most clinicians will need at the coalface, and there is inevitable repetition of some common themes, but we hope that the core information is presented in a way that will encourage thought, help with decision making and provide starting points for more detailed consideration. We all continue to learn (often from our patient’s experiences) and the fi eld of Pain Management is constantly evolving. We have enjoyed collating our author’s insightful contributions that have provided many different perspectives, and take this opportunity to thank them for their patience. This book has been a long time coming but, hopefully, is all the better for it. ‘ The greatest mistake in the treatment of diseases is that there are physi- cians for the body and physicians for the soul, although the two cannot be separated ’. Plato This page intentionally left blank ix Contents Foreword v Preface vii Contributors xi Symbols and abbreviations xv Section 1 Acute pain 1 Basic principles of acute pain 3 2 General pain management techniques 33 3 Specifi c clinical