Introduction"
Part I: Symptoms and Conditions
1. Musculoskeletal Pain: Common Causes
Pain in the Shoulder
- Bursitis
- Arthritis (Glenohumeral and Acromioclavicular)
- Rotator Cuff Injury
- Adhesive Capsulitis
Pain in the Elbow
- Tendinitis
o Tennis Elbow (Lateral Epicondylitis)
o Golfers Elbow (Medial Epicondylitis)
- Olecranon Bursitis
- Traumatic Arthritis
Pain in the Neck (Cervical Spine)
Pain in the Low Back (Lumbar Spine)
- Muscles and Ligaments
- Vertebral Bodies
- Facet Joints
- Vertebral Disc
Pain in the Hip
- Arthritis
- Ischemic (Avascular) Necrosis of the Hip
- Fractures
Pain in the Buttock
- The Sacroiliac Joint (SI joint)
- Greater Trochanteric Bursitis
- Ischiogluteal Bursitis
Pain in the Knees
- Osteoarthritis of the Knee Joint
- Meniscal Tear
- Patellofemoral Arthritis
- Patellar Tendonitis
- Osteochondritis
Case Studies
2. Neuropathic pain
In the Face: Trigeminal Neuralgia
In the Thumb, Index, and Middle Finger: Carpal Tunnel Syndrome
In the Thoracic Region: Postherpetic Neuralgia
In the Back or Neck and Down the Leg or Arm: Radicular Pain
Down the Legs or Arms: Spinal Canal Stenosis
On the Top and Lateral Aspect of the Mid-Thigh: Lateral Femoral Cutaneous Neuropathy (Meralgia Paresthetica)
In the Feet or Hands: Peripheral Neuropathy
In a Stump and Phantom Limb Pain
Postsurgical Neuropathic Pain Syndromes:
- Post-Thoracotomy Pain Syndrome
Postsurgical Pelvic Nerve Entrapment: The Iliohypogastric Nerve, Ilioinguinal Nerve, and Genitofemoral Nerve
Case Studies
3. Cancer Pain
History and Exam
- Metastatic Bone Pain
- Visceral Pain
- Neuropathic Pain Related to Cancer
- Intracranial Primary or Metastatic Tumor Pain, Headache
- Spinal Cord Compression
- Pain caused by surgery for cancer
- Preexisting painful conditions
Treatment
Case Study
4. Abdominal Pain
Visceral Abdominal Pain
Somatic Abdominal Pain
Referred pain
History and Exam
Treatment
Case Studies
5. Pelvic Pain
History and Exam
- Visceral Pelvic Pain
- Somatic Pelvic Pain
- Neuropathic Pelvic Pain
Treatment
- Medications
- Injections
- Surgery
Case Study
6. Podiatric Pain, Foot and Ankle
Plantar fasciitis
Hallux valgus (bunion)
Mortons neuroma
Tarsal tunnel syndrome
Diabetic peripheral neuropathy
History and Exam
Treatment
Case Studies
7. Miscellaneous Pain Disorders that Affect Multiple Areas of the Body: Complex Regional Pain Syndrome (CRPS, formerly known as Reflex Sympathetic Dystrophy), Fibromyalgia, and Sickle Cell Pain
Complex Regional Pain Syndrome (CRPS, Formerly Known as Reflex Sympathetic Dystrophy)
- History and Exam
- Treatment
- Case Study
Fibromyalgia
- History and Exam
- Treatment
- Case Study
Sickle Cell Pain
- History and Exam
- Treatment
- Case Study
8. Postoperative Pain Management
History and Exam
Treatment
Case Studies
Part II: Noninterventional Treatments
9. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
When to Use
How to Use
When Not to Use and Potential Side Effects
Case Study
10. Acetaminophen (Tylenol)
When to Use
How to Use
When Not to Use and Potential Side Effects
Case Study
11. Topical Pain Medications
When to Use
How to Use
When Not to Use and Potential Side Effects
Case Study
12. Muscle Relaxants
When to Use
How to Use
When Not to Use and Potential Side Effects
Case Study
13. Antidepressant Medications Used for Neuropathic Pain
When to Use
How to Use
When Not to Use and Potential Side Effects
Case Study
14. Antiseizure Medications Used for Neuropathic Pain
When to Use
How to Use
When Not to Use and Potential Complications
Case Study
15. Opioids
When to Use
How to Use
- Hospital setting: Intravenous Opioids
- Hospital or outpatient setting: Short-acting oral narcotics
- Outpatient setting, chronic pain: Long-acting oral narcotics
- Long-Acting (Time-Release) Opioid Medication Choices
- Breakthrough Pain Management
- Other Narcotic-Like Pain Medication
When Not to Use and Potential Complications
Case Study
16. The Patient Controlled Analgesia Device (PCA)
When to Use
How to Use
When Not to Use and Potential Complications
Case Study
17. Epidural Catheter Analgesia
When to Use
- Surgical Setting
- Childbirth Setting
How to Use
- Surgical Setting
- Childbirth Setting
When Not to Use and Potential Complications
Case Studies
18. Radiation Therapy
When to Use
- Pain from a Solid Tumor
- Metastatic Bone Pain
- Cord Compression
How to Use
When Not to Use and Potential Complications
Case Study
Part III: Interventional Treatments:
19. Epidural Steroid Injections
When to Use
How the Procedure is Done
- Intralaminar Epidural Steroid Injection
- Transforaminal Lumbar Epidural Steroid Injection
- Reasons for a nontherapeutic response to an epidural steroid injection and modes of correction
When Not to Use and Potential Complications
Case Study
20. Facet Joint Procedures: Facet Joint Injections, Medial Branch Nerve Blocks, and Radiofrequency Ablation of the Medial Branch Nerves
Diagnostic Injection vs. Diagnostic Therapeutic Injection
Facet Joint injections vs. Medial Branch Nerve Block
When to Use
How the Procedure is Done
- Facet Joint Injections (diagnostic and therapeutic injection)
- Medial Branch Nerve Blocks
- Radiofrequency Ablation of the Medial Branch Nerve
When Not to Use and Potential Complications
Case Studies
21. Sacroiliac Joint Injections
When to Use
How the Procedure is Done
- Diagnostic SI Joint Injections
- Therapeutic SI Joint Injection
- SI Joint Radiofrequency
When Not to Use and Potential Complications
Case Study
22. Trigger Point Injections for Myofascial Pain
When to Use
How the Procedure is Done
When Not to Use and Potential Complications
Case Study
23. Joint and Associated Bursa Injections: Shoulders, Elbow, Hip and Knees
When to Use
How the Procedure is Done
- Shoulder region
o Shoulder (glenohumeral) joint injection
o Shoulder (acromiclavicular) joint injection
o Shoulder (subacromial bursa) injection
- Elbow
o Lateral epicondyle (tennis elbow) injection
o Medial epicondyle (golfers elbow) injection
o Elbow Joint Injection
o Olecranon bursa injection
- Hip
o Intra-articular hip injection
o Greater trochanteric bursa injection
- Knee
o Intra-articular knee joint injection (cortisone and viscosupplementation)
When Not to Use and Potential Complications
Case Studies
24. Sympathetic Blocks: Stellate, Celiac, Lumbar, Superior Hypogastric and Ganglion Impar
When to Use
How the Procedure is Done
- Stellate Ganglion Block
- Celiac Plexus Block
- Neurolytic Celiac Plexus Block for Cancer Pain
- Lumbar Sympathetic Block (Paravertebral block)
- Superior Hypogastric Block (Ganglion of Walther)
- Neurolytic Superior Hypogastric Block for Cancer Pain
- Ganglion Impar Block
- Neurolytic Ganglion Impar Block for Cancer Pain
When Not to Use and Potential Complications
Case Studies
25. Vertebroplasty and Kyphoplasty
When to Use
How the Procedures Are Done
When Not to Use and Potential Complications
Case Study
26. Injections for Headache (Occipital Nerve Blocks and Botulinum Toxin Injections)
Occipital Nerve Block
Botulinum Toxin Injection
When to Use
How the Procedures are Done
- Occipital Nerve Block
- Botulinum Toxin Injections for Headache
When Not to Use and Potential Complications
Case Studies
27. Common Nerve Blocks
When to Use
How the Procedure Is Done
- Trigeminal Nerve Block (Trigeminal Neuralgia)
- Median Nerve Block (Carpal Tunnel Syndrome)
- Suprascapular Nerve Block (Frozen Shoulder)
- Intercostal Nerve Block
- Pelvic Nerve Block (Iliohypogastric, Ilioinguinal and Genitofemoral)
- Lateral Femoral Cutaneous Nerve Block (Meralgia Paresthetica)
- Tibial Nerve Block (Tarsal Tunnel Syndrome)
When Not to Use and Potential Complications
Case Studies
28. Discogenic Pain: Lumbar Discography
Introduction
When to Use
How the Procedure is Done
When Not to Use and Potential Complications
Case Study
29. Implantable Pain Devices: Spinal Cord Stimulators
When to Use
How the Procedure is Done
- TrialLower Body Pain
- TrialUpper Body Pain
- Full Implant
When Not to Use and Potential Complications
Case Study
30. Implantable Pain Device: Programmable Intrathecal Pain Pumps
When to Use
How the Procedures Are Done
- The Trial
- Full Implementation
- Pump Refills
When Not to Use and Potential Complications
Case Study
31. Percutaneous Lumbar Disc Decompression
When to Use
How the Procedure is Done
When Not to Use and Potential Complications
Case Study
Part IV: Multimodal Approach to Pain
32. Physical Therapy
When to Use
How to Use
- Balance
- Building Endurance
- Stretching/Range of Motion
- Strengthening
- Other Modalities: Heat, Ultrasound, Transcutaneous Electrical Nerve Stimulation (TENS)
When Not to Use
Case Studies
33. Complementary Treatments
Acupuncture
Cognitive Behavioral Therapy (CBT)
Biofeedback
Therapeutic Massage
Hypnosis
Case Study
34. Chiropractic Treatment
When to Use
How to Use
When Not to Use
Case Study
35. Avoiding Opioid Abuse
Curtailing Abuse and Diversion
- Determine if the patient needs an opioid
- Realistic expectations, prescribing opioids, and the narcotic agreement
- Monitoring patients on opioids: structured follow-up appointments, assessing function, urine drug screens, and prescription monitoring programs
Handling Abuse and Diversion Once Discovered
- Addressing violations of the narcotic agreement
- Discharging patients from the practice
