Fundamentals of Pain Medicine How to Diagnose and Treat your Patients

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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   Golfer’s 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)

·        Morton’s 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 (golfer’s 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

-         Trial—Lower Body Pain

-         Trial—Upper 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

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