Pain Management and Palliative Care: A Comprehensive Guide
Kimberly A. Sackheim
Format: PDF / Kindle (mobi) / ePub
This comprehensive book covers the knowledge needed to diagnosis and treat patients with acute and chronic pain. Sections dedicated to patient evaluation, medication management, treating patients with more complex circumstances and interventional management provide clinically-relevant information on an array of topics relevant to both the generalist and specialist. Some sections being organized in a diagnosis based approach help to focus on these topics and serve as a quick reference. A practical and easy-to-use guide, Pain Management and Palliative Care provides a broad foundation on pain assessment and management and is an invaluable daily companion for those managing patients experiencing pain.
NSAIDs n Tricyclic antidepressant/neuropathic agents (Nortiptyline, Amitriptyline, Gabapentin, Lyrica): central analgesic effect  n Elmiron (pentosan polysulfate sodium, the only FDA-approved medication speciﬁcally approved for IC) 100 mg p.o. tid, which re-establishes the proposed defective glycosaminoglycan layer that coats the bladder urothelium (can be associated with mild hair loss that is reversible with cessation of medication)  n Antihistamines (Hydroxyzine-25–50 mg qhs,
to central amplification of pain perception (CAPP) • CAPP due to increased signaling in ascending (pronociceptive) and decreased signaling in descending (antinociceptive) pathways – Ascending pathway: elevated substance P, nerve growth factor, brain-derived neurotrophic factor and glutamate – Descending pathway: decreased serotonin, norepinephrine and dopamine; increased endogenous opioids and decreased opioid receptor binding • Peripheral sensitization: reduction in the threshold of nociceptive
must be warned that this will be a long protracted course. 51 8 Detoxification from Opiates and Benzodiazepines • Buprenorphine: – Actually easier to rotate onto, but in order to use it for detoxiﬁcation, special training and a special DEA license must be obtained. – The National Alliance of Advocates for Buprenorphine Treatment (www.naabt.org) has a matching service that can locate appropriated trained and licensed physicians. – The basic process is to allow the patient to go into a moderate
sites of onset are the nasolabial fold or the ipsilateral chin • Work Up: – Imaging (CT and MRI) required to rule out central nervous system and hard/soft tissue pathology – Patients usually have seen multiple medical and dental practitioners without identiﬁed source and unsuccessful attempts at multiple interventions. • Diagnosis: – Diagnosis of exclusion • Treatment: – Pharmacologic First-line tricyclic antidepressants (preferred)  117 SSRI or SNRIs Some beneﬁt reported with topiramate
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