The Massachusetts General Hospital Handbook of Pain Management

The Massachusetts General Hospital Handbook of Pain Management

Language: English

Pages: 587

ISBN: 0781723779

Format: PDF / Kindle (mobi) / ePub

The Second Edition of this highly popular pocket guide presents the state-of-the-art approaches to pain management that are currently taught and practiced at the Massachusetts General Hospital. This completely revised new edition is even more user-friendly and clinical than its predecessor. All chapters are updated and 15 new chapters cover epidemiology of pain; quantitative sensory testing; neuroradiology; psychopharmacology for pain; pre-emptive analgesia for acute pain; chronic pain and the difficult patient; physical therapy in chronic pain; neuropathic pain syndromes; depression and pain; pain and drug addiction; pain and suffering; symptom management; palliative care; radiotherapy and cancer pain; and radiopharmaceuticals. A great pocket reference that can be used on the floor daily.

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have the great advantage in children of not being associated with respiratory depression. However, although acetaminophen is relatively free of side effects, the NSAIDs have several potentially dangerous side effects that limit their use. These drugs (including acetaminophen) are described in Chapter 8. Pediatric dosing for the more commonly used of these drugs is presented in Table 1. Table 1. Pediatric dosing of commonly used NSAIDs and acetaminophen (i) Acetaminophen Acetaminophen is the

their use in this situation is scanty. Amitriptyline has been shown to affect headache improvement in double-blind placebo-controlled studies. Dosage ranges from 10 to 100 mg per day or higher if tolerated. In some patients, its use is somewhat limited by its anticholinergic side effects (i.e., sedation, dry mouth, tachycardia, constipation, or urinary retention). To minimize sedation, the drug can be given in a single dose 1 to 2 hours before bedtime. It should be started at a low dose (10 mg

nonsteroidal anti-inflammatory drugs Acetaminophen has been shown to be safe even for newborns, in whom the immature hepatic metabolism system is protective, with decreased production of toxic metabolites. In children who are unable to take acetaminophen by mouth, the rectal route is the next option. However, in the child with cancer, bacterial seeding is a concern. Aspirin, salicylates (such as choline magnesium trisalicylate), and several nonsteroidal anti-inflammatory drugs (NSAIDs), including

diversion should always be maintained, particularly if there is evidence of abuse. If suspicions appear to be correct, closer control of opioid prescribing is indicated and clearly defined parameters must be maintained. This may include obtaining random urine samples to determine if the patient is taking the prescribed drug or, alternatively, to establish the taking of illicit substances. Recurrent excuses about lost or stolen prescriptions should increase the index of suspicion; this may suggest

inflammatory pain in advanced cancer. (i) The World Health Organization guidelines In 1986, the World Health Organization (WHO) released a set of guidelines called Cancer Pain Relief. The central component is the “three-step analgesic ladder” (see Chapter 32, figure 1), which became the guiding principal for cancer pain treatment in many parts of the world. The three-step analgesic ladder recommends initial treatment with nonopioid analgesics, alone or with adjuvants (e.g., anticonvulsants,

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