Pain Management and Palliative Care: A Comprehensive Guide

382 Pages·2015·22.473 MB·English

by  Kimberly A. Sackheim (Editor)

Kimberly A. Sackheim
Pain Management
and Palliative Care
A Comprehensive Guide
123
Pain Management and Palliative Care

Kimberly A. Sackheim
Editor
Pain Management
and Palliative Care
A Comprehensive Guide
Editor
Kimberly A. Sackheim
Department of Rehabilitation Medicine
Interventional Pain Management
New York University
Langone Medical Center
New York , NY , USA
ISBN 978-1-4939-2461-5 ISBN 978-1-4939-2462-2 (eBook)
DOI 10.1007/978-1-4939-2462-2
Library of Congress Control Number: 2015933514
Springer New York Heidelberg Dordrecht London
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To my beautiful daughters. May you get everything you want in life.
Always follow your dreams.
In loving memory of Anita.

Foreword
T he 2011 Institute of Medicine (IOM) report—“Relieving Pain in America: A Blueprint for
Transforming Prevention, Care, Education, and Research”—highlights a sobering statistic:
Chronic pain affects approximately 100 million American adults, more than heart disease,
cancer, and diabetes combined. Pain is a major reason for visits to healthcare professionals,
and most people with chronic pain seek help outside the healthcare system whether or not they
obtain medical care. Very few patients with pain ever see a physician with subspecialty training
in pain management or palliative care. Most patients with chronic pain are older and have one
or more chronic medical disorders. Numerous studies have linked pain with the use of multiple
medications and other treatments, and many have demonstrated the association between pain
and impaired work and role functioning, disturbed mood and sleep, stress on the family, and
relatively poor quality of life. The combined pain-related cost of treatment and loss of work-
force productivity may reach as much as $635 billion annually.
T hese observations underscore the reality that chronic pain is both a profound clinical issue
and a public health challenge. From the public health perspective, the IOM has called for a
strategy that embraces population-level changes that can raise consciousness among profes-
sionals and the public and improve pain assessment and management in the diverse systems
that deliver health care. In so doing, government will certainly seek to apply those precepts
that are at the heart of healthcare reform. These include a focus on quality, safety, and patient
satisfaction and the elimination of disparities in access to care. They also focus on cost con-
tainment through incentives for attainable outcomes and, most important, a shift from a fee-
for-service system to one that shares risk for managing populations in varied models. Hopefully,
the public health imperative in unrelieved chronic pain can be simply incorporated within the
broad changes now emerging in health care, and ultimately, the efforts made to improve the
public health will favorably affect the clinical work necessary to help the individual with
chronic pain.
F rom the clinical perspective, the observations highlighted in the IOM report support the
view that pain is best understood as a serious illness in its own right. Although clinical man-
agement always should include a search for an underlying pathology that can explain the per-
sistence of pain, neither the association between pain and chronic disease nor the hopeful fact
that disease management can sometimes relieve pain diminishes the distinct importance of the
pain phenomenon itself. Patients always deserve access to competent assessment and manage-
ment of pain, even if there are likely to be effective treatments for its cause.
Those with pain commonly engage in self-management strategies, often with the input of
those who promote and sell products and services that purport to help. If this refl ects self-e ffi cacy,
it may be salutary; if indicative of impeded access to medical care, it is part of the problem in
need of redress. Patients who do access medical care for pain may do so through primary care or
specialty care, or in pain subspecialty practices. The array of potentially useful treatments avail-
able to providers in all these settings is impressive: dozens of drug therapies, interventions such
as injections and implants, rehabilitative approaches, psychoeducational and behavioral tech-
niques, neurostimulation approaches, and complementary and alternative therapies.
In accessing care for pain, patients rely on the knowledge, skills, and judgment of
h ealthcare professionals. Many pain therapies, such as long-term administration of opioids or
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viii Foreword
NSAIDs, spinal injections or neural blockade, and implanted generators or pumps, may or
may not benefi t the individual and carry substantial risks over time, and patients must trust
that the professionals they see are knowledgeable and competent as they navigate the com-
plex arena of pain management.
The IOM emphasizes the need for an educated professional force. Education about pain is
essential for physicians and nonphysicians and for generalists and specialists alike. There
should be content about the complex biological and psychosocial aspects to pain, pain syn-
dromes, and the best practices supporting the use of both self-help and therapeutic approaches
to ameliorate pain and aid in adaptation to the pain that remains. Undergraduate and graduate
programs should offer information about pain, and continuing education that is current and
readily accessible is needed for primary care providers and specialists alike. Professionals
need to understand the evidence base, and as research slowly expands what is known, educated
clinicians can ensure that treatments based on the best available evidence and expert experi-
ence are undertaken with increasing safety and effi cacy.
Clinical materials are essential tools in broadening access to education, and there is a never-
ending need for materials in varied formats. There is great value in books, such as Sackheim’s
Pain Management and Palliative Care : A Clinical Guide , that offer clinically relevant infor-
mation for a medical audience about an array of topics relevant in both generalist and specialist
practice. This volume emphasizes common syndromes and treatments, with particular atten-
tion to pharmacotherapy and interventions. It is useful information for those who manage
chronic pain and a piece of a broader foundation in pain assessment and management essential
in addressing the public health and clinical imperatives of poorly controlled pain.
New York , NY , USA Russell K. Portenoy, M.D.
Director
MJHS Institute for Innovation in Palliative Care
Chief Medical Offi cer
MJHS Hospice and Palliative Care
Professor of Neurology
Albert Einstein College of Medicine
New York , NY
Pref ace

Dr. Kimberly A. S ackheim
This book is a comprehensive yet concise guide to interventional and medical pain manage-
ment and palliative care. It can be used as an invaluable daily companion for physicians in all
specialities as a quick reference and guide to the diagnosis and treatment of these patients and
conditions. Whether being treated for an infection, fracture, or chronic medical condition, all
patients experience pain which should be properly managed.
New York, NY, USA Dr. Kimberly A. Sackheim
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