Contents

Cure Arthritis Naturally

Beat Arthritis Naturally

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List of Tables ix

List of Figures xiii

Preface xv

1 Introduction 1

Origins and Development of Pain Management 2

Interdisciplinary Pain Medicine 3

Traditional Medical Models of Pain Management

Versus the Current Biopsychosocial Paradigm 4

Role of Psychiatrists in Interdisciplinary

Pain Medicine 5

Key Points 9

References 9

2 Sensory Pathways of Pain and Acute

Versus Chronic Pain 11

Pain-Relaying Pathways and Mechanisms 12

Role of the Autonomic Nervous System in Pain 18

Pain-Modulating Processes

Within the Nervous System 19

Acute Versus Chronic Pain 25

Classifications of Acute and Chronic Pain 25

Categories of Chronic Pain 27

"Patienthood" as a Psychosocial State:

The Patient With Simple Versus Chronic Pain 27

Multiaxial Pain Classification 30

Key Points 31

References 31

3 Evaluation of the Pain Patient 35

Conducting an Interview 37

Obtaining the Pain History 38

Evaluation of Treatment Suitability 47

Pain Assessment Instruments 47

Key Points 60

References 60

4 Common Psychiatric Comorbidities and Psychiatric Differential Diagnosis of the Pain Patient 63

Pain Disorder 64

Depression 70

Anxiety 72

Sleep Disorders 74

Substance-Related Disorders 75

Personality Disorders 77

Schizophrenia 78

Key Points 79

References 80

5 Pharmacology of Pain 83

Opiate Analgesics 83

Tramadol 94

Nonopiate Analgesics 95

Cyclooxygenase-2 Inhibitors 96

Antidepressants 97

Anticonvulsant Drugs 104

Considering Treatment Options: Antidepressant,

Anticonvulsant, or Both? 106

Antihistamines 110

Benzodiazepines and Anxiolytics 111

Triptans 112

Stimulants 113

Neuroleptics 114

Mexiletine 114

Alpha2-Adrenergic Agonists 115

W-Methyl-D-Aspartate Antagonists 115

Corticosteroids 116

Muscle Antispasmodics 117

Topical Agents 119

Herbal Agents 120

Cannabinoids 120

Placebo Effects 122

Key Points 122

References 124

6 Psychotherapy 131

Resistance to Psychotherapy 133

Factors to Be Addressed in Psychotherapy 134

Behavior Therapy 140

Cognitive-Behavioral Therapy 143

Supportive Therapy 147

Marital, Couples, and Family Therapy 148

Group Therapy 150

Adjunctive Interventions 151

Vocational Rehabilitation 156

Key Points 157

References 158

7 Special Techniques in Pain Management. . . .161

Acupuncture 162

Transcutaneous Electrical Nerve Stimulation 164

Prolotherapy 164

Botulinum Toxin (Botox) Injection 164

Anesthesia at the Level of the Spinal Cord 165

Regional Neural Blockade 166

Neurosurgical Techniques 170

Repetitive Transcranial Magnetic Stimulation 172

Role of the Psychiatrist in Pain Management

Related to Interventions 173

Key Points 177

References 177

8 Common Pain Disorders 179

Headache 179

Back Pain 186

Nonarticular Pain Disorders 188

Osteoarthritis and Rheumatoid Arthritis 194

Neuropathic Pain 197

Sympathetically Mediated Pain: Complex Regional

Pain Syndromes 200

Phantom Limb Pain 202

Cancer and HIV 204

Key Points 207

References 208

9 Special Populations 213

Pediatric Patients 213

Geriatric Patients 216

Pregnancy 219

Cultural Issues 220

Substance-Dependent and Substance-Abusing Patients. . .222

Patients With Terminal Conditions 224

Key Points 229

References 229

10 Forensic Issues Pertaining to Pain 233

Litigation and Pain 233

Medication Diversion 234

Opiate Adulteration and Misuse 236

Legal Issues Related to Opioid Prescribing 237

Patient Contracts 238

Drug Testing in Clinical Practice 240

State and National Prescribing Data Banks 240

Confidentiality 242

Disability Compensation 244

Key Points 247

References 248

Index 251

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