Key Topics in Pain Management PDF

PREFACE

The statements above are two of the more challenging statements about the nature of pain and its management. They support the existence of a specialty of pain medicine, with professionals from all backgrounds integrating their skills. This book attempts to describe the remit of the specialty of pain medicine. It attempts to visit some of the aspects of acute pain medicine where they can be related to chronic pain medicine; however, it is not a textbook of anaesthesia, and fuller accounts of pharmacology and specific techniques of perioperative and postoperative care will have to be sought elsewhere. Similarly, it is not a textbook of rheumatology or orthopaedics, and discussion of diagnosis and management of specific diseases is covered only to give the reader a feel for the place of pain management techniques within the overall management of these conditions.

The issue of whether acute and chronic pain medicine can be tackled in one small volume without detriment to either subject has been a challenge for the authors and reflects the wider debate in the professions as to whether the subjects should be practised and taught in a ‘seamless' way. In the United Kingdom, the Royal College of Anaesthetists has established a Faculty of Pain Medicine to train medically qualified anaesthetists in the management of acute, chronic and cancer pain. Other professional groups may tend to concentrate on one or other field of practice. There is common ground: the value of opioids in treating all pain, and the possible role of acute pain management in preventing the development of chronic pain are examples of this. In other ways the subjects differ from the humane management of physiological disturbance, to a complex rehabilitation exercise.

There have been a few changes in the 4 years since the second edition was published that we need to note. The virtual eclipse of the cyclo-oxygenase type 2 inhibitors, the development of new ways of administration of opioids and the advent of new imaging technology of the brain are just a few examples. The clinical governance agenda in the United Kingdom has resulted in the publication of a number of monographs from professional groups about the management of specific conditions and the use of certain techniques: we have referred to these where appropriate. We have attempted to present the evidence to support a particular treatment: as before, we have made specific reference to systematic reviews, while recognizing that useful treatments may also be supported by less robust evidence. The clauses ‘it is shown that' or ‘it is reported that' refer in the text to higher and lower levels of evidence, respectively.

This third edition came out of a discussion with colleagues about a syllabus for postgraduate anaesthesia training, but we believe that it will be valuable to anyone interested in the management of pain. We have invited guest contributions from several of these colleagues, and we value their enthusiasm and commitment to the subject. Otherwise, we retain the skill and wisdom of the guest authors Andrew Smith and Barrie Tait from the previous edition, together with helpful comments from those whom we acknowledged last time.