Fundamentals of Pain Medicine: How to Diagnose and Treat your Patients

Introduction
Part I: Symptoms and Conditions
1. Musculoskeletal Pain: Common Causes
· Pain in the Shoulder
- Bursitis
- Arthritis (Glenohumeral and Acromioclavicular)
- Rotator Cuff Injury
- Adhesive Capsulitis
· Pain in the Elbow
- Tendinitis
o Tennis Elbow (Lateral Epicondylitis)
o Golfers Elbow (Medial Epicondylitis)
- Olecranon Bursitis
- Traumatic Arthritis
· Pain in the Neck (Cervical Spine)
· Pain in the Low Back (Lumbar Spine)
- Muscles and Ligaments
- Vertebral Bodies
- Facet Joints
- Vertebral Disc
· Pain in the Hip
- Arthritis
- Ischemic (Avascular) Necrosis of the Hip
- Fractures
· Pain in the Buttock
- The Sacroiliac Joint (SI joint)
- Greater Trochanteric Bursitis
- Ischiogluteal Bursitis
· Pain in the Knees
- Osteoarthritis of the Knee Joint
- Meniscal Tear
- Patellofemoral Arthritis
- Patellar Tendonitis
- Osteochondritis
· Case Studies
2. Neuropathic pain
· In the Face: Trigeminal Neuralgia
· In the Thumb, Index, and Middle Finger: Carpal Tunnel Syndrome
· In the Thoracic Region: Postherpetic Neuralgia
· In the Back or Neck and Down the Leg or Arm: Radicular Pain
· Down the Legs or Arms: Spinal Canal Stenosis
· On the Top and Lateral Aspect of the Mid-Thigh: Lateral Femoral Cutaneous Neuropathy (Meralgia Paresthetica)
· In the Feet or Hands: Peripheral Neuropathy
· In a Stump and Phantom Limb Pain
· Postsurgical Neuropathic Pain Syndromes:
- Post-Thoracotomy Pain Syndrome
· Postsurgical Pelvic Nerve Entrapment: The Iliohypogastric Nerve, Ilioinguinal Nerve, and Genitofemoral Nerve
· Case Studies
3. Cancer Pain
· History and Exam
- Metastatic Bone Pain
- Visceral Pain
- Neuropathic Pain Related to Cancer
- Intracranial Primary or Metastatic Tumor Pain, Headache
- Spinal Cord Compression
- Pain caused by surgery for cancer
- Preexisting painful conditions
· Treatment
· Case Study
4. Abdominal Pain
· Visceral Abdominal Pain
· Somatic Abdominal Pain
· Referred pain
· History and Exam
· Treatment
· Case Studies
5. Pelvic Pain
· History and Exam
- Visceral Pelvic Pain
- Somatic Pelvic Pain
- Neuropathic Pelvic Pain
· Treatment
- Medications
- Injections
- Surgery
· Case Study
6. Podiatric Pain, Foot and Ankle
· Plantar fasciitis
· Hallux valgus (bunion)
· Mortons neuroma
· Tarsal tunnel syndrome
· Diabetic peripheral neuropathy
· History and Exam
· Treatment
· Case Studies
7. Miscellaneous Pain Disorders that Affect Multiple Areas of the Body: Complex Regional Pain Syndrome (CRPS, formerly known as Reflex Sympathetic Dystrophy), Fibromyalgia, and Sickle Cell Pain
· Complex Regional Pain Syndrome (CRPS, Formerly Known as Reflex Sympathetic Dystrophy)
- History and Exam
- Treatment
- Case Study
· Fibromyalgia
- History and Exam
- Treatment
- Case Study
· Sickle Cell Pain
- History and Exam
- Treatment
- Case Study
8. Postoperative Pain Management
· History and Exam
· Treatment
· Case Studies

Part II: Noninterventional Treatments
9. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
· When to Use
· How to Use
· When Not to Use and Potential Side Effects
· Case Study
10. Acetaminophen (Tylenol)
· When to Use
· How to Use
· When Not to Use and Potential Side Effects
· Case Study
11. Topical Pain Medications
· When to Use
· How to Use
· When Not to Use and Potential Side Effects
· Case Study
12. Muscle Relaxants
· When to Use
· How to Use
· When Not to Use and Potential Side Effects
· Case Study
13. Antidepressant Medications Used for Neuropathic Pain
· When to Use
· How to Use
· When Not to Use and Potential Side Effects
· Case Study
14. Antiseizure Medications Used for Neuropathic Pain
· When to Use
· How to Use
· When Not to Use and Potential Complications
· Case Study
15. Opioids
· When to Use
· How to Use
- Hospital setting: Intravenous Opioids
- Hospital or outpatient setting: Short-acting oral narcotics
- Outpatient setting, chronic pain: Long-acting oral narcotics
- Long-Acting (Time-Release) Opioid Medication Choices
- Breakthrough Pain Management
- Other Narcotic-Like Pain Medication
· When Not to Use and Potential Complications
· Case Study
16. The Patient Controlled Analgesia Device (PCA)
· When to Use
· How to Use
· When Not to Use and Potential Complications
· Case Study
17. Epidural Catheter Analgesia
· When to Use
- Surgical Setting
- Childbirth Setting
· How to Use
- Surgical Setting
- Childbirth Setting
· When Not to Use and Potential Complications
· Case Studies
18. Radiation Therapy
· When to Use
- Pain from a Solid Tumor
- Metastatic Bone Pain
- Cord Compression
· How to Use
· When Not to Use and Potential Complications
· Case Study

Part III: Interventional Treatments:
19. Epidural Steroid Injections
· When to Use
· How the Procedure is Done
- Intralaminar Epidural Steroid Injection
- Transforaminal Lumbar Epidural Steroid Injection
- Reasons for a nontherapeutic response to an epidural steroid injection and modes of correction
· When Not to Use and Potential Complications
· Case Study
20. Facet Joint Procedures: Facet Joint Injections, Medial Branch Nerve Blocks, and Radiofrequency Ablation of the Medial Branch Nerves
· Diagnostic Injection vs. Diagnostic Therapeutic Injection
· Facet Joint injections vs. Medial Branch Nerve Block
· When to Use
· How the Procedure is Done
- Facet Joint Injections (diagnostic and therapeutic injection)
- Medial Branch Nerve Blocks
- Radiofrequency Ablation of the Medial Branch Nerve
· When Not to Use and Potential Complications
· Case Studies
21. Sacroiliac Joint Injections
· When to Use
· How the Procedure is Done
- Diagnostic SI Joint Injections
- Therapeutic SI Joint Injection
- SI Joint Radiofrequency
· When Not to Use and Potential Complications
· Case Study
22. Trigger Point Injections for Myofascial Pain
· When to Use
· How the Procedure is Done
· When Not to Use and Potential Complications
· Case Study
23. Joint and Associated Bursa Injections: Shoulders, Elbow, Hip and Knees
· When to Use
· How the Procedure is Done
- Shoulder region
o Shoulder (glenohumeral) joint injection
o Shoulder (acromiclavicular) joint injection
o Shoulder (subacromial bursa) injection
- Elbow
o Lateral epicondyle (tennis elbow) injection
o Medial epicondyle (golfers elbow) injection
o Elbow Joint Injection
o Olecranon bursa injection
- Hip
o Intra-articular hip injection
o Greater trochanteric bursa injection
- Knee
o Intra-articular knee joint injection (cortisone and viscosupplementation)
· When Not to Use and Potential Complications
· Case Studies
24. Sympathetic Blocks: Stellate, Celiac, Lumbar, Superior Hypogastric and Ganglion Impar
· When to Use
· How the Procedure is Done
- Stellate Ganglion Block
- Celiac Plexus Block
- Neurolytic Celiac Plexus Block for Cancer Pain
- Lumbar Sympathetic Block (Paravertebral block)
- Superior Hypogastric Block (Ganglion of Walther)
- Neurolytic Superior Hypogastric Block for Cancer Pain
- Ganglion Impar Block
- Neurolytic Ganglion Impar Block for Cancer Pain
· When Not to Use and Potential Complications
· Case Studies
25. Vertebroplasty and Kyphoplasty
· When to Use
· How the Procedures Are Done
· When Not to Use and Potential Complications
· Case Study
26. Injections for Headache (Occipital Nerve Blocks and Botulinum Toxin Injections)
· Occipital Nerve Block
· Botulinum Toxin Injection
· When to Use
· How the Procedures are Done
- Occipital Nerve Block
- Botulinum Toxin Injections for Headache
· When Not to Use and Potential Complications
· Case Studies
27. Common Nerve Blocks
· When to Use
· How the Procedure Is Done
- Trigeminal Nerve Block (Trigeminal Neuralgia)
- Median Nerve Block (Carpal Tunnel Syndrome)
- Suprascapular Nerve Block (Frozen Shoulder)
- Intercostal Nerve Block
- Pelvic Nerve Block (Iliohypogastric, Ilioinguinal and Genitofemoral)
- Lateral Femoral Cutaneous Nerve Block (Meralgia Paresthetica)
- Tibial Nerve Block (Tarsal Tunnel Syndrome)
· When Not to Use and Potential Complications
· Case Studies
28. Discogenic Pain: Lumbar Discography
· Introduction
· When to Use
· How the Procedure is Done
· When Not to Use and Potential Complications
· Case Study
29. Implantable Pain Devices: Spinal Cord Stimulators
· When to Use
· How the Procedure is Done
- Trial-Lower Body Pain
- Trial-Upper Body Pain
- Full Implant
· When Not to Use and Potential Complications
· Case Study
30. Implantable Pain Device: Programmable Intrathecal Pain Pumps
· When to Use
· How the Procedures Are Done
- The Trial
- Full Implementation
- Pump Refills
· When Not to Use and Potential Complications
· Case Study
31. Percutaneous Lumbar Disc Decompression
· When to Use
· How the Procedure is Done
· When Not to Use and Potential Complications
· Case Study

Part IV: Multimodal Approach to Pain
32. Physical Therapy
· When to Use
· How to Use
- Balance
- Building Endurance
- Stretching/Range of Motion
- Strengthening
- Other Modalities: Heat, Ultrasound, Transcutaneous Electrical Nerve Stimulation (TENS)
· When Not to Use
· Case Studies
33. Complementary Treatments
· Acupuncture
· Cognitive Behavioral Therapy (CBT)
· Biofeedback
· Therapeutic Massage
· Hypnosis
· Case Study
34. Chiropractic Treatment
· When to Use
· How to Use
· When Not to Use
· Case Study
35. Avoiding Opioid Abuse
· Curtailing Abuse and Diversion
- Determine if the patient needs an opioid
- Realistic expectations, prescribing opioids, and the narcotic agreement
- Monitoring patients on opioids: structured follow-up appointments, assessing function, urine drug screens, and prescription monitoring programs
· Handling Abuse and Diversion Once Discovered
- Addressing violations of the narcotic agreement
- Discharging patients from the practice