Fundamentals of Pain Medicine > Anesthesiology

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 Golfer’s 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)

· Morton’s 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 (golfer’s 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