Pain Medicine

Pain Medicine: A Multidisciplinary Approach

Siu Lun TSUI
Phoon Ping CHEN
Kwok Fu Jacobus NG
Copyright Date: 2010
Pages: 648
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  • Book Info
    Pain Medicine
    Book Description:

    This is designed as a textbook for medical practitioners preparing for higher qualification examinations in pain medicine, as well as a reference book for other medical and allied healthcare workers. A unique feature of the book is its multidisciplinary approach to manage pain. This is reflected by the contributors' multi-national/cultural origin and the diversity in their medical background (anaesthesiology, neurosurgery, orthopaedic surgery, internal medicine, clinical oncology, clinical psychology, nursing, physiotherapy, and occupational therapy). Essential topics in pain medicine are grouped under five sections: scientific basis of pain medicine, common clinical pain conditions, pain pharmacology, interventional procedures, and multidisciplinary approach. Different aspects and approaches in modern pain medicine are covered, including advances in research on pain mechanism, pain psychology, epidemiology, diagnosis, pain assessment, patient evaluation, pain medications, up-to-date interventional procedures, cognitive behavioral therapy, and other specialized therapeutic modalities. Besides the above topics, which assist the patient in fighting acute, chronnic, and cancer pain, there are two chapters dedicated to paediatric and geriatric patients respectively, as special consideration is need for these age groups.

    eISBN: 978-988-220-623-6
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-viii)
  3. Foreword
    (pp. ix-x)

    The world in the 21st century is shaped by technological advances and human demands which inspire new aspirations. People wish not only to live longer but also better, such that the demand for and improvement in their quality of life is more than before a life priority.

    Pain is at the centre of suffering. For the patient, it becomes an unmitigated evil. For the health care giver, pain relief has been their task since the beginning of time. Yet, the goal of satisfactory pain control at times remains elusive.

    Pain can be acute or chronic. But unlike most symptoms, the...

  4. Preface
    (pp. xi-xii)
    Siu Lun TSUI
  5. Editors, Contributors & Co-contributors
    (pp. xiii-xx)
  6. Section A Scientific Basis of Pain Medicine
    • 1 Neurobiology and Mechanisms of Pain
      (pp. 1-8)
      Michael G. IRWIN and Gordon T.C. WONG

      A thorough understanding of the mechanisms and neurobiology of pain is important for both effective utilisation of current drug regimes and for the future development of new therapeutic targets. Pain is a net result of peripheral and central neuronal sensitisation and a balance between excitatory and inhibitory function at different levels within the nervous system. Peripheral tissue damage and trauma release neurotransmitters and result in increased local concentrations of arachidonic acid metabolites, including prostaglandins and leukotrienes. In addition to directly activating peripheral sensory nerve fibres, these agents can trigger degranulation of nearby mast cells and sensitise the peripheral nerve terminal...

    • 2 Psychological Concepts of Pain
      (pp. 9-18)
      Michael K. NICHOLAS

      The conceptualisation of pain has clear significance for its explanation, assessment and treatment. Throughout recorded history ideas about the nature of pain have fluctuated and even today multiple views are held. This chapter attempts to critically review the different concepts of pain that exist today and their implications for assessment and treatment. This understanding should provide the reader with a perspective from which to make sense of the different assessment and treatment modalities, whether they are physical, psychological and/or social.

      While most people would agree with Kleinman’s [38] observation that pain is a ubiquitous human experience, agreement on definitions of...

    • 3 Principles of Pain Assessment and Evaluation Tools
      (pp. 19-30)
      Joanne W.Y. CHUNG

      This chapter presents a review of the general guidelines for pain assessment and pain assessment tools. A valid and reliable pain assessment tool is required to measure pain and show treatment effects. Therefore, both the advantages and the disadvantages of the various pain assessment tools are deliberated. Validity and reliability of the tools are addressed. Only commonly used tools are discussed and they include the visual analogue scale, numerical rating scale, verbal rating scale, McGill Pain Questionnaire and the Brief Pain Inventory. In addition, the use of the term “tool” or “scale” throughout the chapter in describing the instrument depends...

    • 4 The Clinical Evaluation of Pain
      (pp. 31-48)
      Paul J. WRIGLEY and Philip J. SIDDALL

      The management of persistent pain and its associated distress remains an enormous problem in global terms. In developed countries, the cost of disability programmes for people with pain are staggeringly high, whether viewed from a medical, occupational or psychosocial perspective [20, 49]. This chapter discusses the principles underlying the assessment of pain, provides a practical approach for assessing people presenting with pain and briefly outlines a number of novel pain investigative approaches.

      Although this is a basic question and one that has been addressed previously in this book, how we define pain fundamentally influences our approach to the evaluation of...

    • 5 Epidemiology in Chronic Pain, Gender and Cultural Aspects
      (pp. 49-62)
      Mary CARDOSA and Phoon Ping CHEN

      Epidemiological principles are applied by health care workers as the basis for disease surveillance and investigation. Historically, epidemiology was concerned mainly with investigating epidemics of communicable diseases. Now the application of epidemiological methods has extended to chronic diseases, occupational health and other areas of health care. They are extremely relevant in pain medicine today as it becomes increasingly clear that chronic pain is a major health care concern and public health burden.

      Epidemiology is defined as the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control...

    • 6 Biostatistics in Pain Medicine
      (pp. 63-80)
      Jacqueline YAP and Tony GIN

      The objective of this chapter is to increase the understanding of evidence-based medicine and clinical trials as applied to pain medicine. Practical concerns specific to pain medicine will be addressed and some guidance will be provided for the interpretation of results. Full details of statistical analysis are not within the scope of the chapter since there are numerous resources such as textbooks in biostatistics that are readily available.

      The experience of pain is a biopsychosocial phenomenon. Thus, a traditional biological approach is often not sufficient for research studies in the field of pain medicine. This fact affects the methodology, assessment...

    • 7 Ethics in Pain Medicine
      (pp. 81-92)
      Ramani VIJAYAN

      Ethics is a generic term for various ways of understanding and examining the moral life. Morality refers to norms about right and wrong human conduct that are so widely shared that they form a stable social consensus and are usually referred to as common morality. Professional moralities with standards of conduct that are generally acknowledged by members of a profession are often referred to as codes of behaviour or professional ethics [1]. Medical ethics refers to the health care professional’s code of conduct in the practice of medicine.

      Medical ethics has its origin in the “Hippocratic Oath”, which focused primarily...

  7. Section B Common Clinical Pain Conditions
    • 8 Acute Pain Management
      (pp. 93-130)
      Phoon Ping CHEN, Christopher Ping Wing CHU and Edmond Kin Nam CHUNG

      Acute pain can be defined as pain of recent onset and usually with an identifiable temporal and casual relationship to injury or disease [234]. Although acute pain has been referred to as “protective”, in alerting us to the presence of a noxious insult, unrelieved acute pain has been associated with adverse physiological outcome [154].

      The goal of acute pain management is to provide subjective comfort and minimise physiological side effects of unrelieved pain. By blocking nociceptive impulses via different neurological pathways and mechanisms, the autonomic and somatic reflex responses to pain can be blunted. As a result, the patient has...

    • 9 Cancer Pain
      (pp. 131-156)
      Siu Lun TSUI and Chi Wai CHEUNG

      Cancer is one of the most important causes of death all over the world. The Global Cancer Statistics published in 2002 reported that there were 10.9 million new cases of cancer, 6.7 million cancer deaths and 24.6 million persons alive with cancer [92]. There has been a rising trend over the last decade [93] and cancer deaths have been estimated to be 9 and 11.4 million by the year 2015 and 2030 respectively [153]. In 2002, lung cancer was rated the most common (1.35 million), followed by breast cancer (1.15 million) and colorectal cancer (1 million). As far as the...

    • 10 Headache
      (pp. 157-180)
      Chi Tim HUNG and Steven H.S. WONG

      Headache is a common presenting complaint in medical and dental practice. The true incidence of headache is unknown as many afflicted with minor disorders often resort to selftreatment. In a population study of 25 to 64 year-olds in Denmark [78], the lifetime prevalence of headache was 99% in women and 93% in men. In another survey of elderly rural residents in Italy, the 1-year prevalence for migraine and tension headache was 4.6% and 16% respectively [13]. The prevalence of migraine in Canada was 3.8% in men and 11.7% in women [59]. Locally in Hong Kong, the estimated prevalence rates for...

    • 11 Orofacial Pain
      (pp. 181-198)
      Chi Tim HUNG and Theresa Tak Lai LI

      Pain over the orofacial region can arise from disorders of the nervous system, face, oral cavity, teeth and temporomandibular joint (Table 11.01). Neuralgias such as cranial neuralgia and postherpetic neuralgia have to be differentiated from other organic causes such as tumour or infection. Headaches may be referred to the facial region. The general approach to headache has been described in Chapter 10.

      Nicholas Nadre, a Parisian surgeon, first described the pain involving the trigeminal nerve as trigeminal neuralgia in 1756 and coined the name of tic douloureux. The International Association for the Study of Pain (IASP) defines trigeminal neuralgia as...

    • 12 Neck Pain
      (pp. 199-206)
      Ping Hong CHIN

      Neck pain is defined as pain perceived dorsally in the cervical region of the spinal column, between the superior nuchal line and an imaginary transverse line through the spinous process of T1 [35]. However, referred pain towards the shoulders, trapezius and interscapular regions is not uncommon. This is described in patterns relative to the cervical root distributions over relevant cervical facet joints as described by Dwyer [16].

      However, it should be noticed that this referral pain is not the same as radicular pain caused by nerve root compression. Radicular pain is sharp and, in general, marks a narrow band of...

    • 13 Back Pain
      (pp. 207-220)
      Hau Yan KWOK and Kenneth M.C. CHEUNG

      Back pain is a common and important health issue. It is an individual report of a personal symptom, often with some degree of disability that can be quite variable. The causes can range from a minor injury in our usual life experience that is often responsive to self-treatment to part of a serious spinal disease that requires careful medical attention. There are multiple modulating factors which may affect the clinical presentation of different patients, even with the same pathology [110].

      The concept of back pain has changed in recent decades and it is now considered more as an illness syndrome...

    • 14 Muscular Pain Conditions
      (pp. 221-234)
      Milton L. COHEN

      This chapter will address pain perceived to be in “muscular” or “soft” tissues. The phrase “perceived to be in” has been used, as not only is there an intimate connection with such pain and that perceived to be in joints or in bones (see Chapter 16) but also such attributions are made by patients on the basis of common-sense knowledge rather than biological insight. Certainly “musculoskeletal” pain is ubiquitous in the community and is by far the main contributor to the point prevalence of persistent pain, defined as pain present daily for at least 3 months, of around 20% [9]....

    • 15 Neuropathic Pain
      (pp. 235-252)
      Kwok Fu Jacobus NG

      Both acute and chronic pain can occur after injury or damage to the nervous system. “Neuropathic pain” is a collective term used to describe these pain conditions. Neuropathic pain is a common and important entity in pain medicine with unique pathophysiological mechanisms, and frequently presents as challenging diagnostic and management problems clinically.

      According to the International Association for the Study of Pain (IASP), neuropathic pain is defined as “Pain initiated or caused by a primary lesion or dysfunction in the nervous system” (IASP Pain Terminology, 1994). [52]. This definition includes pain which is initiated or caused by a lesion or...

    • 16 Painful Arthritis and Rheumatic Conditions
      (pp. 253-274)
      Chak Sing LAU

      The increased life expectancy recorded in recent decades, together with changes in lifestyle and diet, has led to a rise in the incidence of non-communicable diseases globally. Of the various non-communicable diseases, rheumatic or musculoskeletal disorders are the major cause of morbidity throughout the world, having a substantial influence on health and quality of life, and inflicting an enormous burden of cost on health systems. In 1998, an estimated 355 million people suffered from arthritis [91]. This number is expected to rise dramatically over the next two decades so that by 2025 degenerative bone and joint disorders will be the...

    • 17 Pain Associated with Medical Diseases
      (pp. 275-298)
      Simon K.C. CHAN and Alice K.Y. MAN

      Pain is traditionally regarded as a sign of disease and the function of the pain sensory system is to detect, localise and identify tissue-damaging processes in order to protect and maintain the body’s homeostasis. Hence, pain is the most common symptom that leads a patient to seek medical advice [26]. In most situations, the appropriate treatment is to limit the disease process and the pain will be alleviated. However, in some situations in which definitive treatment is lacking, such as human immunodeficiency virus (HIV) disease, patients continue to suffer severe chronic pain despite the correct diagnosis having been made. Pain...

    • 18 Pain in the Older Person
      (pp. 299-310)
      C. Roger GOUCKE

      As the percentage of the population over the age of 65 years increases in both the developed and developing world, so will the number of people in this age group with pain. Unrecognised and poorly managed pain results in an unnecessary and serious decline in the quality of life. This chapter will review the epidemiology of pain in the older person, look at some of the physiological differences that age-related changes bring to pain processing and perception, and the types and causes of pain in the older person, together with its assessment and treatment options.

      Population growth varies from country...

    • 19 Pain in Children and Adolescents
      (pp. 311-338)
      George CHALKIADIS

      The last 30 years have seen an explosion in research and publications on pain in childhood and adolescence. Attention has focused on several aspects including the developing nociceptive system, acute, persistent, procedural and cancer pain management.

      Growth and development distinguish children from adults. Clinically, an appreciation of the physiological, anatomical and psychosocial developmental changes during childhood is important in the assessment and management of pain.

      The structural components necessary for pain perception start to form at about 17 weeks and become established from 26 weeks’ gestation [54]. Pituitary-adrenal, sympatho-adrenal and circulatory stress responses to physical insults have been demonstrated in...

  8. Section C Pain Pharmacology
    • 20 Principles of Pharmacological Treatment
      (pp. 339-346)
      Carina Ching Fan LI

      Pain is an experience unique to the individual concerned. It is a multidimensional phenomenon with physio-psycho-social (biopsychosocial) components [9]. Pharmacological treatment is one of several important modalities of an integrated multimodal pain therapy which aims not only at pain symptom relief but also the management of other comorbid conditions, such as insomnia and mood disturbances, and psychiatric disorders, such as anxiety and depression [15]. It is important to discuss with the patient a realistic expectation of pain relief using optimised analgesic regimens together with other therapies. The aim of treatment is to alleviate pain to an extent such that the...

    • 21 Opioid Analgesics
      (pp. 347-366)
      Ming Chi CHU

      Since ancient times, man has prescribed, banned, feared and craved opioids. Wars have been named after them, their praises were sung and laws enacted to control their distribution — before we even knew their chemistry. It was not until 1806 that the first opioid chemical was isolated from the poppy plant extract and named morphine (after Morpheus, the Roman god of dreams) [88]. Another breakthrough came in 1973 when the opioid receptor was found, followed by the identification of endogenous peptides which act on those receptors [137].

      Opioids exert their effects predominantly by acting on ligand specific receptors. They belong to...

    • 22 NSAIDs, COX-2 Inhibitors and Paracetamol
      (pp. 367-378)
      Libby Ha Yun LEE

      Although inflammation is one of nature’s protective defence mechanisms against injury and trauma, an enduring inflammatory response is detrimental as it perpetrates the development of a chronically painful and harmful condition. The wisdom of taking anti-inflammatory agents in order to abort this unfavourable process can be found in medical texts many centuries old. This concept is further strengthened by recent research the roles of anti-inflammatory agents in preventive analgesia.

      Salicylate is found in the bark of the willow tree and was used to treat rheumatism and fever 3,500 years ago. The first documentation of salicylate use was made in the...

    • 23 Antidepressants and Anticonvulsants
      (pp. 379-392)
      Philip Wenn Hsin PENG and Geoff Alexander BELLINGHAM

      Antidepressants are now widely used to treat various types of chronic pain syndromes independent of their mechanisms on patients’ depression. The three main groups of antidepressants that have been well investigated for their analgesic properties are tricyclic antidepressants (TCAs), selective serotonin re-uptake inhibitors (SSRIs) and serotonin norepinephrine re-uptake inhibitors (SNRIs). The role of TCAs and, recently, SNRIs in the management of chronic pain (especially in neuropathic pain) is well established [23, 36]. However, the analgesic role of SSRIs is not as convincing [50]. Both monoamine oxidase inhibitors and selective norepinephrine re-uptake inhibitors have insignificant analgesic effects.

      The analgesic properties of...

    • 24 Other Medications and Adjuvants in Pain Management
      (pp. 393-404)
      Anne Miu Han CHAN

      The pharmacological treatment of pain includes the use of not only opioid, non-steroidal anti-inflammatory drugs, tricyclic antidepressants and anticonvulsants. This chapter discusses the application of other groups of active compounds that are of benefit in the treatment of pain as well as the discomfort which can attend pain treatment.

      Methylphenidate is a piperidine derivative and a mild central nervous system (CNS) stimulant. It is used, particularly in cancer pain patients, to ameliorate opioid-induced somnolence, augment the analgesic effects of opioids, treat depression and improve cognitive function.

      The use of methylphenidate in non-cancer pain is limited because of development of tolerance...

  9. Section D Interventional Procedures in Pain Management
    • 25 Interventional Procedures in Pain Management: An Overview
      (pp. 405-418)
      Steven H. S. WONG

      Interventional procedures for pain management range from local injections to specific neural blockade of the sensory supply to specific body structures. These procedures have been performed by different medical specialists including the orthopaedic surgeons, neurosurgeons and anaesthetists. While they are usually effective in the short term, the efficacies of these interventional procedures in the treatment of chronic pain syndromes have been questioned by a number of recent evidence-based systematic reviews.

      In recent decades, with the introduction and acceptance of the bio-psycho-social model of chronic pain, multidisciplinary pain management clinics have become very popular. These clinics have input from practitioners from...

    • 26 Peripheral Nerve Blocks
      (pp. 419-438)
      Theresa Tak Lai LI

      Peripheral nerve blocks are cost-effective anaesthetic techniques used to provide anaesthesia and analgesia. When applied to multidisciplinary pain management, peripheral nerve blocks serve a dual function of both diagnostic and therapeutic tools.

      There are two approaches to the production of differential neural blockade, an anatomical approach and a pharmacological approach. The anatomical approach is based on sufficient anatomical separation of somatic and/or sympathethic fibres. The pharmacological approach is based on the presumed difference in the sensitivity of the various types of nerve fibres to local anaesthetic agents. While differential neural blockade is not intended to replace a detailed history, a...

    • 27 The Sympathetic Chain: Efficacy of Sympathetic Blockade and Sympathectomy
      (pp. 439-458)
      Philip FINCH

      From its first description by Gaskell and Langley in 1889, few structures in the body have received as much enthusiastic but inappropriate attention as the sympathetic chain. Only in recent times, with improved trial data, has a clearer view appeared. This is especially so in the field of pain medicine, where sympathetic blockade is often placed among the first lines of treatment [51] despite little evidence to support this practice. The theory of “sympathetic efferent hyperactivity” has never been substantiated and blockade of the chain is perhaps based on a false premise [15, 107]. In many instances, the placebo arm...

    • 28 Interventional Procedures for Back and Neck Pain
      (pp. 459-472)
      Kai On SUN and Henry Ka Fai TONG

      Both neck and back pain are very common complaints in many communities. More than half of the population in the United States suffers from low back pain at some time; the annual incidence is at least 5%. Back pain incapacitates up to 20% of workers for long period (>4 weeks), absorbs 41% of the cost of workers’ compensation and costs society more than $15 million each year [1,7,24]. A similar situation exists elsewhere, including Hong Kong [26]. However, the cause can be very diverse, ranging from simple neck and back sprain to some less well-known causes such as facet joint...

    • 29 Neuraxial Analgesia
      (pp. 473-500)
      Kok Eng KHOR

      The discovery of opioid receptors and potent opioid peptides in the nervous system in the early 1970s provided the rationale for the neuraxial delivery of opioid drugs for analgesia [49, 69]. This was demonstrated in experimental animals and patients with chronic pain via intrathecal and epidural routes [11, 99, 103]. The phrase “selective spinal analgesia” was used to describe this specific analgesic state produced by a small dose of morphine without significant sensorimotor or haemodynamic side effects [21]. This heralded a new phase in the management of pain which has expanded to the area of acute postoperative, obstetrical, cancer and...

    • 30 Spinal Cord Stimulation
      (pp. 501-510)
      Tsun Woon LEE

      The gate-control theory proposed by Melzack and Wall in 1965 [29] revolutionised the concept of pain perception and opened the possibility of closing the “gate” for pain transmission by stimulation of large afferent fibres. Following this, Shealy devised the “dorsal column stimulator”, which was an implantable stimulator placed over the spinal cord [43]. It was proposed that stimulation of large fibres contained in the dorsal column above the spinal segment of the painful area would close the “gate”. These attempts offered the possibility of a reversible, non-destructive technique for pain management. Subsequently, it became apparent that although it was uncertain...

    • 31 Neurosurgery in Pain Management
      (pp. 511-522)
      Kwan Ngai HUNG

      Neurosurgical procedures are regarded as being on the uppermost steps of the World Health Organization (WHO) ladder in pain management, both in both cancerous and benign conditions. In some situations, where the underlying causes of pain can be determined, surgical intervention is beneficial. Surgical correction with stabilisation by instrumentation in spinal instability with low back pain and microvascular decompression in trigeminal neuralgia give excellent results. In pain conditions where the underlying cause cannot be corrected, such as neuropathic pain resulting from spinal cord injury, surgical intervention in the form of either destruction or augmentation of the pain pathway is required...

  10. Section E Multidisciplinary Pain Management
    • 32 Radiotherapy in the Management of Pain in Cancer Patients
      (pp. 523-536)
      Rico K.Y. LIU, Arthur YUE and Gordon K.H. AU

      Radiotherapy forms an essential component in the modern multidisciplinary management of cancer patients. Apart from its curative potential alongside surgery and chemotherapy, radiotherapy is a powerful modality in treating patients with pain and other symptoms caused by the primary tumours or their metastases. The multidisciplinary concept is also the cornerstone of success of modern palliative care [8], which is characterised by achieving the best quality of life for patients and their families [72]. Despite great advances in clinical and basic sciences related to cancer treatment in the last two to three decades, it has been estimated that about 70% of...

    • 33 Palliative Care for Patients with Advanced Cancer
      (pp. 537-546)
      Rico K.Y. LIU and Raymond S.K. LO

      Cancer is a common disease and is one of the most important causes of death worldwide. The Global Cancer Statistics published in 2002, reported that there were 10.9 million new cases of cancer, 6.7 million cancer deaths and 24.6 million persons alive with cancer [14]. In Hong Kong, cancer ranks first as the most common cause of death. In the year 2004, there were a total of 22,523 new diagnoses and 11,791 cancer deaths, which accounted for nearly one-third of all deaths in the territory [8]. On the whole, when patients are diagnosed as having advanced cancer, the disease is...

    • 34 Acupuncture and Traditional Chinese Medicine
      (pp. 547-560)
      Anne KWAN

      There are numerous established medical treatments for chronic pain. Most of the conventional treatments have been well studied and the effectiveness of these treatments is supported by positive evidence. Complementary and alternative medicine on the other hand is still lacking in convincing evidence to prove that it is effective. Despite that, for various reasons, it enjoys high popularity and is employed at increasing frequency. Due to the diverse spectrum and mystical nature of complementary and alternative medicine, sound scientific studies are difficult to conduct. Although acupuncture is one of the better studied of its modalities, strong evidence supporting its use...

    • 35 Physiotherapy
      (pp. 561-572)
      Anthony W.K. LAU and Leo C.T. CHEUNG

      Many patients attending physiotherapy do so because of painful conditions such as backache. A variety of pain modulation methods are available to the physiotherapist as tools in the management of pain. Clinically, they are used to provide short-term pain relief to facilitate subsequent use of active treatment. The application of local heat and cryotherapy to areas of pain which result from musculoskeletal injury are two long-established but effective techniques. Other forms of electrotherapy widely applied in physiotherapy include transcutaneous electrical nerve stimulation (TENS), interferential therapy (IFT) and ultrasound. Physiotherapists also use mechanical means in treating painful conditions. Manual therapy is...

    • 36 Occupational Therapy for Chronic Pain: Enhancement of the Role of Productivity and Return to Work
      (pp. 573-580)
      Chetwyn C. H. CHAN and Connie Y. Y. SUNG

      Occupational therapy is a health care discipline which specialises in using daily activities as the media of treatment and engagement as the process to facilitate individuals with disabilities to participate in their life roles [5, 9, 40]. Alongside daily activities such as self-care and work, occupational therapists use technology, assistive devices and the environment in which the individual lives in order to achieve their therapeutic goals. Participation is an important concept in occupational therapy practice, as it maximises both the individual’s physical and mental potential to re-engage in his or her previous life roles and to develop new life roles...

    • 37 Psychological Management in Chronic Pain
      (pp. 581-598)
      Peter W.H. LEE and Amy S.M. FUNG

      Chronic pain has a profound impact on the sufferer’s life. Robinson et al. noted, that “many chronic pain patients develop co-morbid depression; they utilise medical care excessively and feel wronged by the care they receive; many leave their jobs; obtain disability and settle into a lifestyle that, at best, bears faint resemblance to that they once imagined were possible” [44].

      The “complex set of physical and psychosocial burden” of chronic pain patients including: immobility and consequent wasting of muscle and joints; depression of the immune system and increased susceptibility to disease; disturbed sleep; poor appetite and nutrition; dependence on medication;...

    • 38 Functional Rehabilitation and Cognitive Behavioural Interventions
      (pp. 599-620)
      Tak Yi CHUI and Michael K. NICHOLAS

      Pain is a common phenomenon in many medical conditions, and its management is an essential part of the comprehensive and holistic care of the individual patient. Good pain management is advocated by many organisations, including The Joint Commission for hospital accreditation (in the US), which recommended pain be considered as the fifth vital sign [61]. Acute pain (e.g. associated with a fracture, inflammatory arthritis, myocardial infarction, herpes zoster) will usually subside when the original pathology is removed or controlled by treatment. Such pain is relatively short lasting and usually will not be a major or persistent barrier to rehabilitation. However,...

  11. Index
    (pp. 621-636)