Book contents
- Frontmatter
- Contents
- Foreword
- Foreword
- Preface
- Acknowledgments
- Contributors
- 1 Mechanisms and Demographics in Trauma
- 2 Trauma Airway Management
- 3 Shock Management
- 4 Establishing Vascular Access in the Trauma Patient
- 5 Monitoring the Trauma Patient
- 6 Fluid and Blood Therapy in Trauma
- 7 Massive Transfusion Protocols in Trauma Care
- 8 Blood Loss: Does It Change My Intravenous Anesthetic?
- 9 Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
- 10 Anesthesia Considerations for Abdominal Trauma
- 11 Head Trauma – Anesthesia Considerations and Management
- 12 Intensive Care Unit Management of Pediatric Brain Injury
- 13 Surgical Considerations for Spinal Cord Trauma
- 14 Anesthesia for Spinal Cord Trauma
- 15 Musculoskeletal Trauma
- 16 Anesthetic Considerations for Orthopedic Trauma
- 17 Cardiac and Great Vessel Trauma
- 18 Anesthesia Considerations for Cardiothoracic Trauma
- 19 Intraoperative One-Lung Ventilation for Trauma Anesthesia
- 20 Burn Injuries (Critical Care in Severe Burn Injury)
- 21 Anesthesia for Burns
- 22 Field Anesthesia and Military Injury
- 23 Eye Trauma and Anesthesia
- 24 Pediatric Trauma and Anesthesia
- 25 Trauma in the Elderly
- 26 Trauma in Pregnancy
- 27 Oral and Maxillofacial Trauma
- 28 Damage Control in Severe Trauma
- 29 Hypothermia in Trauma
- 30 ITACCS Management of Mechanical Ventilation in Critically Injured Patients
- 31 Trauma and Regional Anesthesia
- 32 Ultrasound Procedures in Trauma
- 33 Use of Echocardiography and Ultrasound in Trauma
- 34 Pharmacologic Management of Acute Pain in Trauma
- 35 Posttrauma Chronic Pain
- 36 Trauma Systems, Triage, and Transfer
- 37 Teams, Team Training, and the Role of Simulation in Trauma Training and Management
- Index
- Plate section
- References
35 - Posttrauma Chronic Pain
Published online by Cambridge University Press: 18 January 2010
Edited by
Book contents
- Frontmatter
- Contents
- Foreword
- Foreword
- Preface
- Acknowledgments
- Contributors
- 1 Mechanisms and Demographics in Trauma
- 2 Trauma Airway Management
- 3 Shock Management
- 4 Establishing Vascular Access in the Trauma Patient
- 5 Monitoring the Trauma Patient
- 6 Fluid and Blood Therapy in Trauma
- 7 Massive Transfusion Protocols in Trauma Care
- 8 Blood Loss: Does It Change My Intravenous Anesthetic?
- 9 Pharmacology of Neuromuscular Blocking Agents and Their Reversal in Trauma Patients
- 10 Anesthesia Considerations for Abdominal Trauma
- 11 Head Trauma – Anesthesia Considerations and Management
- 12 Intensive Care Unit Management of Pediatric Brain Injury
- 13 Surgical Considerations for Spinal Cord Trauma
- 14 Anesthesia for Spinal Cord Trauma
- 15 Musculoskeletal Trauma
- 16 Anesthetic Considerations for Orthopedic Trauma
- 17 Cardiac and Great Vessel Trauma
- 18 Anesthesia Considerations for Cardiothoracic Trauma
- 19 Intraoperative One-Lung Ventilation for Trauma Anesthesia
- 20 Burn Injuries (Critical Care in Severe Burn Injury)
- 21 Anesthesia for Burns
- 22 Field Anesthesia and Military Injury
- 23 Eye Trauma and Anesthesia
- 24 Pediatric Trauma and Anesthesia
- 25 Trauma in the Elderly
- 26 Trauma in Pregnancy
- 27 Oral and Maxillofacial Trauma
- 28 Damage Control in Severe Trauma
- 29 Hypothermia in Trauma
- 30 ITACCS Management of Mechanical Ventilation in Critically Injured Patients
- 31 Trauma and Regional Anesthesia
- 32 Ultrasound Procedures in Trauma
- 33 Use of Echocardiography and Ultrasound in Trauma
- 34 Pharmacologic Management of Acute Pain in Trauma
- 35 Posttrauma Chronic Pain
- 36 Trauma Systems, Triage, and Transfer
- 37 Teams, Team Training, and the Role of Simulation in Trauma Training and Management
- Index
- Plate section
- References
Summary
Objectives
Discuss the pathophysiology and treatment of complex regional pain syndrome (CPRS).
Evaluate and manage posttraumatic headache, whiplash, and phantom limb pain.
Review the incidence, classification, and management of post-spinal cord injury pain.
We must all die. But that I can save him from days of torture that is what I feel as my great and ever new privilege. Pain is a more terrible Lord of mankind than even death itself.
Albert SchweitzerINTRODUCTION
Though advances in trauma care have led to improved survival for victims of major trauma, these patients are frequently living with increased disability and chronic pain. A prospective cohort study of 201 trauma surgical patients found that only one third did not develop chronic pain at seven months, while one third developed significantly debilitating chronic pain at the same interval [1]. Likewise, studies of chronic pain populations have shown that a significant percentage of these patients have a history of trauma or surgery. Clearly, chronic pain is a common and potentially devastating consequence of trauma. In this chapter we will review chronic pain syndromes in the trauma patient after considering the historical and current clinical approach to the chronic pain patient.
A BRIEF HISTORY OF PAIN
Pain has been viewed throughout history as a punishment for sins and has been associated with mystical beliefs for thousands of years.
- Type
- Chapter
- Information
- Trauma Anesthesia , pp. 544 - 568Publisher: Cambridge University PressPrint publication year: 2008
References
Madigan SR, Raj pp. History and current status of pain management. In , ed. Practical Management of Pain, 2nd edition. St. Louis, MO: Mosby Year Book, 2000, pp 3–15.Google Scholar
. A capsule history of pain management. JAMA 2003;290:2470–5.
, . Classification of Chronic Pain, 2nd edition. Seattle: IASP Press, 1994, pp 209–14.Google Scholar
. Contemporary assessment and management of neuropathic pain. Neurology 2005;64(Suppl 3):S21–7.CrossRefGoogle ScholarPubMed
. Injuries of the Nerves and Their Consequences. Philadelphia: JB Lippincott & Co., 1872.Google Scholar
, . Complex regional pain syndrome: mystery explained?Lancet Neurol 2003;2:687–97.CrossRefGoogle ScholarPubMed
Hartick C. Pain due to trauma including sports injuries. In , ed. Practical Management of Pain, 2nd edition. St Louis: Mosby-Year Book, Inc., 1992, pp 409–33.Google Scholar
Binder A, Schattschneider J, Baron R. Complex regional pain syndrome Type I (reflex sympathetic dystrophy). In , ed. Pain Management. Philadelphia: Saunders Elsevier, 2007, pp 283–301.Google Scholar
. Neuropathic pain: implications for the surgeon. Surg Clin N Am 2005;85:225–36.CrossRefGoogle Scholar
. Complex regional pain syndrome (reflex sympathetic dystrophy). Clin Sports Med 2004;23:145–55.CrossRefGoogle Scholar
, . Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet Neurol 2003;2:687–97.Google Scholar
, . Dysynchiria. Watching the mirror image of the unaffected limb elicits pain on the affected side. Neurology 2005;65:751–3.CrossRefGoogle ScholarPubMed
Managing nonmalignant chronic abdominal pain and malignant bowel obstruction. Gastroenterol Clin N Am 2006:35:131–42.CrossRefGoogle ScholarPubMed
. Percutaneous-guided pain control: exploiting the neural basis of pain sensation. Gastroenterol Clin N Am 2006;35:131–42.CrossRefGoogle ScholarPubMed
. Epidemiology and pathogenisis of posttraumatic headache. J Head Trauma Rehabil 1999;14(1):9–21.CrossRefGoogle Scholar
. Pain pathoetiology after TBI neural and nonneural mechanisms. J Head Trauma Rehabil 2004;19(1):72–81.CrossRefGoogle ScholarPubMed
, , . Medical management of posttraumatic headaches: pharmacological and physical treatment. J Head Trauma Rehabil 1999;14(1):34–48.CrossRefGoogle ScholarPubMed
. Aggressive interventional treatment of intractable headaches in the clinic setting. Clin Fam Pract 2005;7(3):545–65.Google Scholar
, , , . Postamputation pain and sensory changes in treatment naïve patients characteristics and responses to treatment with tramadol, amitriptyline, and placebo. Anesthesiology 2005;103:619–28.CrossRefGoogle ScholarPubMed
, , . Vertebral fractures associated with osteoporosis patient management. Am J Med 1997;103(Suppl):44S–50S.CrossRefGoogle ScholarPubMed
, , . Treatment of painful osteoporotic vertebral fracture with percutaneous vertebroplasty or kyphoplasty. Osteoporos Int 2001;12:429–37.CrossRefGoogle Scholar
, , . Kyphoplasty: vertebral augmentation for compression fractures. Clin Geriatr Med 2006;22:535–44.Google Scholar
, , . Current concepts and techniques in percutaneous vertebroplasty. Orthop Clin N Am 2006;37:409–34.Google Scholar
, , . Causes of pain in degenerative bone and joint disease: a lesson from vertebroplasty. Pain 2003;105(3):387–92CrossRefGoogle ScholarPubMed
. Evaluation and treatment of central pain syndromes. Neurology 2004;62(Suppl 2):S30–6.CrossRefGoogle ScholarPubMed
, , . Pain following spinal cord injury: clinical features, prevalence, and taxonomy. Int Assoc Study Pain Newslett 2000;3:3–7.Google Scholar
. Pathophysiological mechanisms of central neuropathic pain after spinal cord injury. Spinal Cord 1998;36:601–12.CrossRefGoogle ScholarPubMed
, . A proposed algorithm for the management of pain following spinal cord injury. Spinal Cord 2006;44:67–77.CrossRefGoogle ScholarPubMed
Basbaum AI. Spinal dorsal horn plasticity following tissue or nerve injury. In , , , ed. Textbook of Pain. Edinburgh: Churchill Liningston, 1994, pp 225–41.Google Scholar
, , , . Spinal cord stimulation in the treatment of paraplegic pain. J Neurosurg 1995;82:35–9.CrossRefGoogle ScholarPubMed
, , , , . Intrathecal clonidine and baclofen in the management of spasticity and neuropathic pain following spinal cord injury: a case study. Arch Phys Med Rehabil 1996;77:824–6.CrossRefGoogle ScholarPubMed
, , , . Combined intrathecal baclofen and morphine infusion for the treatment of spasticity related pain and central deafferentation pain. Funct Rehabil Neurosurg Neurotraumatol 2002;79:75–6.CrossRefGoogle Scholar
, , , . Intrathecal morphine and clonidine in the management of spinal cord injury pain: a case report. Pain 1994;59:147–8.CrossRefGoogle Scholar
, , , , , . Efficacy of intrathecal morphine and clonidine in the treatment of neuropathic pain following spinal cord injury. Anesth Analg 2000;91:1493–8.CrossRefGoogle Scholar
. Subcortical electrical stimulation for control of intractable pain in humans: Report of 122 cases. J Neurosurg 1986;64:543–53.CrossRefGoogle ScholarPubMed
, , . Deep brain stimulation for intractable pain: a 15 year experience. Neurosurgery 1997;40: 736–46.CrossRefGoogle ScholarPubMed
, , , et al. Chronic motor cortex stimulation in the treatment of central and neuropathic pain. Correlations between clinical, electrophysiological and anatomical data. Pain 1999;82:245–51.CrossRefGoogle ScholarPubMed
, , , . Computer assisted DREZ microcoagulation: posttraumatic spinal deafferentation pain. J Spinal Disord 1993;6:48–56.CrossRefGoogle ScholarPubMed
, . Dorsal root entry zone lesions to control central pain in paraplegics. J Neurosurg 1981;55:414–9.CrossRefGoogle ScholarPubMed
, , . Microsurgical DREZotomy for pain due to spinal cord and/or cauda equina injuries: long-term results in a series of 44 patients. Pain 2001;92:159–71.CrossRefGoogle ScholarPubMed