The implications of unrecognized pain in those with MNCD are far-reaching.  Untreated pain can lead to the destabilization of psychiatric conditions such as anxiety, depression, and agitation.  Those with cognitive impairments are more likely to have longer waits for the evaluation of pain and receive weaker analgesia.As needed pain medications given to those with MNCD in the LTC setting may depend too heavily on the judgment of those inadequately trained to assess pain.  Regularly scheduled pain medications may be a more appropriate option. Always keep the possibility of medication error in the differential diagnosis for apparent changes in mental status. Inadequate pain control negatively impacts mental health in older adults.  Those with MNCD with inadequately controlled pain may present with atypical symptoms when compared to those without MNCD. Consider both pharmacologic and nonpharmacologic interventions when formulating a treatment plan for chronic pain in older adults. Opiates may have the best benefit/risk ratio for the treatment of chronic pain in some older adults.

This chapter describes some commonly used nonhuman paradigms for assessing animal behavior and the figures that are used to present those data. The chapter opens with an overview of some animal species used in neuroscience research, a discussion about nonhuman housing, and a description of types of validity that behavioral neuroscientists concern themselves with. The behavioral tests described here are divided into five major categories: motor behaviors; pain; learning and memory; mental disorders such as anxiety, depression, and substance use disorder; and social behaviors. Included is a description of a survival analysis and an explanation of interpreting Kaplan–Meier curves.

Experience is the cornerstone of Epicurean philosophy and nowhere is this more apparent than in the Epicurean views about the nature, formation, and application of concepts. ‘The Epicureans on Preconceptions and Other Concepts’ by Gábor Betegh and Voula Tsouna aims to piece together the approach to concepts suggested by Epicurus and his early associates, trace its historical development over a period of approximately five centuries, compare it with competing views, and highlight the philosophical value of the Epicurean account on that subject. It is not clear whether, properly speaking, the Epicureans can be claimed to have a theory about concepts. However, an in-depth discussion of the relevant questions will show that the Epicureans advance a coherent if elliptical explanation of the nature and formation of concepts and of their epistemological and ethical role. Also, the chapter establishes that, although the core of the Epicurean account remains fundamentally unaffected, there are shifts of emphasis and new developments marking the passage from one generation of Epicureans to another and from one era to the next.

Managing oral pain is a daily task for dental practitioners. Understanding the type of pain, accurately diagnosing the cause and being able to choose the most appropriate drug regimen (if required) is a fundamental skill for all dentists. This chapter describes the medicines commonly used for pain management in dentistry, their mechanism of action, appropriate doses, adverse effects, common drug interactions and their place in therapy.

This chapter covers an account of fieldwork among Filipino Roman Catholic ritual practitioners alongside those of phenomenologically inclined anthropologists and performance studies scholars, particularly those who have deployed a ‘radically empirical’ approach. The author examines how these scholars have channelled the vicissitudes and anxieties of fieldwork towards productive ethnographic insights. The radical empiricist project is particularly feasible in contexts in which ethnographers encounter less ‘rational’ but intrinsically human experiences such as pain, suffering, healing, and illness in the reenactment of Christ’s Passion. This chapter offers a reflection on the methodological feasibility of embodied and ‘distendedly reflexive’ approaches towards a more expansive understanding of religious pain and suffering.

Focusing on contemporary life writing of chronic pain, specifically lyric essays, this chapter explores the language of pain, refuting its untranslatability, and suggesting that creative forms and experimental expression are helping to develop language to meet experience. Recent illness narratives are building a common language with which to articulate their physical sensations, with Eula Biss’s ‘The Pain Scale’ (2005) encouraging a community of pain expression, and becoming a generative intertext. While pain sufferers reclaim their experiences, they are also reclaiming and renewing diagnostic vocabulary, for example through ‘subterfuge‘, which requires readers to better engage in attentive listening, with an ethical obligation not to overlook or mishear marginalized voices. Alongside Biss, this chapter explores the work of Amy Berkowitz, Molly McCully Brown, Anne Boyer, Sinéad Gleeson, Sonya Huber, and Lisa Olstein.

Occipital neuralgia (ON) is a rare headache disorder mainly affecting the posteriorupper neck and posterior head region. By definition, ON is characterized by paroxysmal shooting or stabbing, sudden-onset pain that has frequent recurrence, lasting for a few minutes at a time. This pain syndrome is related to the nerve distribution that involves spinal nerves emerging from the upper cervical region that traverse to the base of the neck and run up the posterior scalp. It involves compression, injury, or trauma to greater occipital nerve (GON), lesser occipital nerve (LON), and then rarely due to third occipital nerve (TON). Conceptually, nerve entrapment between anatomical structures have been hypothesized to be a large contributing factor to the pathophysiology of ON. Most cases of ON are idiopathic with no clear etiology that is structurally identifiable. It is hypothesized that the pain from ON is due to compression, injury, or irritation (e.g. chronic instability, entrapment, trauma, inflammation) of the greater occipital nerve, lesser occipital nerve, and/or the third occipital nerve. Treatment can be conservative or interventional modalities.

Oral medication has been the mainstay of therapy; however, the use of topical formulation for chronic pain can reduce serious systemic side effects caused by oral medications. Topical administration of medication via patches, gels, creams, ointments, and solutions can provide local anesthesia and bypass major organ system. Lidocaine is an amide-type local anesthetic agent stabilizing the neuronal membranes by inhibiting the ionic fluxes required for initiation and conduction of impulses. Capsaicin is a selective agonist for TRPV1 receptor expressed in afferent neuronal C fibers and Ad fibers resulting in loss of receptor functionality causing impaired local nociception.Diclofenac works via inhibition of prostaglandin synthesis by blocking COX-1 and COX-2.

Neuropathic pain (NP) is a common complication of spinal cord injury (SCI) that is difficult to treat. Chronic NP is associated with increased levels of inflammatory mediators and ion channel dysfunction, as well as nerve damage and nerve-glia crosstalk. Recent studies have made headway in identifying novel biomarkers, including microRNA and psycho-social attributes that can predict progress from SCI to chronic NP (CNP). Conventional medical treatment has limited success, but recent studies have identified new biomarkers and promising drugs, such as baclofen and ziconotide, that can provide pain relief. However, further studies are needed to determine the safety profile of these drugs. Nonmedical interventions, such as brain sensitization and biofeedback techniques, have also shown promise in managing CNP. A multidisciplinary approach, including psycho-social support, medical and nonmedical interventions, is necessary to effectively manage CNP in SCI patients.

There are simple and accurate methods to identify nerve entrapment; however, it is still underdiagnosed and undertreated. Giving postsurgical nerve entrapment more attention will decrease morbidity, improve outcomes, and decrease healthcare worker costs. Physicians and other medical providers should be highly suspicious of postsurgical nerve entrapment, particularly when patients present with over one to two months of unresolved pain. Nonoperative management includes pharmacotherapy, psychical therapy, and injections. Injections and blocks should be performed under ultrasound guidance. Neuroablative therapy and cryoanalgesic ablation are still being explored and need to be further studied. Refractory neuropathic pain unresolved with pharmacotherapy and nonoperative procedures should undergo neurectomy.

Breast cancer is the second most common cancer in males and females and the most common overall in the female population. Cosmetic breast surgery is commonly performed in the United States with 520,000 procedures of the total 1.8 million cosmetic procedures in 2018 being related to the breast. Post-mastectomy pain syndrome is a specific etiology following cosmetic breast surgery. Where patients feel their chronic pain is dependent on the incision site for the procedure and the type of procedure performed. Initially, each patient following a cosmetic breast procedure experiences some level of acute pain. The nerve injuries that are associated with chronic pain can be masked by this initial presentation. Initial management includes a trial of medical management (NSAIDs, neuropathic pain medication) for at least three months.