Primum non nocere... The fact that a surgical procedure can leave any kind of pain casts a shadow over this tenet, which is seen as the basis of medical practice and anchor of its principle ethic... It is all the more surprising in that medicine has only paid attention to this paradoxical chronic pain situation for the past few years. Clarifying the knowledge acquired in this field has become all the more urgent for any care-giver today confronted by a legitimate request from patients: Why and how can a surgical procedure, which is supposed to bring relief, leave behind an unacceptable sequela? This is the approach which the contributors to this new subject of major clinical interest invite you to follow as you work your way through this book.
Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.
This book provides a comprehensive review of the challenges, risk stratification, approaches and techniques needed to improve pain control in ambulatory surgery centers (ASCs). It addresses not only the management of acute perioperative pain but also describes modalities that could potentially reduce the risk of evolution of acute pain into chronic pain, in addition to weaning protocols and follow ups with primary surgical specialties and pain physicians as needed. Organized into five sections, the book begins with the foundations of managing ASCs, with specific attention paid to the current opioid epidemic and U.S. policies relating to prescribing opioids to patients. Section two and three then explore facets of multimodal analgesia and non-operating room locations, including the use of ultrasounds, sedation in specific procedures, regional anesthesia, ketamine infusions, and the management of perioperative nausea and intractable pain in outpatient surgery. Section four examines the unique challenges physicians face with certain patient demographics, such as the pediatric population, those suffering from sleep apnea, and those with a history of substance abuse. The book closes with information on discharge considerations, ambulatory surgery protocols, recovery room protocols, and mandatory pain management services. An invaluable reference for all health personnel and allied specialties, Pain Control in Ambulatory Surgery Centers (ASCs) meets the unmet need for a resource that covers optimum pain control in patients undergoing outpatient surgery as well as the urgent ASCs challenges that are presented on an immense scale with national and international impact.
Some people suffer from chronic, debilitating disorders for which no conventional treatment brings relief. Can marijuana ease their symptoms? Would it be breaking the law to turn to marijuana as a medication? There are few sources of objective, scientifically sound advice for people in this situation. Most books about marijuana and medicine attempt to promote the views of advocates or opponents. To fill the gap between these extremes, authors Alison Mack and Janet Joy have extracted critical findings from a recent Institute of Medicine study on this important issue, interpreting them for a general audience. Marijuana As Medicine? provides patientsâ€"as well as the people who care for themâ€"with a foundation for making decisions about their own health care. This empowering volume examines several key points, including: Whether marijuana can relieve a variety of symptoms, including pain, muscle spasticity, nausea, and appetite loss. The dangers of smoking marijuana, as well as the effects of its active chemical components on the immune system and on psychological health. The potential use of marijuana-based medications on symptoms of AIDS, cancer, multiple sclerosis, and several other specific disorders, in comparison with existing treatments. Marijuana As Medicine? introduces readers to the active compounds in marijuana. These include the principal ingredient in Marinol, a legal medication. The authors also discuss the prospects for developing other drugs derived from marijuana's active ingredients. In addition to providing an up-to-date review of the science behind the medical marijuana debate, Mack and Joy also answer common questions about the legal status of marijuana, explaining the conflict between state and federal law regarding its medical use. Intended primarily as an aid to patients and caregivers, this book objectively presents critical information so that it can be used to make responsible health care decisions. Marijuana As Medicine? will also be a valuable resource for policymakers, health care providers, patient counselors, medical faculty and studentsâ€"in short, anyone who wants to learn more about this important issue.
All physicians are involved in the management of pain at some level or the other, but of the various specialties and health professions, surgeons are at the frontline of delivering perioperative pain care. Perioperative Pain Management for General and Plastic Surgery offers a concise yet comprehensive overview of the surgical pain management field to help practitioners effectively plan and enhance perioperative pain control. Chapters provide guidance on solving common dilemmas facing surgeons who are managing patients with pain related problems and clinical decision-making, and explore essential topics required for the trainee and practitioner to quickly assess the patient with pain, to diagnose pain and painful conditions, determine the feasibility and safety of surgical procedure needed, and arrange for advanced pain management consults and care if needed. This text also explores the latest evolving techniques and appropriate utilization of modern equipment and technology to safely provide care. Highly accessible and written by experts in the field, Perioperative Pain Management for General and Plastic Surgery is an ideal resource for practicing surgeons, anesthesiologists, critical care personnel, residents, medical students.
According to the Centers for Disease Control and Prevention (CDC), there were nearly 40,000 opioid-related deaths in the U.S in the last year alone. These numbers have increased considerably for a variety of reasons, and the growing role of prescription drug abuse has been widely recognized. There has also been increasing consciousness of the lack of dedicated and formalized training dedicated to prescription of analgesics, particularly among surgical trainees and practicing surgeons. Recent studies demonstrate that only a small minority of training programs mandates any opioid prescribing education, despite the fact that nearly all programs allow trainee prescription of opioids on an outpatient basis. Therefore, it is not surprising that despite a growing body of literature illustrating the value of opioid alternatives and adjuncts, practicing surgeons in all specialties largely ignore these evidence-based practices and continue to prescribe opioids in situations for which alternatives are proven, safe, and effective. There are many reasons for preparing a concise and practical resource describing evidence-based practices targeting surgeons and surgical subspecialists, including but not limited to: (1) The exponential increase in prescription drug abuse associated with the “opioid epidemic,” as surgeons play an important role in managing perioperative and chronic pain in a variety of practice setting; this issue bears importance from the patient, physician, and policymaker standpoint; (2) With increasing recognition of the role of quality improvement in patient safety initiatives, and literature demonstrating inadequate opioid prescribing education (OPE) in surgical training programs, it is only a matter of time before accreditation bodies including the ACGME incorporate strong recommendations and mandates for OPE; (3) Myriad literature demonstrating the existence of evidence-based alternatives to opioids – All surgeons and surgical subspecialists would benefit from a practical guide concisely laying this literature out. We feel that surgeons of all experience levels may benefit, ranging from the first year surgical intern to an experienced practitioner trying to remain compliant with the evolving opioid regulatory environment. Hence, the appropriate target audience for this text would be for the tens of thousands of current surgical trainees in many specialties, including general surgery, thoracic surgery, otolaryngology, plastic surgery, urology, gynecology, vascular surgery, neurosurgery, and orthopedic surgery. Furthermore, surgeons out of training would be another audience of interest, as there are increasing courses for continuing medical education based on perioperative and chronic pain management. Currently, there are no comparable and competitive guides with these target audiences; all of the existing literature about perioperative and chronic pain is targeted either specifically for patients, anesthesiologists, or pain medicine physicians. This will be the only up to date guide focusing on evidence-based practices for perioperative pain control, and each section will also include information on chronic pain sequelae relevant to each surgical specialty. The editors envision this text being an interdisciplinary endeavor, incorporating surgeons from multiple specialties, anesthesiologists, pain medicine physicians, and palliative physicians as appropriate.
