Pain is a common symptom of many diseases and is often referred for a physical medicine and rehabilitation consultation. Despite the availability of information on the pathophysiology, assessment, and management of acute musculoskeletal pain, chronic pain still remains an unsolved problem for many patients. Pathophysiology in these patients often remains obscure, assessment difficult, and management frustrating. These issues become magnified when pain, acute or chronic, complicates a primary disabling disease such as spinal cord injury, cerebrovascular accident or multiple sclerosis. To date, the physiatric management of these complex syndromes has not been dealt with in a comprehensive fashion, especially with regard to the relationship of pain, functional status, and quality of life in these patients. Pain Management in Rehabilitation provides a single source that synthesizes information about the diagnosis and management of various pain syndromes in patients with primary disabling diseases. It discusses pain as it relates to various disease processes from the perspective of both rehabilitation specialists and primary care providers. It describes pain syndromes, their assessment and management, in some of the most common impairments seen in a rehabilitation setting. Relevant literature is reviewed, with emphasis on assessment and physiatric management. This valuable text is an unparalleled guide to the successful management of pain in persons with a primary disabling disease, with the goal of preventing physiological and functional decline and the improvement of functional abilities, which in turn lead to enhanced psychosocial functioning and quality of life.
Neuropathic pain is a clinical entity that presents unique diagnostic and therapeutic challenges. This chapter addresses the classification, epidemiology, pathophysiology, diagnosis, and treatment of neuropathic pain syndrome. Neuropathic pain can be distinguished from nociceptive pain based on clinical signs and symptoms. Although neuropathic pain presents a significant burden to individuals and society, a more accurate assessment of resource utilization, costs, and impairments associated with neuropathic pain would facilitate appropriate planning of healthcare policies. The underlying pathophysiology of neuropathic pain is not well defined. Several theories regarding the mechanism of neuropathic pain have been proposed, including central and peripheral nervous system sensitization, deafferentation, neurogenic inflammation, and the wind up theory. Neuropathic pain is a clinical diagnosis and requires a systematic approach to assessment, including a detailed history, physical examination, and appropriate diagnostic testing. The mainstay of treatment for neuropathic pain is pharmacological, including the use of antidepressants, antiepileptics, topical anesthetics, and opioids. Nonpharmacological treatments include psychological approaches, physical therapy, interventional therapy, spinal cord stimulation, and surgical procedures. Neuropathic pain is difficult to treat, but a combination of therapies may be more effective than monotherapy. Clinical practice guidelines provide an evidence-based approach to the treatment of neuropathic pain.
Drawing on an eclectic array of research and evaluative studies culled from a mix of sources, this volume analyzes Brazilian hospital performance along several policy dimensions including resource allocation and use within hospitals, hospital payment mechanisms, organizational and governance arrangements, management practices, and regulation and quality. An agenda for hospital reform is proposed which synthesizes priorities that are integral to improving hospital performance-and which should be considered for implementation in the near and medium term.
Murray and Nadel’s Textbook of Respiratory Medicine has long been the definitive and comprehensive pulmonary disease reference. Robert J. Mason, MD now presents the fifth edition in full color with new images and highlighted clinical elements. The fully searchable text is also online at www.expertconsult.com, along with regular updates, video clips, additional images, and self-assessment questions. This new edition has been completely updated and remains the essential tool you need to care for patients with pulmonary disease. Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability. Compatible with Kindle®, nook®, and other popular devices. Master the scientific principles of respiratory medicine and its clinical applications. Work through differential diagnosis using detailed explanations of each disease entity. Learn new subjects in Pulmonary Medicine including Genetics, Ultrasound, and other key topics. Grasp the Key Points in each chapter. Search the full text online at expertconsult.com, along with downloadable images, regular updates, more than 50 videos, case studies, and self-assessment questions. Consult new chapters covering Ultrasound, Innate Immunity, Adaptive Immunity, Deposition and Clearance, Ventilator-Associated Pneumonia. Find critical information easily using the new full-color design that enhances teaching points and highlights challenging concepts. Apply the expertise and fresh ideas of three new editors—Drs. Thomas R. Martin, Talmadge E. King, Jr., and Dean E. Schraufnagel. Review the latest developments in genetics with advice on how the data will affect patient care.
Pain is a common symptom of many diseases and is often referred for a physical medicine and rehabilitation consultation. Despite the availability of information on the pathophysiology, assessment, and management of acute musculoskeletal pain, chronic pain still remains an unsolved problem for many patients. Pathophysiology in these patients often remains obscure, assessment difficult, and management frustrating. These issues become magnified when pain, acute or chronic, complicates a primary disabling disease such as spinal cord injury, cerebrovascular accident or multiple sclerosis. To date, the physiatric management of these complex syndromes has not been dealt with in a comprehensive fashion, especially with regard to the relationship of pain, functional status, and quality of life in these patients. Pain Management in Rehabilitation provides a single source that synthesizes information about the diagnosis and management of various pain syndromes in patients with primary disabling diseases. It discusses pain as it relates to various disease processes from the perspective of both rehabilitation specialists and primary care providers. It describes pain syndromes, their assessment and management, in some of the most common impairments seen in a rehabilitation setting. Relevant literature is reviewed, with emphasis on assessment and physiatric management. This valuable text is an unparalleled guide to the successful management of pain in persons with a primary disabling disease, with the goal of preventing physiological and functional decline and the improvement of functional abilities, which in turn lead to enhanced psychosocial functioning and quality of life.
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