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Wu purchase nizoral 200mg without a prescription, MD, Associate Professor of Anesthesiology, Director, Regional Anesthesia, Johns Hopkins University Hospital, Baltimore, Maryland Tony L. Yaksh, PhD, Department of Anesthesiology, School of Medicine, University of California, San Diego, La Jolla, California This page intentionally left blank. FOREWORD This concise volume, edited by two of today’s leading pain clinician-scien- tists, represents the culmination of several forces. First and foremost is the recognition that the knowledge and skills sup- porting current medical management of pain have grown sufficiently large that this field has become a discipline in its own right. Accordingly, candi- dates who meet the requirements of the American Board of Anesthesiology may now become board-certified in Pain Management and achieve diplo- mate status just as their colleagues in other areas have done for years. The American Academy of Pain Medicine has been recognized to provide equivalent rigor in its certification process and many physicians (including this writer! Wallace and Staats have wisely drawn on the expertise and scholar- ship of a galaxy of “stars” from these two overlapping groups to achieve an amazing harmony between conciseness of each chapter and a comprehen- sive scope of chapters. In aggregate, the 70 chapters in this volume suffice to prepare candidates to sit successfully for either board examination, and in the future for the conjoined board, if both accreditation mechanisms were to coalesce. The second trend, evident throughout medical education and clinical care, is to take stock of the evidence for the concepts and interventions cov- ered so as to practice “evidence-based” pain medicine. This trend is clearly subscribed to by the editors, with many of their contributors frankly and objectively spelling out which of their recommendations is supported by consensus alone and which have experimental support in the form of ran- domized controlled trials, quasi-experimental studies, and case series. In an era of pervasive managed care, and its frequent need to justify—or at least provide a basis for—all medical, behavioral, and procedural interventions, this information is indispensable. Third is the rise of “knowledge distilleries” in the form of published materials and Internet sites, whose genesis lies in clinicians’ pleas for help in sorting out high-quality evidence from low-quality evidence and simply in wading through the flood of information from all sources. The literature on pain control has recently doubled in size about every five years, pre- venting any one person from absorbing, or even skimming, this vast amount xvii Copyright © 2005 by The McGraw-Hill Companies, Inc. Pain-related knowledge distilleries include the Cochrane Collaboration, which emphasizes formal systematic reviews and, whenever possible, quantitative syntheses (meta-analyses) of randomized controlled trials.

A MODEL OF THE PSYCHOSOCIAL FACTORS IMPLICATED IN THE ETIOLOGY AND MAINTENANCE OF CHRONICALLY PAINFUL ILLNESS Although health professionals who work in pain research and practice have become pioneers in the design and running of smoothly functioning multi- disciplinary teams generic nizoral 200 mg overnight delivery, it is arguable that when examining the key social influ- ences that affect pain and pain behavior, we have been slow to draw on contributions from the wider range of social science disciplines available, and to extend and apply them to improve our understanding of the pain re- sponse and its management. SOCIAL INFLUENCES ON PAIN RESPONSE 183 the social factors that affect pain, illness, and treatments, with the aim of il- luminating the inherently complex interaction between a pain sufferer and their psychosocial environment. Furthermore, it is not possible to do this properly without taking a multidisciplinary approach but within the per- spective of a different but overlapping set of disciplines. The model developed by Skevington (1995) proposes four levels of un- derstanding that provide a framework within which the social aspects of chronic pain may be better appreciated, and this is shown in Fig. Level 1 defines the individual processes affected by social influences, such as per- ceived bodily sensations. In contrast, Level 2 characterizes salient interper- sonal behaviors, in particular, that person’s relationship with significant others. Level 3 defines group and intergroup behaviors such as group be- liefs, experience, and influences, whereas Level 4 encompasses some of the higher order factors that affect sociopsychological processing, such as health ideology and health politics. Although reductionist, this model aims to understand the processes within each level and the relationships be- tween levels, rather than assuming that each level can be better explained by looking at the level below. The model broadens our conceptualization of chronic pain by removing the individual from his or her social and cultural “black box. The aim here is to extend the model and elab- orate it through a discussion of individual differences. Level 1: Individual Behaviors Affected by Social Processes Individual behaviors affected by social processes include a multitude of subjective factors including perceived bodily sensations, the perceived se- verity of symptoms, lifetime personal and social schema, social and per- sonal emotions, individual representations, and personal motivation. This level of analysis is probably most familiar to those who work on chronic pain, and with pain patients where internal biological and psychological fac- tors have been investigated at a micro level. Although sensations superfi- cially appear to be physiologically determined, there is now extensive cross-cultural evidence to show that pain thresholds and pain tolerance lev- els are influenced by a wide variety of different social and cultural factors (Bates, 1987; McCracken, Matthews, Tang, & Cuba, 2001; Nayak, Shiflett, Eshun, & Levine, 2000; Zborowski, 1969; also see chap. For instance, in the Hispanic culture, stoicism is highly prized (Juarez, Ferrell, & Bornemann, 1998), whereas in other cultures describing the pain in a vivid and extended detail is much more the norm (Zborowski, 1969).

Patt discount 200 mg nizoral with amex, MD 272 50 Complementary and Alternative Medicine Maneesh Sharma, MD 277 51 Cryoneurolysis Lloyd Saberski, MD 282 52 Spinal Cord Stimulation Richard B. Rowlingson, MD 289 54 Facet Joint Blocks Somayaji Ramamurthy, MD 295 55 Intravenous Drug Infusions Theodore Grabow, MD 296 56 Neurosurgical Techniques Kenneth A. Davies, MD 315 59 Prolotherapy Felix Linetsky, MD, Michael Stanton-Hicks, MB, BS, Conor O’Neill, MD 318 60 Rehabilitation Evaluation and Treatment in Patients with Low Back Pain Michael Kaplan, MD 325 61 Piriformis Syndrome Wesley Foreman, MD, Gagan Mahajan, MD, Scott M. Fishman, MD 331 x CONTENTS 62 Sacroiliac Joint Dysfunction Norman Pang, MD, Gagan Mahajan, MD, Scott M. Fishman, MD 336 63 Spinal Drug Delivery Stuart Du Pen, MD 341 64 Sympathetic Blockade Mazin Elias, MD, FRCA, DABA 344 65 Transcutaneous Electrical Nerve Stimulation Gordon Irving, MD 349 66 Discography/Intradiscal Electrothermal Annuloplasty Richard Derby, MD, Sang-Heon Lee, MD, PhD 350 67 Nucleoplasty Philip S. Day, MD 360 Section IX DISABILITY EVALUATION 365 69 Disability/Impairment Gerald M. Abram, MD, Professor, Department of Anesthesiology, University of New Mexico School of Medicine, Albuquerque, New Mexico Eric Rey Amador, MD, Clinical Instructor, Department of Anesthesia, Lucile Packard Children’s Hospital at Stanford, Stanford, California Charles E. Argoff, MD, Director, Cohn Pain Management Center, North Shore University Hospital; Assistant Professor of Neurology, New York University School of Medicine, Bethpage, New York Gerald M. Aronoff, MD, Chairman, Department of Pain Medicine, Presbyterian Orthopedic Hospital, Charlotte, North Carolina Misha-Miroslav Backonja, MD, Associate Professor, Department of Neurology, University of Wisconsin, Madison, Wisconsin Allan J. Belzberg, MD, FRCSC, Associate Professor of Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland Ira M. Bernstein, MD, Department of Obstetrics/Gynecology, University of Vermont College of Medicine, Burlington, Vermont Allen W. Burton, MD, Associate Professor of Anesthesiology, Section Chief, Cancer Pain Management Section, University of Texas MD Anderson Cancer Center, Houston, Texas Michael G. Byas-Smith, MD, Assistant Professor of Anesthesiology, Emory University School of Medicine Hospital, Atlanta, Georgia Paul J. Christo, MD, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Michael R. Clark, MD, MPH, Associate Professor and Director, Chronic Pain Treatment Programs, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins Medical Institutions, Baltimore, Maryland Mitchell J. Cohen, MD, Department of Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, Pennsylvania Paul W.