BASICS OF
PAIN MEDICINE
BY
Prof. Brig. M. Salim SI (M)
MBBS, FRCA, FCPS, PhD
nd
2 Edition 2014
HIGHR EDUCATION COMMISSION
ISLAMABAD
1
, Copyrights @ Higher Education Commission
Islamabad
Lahore Karachi Peshawar
All rights are reserved. No part of this publication may be reproduced, or transmitted, in
any form or by any means – including, but not limited to, electronic, mechanical,
photocopying, recording, or, otherwise or used for any commercial purpose what so ever
without the prior written permission of the publisher and, if publisher considers necessary,
formal license agreement with publisher may be executed.
Project: ―Monograph and Textbook Writing Scheme‖ aims to develop a culture of writing
and to develop authorship cadre among teaching and researcher community of higher
education institutions in the country. For information please visit: www.hec.gov.pk
HEC – Cataloging in Publication (CIP Data):
Salim, M.
Basics of pain medicine
1. Pain
2. Medicine
Includes index
616.849-dc22
ISBN: 969-8963-00-6
First Edition 2007
Second Edition 2015
Copies Printed: 500
st
1 Edition Published By: D. G. Administration, Higher Education Commission,
Islamabad–Pakistan
Disclaimer: The publisher has used its best efforts for this publication through a rigorous
system of evaluation and quality standards, but does not assume, and hereby disclaims,
any liability to any person for any loss or damage caused by the errors or omissions in
this publication, whether such errors or emissions result from negligence, accident, or
any other cause.
2
, DEDICATION
In addition to the traditional mode of dedicating works to near and dear one’s. I
wish this book to serve as an instrument of encouragement to my gifted son
Dr. Babur who happens to be a bright and dedicated man of medicine, with the
prayers that he succeed his father with a distinctive professional edge and
commitment to prove a worthy torch bearer of this venture on relief of pain.
May Allah Almighty bless him with wisdom and fortitude! Amen.
3
, CONTENTS
About the Author .........................................................................................................................................
Foreword to the 2nd edition. Preface to the 2nd editions ............................................................................
Foreword to 1st edition. ...............................................................................................................................
Preface to the 1st editihon ...........................................................................................................................
Acknowledgement .......................................................................................................................................
CHAPTER-1 BASIC MECHANISM
CHAPTER-2 ACUTE PAIN
CHAPTER-3 CLINICAL ASSESSMENT IN ADULT PATIENTS
CHAPTER-4 ASSESSMENT OF CHRONIC PAIN – HISTORY
CHAPTER-5 RADIOLOGIC EVALUATION
CHAPTER-6 DRUGS TO RELIEVE PAIN
CHAPTER-7 TOPICAL AGENTS
CHAPTER-8 ANTIDEPRESSANTS
CHAPTER-9 ANTICONVULSANT DRUGS
CHAPTER-10 SODIUM AND CALCIUM CHANNEL ANTAGONISTS
CHAPTER-11 TRAMADOL
CHAPTER-12 OPIOIDS
CHAPTER-13 MISCELLANEOUS DRUGS
CHAPTER-14 NEUROLYTIC AGENTS
CHAPTER-15 BOTULINUM TOXIN
CHAPTER-16 CANNABINOIDS
CHAPTER-17 UPPER EXTREMITY PAIN
CHAPTER-18 LOWER EXTREMITY PAIN
CHAPTER-19 NECK AND SHOULDER PAIN
CHAPTER-20 ARTHRITIS
CHAPTER-21 NEUROPATHIC PAIN
CHAPTER-22 COMPLEX REGIONAL PAIN SYNDROME
CHAPTER-23 BASIC ASPECTS OF MUSCLE PAIN
CHAPTER-24 MYOFASCIAL PAIN AND FIBROMYALGIA
CHAPTER-25 NEURALGIA AND PERIPHERAL NEUROPATHY
CHAPTER-26 TRIGEMINAL NEURALGIA (TGN)
CHAPTER-27 MIGRAINE HEADACHE
4
PAIN MEDICINE
BY
Prof. Brig. M. Salim SI (M)
MBBS, FRCA, FCPS, PhD
nd
2 Edition 2014
HIGHR EDUCATION COMMISSION
ISLAMABAD
1
, Copyrights @ Higher Education Commission
Islamabad
Lahore Karachi Peshawar
All rights are reserved. No part of this publication may be reproduced, or transmitted, in
any form or by any means – including, but not limited to, electronic, mechanical,
photocopying, recording, or, otherwise or used for any commercial purpose what so ever
without the prior written permission of the publisher and, if publisher considers necessary,
formal license agreement with publisher may be executed.
Project: ―Monograph and Textbook Writing Scheme‖ aims to develop a culture of writing
and to develop authorship cadre among teaching and researcher community of higher
education institutions in the country. For information please visit: www.hec.gov.pk
HEC – Cataloging in Publication (CIP Data):
Salim, M.
Basics of pain medicine
1. Pain
2. Medicine
Includes index
616.849-dc22
ISBN: 969-8963-00-6
First Edition 2007
Second Edition 2015
Copies Printed: 500
st
1 Edition Published By: D. G. Administration, Higher Education Commission,
Islamabad–Pakistan
Disclaimer: The publisher has used its best efforts for this publication through a rigorous
system of evaluation and quality standards, but does not assume, and hereby disclaims,
any liability to any person for any loss or damage caused by the errors or omissions in
this publication, whether such errors or emissions result from negligence, accident, or
any other cause.
2
, DEDICATION
In addition to the traditional mode of dedicating works to near and dear one’s. I
wish this book to serve as an instrument of encouragement to my gifted son
Dr. Babur who happens to be a bright and dedicated man of medicine, with the
prayers that he succeed his father with a distinctive professional edge and
commitment to prove a worthy torch bearer of this venture on relief of pain.
May Allah Almighty bless him with wisdom and fortitude! Amen.
3
, CONTENTS
About the Author .........................................................................................................................................
Foreword to the 2nd edition. Preface to the 2nd editions ............................................................................
Foreword to 1st edition. ...............................................................................................................................
Preface to the 1st editihon ...........................................................................................................................
Acknowledgement .......................................................................................................................................
CHAPTER-1 BASIC MECHANISM
CHAPTER-2 ACUTE PAIN
CHAPTER-3 CLINICAL ASSESSMENT IN ADULT PATIENTS
CHAPTER-4 ASSESSMENT OF CHRONIC PAIN – HISTORY
CHAPTER-5 RADIOLOGIC EVALUATION
CHAPTER-6 DRUGS TO RELIEVE PAIN
CHAPTER-7 TOPICAL AGENTS
CHAPTER-8 ANTIDEPRESSANTS
CHAPTER-9 ANTICONVULSANT DRUGS
CHAPTER-10 SODIUM AND CALCIUM CHANNEL ANTAGONISTS
CHAPTER-11 TRAMADOL
CHAPTER-12 OPIOIDS
CHAPTER-13 MISCELLANEOUS DRUGS
CHAPTER-14 NEUROLYTIC AGENTS
CHAPTER-15 BOTULINUM TOXIN
CHAPTER-16 CANNABINOIDS
CHAPTER-17 UPPER EXTREMITY PAIN
CHAPTER-18 LOWER EXTREMITY PAIN
CHAPTER-19 NECK AND SHOULDER PAIN
CHAPTER-20 ARTHRITIS
CHAPTER-21 NEUROPATHIC PAIN
CHAPTER-22 COMPLEX REGIONAL PAIN SYNDROME
CHAPTER-23 BASIC ASPECTS OF MUSCLE PAIN
CHAPTER-24 MYOFASCIAL PAIN AND FIBROMYALGIA
CHAPTER-25 NEURALGIA AND PERIPHERAL NEUROPATHY
CHAPTER-26 TRIGEMINAL NEURALGIA (TGN)
CHAPTER-27 MIGRAINE HEADACHE
4
