The field of interventional pain management is a forever evolving field. There are new developments occurring daily with new approaches and new equipment that make therapies safer and more effective.
This book gives clinical pearls on strategies that we use in interventional pain management. It has been designed as an easy-to-use source for most of the interventional pain specialists needs. It is not intended to replace a comprehensive fellowship in pain management. The pros and cons of medications, the psychological approaches effective in pain, as well as the comprehensive use of rehabilitation and complementary approaches are simply not covered. This book, however, does provide the physician with relevant anatomy and should prompt a thoughtful approach to specific pain syndromes and what causes them. Many years ago, patients with pain referred to as having "chronic pain syndrome" or sometimes were maligned with pejorative terms. Patients were called malingerers, assumed to have major psychiatric disorders or were assumed to be drug seeking. While all of these certainly occur, I believe patients with legitimate medical problems were frequently misdiagnosed. This occurred because there was not an adequate training of physicians to diagnose and treat complex pain disorders. To date, many physicians have inadequate training in recognizing complex medical and neurologic disorders, and many syndromes are missed.
In previous decades there were a few procedures that were commonly performed. Epidurals, Trigger points, and major joint injections were common. Complex procedures were rarely performed. Medications were (and still are) a mainstay of a comprehensive pain practice. While we today still use these classes of analgesics, we are now recognizing that the medication approach is not without risks. The use of opiates has increased dramatically over the past twenty years. With this we have seen a dramatic rise in deaths attributed, at least in part to the use of prescription analgesics. It was estimated that in 2012 there were over 16 thousand deaths with a prescription opioid as at least a part of the problem.
Pain management is not just about giving a patient drugs. It is about making an accurate diagnosis, developing a therapeutic plan, and devising a minimally invasive approach when possible to effectively treat or manage the problem. The Diwan–Staats Atlas puts together what we know about various pain states, along with the most current information in anatomy and pathophysiology. We concentrate on the most minimally invasive techniques available, thereby enhancing safety. This book is really the "how to" of current interventional pain management; however, it does not address the "when to." The "when to" involves clinical judgment, careful evaluation, and individual case-specific issues, along with evidence-based medicine and an assessment of the risks, benefits, and alternatives of all interventional procedures. Summarizing all the available clinical trials would have been beyond the scope of a single volume.
There are so many leaders and influential figures that have helped the development of this field. Dr. Bonica, Dr. Stanton Hicks, Dr. Gabor Racz, Dr. Prithvi Raj, and Dr. Lax Manchikanti are a few who have devoted so much of their life to advancing the specialty of interventional pain. On behalf of the millions of pain sufferers and the physicians you have taught, we thank you.
We would like to express our deep appreciation to so many individuals. First, we must thank the section editors, Drs. Lema, Patel, Trescot, Vad, Gharibo, and Shah who have gone above and beyond, reviewing and re-reviewing the chapters. Thank you to our numerous authors who have created such wonderful original works. The synthesis of all of your works has made this volume special.
With all of the talk about evidence-based medicine, and the needs for multiple randomized controlled trials to support reimbursement, and the battles in the halls of Congress, and the battles with insurers, we sincerely hope that this book will help physicians help patients, as safely and effectively as possible. That's why we all do what we do.