Pain Disorders Spotlight

This section provides access to pain management resources addressing common painful disorders or conditions of special interest and importance. The informational and educational needs of all healthcare providers who treat these disorders are addressed; including physicians, pharmacists, dentists, nurses, nurse practitioners (NPs), physician's assistants (PAs), and others.

• Low-Back Pain (LBP)
• Headache Pain
• Pain Treatment in Palliative Care
• Cancer-Related Pain 
• Fibromyalgia Pain
• Shingles/PHN (Postherpetic Neuralgia)
• Pain Treatment in Pediatrics
• Other Sections Are in Development

For guidelines, CMEs, and other documents pertaining to each pain disorder, see the details listings page for the respective section below.

For additional, more general information on pain see "Overview - Pain Management & Tx" under Clinical Concepts. <Click Here>

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Low-Back Pain (LBP)

Lifetime prevalence of LBP is estimated at 70%, and nearly 20% of adults suffer from back pain in any given year. Acute LBP often is self-limiting; however, back pain is one of the most common reasons for visits to healthcare providers. The documents recommended in this section address this ubiquitous, oftentimes persistent, and difficult to treat condition.

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Diagnostic Imaging for Low Back Pain

From: Chou R, Qaseem A, Owens, DK, et al. Annals of Internal Medicine; 2011. See details>

Guideline Update: Best Approach to Acute Low Back Pain

From: Bach SM, Holten KB. Journal of Family Practice; 2009.
See details>

Adult Low Back Pain Guidelines

From: Institute for Clinical Systems Improvement (ICSI); 2008.
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Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline

From: the American College of Physicians and the American Pain Society; by Chou R, et al. Annals of Internal Medicine; 2007.

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Evaluation and Treatment of Acute Low Back Pain

From: American Academy of Family Physicians (AAFP); 2007; 8 pages.
See details>

Clinic on Low-Back Pain in Interdisciplinary Practice (CLIP)

From: Agency for Health & Social Services; Montreal, Canada; 2007.
See details>

Acute Low Back Pain

From: University of Michigan Health System; Revised 2005.
See details>

Evaluation and Treatment of Low Back Pain in Family Practice

By: Rives PA, Douglass AB. Journal of the American Board of Family Medicine; 2004. See details>

European Guidelines for Prevention in Low Back Pain

From: European Commission Working Groups; 2004. See details>

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Headache Pain

Headache pain is one of the most frequent reasons for healthcare visits. Documents in this section address the various forms of headache, including migraine, cluster, tension-type, sinus-related, and others. An emphasis is on diagnosis and symptom management via approaches incorporating pharmacologic, non-pharmacologic, and/or complementary therapies, as well as other components of comprehensive pain management.

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Biofeedback in Headache: Overview of Approaches

By: Andrasik F. Cleveland Clin J Med; 2010. See details...>

Breaking the Cycle of Medication Overuse Headache

By: Tepper SJ, Tepper DE. Cleveland Clin J; 2010. See details...>

Headache: Pediatric Perspective

From: eMedicine from WebMD; Updated June 2008. See details...>

How Clinicians Can Detect, Prevent and Treat Medication Overuse Headache

By: Dodick DW, Silberstein SD. Cephalalgia; 2008. See details...>

Practice Guideline for Diagnosis and Management of Migraine Headaches in Children and Adolescents

From: Medscape; 2007-2008. See details...>

Guidelines for All Healthcare Professionals in the Diagnosis and Management of Migraine, Tension-Type, Cluster and Medication-Overuse Headache

From: British Assoc. for the Study of Headache; 2007. See details...>

Migraine — Special Edition, The Pain Practitioner

From: American Acad of Pain Managmt; 2007 [Spring]. See details...>

Mind-Body Therapies For Headache

By: Sierpina V, Astin J, Giordano J. American Family Physician; 2007. See details...>

The Differential Diagnosis of Chronic Daily Headaches: An Algorithm-Based Approach

By: Bigal ME, Lipton RB. J Headache Pain; 2007. See details...>

Head Pain — Special Edition, The Pain Practitioner

From: American Acad Pain Managmnt; 2006 [Fall]. See details...>

Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies

By: Biondi DM. Journal of the American Osteopathic Association; 2005. See details...>

The Patient With Daily Headaches

By: Maizels M. American Family Physician; 2004. See details...>

21st Century Prevention and Management of Migraine Headaches

From: National Institute of Neurological Disorders and Stroke (NINDS); 2001. See details...>

Information for Health Professionals [19 Headache Fact Sheets]

From: American Headache Society. See details...>

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Pain Treatment in Palliative Care

(including Hospice Care)

Palliative care focuses on patients of all ages with a chronic disorder – whether an illness, condition, or injury – that adversely affects daily functioning or reduces life expectancy. Documents in this section focus on pain and associated symptom management during palliative care via approaches incorporating pharmacologic, nonpharmacologic, and/or complementary therapies, as well as other components of a comprehensive pain management program.

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IAHPC List of Essential Medicines for Palliative Care

From: International Association for Hospice & Palliative Care; 2007.

See details...>

Principles of Effective Pain Management at the End of Life

By: Fine PG, Mac Low C. Medscape Today; 2007.  See details...>

Pain Management at the End of Life [book]

From: Hospice Foundation of America; 2006. See details...>

EPERC - Pain Topics from the “Fast Facts Index”

From: End of Life/Palliative Education Resource Center; 2005-2007.
See details...>

Methadone, Pain Management, and Palliative Care

By: McPherson ML. Medscape and ASHP; 2006. See details...>

The IAHPC Manual of Palliative Care [book]

By: Doyle D, Woodruff R. International Association for Hospice & Palliative Care; 2nd Edition; 2008.  See details...>

Managing Pain in the Dying Patient

By: Whitecar PS, Jonas AP, Clasen ME. American Family Physician; 2000. See details...>

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Cancer-Related Pain

Pain is one of the most common and often most feared symptoms in patients with cancer. Therefore, effective management of cancer-related pain is both a high priority and an ongoing challenge in clinical practice. Cancer-related pain may be due to active cancer itself, cancer treatments, and/or comorbidities arising from cancer. Documents in this special section focus on cancer pain control and associated symptom management via pharmacotherapies, nonpharmacologic strategies, and/or complementary approaches during cancer care.

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Pain Management in Patients with Cancer: Focus on Opioid Analgesics

From: Leppert W. Current Pain and Headache Reports; 2011.
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Adult Cancer Pain

From: National Comprehensive Cancer Network; 2011. See details...>

The Management of Cancer Pain

From: Paice JA, Ferrell, B. CA: A Cancer Journal for Clinicians; 2011.
See details...>

Management of Pain in the Older Person With Cancer

From: Cancernetwork.com; 2008. See details...>

Cancer-Related Pain and Its Pharmacologic Management in the Patient With Bone Metastasis

By: Slatkin N. Journal of Supportive Oncology; 2006. See details...>

Pharmacologic Management of Cancer Pain

By: Pharo GH, Zhou L. Journal of the American Osteopathic Assoc.; 2003. See details...>

Management of Cancer Pain in Geriatric Patients

By: Balducci L. Journal of Supportive Oncology; 2003. See details...>

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Fibromyalgia Pain

Fibromyalgia syndrome (FMS) is a diffuse pain and fatigue disorder for which an exact etiology is remains unknown and medical diagnosis can be challenging. Pain, the cardinal symptom of fibromyalgia, seems to emanate from muscles, tendons, ligaments, bursa, and joints. Fatigue, lethargy, depression, sleep disturbances, and other symptoms also may be present. Documents in this section focus primarily on approaches and strategies that have proven most successful for managing fibromyalgia pain and associated symptoms.

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Fibromyalgia: An Afferent Processing Disorder Leading to a Complex Pain Generalized Syndrome

From: Smith HS, Harris R, Clauw D. Pain Physician; 2011.
See details...>

New Developments in the Diagnosis of Fibromyalgia Syndrome: Say Goodbye to Tender Points?

By: Wilke WS. Cleveland Clinic J Med. 2009:76(6):345-352.
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Fibromyalgia: Psychiatric Drugs Target CNS-Linked Symptoms

By: Stanford SB. Current Psychiatry Online; 2009. See details…>

Fibromyalgia – Special Edition, The Pain Practitioner

From: American Academy of Pain Management; 2008 [Spring].
See details…>

Understanding the Fibromyalgia Syndrome

By: Rao SG, Gendreau JF, Kranzler JD. From Medscape Ob/Gyn & Women’s Health; 2008. See details...>

The Diagnosis and Treatment of Fibromyalgia

By: Horowitz S. Alternative & Complementary Therapies; 2008.
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Fibromyalgia

By: Chakrabarty S, Zoorob R. American Family Physician; 2007.
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EULAR Guidelines for the Treatment of Fibromyalgia Syndrome

By: Barclay L. From Medscape Medical News; 2007. See details...>

A Review of Fibromyalgia and Its Treatment

By: St. Onge EL, Rose RL, Alighanbari V. Drug Topics; 2005.
See details...>

The Fibromyalgia Impact Questionnaire (FIQ)

By: Bennet R. Clin Exp Rheumatol; 2005. See details...>

Management of Fibromyalgia Syndrome

By: Goldenberg DL, Burckhardt C, Crofford L. JAMA; 2004.
See details...>

A Review of Fibromyalgia

By: Nampiaparampil DE, Schmerling RH. American Journal of Managed Care; 2004. See details...>

The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia

By: Wolfe F, Smythe HA, Yunus MB, et al. Arthritis and Rheumatism; 1990. See details...>

The Science of Fibromyalgia

From: National Fibromyalgia Association; undated. See details...>

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Shingles / PHN (Postherpetic Neuralgia)

Shingles, or acute herpes zoster infection, is a common complication of reactivated varicella zoster virus (chicken pox). In turn, this may foster development of the chronic pain syndrome, postherpetic neuralgia (PHN). Shingles begins as pain in a dermatomal distribution with a rash consisting of papules and vesicles. PHN has been defined as pain persisting or recurring at the site of shingles at least one month after onset of the acute rash. The pain of PHN may last for a few months or a lifetime, although there are many options for treating it.

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Herpes Zoster

From: Medscape Reference; updated May 2011. See details>

Postherpetic Neuralgia: An Overview of the Pathophysiology, Presentation, and Management

By: Gharibo C, Kim C. Pain Medicine News; 2011. See details>

Alarming New Evidence About Painful Shingles-PHN

From: Pain-Topics UPDATES, 2011(Feb 11). See details>

Herpes Zoster (Shingles) and Postherpetic Neuralgia. Concise Review for Clinicians

By: Sampathkumar P, Drage LA, Martin DP. Mayo Clinic Proceedings; 2009. See details>

Shingles: Hope Through Research

From: National Institutes of Health, National Institute of Neurological Disorders and Stroke; updated January 2011. See details>

Recommendations for the Management of Herpes Zoster

By: Dworkin RH, Johnson RW, Breuer J, et al. Clinical Infectious Diseases; 2007. See details>

Practice Parameter: Treatment of Postherpetic Neuralgia

By: Dubinsky RM, Kabbani H, El-Chami Z, et al. Neurology; 2004.
See details>

Shingles Vaccination: What You Need to Know

From: Centers for Disease Control and Prevention; updated January 2011. See details>

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Pain Treatment in Pediatrics

Infants and children can and do feel pain comparable to pain in adults. Research into pediatric pain has grown rapidly, and numerous drug and non-drug therapies have been developed and tested in a variety of clinical populations and settings. However, the large number of available interventions may be a source of confusion, and inadequate prevention and relief of pediatric pain are still widespread. This section focuses on the most appropriate, cost effective, and evidence-based interventions, taking into account all components of the child’s pain experience.

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2011 ACR Recommendations for the Treatment of Juvenile Idiopathic Arthritis

From: Beukelman T, Patkar NM, Saag KG, et al. Arthritis Care & Research; 2011. See details...>

Neuropathic Pain in Children: Special Considerations

By: Walco GA, Dworkin RH, Krane EJ, et al. Mayo Clinic Proceedings; 2010. See details...>

Review for the Generalist: Evaluation of Pediatric Foot and Ankle Pain

By: Houghton KM. Pediatric Rheumatology Online Journal; 2008.
See details...>

Headache: Pediatric Perspective

From: eMedicine from WebMD; Updated June 2008. See details...>

Evaluation of Back Pain in Children and Adolescents

By: Bernstein RM, Cozen H. American Family Physician; 2007.
See details...>

Pediatric Cancer Pain

From: National Comprehensive Cancer Network; 2007. See details...>

Treatment of Chronic Pain in Pediatric Rheumatic Disease

By: Kimura Y, Walco GA. Nature Clinical Practice Rheumatology; 2007.
See details...>

Chronic Musculoskeletal Pain in Children

From: American Academy of Family Physicians; 2006. See details...>

Psychological Interventions for Acute and Chronic Pain in Children

From: International Association for the Study of Pain; 2006.
See details...>

Complementary and Alternative Medicine Approaches for Pediatric Pain: A Review of the State-of-the-Science

By: Tsao JCI, Zeltzer LK. Evidence-based Complementary and Alternative Medicine; 2005. See details...>

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems

By: Zempsky WT, Cravero JP, et al. Pediatrics; 2004. See details...>

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