Decision Making in Pain Management, 2nd Edition by Somayaji Ramamurthy MD, Euleche Alanmanou MD, James N.

By Somayaji Ramamurthy MD, Euleche Alanmanou MD, James N. Rogers MD

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The spinal needle is removed and the patient is turned to the supine position. If the patient has no pain relief despite having a significant sensory and motor block in the painful area then the etiology is proximal to the site of block. This patient is not likely to benefit from procedures such as injections or surgery. Proximal etiology such as CNS lesions, encephalization, malingering, or psychogenic pain is to be considered. If the patient has pain relief, then the etiology would be either sympathetic or somatic.

In chest and abdominal pain, plain radiography is a good initial choice with a lack of finding leading to consideration of echocardiography, ECG, CT, ultrasound, or gastrointestinal contrast examinations for further evaluation. For neck and upper extremity complaints, plain radiographs are a good start, followed by CT in the presence of acute trauma, and MRI if the problems are chronic. In low back pain for which imaging is indicated, plain films are the initial choice followed by MRI for most situations.

Anaesth Intensive Care 1996;24:658–664. Upton RN, Semple TJ, Macintyre PE: Pharmacokinetic optimisation of opioid treatment in acute pain therapy. Clin Pharmacokinet 1997;33:225–244. Acute Herpes Zoster ROBERT SPRAGUE Acute herpes zoster (HZ) is an infectious disease involving reactivation of the varicella virus, which affects the dorsal root ganglia primarily. Immunocompromised individuals, whether due to age, malignancy, or other systemic illnesses, are most often affected. Children make up only 5% to 8% of cases, whereas patients older than 50 years of age account for 40% of cases.

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