When presented with pain, we, as healthcare professionals, are asked to find appropriate solutions. The clinical presentation may be acute or chronic, and successful management involves an accurate diagnosis and implementation of a suitable therapy or therapies. For a beginner in pain management, this can pose a significant challenge. We have placed a clinical scenario at the end of nearly all of the chapters, for a total of 33 cases, in an attempt to present a collection of common pain-related clinical problems and possible ways to manage them effectively.
Treatment of pain begins with a detailed history taking, a thorough clinical examination, specific investigations, and the right intervention. The importance of history and clinical examination in pain management cannot be overstressed. The knowledge, attitude, and skills needed in managing pain are acquired over time, and the management involves multidisci-plinary teams and multimodal approaches. This is exemplified in the clinical scenarios. It is also important to re-explore and re-assess when there is a change in the clinical picture.
The clinical scenarios are presented in a question-and-answer format. The reader is encouraged to go through the questions first and to come up with a solution before reading the given answer. There is always a potential for a different approach to the given clinical problem.
Many of these scenarios were taken from our day-to-day practice of pain medicine. While we have presented the scenarios in a positive note with regard to the effectiveness of pain management strategies, we have the humility to admit that we may sometimes be too optimistic in our outlook.
Dr. Sreekumar Kunnumpurath, MBBS, MD, FCARCSI, FRCA, FFPMRCA
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