- Email: [email protected]
Challenging Pain Syndromes
Challenging Pain Syndromes
Preface Challenging Pain Syndromes
Adam L. Schreiber, DO Editor
No matter whether a general or subspecialized physiatrist, we all encounter pain syndromes; therefore, when Dr Greg Carter invited me to edit an issue of Physical Medicine and Rehabilitation Clinics of North America, the topic appealed to my desire to produce an issue that spans the breadth of the specialty. Another focus of this issue is to serve as a guide to clinical medicine, which entails the best evidence with the experience of our authors to produce practical recommendations. As I edited the work of the authors, I found common themes that I would like to emphasize. In regard to ordering testing, “care must be exerted with regard to interpretation so as not to ‘over-read’ the importance of particular abnormality,” wrote Dr Michael Saulino. This applies to all aspects of medicine, but by the nature of a syndrome, testing is never pathognomonic. How many of our patients marry the finding of L5 disc bulge? Many times this does not explain any or all of their symptoms, yet 10 years later they remain devout to the beloved bulge, which may have even reabsorbed. Prior to ordering tests, I try to counsel patients that tests will likely have abnormalities; it only matters if the the findings correlate with what “you share with me.” An example is Dr Gerry Herbison has been preaching for decades that EMG is confirmation of our clinical impression; to a degree that notion should apply to all testing, especially in regard to pain syndromes. Another common theme was medication use. There are several medication utilized with pain syndromes. The rationale for use may differ for the clinical syndrome but the side-effect profile remains the same. Therefore, we added an addendum in this issue for side effects to keep the syndrome articles focused on the topic and also as a handy compiled reference for side-effect risk profiles. I am confident the issue will be of interest to our entire field and serve as a strong reference of clinical information that will help you teach others and treat your patients. Thanks to this issue authors for their time, expertise, and efforts. Thanks to Dr Greg Carter for the opportunity to give back to our specialty. In addition, a special thanks to
Phys Med Rehabil Clin N Am 25 (2014) xv–xvi http://dx.doi.org/10.1016/j.pmr.2014.02.002 1047-9651/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
pmr.theclinics.com
xvi
Preface
my wife, Jeanne, and sons, Noah and Leo, for providing the support to take on such an endeavor. Adam L. Schreiber, DO Department of Rehabilitation Medicine Jefferson Medical College of Thomas Jefferson University Jefferson Rehabilitation Medicine Associates 25 South 9th Street Philadelphia, PA 19107, USA E-mail address: [email protected]
Preface Challenging Pain Syndromes
Adam L. Schreiber, DO Editor
No matter whether a general or subspecialized physiatrist, we all encounter pain syndromes; therefore, when Dr Greg Carter invited me to edit an issue of Physical Medicine and Rehabilitation Clinics of North America, the topic appealed to my desire to produce an issue that spans the breadth of the specialty. Another focus of this issue is to serve as a guide to clinical medicine, which entails the best evidence with the experience of our authors to produce practical recommendations. As I edited the work of the authors, I found common themes that I would like to emphasize. In regard to ordering testing, “care must be exerted with regard to interpretation so as not to ‘over-read’ the importance of particular abnormality,” wrote Dr Michael Saulino. This applies to all aspects of medicine, but by the nature of a syndrome, testing is never pathognomonic. How many of our patients marry the finding of L5 disc bulge? Many times this does not explain any or all of their symptoms, yet 10 years later they remain devout to the beloved bulge, which may have even reabsorbed. Prior to ordering tests, I try to counsel patients that tests will likely have abnormalities; it only matters if the the findings correlate with what “you share with me.” An example is Dr Gerry Herbison has been preaching for decades that EMG is confirmation of our clinical impression; to a degree that notion should apply to all testing, especially in regard to pain syndromes. Another common theme was medication use. There are several medication utilized with pain syndromes. The rationale for use may differ for the clinical syndrome but the side-effect profile remains the same. Therefore, we added an addendum in this issue for side effects to keep the syndrome articles focused on the topic and also as a handy compiled reference for side-effect risk profiles. I am confident the issue will be of interest to our entire field and serve as a strong reference of clinical information that will help you teach others and treat your patients. Thanks to this issue authors for their time, expertise, and efforts. Thanks to Dr Greg Carter for the opportunity to give back to our specialty. In addition, a special thanks to
Phys Med Rehabil Clin N Am 25 (2014) xv–xvi http://dx.doi.org/10.1016/j.pmr.2014.02.002 1047-9651/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
pmr.theclinics.com
xvi
Preface
my wife, Jeanne, and sons, Noah and Leo, for providing the support to take on such an endeavor. Adam L. Schreiber, DO Department of Rehabilitation Medicine Jefferson Medical College of Thomas Jefferson University Jefferson Rehabilitation Medicine Associates 25 South 9th Street Philadelphia, PA 19107, USA E-mail address: [email protected]