Pain Management in Vulnerable Populations (August 2024)

Pain is ubiquitous to human experience. When pain becomes chronically persistent after acute injuries are repaired or as diseases progress, health systems are challenged to reduce pain’s negative impact on an individual patient’s life trajectory and chronic pain’s collective impact on public health. Pain Management in Vulnerable Populations presents a diverse set of chapters that examine this challenge through the lens of vulnerability. There are special considerations for patients who are considered pain-vulnerable with respect to assessment and treatment and the variability of their access to good care. Medicine’s practices, while increasingly being guided by evidence-based algorithms from large data, are also becoming more personalized and tailored to individual patient needs. Each vulnerable group demands a unique approach – this book reveals the details behind the history, examination, and therapeutic options for vulnerable patients in pain.

Individual chapters explore conceptual models of vulnerability to pain across the lifespan, beginning in infancy, and in specific clinical populations defined by age, gender, sexual orientation, clinical condition, and healthcare setting. Topics examined range from genomics to sociomedical contexts affecting care such as medical ethics, racial disparities, adverse childhood experiences, disability and workers’ compensation, incarceration, torture, military, youth sport, and LGBTQ identity. Challenges to the management of the trajectory of pain are considered in settings ranging from emergency room, palliative and end-of-life care, and nursing homes, prisons, the battlefield, and developing nations. Chapters on illnesses such as sickle cell disease, substance use and mental illness, dental disease, obesity, suicide, HIV, COVID-19, and GI disease discuss personalized treatment plans for each patient’s unique needs.

Pain Management in Vulnerable Populations serves as an invaluable resource for pain physicians and will also appeal to primary care physicians as pain is one of the most frequently stated reasons for seeing a primary care physician.

TABLE OF CONTENTS

Section 1: What is a Vulnerable Patient?
Chapter 1: Model of Pain in Vulnerable Populations. What is a Vulnerable Chronic Pain Patient? Social Determinants of Health
Chapter 2: Ethical Considerations in the Context of the Biopsychosocial Model
Chapter 3: Pain Genomics-Defining the Vulnerable Patient
Section 2: The Vulnerable Patient: Pain Throughout the Lifespan
Chapter 4: The Vulnerable Patient: Pain Throughout the Lifespan
Chapter 5: Pain in Infants and Children
Chapter 6: Pain in Older Adults
Chapter 7: Pain in Women
Chapter 8: Pain in LGBTQ
Chapter 9: Pain in the Disabled (and in Worker’s Compensation)
Chapter 10: Pain in Patients with Cognitive Impairment (Dementia, Brain Injury, and Developmental Delay)
Chapter 11: Pain among Military Personnel
Chapter 12: Pain at the End-of-Life
Section 3: The Vulnerable Patient: Social Determinants of Pain
Chapter 13: Pain and Adverse Childhood Experiences
Chapter 14: Racial Disparities and Pain- Black, Native American, Latino
Chapter 15: Pain in Patients living in Congregant Settings (Nursing Home, Incarceration, Migrant and Border Settings)
Chapter 16: Pain and Torture: War’s Civilian Survivors and Refugees
Chapter 17: Pain in Extreme Situations: The Battlefield and Disasters
Chapter 18: Pain in Developing Nations
Section 4: The Vulnerable Patient: Pain Related to Substance Use, Mental Health, and Suicide
Chapter 19: Pain in Patients with Substance Use Disorders
Chapter 20: Pain and Mental Health (Depression and Anxiety Disorders)
Chapter 21: Pain and Suicide
Chapter 22: Pain in the Seriously Mentally Ill
Section 5: The Vulnerable Patient: Pain Related to Medical Conditions
Chapter 23: Cancer Pain
Chapter 24: Pain in Sickle Cell Disease
Chapter 25: Pain in Chronic GI Disease: Irritable Bowel and Regional Enteritis
Chapter 26: Pain in Patients with HIV
Chapter 27: Pain Related to Thoracic Outlet Syndrome
Chapter 28: Pain Related to Obesity
Chapter 29: Pain and Covid-19
Section 6: The Vulnerable Patient: Management of Pain in Special Circumstances
Chapter 30: Pain and Youth Sports
Chapter 31: Managing Pain in Patients on Long Term Opioids (Surgery and Outpatient)
Chapter 32: Risk of Chronic Pain during Acute, ICU, and Postsurgical Pain
Chapter 33: Pain in ER patients
Chapter 34: Facial and Dental Pain