bluuebunny/crossref_metadata_2025 huggingface dataset:
Animal Models for Post-Traumatic Stress Disorder
Authors: Perkins Elizabeth C. , Brothers Shaun P. , Nemeroff Charles B.
Published: October 2018

Animal models of post-traumatic stress disorder (PTSD) provide a wellspring of biological information about this complex condition by providing the opportunity to manipulate trauma exposure and measure biological outcomes in a systematic manner that is not possible in clinical studies. Symptoms of PTSD may be induced in animals by physical (immobilization, foot shock, underwater stress) and psychological stressors (exposure to predator, social defeat, early life trauma) or a combination of both. In addition, genetic, epigenetic and transgenic models have been created by breeding animals with a behavioral propensity for maladaptive stress response or by directly manipulating genes that have been implicated in PTSD. The effect of stressors in animals is measured by a variety of means, including observation of behavior, measurement of structural alterations in the brain and of physiological markers such as HPA axis activity and altered gene expression of central nervous system neurotransmitter system components including receptors. By comparing changes observed in stress exposed animals to humans with PTSD and by comparing animal response to treatments that are effective in humans, we can determine the validity of PTSD animal models. The identification of a reliable physiological marker of maladaptive stress response in animals as well as standard use of behavioral cutoff criteria are critical to the development of a valid animal model of PTSD.
Multigenerational Legacies of Trauma
Authors: Danieli Yael , Engdahl Brian
Published: October 2018

Multigenerational legacies of suffering are universal and as old as humankind. Given ongoing worldwide violent atrocities, understanding and addressing their intergenerational consequences is vital. Transmission mechanisms explored range from the basic biological to the complex psychological, and the sociopolitical. The first and most frequently investigated offspring population is that of Nazi Holocaust survivors. The chapter synthesizes the research on these offspring and some of the more recently studied offspring groups. It then presents the major theory of multigenerational trauma transmission—Trauma and the Continuity of Self: A Multidimensional, Multidisciplinary Integrative Framework, that provides the bases for the first valid transmission assessment measure—the Danieli Inventory for Multigenerational Legacies of Trauma. Part II of the Danieli Inventory—Reparative Adaptation Impacts—is key to assessing the well-being of the second generation. Recommendations for further research and enhancing clinical interventions are included.
PTSD and Co-Occurring Substance Use Disorders
Authors: Gilmore Amanda K. , Bountress Kaitlin E. , Barrett Emma L. , Back Sudie E. , Brady Kathleen T.
Published: October 2018

Post-traumatic stress disorder (PTSD) commonly co-occurs with a number of psychiatric disorders including depression, other anxiety disorders, and medical comorbidity. Substance use disorders (SUD) are among the most commonly co-occurring disorders with PTSD and can complicate the course of illness and treatment. This chapter will discuss co-occurring PTSD and SUD (PTSD/SUD) in terms of epidemiology, theoretical underpinnings, and clinical implications. This chapter also describes clinical assessments for PTSD/SUD and provides a list of potential assessments for use in clinical settings. Further, behavioral and pharmacological evidence-based treatments are described that can be effective in reducing both SUD and PTSD symptoms among individuals with PTSD/SUD. Future work that would help move the field forward regarding etiology and treatment of PTSD/SUD are discussed.
Psychotherapy: Psychodynamic
Authors: Gabbard Glen O.
Published: October 2018

Because of the limited data in support of psychodynamic psychotherapy, it is best considered as an alternative to empirically-validated therapies that is useful when standard forms of treatment are not desired or not effective. Recent reports have noted that many PTSD patients cannot tolerate the approaches of CPT or PE. Psychodynamic psychotherapy is a valuable alternative because the development of the therapeutic alliance may be crucial for patients to participate actively in the treatment. The psychodynamic perspective focuses on what is unique and idiosyncratic about the individual rather than how that individual is similar to other groups of patients. The specific meanings of the trauma, the defenses brought to bear to deal with the trauma, and the way the traumatic experience affects the individual’s relationships are all major foci of the treatment. Attention to rupture and repair of the therapeutic alliance may be crucial for the success of the therapy. Much more systematic research is required to support the value of this modality.
Neuromodulation Methods in PTSD
Authors: Todder Doron , Avirame Keren , Cohen Hagit
Published: October 2018

This chapter discusses the rationale and methodology for applying techniques of active and passive neuromodulation for treatment-refractory post-traumatic stress disorder (PTSD). Neuromodulation derives from the concept of neuroplasticity, which signifies long-term changes in the effectiveness of connections between distinct parts of the central nervous system. These changes are reflected across multiple levels of the nervous system, going from the cellular level to circuits and large-scale brain networks. It has been long suggested that altered neuroplasticity is a biomarker of neuropsychiatric diseases. With recent advances in neuroscience, research is emerging on evaluating the potential of modulating neural circuits by using innovative technologies, including noninvasive and invasive brain stimulation, EEG-neurofeedback, and fMRI neurofeedback.
Investigational Agents in the Treatment of Post-Traumatic Stress Disorder
Authors: Kelmendi Benjamin , Adams Thomas G. , Abdallah Chadi , Esterlis Irina , Harpaz-Rotem Ilan , Southwick Steve , Krystal John H.
Published: October 2018

This chapter highlights the breadth of the range and shallowness of the depth with which novel therapeutics for PTSD have been evaluated. None of the new treatments reviewed in this chapter have sufficient data supporting their efficacy to be strongly recommended for the treatment of PTSD. Nonetheless, the interventional approaches reviewed here are guided by our current understanding of the neurobiology of stress in animals and PTSD in humans. The range of therapeutic targets considered in this chapter reflects our growing appreciation of the complex neurobiology of PTSD. Thus, it should not be surprising that drugs targeting glutamatergic, GABAergic, opiates, glucocorticoids, cannabinoids, and voltage-gated calcium channels are in various stages of evaluation.
Addiction: Definition, Epidemiology, and Neurobiology
Authors: Torrington Matthew
Published: October 2018

This chapter discusses the DSM-5 diagnostic criteria for substance use disorders and identifies addiction as a disease of reward, motivation, and memory rooted in complex biologic changes. It explains the epidemiology of addiction and identifies the rise and fall of specific drug use and behaviors. It then moves to the neurobiology of addiction, naming the numerous survival systems that are intertwined with addiction’s genetics, early brain development, and learning pathways. Finally, it looks at why some people become addicts, describing it as a pro-inflammatory, bio-psycho-social-environmental-spiritual disease state. Addicted persons often engage in this behavior, no longer to obtain pleasure, but to relieve discomfort created by withdrawal from the drug and the negative life consequences of addiction. The chapter concludes by addressing what needs to be done in both the short- and long-term, noting that applying the disease model to addiction has been the most effective method of saving lives.
Overview of the Addiction Recovery Industry
Authors: Torrington Matthew
Published: October 2018

This chapter traces the history of drug and alcohol use in America, starting in the 1850s through Prohibition, the emergence of Alcoholics Anonymous in 1935, and the treatment evolution around the 1950s. It reviews the US Drug Policy in the 1970s, the rise of the “designated driver” movement in the 1980s. There were 52,000 deaths due to overdose in 2015 with 33,000 of these attributed to opiates. The addiction-recovery business is now a $35 billion industry; yet there is still an access-to-care issue. Finally, this chapter examines the shift in medical culture to include risk evaluation and mitigation strategies, mandatory training in addiction and pain management, and the American College of Graduate Medical Education (ACGME) recognized medical specialty, addiction medicine. It presents the six different domains to best assess what intervention or treatment program is likely to help the patient and concludes that more money needs to be directed at mental health and addiction recovery programs.
Food Addiction
Authors: Mello Edison de
Published: October 2018

Although an impressive and increasing amount of research has shown how particular foods affect brain chemistry and can lead to food addictions, the idea of food addiction as an actual disease is still controversial. The alarming growth in the obesity epidemic in the United States, however, is quickly eating away at this controversy. Research now shows that genetics, the nucleus accumbens, the gut bacteria (microbiota), and other physiological factors have a vast effect on obesity, cravings, binge eating, and food addiction. Speculation that the food industry has utilized the effects of the high glycemic index foods, such as refined starches, sugars, and fat have on the brain to engineer foods for taste, not nutrition and to get people “hooked” is also discussed. Integrative treatment approaches to food addiction that can synergically help with food addiction recovery are presented. These include biochemical restoration, IV nutrient therapy, meditation practices, pharmacological intervention, and more.
Integrative Approach to Sedative-Hypnotic Use Disorder
Authors: Rees Gayla , Shapiro Benjamin , Torrington Matthew
Published: October 2018

Sedatives, hypnotics, and anxiolytics are CNS depressants with GABAergic activity that are potentially habit-forming due to their activity in brain reward pathways. They are central in the drug overdose epidemic with benzodiazepines (BZD) being involved in approximately 31% of all fatal overdoses. There are 4 withdrawal syndromes: High dose minor and major withdrawal, low dose withdrawal, and protracted withdrawal. Benzodiazepines are chemically related positive allosteric modulators of the GABA at the GABA-A receptor. In differential expression 5 different receptor subunits play a role in acute and prolonged withdrawal syndromes. Benzodiazepines have supplanted barbiturates for treatment of anxiety and insomnia due to their wider therapeutic index. Barbiturates can be helpful managing opiate and benazodiazapeine withdrawal. Traditional Chinese Medicine can improve hypnotics-dependent insomnia. Mindfulness-based relapse prevention and yoga may offer benefits but are poorly studied.
Integrative Approach to Cannabis-Use Disorder
Authors: Danovitch Itai , Modir Shahla J.
Published: October 2018

Recreational cannabis use is widespread, with estimates of 2.8% to 4.5% of the world population having used in the past year, and many more having used over their lifetimes. While most occasional users do not suffer any consequences, among persons who have ever used cannabis, approximately 9% will develop a cannabis-use disorder at some point in their lives, and 1.8% will meet diagnostic criteria for cannabis-use disorder within the past year. Several interventions are available to treat cannabis-use disorder. Psychotherapy, delivered individually as well as in groups, is the most well-established treatment approach. Several medications may offer benefit, though evidence supporting their role is weak. Integrative treatment approaches also show promise, notwithstanding a paucity of evidence. This chapter reviews the current understanding of cannabis-use disorder, including diagnosis, epidemiology, neurobiology, and treatment. Psychotherapeutic, medication, and integrative interventions are reviewed, with a particular focus on integrative approaches.
Integrative Approach to Opiates, Opioids, and Opiate Use Disorder
Authors: Ling Walter , Torrington Matthew
Published: October 2018

This chapter defines terms such as “opiate” and “opioid” and explains their physiological functions as agonist, antagonist, and partial agonist. It notes the long history of medicinal opioid use for acute pain, as well as the curse of addiction with chronic use, highlighting the three opioid use epidemics in the United States: the morphine addiction of the Civil War era, the heroin addiction of the Vietnam War era, and the current epidemic of prescription opioid addiction. The chapter describes the commonly encountered natural, synthetic, and semi-synthetic opioids, noting their therapeutic use, potential for abuse, and their use in management of opioid use disorders. Of particular interest are the sections on detoxification and relapse prevention using methadone, buprenorphine, and naltrexone. The sections also explain the rationale for their use against the epidemiological background and recent exploration of genetic influences. The chapter also emphasizes the need for an integrated strategy in overcoming opioid addiction.
Integrative Approach to Behavioral Addictions: Internet Gaming Disorder (IGD) and Compulsive Buying Disorder (CBD)
Authors: Sagan Meredith , Fong Timothy
Published: October 2018

In recent years, awareness and concern has grown within the psychological and medical communities regarding “behavioral addictions”: these are defined as the compulsive performance of otherwise normal everyday activities such as sex, gambling, use of the Internet and online video games, and shopping. This chapter examines 3 such addictive disorders: gambling disorder, compulsive buying disorder (CBD), and Internet gaming disorder (IGD), exploring their definitions, prevalence, diagnoses, consequences, and treatment. All 3 disorders share similar neurobiological mechanisms, acting on the pleasure centers of the brain and having potentially severe social, mental, and psychological repercussions, including loss of interest in life and withdrawal symptoms as intense as those felt by substance abusers when quitting drugs. Certain pharmaceuticals, CBT, and treatment principles similar to those followed by substance abusers, as well as various non-traditional modalities such as acupuncture and yoga, all have shown promise in treating these disorders.
Psychiatric Assessment and Co-Occurring Disorders
Authors: Modir Shahla J. , Tsuang John
Published: October 2018

This chapter on co-occurring disorders examines issues pertaining to substance-use disorder and psychiatric illnesses. It takes a very close look at prevalence, diagnoses, and medication treatment strategies for both psychiatric disorders, as well as for substance-use disorders. The chapter puts special emphasis on psychiatric disorders such as depression, bipolar disorder, anxiety, psychosis, and attention deficit hyperactivity disorder. Complementary treatment tools such as use of various vitamins, fish oil, and other natural chemical agents are reviewed here as well. Finally, alternative therapies such as social rhythm therapy, exercise, neurofeedback, and meditation—which can all integrate into treatment of this population—are presented and examined.
Psychosocial Treatment Approaches for Substance Use
Authors: McFarr Lynn , Snyder Julie , Benson Lisa , Higier Rachel
Published: October 2018

Multiple psychosocial treatments for substance-use disorders have been studied for efficacy. A recent meta-analysis indicates that psychosocial interventions are effective across multiple types of substances used. In the case of opiates, psychosocial interventions combined with medication appear to be the most effective. Many studies further agree that psychosocial interventions are an integral and necessary part of treating substance-use disorders. Although theoretical orientations may differ across psychosocial treatments, they have several principles and practices in common. All involve talk therapy or talk in communities as a way to clarify triggers, build commitment, and improve accountability. Many also target addiction behaviors and work to develop alternative contingencies to reduce or eliminate use. Finally, targeting repeated performance (or building “chains of committed behavior”) decreases the likelihood of relapse. This chapter discusses the most frequently studied and employed psychosocial treatments for substance use including CBT, motivational interviewing, contingency management, mindfulness, and community-based programs.
Homeopathic Approach to Addiction
Authors: Constantinides Avghi , Modir Shahla J.
Published: October 2018

This chapter describes the homeopathic approach to the treatment of addiction, exploring both how homeopathy works and how it is helpful in the treatment of various addictions. It reviews the history of homeopathy, the homeopathic paradigm of disease, and the principles of remedy choice from a homeopathic perspective. It discusses the laws of homeopathy, including the law of similar vital force, treatment of the whole person, and the principle of minimum dose. The chapter provides case examples for alcohol, stimulants, and opiate addictions that utilize case study and observational data suggesting the value of homeopathic remedies. It reviews the administration of a homeopathic remedy including potency, frequency, contraindications, and side effects. It discusses the differences between acute and chronic homeopathy including the contrasting relationship between Western and homeopathic medicine.
Nutritional Support and Addiction
Authors: Krochmal Robert
Published: October 2018

Nutrition occupies a central position in the treatment of SUDs. Given the paradox that food can have apparently opposing effects in either causing addiction or in influencing its remedy, it is important to clarify this difference. Evidence is mounting that diseases such as obesity, heart disease, diabetes, and mental health disorders including addiction have a common root cause related to the increase in sugar and processed food consumption rather than fat consumption as has been commonly held. In addition to new integrative approach models encompassing a holistic perspective, new developments in genetics and epigenetics as well as the human microbiome and gut-brain health provide further evidence of the mechanisms by which a healthy approach to nutrition can change outcomes. Building upon the neurobiological theory of addiction and reward deficiency, these breakthroughs lead to new hope for a successful approach to recovery.
Functional Medicine Approach to Addiction
Authors: Muñoz George E. , Garcia Isabella Leoni
Published: October 2018

The functional medicine protocol complements and enhances the traditional approach to recovery. Seen from a functional medicine perspective, the path to substance/and or food addiction recovery involves a multimodal approach. It shifts the focus from the imbalances in the brain and neurotransmitters to treat the whole person. It does so by considering the metabolic, hormonal, psychologic, immunologic, and neurologic functions that have been disturbed by addiction and that further perpetuate the inflammatory state of active addiction and during recovery phases. The gut-brain axis is reviewed from all aspects. Specific microbiome interventions, micronutrient, and vitamin deficiency support is reviewed. These interventions can be addressed through lifestyle modifications (including stress-reduction techniques), nutrition, supplementation, and in-depth case protocols, which will be further reviewed in the chapter.
Exercise for Addiction and Recovery
Authors: Muñoz George E.
Published: October 2018

The role of a healthy, balanced exercise program is reviewed by Dr. Munoz from the perspective of an integrative, sports, wellness, and chronic pain specialist. The concepts are applied to the whole person approach of integrative recovery. The science involved in addiction systemic and brain inflammation is reviewed as well as the beneficial impact of exercise on these disturbances at the cytokine and molecular levels. The why, how, and what questions regarding exercise are reviewed. The role of a balanced exercise prescription in recovery and addiction treatment is reviewed with special attention to the needs of the recovering individual. Relevant supplements, specific types of exercise, and appropriate nutrition for a successful exercise prescription are reviewed including managing pain before and after exercise with safe supplements and other techniques.
Nutraceutical Treatments for Addiction Recovery
Authors: Becker Jeffrey
Published: October 2018

Current medical treatment in substance-use disorders and addiction recovery often fails to address the underlying molecular pathophysiologic mechanisms of addiction morbidity. Psychopharmacology and behavioral interventions do not directly address the cellular patterns of dysfunction in addiction but natural treatments can and should be employed in a research-based manner to support existing treatment protocols. Research into addiction pathophysiology is clear: removing the offending agent through sobriety is often not enough to restore natural premorbid physiology. Drug-induced oxidative stress and inflammation may inhibit full recovery by damaging molecular health, homeostasis, and neurological function. Prolonged activation of stress systems likely affects judgment during the “white-knuckle” stage of recovery. The author discusses research characterizing the following 3 functional categories of addiction pathophysiology: inflammation and antioxidant system degradation, stress system activation, and vitamin and mineral depletion patterns. Each section is followed by discussion of research-based natural treatments employed to support addiction recovery at the cellular level.
Interaction of Spirituality and Religion with Health, Mental Health, and Substance Abuse
Authors: Lee Bruce Y. , Newberg Andrew B. , Modir Shahla J.
Published: October 2018

Medical and scientific communities have become interested in the effects of religion on health, mental health, and substance abuse. Coverage of the interplay of religion and health is more frequent in the main stream media. There is a surge in the popularity of spiritual activities, such as yoga and mindfulness meditation, that aim to improve physical and mental health, as well as help with substance abuse. Many patients consider religion to be important and have indicated they would like to discuss religious issues with their psychiatrists. This chapter reviews the clinical effects of religious and spiritual practices on physical, mental health and health-related behaviors. Additionally, we will review the interactive effect of AA on spirituality and recovery, and the impact spirituality can have on improving abstinence from substance abuse. We also will discuss future directions in the roles of religion and spirituality in health care.
Three Dynamic Healing Modalities for the Treatment of Substance Use and Co-Occurring Disorders: Aromatherapy, Equine Therapy, and Creative Arts Therapies
Authors: Scott E. Hitchcock
Published: October 2018

This chapter comprises three subchapters, and each subchapter offers a brief introduction to 1 of 3 healing modalities: (1) aromatherapy, (2) equine therapy, and (3) creative arts therapies. All 3 healing processes are considered to be well regarded in the field of addiction treatment. Yet the credibility of each one could benefit from more well-designed, large-scale, randomized controlled trials. Even so, there is significant research supporting the efficacy of each of the 3 treatment modalities. Safety is especially important with impulsive patient populations, such as those with dual diagnoses, addiction and trauma. All three modalities are able to be powerful, and at times transformative, when practiced by qualified health practitioners. For patients who struggle with substance abuse, co-occurring disorders and adverse childhood experiences, especially those who have felt as if they were failed by traditional treatment programs, a non-traditional treatment modality may provide just the right intervention.
Creative Arts Therapies: An Integrative Modality for Addiction and Trauma Treatment
Authors: Scott E. Hitchcock
Published: October 2018

This textbook subchapter examines how the creative arts therapies are an important modality for addiction treatment. A valid argument can be made regarding art as an essential tool for effective healing, based in part upon a comprehensive review of current research. Unfortunately, due to inadequately educated staff many addiction programs are mislabeling arts and crafts projects as “creative arts psychotherapy.” This subchapter seeks to address this misnomer as well as the remarkable healing potential of art therapy when facilitated by certified professionals. The benefits and challenges of art therapy will be addressed in a preliminary fashion by providing a definition, case study overview, examples of art, an example each of the journal writing and poetry produced, and a subjective description of the impact of the creative and expressive arts via the client’s perceptions. These will be followed by a Haiku that foreshadowed the client’s success with long-term sobriety after treatment.
The Role of Aromatherapy in the Treatment of Substance Use and Co-Occurring Disorders
Authors: Skipper Cathy , Birkmayer Florian
Published: October 2018

Aromatherapy can be an important tool in the treatment of substance abuse and co-occurring disorders. When used by trained specialists, essential oils are safe, simple, and effective both in alleviating symptoms as well as helping increase self-awareness and transform consciousness. Olfaction is a powerful sensory modality, and olfactory receptors have been found in nearly every tissue of the body and parts of the Central Nervous System (CNS) relevant to addiction and motivation. Essential oils are widely used to support and alleviate nervous symptom disorders such as those triggered by addiction (i.e., anxiety, sleep problems, panic attacks, depression, stress etc.). The available scientific literature supports the traditional uses of the most common essential oils in this domain and is encouraging for the continued development of these powerful plants extracts for addiction support.
Equine-Assisted Psychotherapy for Substance Use and Co-Occurring Disorders
Authors: Birkmayer Florian
Published: October 2018

Equine-assisted psychotherapy is a promising emerging treatment for clients with substance-use and co-occuring disorders that can cause rapid transformation away from self-defeating thought and behavior patterns to a deeper sense of self-awareness, connectedness, and resilience. Reviewed here are the unique characteristics of horses as prey and as herd animals willing to interact with humans. This section will show how they become powerful therapeutic partners. Standards of practice of several equine-assisted therapy organizations are introduced. Studies and data on the effectiveness of equine-assisted therapy in substance use and co-occuring disorders are discussed.
Shamanism: Addiction and Soul Sickness
Authors: Taraborelli Dean , Villoldo Alberto , Muñoz George E.
Published: October 2018

The path of healing, self-discovery, and tackling the existential questions as to why people use drugs is addressed in this chapter. The chapter outlines the healing concepts within the Quero tradition, as these peoples were direct descendants of the Inca from ancient Andean Peru. The cosmology and oral traditions through healing motifs are timeless irrespective of cultural and chronological differences. The case examples serve as an ideal platform to launch this chapter on healing and the shamanic path in addiction treatment. Exploration of time, space, relativity, quantum physics—and their interconnectivity to the healing path—are explored. As a valuable addition to the classic approach to addiction and recovery, this chapter conforms to the whole person spiritual approaches available through medical anthropology cultural exploration: in this case, the Inca descendants, the Quero and their wisdom healing traditions.
Group Therapy and Support in Addiction Treatment
Authors: Ginsberg Rick
Published: October 2018

This chapter examines and defines the differences between group therapy and group support for people with substance abuse and addiction and investigates how these therapeutic interventions are used. A model providing guidance to integrative health-care providers on how to best assess the quality and appropriateness of various group interventions (group therapy and group support) is presented, and calls for future research are made to assist providers, clients, and researchers in determining the specific curative factors in these group interventions.
Integrative Approaches to Post-acute Withdrawal and Relapse Prevention
Authors: Modir Shahla J. , Ling Walter , Muñoz George E.
Published: October 2018

Dr. Walter Ling begins this chapter by discussing the distinction between the process of detoxification and role relapse prevention. He reviews the post acute withdrawal period, its neurobiological underpinnings, and discusses the role of stress hormones, neuro-circuity, and the importance of relapse prevention. The existential question as to why people take drugs is posed. Complex aspects of the neurobiology of post-acute withdrawal and subsequent treatment ramifications are reviewed. Drug-specific neurochemical changes are explained, including treatment to reduce cortisol and noradrenergic responses pharmacologically. Then the integrative approach to relapse prevention is reviewed by Dr. Munoz. The concept of “relapse prevention plan” is introduced and the roles of exercise, 12-step social support, and the use of novel neuro-diagnostics including Event Related Potentials (ERP) to aid in personalized risk stratification of potential future relapse. The importance and evidence of multidisciplinary approaches and social 12-step-type support are also reviewed and close out the neuroscience of the first 2 sections.
Barriers to Optimal Pain Management in the General Surgery Population
Authors: Thakur Anand C.
Published: October 2018

Barriers to the implementation of adequate pain control are multifactorial and encompass all caregivers. A complete list of barriers to adequate pain control would involve biopsychosocial factors, physiological factors, pharmacological concerns, and medical legal concerns. A short list of barriers to adequate pain control can be separated into physician knowledge, expectations and perceptions, nurses’ and other ancillary providers’ knowledge, expectations and perceptions, patient expectations and perception, management of acute pain, management of chronic pain, discrepancies of pain perception and different population groups, and both regulatory and formulary issues. To have an understanding of up-to-date recommendations and standards regarding evidence-based pain management requires a multimodal approach with a team of physicians.
Preemptive, Preventive, and Multimodal Analgesia
Authors: Chang Daniel , Castro Mia , Ratnamma Vineetha S. , Verzelloni Alessandra , Rudison Dionne , Vadivelu Nalini
Published: October 2018

Preemptive analgesia focuses on postoperative pain control and the prevention of central sensitization and chronic neuropathic pain by providing analgesia administered preoperatively. Preventive analgesia reduces postoperative pain and consumption of analgesics, and this appears to be the most effective means of decreasing postoperative pain. Preventive analgesia, which includes multimodal preoperative and postoperative analgesic therapies, results in decreased postoperative pain and less postoperative consumption of analgesics. Several advances have been made in our understanding of pain signaling pathways, which have since enabled caregivers to treat pain using a multimodal (or “balanced”) approach to providing adequate pain relief while minimizing side effects. This allows for a reduction in the doses of individual drugs and thus a lower incidence of adverse effects from any particular medication used for analgesia.
Tumescent Anesthesia in General Surgery
Authors: Cole Jacob , Rivera Victor , Tucker Anthony
Published: October 2018

Tumescent anesthesia is a fairly novel anesthetic technique originating in dermatologic and cosmetic surgery. In the 30 years since this technique was first described, it has gradually gained wider acceptance as a viable anesthetic technique for a variety of procedures. This chapter discusses the development of the tumescent anesthesia technique including the benefits of tumescence over standard local anesthesia and the safety of the technique. Local anesthetic pharmacology and pharmacodynamics are reviewed along with the different additives that complement the tumescent solution formulation. Finally, this chapter reviews some of the more common procedures utilizing tumescent anesthesia.
Pain Management for General Surgery
Authors: Stammen Katherine , Siddaiah Harish , Brechtel Cody , Cornett Elyse M. , Fox Charles J. , Kaye Alan D.
Published: October 2018

Pain is multidimensional and subjective, which makes it difficult to treat. Newer treatment modalities have been under development with a better understanding of pain pathways in recent years. These treatments take advantage of the multifactorial components of pain, including agents such as ketamine, capsaicin, gabapentin, pregabalin, long-acting opioids, peripheral nerve blockade, and patient-controlled analgesia. Numerous studies have revealed not only efficacy but additive and/or synergistic effects when multiple agents are utilized for pain management. Overall, adequate perioperative pain control is important both in an acute setting and in preventing the development of a chronic pain condition, which causes significant short- and long-term negative consequences. Best practice strategies are being utilized based on clinical studies to reduce pain and improve patient needs after surgery.
Neuraxial Analgesia and Anesthesia in Chronic Opioid Users and Patients with Pre-existing Pain
Authors: Chen Grace , Valentine Ashley
Published: October 2018

Neuraxial anesthesia and analgesia are effective modalities for surgery and perioperative pain management, respectively. These techniques may have nonanalgesic benefits as well, including improved 30-day mortality benefit, decreased risk of perioperative pneumonia, decreased risk of persistent postoperative pain, and attenuation of the stress response to surgery with improved survival in certain cancers. Post-operative pain control with epidural can be especially beneficial for opioid tolerant chronic pain patients compared to enteral or parenteral analgesics alone. In patients with previous back surgery or scoliosis, neuraxial techniques may be technically difficult. However, there is no evidence to suggest neuraxial approaches worsen pre-existing back pain. The exceptions are a pathology that reduces spinal canal cross-sectional area (e.g., severe spinal stenosis) and spinal infection. Neuraxial techniques should be avoided in these patients. Preprocedural labs and imaging are dictated by patient comorbidities, medication, and anatomy (e.g. scoliosis or spinal column pathology).
Pain Management in Body Contouring Procedures
Authors: Gary Cyril S. , Kim Samuel , Narayan Deepak
Published: October 2018

Body contouring procedures, including abdominoplasty, liposuction, implant placement, body contouring following bariatric surgery, and gluteal augmentation with autologous fat grafting, continue to be some of the most popular plastic surgery operations performed. Given that these surgeries frequently involve perturbing large areas of the body, postoperative pain can be significant, and effective perioperative pain management (with a particular emphasis on multimodal pain management strategies aimed at minimizing opioid consumption) is crucial for optimizing outcomes and patient satisfaction. Subsequently, the first half of this chapter addresses general management strategies for body contouring procedures, and the second half covers specific considerations for each aforementioned body contouring procedure.
Nonpharmacologic Management of Postsurgical Pain
Authors: Carter Jessica , Pyati Srinivas
Published: October 2018

As a component of a multimodal analgesic approach, psychological and behavioral interventions are gaining popularity and importance with a goal to reduce the doses of the analgesics consumed during the perioperative period. This chapter reviews the use of neurostimulation, including transcutaneous electrical stimulation (TENS), in the postoperative period. The goal is to broaden perspectives on possible components of a multimodal, patient-centered regimen that includes pharmacologic and nonpharmacologic therapies to improve the postoperative experience.
Management of Neuropathic Postoperative Pain
Authors: Saberski Ean , Saberski Lloyd
Published: October 2018

Pain following surgery is routine and unavoidable but expected to resolve with time. In some cases, postoperative pain persists as the result of a neuropathic process such as a neuroma or nerve entrapment. Postoperative neuropathic pain is physiologically distinct from acute pain, but the mechanisms by which pain is transduced, transmitted, decoded, and modulated are shared. Effective treatment regimens for postoperative neuropathic pain employ a deliberate strategy to disrupt the aberrant nociceptive signal. Some surgeries are high risk for chronic postoperative pain with postherniorrhaphy pain syndrome and persistent pain following breast cancer surgery existing as well described entities in the literature.
Preoperative Patient Evaluation for Anesthesia Care Outside of the Operating Room
Authors: Beg Yasmeen , Sweitzer BobbieJean
Published: October 2018

Increasing numbers of patients with serious comorbidities undergo procedures that require anesthesia services outside of the operating room (OOOR). A general anesthetic requiring instrumentation of the airway may pose a greater risk than many procedures performed in OOOR settings. A thorough review of the patient’s history and medical records should be undertaken as part of the preanesthetic assessment. Preprocedure testing is often unnecessary unless there is a medical indication or the results will alter management. The patient’s comorbidities and the nature of the procedure are considered when managing medications. Preparation to lower the risk of complications and improve outcomes during and after procedures requiring anesthesia is the most important goal. Identification and modification of risk are essential. As the numbers of patients having anesthesia in OOOR locations increase, anesthesiologists must continue to innovate to provide patients with the best preoperative services.
Recovery and Discharge for Procedures Conducted Outside of the Operating Room
Authors: Abdullah Hairil R. , Chung Frances
Published: October 2018

This chapter provides contemporary perspectives on the issues of recovery assessment and monitoring, as well as an overview of the criteria-related discharge following anesthesia outside the operating room. The need for appropriate monitoring in the recovery period is argued based on data from an outcomes and claims registry. Discharge scoring systems are also discussed together with pertinent postanesthesia issues that may delay discharge from the postanesthesia care unit, such as nausea and vomiting, significant pain, as well as the need for mandatory patient escort. The standards and guidelines mentioned in this chapter apply not only to the anesthesiologists, but also to other physicians who supervise the recovery of patients in different units.
CT- and PET/CT-Guided Interventional Radiology Procedures
Authors: Bhagavatula Sharath K. , Souza Daniel A. T. , Flusberg Milana , Silverman Stuart G. , Shyn Paul B.
Published: October 2018

Computed tomography (CT) has become a valuable guidance modality for a large number of diagnostic and therapeutic percutaneous interventions. Diagnostic and therapeutic interventions guided by CT are among the most common interventional radiology procedures performed in clinical practice. Common diagnostic CT-guided interventions include tissue biopsies, fluid aspirations, and catheter drainages. Needle biopsies can be used to obtain tissue for cytologic or histologic assessment from almost any anatomical region of the body. Positron emission tomography (PET)/CT–guided diagnostic and therapeutic interventions have emerged recently and are increasing in frequency and number of indications. This chapter discusses common interventional procedures that are performed in both the interventional CT and PET/CT suites and outlines patient issues, procedural techniques, radiation/safety, and other clinical considerations that pertain to both interventionalists and anesthesiologists.
Anesthesia for Diagnostic and Therapeutic Radiologic Procedures
Authors: Amin Annie , Cutter Thomas W.
Published: October 2018

This chapter discusses the use of anesthetics in a variety of diagnostic and therapeutic radiologic procedures. Diagnostic procedures are anatomic or functional, minimally or noninvasive, and seldom require anesthesia support; anesthesia is typically only requested for these procedures because of a patient’s physiological or psychological needs. Recognizing and addressing a patient’s comorbidities and other concerns are similar to care given in the surgical setting. The imaging environment and procedures pose additional requirements and constraints, which are unique and require specific solutions; there is frequently no single best anesthetic technique for a given procedure. Radiologists serve the critical function of deciding whether to consult the anesthesiologist or perform a procedure alone. If the decision is to proceed with moderate sedation (administered by a nonanesthesia professional), the importance of vigilant clinical monitoring cannot be understated. In all cases, the patient deserves care that is consistent with the parameters, guidelines, and standards established by the various accrediting agencies and professional societies
Anesthesia in the Radiation Oncology Suite
Authors: Harris Eric A. , Candiotti Keith
Published: October 2018

Cancer continues to be a leading cause of mortality worldwide and ranks second among the pediatric population. Radiation therapy (XRT) is a potent tool used by oncologists to manage this disease. Although treatment is typically painless, the need for immobilization has resulted in anesthesiologists frequently being consulted to provide service to these patients during their treatment. In addition to the challenges of providing anesthesia in a non–operating room environment, the provider must tailor an appropriate anesthetic for the simulation or XRT treatment sessions. Complications are rare but may be exacerbated by the distance between the patient and the anesthesia provider. Finally, the anesthesiologist must be prepared to discuss issues related to multiple anesthetic exposures with the patient and caregivers.
Anesthesia for Assisted Reproductive Technologies
Authors: Kovacheva Vesela , Sequeira Patricia M.
Published: October 2018

This chapter provides a review of the current sedation and anesthetic approaches for in vitro fertilization (IVF). It starts with a concise overview of the medical fundamentals of IVF, including controlled ovarian hyperstimulation (COH), oocyte retrieval (OR), sperm retrieval, embryo transfer, and dilation and curettage. Next follows a description of the facilities and roles of the personnel involved. The main part of the chapter focuses on the sedation goals, risks, and selection of anesthetic techniques for IVF. At the end of the chapter, the most common postsedation considerations—like pain, postoperative nausea and vomiting (PONV), vasovagal syncope, and bleeding—are discussed.
Anesthesia for Urologic Procedures
Authors: Maani Christopher V. , Horne Gaelen
Published: October 2018

With advances in technology over the past few decades and the development of new and less invasive surgical techniques, procedures that once required a traditional operating room can now be accomplished in smaller outpatient settings. Maximizing efficiency and improving patient outcomes, while minimizing hospitalization and recovery time has become a focus of many anesthetic practices throughout the United States. Because more procedures are being performed in outpatient and outside of the OR (OOOR) settings, it is increasingly important for the anesthesiologist to ensure patient and personnel safety in addition to providing an optimal anesthetic for the patient. This chapter will discuss anesthesia for common urologic outpatient/OOOR procedures, including cystourethroscopy, ureteroscopy, transurethral procedures except TURP, laser use, percutaneous renal procedures, and extracorporeal shock wave lithotripsy.
Anesthesia for Procedures in the Emergency Department
Authors: Andruchow James E. , Easter Benjamin
Published: October 2018

The practice of emergency medicine has changed significantly over the past several decades. It has evolved into a separate and distinct specialty with a unique knowledge base and training program. As the specialty has evolved, so too has the complexity of patients being cared for in the emergency department (ED), as well as the range of tests and treatments being performed. For many of these patients, the acute management of pain and anxiety is an essential component of their ED care and fundamental to the performance of diagnostic and therapeutic interventions. Consequently, possessing an arsenal of anesthesia techniques is essential to the safe and effective practice of modern emergency medicine. This chapter reviews the provision of such anesthesia in the ED setting.
Procedures in the Adult and Neonatal Intensive Care Units
Authors: Read Matthew , Maani Christopher V.
Published: October 2018

Bedside procedures in the ICU are an integral component of critical care medicine. Anesthesiologists who are assigned to the ICU must adapt principles of safe and effective anesthesia practice to this novel outside-of-the-operating-room environment. There are several reasons for surgical procedures to sometimes be performed at the bedside in the ICU, such as the avoidance of transporting unstable patients from the ICU to the OR, or the lack of adequate time to mobilize resources to perform an urgent procedure in the OR. Readiness of the entire ICU team is essential to avoid compromising care due to production pressure or lack of standards routine to the OR environment. This chapter discusses the types of procedures performed in the ICU and reviews the requirements of performing them successfully.
Pain Management Procedures
Authors: Maani Christopher V. , Lopez LT Col Edward M.
Published: October 2018

Patients referred to pain clinics are often those with the most severe pain, who have failed more conservative approaches or strictly medical modalities. In other instances, the patients are referred for concerns of comorbidities or lack of pain management resources such as a clinic and procedure room with fluoroscopic capabilities. While the goal for these percutaneous interventions is improved pain control, they should be considered adjuncts and not replacements for a comprehensive pain management strategy. Most patients benefit from multimodal pain medication strategies, physical therapy, stress management and relaxation training, occupational therapy, acupuncture, or other treatment therapies. This chapter provides an overview and discussion of several of the most common pain procedures encountered in clinical pain management practices today. Each procedure is discussed with an initial description of the strategy, including technical aspects, medical indications, and relevant complications important for the pain management physician to understand. This will be followed by a section on considerations for anesthetic management.