CORE CURRICULUM FOR PROFESSIONAL EDUCATION IN PAIN

Mission Statement of IASP Press

The International Association for the Study of Pain (IASP) is a nonprofit, interdisciplinary organization devoted to understanding the mechanisms of pain and improving the care of patients with pain through research, education, and communication. The organization includes scientists and health care professionals dedicated to these goals. The IASP sponsors scientific meetings and publishes newsletters, technical bulletins, the journal Pain, and books. The goal of IASP Press is to provide the IASP membership with timely, high-quality, attractive, low-cost publications relevant to the problem of pain. These publications are also intended to appeal to a wider audience of scientists and clinicians interested in the problem of pain.

CORE CURRICULUM FOR PROFESSIONAL EDUCATION IN PAIN

Editor

J. Edmond Charlton, MBBS, FRCA

Committee on Education of the International Association for the Study of Pain J. Edmond Charlton, MBBS, FRCA, United Kingdom, Chair Pedro F. Bejarano, MD, Spain Michael J. Bond, MD, PhD, DSc, DUniv, FRCS, FRCPsych, FRCP, FRCA, FRSE, FRSA, United Kingdom, ex officio Stephen H. Butler, MD, Sweden Geoffrey Gourlay, PhD, BPharm, Australia Dilip Kapur, MB ChB, United Kingdom Patricia A. McGrath, PhD, Canada Barry J. Sessle, MDS, PhD, Canada Olaitan A. Soyannwo, MMed, DA, FWACS, Nigeria Masaya Tohyama, MD, PhD, Japan Dennis C. Turk, PhD, USA Paul J. Watson, MSc, MCSP, United Kingdom C. Peter N. Watson, MD, FRCP, Canada Harriet M. Wittink, PhD, PT, USA

IASP PRESS SEATTLE

 2005 IASP Press International Association for the Study of Pain

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Timely topics in pain research and treatment have been selected for publication, but the information provided and opinions expressed have not involved any verification of the findings, conclusions, and opinions by IASP. Thus, opinions expressed in Core Curriculum for Professional Education in Pain do not necessarily reflect those of IASP or of its officers, councillors, and committee members. No responsibility is assumed by IASP for any injury and/or damage to persons or property as a matter of product liability or negligence, or from any use of any methods, products, instruction, or ideas contained in the material herein. Because of the rapid advances in the medical sciences, the publisher recommends that there should be independent verification of diagnoses and drug dosages.

Published by: IASP Press International Association for the Study of Pain 909 NE 43rd St., Suite 306 Seattle, WA 98105-6020, USA Fax: 206-547-1703 www.iasp-pain.org www.painbooks.org

Contents
Contributing Authors Foreword Part I. General 1. Anatomy and Physiology 2. Pharmacology of Pain Transmission and Modulation 3. The Development of Pain Systems 4. Designing, Reporting, and Interpreting Clinical Research Studies about Treatments for Pain: Evidence-Based Medicine 5. Animal Models of Pain and Ethics of Animal Experimentation 6. Ethical Standards in Pain Management and Research Part II. Assessment and Psychology of Pain 7. 8. 9. 10. 11. 12. A. 13. 14. 15. 16. B. 17. 18. 19. 20. 21. 22. 23. 24. A. 25. B. 26. 27. 28. Pain Measurement in Humans Placebo and Pain Clinical Nerve Function Studies and Imaging Epidemiology Psychosocial and Cultural Aspects of Pain Sex and Gender Issues in Pain Pharmacology Opioids Antipyretic Analgesics: Nonsteroidals, Acetaminophen, and Phenazone Derivatives Antidepressants and Anticonvulsants Miscellaneous Agents Other Methods Psychological Treatments (Cognitive-Behavioral and Behavioral Interventions) Psychiatric Treatment Stimulation-Produced Analgesia Interventional Pain Management Including Nerve Blocks and Lesioning Surgical Pain Management Physical Medicine and Rehabilitation Work Rehabilitation Complementary Therapies Taxonomy Taxonomy of Pain Syndromes Tissue Pain Acute and Postoperative Pain Cancer Pain Cervical Radicular Pain

Part III. Treatment of Pain

Part IV. Clinical States

29. 30. 31. 32. 33. C. 34. 35. 36. D. 37. 38. E. 39. 40. F. 41. 42. 43. 44. 45.

Neck Pain Lumbar Radicular Pain Low Back Pain Musculoskeletal Pain Muscle and Myofascial Pain Visceral Pain Visceral Pain Chronic Urogenital Pain Pain in Pregnancy and Labor Headache and Facial Pain Headache Orofacial Pain Nerve Damage Neuropathic Pain Complex Regional Pain Syndromes Special Cases Pain in Infants, Children, and Adolescents Pain in Older Adults Pain Issues in Individuals with Limited Ability to Communicate Due to Cognitive Impairment Pain Relief in Substance Abusers Pain Relief in Areas of Deprivation and Conflict

Contributing Authors
Anna Maria Aloisi, MD Instituto di Fisiologia Umana Universito degli Studi di Siena Via Aldo Moro 53100 Siena Italy Ralf Baron, MD Klinik fr Neurologie CAU-Kiel Niemannsweg 147 24105 Kiel Germany Rae F. Bell, BA, MD Department of Anaesthesia and Intensive Care Haukeland University Hospital 5021 Bergen Norway Richard E. Berger, MD Department of Urology Health Sciences Building University of Washington Box 356510 1959 NE Pacific Seattle, WA 98195 USA Nikolai Bogduk, MD, PhD Newcastle Bone and Joint Institute David Madison Building Royal Newcastle Hospital Newcastle, NSW 2300 Australia Lynn M. Breau, PhD Pediatric Pain Management Program University of Dalhousie and IWK Health Centre Halifax, NS B3H 4H7 Canada Brenda Bursch, PhD Neuropsychiatric Pain Service UCLA Westwood Plaza Los Angeles, CA 90024 USA M. Catherine Bushnell, PhD Center for Research on Pain Room M-19 Strathcona A&D Building McGill University 3640 University Street Montreal, PQ H3A 2B2 Canada Michael J. Butler, MB ChB, DOb(NZ), FRCP, FRACP, FFPMANZCA Rheumatology Department Building 7 Private Bag 92024 1 Auckland New Zealand Stephen H. Butler, MD Department of Anesthesia and Intensive Care University Hospital 75185 Uppsala Sweden J. Edmond Charlton, MBBS, DObstRCOG, FRCA 1 The Wynding Bamburgh Northumberland NE69 7DB United Kingdom Fernando Cervero, MD, PhD, DSc Anesthesia Research Unit Room 1207 McGill University McIntyre Medical Building 3655 Promenade Sir William Osler Montreal, PQ H3G 1Y6 Canada C. Richard Chapman, PhD Pain Research and Management Center University of Utah 615 Arapeen Drive #200 Salt Lake City, UT 84108 USA David A Cherry, MBBS, FFARACS Pain Management Unit Flinders Medical Centre Bedford Park, SA 5042 Australia Jose Closs, PhD, MPhil, RGN Department of Nursing Research School of Healthcare Studies Baines Wing University of Leeds Woodhouse Lane Leeds LS2 9UT United Kingdom Beverly J. Collett, MBBS, FRCA Pain Management Centre Leicester Royal Infirmary Infirmary Square Leicester LE1 5WW United Kingdom Peggy Compton, RN, PhD Acute Care Section UCLA School of Nursing 4-246 Factor Building Los Angeles, CA 90095 USA Sandra J. Counts, MD, FASAM 4131 42nd NE Seattle, WA 98105 USA Edward C. Covington, MD Section on Pain Medicine Cleveland Clinic Foundation 9500 Euclid Avenue Cleveland, OH 44106 USA Michael J Cousins, AM, MB, MS, MD, FANZCA, FFPMANZCA Department of Anaesthesia and Pain Management University of Sydney Royal North Shore Hospital St Leonards, NSW 2065 Australia Kenneth D. Craig, PhD Department of Psychology University of British Columbia 2136 West Mall Vancouver, BC V6T 1Z4 Canada

Anthony H. Dickenson, PhD Department of Pharmacology University College London Gower Street London WC1E 6BT United Kingdom Robert H. Dworkin, PhD Department of Anesthesiology University of Rochester Medical Center 601 Elmwood Drive, Box 604 Rochester, NY 14642 USA W. Thomas Edwards, MD, PhD Harborview Medical Center Anesthesiology Box 359724 Seattle, WA 98104 USA John T. Farrar, MD, PhD Center for Clinical Epidemiology and Biostatistics University of Pennsylvania 423 Guardian Dr., Blockley Hall, Room 816 Philadelphia, PA 19104 USA Roger B. Fillingim, PhD University of Florida Public Health Service and Research PO Box 100404 1600 SW Archer Road, Room D8-44A Gainesville, FL 32610 USA Maria Fitzgerald, PhD Department of Anatomy and Developmental Biology University College London Gower Street London WC1E 6BT United Kingdom Roeland Gaymans, MD, PhD Lignestraat 15 4921 ET Made The Netherlands Stephen J. Gibson, PhD National Ageing Research Institute PO Box 31 Parkville, VIC 3052 Australia Gerald F. Gebhart, PhD Department of Pharmacology Bowen Science Building University of Iowa Iowa City, IA 52242 USA

Douglas Gourlay, MD, MSc, FRCPC, FASAM Centre for Addiction and Mental Health Wasser Pain Management Centre Mount Sinai Hospital University of Toronto 600 University Avenue Toronto, ON M5G 1X5 Canada Geoffrey Gourlay, PhD, FFPMANZCA Pain Management Unit Flinders Medical Centre Bedford Park, SA 5042 Australia Ruth E. Grunau, PhD Centre for Community Child Health Research University of British Columbia F605B 4480 Oak Street Vancouver, BC V6H 3V4 Canada Thomas Hadjistavropoulos, PhD Department of Psychology University of Regina 3737 Waskana Parkway Regina, SK S4S 0A2 Canada Ji-Sheng Han, MD Neuroscience Research Institute Peking University Health Science Center 38 Xue Yuan Road 100083 Beijing Peoples Republic of China Howard A. Heit, MD, FACP, FASAM 8316 Arlington Boulevard, Suite 232 Fairfax, VA 22031 USA Fiona Hicks Consultant in Palliative Medicine St Jamess University Hospital Becket Street Leeds, W. Yorks LS9 7TF United Kingdom Anita Holdcroft, MB, ChB, MD, FRCA Department of Anaesthesia Chelsea and Westminster Hospital 369 Fulham Road London SW10 9NH United Kingdom

John H. Hughes, MB, BS, FRCA Department of Pain Relief James Cook University Hospital Marton Road Middlesbrough TS4 3BW United Kingdom Anne Hunt, RGN, PhD Royal College of Nursing Institute Radcliffe Infirmary Woodstock Road Oxford OX2 6HE United Kingdom Troels S. Jensen, MD, PhD Department of Neurology Aarhus University Hospital 8000 Aarhus Denmark Eija A Kalso, MD, PhD Pain Relief Unit Helsinki University Haartmaninkatu 4 PO Box 340 0029 Helsinki Finland Dilip Kapur, MB, ChB, FRCA Pain Management Unit Flinders Medical Centre Bedford Park, SA 5042 Australia Francis J. Keefe, PhD Box 3159 Department of Psychology Duke University Medical Center Durham, NC 27710 USA Margaret M. Kotz, DO Addiction Recovery Services University Hospitals of Cleveland Case Western Reserve Medical School 11100 Euclid Ave. Cleveland, OH 44106 USA Walter Ling, MD 16556 Park Lane Circle Los Angeles, CA 90049 USA Phillipe A. Lacoux, MD Department of Anaesthesia Ninewells Hospital Dundee DD1 9SY United Kingdom

John D. Loeser, MD Department of Neurological Surgery University of Washington Box 356470 Seattle WA 98195 USA Joyce H. Lowinson, MD Department of Psychiatry The Rockefeller University 1230 York Avenue New York, NY 10021 USA Pamela E. MacIntyre, MBBS, FANZCA Acute Pain Service University of Adelaide Royal Adelaide Hospital North Terrace Adelaide, SA 5000 Australia William A. Macrae, MB, ChB, DObstRCOG, FRCA The Pain Service Ninewells Hospital Dundee DD1 9SY United Kingdom S. Malhotra, MBBS, FRCA Magill Department of Anaesthesia, Intensive Care and Pain Management Department of Anaesthesia Chelsea and Westminster Hospital 369 Fulham Road London SW10 9NH United Kingdom Gary J. McFarlane, MB, ChB, PhD Chronic Disease Epidemiology Unit Room 2-705 University of Manchester Stopford Building Oxford Road Manchester M13 9PT United Kingdom Patricia A. McGrath, PhD Chronic Pain Program The Hospital for Sick Children University of Toronto 555 University Avenue Toronto, ON M5G 1X8 Canada Patrick J. McGrath, PhD Pain and Palliative Care Program Dalhousie University and IWK Health Centre Halifax, NS B3H 4H7 Canada

Ross McPherson, MBBS, FANZCA Department of Anaesthesia and Pain Management University of Sydney Royal North Shore Hospital St Leonards, NSW 2065 Australia Henry J. McQuay, DM, FRCA, FRCP(Edin) Oxford Pain Relief Unit Churchill Hospital Headington, Oxford OX3 7LJ United Kingdom George Mendelson, MBBS, MD, FRANZCP, FFPMANZCA Suite 18, 33 Queens Road Melbourne, VIC 3004 Australia Henry R. Miyoshi, BS Department of Pharmacy Harborview Medical Center ZA-55 325 Ninth Avenue Seattle, WA 98104 USA Lnac Monconduit, PhD INSERM E216 Neurobiologie de la Douleur Trigminale Facult de Chirurgie Dentaire 11 Boulevard Charles de Gaulle 63000 Clermont-Ferrand France Turo J. Nurmikko, MD Pain Research Institute Clinical Sciences Building University Hospital Aintree Liverpool L9 7AL United Kingdom Tim F. Oberlander, MD, FRCPC Division of Developmental Pediatrics and Centre for Community Child Health Research University of British Columbia 4480 Oak Street Vancouver, BC V6H 3V4 Canada Akiko Okifuji, PhD Pain Research and Management Center University of Utah 615 Arapeen Drive #200 Salt Lake City, UT 84108 USA

Jes Olesen, MD Department of Neurology University of Copenhagen Glostrup Hospital 57 Nordre Ringwej 2600 Glostrup Denmark Jon B. Olson, MD 11505 6th NW Seattle, WA 98177 USA Gayle G. Page, RN, DNSc School of Nursing Johns Hopkins University 525 North Wolfe Street Baltimore, MD 21205 USA Minha Rajput, ND, DO, BsC The Pain Service Ninewells Hospital Dundee DD1 9SY United Kingdom Ke Ren, MD, PhD 666 West Baltimore Street, Room 5A26 University of Maryland Dental School Baltimore, MD 21201 USA Patricia A. Roche, MSc, PhD, CSP(Dip) School of Health Sciences, Physiotherapy Queen Margaret University College Leith Campus Edinburgh EH6 8HF United Kingdom Michael C. Rowbotham, MD UCSF Pain Clinical Research Center 1701 Divisadero Street Suite 480 San Francisco, CA 94115 USA Seddon R. Savage, MS, MD Dartmouth Center on Addiction, Recovery and Education 40 North College Street Hanover, NH 03755 USA Sidney H. Schnoll, MD, PhD Purdue Pharma L.P. One Stamford Forum Stamford, CT 06901 USA

Catherine J. Seers Royal College of Nursing Institute Radcliffe Infirmary Woodstock Road Oxford OX2 6HE United Kingdom Barry J. Sessle, MDS, PhD, DSc, FRSC Faculty of Dentistry University of Toronto 124 Edward Street Room 366 Toronto ON M5G 1G6 Canada Karen H. Simpson, FRCA Consultant in Anaesthesia and Pain Management St Jamess University Hospital Becket Street Leeds, W. Yorks LS9 7TF United Kingdom Soren H. Sindrup, MD Department of Clinical Pharmacology Institute of Medical Biology Odense University 5000 Odense Denmark R. William Stones, MD, FRCOG Department of Gynaecology University of Southampton Level F (815) Princess Anne Hospital Southampton SO16 5YA United Kingdom Karen L. Syrjala, PhD Fred Hutchinson Cancer Research Center D5-220 1100 Fairview Avenue North Seattle, WA 98109 USA

Rolf-Detlef Treede, MD Institute of Physiology Duesbergweg 6 55128 Mainz Germany Dennis C. Turk, PhD John and Emma Bonica Professor of Anesthesiology and Pain Research Department of Anesthesiology University of Washington Seattle, WA 98195 USA Luis Villanueva, DDS, PhD INSERM, E216, Neurobiologie de la Douleur Trigminale Facult de Chirurgie Dentaire 11, Boulevard Charles de Gaulle 63000 Clermont-Ferrand France Paul J. Watson, PhD, MSc, MCSP Department of Anaesthesia and Pain Management University of Leicester Gwendolen Road Leicester LE5 4PW United Kingdom Judith Watt-Watson, RN, PhD Faculty of Nursing and Centre for the Study of Pain University of Toronto 124 Edward Street, Room 374 Toronto, ON M5G 1G6 Canada

Amanda C. Williams, PhD Clinical Health Psychology University College London Gower Street London WC1E 6BT United Kingdom Harriet M. Wittink, PhD, PT, OCS Scherpenburgerwaard 6 3984 PB Odijk The Netherlands S.M. Yentis, FRCA Magill Department of Anaesthesia, Intensive Care and Pain Management Department of Anaesthesia Chelsea and Westminster Hospital 369 Fulham Road London SW10 9NH United Kingdom Lonnie K. Zeltzer, MD Pediatric Pain Program UCLA School of Medicine 10833 Le Conte Avenue, #22-464 MDCC Los Angeles, CA 90095 USA

Foreword
T he third revision of the International
Association for the Study of Pain (IASP) Core Curriculum has been many years in gestation. It follows the very successful format used by Dr. Howard L. Fields, editor of the second edition. For the first time IASP proposes to make this core curriculum available both in printed form and via the IASP Web site (www.iasp-pain.org). Inevitably, the information in this curriculum is, to a greater or lesser degree, out of date before publication. In the future, the curriculum core group believes the Web to be an ideal way to bring timely and rapid updates of this curriculum to the widest possible audience. We hope that this resource can become a dynamic and freely available asset for anyone with an interest in pain. Readers and users of the core owe the biggest debt of thanks to the many authors who have given their time and knowledge to this revision of the curriculum. The content has been expanded by over one-third; new chapters have been added, and virtually all the text and the references have been revised. It is hoped that members will find this a significantly improved resource for patient care and training purposes. The completion of the third edition of the core would not have been possible without the huge amounts of hard work carried out by the editorial production team in the IASP office in Seattle: Elizabeth Endres (Production Editor), Kathy Havers (Programs Coordinator), and Dale Schmidt (Desktop Technician). In addition, three individuals have carried the majority of the workload of preparing and collating the material in the Core Curriculum. This group has seen this project through to its conclusion, and it is a pleasure to acknowledge the enormous contributions of Drs. Stephen Butler, Dil Kapur, and, in particular, Geoffrey Gourlay. J. EDMOND CHARLTON