Neuropathic Pain Causes, Management and Understanding 1st Edition

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Neuropathic Pain: Causes, Management and Understanding 1st Edition
by Cory Toth (Editor), Dwight E. Moulin (Editor)

Preface
As neurologists, we remember the stories about epi-
lepsy being in the Dark Ages of treatment. When
scribed by the ancient Babylonians 3000 years ago,
epilepsy was described as “demons attacking the
person.” Different seizures were due to different
spirits invading the body. Over time, epilepsy evolved
to become the “falling sickness” in the Middle Ages,
and the concept of being caused by demons started to
fade, but patients with the condition were still kept in
mental hospitals. It was only after scientific discover-
ies over the past century took place that epilepsy was
understood to be a treatable brain disorder, and dis-
crimination against epilepsy started to be repealed.
As neurologists, we look at the history of epilepsy
and see parallels with that of chronic pain. Today,
chronic pain is an evolving condition in many ways.
Previously, pain was not seen in the same light.
Ancient civilizations believed pain was somehow
related to evil and magic; for this reason, the responsi-
bility of treatment was in the realm of sorcerers and
priests. After the Middle Ages, just as with epilepsy,
understanding started to shift. The brilliant works of
Da Vinci assisted in understanding of anatomy, and
proposals that the spinal cord could transmit sensa-
tions to the brain, the main organ for recognition of
pain. When Rene Descartes first described a “pain
pathway” in 1664, this led to the concept that pain
travelled through one passageway with an anatomical
basis. However, treatments largely still consisted of
prayer, forms of quackery, or medical devices; other
patients simply endured the pain. Then, in the nine-
teenth century, the first scientific discovery of pain
treatment using opioids occurred, even though their
use goes back millennia. The past century has yielded
custom-designed analgesics and has provided further
interpretations of chronic pain including Melzack’s
neuromatrix, development of cognitive behavioral
therapies, and the impact of genomics.
All of these advances apply to neuropathic pain
and yet, a large number of our patients still suffer with
refractory neuropathic pain. Although chronic pain
has emerged from the Dark Ages, we are still sur-
rounded with uncertainty about best management, a
lack of understanding of why acute pain becomes
chronic, and intolerability of our best medications in
many patients. Clearly, there remains room for
improvement in the knowledge of cause, understand-
ing, and management of neuropathic pain. This is the
setting for the book in your hands.
Pain management remains a still fledgling field.
Not embraced by any one specialty, pain management
encompasses several fields within and outside of
medicine. As our experience and understanding grow,
we fully anticipate the field of pain to become more
organized and mature. Simply practicing pain man-
agement does not enable one to understand how or
why pain may occur, why it varies between individ-
uals, and how it fluctuates based upon emotions,
distractions, and even with weather changes. In the
future, understanding of chronic pain and even of
neuropathic pain is anticipated to contribute to a
new unified field of medicine along with partnerships
in science and the allied health fields.
This book is designed to provide pain manage-
ment specialists, but also other healthcare providers
and scientists, greater insights into the entire concept
of neuropathic pain. Many authors of this book gave
long hours of their time to compose chapters at night
or during their weekends in order to provide the best
educational resource possible. Their product is a book
that is a tremendous addition to all reference libraries
as well as an enjoyable read. Our chapters weave
together a picture of the clinical presentations of pain

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and the diagnostic testing that may assist in its greater
understanding. This is followed by additions explain-
ing our current appreciation of how pain develops
and is maintained. Next, this understanding is applied
to the most common conditions of neuropathic
pain affecting the peripheral and central nervous
systems. After the recognition of the condition and
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the patient’s state, treatment options are considered
individually or in combination. Perhaps the most
unusual chapter is a contribution by a chronic pain
patient explaining her journey with chronic pain and
perspectives not always appreciated by the treating
clinician. Once the treatment has begun, outcomes
are explored including follow-up chapters on medical
outcomes and impact of comorbid psychological and
psychiatric conditions. Finally, we culminate with a
prognostication on the future of chronic pain con-
cepts and therapies. This unique design and patient
perspective input make this book a singular product.
In total, this book provides a head-to-toe over-
view of neuropathic pain that we hope will be
viewed as an important compilation for readers
involved in chronic pain as well as those not
involved. As editors of these works, we immensely
enjoyed both writing and editing this collection,
and we hope that you have a similar experience.
We would like to thank our families for their will-
ingness to permit us to dedicate our careers to this
field, as well as our students, nurses, and assistants
whose help over the years has permitted us to stay
focused upon the goals of understanding and man-
aging neuropathic pain.
Cory Toth MD
Dwight E. Moulin MD

Publisher ‏ : ‎ Cambridge University Press; 1st edition (January 13, 2014)
Language ‏ : ‎ English
FORMAT: ORIGINAL PDF/PRINT REPLICA
ISBN-10 ‏ : ‎ 1107023718
ISBN-13 ‏ : ‎ 978-1107023710