Table Of ContentEvidence-Based Interventional Pain Medicine
According to Clinical Diagnoses
Evidence-Based
Interventional Pain Medicine
According to Clinical Diagnoses
EDITED BY
JAN VAN ZUNDERT MD, PhD, FIPP
Anesthesiologist
Department of Anesthesiology and Multidisciplinary Pain Centre
Ziekenhuis Oost-Limburg
Genk, Belgium
JACOB PATIJN MD, PhD
Neurologist
Department of Anesthesiology and Pain Management
Maastricht University Pain Centre
Maastricht, the Netherlands
CRAIG T. HARTRICK MD, DABPM, FIPP
Anesthesiologist
Departments of Anesthesiology, Biomedical Sciences, and Health Sciences
Oakland University William Beaumont School of Medicine
Rochester, MI, USA
ARNO LATASTER, MSc
Anatomist
Department of Anatomy and Embryology
Maastricht University
Maastricht, the Netherlands
FRANK J.P.M. HUYGEN MD, PhD, FIPP
Anesthesiologist
Department of Anesthesiology and Pain Management
Erasmus Medical Centre
Rotterdam, the Netherlands
NAGY MEKHAIL MD, PhD, FIPP
Carl E. Wasmthus professor and chair
Department of Pain Management
Cleveland Clinic
Cleveland, OH, USA
MAARTEN VAN KLEEF MD, PhD, FIPP
Anesthesiologist
Department of Anesthesiology and Pain Management
Maastricht University Medical Centre
Maastricht, the Netherlands
EDITORIAL COMMISSIONERS
ROGIER TROMPERT, Medical Illustrator
NICOLE VAN DEN HECKE, Coordinator
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2012, © 2012 by John Wiley & Sons, Ltd
Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientifi c, Technical
and Medical business with Blackwell Publishing.
Registered offi ce: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial offi ces: 9600 Garsington Road, Oxford, OX4 2DQ, UK
The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
111 River Street, Hoboken, NJ 07030-5774, USA
For details of our global editorial offi ces, for customer services and for information about how to apply for
permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell
The right of the author to be identifi ed as the author of this work has been asserted in accordance with the UK
Copyright, Designs and Patents Act 1988.
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, except as permitted
by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand names
and product names used in this book are trade names, service marks, trademarks or registered trademarks of
their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
This publication is designed to provide accurate and authoritative information in regard to the subject matter
covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If
professional advice or other expert assistance is required, the services of a competent professional should be
sought.
The contents of this work are intended to further general scientifi c research, understanding, and discussion
only and are not intended and should not be relied upon as recommending or promoting a specifi c method,
diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no
representations or warranties with respect to the accuracy or completeness of the contents of this work
and specifi cally disclaim all warranties, including without limitation any implied warranties of fi tness for a
particular purpose. In view of ongoing research, equipment modifi cations, changes in governmental regulations,
and the constant fl ow of information relating to the use of medicines, equipment, and devices, the reader is
urged to review and evaluate the information provided in the package insert or instructions for each medicine,
equipment, or device for, among other things, any changes in the instructions or indication of usage and for
added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an
organization or Website is referred to in this work as a citation and/or a potential source of further information
does not mean that the author or the publisher endorses the information the organization or Website may
provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this
work may have changed or disappeared between when this work was written and when it is read. No warranty
may be created or extended by any promotional statements for this work. Neither the publisher nor the author
shall be liable for any damages arising herefrom.
A catalogue record for this book is available from the British Library.
This book is published in the following electronic formats: ePDF 9781119968344; Wiley Online Library
9781119968375; ePub 9781119968351; mobi 9781119968368
Set in 9.25/12pt Minion by Toppan Best-set Premedia Limited, Hong Kong
1 2012
Contents
Contributor List, vii 10 Thoracic Pain, 62
Maarten van Kleef, Robert Jan Stolker, Arno
Foreword by Menno E. Sluijter, x
Lataster, José W. Geurts, Honorio T. Benzon
Foreword by P. Prithvi Raj, xi and Nagy Mekhail
Intoduction, xiii 11 Lumbosacral Radicular Pain, 71
Koen Van Boxem, Jianguo Cheng, Jacob Patijn,
1 Trigeminal Neuralgia, 1
Maarten van Kleef, Arno Lataster, Nagy
Maarten van Kleef, Wilco E. van Genderen,
Mekhail and Jan Van Zundert
Samer Narouze, Turo J. Nurmikko, Jan Van
Zundert, José W. Geurts and Nagy Mekhail 12 Pain Originating from the Lumbar Facet Joints, 87
Maarten van Kleef, Pascal Vanelderen,
2 Cluster Headache, 8
Steven P. Cohen, Arno Lataster, Jan Van
Maarten van Kleef, Arno Lataster, Samer Narouze,
Zundert and Nagy Mekhail
Nagy Mekhail, José W. Geurts and Jan Van Zundert
13 Sacroiliac Joint Pain, 96
3 Persistent Idiopathic Facial Pain, 14
Pascal Vanelderen, Karolina Szadek, Steven P. Cohen,
Paul Cornelissen, Maarten van Kleef, Nagy
Jan De Witte, Arno Lataster, Jacob Patijn, Nagy Mekhail,
Mekhail, Miles Day and Jan Van Zundert
Maarten van Kleef and Jan Van Zundert
4 Cervical Radicular Pain, 18
Jan Van Zundert, Marc Huntoon, Jacob Patijn, 14 Coccygodynia, 103
Arno Lataster, Nagy Mekhail and Maarten van Kleef Jacob Patijn, Markus Janssen, Salim Hayek,
Nagy Mekhail, Jan Van Zundert and Maarten
5 Cervical Facet Pain, 31
van Kleef
Maarten van Eerd, Jacob Patijn, Arno Lataster,
Richard W. Rosenquist, Maarten van Kleef, 15 Discogenic Low Back Pain, 107
Nagy Mekhail and Jan Van Zundert Jan Willem Kallewaard, Michel A. M. B. Terheggen,
Gerbrand J. Groen, Menno E. Sluijter, Richard Derby,
6 Cervicogenic Headache, 40
Leonardo Kapural, Nagy Mekhail and
Hans van Suijlekom, Jan Van Zundert, Samer
Maarten van Kleef
Narouze, Maarten van Kleef and Nagy Mekhail
16 Complex Regional Pain Syndrome, 123
7 Whiplash-Associated Disorders, 45
Frank van Eijs, Michael Stanton-Hicks, Jan Van
Hans van Suijlekom, Nagy Mekhail, Nileshkumar
Zundert, Catharina G. Faber, Timothy R.
Patel, Jan Van Zundert, Maarten van Kleef
Lubenow, Nagy Mekhail, Maarten van Kleef
and Jacob Patijn
and Frank Huygen
8 Occipital Neuralgia, 49
Pascal Vanelderen, Arno Lataster, Robert Levy, 17 Herpes Zoster and Post-Herpetic Neuralgia, 137
Nagy Mekhail, Maarten van Kleef Albert J. M. van Wijck, Mark Wallace, Nagy Mekhail
and Jan Van Zundert and Maarten van Kleef
9 Painful Shoulder Complaints, 55 18 Painful Diabetic Polyneuropathy, 145
Frank Huygen, Jacob Patijn, Olav Rohof, Wouter Pluijms, Frank Huygen, Jianguo Cheng,
Arno Lataster, Nagy Mekhail, Maarten van Nagy Mekhail, Maarten van Kleef, Jan Van Zundert
Kleef and Jan Van Zundert and Robert van Dongen
v
Contents
19 Carpal Tunnel Syndrome, 151 24 Chronic Refractory Angina Pectoris, 191
Jacob Patijn, Ricardo Vallejo, Markus Janssen, Maarten van Kleef, Peter Staats, Nagy Mekhail
Frank Huygen, Arno Lataster, Maarten van and Frank Huygen
Kleef and Nagy Mekhail
25 Ischemic Pain in the Extremities and Raynaud’s
20 Meralgia Paresthetica, 155 Phenomenon, 196
Jacob Patijn, Nagy Mekhail, Salim Hayek, Arno Jacques Devulder, Hans van Suijlekom, Robert Van
Lataster, Maarten van Kleef and Jan Van Zundert Dongen, Sudhir Diwan, Nagy Mekhail, Maarten
van Kleef and Frank Huygen
21 Phantom Pain, 160
Andre Wolff, Eric Vanduynhoven, Maarten van Kleef, 26 Pain in Chronic Pancreatitis, 202
Frank Huygen, Jason E. Pope and Nagy Mekhail Martine Puylaert, Leonardo Kapural, Jan Van Zundert,
Dirk Peek, Arno Lataster, Nagy Mekhail, Maarten
22 Traumatic Plexus Lesion, 168
van Kleef and Yolande C. A. Keulemans
Robert van Dongen, Steven P. Cohen, Maarten
van Kleef, Nagy Mekhail and Frank Huygen Index, 212
23 Pain in Patients with Cancer, 173
Kris C. P. Vissers, Kees Besse, Michel Wagemans, Wouter
Zuurmond, Maurice J.M.M. Giezeman, Arno Lataster,
Nagy Mekhail, Allen W. Burton, Maarten van Kleef and
Frank Huygen
vi
Contributor List
Honorio T. Benzon MD, FIPP Richard Derby, MD, FIPP Jos é W. Geurts, MSc
Department of Anesthesiology Medical Director Department of Anesthesiology and Pain
Northwestern University Feinberg School of Spinal Diagnostics and Treatment Center Management
Medicine Daly City, CA, USA Maastricht University Medical Centre
Chicago, IL, USA Maastricht, the Netherlands
Jacques Devulder MD, PhD
Kees Besse MD, FIPP Department of Anesthesiology and Maurice J.M.M. Giezeman MD, PhD
Department of Anesthesiology Pain and Palliative Multidisciplinary Pain Centre Department of Anesthesiology and Pain
Medicine University Hospital Ghent Management
Radboud University Ghent, Belgium Diakonessenhuis, Utrecht
Nijmegen Medical Centre the Netherlands
Nijmegen, the Netherlands Sudhir Diwan, MD, DABIPP, FIPP
Executive Director Gerbrand J. Groen MD, PhD
Allen W. Burton MD, FIPP The Spine & Pain Institute of New York Department of Anesthesiology & Pain Treatment,
Department of Pain Medicine Staten Island University Hospital University Medical Centre Groningen
UT MD Anderson Cancer Center New York University of Groningen, Groningen, the
Houston, TX, USA Netherlands
R obert van Dongen MD, PhD, FIPP
Jianguo Cheng MD, PhD Department of Anesthesiology, Pain Craig T. Hartrick, MD, FIPP
Department of Pain Management
and Palliative Medicine Department of Anesthesiology, Biomedical
Cleveland Clinic, Cleveland
Radboud University Nijmegen Medical Centre Sciences, and Health Sciences
OH, USA
Nijmegen, the Netherlands Oakland University William Beaumont School of
Medicine
S teven P. Cohen MD Maarten van Eerd MD, FIPP Rochester, MI, USA
Department of Anesthesiology & Critical Care
Department of Anesthesiology and Pain
Medicine Management S alim Hayek MD, PhD, FIPP
John Hopkins School of Medicine, Baltimore
Amphia Ziekenhuis, Breda Division of Pain Medicine
Walter Reed Army Medical Center
The Netherlands University Hospitals
Washington, DC, USA
Cleveland, OH, USA
Frank van Eijs MD
Paul Cornelissen MD Department of Anesthesiology and Pain M arc Huntoon MD
Department of Anesthesiology and Pain
Management Division of Pain Medicine
Management
St. Elisabeth Hospital Chief
Jeroen Bosch Ziekenhuis ’ s Hertogenbosch
Tilburg, the Netherlands Professor of Anesthesiology
the Netherlands
Vanderbilt University,
Catharina G. Faber MD, PhD Nashville TN, USA
Miles Day MD, DABA FIPP, DABIPP
Department of Neurology
Professor Maastricht University Medical Centre F rank Huygen MD, PhD, FIPP
Medical Director
the Netherlands Department of Anesthesiology and Pain
International Pain Centre Texas Tech
Management
University HSC
Wilco E. van Genderen, MD Erasmus University Medical Centre
Lubbock, Texas, USA
Department of Anesthesiology and Pain Rotterdam
Management
J an De Witte MD
Medical Centre Jan van Goyen
Department of Anesthesiology
Amsterdam, the Netherlands
Intensive Care Medicine, and Pain Management
OLV - Ziekenhuis, Aalst, Belgium
vii
Contributor List
Markus Janssen MD, FIPP N ileshkumar Patel MD, MBA M ichael Stanton- Hicks MB; BS,
Department of Anesthesiology and Pain Clinical Professor, Anesthesiology Dr med, FIPP
Management Advanced Pain Management Department of Pain Management
Maastricht University Medical Centre, Maastricht Green Bay, WI, USA Cleveland Clinic, Cleveland
The Netherlands OH, USA
Jacob Patijn, MD, PhD
J an Willem Kallewaard MD, FIPP Department of Anesthesiology and Pain R obert Jan Stolker MD, PhD
Department of Anesthesiology and Pain Management Department of Anesthesiology and Pain
Management Maastricht University Pain Centre Management
Rijnstate Hospital Maastricht, the Netherlands Erasmus University Medical Centre
Arnhem, the Netherlands Rotterdam the Netherlands
D irk Peek MD
L eonardo Kapural MD, PhD, FIPP Department of Anesthesiology and Pain Medicine Hans van Suijlekom MD, PhD
Department of Pain Management, St. Jans Gasthuis, Weert Department of Anesthesiology and Pain
Cleveland Clinic The Netherlands Management
Cleveland, OH, USA Catharina Ziekenhuis, Eindhoven
Wouter Pluijms MD The Netherlands
Yolande Keulemans, MD, PhD Department of Anesthesiology and Pain
Department of Gastroenterology Management K arolina Szadek MD
Maastricht University Medical Centre Maastricht University Medical Department of Anesthesiology and Pain
Maastricht, the Netherlands Centre, Maastricht Management
Vrije Universiteit Amsterdam
Maarten van Kleef, MD, PhD, FIPP Jason E. Pope, MD Amsterdam, the Netherlands
Department of Anesthesiology and Pain Director of the Headache Center
Management Napa Pain Institute Michel A. M. B. Terheggen MD
Maastricht University Pain Centre Napa, CA Department of Anesthesiology and Pain
Maastricht, the Netherlands Assistant Professor of Anesthesiology Management
Vanderbilt University Medical Center Rijnstate Hospital
Arno Lataster MSc Nashville, TN Arnhem, the Netherlands
Department of Anatomy and Embryology
Maastricht University M artine Puylaert MD, FIPP R icardo Vallejo MD, PhD, FIPP
Maastricht, the Netherlands Department of Anesthesiology and Millennium Pain Center
Multidisciplinary Pain Centre Bloomington, IL, USA
Robert Levy MD, PhD Ziekenhuis Oost - Limburg
Professor and Chairman Genk, Belgium Koen Van Boxem MD, FIPP
Department of Neurological Surgery and Department of Anesthesiology and Pain
Co-Director, P rithvi Raj, MD, FIPP Management
Shands Jacksonville Neuroscience Institute Department of Anesthesiology and Pain Medicine Sint - Jozefkliniek, Bornem and Willebroek
University of Florida College of Medicine Texas Tech University Bornem, Belgium
Jacksonville, Fl, USA Texas, TX, USA
E ric Vanduynhoven MD
T imothy R. Lubenow MD, FIPP Olav Rohof MD, PhD, FIPP Department of Anesthesiology and Pain
Department of Anesthesiology Orbis Medisch Centrum, Management
Rush University Medical Center Pijnkliniek GZA, Campus Sint
Chicago, IL, USA Sittard Geleen Augustinus, Antwerp
the Netherlands Belgium
Nagy Mekhail, MD, PhD, FIPP
Department of Pain Management Richard W. Rosenquist MD Pascal Vanelderen MD, FIPP
Cleveland Clinic Chairman of the Pain Management Department Department of Anesthesiology and
Cleveland, OH, USA Cleveland Clinic Multidisciplinary Pain Centre
Cleveland, OH, USA Ziekenhuis Oost - Limburg, Genk, Belgium
Samer Narouze MD, MSc, FIPP
Centre For Pain Medicine Menno E. Sluijter MD, PhD, FIPP Jan Van Zundert, MD, PhD, FIPP
Summa Western Reserve Hospital Pain Unit, Swiss Paraplegic Centre Department of Anesthesiology and
Cuyahoga Falls, Oh, USA Nottwil, Switzerland Muitidisciplinary Pain Centre
Ziekenhuis Oost - Limburg, Genk, Belgium
T uro J. Nurmikko MD, PhD P eter Staats MD, FIPP
Pain Research Institute and Department of Anesthesiology and Critical Care
Faculty of Health and Life Sciences Medicine
University of Liverpool John Hopkins University
Liverpool, UK Baltimore, MA, USA
viii
Contributor List
K ris C. P. Vissers MD, PhD, FIPP Mark Wallace MD A ndre Wolff MD, PhD
Department of Anesthesiology Pain and Palliative Center for Pain Medicine Department of Anesthesiology Pain
Medicine University of California and Palliative Medicine
Radboud University San Diego Medical Center Radboud University Nijmegen Medical Centre
Nijmegen Medical Centre San Diego, CA, USA Nijmegen, the Netherlands
Nijmegen, the Netherlands
A lbert J. M. van Wijck MD, PhD Wouter Zuurmond MD, PhD
M ichel Wagemans MD, PhD Department of Anesthesiology and Pain Department of Anesthesiology, Pain Therapy and
Department of Anesthesiology and Pain Management Palliative Care
Management University Medical Centre, Utrecht VU Medical Centre, Amsterdam
Renier de Graaf Groep the Netherlands The Netherlands
Delft, The Netherlands
ix
Foreword
by Menno E. Sluijter MD, PhD, FIPP
Seeing this book makes me proud of my university city Maas- If this is placebo, so be it. It makes pain treatment different from
tricht, where I have left so many footsteps and where I still have putting a stent into a coronary artery or from removing a tumor
many friends. It is a great honor for me to have been invited to under general anesthesia.
write this foreword. Maturity is a sign of growth and it has to be encouraged.
Besides accurately describing the various techniques in detail, Evidence - based medicine will be an indispensible and welcome
this book has an accent on evidence - based medicine. This comes element of invasive pain treatment in the time to come. It
naturally for the Dutch since soberness and standing fi rmly on the will save patients from getting useless treatments and it will con-
ground belong to their prominent features. It makes the book into vince insurers to follow up on reasonable demands. It will hope-
a solid and reliable guide for many pain practitioners. fully discourage those who seek fi nancial gain from a vulnerable
My fi rst footsteps in the world of invasive pain treatment date group of patients. It will also provide interventional pain treat-
back to a very different period. My mentors and teachers were ment with the respected place in the medical community that it
Jur Bouma in the Netherlands and legendary names, such as deserves.
Sampson Lipton and Mark Mehta, who played such a pivotal But, on the other hand, maturity may also be taken as a sign of
role in their time. Those were the days when solitary observa- immanent old age. When reading this book the reader should also
tions easily sparked attention or even a trend. Epidural phenol at realize that all these procedures have once been done for the fi rst
T12 has been recommended for anal pain for about a decade, one time. This refl ects a mixture of prudence and courage, but also
author copying it from another because it was so bizarre. Ond- alertness to observations and the urge to make it a better world for
ine ’ s syndrome, as a complication of a cordotomy, received undue patients who could not be helped before. This process of growth
attention probably because of its romantic name. Evidence - based and renewal must not be lost. It should be seen as a complement
medicine was still a far cry. of evidence - based medicine rather than as a contradiction. After
This book therefore symbolizes for me how invasive pain treat- all, without ideas and innovation the need for evidence would
ment has become mature within a relatively short period. This soon dry up, and what good is a new procedure without evidence?
process of growth has taken place despite a head wind that is The book underscores the need for proper training. The preva-
specifi c for the subject. Many of the procedures are intricate, and lence of chronic pain is such that, despite the laudable efforts of
success or failure may depend on seemingly trivial details, causing World Institute of Pain, there is still a shortage of well trained
differences in results between researchers. Also pain is a subjective doctors who can provide this type of treatment. This is a problem
experience and this has various consequences. It makes it particu- because reading even this book is not enough and practical train-
larly diffi cult to translate results into numbers that are suitable ing is costly in terms of material and manpower. It is to be hoped
for meaningful statistical analysis. It may even infl uence results. that the increasing number of potential trainers will gradually
I fi rmly believe that a procedure that is performed by a friendly, resolve the problem.
interested doctor in a friendly environment has a greater chance I recommend this book as a standard manual in the library of
of success than a procedure under less favorable circumstances. every interventionalist. Happy reading!
x
Foreword
by P. Prithvi Raj MD, FIPP
Jan Van Zundert, Jaap Patijn, Craig Hartrick, Arno Lataster, Frank where their pain will be relieved over the short - term rather than
Huygen, Nagy Mekhail, and Maarten van Kleef, all internation- addressing the long - term goal of improving the patient ’ s function
ally renowned pain physicians, have embarked on writing “ Evi- and quality of life. That is why one fi nds a prolifi c growth of Inter-
dence - Based Interventional Pain Medicine According to Clinical ventional Pain Management Clinics and decrease in University -
Diagnosis ” . They have devoted most of their lives to improving based Multidisciplinary Clinics. This is certainly the case in the
the pain management of patients globally. At their request, I am USA and is also becoming common in other countries.
honored to write a Foreword for their new book. Pain Physicians have not tackled at all the discrepancy in pain
To emphasize the importance of this book, I need to reiterate practices between developed, developing and under developed
the statistics available to us on chronic pain today. Chronic pain countries. There is no factual account of the epidemiology of pain
prevails globally, the total number of persons living with this spe- the world over; one cannot say for certain how many Pain Physi-
cifi c disease or condition with feeling of pain, ranges from 54% cians are available per capita in any community. We certainly have
in Sweden to 13% in Japan. These studies show that in the rest of made advances in understanding the new theories of pain, and
the developed countries, such as United States, United Kingdom in some pain syndromes, the longitudinal natural course, but we
and Australia, the incidence is somewhere in between. Studies also are far from having a reliable algorithm for any pain disorder. It
show that pain imposes a huge economic burden on all countries; is still hit and miss.
for example, in the United States it was calculated that in 1991, the The challenge today is to train Pain Physicians in such a way
USA spent eighty - six billion dollars on chronic back pain man- that they have a standardized curriculum during their Residency
agement. Today, because the elderly are living longer, the prev- and Pain Fellowship programs, followed by skilled practical train-
alence of chronic pain is rising with age. Another problem one ing, either in Anesthesiology, Neurosurgery, Physical Medicine
needs to recognize is that only one billion people in the developed and Rehabilitation or Psychiatry. Once trained, they need to be
countries have the luxury of utilizing the most advanced pain examined and tested periodically for their competency. This will
management techniques. The other fi ve billion people, who have raise the standard of pain practice, not only in the USA, but all
medium to low standards of living, are unable to receive the ben- over the world.
efi ts of these new techniques of pain management. Evidence - based medicine (EBM) or evidence - based practice
The World Institute of Pain (WIP) and its members have been (EBP) aims to apply the best available evidence gained from
aware of this problem and the disparities between countries in scientifi c methods to clinical decision making. It seeks to assess
terms of standard of care and practices of pain management. the strength of evidence of the risks and benefi ts of treatments
Since 1994, WIP ’ s mission has been to train pain physicians and (including lack of treatment) and diagnostic tests. Evidence
certify their competency in interventional pain management. By quality can range from meta - analyses and systematic reviews of
all accounts, this mission has become very successful globally. double - blind, placebo - controlled clinical trials at the top end,
Pain practice today is fortunate to have many physicians taking down to conventional wisdom at the bottom.
this practice as a professional part of their career. They come Let me explain the history of evidence - based medicine ’ s origin.
from all specialties and the book now has to refl ect the advances Traces of evidence - based medicine ’ s origin can be found in
in Pain Practice of all those specialties, not just those in Anesthe- ancient Greece. Although testing medical interventions for effi -
siology. The debate is still raging whether a single pain specialist cacy has existed since the time of Avicenna ’ s The Canon of Medi-
can deliver better pain management than a group of specialists cine in the 11th century, it was only in the 20th century that this
together. The cost of managing such multidisciplinary clinics has effort evolved to impact almost all fi elds of health care and policy.
been called into question especially by the reimbursement agen- Professor Archie Cochrane, a Scottish Epidemiologist, through
cies. A program developed by a multidisciplinary clinic is nowa- his book Effectiveness and Effi ciency: Random Refl ections on
days rejected outright by the reimbursement agencies, and even if Health Services (1972) and subsequent advocacy caused increas-
it is approved, the effi cacy of such programs is questionable. More ing acceptance of the concepts behind evidence - based practice.
and more the patients are referring themselves to the Pain Clinics Cochrane ’ s work was honored through the naming of centers
xi
