Dr. D's Pain Treatment Manual: Practical Pain Management Solutions (REVISED NEW EDITION 2024)

By Baburao Doddapaneni

A must have pain management manual for primary care physicians, specialists outside the field, physician assistants, nurse practitioners, residents in training and senior medical students.

Dr. D's Pain Treatment Solutions is comprehensive guide that offers step-by-step instructions for medical professionals to treat pain condit

• Language: English
• Publisher: B. Doddapaneni, MD, LLC.
• Release date: Dec 1, 2023
• ISBN: 9798890302830

Baburao Doddapaneni

Dr. Baburao Doddapaneni is an Indian educated, British and Scottish trained general surgeon, and an American trained and Board Certified anesthesiologist and pain management specialist. He completed his British M.D. of medicine at the world renowned prestigious Royal College of Surgeons & Physicians in London, England and his training in general surgery at the Royal College of Surgeons of Edinburgh in Scotland. Dr. Doddapaneni furthered his training and completed his residency in anesthesiology and pain management at Boston University Hospital, where he was chief resident and later became the Director of Pain Management. After relocating to New York, he served as the Director of Pain Management at Cornell University Methodist Hospital, and thereafter began his private practice. With over 40 years of experience in healthcare, Dr. D - as his patients call him - brings his vast knowledge and clinical experience as the author of Dr. D's Pain Treatment Manual. As both a pioneer and leader in the field of pain management, he offers a comprehensive and practical guide to treating a wide arrange of pain conditions in a systematic manner. Dr. D's multidisciplinary approach to treating pain provides healthcare professionals ranging from senior medical students, nurses to primary care physicians, the tools and confidence to effectively treat their patients' pain.

Book preview

Dr. D’s

Pain Treatment

Manual

Practical Pain Management Solutions

Baburao Doddapaneni, MD, FRCS, FACAN, DABA

DR D’S PAIN TREATMENT MANUAL

Copyright © 2023 Baburao Doddapaneni, MD, FRCS, FACAN, DABA.

No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in reviews and certain other non-commercial uses permitted by copyright law.

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ISBN 979-8-89030-282-3 (Paperback)

ISBN 979-8-89030-283-0 (Ebook)

ISBN 979-8-89030-218-2 (Hardcover)

Printed in the United States of America

Dr. D’s Pain Treatment Manual

Practical pain management solutions for primary care physicians, physician assistants, nurse practitioners/CRNAs, residents in training, senior medical students, and all others with an interest in pain management.

Preface

By Author Dr. Baburao Doddapaneni, MD, FRCS, FACAN, DABA

General Surgery, Edinburgh, Scotland

Past Clinical Director, Anesthesiology Residency Program, Boston University Hospital

Past Director, Pain Management, Boston University Hospital, Boston, MA

Past Director, Pain Management, Cornell Methodist Hospital, Brooklyn, NY

Past Medical Director, Interventional Pain Management Private Practice, Brooklyn, NY

Forewords

Dr. Nagagopal Venna, MD, MRCP (UK), MRCP (Ireland)

Associate Professor in Neurology, Harvard University Medical School, Boston, MA

Chief, Division of Neuroimmunology and Infectious Diseases, Mass General Hospital

Dr. B. Somaraju, MD, DM

Chairman of CARE Teaching Hospitals Group, India

Professor, Interventional Cardiology

Padma Shri Award Recipient

Contents

Preface

Acknowledgements

Foreword

Foreword

Pain Pathways

The Role of Narcotics in Pain Management

Short/Long-Acting Narcotics

Non-Narcotic Analgesia in Pain Management

Headaches

Headache History/Physical Exam/Diagnostic Testing

Primary Headaches

I. Migraine headaches

II. Cluster headaches

III. tension headache

Neck Whiplash Injury and Acute Cervicalgia

Chronic Low Back Pain: History Taking/Physical Exam

Chronic Low Back Pain Conditions and Risk Factors

The Clinical Course of Chronic Low Back Pain

Chronic Low Back Pain: Treatment Plan Outlines

Failed Back Surgery: Post-laminectomy Syndrome

Sacroiliac Joint Pain/Dysfunction

Piriformis Syndrome Pain Management

Fibromyalgia

Complex Regional Pain Syndrome: CRPS I and II

Diabetic Neuropathy

Gout Pain Management

Rheumatoid Arthritis Pain Management

Common Conditions and Therapeutic Injections of the Shoulder

Knee Joint Pain Management

Occipital Neuralgia

Phantom Limb Pain/Stump Pain

Cancer Pain Management

Herpes Zoster (Shingles) and Post-herpetic Neuralgia

Role of Yoga in Chronic Pain Management

Role of Meditation (Biofeedback) in Office Pain Management

Psychiatric Assessment for Chronic Pain

A Primer on Substance Abuse Disorder (SUD)

Ordering And Contact Information

Preface

I have more than 35 years of accumulated clinical and scientific knowledge in the field of pain management, including faculty positions at major teaching institutions in Boston and New York in the United States, as well as my medical education and training at the Royal Colleges of England and Scotland. The objective of this pain book is to draw upon my experience to instill confidence in front-line health care providers, beginning at the level of advanced medical students and all residents in training, who at times will be required to provide comfort to patients in pain.

In my professional career as an interventional pain management specialist with training in anesthesiology, I have cared for those who suffer from the most painful conditions known to humanity and which cannot be managed outside the hospital setting. However, most chronic pain conditions, which are usually benign, can be effectively treated in a primary care office setting and do not require expensive interventional/surgical procedures or inpatient care.

I have been planning this endeavor since I witnessed a close family member suffer painfully during her fight against cancer. During this process, it became obvious to me that most doctors are not adequately prepared in the management of pain. This deficit in medical training has led to the over-prescription of narcotics and the plague of opioid addiction, which has turned so many of our loved ones into helpless drug seekers.

I pray that I may use my scientific knowledge to provide those suffering from pain with simple explanations that they may absorb while gaining confidence in their care. I abhor the complication of simple solutions, especially in the area of chronic pain. I have tried to present simple and practical solutions that are rooted in sound science and guided by my extensive clinical experience. All treatment plans presented herein align with U.S. Drug Enforcement Administration (DEA) guidelines and state laws.

My goal is to provide the reader with a solid foundation in the anatomical principles of pain, including a review of the neurological system, chemical mediators, neurotransmitters, cerebral cortex, and the links between these elements. I hope to provide clarity on the three orders of neurons, which constitute the underlying principle for all pain. I have tried to provide appropriate examples and to address the most common chronic pain conditions such as headaches and backaches. I also discuss the use of medications including narcotics, other pharmaceutical agents, and nutraceuticals. By utilizing effective charts and easy-to-follow visuals, my goal is to help transfer effective skills to the reader, including the proper technique for joint injections.

Our society is suffering from overwhelming rates of drug addiction, and my aim is to help anyone reading this book alleviate the suffering of others in a clinically and scientifically sound manner. I hope that my contribution will help foster a new approach to pain management.

This book is dedicated to my beloved wife, Prasuna, whose fight with terrible pain was accompanied by a positive attitude, and who taught me the power of mind and faith in coping with unfavorable odds. All of the residents, fellows, and faculty at Memorial Sloan Kettering Cancer Center who aided in the treatment of my wife will forever remain our heroes, and it is these medical professionals who, in helping my wife, gave me the inspiration to write this manual.

ACKNOWLeDGeMeNtS

I wish to acknowledge the help and contributions received from the following distinguished individuals.

-Dr. Nagagopal Venna, MD, MRCP, board certified by American Board of Psychiatry and Neurology

Faculty at Harvard University Medical School and Mass General Hospital, Boston, MA

Dr. Venna provided invaluable guidance and encouragement. He is an exceptional professor and a well-respected clinician.

-Dr. Sasi Doddapaneni, MD, board certified by American Board of Psychiatry and Neurology

Distinguished practicing psychiatrist in Atlanta, GA with training from Johns Hopkins University, Baltimore, MD

Dr. Doddapaneni provided tremendous knowledge and valuable suggestions for my manuscript.

-Ms. Anu Doddapaneni, M.A., healthcare administrator

Extensive experience in pain management, with master’s degree in clinical psychology from New York University, New York, NY

I thank her for her tireless help in compiling hundreds of pages of my research into a valuable manuscript. Anu showed brilliance in absorbing medical concepts and establishing a format to communicate my work.

-Dr. Prasad Ancha, MD, board certified by American Board of Psychiatry and Neurology

Highly regarded practicing neurologist in Orlando, FL with training from Cook County and VA Hospital in Chicago, IL

I thank him for his supportive guidance and for his extraordinary skills in helping me prepare this book.

-Nutan Oak, computer consultant

I thank her for her commitment and expertise with organizing and creating graphs and visuals for this book.

-Rajesh Kesineni, information technology consultant

I thank him for his knowledge, guidance and support in utilizing various computer programs in the making of this book.

FOReWORD

Dr. Nagagopal Venna, MD, MRCP (UK), MRCP (Ireland)

Associate Professor in Neurology

Harvard University Medical School, Boston, MA

|Chief, Neuroimmunology and Infectious Diseases

Mass General Hospital, Boston MA

I am honored and delighted to write a foreword for Dr. D’s Pain Treatment Manual. I have known Dr. Doddapaneni from our medical school years in India, during his training and practice in surgery in Ireland and England, through the training and practice in anesthesiology in the USA and later during his dedicated practice of comprehensive management of pain in all its variety and complexity. The decades of practice based on sound training and thoughtful experience combined with a rare compassionate and holistic approach to the relief of pain, are thoroughly and admirably reflected in this manual.

The lucid and clear depiction of anatomical, physiological and neurotransmitter underpinnings of pain and painful disorders provides an excellent and sound basis for methodical and comprehensive approach to the diagnosis and management of the common and disabling pain syndromes, for which patients seek help from physicians of many different specialties and practices. Dr. Doddapaneni’s insightful approach, refined by years of rigorous and reflective experience, offers a systematic approach to the fundamentals of diagnosis of etiology and pathogenesis of the pain in each patient and the attention to the many complex factors that contribute to persistence of pain syndromes, especially in chronic pain conditions. The integration of a multidisciplinary approach to the relief of pain and improvement of quality of life, delivered and sustained by compassionate care are the highlights of the manual.

A special attribute of this manual is that Dr. Doddapaneni has distilled his large and examined experience into it, unlike disparate presentations in the many tomes of multi- authored books. The personal and telling anecdotes and informal style of his advice and insights make reading this book a most pleasant and rewarding experience as the author emphasizes important principles in each section of the book. As a practicing neurologist for many years and dealing with the many challenges of treating patients with neurogenic pain disorders, I have gleaned many helpful pointers, useful insights and pearls of wisdom from Dr. Doddapaneni’s admirable work. I am confident that physicians in primary care as well as in a wide range of medical specialties and other health care providers will find this manual a most welcome, helpful and reliable guide.

FOReWORD

Dr. B. Somaraju, MD, DM

Chairman of CARE Teaching Hospitals Group, India

Professor, Interventional Cardiology

|Padma Shri Award Recipient

I am very pleased to write this foreword for Dr. D’s Pain Treatment Manual by Dr. Baburao Doddapaneni, MD, FRCS, FACAN, DABA. This is Dr. Doddapaneni’s second publication, his first in 1983 titled Global Emergency Medical System. I have known the author since medical school to be an honorable, hardworking, and compassionate student with a passion for medicine and patient care. He left India in 1972 to advance his training in surgery in London, England. While working as a postgraduate at British and Irish hospitals, Dr. Doddapaneni completed his surgical training in 1977 at the prestigious Royal College of Surgeons of Edinburgh. To further his education, with determination and perseverance, he completed his anesthesiology training at the renowned Boston University Hospital. There, he was appointed as Clinical Director for their residency program, Quality Control Director and Director of Pain Management. The pain management program was his own brainchild in 1982-1985, putting Boston University on the map as a center for pain management. With over 35 years of experience, Dr. Doddapaneni is a leader in pain management and has both a tremendous knowledge base and practical experience in the field.

I have had the opportunity and pleasure to read Dr. D’s Pain Treatment Manual. It presents a complicated subject matter in an easy-to-understand, systematic format and provides a comprehensive and practical guide to pain management for medical professionals. This book fills a considerable gap and provides much needed education that most medical professionals do/did not receive in school, professional training or within their practices. The opioid epidemic crisis in the U.S. and in other countries has wearied many physicians, who are inexperienced in addressing their patients’ pain. Furthermore, narcotics and opioids are slowly but surely making their way to other countries including India. However, most physicians are not familiar with the prescribing guidelines of narcotics, their mechanisms or potential side effects.

Dr. Doddapaneni’s multidisciplinary approach to pain management not only addresses these concerns, but also will give medical professionals the confidence and tools to effectively treat their patients’ pain. Offering a safe and thorough approach, this manual provides step-by-step instructions for medical professionals to treat pain conditions encompassing the spectrum, ranging from acute pain to severe chronic pain conditions. Dr. Doddapaneni meticulously addresses specific conditions in dedicated chapters including those on chronic headaches, fibromyalgia, joint pain, chronic low back