Pain Medicine
Contact Us
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Outpatient Pain Management Center |
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Clinical Phone: 415-885-PAIN (7246) General Clinical Fax: 415-885-7575 New Patient Referral Fax: 415-885-3883
Diane Ozawa Phone: 415-514-6633
Click here to see a list of UCSF Pain Management Center faculty |
Clinical Phone: 415-353-1328
Clinical Fax: 415-353-3729
Administrative Supervisor UCSF Pediatric Pain, Palliative & Integrative Medicine Center Phone: 415-353-9517
Click here to see a list of Pediatric Pain, Palliative & Integrative Medicine Center faculty |
Administrative Contact Information
Pain Medicine Fellowship Coordinator
Email: [email protected]
Phone: +1 415 476-9767
Mission of the Division of Pain Medicine at UCSF
As our understanding of the mechanisms driving acute and chronic pain continue to develop, so too are the number of options available to effectively treat painful conditions.
However, effective pain management is not simply applying all possible therapeutic choices at once, but rather establishing a diagnosis through expert evaluation, providing evidence–based treatment options and allowing for meaningful follow up to ensure improved function and quality of life. In the majority of cases, such effective pain management utilizes an integrated team approach. The UCSF Pain Medicine Website provides a bridge linking the expertise of our UCSF pain medicine teams and educators to our patients and other health care providers in need of additional pain management resources.
Driven by a sense of urgency and our public mission, UCSF is advancing health by developing innovative pain care pathways that ensure continuity of pain management from inpatient to outpatient for both children and adults. This involves breaking down traditional boundaries through the integration of pain management care, education and research to ensure the best quality, safety and satisfaction for our patients. For more information, we invite you to explore the links at the left of the page.
Contact Us
| Clinical Contact Information | Administrative Contact Information |
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Clinical Phone: 415-885-PAIN (7246) General Clinical Fax: 415-885-7575 New Patient Referral Fax: 415-885-3883 Diane Ozawa UCSF Pain Management Center |
Pain Fellowship Coordinator Phone: 415-476-9767 Fax: 415-514-0185 (no PHI please) |
Pain Division Chief
Pain Medicine Service Members
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Division of Pain Medicine Clinical Services and Directors |
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Pain Management Center (Outpatient Chronic Pain Service) |
Inpatient Chronic Pain Consultation Service |
Inpatient Acute Pain Service |
Regional Anesthesia Service |
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Amber Borucki, MD (Pediatric Anesthesia Pain Director) |
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| Name | Title/Role | Service |
| Christopher Abrecht, MD |
Director, Inpatient Chronic Pain Service, Associate Director, Inpatient Acute Pain Service, Associate Director, Pain Management Center |
Pain Management Center | Inpatient Chronic Pain Consultation Service | Inpatient Acute Pain Service | Regional Anesthesia Service |
| Pedram Aleshi, MD | Director, Regional Anesthesia Service and Acute Pain and Regional Anesthesia Fellowship | Regional Anesthesia Service |
| Atsuko Baba, MD | Director, Pediatric PREPARE | Pediatric Pain, Palliative & Integrative Medicine Center |
| Matthias Behrends, MD | Director, Inpatient Acute Pain Service | Regional Anesthesia Service | Inpatient Acute Pain |
| Cristina Benki, PhD | Pediatric Pain Psychologist | Pediatric Pain, Palliative & Integrative Medicine Center |
| Philip Bickler, MD, PhD | Regional Anesthesia Service | |
| Danielle Binler, MD | 2020 - 2021 Pain Medicine Fellow | |
| Amber Borucki, MD | Director, Pediatric Anesthesia Pain | Pediatric Pain, Palliative & Integrative Medicine Center |
| Matthias Braehler, MD, PhD | Regional Anesthesia Service | |
| Daniel Burkhardt, MD | Medical Director, UCSF Parnassus Preoperative Evaluation (PREPARE) Clinic | Inpatient Acute Pain Service |
| Nu "Cindy" Chai, MD | Associate Progam Director, Pain Medicine Fellowship. PMC Neurologist | Pain Management Center | Inpatient Chronic Pain Consultation Service |
| Alexandra Chang, MD | 2020 - 2021 Pain Medicine Fellow | |
| Lee-lynn Chen, MD | Inpatient Acute Pain Service | |
| Mario De Pinto, MD | Director, Pain Management Center | Pain Management Center | Inpatient Chronic Pain Consultation Service | Inpatient Acute Pain Service | Regional Anesthesia Service |
| Gerald Dubowitz, MD | Regional Anesthesia Service | |
| Marla Ferschl, MD | Director, Fetal Anesthesia, Director, Pediatric Anesthesia Fellowship | Pediatric Pain, Palliative & Integrative Medicine Center |
| Darren Fiore, MD | Pediatric Pain, Palliative & Integrative Medicine Center | |
| Audrey Foster-Barber, MD, PhD | Medical Director Compass Care, UCSF Pediatric Palliative Care, Residency Director, Child Neurology | Pediatric Pain, Palliative & Integrative Medicine Center |
| Medical Director, Center of Pediatric Pain, Palliative and Integrative Medicine at Benioff Children's Hospitals in Oakland and San Francisco | ||
| Seema Gandhi, MD | Regional Anesthesia Service | |
| Zhonghui Guan, MD | Pain Management Center | Inpatient Chronic Pain Consultation Service | |
| Alicia Heilman, RN | Pediatric Nurse | Pediatric Pain, Palliative & Integrative Medicine Center |
| Melanie Henry, MD | Pain Management Center | Inpatient Chronic Pain Consultation Service | |
| Christina Inglis-Arkell, MD | Director, UCSF Mount Zion OR | Regional Anesthesia Service |
| Pain Psychologist, PMC | Pain Management Center | |
| Valerie Jackson, PhD | Pain Psychologist, PMC | Pain Management Center |
| Sunitha Kaiser, MD | Pediatric Pain, Palliative & Integrative Medicine Center | |
| Cynthia Kim, MD | Pediatric Pain, Palliative & Integrative Medicine Center | |
| Sakura Kinjo, MD | Medical Director, Orthopaedic Institute | Regional Anesthesia Service | Inpatient Acute Pain |
| Kerstin Kolodzie, MD, PhD | Regional Anesthesia Service | |
| Merlin Larson, MD | Inpatient Acute Pain Service | |
| David Lee, MD | Pain Management Center | Inpatient Chronic Pain Consultation Service | |
| Solmaz Manuel, MD | Regional Anesthesia Service | Inpatient Acute Pain | |
| Robin McCrane, RN | Pediatric Sedation Nurse | Pediatric Pain, Palliative & Integrative Medicine Center |
| Rachel Eshima McKay, MD | Director, UCSF Mission Bay Preoperativev Evaluation (PREPARE) Clinic | Regional Anesthesia Service |
| Julian Motzkin, MD | 2020 - 2021 Pain Medicine Fellow | |
| Hung Gia Nguyen, MD | Pediatric Pain, Palliative & Integrative Medicine Center | |
| George Pasvankas, MD | Director, Pain Medicine Fellowship Program | Pain Management Center | Inpatient Chronic Pain Consultation Service | Inpatient Acute Pain Service | Regional Anesthesia Service |
| Thoha Pham, MD | Pain Management Center | Inpatient Chronic Pain Consultation Service | Inpatient Acute Pain Service | Regional Anesthesia Service | |
| Carlos Plata-Martinez, MD | 2020 - 2021 Pain Medicine Fellow | |
| Lawrence Poree, MD, PhD | Director, Neuromodulation Program | Pain Management Center | Inpatient Chronic Pain Consultation Service |
| Heidi Reetz, MD | PMC Family Medicine | Pain Management Center | Inpatient Chronic Pain Consultation Service |
| Thomas Reid, MA, MD | Associate Program Director for the UCSF Hospice and Palliative Medicine Fellowship program, Director of the 4th year Medical Student elective in Palliative Medicine | Pediatric Pain, Palliative & Integrative Medicine Center |
| David Robinowitz, MD, MHS, MS | Pediatric Pain, Palliative & Integrative Medicine Center | |
| Glenn Rosenbluth, MD | Associate Professor, Pediatrics; Director, Quality and Safety Programs GME; Associate Director, Pediatrics Residency Training Program | Pediatric Pain, Palliative & Integrative Medicine Center |
| Michael Rowbotham, MD | PMC Neurologist | Pain Management Center |
| Gabriel Sarah, MD | Pediatric Pain, Palliative & Integrative Medicine Center | |
| Mark Schumacher, MD, PhD | Chief, Division of Pain Medicine, Department of Anesthesia and Perioperative Care | Inpatient Acute Pain Service |
| Ann Cai Shah, MD | Pain Management Center | Inpatient Chronic Pain Consultation Service | |
| Prasad Shirvalkar, MD, PhD | PMC Neurologist | Pain Management Center | Inpatient Chronic Pain Consultation Service |
| Claas Siegmueller, MD, PhD, MBA | Regional Anesthesia Service | Inpatient Acute Pain Service | |
| David Steinhardt, MD | 2020 - 2021 Pain Medicine Fellow | |
| Karen Sun, MD | Chief, Division of Pediatric Hospital Medicine; Associate Director, Pediatric Pain and Sedation Service | Pediatric Pain, Palliative & Integrative Medicine Center |
| Steve Wilson, MD, PhD | Associate Chief Medical Officer, UCSF Benioff Children's Hospital | Pediatric Pain, Palliative & Integrative Medicine Center |
| Xiaobing Yu, MD | Rotation Director, M-PN & Z-PN Anesthesia Resident Rotations and Medical Student Pain Clerkship | Pain Management Center | Inpatient Chronic Pain Consultation Service |
| Maurice Zwass, MD | Chief, Pediatric Anesthesia | Pediatric Pain, Palliative & Integrative Medicine Center |
Psychology Faculty
Cristina Benki, PhD
Child and Adolescent Psychologist, IP3
Pain Psychologist, PMC
Valerie Jackson, PhD, MPH
Pain Psychologist, PMC
Pain Fellows
Danielle Binler, MD
2020 - 2021 Pain Medicine Fellow, Anesthesia
Alexandra Chang, MD
2020 - 2021 Pain Medicine Fellow, Anesthesia
Julian Motzkin, MD
2020 - 2021 Pain Medicine Fellow, Anesthesia
Carlos Plata-Martinez, MD
2020 - 2021 Pain Medicine Fellow, Anesthesia
David Steinhardt, MD
2020 - 2021 Pain Medicine Fellow, Anesthesia
Pain Nursing
Nurse Manager, PMC
Nurse Practitioner, PMC
Alicia Heilman, RN
Outpatient Case Manager,
IP3
Charmaine Penaflor, RN
Clinical Nurse, PMC
Erica Fuchs, RN
PMC
Pain Staff
Administrative Director, UCSF Pain Management Center
Practice Assistant to Dr. Mario De Pinto
Patient Care Manager, IP3
Practice Assistant to Drs. George Pasvankas and Thoha Pham, PMC
Front Office Assistant
Pain Fellowship Coordinator
Practice Assistant, PMC
Medical Assistant
Practice Coordinator - Front Desk
Practice Assistant to Dr. Zhonghui Guan, PMC
Make an Appointment
New Adult Patients
Need a referral or consultation request submitted by their primary physician or care team, for:
Chronic Pain Management
Acute Pain Management
Returning Adult Patients
Call the UCSF Pain Management Center at (415) 885-PAIN (7246) or
Request your follow-up appointment via UCSF MyChart, an online resource for your routine healthcare needs.
Pediatric Patients
Caregivers can call the Pediatric Pain, Palliative & Integrative Medicine Center at (415) 353-9517
Locations
Outpatient Clinics
Integrated Pediatric Pain & Palliative Care Clinics
1825 Fourth Street, Fifth floor, 5A
San Francisco, CA 94143-0106
Inpatient Locations
The UCSF Osher Center for Integrative Medicine provides several non-pharmaceutical pain management services that can be integrated with the Pain Management Center's services, whether your pain condition is acute or chronic. Treatments that we offer are supported by scientific studies for pain management, and include:
- Mind-Body Medicine (Biofeedback, Guided Imagery, Mindfulness, and Yoga)
- Manual Medicine (Massage Therapy and Spinal Manipulation)
Services
The Division of Pain Medicine, in partnership with our colleagues, provides pain care pathways to ensure outstanding pain care from inpatient to outpatient settings for both children and adults. See below for details.
Adult Pain Medicine
Outpatient Chronic Pain Management Center Clinic
Established in 1987 by the Department of Anesthesia and Perioperative Care, the PMC helps patients with various stages and types of complex, acute, and chronic pain. We offer a variety of treatment options with a comprehensive and multidisciplinary approach.
Our Center, located at the UCSF Mount Zion campus, provides pain treatment for a wide variety of conditions, including but not limited to the conditions listed below.
Click the links below to get more details about these conditions and the treatments we offer for each.
Inpatient Acute and Chronic Pain Services
The Acute and Chronic Pain Services at the Moffitt-Long, Mission Bay, and Mount Zion Hospitals serve as consultant services for our medicine and surgical colleagues who request our help with acute or chronic pain management. For these patients, we make evidence-based recommendations in collaboration with our colleagues, and a final plan for pain management is implemented.
We assess each patient's overall medical condition in the context of an acute or chronic pain episode or acute on chronic pain history. Our goal is to reduce pain while improving function, thus improving morbidity and mortality and decreasing length of stay. In addition, utilization of multimodal analgesia, including peripheral nerve and neuraxial catheters for adult and pediatric patients represents a frequently used technique to achieve such evidence-based goals.
The Acute and Chronic Inpatient Pain Services are available 24/7.
Pediatric Pain Medicine
Integrated Pediatric Pain and Palliative Care Program (IP3)
IP3 is a combined service staffed with pediatric anesthesiologists, pediatric integrative pain specialists, and pediatric palliative care specialists, including nurse practitioners and resident physicians functioning as a cohesive team.
At least one member of the IP3 team is available 24/7 to consult with the inpatient care team, and to initiate a pain and symptom management plan that applies the right management technique for the right child at the right time. Pediatric palliative care services include providing a model of care of hope and resources to support children and their families with life threatening and complex illnesses.
We also staff an outpatient pediatric pain practice, known as the Integrated Pediatric Pain and Palliative Care (IP3) Clinic, which includes symptom management of complex medical conditions.
Pediatric Patient Education Videos:
See article in UCSF Leaps and Bounds:
Zapping the Pain
See article in UCSF News:
Acupuncture Helps Pediatric Patients Manage Pain and Nausea
UCSF is One of Few Academic Medical Centers to Offer Treatment to Inpatients and Outpatients
Osher Center Mini Medical School for the Public – Pain: New Insights and New (and Old) Treatments
February 11
BACK TO THE FUTURE OF PAIN MEDICINE
Mark Schumacher, PhD, MD
Professor and Chief, Division of Pain Medicine, Department of Anesthesia and Perioperative Care, UCSF
February 18
BEING “UNSYMPATHETIC”: PSYCHOLOGY’S SECRET WEAPON FOR MANAGING PAIN
Jessica Pullins, PhD
Licensed Clinical Psychologist, Private Practice
February 25
TECHNOLOGY VERSUS PAIN: TARGETED DRUG DELIVERY AND ELECTRICAL STIMULATION
Lawrence Poree, MD, PhD
Professor, Department of Anesthesia and Perioperative Care; Director, Neuromodulation Service, UCSF
March 3
MY ACHING NECK - MY ACHING BACK
Mario De Pinto, MD
Associate Professor, Department of Anesthesia and Perioperative Care; Director, Pain Management Center, UCSF
March 10
EAST MEETS WEST: ACUPUNCTURE AND BEYOND FOR ALL AGES
Sanjay Reddy, MD
Associate Clinical Professor of Medicine; Director, Congestive Heart Failure, Bone Marrow Transplant and Nighttime Hospitalist Services, UCSF
Instructions for Outpatient Pain Procedures
Link to Verbal Instructions (English)
Link to Written Instructions (English)
Other Resources
Please visit the UCSF Osher Center for Integrative Medicine website. The Osher Center offers a variety of groundbreaking lectures, classes, workshops, and therapeutic programs for the public.
Information about various conditions and treatments can be found on the UCSF Medical Center Patient Education page.
The NIH Pain Consortium website includes press releases and news about federal pain activities. You can also find a pain information brochure, indexing various National Institute of Health publications about pain symptoms, conditions and treatments.
Disclaimer
This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.
Anesthesia Pain Faculty and Resident Clinical Schedule Assignments
Please click here for the Anesthesia Pain Services Clinical Assignments, now on QGenda.
Pediatric Pain, Palliative & Integrative Medicine Call Schedule
The Pediatric Pain, Palliative & Integrative Medicin Call Schedule is available on Amion.com.
Contact Us
Moffitt Long Hospital Pain Services Phone Numbers
Acute Pain Pager
(415) 443‑6889
Chronic Pain Pager
(415) 443‑4332
Acute Pain Resident ASCOM Day-Time Phone
(415) 514‑6593
Mission Bay Adult Hospitals Pain Services Phone Numbers
Adult Pain Pager
(415) 443‑2676 (voalte 20450)
IP3 (Pedi Pain) Pager
(415) 443‑6100 (voalte 514‑9500)
How to Refer a Patient
Non-UCSF Referring Providers
Please complete the UCSF Pain Referral and fax to us at (415) 885-3883.
UCSF Referring Providers
Please complete a referral within APeX.
Services Available
- Back / Spine Pain
- Cervical and Lumbar Facet Joint Disease
- Failed Back Surgery Syndrome (FBSS)
- Herniated Discs
- Low Back Pain
- Cancer Pain
- Chronic Abdominal and Pelvic Pain
- Complex Medication Management Services
- Head, Neck, and Facial Pain
- Headaches
- Musculoskeletal Pain
- Fibromyalgia
- Myofascial (Muscular) Pain
- Sacroiliac Joint Disease
- Shoulder, Hip, and Knee Pain
- Spasticity
- Spinal Stenosis
- Neuropathic (Nerve) Pain
- Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy or RSD)
- Nerve Entrapment Syndromes
- Peripheral Neuropathy
- Phantom Limb Pain
- Post-Herpetic Neuralgia (Shingles Pain)
- Spinal Cord Injury (Central Pain)
- Pediatric Pain
- Comprehensive acute and chronic pain management in both the inpatient and outpatient settings
- Post-Surgical Pain
- Pain Psychology Services
Related Clinics & Centers
The Osher Center for Integrative Medicine provides complementary non-pharmacological pain services that can be integrated with conventional medicine, including pharmacological approaches to pain. Integrative Medicine has much to contribute to the management of pain, whether acute or chronic, inpatient or outpatient. Our evidence-based integrative modalities, including acupuncture, mind-body medicine, and manual medicine, can help patients successfully manage their pain, while offering cost-effective alternatives and adjuncts to opiate and other pain medications.
Pain Management Resources at UCSF
UCSF Practice Guidelines
Drug Information Summary-Nalbuphine
Please find the following documents on UCSF CareLinks:
Antithrombotics and Neuraxial Intervention
Opioid Equivalence Table
UCSF Patient Provider Agreement Opioid Therapy
UCSF Pediatric- Patient Provider Agreement Opioid Therapy
UCSF Grand Rounds
Wednesday, September 7, 2016
Combined Surgery and Anesthesia Grand Rounds
Prescribing Opioids in the Management of Chronic Pain
Osher Center Mini Medical School for the Public – Pain: New Insights and New (and Old) Treatments
February 11, 2016
BACK TO THE FUTURE OF PAIN MEDICINE
Mark Schumacher, PhD, MD
Professor and Chief, Division of Pain Medicine, Department of Anesthesia and Perioperative Care, UCSF
BEING “UNSYMPATHETIC”: PSYCHOLOGY’S SECRET WEAPON FOR MANAGING PAIN
Jessica Pullins, PhD
TECHNOLOGY VERSUS PAIN: TARGETED DRUG DELIVERY AND ELECTRICAL STIMULATION
Lawrence Poree, MD, PhD
Professor, Department of Anesthesia and Perioperative Care; Director, Neuromodulation Service, UCSF
March 3, 2016
MY ACHING NECK - MY ACHING BACK
Mario De Pinto, MD
Associate Professor, Department of Anesthesia and Perioperative Care; Director, Pain Management Center, UCSF
March 10, 2016
EAST MEETS WEST: ACUPUNCTURE AND BEYOND FOR ALL AGES
Sanjay Reddy, MD
Associate Clinical Professor of Medicine; Director, Congestive Heart Failure, Bone Marrow Transplant and Nighttime Hospitalist Services, UCSF
Pain Summits
2015
Case 1 Presentations
Case 2 Presentations
Case 3 Presentations
Full Program
Date: May 8, 2015
Time: 8:00am-3:00pm
Location: Cole Hall, Millberry Union
Recorded Sessions:
Time: 8:45am Click to View
Time: 1:00pm Click to View
For more information, please contact: [email protected]
EXTERNAL LINKS
American Pain Society (APS) Library - Clinical Practice Guidelines
International Association for the Study of Pain (IASP) - Guidelines
American Society of Regional Anesthesia and Pain Medicine (ASRA)
National Institutes of Health (NIH) Pain Consortium
North American Neuromodulation Society (NANS)
American Academy of Pain Physician (AAPM)
American Society of Addiction Medicine (ASAM)
PubMed - US National Library of Medicine
Recommended Reading
GENERAL
Deer TR, Leong MS. Comprehensive Treatment of Chronic Pain by Medical, Interventional, and Integrative Approaches. New York, NY: Springer; 2013.
Macintyre PE, Schug SA, Scott DA, Visser EJ, Walker SM; APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine (2010), Acute Pain Management: Scientific Evidence (3rd edition), ANZCA & FPM, Melbourne.
Urman RD, Vadivelu N. Pocket Pain Medicine. Philadelphia, PA: Lippincott, Williams & Wilkins; 2011.
ACUTE PAIN
Carr DB, Goudas LC. Acute Pain. The Lancet. 1999 353:2051-58.
Dolin SJ, Cashman JN. Tolerability of acute postoperative pain management: nausea, vomiting, sedation, pruritus, and urinary retention. Evidence from published data. Br J Anaesth. 2005 Nov;95(5):584-91.
Egbert LD, Battit GE, Welch CE, Bartlett MK. Reduction of postoperative pain by encouragement and instruction of patients. A study of doctor – patient rapport. N Engl J Med. 1964 Apr 16;270:825-7.
Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, Peelen LM, Kappen TH, van Wijck AJ, Kalkman CJ, Meissner W. Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 2014 May;120(5):1237-45.
Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth. 2010 Dec;105 Suppl 1:i16-23.
Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology. 2002 Mar;96(3):725-41.
Moore RA, Derry S, McQuay HJ, Wiffen PJ. Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database Syst Rev. 2011 Sep 7;(9):CD008659.
Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012 Feb;116(2):248-73.
Serpell MG, Makin A, Harvey A. Acute pain physiology and pharmacological targets: The present and future. Acute Pain. 1998 Jun;1(3):31-47.
Woolf CJ. Recent advances in the pathophysiology of acute pain. Br J Anaesth. 1989 Aug;63(2):139-46.
EPIDURAL
Arakawa M, Aoyama Y, Ohe Y. Block of the sacral segments in lumbar epidural anaesthesia. Br J Anaesth. 2003 Feb;90(2):173-8.
Asato F, Hirakawa N, Araki K, Nagasawa I, Uchiyama A, Watanabe N, Totoki T. A technique for obtaining successful sacral spread with continuous lumbar epidural anesthesia. Anesth Analg. 1990 Jun;70(6):662-4.
Choi S, Mahon P, Awad IT. Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review. Can J Anaesth. 2012 Jul;59(7):681-703.
Dam-Hieu P, Rodriguez V, De Cazes Y, Quinio B. Computed tomography images of entrapped epidural catheter. Reg Anesth Pain Med. 2002 Sep-Oct;27(5):517-9.
Hogan Q. Distribution of solution in the epidural space: examination by cryomicrotome section. Reg Anesth Pain Med. 2002 Mar-Apr;27(2):150-6.
Gallart L, Blanco D, Samsó E, Vidal F. Clinical and radiologic evidence of the epidural plica mediana dorsalis. Anesth Analg. 1990 Dec;71(6):698-701.
Hermanides J, Hollmann MW, Stevens MF, Lirk P. Failed epidural: causes and management. Br J Anaesth. 2012 Aug;109(2):144-54.
Hogan Q. Distribution of solution in the epidural space: examination by cryomicrotome section. Reg Anesth Pain Med. 2002 Mar-Apr;27(2):150-6.
Park WY, Thompson JS, Lee KK. Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study. Ann Surg. 2001 Oct;234(4):560-9; discussion 569-71.
Pöpping DM, Elia N, Van Aken HK, Marret E, Schug SA, Kranke P, Wenk M, Tramèr MR. Impact of epidural analgesia on mortality and morbidity after surgery: systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2014 Jun;259(6):1056-67.
Ramsay N, Walker J, Tang R, Vaghadia H, Sawka A. Flexion-rotation manoeuvre increases dimension of the acoustic target window for paramedian thoracic epidural access. Br J Anaesth. 2014 Mar;112(3):556-62.
Renehan EM, Peterson RA, Penning JP, Rosaeg OP, Chow D. Visualization of a looped and knotted epidural catheter with a guidewire. Can J Anaesth. 2000 Apr;47(4):329-33.
Statlock Image:
Stevens DS, Balkany AD. Appearance of plica mediana dorsalis during epidurography. Pain Physician. 2006 Jul;9(3):268-70.
Wilson MJ, Macarthur C, Shennan A; COMET Study Group (UK). Urinary catheterization in labour with high-dose vs mobile epidural analgesia: a randomized controlled trial. Br J Anaesth. 2009 Jan;102(1):97-103.
Zaouter C, Kaneva P, Carli F. Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia. Reg Anesth Pain Med. 2009 Nov-Dec;34(6):542-8.
ANTISEPTICS
Hebl JR. The importance and implications of aseptic techniques during regional anesthesia. Reg Anesth Pain Med. 2006 Jul-Aug;31(4):311-23.
Sviggum HP, Jacob AK, Arendt KW, Mauermann ML, Horlocker TT, Hebl JR. Neurologic complications after chlorhexidine antisepsis for spinal anesthesia. Reg Anesth Pain Med. 2012 Mar-Apr;37(2):139-44.
CATHETER
Bouman EA, Gramke HF, Wetzel N, Vanderbroeck TH, Bruinsma R, Theunissen M, Kerkkamp HE, Marcus MA. Evaluation of two different epidural catheters in clinical practice. narrowing down the incidence of paresthesia! Acta Anaesthesiol Belg. 2007;58(2):101-5.
EPIDURAL ADJUVANTS
Baron CM, Kowalski SE, Greengrass R, Horan TA, Unruh HW, Baron CL. Epinephrine decreases postoperative requirements for continuous thoracic epidural fentanyl infusions. Anesth Analg. 1996 Apr;82(4):760-5.
Neal JM. Effects of epinephrine in local anesthetics on the central and peripheral nervous systems: Neurotoxicity and neural blood flow. Reg Anesth Pain Med. 2003 Mar-Apr;28(2):124-34.
EPIDURAL INFECTION
American Society of Anesthesiologists Task Force on infectious complications associated with neuraxial techniques. Practice advisory for the prevention, diagnosis, and management of infectious complications associated with neuraxial techniques: a report by the American Society of Anesthesiologists Task Force on infectious complications associated with neuraxial techniques. Anesthesiology. 2010 Mar;112(3):530-45.
Brookman CA, Rutledge ML. Epidural abscess: case report and literature review. Reg Anesth Pain Med. 2000 Jul-Aug;25(4):428-31.
Du Pen SL, Peterson DG, Williams A, Bogosian AJ. Infection during chronic epidural catheterization: diagnosis and treatment. Anesthesiology. 1990 Nov;73(5):905-9.
Grewal S, Hocking G, Wildsmith JA. Epidural abscesses. Br J Anaesth. 2006 Mar;96(3):292-302.
Hebl JR, Horlocker TT. You're not as clean as you think! The role of asepsis in reducing infectious complications related to regional anesthesia. Reg Anesth Pain Med. 2003 Sep-Oct;28(5):376-9.
Horlocker TT, Wedel DJ. Neurologic complications of spinal and epidural anesthesia. Reg Anesth Pain Med. 2000 Jan-Feb;25(1):83-98.
Nickels JH, Poulos JG, Chaouki K. Risks of infection from short-term epidural catheter use. Reg Anesth. 1989 Mar-Apr;14(2):88-9.
Ruppen W, Derry S, McQuay H, Moore RA. Incidence of epidural hematoma, infection, and neurologic injury in obstetric patients with epidural analgesia/anesthesia. Anesthesiology. 2006 Aug;105(2):394-9.
Strafford MA, Wilder RT, Berde CB. The risk of infection from epidural analgesia in children: a review of 1620 cases. Anesth Analg. 1995 Feb;80(2):234-8.
EPIDURAL OPIOIDS
Bernards CM, Shen DD, Sterling ES, Adkins JE, Risler L, Phillips B, Ummenhofer W. Epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidural opioids (part 1): differences among opioids. Anesthesiology. 2003 Aug;99(2):455-65.
Flack SH, Anderson CM, Bernards C. Morphine distribution in the spinal cord after chronic infusion in pigs. Anesth Analg. 2011 Feb;112(2):460-4.
Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology. 2000 Mar;92(3):739-53.
EPIDURAL FENTANYL
Ginosar Y, Riley ET, Angst MS. The site of action of epidural fentanyl in humans: the difference between infusion and bolus administration. Anesth Analg. 2003 Nov;97(5):1428-38.
Guinard JP, Carpenter RL, Chassot PG. Epidural and intravenous fentanyl produce equivalent effects during major surgery. Anesthesiology. 1995 Feb;82(2):377-82.
Loper KA, Ready LB, Downey M, Sandler AN, Nessly M, Rapp S, Badner N. Epidural and intravenous fentanyl infusions are clinically equivalent after knee surgery. Anesth Analg. 1990 Jan;70(1):72-5.
Privado MS, Issy AM, Lanchote VL, Garcia JB, Sakata RK. Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial. Sao Paulo Med J. 2010 Jan;128(1):5-9.
KNOTTED CATHETER
Dam-Hieu P, Rodriguez V, De Cazes Y, Quinio B. Computed tomography images of entrapped epidural catheter. Reg Anesth Pain Med. 2002 Sep-Oct;27(5):517-9.
David M. Knotted peripheral nerve catheter. Reg Anesth Pain Med. 2003 Sep-Oct;28(5):487-8.
PROCEDURES AND POLICIES
UCSF Medical Center, Department of Nursing, Nursing Procedures Manual, Epidural Analgesia (General), 2013.
ESSENTIAL ARTICLES
Basbaum AI, Bautista DM, Scherrer G, Julius D. Cellular and molecular mechanisms of pain. Cell. 2009 Oct 16;139(2):267-84.
GABAPENTINOIDS
Davies A, Hendrich J, Van Minh AT, Wratten J, Douglas L, Dolphin AC. Functional biology of the alpha(2)delta subunits of voltage-gated calcium channels. Trends Pharmacol Sci. 2007 May;28(5):220-8.
Schmidt PC, Ruchelli G, Mackey SC, Carroll IR. Perioperative gabapentinoids: choice of agent, dose, timing, and effects on chronic postsurgical pain. Anesthesiology. 2013 Nov;119(5):1215-21.
GABAPENTIN
Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology. 2002 Sep;97(3):560-4.
Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain--a systematic review of randomized controlled trials. Pain. 2006 Dec 15;126(1-3):91-101.
Hurley RW, Cohen SP, Williams KA, Rowlingson AJ, Wu CL. The analgesic effects of perioperative gabapentin on postoperative pain: a meta-analysis. Reg Anesth Pain Med. 2006 May-Jun;31(3):237-47.
Pandey CK, Priye S, Singh S, Singh U, Singh RB, Singh PK. Preemptive use of gabapentin significantly decreases postoperative pain and rescue analgesic requirements in laparoscopic cholecystectomy. Can J Anaesth. 2004 Apr;51(4):358-63.
Rorarius MG, Mennander S, Suominen P, Rintala S, Puura A, Pirhonen R, Salmelin R, Haanpää M, Kujansuu E, Yli-Hankala A. Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. Pain. 2004 Jul;110(1-2):175-81.
Stewart BH, Kugler AR, Thompson PR, Bockbrader HN. A saturable transport mechanism in the intestinal absorption of gabapentin is the underlying cause of the lack of proportionality between increasing dose and drug levels in plasma. Pharm Res. 1993 Feb;10(2):276-81.
Turan A, White PF, Karamanlioglu B, Memis D, Tasdogan M, Pamukçu Z, Yavuz E. Gabapentin: an alternative to the cyclooxygenase-2 inhibitors for perioperative pain management. Anesth Analg. 2006 Jan;102(1):175-81.
PREGABALIN
Bornemann-Cimenti H, Lederer AJ, Wejbora M, Michaeli K, Kern-Pirsch C, Archan S, Rumpold-Seitlinger G, Zigeuner R, Sandner-Kiesling A. Preoperative pregabalin administration significantly reduces postoperative opioid consumption and mechanical hyperalgesia after transperitoneal nephrectomy. Br J Anaesth. 2012 May;108(5):845-9.
HISTORY
Cartwright PD, Helfinger RG, Howell JJ, Siepmann KK. Introducing an acute pain service. Anaesthesia. 1991 Mar;46(3):188-91.
Ready LB, Oden R, Chadwick HS, Benedetti C, Rooke GA, Caplan R, Wild LM. Development of an anesthesiology-based postoperative pain management service. Anesthesiology. 1988 Jan;68(1):100-6.
Werner MU, Søholm L, Rotbøll-Nielsen P, Kehlet H. Does an acute pain service improve postoperative outcome? Anesth Analg. 2002 Nov;95(5):1361-72, table of contents.
Wheatley RG, Madej TH, Jackson IJ, Hunter D. The first year's experience of an acute pain service. Br J Anaesth. 1991 Sep;67(3):353-9.
Zimmermann DL, Stewart J. Postoperative pain management and acute pain service activity in Canada. Can J Anaesth. 1993 Jun;40(6):568-75.
KETAMINE
Carroll IR, Angst MS, Clark JD. Management of perioperative pain in patients chronically consuming opioids. Reg Anesth Pain Med. 2004 Nov-Dec;29(6):576-91.
Domino EF. Taming the ketamine tiger. 1965. Anesthesiology. 2010 Sep;113(3):678-84.
Felsby S, Nielsen J, Arendt-Nielsen L, Jensen TS. NMDA receptor blockade in chronic neuropathic pain: a comparison of ketamine and magnesium chloride. Pain. 1996 Feb;64(2):283-91.
Hollmann MW, Liu HT, Hoenemann CW, Liu WH, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium. Part II: interactions with volatile anesthetics. Anesth Analg. 2001 May;92(5):1182-91.
Liu HT, Hollmann MW, Liu WH, Hoenemann CW, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium: Part I. Anesth Analg. 2001 May;92(5):1173-81.
Petrenko AB, Yamakura T, Baba H, Shimoji K. The role of N-methyl-D-aspartate (NMDA) receptors in pain: a review. Anesth Analg. 2003 Oct;97(4):1108-16.
Rakhman E, Shmain D, White I, Ekstein MP, Kollender Y, Chazan S, Dadia S, Bickels J, Amar E, Weinbroum AA. Repeated and escalating preoperative subanesthetic doses of ketamine for postoperative pain control in patients undergoing tumor resection: a randomized, placebo-controlled, double-blind trial. Clin Ther. 2011 Jul;33(7):863-73.
Remérand F, Le Tendre C, Baud A, Couvret C, Pourrat X, Favard L, Laffon M, Fusciardi J. The early and delayed analgesic effects of ketamine after total hip arthroplasty: a prospective, randomized, controlled, double-blind study. Anesth Analg. 2009 Dec;109(6):1963-71.
Weinbroum AA. Non-opioid IV adjuvants in the perioperative period: pharmacological and clinical aspects of ketamine and gabapentinoids. Pharmacol Res. 2012 Apr;65(4):411-29.
ANTI-HYPERALGESIA
Bell RF. Low-dose subcutaneous ketamine infusion and morphine tolerance. Pain. 1999 Oct;83(1):101-3.
Bell RF, Dahl JB, Moore RA, Kalso E. Peri-operative ketamine for acute post-operative pain: a quantitative and qualitative systematic review (Cochrane review). Acta Anaesthesiol Scand. 2005 Nov;49(10):1405-28.
De Kock M, Lavand'homme P, Waterloos H. 'Balanced analgesia' in the perioperative period: is there a place for ketamine? Pain. 2001 Jun;92(3):373-80.
Elia N, Tramèr MR. Ketamine and postoperative pain--a quantitative systematic review of randomised trials. Pain. 2005 Jan;113(1-2):61-70.
Himmelseher S, Durieux ME. Ketamine for perioperative pain management. Anesthesiology. 2005 Jan;102(1):211-20.
Lavand'homme P, De Kock M, Waterloos H. Intraoperative epidural analgesia combined with ketamine provides effective preventive analgesia in patients undergoing major digestive surgery. Anesthesiology. 2005 Oct;103(4):813-20.
Minville V, Fourcade O, Girolami JP, Tack I. Opioid-induced hyperalgesia in a mice model of orthopaedic pain: preventive effect of ketamine. Br J Anaesth. 2010 Feb;104(2):231-8.
Urban MK, Ya Deau JT, Wukovits B, Lipnitsky JY. Ketamine as an adjunct to postoperative pain management in opioid tolerant patients after spinal fusions: a prospective randomized trial. HSS J. 2008 Feb;4(1):62-5.
MAGNESIUM
De Oliveira GS Jr, Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials. Anesthesiology. 2013 Jul;119(1):178-90.
Hollmann MW, Liu HT, Hoenemann CW, Liu WH, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium. Part II: interactions with volatile anesthetics. Anesth Analg. 2001 May;92(5):1182-91.
Liu HT, Hollmann MW, Liu WH, Hoenemann CW, Durieux ME. Modulation of NMDA receptor function by ketamine and magnesium: Part I. Anesth Analg. 2001 May;92(5):1173-81.
Petrenko AB, Yamakura T, Baba H, Shimoji K. The role of N-methyl-D-aspartate (NMDA) receptors in pain: a review. Anesth Analg. 2003 Oct;97(4):1108-16.
Traynelis SF, Wollmuth LP, McBain CJ, Menniti FS, Vance KM, Ogden KK, Hansen KB, Yuan H, Myers SJ, Dingledine R. Glutamate receptor ion channels: structure, regulation, and function. Pharmacol Rev. 2010 Sep;62(3):405-96.
Wilder-Smith CH, Knöpfli R, Wilder-Smith OH. Perioperative magnesium infusion and postoperative pain. Acta Anaesthesiol Scand. 1997 Sep;41(8):1023-7.
MULTIMODAL
Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009 Oct;22(5):588-93.
Usichenko TI, Röttenbacher I, Kohlmann T, Jülich A, Lange J, Mustea A, Engel G, Wendt M. Implementation of the quality management system improves postoperative pain treatment: a prospective pre-/post-interventional questionnaire study. Br J Anaesth. 2013 Jan;110(1):87-95.
OPIOIDS
ALFENTANIL
Camu F, Gepts E, Rucquoi M, Heykants J. Pharmacokinetics of alfentanil in man. Anesth Analg. 1982 Aug;61(8):657-61.
Egan TD, Minto CF, Hermann DJ, Barr J, Muir KT, Shafer SL. Remifentanil versus alfentanil: comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers. Anesthesiology. 1996 Apr;84(4):821-33.
Persson MP, Nilsson A, Hartvig P. Pharmacokinetics of alfentanil in total i.v. anaesthesia. Br J Anaesth. 1988 Jun;60(7):755-61.
Shafer SL, Varvel JR. Pharmacokinetics, pharmacodynamics, and rational opioid selection. Anesthesiology. 1991 Jan;74(1):53-63.
Bujedo BM. Current evidence for spinal opioid selection in postoperative pain. Korean J Pain. 2014 Jul;27(3):200-9.
Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ. 2014 Feb 11;348:g1251.
BUTORPHANOL
Dawn AG, Yosipovitch G. Butorphanol for treatment of intractable pruritus. J Am Acad Dermatol. 2006 Mar;54(3):527-31.
Dunteman E, Karanikolas M, Filos KS. Transnasal butorphanol for the treatment of opioid-induced pruritus unresponsive to antihistamines. J Pain Symptom Manage. 1996 Oct;12(4):255-60.
Lee H, Naughton NN, Woods JH, Ko MC. Effects of butorphanol on morphine-induced itch and analgesia in primates. Anesthesiology. 2007 Sep;107(3):478-85.
CODEINE
Bradley CM, Nicholson AN. Effects of a mu-opioid receptor agonist (codeine phosphate) on visuo-motor coordination and dynamic visual acuity in man. Br J Clin Pharmacol. 1986 Nov;22(5):507-12.
HYDROMORPHONE
Felden L, Walter C, Harder S, Treede RD, Kayser H, Drover D, Geisslinger G, Lötsch J. Comparative clinical effects of hydromorphone and morphine: a meta-analysis. Br J Anaesth. 2011 Sep;107(3):319-28.
Smith MT. Neuroexcitatory effects of morphine and hydromorphone: evidence implicating the 3-glucuronide metabolites. Clin Exp Pharmacol Physiol. 2000 Jul;27(7):524-8.
Wright AW, Mather LE, Smith MT. Hydromorphone-3-glucuronide: a more potent neuro-excitant than its structural analogue, morphine-3-glucuronide. Life Sci. 2001 Jun 15;69(4):409-20.
ILEUS / CONSTIPATION
Becker G, Blum HE. Novel opioid antagonists for opioid-induced bowel dysfunction and postoperative ileus. Lancet. 2009 Apr 4;373(9670):1198-206.
Garten L, Degenhardt P, Bührer C. Resolution of opioid-induced postoperative ileus in a newborn infant after methylnaltrexone. J Pediatr Surg. 2011 Mar;46(3):e13-5.
Thomas J. Opioid-induced bowel dysfunction. J Pain Symptom Manage. 2008 Jan;35(1):103-13.
METHADONE
Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, Taylor RJ, Fry-Smith A, Day E, Lintzeris N, Roberts T, Burls A, Taylor RS. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess. 2007 Mar;11(9):1-171, iii-iv.
Eap CB, Déglon JJ, Baumann P. Pharmacokinetics and Pharmacogenetics of Methadone: Clinical Relevance. Heroin Add & Rel Clin Probl. 1999;1(1):19-34.
Ferrari A, Coccia CP, Bertolini A, Sternieri E. Methadone--metabolism, pharmacokinetics and interactions. Pharmacol Res. 2004 Dec;50(6):551-9.
González-Barboteo J, Porta-Sales J, Sánchez D, Tuca A, Gómez-Batiste X. Conversion from parenteral to oral methadone. J Pain Palliat Care Pharmacother. 2008;22(3):200-5.
Lipman AG. Methadone: a double edged sword. J Pain Palliat Care Pharmacother. 2005;19(4):3-4.
Lugo RA, Satterfield KL, Kern SE. Pharmacokinetics of methadone. J Pain Palliat Care Pharmacother. 2005;19(4):13-24.
Manfredi PL, Houde RW. Prescribing methadone, a unique analgesic. J Support Oncol. 2003 Sep-Oct;1(3):216-20.
McCance-Katz EF, Sullivan LE, Nallani S. Drug interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. Am J Addict. 2010 Jan-Feb;19(1):4-16.
Price LC, Wobeter B, Delate T, Kurz D, Shanahan R. Methadone for pain and the risk of adverse cardiac outcomes. J Pain Symptom Manage. 2014 Sep;48(3):333-42.e1.
Sharma A, Tallchief D, Blood J, Kim T, London A, Kharasch ED. Perioperative pharmacokinetics of methadone in adolescents. Anesthesiology. 2011 Dec;115(6):1153-61.
Toombs JD, Leavitt SB. Oral Methadone Dosing for Chronic Pain: A Practitioner’s Guide. Pain Topics.org. March 12, 2008.
Walker PW, Palla S, Pei BL, Kaur G, Zhang K, Hanohano J, Munsell M, Bruera E. Switching from methadone to a different opioid: what is the equianalgesic dose ratio? J Palliat Med. 2008 Oct;11(8):1103-8.
MORPHINE
Christrup LL. Morphine metabolites. Acta Anaesthesiol Scand. 1997 Jan;41(1 Pt 2):116-22.
NALBUPHINE
Aitkenhead AR, Lin ES, Achola KJ. The pharmacokinetics of oral and intravenous nalbuphine in healthy volunteers. Br J Clin Pharmacol. 1988 Feb;25(2):264-8.
Friedman JD, Dello Buono FA. Opioid antagonists in the treatment of opioid-induced constipation and pruritus. Ann Pharmacother. 2001 Jan;35(1):85-91.
Gunion MW, Marchionne AM, Anderson CTM. Use of the mixed agonist – antagonist nalbuphine in opioid based analgesia. Acute Pain. 2004;6:29-39.
Jannuzzi R. Nalbuphine for the treatment of opioid-induced pruritus: a systematic review. J Pain. 2013 Apr;14(4):S10.
Liao CC, Chang CS, Tseng CH, Sheen MJ, Tsai SC, Chang YL, Wong SY. Efficacy of intramuscular nalbuphine versus diphenhydramine for the prevention of epidural morphine-induced pruritus after cesarean delivery. Chang Gung Med J. 2011 Mar-Apr;34(2):172-8.
Naidu RK. Drug Information Summary Sheet: Nalbuphine. September 17, 2012.
Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: a review. J Clin Anesth. 2003 May;15(3):234-9.
Yeh YC, Lin TF, Lin FS, Wang YP, Lin CJ, Sun WZ. Combination of opioid agonist and agonist-antagonist: patient-controlled analgesia requirement and adverse events among different-ratio morphine and nalbuphine admixtures for postoperative pain. Br J Anaesth. 2008 Oct;101(4):542-8.
P&T COMMITTEE
Nalbuphine for Opioid Induced Pruritus. UCSF P&T.
Nguyen N. Nalbuphine Monograph. UCSF P&T. July 2013.
Schumacher M, Naidu R. Nalbuphine Summary: Requesting Addition to Formulary for Treatment of Opioid Induced Pruritus. UCSF P&T. October 9, 2013.
NAUSEA
OIH
Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006 Mar;104(3):570-87.
DuPen A, Shen D, Ersek M. Mechanisms of opioid-induced tolerance and hyperalgesia. Pain Manag Nurs. 2007 Sep;8(3):113-21.
Joly V, Richebe P, Guignard B, Fletcher D, Maurette P, Sessler DI, Chauvin M. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology. 2005 Jul;103(1):147-55.
Kieffer BL, Evans CJ. Opioid tolerance-in search of the holy grail. Cell. 2002 Mar 8;108(5):587-90.
Koppert W. Opioid-induced hyperalgesia—–Pathophysiology and clinical relevance. Acute Pain. 2007;9:21-34.
Laulin JP, Maurette P, Corcuff JB, Rivat C, Chauvin M, Simonnet G. The role of ketamine in preventing fentanyl-induced hyperalgesia and subsequent acute morphine tolerance. Anesth Analg. 2002 May;94(5):1263-9, table of contents.
Mercadante S. Opioid-induced hyperalgesia. Advances in Palliative Medicine. Formerly: Polska Medycyna Paliatywna. 2006;5(2):76–81.
Richebé P, Rivat C, Rivalan B, Maurette P, Simonnet G.
[Low doses ketamine: antihyperalgesic drug, non-analgesic]. Ann Fr Anesth Reanim. 2005 Nov-Dec;24(11-12):1349-59.
Richebe P, Cahana A, Rivat C. Tolerance and opioid-induced hyperalgesia. Is a divorce imminent? Pain. 2012 Aug;153(8):1547-8.
Silverman SM. Opioid induced hyperalgesia: clinical implications for the pain practitioner. Pain Physician. 2009 May-Jun;12(3):679-84.
OPIOID DEFINITION: Describes ALL compounds that work at the opioid receptors.
OPIATE DEFINITION: only naturally occurring alkaloids such as morphine or codeine
NARCOTIC DEFINITION (Gr. stupor): originally used to describe sleep-inducing medications, then opioids, but now is a LEGAL term to describe illicit substances.
OPIOID EQUIVALENCY
Aveline C, Roux AL, Hetet HL, Gautier JF, Vautier P, Cognet F, Bonnet F. Pain and recovery after total knee arthroplasty: a 12-month follow-up after a prospective randomized study evaluating Nefopam and Ketamine for early rehabilitation. Clin J Pain. 2014 Sep;30(9):749-54.
Basbaum AI, Bautista DM, Scherrer G, Julius D. Cellular and molecular mechanisms of pain. Cell. 2009 Oct 16;139(2):267-84.
Fine PG, Portenoy RK; Ad Hoc Expert Panel on Evidence Review and Guidelines for Opioid Rotation. Establishing "best practices" for opioid rotation: conclusions of an expert panel. J Pain Symptom Manage. 2009 Sep;38(3):418-25.
GIG CYMRU NHS Wales. Bwrdd lechyd Aneurin Bevan Health Board. Opiate Conversion Doses. October 2010.
Gippsland Region Palliative Care Consortium Clinical Practice Group. Opioid Conversion Guidelines. Ratified July 2011, Reviewed August 2013.
McPherson ML. Introduction to Opioid Conversion Guidelines. In: Demystifying Opioid Conversion Calculations. A Guide for Effective Dosing. Bethesda, MD: American Society of Health System Pharmacists; 2010:4-7.
Patanwala AE, Duby J, Waters D, Erstad BL. Opioid conversions in acute care. Ann Pharmacother. 2007 Feb;41(2):255-66.
Pereira J, Lawlor P, Vigano A, Dorgan M, Bruera E. Equianalgesic dose ratios for opioids. a critical review and proposals for long-term dosing. J Pain Symptom Manage. 2001 Aug;22(2):672-87.
Shaheen PE, Walsh D, Lasheen W, Davis MP, Lagman RL. Opioid equianalgesic tables: are they all equally dangerous? J Pain Symptom Manage. 2009 Sep;38(3):409-17.
OPIOID METABOLISM
OPIOID PHARMACOLOGY
Trescot AM, Datta S, Lee M, Hansen H. Opioid pharmacology. Pain Physician. 2008 Mar;11(2 Suppl):S133-53.
OPIOID PHARMACOKINETICS
SHAFER
Davis MP, Pasternak GW. Opioid receptors and opioid pharmacodynamics. In: Davis MP, Glare PA, Hardy J, Quigley C, eds. Opioids in Cancer Pain. 2nd Ed. Oxford Medicine Online; 2009.
OXYCODONE
Lugo RA, Kern SE. The pharmacokinetics of oxycodone. J Pain Palliat Care Pharmacother. 2004;18(4):17-30.
OXYMORPHONE
Adams MP, Ahdieh H. Pharmacokinetics and dose-proportionality of oxymorphone extended release and its metabolites: results of a randomized crossover study. Pharmacotherapy. 2004 Apr;24(4):468-76.
Hale ME, Ahdieh H, Ma T, Rauck R; Oxymorphone ER Study Group 1. Efficacy and safety of OPANA ER (oxymorphone extended release) for relief of moderate to severe chronic low back pain in opioid-experienced patients: a 12-week, randomized, double-blind, placebo-controlled study. J Pain. 2007 Feb;8(2):175-84.
P450
Dean L. Codeine Therapy and CYP2D6 Genotype. In: Medical Genetics Summaries. Bethesda, MD: National Center for Biotechnology Information (US); 2012.
Yee MM, Josephson C, Hill CE, Harrington R, Castillejo MI, Ramjit R, Osunkwo I. Cytochrome P450 2D6 polymorphisms and predicted opioid metabolism in African American children with sickle cell disease. J Pediatr Hematol Oncol. 2013 Oct;35(7):e301-5.
Zhou SF. Polymorphism of human cytochrome P450 2D6 and its clinical significance: Part I. Clin Pharmacokinet. 2009;48(11):689-723.
PERIOPERATIVE MANAGEMENT OF PATIENTS ON MEDICATIONS TO MANAGE OPIOID ADDICTION
Bryson EO. The perioperative management of patients maintained on medications used to manage opioid addiction. Curr Opin Anaesthesiol. 2014 Jun;27(3):359-64.
PRURITUS
Charuluxananan S, Kyokong O, Somboonviboon W, Lertmaharit S, Ngamprasertwong P, Nimcharoendee K. Nalbuphine versus propofol for treatment of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg. 2001 Jul;93(1):162-5.
Friedman JD, Dello Buono FA. Opioid antagonists in the treatment of opioid-induced constipation and pruritus. Ann Pharmacother. 2001 Jan;35(1):85-91.
Jannuzzi R. Nalbuphine for the treatment of opioid-induced pruritus: a systematic review. J Pain. 2013 April;14(4):S10.
Kjellberg F, Tramèr MR. Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials. Eur J Anaesthesiol. 2001 Jun;18(6):346-57.
Ko MC, Husbands SM. Effects of atypical kappa-opioid receptor agonists on intrathecal morphine-induced itch and analgesia in primates. J Pharmacol Exp Ther. 2009 Jan;328(1):193-200.
Larijani GE, Goldberg ME, Rogers KH. Treatment of opioid-induced pruritus with ondansetron: report of four patients. Pharmacotherapy. 1996 Sep-Oct;16(5):958-60.
Reich A, Szepietowski JC. Opioid-induced pruritus: an update. Clin Exp Dermatol. 2010 Jan;35(1):2-6.
Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: a review. J Clin Anesth. 2003 May;15(3):234-9.
PUBLIC HEALTH
Okie S. A flood of opioids, a rising tide of deaths. N Engl J Med. 2010 Nov 18;363(21):1981-5.
SLEEP
Cronin AJ, Keifer JC, Davies MF, King TS, Bixler EO. Postoperative sleep disturbance: influences of opioids and pain in humans. Sleep. 2001 Feb 1;24(1):39-44.
Dimsdale JE, Norman D, DeJardin D, Wallace MS. The effect of opioids on sleep architecture. J Clin Sleep Med. 2007 Feb 15;3(1):33-6.
Wang D, Teichtahl H. Opioids, sleep architecture and sleep-disordered breathing. Sleep Med Rev. 2007 Feb;11(1):35-46.
Webster LR, Choi Y, Desai H, Webster L, Grant BJ. Sleep-disordered breathing and chronic opioid therapy. Pain Med. 2008 May-Jun;9(4):425-32.
TRAMADOL
Vergnion M, Degesves S, Garcet L, Magotteaux V. Tramadol, an alternative to morphine for treating posttraumatic pain in the prehospital situation. Anesth Analg. 2001 Jun;92(6):1543-6.
PCA
Carstensen M, Møller AM. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain: a qualitative review of randomized trials. Br J Anaesth. 2010 Apr;104(4):401-6.
Elia N, Lysakowski C, Tramèr MR. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology. 2005 Dec;103(6):1296-304.
Felden L, Walter C, Harder S, Treede RD, Kayser H, Drover D, Geisslinger G, Lötsch J. Comparative clinical effects of hydromorphone and morphine: a meta-analysis. Br J Anaesth. 2011 Sep;107(3):319-28.
Grass JA. Patient-controlled analgesia. Anesth Analg. 2005 Nov;101(5 Suppl):S44-61.
Hicks RW, Sikirica V, Nelson W, Schein JR, Cousins DD. Medication errors involving patient-controlled analgesia. Am J Health Syst Pharm. 2008 Mar 1;65(5):429-40.
Lehmann KA. Recent developments in patient-controlled analgesia. J Pain Symptom Manage. 2005 May;29(5 Suppl):S72-89.
Lin TF, Yeh YC, Lin FS, Wang YP, Lin CJ, Sun WZ, Fan SZ. Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia. Br J Anaesth. 2009 Jan;102(1):117-22.
Marret E, Kurdi O, Zufferey P, Bonnet F. Effects of nonsteroidal antiinflammatory drugs on patient-controlled analgesia morphine side effects: meta-analysis of randomized controlled trials. Anesthesiology. 2005 Jun;102(6):1249-60.
Momeni M, Crucitti M, De Kock M. Patient-controlled analgesia in the management of postoperative pain. Drugs. 2006;66(18):2321-37.
Pasero C, McCaffery M. Orthopaedic postoperative pain management. J Perianesth Nurs. 2007 Jun;22(3):160-72; quiz 172-3.
Sam WJ, MacKey SC, Lötsch J, Drover DR. Morphine and its metabolites after patient-controlled analgesia: considerations for respiratory depression. J Clin Anesth. 2011 Mar;23(2):102-6.
Sveticic G, Eichenberger U, Curatolo M. Safety of mixture of morphine with ketamine for postoperative patient-controlled analgesia: an audit with 1026 patients. Acta Anaesthesiol Scand. 2005 Jul;49(6):870-5.
Meds + Opioids = Sedation
Scope of Education
Despite the prominence and the availability of resources and guidelines from national and international pain societies (American Pain Society; International Association for the Study of Pain), under-treatment of pain remains a widespread challenge. The source of pain management gaps are complex, both at the level of individual providers and at a systems level. Practice gaps include: inadequate understanding of pain assessment scales and appropriate use of analgesic medications, failure to assess and reassess pain in a systematic fashion, fear of producing iatrogenic addiction, concern about analgesic side effects (respiratory depression, hepatic, GI and renal dysfunction) and inability to differentiate opioid tolerance from physical dependence and addiction (Murnion BP et al. Pain Med. 2010 Jan;11(1):58-66. Epub 2009 Nov 17).
Many of these barriers are due to a combination of gaps in knowledge base and at the institutional level due to a failure to embrace an interprofessional model of pain management. A systematic review of the literature suggests that interprofessional education (IPE) is promising as an interventional tool for developing effective pain management skills (Satterfield JM, et al. Acad Med. 2004 Jan;79(1):6-15). As hosted by the Division of Pain Medicine, this website is intended as a tool to address this challenge by establishing a platform for meaningful collaborations across all four professional health science schools at the University of California, San Francisco (UCSF) and beyond.
UCSF Center of Excellence in Pain Education (CoEPE) 2012-2013
The National Institutes of Health Pain Consortium has selected 12 health professional schools as designated Centers of Excellence in Pain Education (CoEPEs). The CoEPEs will act as hubs for the development, evaluation, and distribution of pain management curriculum resources for medical, dental, nursing and pharmacy schools to enhance and improve how health care professionals are taught about pain and its treatment.
2012-2013 CoEPE Certificate of Award
Learning Modules
NIH CoEPE Curriculum Resources
Newsletters
UCSF CoEPE Newsletter, Year 1, Issue 1
UCSF CoEPE Newsletter, Year 1, Issue 2
Undergraduate Medical Education Opportunities
UCSF Anesthesia & Perioperative Care Pain Management Clerkship
This course in pain management allows students to participate in the assessment and treatment of patients with chronic pain in an outpatient setting.
For more information and a full Anesthesia Clerkships course list, please visit:
UCSF Department of Anesthesia and Perioperative Care
UCSF Undergraduate Medical Education
For specific information for visiting students:
UCSF Undergraduate Medical Education - Visiting Students
For any other information, please contact:
Marie Lim
Anesthesia Clerkship Programs Coordinator
Department of Anesthesia and Perioperative Care
University of California, San Francisco
Email: [email protected]
Graduate Medical Education Opportunities
INTERNS
The interdisciplinary Anesthesia internship program at UCSF is a rigorous yet richly rewarding year that includes intensive training in internal medicine, surgery, critical care, neurology, and emergency medicine alongside some of the finest physicians in the country. To gain pain management experience, interns may elect to rotate through our UCSF Pain Management Center and Inpatient Acute Pain Services.
RESIDENTS
The UCSF Pain Management Center welcomes any resident who would like to rotate through the clinic. Coordination with the UCSF Department of Anesthesia & Perioperative Care Residency Program is required for both visiting and UCSF trainees.
Applicants who would like to apply for a full Anesthesia Internship or Residency must complete an ERAS (Electronic Residency Application Service) application.
For more information, please contact:
Department of Anesthesia and Perioperative Care
University of California, San Francisco
Email: [email protected]
FELLOWS
UCSF Pain Medicine Fellowship training consists of 12 months of full-time training after satisfactory completion of a core ACGME accredited residency program.
UCSF Pain Medicine Fellowship Program Overview
Pain Medicine Fellowship Application
The UCSF Hospice and Palliative Medicine Fellowship Program is a one-year ACGME-accredited clinical fellowship devoted to training future leaders in all areas of Hospice and Palliative Medicine.
UCSF Hospice and Palliative Medicine Fellowship Program Overview
Applicants interested in pursuing training with the UCSF Palliative Medicine Fellowship should follow the instructions via the ERAS Fellowship Documents Office. More information can be found at UCSF Graduate Medical Education.
Inter-program training between the Pain Medicine Fellowship and Palliative Care Fellowship Programs are under discussion.
Other Educational Opportunities
Observational preceptorships of varying lengths are also available. Visiting physicians, scientists, physician's assistants, physical therapists, pharmaceutical representatives, and others have joined us in this capacity. No direct patient care is permitted.
To apply, please contact:
Mario De Pinto, MD
Medical Director, UCSF Pain Management Center
Pain Medicine Fellowship Programs
ACGME Approved Chronic Pain Medicine Fellowship
The Joint Commission Approved Pain Management Center
George Pasvankas, MD
Fellowship Director
FROM THE DIRECTOR
The UCSF Pain Management Center specializes in the multidisciplinary management of patients suffering from acute, chronic, and cancer pain. The faculty consists of the Medical Director, the Administrative Director, the Fellowship Director, anesthesiologists, neurologists, psychologists, physical therapists, nurses, administrative staff, and consultants in Orthopedic Surgery, Neurosurgery, Neurology, Rheumatology, Radiology, Internal Medicine, Oncology, and Pharmacology.
ACGME Approved Acute Pain and Regional Anesthesiology Fellowship
Fellowship Director
FROM THE DIRECTOR
The UCSF Acute Pain and Regional Anesthesiology Fellowship is one of the first in the nation, with only 8 other institutions offering this ACGME approved fellowship in 2017. This fellowship includes structured acute and chronic pain rotations at UCSF Helen Diller Medical Center at Parnassus Heights, UCSF Mission Bay, some at Kaiser South San Francisco and some at ZSFG. It includes an increased emphasis on acute pain and on multimodal pharmacologic approaches to treat it. “We have a much larger arsenal of tools to treat pain after complex surgeries, and with the opiate crisis, this is especially important,” says Dr. Aleshi. “Using that arsenal effectively demands another level of expertise and our fellows will be much better trained in this aspect of treating pain.”
To Read More, Please visit our Fellowships page
Resources for Current Trainees
ML APS/M-PN Resident Orientation July 2018
Mount Zion Adult Chronic Pain Rotation (Z-PN)
When: 7am arrival on your first day of rotation (Monday)
Where: UCSF Pain Management Center (PMC) at 2255 Post Street, MZ campus
Z-PN Rotation Welcome Letter_January 2018
Medical student PMC rotation handbook 2015
Pain and Addiction Research Center at UCSF
PARC is a transdisciplinary research center focused on developing and testing new approaches for treating pain, decreasing the negative consequences of opioids, and developing effective ways to mitigate the impact of opioid overuse. Click here for more info.
Research in the Division of Pain Medicine
For up-to-date research lectures and more, check the Events section of the Anesthesia and Perioperative Care website. To see a list of all UCSF Pain Research Group lectures, please click here or see the Pain Research Group link at the left side of this page.
For more information, or to be added to the Pain Research Group's email distribution list, please contact:
Julie Leong
Research Administration Analyst
UCSF Department of Anesthesia & Perioperative Care
Email: [email protected]
| Date | Speaker | Institution | Presentation | Recordings |
|---|---|---|---|---|
|
Sep 28, 2017 |
Jose Moron- Concepcion, PhD Associate Professor |
Washington University Pain Center Washington University School of Medicine |
"Opioid-Induced Plasticity and the Intersection with Pain" | Click Here |
| Oct 26, 2017 8:00AM-9:00AM N-721 |
Yeong-Ray Wen Attending Anesthesiologist |
China Medical University Hospital China Medical University Taichung, Taiwan |
"Pulse Radio Frequency Ablation of DRG to Treat Chronic Pain" | Click Here |
|
Nov 16, 2017 |
Franziska Denk, MSc Lecturer |
King's College London | "What Cell Sorting Can Teach Us About Pain and Neuro-Immune Interactions" | Click Here |
| Apr 4, 2018 5:00PM-6:00PM S-170 |
Jianren Mao, MD, PhD Chief, Division of Pain Medicine |
Massachusetts General Hospital | "Current Challenges in Translational Pain Research" | |
| June 14, 2018 8:00AM-9:00AM N-721 |
Prasad Shirvalkar, MD, PhD Assistant Professor Department of Anesthesiology (Pain Management) Department of Neurology |
University of California, San Francisco | "Closing the Loop on Deep Brain Stimulation for Chronic Pain" | Click Here |
| October 18, 2018 8:00AM-9:00AM HSW302 |
Thomas Buchheit, MD Chief of Pain Medicine
|
Duke University | "Nerve Injury, Arthritis, and the Future of Biologic Therapies for Pain" |
|
|
January 10, 2019
8:00AM-9:00AM
N721
|
Assistant Professor of Anesthesiology, Perioperative and Pain Medicine, Neurosurgery, and by courtesy, Molecular and Cellular Physiology
|
Stanford University | "The Neural Basis of Pain Unpleasantness and its Modulation by Opioids" | Click Here |
|
February 14,
2019
8:00am- 9:00am
N721 |
Irene Tracey, MA (Oxon), Dphil., FRCA, FMedSci Nuffield Department of Clinical Neurosciences |
University of Oxford | "Pain Biomarkers: Is There a Role for Neuroimaging?" |
Click Here |
|
April 17, 2019 7:00am-8:00am N217
|
Chad Brummett, MD Associate Professor, Anesthesiology Director, Anesthesia Clinical Research Director, Division of Pain Research |
University of Michigan Medical School | "The Role of Acute Care Prescribing in the Opioid Epidemic" | |
| May 2, 2019 8:00am-9:00am N721 |
Dr. Larry Carbone, DVM, PhD, DACAW, DACLAM Director, IACUP |
UCSF | "Clinical Pain Management for Lab Animals: Some Notes from Your Mouses’s Veterinarian" | |
| June 13, 2019 8:00am-9:00am N721 |
Fan Wang, PhD Morris N. Broad Professor, Department of Neurobiology |
Duke University Medical Center | "General Anesthesia, Sleep, and Pain" | |
|
TBA |
Stephen McMahon |
King’s College | TBA |
2016 - 2017 UCSF Pain Research Group Schedule
|
Date |
Speaker | Institution | Presentation | Recordings |
|---|---|---|---|---|
|
Aug 29, 2016 |
Frank Porreca, PhD |
University of Arizona | "Brain Circuits Mediating Pain and Its Relief" | Click Here |
|
Nov 10, 2016 |
Hui-Lin Pan, MD, PhD |
University of Texas MD Anderson Cancer Center |
"Epigenetic and Synaptic Mechanisms of Neuropathic Pain" | Click Here |
| Dec 8, 2016 8:00AM- 9:00AM N-721 |
David Bennett, MB PhD, FRCP |
University of Oxford | "Human Pain Channelopathies" | Click Here |
| Feb 23, 2017 8:00AM- 9:00AM N-721 |
Donald Manning, MD, PhD |
Adynxx | "Found in Translation" - Transcription Factor Targeting for Pain Management and Prevention | Click Here |
| Mar 9, 2017 8:00AM- 9:00AM N-721 |
Theodore Price, PhD |
University of Texas at Dallas | "Translation Regulation in Chronic Pain: Targeting Translation from the 5' and 3' Ends and New Insight from New Generation Sequencing" | Click Here |
| Mar 21, 2017 5:00PM- 6:00PM N-721 |
Lawrence Poree, MD, PhD |
University of California, San Francisco | "Dorsal Root Ganglion Stimulation for the Treatment of Posttraumatic Neuralgia: Case Presentations and Results of Multicenter Randomized Clinical Trail" | Click Here |
| RESCHEDULED Mar 22, 2017 |
Quinn Hogan, MD |
Medical College of Wisconsin | "The Sensory Neuron T-junction is a Natural Impulse Filter and a Potential Therapeutic Target" | |
|
Apr 20, 2017 |
Andrew Todd |
University of Glasgow | "Defining the Roles of Dorsal Horn Interneurons in the Spinal Processing of Pain and Itch" | |
|
May 25, 2017 |
Qiufu Ma, PhD |
Harvard Medical School Dana-Farber Cancer Institute |
TBA |
|
2015 - 2016 UCSF Pain Research Group Schedule
| Date | Speaker | Institution | Presentation | Recordings |
|---|---|---|---|---|
| Nov 12, 2015 8:00AM-9:00AM N-721 |
Neil Schwartz, PhD |
University of California, San Francisco | "Striatal Regulation of the Impact of Pain on Reward-Directed Behavior" | Click Here |
|
Dec 3, 2015 |
Michael Rowbotham, MD |
University of California, San Francisco | Patient Presentation | Click Here |
| Jan 14, 2016 8:00AM-9:00AM N-721 |
Jeffrey Mogil, PhD |
McGill University Montreal, Quebec, Canada |
"Sex Differences in Pain from Both Sides of the Syringe" | Click Here |
| Feb 11, 2016 8:00AM-9:00AM N-721 |
John Neubert, DDS, PhD |
University of Florida | "Operant Assessments of Orofacial Pain (Building a Better Mouse Trap)" | Click Here |
| Apr 14, 2016 8:00AM-9:00AM N-721 |
Gregory Scherrer, PhD Assistant Professor |
Stanford University School of Medicine |
"Molecular Mechanisms of Pain Modulation by Endogenous and Exogenous Opiods" | |
|
May 12, 2016 |
Xinzhong Dong, PhD |
Xinzhong Dong, PhD |
"Mechanisms of Pain and Itch" | Click Here |
2014 - 2015 UCSF Pain Research Group Schedule
| Date | Speaker | Institution | Presentation | Recordings |
|---|---|---|---|---|
|
Dec 4, 2014 |
William Schmidt, PhD |
NorthStar Consulting, LLC |
"Standing on the Shoulders of Giants: |
Click Here |
|
Jan 22, 2015 |
Andrew Charles, MD |
University of California, Los Angeles |
"Advances in the Basic and Clinical Science of Migraine" | Click Here |
|
Feb 26, 2015 |
Mark Schumacher, MD, PhD |
University of California, San Francisco |
"Chronification of Pain: The Role of Sp1-like Transcription Factors" | Click Here |
|
Apr 9, 2015 |
Bradley Taylor, PhD |
University of Kentucky | "Endogenous Opioid Receptor Analgesia and Dependence" | Click Here |
|
Apr 30, 2015* |
Yves De Koninck, PhD |
Laval University Quebec City, Canada |
"Targeting Chloride Transport for the Treatment of Chronic Pain" | Click Here |
|
May 7, 2015 |
Michael Rowbotham, MD |
University of California, San Francisco |
"Case Presentation" | Click Here |
|
May 21, 2015 |
Cheryl Stucky, PhD |
Medical College of Wisconsin | "Mechanisms Underlying Pain in Sickle Cell Disease" | Click Here |
2013 - 2014 UCSF Pain Research Group Schedule
| Date | Speaker | Institution | Presentation | Recordings |
|---|---|---|---|---|
|
Dec 5, 2013 |
Bruce Hammock, PhD |
University of California, Davis |
"Soluble Epoxide Hydrolase Inhibitors Reduce Neuropathic Pain in Diabetic Models and in Companion Animals" |
Click Here |
|
Jan 16, 2014 |
Merlin Larson, MD |
University of California, |
"Opioid Effect on Pupillary Unrest - Theory and Clinical Application" | Click Here |
|
Mar 6, 2014 |
Robert Gereau, PhD |
Washington University Pain Center |
"Translational Pain Research: Targeting Central Sensitization" | Click Here |
|
Apr 24, 2014 |
Ru Rong Ji, PhD |
Duke University Medical Center |
"Neuroinflammation Drives Chronic Pain" | Click Here |
|
May 8, 2014 |
Tor Wager, PhD |
University of Colorado, Boulder |
"Towards fMRI-Based Biomarkers for Pain and Emotion" | Click Here |
|
Jun 5, 2014 |
Zhonghui Guan, MD |
University of California, San Francisco |
"How Do Injured DRG Neurons Activate Microglia and Contribute to Neuropathic Pain" |
Click Here |
2012 - 2013 UCSF Pain Research Group Schedule
| Date | Speaker | Institution | Presentation | Recordings |
|---|---|---|---|---|
|
Nov 29, 2012 |
Tomoyuki Kawamata, MD |
Shinshu University |
"TRPV1 and TRPV2 Detect Different Modalities
|
|
|
Dec 6, 2012 |
Luc Jasmin, MD, PhD |
Cedars Sinai Medical Center | "How Significant is Non-Synaptic Transmission? Very Significant in the Sensory Ganglion" |
|
|
Jan 10, 2013 |
Pamela Palmer MD, PhD |
AcelRx Pharmaceuticals |
"Sublingual Sufentanil NanoTab PCA System for Postoperative Pain Management" |
Click here |
|
Feb 7, 2013 |
Tony Yaksh, PhD |
University of California, |
"Spinal Toll Receptors in Nociceptive Signaling |
Click here |
|
Mar 28, 2013 |
Kenneth Hargreaves, DDS, PhD |
University of Texas |
"Wham, Bam, OLAMs - Studies on the Role of Endogenous TRPV1 Agonists" |
Click here |
|
May 16, 2013 |
Pain Summit |
|
|
|
|
Jun 6, 2013 |
Mark Zylka, PhD |
University of North Carolina |
"Sensory Mechanism for Heat Inhibition of Cold" | Click here |
The UCSF Pain Management Center, located at the UCSF Mount Zion campus, was established in 1987 by the Department of Anesthesia and Perioperative Care to help patients with various stages and types of complex, acute, and chronic pain. We offer a variety of treatment options with a comprehensive and multidisciplinary approach.
Contact
UCSF Pain Management Center
2255 Post Street
San Francisco, CA
94143-1654
(Express mail ZIP 94115)
Phone: 415.885.PAIN (7246)
Fax: 415.885.7575
Fax for New Patient Referrals: 415.885.3883
Our Center
Combines traditional and complementary approaches
- Was designated as a Clinical Center of Excellence in Pain Management in 2007 by the American Pain Society
- Empowers patients through education about their conditions
- Identifies the best methods to relieve pain, promote healing, and restore maximum levels of function
- Has extensive knowledge of the latest pain management treatments and techniques
- Averages about 800 patient visits per month
Our Center provides pain treatment for a wide variety of conditions, including but not limited to:
Chronic pain is a multifaceted medical problem that affects all aspects of a patient’s life. Our Center is staffed by professionals from multiple disciplines, including Anesthesia, Neurology, Psychology, and Nursing to address the range of issues brought about by pain. Patient involvement and education are important components of our program.
Map and Directions
Pathway is your guide to getting directions to UCSF at Parnassus Heights, UCSF at Mount Zion, and UCSF at Mission Bay and China Basin.
Referral Information
The UCSF Pain Management Center is a consultative practice and all patients must be referred for consultation by their primary care physician or other health care provider.
NON-UCSF REFERRING PROVIDERS:
Please complete the UCSF Pain Referral and fax to us at (415) 885-3883.
UCSF REFERRING PROVIDERS:
Please complete a referral within APeX
ALL REFERRING PROVIDERS:
Along with a completed referral form, please include:
- Reason for referral
- Most recent medical evaluations
- Most recent operative reports
- Most recent X-ray/MRI reports
- Any psychological evaluations or reports
- A list of the patient’s current medications
- If required by the patient’s insurance, the authorization for the referral to the PMC
Evaluation Process:
- We receive your referral
- We contact the patient and schedule them for an initial evaluation
- We send the patient an appointment confirmation letter, with:
- Directions and parking and transportation information
- Information about enrolling in UCSF MyChart, a confidential on-line resource for UCSF patients’ routine health care needs.
Once we have evaluated the patient, the referring provider will be sent a copy of our evaluation summary, treatment plan & recommendations. If you need additional info, please contact us at (415) 885-7347.
Treatments and Recommendations
We will provide recommendations about the proposed treatment or suggested medication regimen to the referring provider.
If required by the patient’s insurance, we will secure prior authorization for recommended treatments prior to scheduling the patient’s appointment.
Pain Psychology Services Available
Osher Mini Medical School for the Public Lecture
BEING “UNSYMPATHETIC”: PSYCHOLOGY’S SECRET WEAPON FOR MANAGING PAIN
Jessica Pullins, PhD
Pediatric Pain, Palliative & Integrative Medicine Center
The Pediatric Pain, Palliative & Integrative Medicine Center is dedicated to relieving pain and improving quality of life for our youngest hospitalized patients, and is available 24 hours a day, seven days a week. Our team includes pediatric hospitalists (specialists in managing the care of hospitalized patients), pediatric anesthesiologists, pediatric palliative care specialists, a nurse practitioner, a psychologist and nurses.
To provide the right care for each patient, the service is staffed by two teams. The acute and chronic pain team focuses on comprehensive pain management, while the palliative care team provides an extra layer of support for children and families facing serious illness. When a patient is ready for discharge, we work collaboratively with providers from all relevant specialties to bridge the transition home.
Acute and chronic pain team
We embrace innovative and integrative approaches to relieving and managing pain. Our services include:
Palliative care team
For children with serious illnesses, our team – which includes specialists from several fields – focuses on relieving symptoms and stress, fostering wellness and offering comfort. The overarching goal is to improve quality of life for both the child and their family by partnering and collaborating with everyone affected and by ensuring that care meets individual needs and values. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative or life-prolonging treatment.
Our services include:
- Treatments for acute pain, or short-lived pain related to illness or injury
- Treatments for chronic pain
- Specialized treatment for amplified pain, an abnormal neurological response that causes pain to be felt with unusual intensity
- Sedation for medical procedures
- Regional anesthesia (numbing the area of the body being treated), such as an epidural injection
- Complementary and integrative therapies:
- Acupressure and acupuncture
- Aromatherapy
- Biofeedback
- Massage therapy
- Music therapy
- Relaxation training
- Short-term cognitive behavioral therapy
- Transcutaneous electrical nerve stimulation (TENS)
- Management of symptoms, such as pain, nausea, constipation, shortness of breath and anxiety
- Discussions to clarify individual goals of care
- Help understanding medical conditions
- Decision-making support
- Advance care planning
- Support for emotional, psychological and spiritual issues in developmentally appropriate ways
- Care coordination for complex and chronic conditions
- Support and counseling for grief and loss
- Complementary and integrative therapies, such as massage, music therapy and art therapy
- Coordination with hospice agencies
- Coordination with home-based palliative care programs
Click here to see a list of Pediatric Pain, Palliative & Integrative Medicine Center providers.
Patient Education Videos
Location
1825 Fourth Street, Fifth and Sixth Floors
San Francisco, CA 94143-0106
(415) 353-9517 Phone
From UCSF News
Acupuncture Helps Pediatric Patients Manage Pain and Nausea UCSF is One of Few Academic Medical Centers to Offer Treatment to Inpatients and Outpatients
From UCSF Leaps and Bounds
From NPR
Pain Rescue Team Helps Seriously Ill Kids Cope In Terrible Times
Pain and Addiction Research Center Events
Anesthesia Grand Rounds
For more information, please visit the "Events" section of the Department of Anesthesia & Perioperative Care website.
UCSF Osher Center Intergrative Medicine Grand Rounds
To make a secure donation online, please visit our make a gift page, select “Direct your gift to a specific area,” and choose [Division of Pain Medicine].
For more information, please contact:
Allison White
Assistant Director, University Development
220 Montgomery Street, 5th Floor
San Francisco, CA 94104
Office Tel: (415) 502-5868
Email: [email protected]