Pain Medicine
Mission & History 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.
UCSF is 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.
Pain Leadership
Mark Schumacher, PhD, MD
Professor, Anesthesia
Chief, Division of Pain Medicine, Dept of Anesthesia & Perioperative Care
Acute Pain Faculty
Ramana Naidu, MD
Assistant Professor, Anesthesia
Director, Acute Pain Service
Matthias Behrends, MD
Associate Clinical Professor, Anesthesia
Daniel Burkhardt, MD
Associate Clinical Professor, Anesthesia
Director, Moffitt-Long Prepare Clinic
Lee-lynn Chen, MD
Health Science Clinical Professor, Anesthesia
Mario De Pinto, MD
Associate Clinical Professor, Anesthesia
Director, PMC & Chronic Pain
Matthew Haight, DO
Associate Clinical Professor, Anesthesia
Sakura Kinjo, MD
Health Science Clinical Professor
Medical Director, Orthopaedic Institute
Merlin D. Larson, MD
Clinical Professor - Emeritus, Anesthesia
Mark Latronica, MD
Assistant Clinical Professor, Anesthesia
Rachel Eshima McKay, MD
Clinical Professor, Anesthesia
Director, Mission Bay Prepare Clinic
Mark Schumacher, PhD, MD
Professor, Anesthesia
Chief, Division of Pain Medicine, Dept of Anesthesia & Perioperative Care
C. Spencer Yost, MD
Clinical Professor, Anesthesia
Chief of Anesthesia, ICU Medical Director, UCSF-Bakar Cancer Hospital at Mission Bay
Chronic Pain Faculty
Mario De Pinto, MD
Associate Clinical Professor, Anesthesia
Director, PMC & Chronic Pain
George Pasvankas, MD
Associate Clinical Professor, Anesthesia
Director, UCSF Pain Medicine Fellowship Program
Nu "Cindy" Chai, MD
Assistant Professor, Anesthesia and Neurology
Zhonghui Guan, MD
Assistant Professor in Residence, Anesthesia
Melanie M. Henry, MD, MPH
Associate Clinical Professor, Anesthesia
David J. Lee, MD
Clinical Professor, Anesthesia
Ramana Naidu, MD
Assistant Professor, Anesthesia
Director, Acute Pain Service
Thoha Pham, MD
Associate Clinical Professor, Anesthesia
Lawrence Poree, MPH, MD, PhD
Professor, Director, Neuromodulation Service
Heidi Reetz, MD
Assistant Professor, Anesthesia and Family & Community Medicine
Michael Rowbotham, MD
Professor
Xiaobing Yu, MD
Assistant Professor in Residence, Anesthesia
Integrated Pediatric Pain & Palliative Care (IP3) Faculty
Gabriel Sarah, MD
Assistant Professor, Interim Director, Anesthesia Pain
Karen Sun, MD
Assoc Clin Prof, Pediatric Hospital Medicine
Chief, Division of Pediatric Hospital Medicine
Member, IP3 Governance Board
Steve Wilson, MD, PhD
Clinical Professor, Pediatric Hosp Med
Assoc Chief Medical Officer, UCSF Benioff Children's Hospital
Maurice Zwass, MD
Professor of Clinical Anesthesia, Anesthesia
Director, Pediatric Anesthesia
Atsuko Baba, MD
Clinical Professor, Pediatric Anesthesia
Member, IP3 Governance Board
Jori Bogetz, MD
Assistant Clinical Professor, Pediatric Hospital Medicine
Marla Ferschl, MD
Associate Professor,
Director, Pediatric Anesthesia Fellowship Program
Darren Fiore, MD
Associate Professor, Pediatrics
Fellowship Director, Pediatric Hospital Medicine
Director, Peds Hosp Med Fellowship Program
Audrey Foster-Barber, MD, PhD
Associate Professor, Clinical Neurology
Sunitha Kaiser, MD, MSc
Assistant Professor, Pediatrics
IP3
Cynthia Kim, MD
Associate Clinical Professor, Pediatric Hospital Medicine
Ramana Naidu, MD
Assistant Professor, Anesthesia
Director, Acute Pain Service
Hung Gia Nguyen, MD
Assistant Clinical Professor, Anesthesia
Thomas Reid, MD
Asst Clin Prof, Hospital Medicine
Assoc Prog Dir, UCSF Hospice & Palliative Medicine Fellowship
David Robinowitz, MD, MHS, MS
Associate Clinical Professor, Pediatric Anesthesia
Glenn Rosenbluth, MD, MSc
Associate Professor, Pediatrics Director, Quality and Safety Programs GME Associate Director, Pediatrics Residency Training Program
IP3
Psychology Faculty
Cristina Benki, PhD
Child and Adolescent Psychologist, IP3
Sue Gritzner, Psy.D
Pain Psychologist, PMC
Regional Anesthesia Faculty
Pedram Aleshi, MD
Associate Professor,
Anesthesia, Director, Regional Anesthesia
Matthias Behrends, MD
Associate Clinical Professor, Anesthesia
Philip Bickler, MD, PhD
Professor, Anesthesia
Matthias Braehler, MD, PhD
Associate Professor
Mario De Pinto, MD
Associate Clinical Professor, Anesthesia
Director, PMC & Chronic Pain
Gerald Dubowitz, MD
Associate Professor, Anesthesia
Seema Gandhi, MD
Associate Professor, Anesthesia
Matthew Haight, DO
Associate Clinical Professor, Anesthesia
Monica Harbell, MD
Assistant Professor, Anesthesia
Christina Inglis-Arkell, MD
Assistant Professor, Anesthesia
Director, MZ OR
Sakura Kinjo, MD
Professor, Anesthesia
Medical Director, Orthopaedic Institute
Kerstin Kolodzie, MD, PhD
Associate Professor, Anesthesia
Mark Latronica, MD
Assistant Clinical Professor, Anesthesia
Ramana Naidu, MD
Assistant Professor, Anesthesia
Director, Acute Pain Service
George Pasvankas, MD
Associate Clinical Professor, Anesthesia
Director, UCSF Pain Medicine Fellowship Program
Thoha Pham, MD
Associate Clinical Professor, Anesthesia
Ahmed Shalabi, MD
Assistant Professor, Anesthesia
Claas Siegmueller, MD, PhD, MBA
Assistant Professor, Anesthesia
Pain Fellows
Christopher Abrecht, MD
2016-2017 Pain Management Fellow, Anesthesia
Deepali Dhar, MD
2016-2017 Pain Management Fellow, Anesthesia
Keeley Dohmeier, MD
2016-2017 Pain Management Fellow, Anesthesia
Ann Cai Shah, MD
2016-2017 Pain Management Fellow, Anesthesia
Prasad Shirvalkar, MD
2016-2017 Pain Management Fellow, Anesthesia
Pain Nursing
Charlene Michelle Gibson, RN
Clinical Nurse, PMC
Alicia Heilman, RN
Outpatient Case Manager,
IP3
Charmaine Penaflor, RN
Clinical Nurse, PMC
Erica Fuchs, RN
PMC
Pain Staff
Dennis Lew, RN
Administrative Director, UCSF Pain Management Center
June SL Chan, MSN, MSA, RN
Administrative Director, Acute Care Pediatrics and Clinical Support Services @ UCSF Benioff Childrens Hospital
IP3
Diane Ozawa
Practice Supervisor, PMC
Practice Assistant to Drs. Mario De Pinto and Ramana Naidu
Lisa Purser, RN
Patient Care Manager, IP3
Morgen Ahearn
Assistant to Dr. Mark Schumacher, Anesthesia
Administrator, Division of Pain Medicine
Tonia Broden-Gonzales
Practice Assistant to Drs. George Pasvankas and Thoha Pham, PMC
Wendy Ham
Practice Assistant - Front Desk, PMC
Marie Hollero
Pain Fellowship Coordinator
Lona Hermawan
Practice Assistant, PMC
Kai the Dog
Therapy Dog, IP3
Shanda Vaughn
Practice Assistant to Dr. Zhonghui Guan, PMC
Robert Waymack
Practice Assistant - New Patient Coordinator, PMC
Make an Appointment
NEW PATIENTS
Need a referral or consultation request submitted by their primary physician or care team, for:
Chronic Pain Management
Acute Pain Management
RETURNING PATIENTS
Call the UCSF Pain Management Center at (415) 885-PAIN / (415) 885-7246 --or--
Request your follow-up appointment via UCSF MyChart, an online resource for your routine healthcare needs.
PEDIATRIC PATIENTS
Call the Integrated Pediatric Pain & Palliative Care (IP3) Clinic at (415) 353-1328
Locations
UCSF Pain Management Center
Integrated Pediatric Pain & Palliative Care (IP3)
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.
Adult Pain Medicine
OUTPATIENT CHRONIC PAIN MANAGEMENT CENTER
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:
- Back / Spine Pain
- Cancer Pain
- Chronic Abdominal and Pelvic Pain
- Complex Medication Management Services
- Head, Neck, and Facial Pain
- Headaches
- Musculoskeletal Pain
- Neuropathic (Nerve) Pain
- Post-Surgical Pain
INPATIENT ACUTE PAIN
The Acute Pain Service at the Moffitt-Long, Mission Bay, and Mount Zion Hospitals serves as a consultant service for our medicine and surgical colleagues who request our help with 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 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 peripheral nerve and neuraxial catheters for adult and pediatric patients represents a frequently used technique to achieve such evidence-based goals.
The Acute Inpatient Pain Service is available 24/7.
Pediatric Pain Medicine
INTEGRATED PEDIATRIC PAIN & 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.
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
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.
Anesthesia Pain Faculty and Resident Clinical Schedule Assignments
Please click here for the Anesthesia Pain Services Clinical Assignments, now on QGenda.
IP3 Call Schedule 2016-2017
Please click here to view the IP3 call schedule
Contact Us
MOFFITT-LONG HOSPITAL CONTACT INFO
Acute Pain Pager
(415) 443‑6889
Chronic Pain Pager
(415) 443‑4332
Acute Pain Resident ASCOM Phone
(415) 514‑6593
MISSION BAY HOSPITAL CONTACT INFO
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
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 Summit 2015 Resources
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
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
Assistant Clinical Professor, Department of Anesthesia and Perioperative Care; Clinical Psychologist, Pain Management Center, UCSF
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
March 17
THE PRESCRIPTION OPIOID EPIDEMIC: CRISIS AND OPPORTUNITY
Ramana Naidu, MD
Assistant Professor, Department of Anesthesia and Perioperative Care; Director of Acute Pain Services; Chair of the UCSF Pain Committee, 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: ucsfcoepe@anesthesia.ucsf.edu
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
UCSF CoEPE Organization & Leadership
Sam Hawgood, MBBS
Chancellor, UCSF
UCSF
Mark Schumacher, PhD, MD
Principal Investigator
UCSF
Mark Rollins, MD, PhD
Lead Faculty, Lead Case Faculty, Undergraduate Education
UCSF School of Medicine
Allan Basbaum, PhD
Content Expert
UCSF School of Medicine
Sarah Brynelson, RN, MS, CNS, CPAN,
Case Faculty
UCSF School of Medicine
Peter Goadsby, MD, PhD
Content Expert
UCSF School of Medicine
Susan Masters, PhD
Associate Dean, Undergraduate Education, Curriculum Advisor
UCSF School of Medicine
Daniel Lowenstein, MD
Curriculum Advisor
UCSF School of Medicine
Jason Satterfield, PhD
Curriculum Advisor
UCSF School of Medicine
Scott Reeves, PhD, MSc, PGCE
Director, UCSF Center for Interprofessional Education, Curriculum Advisor
UCSF Center for Interprofessional Education
Sandrijn Van Schaik, MD
Director, UCSF Kanbar Center for Simulation, Clinical Skills and Telemedicine Education
UCSF Kanbar Center for Simulation, Clinical Skills and Telemedicine Education
B. Joseph Guglielmo, PharmD
Dean, Curriculum Advisor
UCSF School of Pharmacy
Sherilyn VanOsdol, PharmD, BCPS
Lead Faculty
UCSF School of Pharmacy
Tina Brock, EdD, MS, BSPharm
Curriculum Advisor
UCSF School of Pharmacy
David Vlahov, RN, PHD, FAAN
Curriculum Advisor
UCSF School of Nursing
Christine Miaskowski, RN, PhD, FAAN
Lead Faculty, Lead Case Faculty and Content Expert
UCSF School of Nursing
John Featherstone, PhD
Dean, Curriculum Advisor
UCSF School of Dentistry
Jon Levine, MD, PhD
Lead Faculty and Content Expert
UCSF School of Dentistry
Scott Steiger, MD
Lead Case Faculty
UCSF School of Medicine
Lori Reisner, PharmD
Lead Case Faculty
UCSF School of Pharmacy
Kimberly Topp, PhD, PT
Lead Case Faculty
UCSF School of Medicine
Jill Gleason, PT
Lead Case Faculty
UCSF School of Medicine
Linda Giudice, MD, PhD
Lead Case Faculty
UCSF School of Medicine
Priscilla Abercrombie, RN, PhD, WHNP
Lead Case Faculty
UCSF School of Medicine
Thomas Shimotake, MD
Lead Case Faculty
UCSF School of Medicine
Linda Franck, RN, PhD, FAAN
Lead Case Faculty, Case Faculty
UCSF School of Medicine
Maurice Zwass, MD
Lead Case Faculty
UCSF School of Medicine
David Rempel, MD, MPH
Lead Case Faculty
UCSF School of Medicine
Chris Pasero, MS, RN-BC, FAAN
Case Faculty, Content Expert
Independent Consultant
Daphne Stannard, RN, PhD, CCRN
Case Faculty
UCSF School of Nursing
Adam Cooper, RN, BSN, MSN
Case Faculty
UCSF School of Nursing
Octavia Plesh, DDS, MS
Case Faculty
UCSF School of Dentistry
Charles McNeill, DDS
Case Faculty
UCSF School of Dentistry
Patricia Rudd, PT
Case Faculty
UCSF School of Medicine
Wolf Mehling, MD
Case Faculty
UCSF School of Medicine
Margaret Chesney, PhD
Case Faculty
UCSF School of Medicine
Shelley Adler, PhD
Case Faculty
UCSF School of Medicine
Diana Coffa, MD
Case Faculty
UCSF School of Medicine
Eric Widera, MD
Case Faculty
UCSF School of Medicine
Steven Pantilat, MD
Case Faculty
UCSF School of Medicine
Ramana Naidu, MD,
Case Faculty
UCSF School of Medicine
Jessica Pullins, PhD,
Case Faculty
UCSF School of Medicine
Sanjay Reddy, MD,
Case Faculty
UCSF School of Medicine
Adam Jacobson
IT Consultant
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: applicants@anesthesia.ucsf.edu
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: residency@anesthesia.ucsf.edu
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 Program
- ACGME Approved 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.
To Read More, Please visit our Fellowships page
Research @ UCSF
For up-to-date research lectures and more
UCSF Pain Research Group
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: leongj2@anesthesia.ucsf.edu
Faculty Research & Scholarly Activity
Pedram Aleshi, MD
Associate Professor,Anesthesia, Director,
Regional Anesthesia
Atsuko Baba, MD
Clinical Professor, Pediatric Anesthesia
Member, IP3 Governance Board, IP3
Matthias Behrends, MD
Associate Clinical Professor, Anesthesia
Regional Anesthesia and Acute Pain
Philip Bickler, MD, PhD
Professor, Anesthesia
Regional Anesthesia
Jori Bogetz, MD
Assistant Clinical Professor, Pediatric Hospital Medicine
Matthias Braehler, MD, PhD
Associate Professor,
Regional Anesthesia
Daniel Burkhardt, MD
Associate Clinical Professor, Anesthesia
Acute Pain
Lee-lynn Chen, MD
Professor, Anesthesia
Acute Pain
Gerald Dubowitz, MD
Associate Professor,
Anesthesia, Regional Anesthesia
Marla Ferschl, MD
Associate Professor,
Director, Pediatric Anesthesia Fellowship Program, IP3
Darren Fiore, MD
Associate Professor, Pediatrics
Fellowship Director, Pediatric Hospital Medicine
Director, Peds Hosp Med Fellowship Program
Audrey Foster-Barber, MD, PhD
Associate Professor, Clinical Neurology
IP3
Seema Gandhi, MD
Associate Professor,
Anesthesia, Regional Anesthesia
Zhonghui Guan, MD
Assistant Professor in Residence, Anesthesia
Chronic Pain
Sue Gritzner, Psy.D
Pain Psychologist, PMC
Matthew Haight, DO
Associate Professor, Anesthesia
Regional Anesthesia and Acute Pain”
Monica Harbell, MD
Assistant Professor,
Anesthesia, Regional Anesthesia
Melanie M. Henry, MD, MPH
Associate Clinical Professor, Anesthesia
Christina Inglis-Arkell, MD
Assistant Professor, Anesthesia
Director, MZ OR,
Regional Anesthesia
Cynthia Kim, MD
Professor, Pediatric Hospital Medicine
IP3
Sakura Kinjo, MD
Professor, Anesthesia
Medical Director, Orthopaedic Institute
Regional Anesthesia and Acute Pain
Kerstin Kolodzie, MD, PhD
Associate Professor,
Anesthesia, Regional Anesthesia
Merlin D. Larson, MD
Clinical Professor - Emeritus, Anesthesia
Acute Pain
Mark Latronica, MD
Assistant Clinical Professor, Anesthesia
Regional Anesthesia and Acute Pain
David J. Lee, MD
Clinical Professor, Anesthesia
Chronic Pain
Rachel Eshima McKay, MD
Clinical Professor, Anesthesia
Acute Pain
Ramana Naidu, MD
Assistant Professor, Anesthesia
Director, Regional Anesthesia, Acute Pain, Chronic Pain, IP3
Hung Gia Nguyen, MD
Assistant Clinical Professor, Anesthesia
IP3
George Pasvankas, MD
Associate Clinical Professor, Anesthesia
Director, UCSF Pain Medicine Fellowship Program
Chronic Pain
Thoha Pham, MD
Associate Clinical Professor, Anesthesia
Regional Anesthesia, Acute Pain, Chronic Pain
Mario De Pinto, MD
Associate Clinical Professor, Anesthesia
Director, PMC & Chronic Pain Regional Anesthesia,
Acute Pain, Chronic Pain
Jessica Pullins, PhD
Clinical Health Psychologist, PMC
Chronic Pain
Lawrence Poree, MPH, MD, PhD
Professor, Director, Neuromodulation Service; Chronic Pain
Thomas Reid, MD
Associate Professor, Hospital Medicine
Assoc Program Director, UCSF Hospice and Palliative Medicine Fellowship, IP3
David Robinowitz, MD, MHS, MS
Associate Clinical Professor, Pediatric Anesthesia
IP3
Glenn Rosenbluth, MD, MSc
Associate Professor, Pediatrics Director, Quality and Safety Programs GME Associate Director, Pediatrics Residency Training Program
IP3
Michael Rowbotham, MD
Professor, Chronic Pain
Gabriel Sarah, MD,
Assistant Professor, Interim Director, Anesthesia Pain
Mark Schumacher, PhD, MD
Professor, Anesthesia
Chief, Division of Pain Medicine, Dept of Anesthesia & Perioperative Care
Ahmed Shalabi, MD
Assistant Professor, Anesthesia, Regional Anesthesia
Alok Sharma, MD
Associate Professor, Anesthesia
Regional Anesthesia and Acute Pain
Claas Siegmueller, MD, PhD, MBA
Assistant Professor, Anesthesia
Karen Sun, MD
Assoc Clin Prof, Pediatric Hospital Medicine
Chief, Division of Pediatric Hospital Medicine
Member, IP3 Governance Board, IP3
Stephen Wilson, MD, PhD
Clinical Professor, Pediatric Hospital Medicine
Member, IP3 Governance Board, IP3
C. Spencer Yost, MD
Professor; Chief,Anesthesia and Director
ICU, UCSF-Bakar Cancer Hospital,
Acute Pain
Xiaobing Yu, MD
Assistant Professor in Residence, Anesthesia
Chronic Pain
Maurice Zwass, MD
Professor, Chief,
Pediatric Anesthesia, IP3
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
- Once October 8, 2014
- An appointment confirmation letter
- 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.
Integrated Pediatric Pain and Palliative Care (IP3) Clinic
SCOPE OF SERVICES
IP3 is a combined service staffed with pediatric anesthesiologists, pediatric integrative pain specialists, and pediatric palliative care specialists. Nurse practitioners bridge services along with Child Life and pharmacy support.
IP3 provides comprehensive acute and chronic pain management for pediatric patient populations in both the inpatient and outpatient settings. The outpatient IP3 practice is known as the Integrated Pediatric Pain and Palliative Care Clinic, and is located at the UCSF Ron Conway Family Gateway Medical Building at 1825 Fourth Street, on the Fifth floor, in suite 5A.
IP3 provides expert pain medicine care and consultative services across the Benioff Children’s Hospital and works collaboratively with providers across disciplines. This includes intradepartmental coordination with the faculty and Chief of the Division of Pediatric Anesthesia and interdepartmentally with the Dept. of Pediatrics and the Chief of the Division of Hospital Medicine. The spectrum of pain management therapies are offered, from biofeedback and acupuncture to epidurals and regional nerve blocks. IP3 is seen as an innovative approach to provide the best possible care for the pediatric population that we serve at UCSF.
Both the adult and pediatric pain services are available 24 hours/day.
IP3 Therapy Dog, Kai
Location
UCSF Ron Conway Family Gateway Medical Building
Integrated Pediatric Pain & Palliative Care Clinics
1825 Fourth Street, Fifth floor, 5A
San Francisco, CA 94143-0106
(415) 353-1328 Phone
(415) 353-3729 Fax
IP3 Logistics
- Pager: 443-6100
- APeX Consult: IP-3 Consult
- OK to consult for specific services (e.g. acupuncture only) or for full evaluation (pain and palliative care services)
- Can continue to follow patients post discharge
IP3 Structure
- Combined service staffed with pediatric anesthesiologists, pediatric integrative pain specialists, and pediatric palliative care specialists
- Nurse practitioners to bridge services
- Child Life and Pharmacy support
IP3 Offerings (Pain)
- Support for pain medication management (opiates, non-opiates, PCA, adjunctive meds)
- Post-operative and interventional pain control (epidurals, regional nerve blocks, etc)
- Outpatient Pediatric Pain Clinic
- Integrative modalities for pain and other symptoms (acupuncture, acupressure, biofeedback, art and music therapy, canine companion)
IP3 Offerings (Palliative Care)
- Outpatient Complex Care Clinic
- Coordination of home hospice care
- Coordination of end-of-life care
- Family and staff bereavement support
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
UCSF Pain Research Group Lectures
For up-to-date research lectures and more
UCSF Pain Research Group
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: Julie.Leong@ucsf.edu
Grand Rounds
For more information, please visit the Department of Anesthesia & Perioperative Care website.
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: Allison.White@ucsf.edu