Pain Management in Vulnerable Populations

Pain is ubiquitous to human experience. When pain becomes chronically persistent after acute injuries are repaired or as diseases progress, health systems are challenged to reduce pain’s negative impact on an individual patient’s life trajectory and chronic pain’s collective impact on public health. Pain Management in Vulnerable Populations presents a diverse set of chapters that examine this challenge through the lens of vulnerability. There are special considerations for patients who are considered pain-vulnerable with respect to assessment and treatment and the variability of their access to good care. Medicine’s practices, while increasingly being guided by evidence-based algorithms from large data, are also becoming more personalized and tailored to individual patient needs. Each vulnerable group demands a unique approach – this book reveals the details behind the history, examination, and therapeutic options for vulnerable patients in pain. Individual chapters explore conceptual models of vulnerability to pain across the lifespan, beginning in infancy, and in specific clinical populations defined by age, gender, sexual orientation, clinical condition, and healthcare setting. Topics examined range from genomics to sociomedical contexts affecting care such as medical ethics, racial disparities, adverse childhood experiences, disability and workers’ compensation, incarceration, torture, military, youth sport, and LGBTQ identity. Challenges to the management of the trajectory of pain are considered in settings ranging from emergency room, palliative and end-of-life care, and nursing homes, prisons, the battlefield, and developing nations. Chapters on illnesses such as sickle cell disease, substance use and mental illness, dental disease, obesity, suicide, HIV, COVID-19, and GI disease discuss personalized treatment plans for each patient’s unique needs. Pain Management in Vulnerable Populations serves as an invaluable resource for pain physicians and will also appeal to primary care physicians as pain is one of the most frequently stated reasons for seeing a primary care physician.