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.

Dr. Christo is an Associate Professor in the Division of Pain Medicine at the Johns Hopkins University School of Medicine where he directed the Multidisciplinary Pain Fellowship Training Program, and the Blaustein Pain Treatment Center. He lectures internationally, serves on journal editorial boards, teaches, co-edited 4 textbooks on pain, and has published over 100 articles and book chapters. He is the author of ＂Aches and Gains＂ A Comprehensive Guide to Overcoming Your Pain, hosts ＂Aches and Gains＂ an award-winning, national SIRIUS XM radio talk show on overcoming pain, and is a frequent media contributor on pain and addiction.

Dr. Gallagher’s early academic career (family medicine, psychiatry/behavioral medicine, education deanship, epidemiology) informed decades of research, teaching, clinical care and policy work while developing academic pain programs (Vermont, Stony Brook, Drexel, Penn, VA/DOD) focused on studying clinical trajectories of painful conditions and their biopsychosocial team management, documented in government reports, books, over 200 publications, Editor-in-Chief of Pain Medicine(2000-2020), ACGME Pain Fellowship Committee and AAPM Board(1997-2023[President 2009]). Recent positions: National Director, Pain Management, Veterans Administration; Co-Chair Pain Workgroup, VA/DoD HEC(2010-16); Clinical Professor, Psychiatry/Anesthesiology and Director, Pain Policy Research/Primary Care, UPenn (2004-2018); Co-chair, NIH-IPRCC Education/training Committee(2013-14); Chair, Subcommittee 1, HHS Pain Task Force (2018-19).

Dr. Katzman is a neurologist and Professor at the University of New Mexico (UNM). She is Director of the UNM Pain Center and Project ECHO’s Public Health programs. In 2008, Dr. Katzman created the Pain and Opioid Management ECHO, which has been replicated by the DoD, the VA, the Indian Health Service, over 145 medical centers, and over 20 countries. She is currently working with the US Centers for Disease Control- Opioid Rapid Response Program. Dr. Katzman’s clinical research focuses on the public health benefits of take-home naloxone at both the UNM Pain Center and Addiction and Substance Use Clinic.

Dr. Williams is an Associate Professor of Anesthesiology and Pain Medicine and Vice Chair for System Integration and Population Health in the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine. He also holds a joint appointment as Associate Professor at the Johns Hopkins Carey Business School. He has authored and co-authored over 50 publications in his area of research interest, including neuropathic pain, neuromodulation, and healthcare operations management. He serves on the National Institutes of Health (NIH) Neurobiology of Pain and Itch study section, and as President of the American Academy of Pain Medicine 2022-2023.