This issue of Continuum, devoted to the subjects of pain and palliative care, addresses topics that are critically important for neurologists. Yet they are often inadequately addressed in neurology training programs, and, consequently, many neurologists are uncomfortable dealing with these matters. The contributions of Richard Payne, MD, and the rest of the faculty of this issue should smooth the path considerably for neurologists dealing with patients at the end of life, as well as those with other forms of pain.
In the first chapter, Dr Payne offers a general overview of the issues related to palliative care. He addresses both fundamental principles and specific symptomatic management. Next, Jerome Kurent, MD, applies and extends this discussion to specific neurological disorders for which palliative care is often appropriate. Caring for terminally ill patients raises a number of ethical concerns, many of which are poorly understood by patients, families, and physicians alike. Robert Taylor, MD, skillfully explores these issues so that the reader should achieve a level of comfort in making difficult decisions when dealing with dying patients.
Neurologists are all too familiar with the vexing problems of neck and back pain. The specific etiology of the particular pain syndrome often eludes detection by conventional diagnostic methods. Yet, without precision diagnosis, appropriate treatment is difficult to achieve. To elucidate this subject, Continuum has gone "down under" to solicit a contribution from Nikolai Bogduk, MBBS, PhD, MD, Dsc, one of the world's foremost authorities on the modern management of neck and back pain. With the assistance of his co-author, Michael Karasek, MD, Dr Bogduk explores many modern and controversial approaches to both diagnosis and treatment.
Living in a world of deadlines, editors sleep with their own peculiar set of nightmares. When Dr Payne, having undergone a major career change after accepting his assignment as faculty chair, was unable to fulfill all his responsibilities, a potential crisis loomed. I was very fortunate to be able to enlist the very capable aid of friends and colleagues. Ronald Kanner, MD, a highly qualified and authoritative expert in pain medicine, graciously agreed, on short notice, to provide the coda for this issue with a series of instructive case vignettes. My colleague at Mount Sinai School of Medicine, Alan Carver, MD, who had already agreed to do the Quintessentials module that accompanies this issue, accepted the additional challenge of producing an instructive patient management problem. To help with these assignments he recruited two talented and enthusiastic chief residents at Mount Sinai, Laurence Ufford, MD, and Jessica Robinson Papp, MD. I, as well as the readers of Continuum, are indebted to all of these contributors for their excellent work in translating the principles of pain management and palliative care into practical application for individual patient scenarios.
Finally, once again, I urge the reader not to overlook the multiple-choice questions. Ably crafted by Ronnie Bergen, MD, and Eduardo Benarroch, MD, they provide a final review of the material covered while testing one's grasp of these important subjects.
Pain is too ubiquitous and palliative care too important for neurologists to neglect. I am confident that after devouring this issue of Continuum, working through the practical case material and pointers of Quintessentials, and performing the exercises of the patient management problem and the multiple-choice questions, the reader will feel much better prepared to tackle these critical matters.
Aaron E. Miller, MD