Chronic Pain

Beverly J. Field, PhD, is Assistant Professor in the Departments of Anesthesiology and Psychiatry, Washington University School of Medicine, St. Louis, Missouri. She is cofounder and director of the STEPP program, a cognitive-behavioral program for patients with chronic pain. In addition to her clinical and teaching responsibilities, she lectures regularly on psychological therapies in multidisciplinary pain management. Robert A. Swarm, MD, is Associate Professor and Chief, Division of Pain Management in the Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri. He is also the Director of the Pain Management Fellowship Training Program at Washington University, and Director of the Barnes-Jewish Hospital, Washington University Pain Management Center. His clinical work is exclusively focused on the multidisciplinary management of acute, chronic, and cancer pain. Dr. Field and Dr. Swarm have been colleagues at the Barnes-Jewish Hospital, Washington University Pain Management Center since 1994. Advances

Foreword; 1 Description of the Disorder; 1.1 Definitions; 1.2 Terminology; 1.2.1 Classification of Pain; 1.3 Epidemiology; 1.3.1 Prevalence of Chronic Pain; 1.3.2 Economic Impact of Pain; 1.4 Course and Prognosis; 1.5 Differential Diagnosis; 1.6 Comorbidities; 1.6.1 Sleep Disorders; 1.6.2 Depression; 1.6.3 Anxiety; 1.6.4 Substance Abuse; 1.7 Diagnostic Procedures and Documentation; 2 Theories and Models of the Disorder; 2.1 Dualistic Models; 2.2 Gate-Control Theory; 2.3 Biopsychosocial Model; 2.3.1 Operant Conditioning Model; 2.3.2 Cognitive-Behavioral Model; 2.3.3 Multidisciplinary Management; 3 Diagnosis and Treatment Indications; 3.1 Referral Questions and Medical Record Review; 3.2 Guidelines for Assessing Medical History; 3.2.1 History of Pain Complaint; 3.2.2 Pain Intensity, Location, Aggravating and Relieving Factors; 3.2.3 Medical History; 3.3 Guidelines for Assessing Cognitions; 3.3.1 Beliefs and Expectations; 3.3.2 Cognition; 3.4 Guidelines for Assessing Psychiatric Disorders; 3.4.1 Behavioral Observations and Mental Status; 3.4.2 Depression; 3.4.3 Anxiety Disorders; 3.4.4 Substance Abuse; 3.5 Guidelines for Assessing Daily Activity Patterns; 3.5.1 Work and Everyday Activities; 3.5.2 Relationships - Family and Friends; 3.6 Additional Areas for Assessment; 3.6.1 Anger; 3.6.2 Social History; 3.6.3 Educational and Employment History; 3.6.4 Presurgical Screening; 3.7 Diagnosis and Treatment Recommendations; 3.7.1 Diagnosis; 3.7.2 Treatment Plan; 3.7.3 Referrals to Additional Providers and Communication with Referring Physicians; 4 Treatment; 4.1 Introduction; 4.2 Methods of Treatment; 4.2.1 Medical Treatments; 4.3 Psychological Interventions; 4.3.1 Cognitive-Behavioral Therapy; 4.3.2 Education; 4.3.3 Identifying and Restructuring Negative Cognitions; 4.3.4 Changing Behaviors; 4.3.5 Self-Regulatory Techniques; 4.4 Efficacy and Prognosis; 4.5 Mechanisms of Action; 4.6 Variations and Combinations of Methods; 4.6.1 Physical Therapy; 4.6.2 Complementary and Alternative Medicine; 4.7 Problems in Carrying Out the Treatments; 4.8 Multicultural Issues; 4.9 Conclusion; 5 Case Vignette; 6 Further Reading; 7 References; 8 Appendix: Tools and Resources.