Navigating Life with Chronic Pain

Robert A. Lavin, MD, MS is Assistant Professor in Department of Neurology at the University of Maryland School of Medicine and Director of Chronic Pain Management at VA Maryland Health Care Services in Baltimore, MD. Sara Clayton, PhD is the Director of Pain Psychology at VA Maryland Health Care Services at a member of the Department of Neurology at the Baltimore VAMC in Baltimore, MD. Lindsay Zilliox, MD is part of the Department of Neurology at the University of Maryland School of Medicine in Baltimore, MD.

Table of Contents

1.Understanding Chronic Pain
How the Brain Interprets Pain
How the Brain Modifies Pain
What is the Difference between Acute and Chronic Pain, and Why Does It Matter?
Will My Chronic Pain Improve?
You Are Not Alone

2. Different Types of Chronic Pain
The Nervous System
What is Nerve Pain?
Arthritis Pain
Myofascial Pain
Fibromyalgia
Back Pain
Headaches

3. What You Might Expect During a Doctor's Appointment
Why Do I Need to Complete All of These Forms?
Talking with Your Doctor About Chronic Pain
Diagnostic Tests That Your Doctor May Request
Injections

4. Taking Control of Your Life
Inactivity
Loss of Flexibility
Exercise as a Prescription
Other Problems Caused by Immobility
Making the Most of Things
Feeling Better
The Unseen Enemy: Depression, Anxiety, PTSD, Sleep Disturbances

5. Behavioral Approaches
What is the Biopsychosocial Model of Pain?
The Pain Experience
Cognitive Behavioral Therapy
Meditation and Mindfulness
Acceptance and Commitment Therapy
Hypnosis
Exercise
Biofeedback

6. Lifestyle Modifications
What is the Role of Exercise and Nutrition?
What are Complementary and Alternative (CAM) Treatments?
What are Orthotic and Assistive Devices?
What are Environmental Modifications?

7. Non-opioid Pain Medications
Medications - Why They Don't Always Work and How to Use Them Safely
Commonly Prescribed Pain Medications and Common Side Effects
Acetaminophen, Nonsteroidal Anti-inflammatory Drugs (NSAIDs), Antidepressants, Antiepileptics, Muscle Relaxants
Medical Marijuana

8. Opioid Pain Medications
So Why Do Opioids Work for Pain?
Why are Opioids So Controversial?
Commonly Prescribed Opioid Medications: Indications and Common Side Effects
Confusing Concepts: Dependence, Addiction, Withdrawal, Tolerance, and Hyperalgesia
When to Call Your Doctor

9. Injections, Implants, and Surgery - Benefits and Limitations
Why Spine Surgery May Not Fix the Pain Problem
Why Can't They Cut Out the Pain?
Spinal Fusion Surgeries
Other Surgical Limitations
Why Can't I have an Injection?
What Should I Expect from Interventional Procedures?
What are the Risks of Injections?

10. Pain and Your Significant Others
Social interactions and Communication
Intimacy
Caregiver Burnout

Appendix: Practical Patient/Caregiver Aids
Appendix: Resources List