Chronic Pain E-Book

Beverly J Field

• Herausgeber: Hogrefe Publishing
• Kategorie: Fachliteratur
• Serie: Advances in Psychotherapy - Evidence-Based Practice
• Sprache: Englisch

Seitenzahl: 221

Veröffentlichungsjahr: 2008

Beschreibung

Although there are now proven behavioral and psychological methods of dealing with and alleviating chronic pain, methods that can supplement or replace drug treatments, these are not always applied in clinical practice. This volume in the series, Advances in Psychotherapy -- Evidence-Based Practice, provides psychological and medical therapists (and students) with practical and evidence-based guidance on diagnosis and treatment of chronic pain, and does so in a uniquely "reader-friendly" manner. The book is both a compact "how-to" reference, for use by professional clinicians in their daily work, as well as an ideal educational resource for students and for practice-oriented continuing education.

Leseprobe

Chronic Pain

About the Authors

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 in Psychotherapy – Evidence-Based Practice

Danny Wedding; PhD, MPH, Prof., St. Louis, MO

(Series Editor)

Larry Beutler; PhD, Prof., Palo Alto, CA

Kenneth E. Freedland; PhD, Prof., St. Louis, MO

Linda C. Sobell; PhD, ABPP, Prof., Ft. Lauderdale, FL

David A. Wolfe; PhD, Prof., Toronto

(Associate Editors)

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a “reader-friendly” manner. Each book in the series is both a compact “how-to-do” reference on a particular disorder for use by professional clinicians in their daily work, as well as an ideal educational resource for students and for practice-oriented continuing education.

The most important feature of the books is that they are practical and “reader-friendly:” All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls”, marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

Chronic Pain

Beverly J. Field

Washington University School of Medicine, St. Louis, MO

Robert A. Swarm

Washington University School of Medicine, St. Louis, MO

Library of Congress Cataloging in Publication

is available via the Library of Congress Marc Database under the LC Control Number 2007938384

Library and Archives Canada Cataloguing in Publication

Field, Beverly J

Chronic pain / Beverly J. Field, Robert A. Swarm.

(Advances in psychotherapy–evidence-based practice)

Includes bibliographical references.

ISBN 978-0-88937-320-4

1. Chronic pain–Psychological aspects. 2. Chronic pain–Treatment.

I. Swarm, Robert A. II. Title. III. Series.

RB127.F44 2008                616’.0472019             C2007-906047-1

© 2008 by Hogrefe & Huber Publishers

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Format: EPUB

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Foreword

Chronic pain is highly prevalent with one third of Americans experiencing frequent or persistent pain. Of those who have pain, function or quality of life is significantly impacted. Chronic pain is also extraordinarily complex, at times associated with progressive damage to virtually any tissue, or occurring in the absence of an explanatory lesion. Some patients are highly disabled by their pain, whereas others function well despite similar pathology.

From a clinical perspective, it is useful to classify pain as nociceptive or neuropathic pain, acute or chronic, cancer or noncancer, in the back or in the abdomen. Classification leads to treatment guidelines and best practices yet these distinctions are an extreme simplification. Chronic pain is better understood as the integration of related processes – biomedical and psychological – that may sustain pain and predispose individuals. Chronic pain is, in fact, many diseases only now being defined, classified, and analyzed. For many patients chronic pain becomes the disease itself with the sensory experience of pain and the adverse effects on mood and function. This understanding of pain as illness is one of the foundations of the modern approach to pain management.

There is substantial documentation that many, if not the majority of patients suffering pain remain vastly underdiagnosed and undertreated. Even with evidence-based consensus, best-practice approaches are not being followed for most patients, and access to specialists is very limited. Chronic pain has become a major public health problem with annual costs in the United States estimated at $100 billion.

Chronic Pain presents up-to-date information to the provider who has been overlooked in the treatment of pain. In the attempt to look for pathology and treat symptoms, the role of psychology has been underestimated. Any chronic illness is best treated with a patient-focused, integrated approach relying heavily on patient self-care. Patients need to learn management skills, controlling symptoms while maintaining meaningful and active lifestyles. Psychology is uniquely positioned to help in this treatment. This volume joins an ever-growing number of books, journals, and other sources of information that document these advances and educate the health care giver about pain and its management.

Progress comes slowly and treatment can be controversial. The debate often reaches into the area of public policy with mandated pain education and prosecution of providers for over- and underprescribing of opioids. Nonetheless, the advances in research and the increasing number of consensus views within the professional community provide the means to help many patients. Pain is complex and ever-changing. Treating patients requires time and patience. Perhaps it will someday be possible that every patient will have access to competent care for the potentially devastating illness of chronic pain.

Bill H. McCarberg, MD

Chronic Pain Management Program, Kaiser Permanente, San Diego

School of Medicine, University of California, San Diego

Table of Contents

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 (CAM)

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

1

Description of the Disorder

1.1   Definitions

Pain is a complex, subjective experience with no objective tests or physiological markers

Pain is a basic biological warning mechanism signaling tissue damage and physiological harm. It was described by Albert Schweitzer (1931, p. 62) as “…a more terrible Lord of mankind than even death itself.” In Paradise Lost, Milton (1910, p. 47) wrote that, “Pain is perfect misery, the worst of evils, and excessive, overturns all patience.” Webster’s dictionary (1983) defines pain as: (1) The sensations one feels when hurt mentally or physically, especially distress, suffering, great anxiety, anguish, grief, etc.: opposed to pleasure. (2) A sensation of hurting or strong discomfort in some part of the body. These descriptions and definitions speak to both the sensation of pain and to the suffering that accompanies it.

The International Association for the Study of Pain Subcommittee on Taxonomy (Mersky, 1979) defined pain as:

An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

This definition recognizes the complexity of pain, its sensory and emotional aspects, and its subjective nature. There are no reliable tests or consistent physiological markers of pain, and it is not always referable to any objective findings. To understand another person’s pain, it is necessary to rely on the subjective narration of his or her personal experience. The subjectivity of pain is acknowledged in the International Association for the Study of Pain (IASP) definition, as is the recognition of pain in the absence of tissue damage, which discounts previously held distinctions between somatogenic (or “real”) pain and psychogenic (or “imaginary”) pain.