Chronic Pain

Beverly J. Field, PhD
Robert A Swarm, MD
Dr. Michele D. Levine

Course Outline

Chronic Pain

There are effective psychological interventions for patients with chronic pain that can serve as an independent treatment or in conjunction with medical and physiological treatments. This volume in the series Advances in Psychotherapy- Evidence-Based Practice provides psychologists, physicians, and other health care providers with practical and evidence-based guidance on the psychological diagnosis and treatment of chronic pain in a reader-friendly format. In addition, it includes information about medical treatments, multidisciplinary management, and complementary and alternative therapies.

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 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.

Learning Objectives

After completing this course you’ll be able to:

1. Describe acute pain.
2. Describe the transition from acute to chronic pain.
3. Describe nociception.
4. Describe fibromyalgia.
5. Discuss low back pain.
6. List the two primary treatment goals of chronic pain.
7. Compare somatization and malingering.
8. List common comorbidities in chronic pain.
9. List two factors why it is difficult to obtain accurate estimates of the prevalence of depression with chronic pain.
10. Discuss suicidal ideation in the chronic pain patient.
11. Describe generalized anxiety disorder.
12. Compare tolerance and physical dependence.
13. Define pseudoaddiction.
14. Describe the various tools used to assess pain.
15. Define somatogenic and psychogenic pain.
16. Describe the gate-control model.
17. Describe treatment in the operant conditioning model.
18. Describe cognitive behavior therapy.
19. Discuss the origin of multidisciplinary treatment of pain.
20. Discuss the statement, “nothing helps” when the patient is asked about treatment for pain.
21. Describe the McGill Pain Questionnaire (Table 17).
22. Describe the four common cognitive distortions (Table 18).
23. Compare a depressed mood and a major depressive disorder.
24. Discuss suicidal ideation in the chronic pain population.
25. State the primary goal of psychological interventions for chronic pain.
26. Describe how anger plays a role in patients with chronic pain.
27. List five factors that do not contraindicate surgery but decrease the prognosis for a positive surgical outcome.
28. List four behaviors expressed by people who have chronic pain.
29. List several nonopioid analgesics.
30. List six adverse effects of long term use of opioids.
31. Describe adjuvant analgesics.
32. Describe a neurolytic technique, radiofrequency ablation, and spinal analgesic infusion pump.
33. Discuss advantages of individual and group cognitive behavioral therapy.
34. Describe Wilbur Fordyce’s pain management program.
35. Describe the three elements of goals.
36. Define pacing.
37. Compare progressive relaxation and passive relaxation.
38. Describe autogenic techniques.
39. List three characteristics of hypnosis that make it useful for managing pain.
40. Define electromyographic and thermal biofeedback.
41. List three reasons cognitive behavioral therapy is difficult to evaluate.
42. Describe the five categories of Complementary and Alternative Medicine.
43. Describe four types of massage therapy.
44. List problems in carrying out treatments.
45. Discuss the findings of Green and colleagues (2003) regarding ethnic and racial disparities when treating pain.

Course Contents

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 of 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 of 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


Chronic Pain is a small gem. [The authors] provide sage insights based on their clinical experience and available research into the complexities of patients with chronic pain… in a succinct and user-friendly package.” - Dennis C. Turk, PhD, Professor, Department of Anesthesiology, University of Washington

“[This book] contains an invaluable overview of assessment and treatment strategies for persons with chronic pain. [It] is highly recommended for healthcare providers and students alike.” - Robert N. Jamison, PhD, Director of Clinical Psychology and Associate Professor, Harvard Medical School

“A brief, highly readable volume that, nonetheless, is packed with important clinical information and savvy insights on the assessment and treatment of patients.” - Raymond C. Tait, PhD, Professor, Department of Neurology and Psychiatry, Saint Louis University School of Medicine

“Chronic Pain presents up-to-date information to the provider who has been overlooked in the treatment of pain.” - Bill H. McCarberg, MD, Chronic Pain Management Program, Kaiser Permanente and Assistant Clinical Professor, School of Medicine, University of California, San Diego

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