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; 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.

About the Author

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

Reviews

"Chronic Pain is a small gem. Field and Swarm provide sage insights based on their clinical experience and available research into the complexities of patients with chronic pain, describe an efficient approach to assessment, provide an overview of the range of the most commonly used pharmacological and nonpharmacological modalities, and conclude with a practical approach to pain management - all in a succinct and user-friendly package. I highly recommend this brief volume to clinicians who are looking for an introduction into the challenges of assisting patients with persistent pain and disability." Dennis C. Turk, PhD, Professor, Department of Anesthesiology, University of Washington "Drs. Field and Swarm have compiled a practical up-to-date, evidence-based book rooted in theory that contains an invaluable overview of assessment and treatment strategies for persons with chronic pain. This book places an emphasis on the behavioral medicine perspective of chronic pain packed with "pearls" that can be implemented in a pain practice. The book is well organized and easy to follow with a review of treatments that are proven to be effective. This book is highly recommended for healthcare providers and students alike." Robert N. Jamison, PhD, Director of Clinical Psychology and Associate Professor, Harvard Medical School "Drs. Field and Swarm have produced a brief, highly readable volume that, nonetheless, is packed with important clinical information and savvy insights on the assessment and treatment of patients with chronic pain. Not only does it cover the range of psychological and medical approaches to the treatment of pain (that also are well-referenced), but it includes numerous "clinical pearls" relevant to assessment and treatment, some of which I had to learn by hard experience over many years. I would recommend this volume to clinicians who plan to add the treatment of pain patients to their practice and to educators that are looking for a resource that students will find both accessible and informative." Raymond C. Tait, PhD, Professor, Department of Neurology and Psychiatry, Saint Louis University School of Medicine"Before traveling to a foreign country, my first instinct is to go to my local bookstore and pick up one or more travel guidebooks. I really don't need or want a detailed, comprehensive discussion of the history, culture, or economic system of a country. Rather, I want one that provides an overview to orient me and provide a quick reference for information as I need it (colorful pictures are a plus). If I am planning a specific activity such as snorkeling, I look for a book tailored to my specific interests and activities.For those wishing to learn about or begin to practice in the world of chronic pain, authors Beverly Field and Robert Swarm have created a brief (about 100 pages) but well-focused guide to introduce psychologists to the language and concepts needed for their venture. Developed with the support of APA Division 12, this book is the 11th in the series Advances in Psychotherapy-Evidence Based Practice. Like a good guidebook, Chronic Pain introduces the reader to key concepts, techniques, and resources helpful in the evaluation and treatment of persons with chronic pain.The first half of the book reviews key information helpful in understanding the medical and biopsychosocial problem of chronic pain. Basic medical terminology is defined, and an overview is provided of the epidemiology of the disorder, as well as common comorbid problems such as sleep problems, depression, and misuse of medications. In a very logical manner, the authors then review the basic elements necessary for a psychological evaluation of a person with chronic pain. Despite the brevity of the review, the discussion reflects not only an awareness of the literature but also the practical observations and insights of a clinician. The primary psychometric measures used are discussed. Specific guidelines are given to assess cognitive aspects of pain. Helpfully, the authors provide an extensive array of sample questionnaires in the appendix.The authors then proceed with an overview of methods for treatment of chronic pain. A helpful but very brief review of medical treatment and medications is provided. The tables in this section are worth the price of the book for nonphysicians for they provide an overview of types of medication, typical dosage, and considerations in their use.The overview of psychological treatment for chronic pain is quite brief, only 26 pages. As a result, it is the most challenging aspect of the book. The book covers most basic treatment techniques including cognitive-behavioral therapies, cognitive restructuring, behavioral changes such as pacing, goal setting, and sleep hygiene, and introduces a variety of self-regulation techniques for pain control. The discussion is impressive in two ways. It does manage to cover the majority of techniques clinicians use in treatment. It also provides helpful sample scripts (listed as A"clinical pearlsA") that a clinician could use for these therapies. In fact, three scripts for hypnosis are provided, with each one tailored to a different therapeutic goal. A brief review of the scientific literature is also provided for the efficacy of cognitive-behavioral therapies. Finally, interdisciplinary treatment programs are mentioned as the most effective way of treating chronic pain, but they receive fewer than three pages of discussion, with very little information on the core elements and structures of a program.Several features of this book will be of particular value. As noted above, the brief review of the medical aspects of chronic pain is very helpful. The tables regarding medications are so helpful that, like maps placed in the back of a guidebook, they might have been more helpful as pull-out appendices that could be easily referenced. The tables containing A"clinical pearlsA" do effectively move readers from an overview to clinically useful scripts and examples. Finally, the list of references for further reading in Chapter 6 does provide an excellent sampling of materials that clinicians will find quite helpful in working with patients.Inherent in the design of this book are several major limitations. Some readers may find themselves frustrated by the very limited attention to the research regarding models of pain processing. Although a brief review of the gate control theory is provided, the extensive literature regarding well-designed and researched models of pain processing is not reviewed. For example, there is little discussion of basic models regarding psychological processes in processing of pain or of the evolution of the constellation of symptoms and behaviors characterizing chronic pain (Gatchel & Turk, 1996). These models provide an understanding of the physiological basis and psychological conceptual framework for the cognitive-behavioral interventions discussed in more detail.A second limitation is the minimal discussion of interdisciplinary programs. It would have been helpful to provide guidance for clinicians in determining when comprehensive pain management programs may be more effective than therapy provided by an individual clinician. Also, a somewhat more detailed review of the evidence for efficacy and cost-effectiveness of interdisciplinary programs would have been useful.However, these details do not diminish the substantial value of this slim text. A brief review of a comprehensive topic can be the most difficult. To then make this comprehensive review one that is clinically useful and is A"reader friendlyA" is an even greater challenge. Yet Chronic Pain has accomplished this focused goal.Eighteen years ago, when I shifted the focus of my practice as a neuropsychologist to pain management, I could not find a succinct A"guidebookA" that could introduce me to this new arena of practice. I was overwhelmed by massive textbooks regarding pain management (e.g., McMahon & Koltzenburg, 2006). This book would have provided a needed introductory guide. Today, students and therapists expanding into this area of practice will find this text to be a valuable orientation and resource manual to begin their education and initiate their practice.PsycCRITIQUES A(c) 2008, American Psychological Association1554-0138July 9, 2008, Vol. 53, Release 28, Article 2Reviewed by Timothy S. Clark