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 PainHow the Brain Interprets PainHow the Brain Modifies PainWhat 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 PainThe Nervous SystemWhat is Nerve Pain?Arthritis PainMyofascial Pain Fibromyalgia Back Pain Headaches 3. What You Might Expect During a Doctor's AppointmentWhy Do I Need to Complete All of These Forms? Talking with Your Doctor About Chronic PainDiagnostic Tests That Your Doctor May RequestInjections 4. Taking Control of Your Life InactivityLoss of FlexibilityExercise as a PrescriptionOther Problems Caused by ImmobilityMaking the Most of ThingsFeeling BetterThe Unseen Enemy: Depression, Anxiety, PTSD, Sleep Disturbances 5. Behavioral Approaches What is the Biopsychosocial Model of Pain?The Pain ExperienceCognitive Behavioral TherapyMeditation and Mindfulness Acceptance and Commitment TherapyHypnosisExerciseBiofeedback 6. Lifestyle ModificationsWhat 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 SafelyCommonly Prescribed Pain Medications and Common Side Effects Acetaminophen, Nonsteroidal Anti-inflammatory Drugs (NSAIDs), Antidepressants, Antiepileptics, Muscle RelaxantsMedical 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 EffectsConfusing Concepts: Dependence, Addiction, Withdrawal, Tolerance, and HyperalgesiaWhen to Call Your Doctor 9. Injections, Implants, and Surgery - Benefits and LimitationsWhy Spine Surgery May Not Fix the Pain ProblemWhy Can't They Cut Out the Pain?Spinal Fusion SurgeriesOther Surgical LimitationsWhy 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 CommunicationIntimacyCaregiver Burnout Appendix: Practical Patient/Caregiver Aids Appendix: Resources List