1 ACPA – Stanford Resource Guide To Chronic Pain Management An Integrated Guide to Comprehensive Pain Therapies 2021 Edition P.O Box 850 1070 Arastradero Road, Suite 200 Rocklin, CA 95677 Palo Alto, CA 94304 T: 800-533-3231 T: 650-724-9143 F: 916-652-8190 F: 650-725-9642 E: [email protected] E: Stanford Pain Medicine Feedback W: American Chronic Pain Association W: Stanford Division of Pain Medicine Twitter: @StanfordPain Copyright 2021 American Chronic Pain Association, Inc., and Stanford University Division of Pain Medicine All rights reserved. No portion of this book may be reproduced without permission of the American Chronic Pain Association, Inc., and Stanford University Division of Pain Medicine American Chronic Pain Association and Stanford University Division of Pain Medicine Copyright 2021 2 Table of Contents Preface ......................................................................................................................................................................................... 6 Updates to 2021 Edition.................................................................................................................................................................. 7 INTRODUCTION .............................................................................................................................................................................. 9 Glossary of Terms used in this Resource Guide ............................................................................................................................... 11 OVERVIEW OF CHRONIC PAIN AND ITS TREATMENT ......................................................................................................................... 13 WHAT DOES SUCCESSFUL PAIN TREATMENT LOOK LIKE? ................................................................................................................. 15 PAIN DEFINITION AND TYPES ......................................................................................................................................................... 17 PAIN TERMS & TYPES .................................................................................................................................................................... 18 PAIN IN SPECIAL POPULATIONS ..................................................................................................................................................... 20 Pain in Older Persons ................................................................................................................................................................. 20 Pain in Pregnancy ...................................................................................................................................................................... 22 Pain in Children and Adolescents................................................................................................................................................. 24 PELVIC PAIN ................................................................................................................................................................................ 27 MAJOR TYPES OF INTERVENTIONS FOR PAIN .................................................................................................................................. 30 FUNCTIONAL RESTORATION APPROACHES & PROGRAMS ................................................................................................................. 31 SELF-DIRECTED GROUP AND SELF-MANAGEMENT ........................................................................................................................... 33 Self-Care, Self-Management, Self-Development ........................................................................................................................... 33 ACPA Groups.............................................................................................................................................................................. 33 Classes in Chronic Pain & Chronic Disease Self-Management ......................................................................................................... 34 ACTIVE INTERVENTIONS ............................................................................................................................................................... 35 Pain Education Information: Retraining the Body and the Mind ..................................................................................................... 35 Physical Activity & Exercising...................................................................................................................................................... 36 Aquatic Exercise ........................................................................................................................................................................ 36 Yoga ......................................................................................................................................................................................... 38 Pilates ...................................................................................................................................................................................... 38 Desensitization Therapy ............................................................................................................................................................. 39 Postural Awareness Exercise....................................................................................................................................................... 40 Functional Activity Training ........................................................................................................................................................ 41 Adjunctive Therapies ................................................................................................................................................................. 41 Personal Goal Attainment Program (PGAP®) ................................................................................................................................. 44 Chronic Pain Self-Management Program (CPSMP) ........................................................................................................................ 44 Cognitive Behavioral Therapy for Pain (Pain-CBT) ........................................................................................................................ 45 Acceptance and Commitment Therapy (ACT) ................................................................................................................................ 47 Motivational Interviewing .......................................................................................................................................................... 47 Fear Avoidance Therapy ............................................................................................................................................................. 48 Stress-reducing Interventions..................................................................................................................................................... 49 Mindfulness-based Stress Reduction (MBSR) and Meditation ......................................................................................................... 50 Guided Imagery ......................................................................................................................................................................... 51 Art & Music ................................................................................................................................................................................ 52 Biofeedback .............................................................................................................................................................................. 52 Hypnosis ................................................................................................................................................................................... 53 Reconditioning Brain and Mind ................................................................................................................................................... 53 NUTRITION .................................................................................................................................................................................. 57 COMPLEMENTARY, ALTERNATIVE & INTEGRATIVE MEDICINE (CAM) ................................................................................................... 57 Traditional Chinese Medicine (TCM) ............................................................................................................................................. 59 ACUPUNCTURE and ACUPRESSURE ................................................................................................................................................ 60 PHYSICAL MODALITIES – NONINVASIVE INTERVENTIONS ................................................................................................................. 63 American Chronic Pain Association and Stanford University Division of Pain Medicine Copyright 2021 3 INVASIVE INTERVENTIONS ............................................................................................................................................................ 71 MEDICATION