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Chronic Pain Chapter

The chapter on “Chronic Pain” was revised in October 2008 and again in 2011 for the Third Edition. The chapter contains the  following enhancements: 

• Over 200 recommendations focusing on diagnostic and other testing and treatments for several chronic pain conditions, including complex regional pain syndrome (CRPS), neuropathic pain, trigger points/myofascial pain, chronic persistent pain, and chronic low back pain.
• An extensive in-depth review of pharmacologic interventions (prescription, over-the-counter, complementary and alternative) used to treat patients with chronic pain, including a comprehensive appendix on guidance for the use of opioids.
• Detailed recommendations regarding the use of appliances, skilled allied health provided medical therapies, electrical therapies, and injection therapies.
• Discussion of spinal cord stimulation for CRPS and other painful conditions.
• Detailed review of psychological services and rehabilitation for delayed recovery.
• Discussion of the use of progressive exercise programs to facilitate maximal medical improvements, increased functional status, return to limited work, or in best cases, return to unrestricted work as cornerstone therapies.
• Recommendations for clinicians to address psychosocial and workplace factors that may be impeding patient recovery to facilitate functional improvement.
• Emphasis on the need for the clinical evaluation to provide a comprehensive picture of the physical, psychological and socio-environmental factors that may be contributing to pain and the use of descriptions of current functional activities rather than pain ratings, to quantify the impact of pain.
• A focus on functional restoration including an active exercise program and behavioral program.
• A comprehensive appendix which covers treatment options for patients with tender points/fibromyalgia.
• An extensive volume of literature relied upon to develop the evidence-based recommendations contained in the chapter—1,557 references including 546 randomized controlled trials. 

Single copies of the 2008 Chronic Pain chapter may be ordered for $59.95 for ACOEM members/$69.95 for non-members.