Top 5 Tips for Managing Chronic Pain (Watch Video)

In the past decade, pain neuroscience has exposed some important contrasts for managing acute vs chronic pain.

ChiroUp has recently synthesized the current chronic pain best practices and we are ecstatic to announce the release of our 101st protocol- Chronic Pain.

This week’s blog reviews a quick synopsis of new strategies for old complaints. Be sure to take a look at the new protocol the next time you log into your ChiroUp account.

Chronic pain is defined as persistent or recurrent pain lasting longer than three months (1), or pain that occurs on at least half the days for six months or more. (2) Estimates suggest that chronic pain affects more than 20% of the global population. (3-10) In the US alone, an estimated 70-100 million adults suffer from chronic pain. (120-122,126)

The best-practice management of chronic pain requires that clinicians identify both peripheral and central pain generators, then combine passive interventions with a healthy dose of self-care and active measures. (25,39,53-55)

Core strategies include pain neuroscience education, self-management, and non-pharmacologic therapies. (26,39,56-59) Patients and clinicians must both clearly understand that treatment seeks to effectively manage rather than cure chronic pain. (39)

Check out our top five tips for the best practice assessment and management of chronic pain.

As noted in the accompanying video, distinguishing the origin(s) of pain is essential. The following chart will help outline the features of three potential neuroanatomical sites of chronic pain.

Want even more? You can find it in ChiroUp’s complete protocol for Chronic Pain in our Condition Reference library.

Seriously - go check it out! This new protocol has literally dozens of additional best practice recommendations, supported by 127 up-to-date references. And don’t forget this also means you can create the associated patient condition report or simply add the Chronic Pain ADL advice to any care plan.

This is potent information for an emerging topic that changes day. We are so excited for our subscribers to check it out so please let us know what you think!

Alert

Did you know that receiving this weekly blog is not the same as being a ChiroUp subscriber?

It’s kind of like the difference between receiving the Mayo Clinic newsletter and being a Mayo Clinic Provider- two very different things.

If you like our blog, you’ll love our service. Check it out today at no cost and no commitment!

  • Hylands-White N, Duarte RV, Raphael JH. An overview of treatment approaches for chronic pain management. Rheumatology international. 2017 Jan 1;37(1):29-42. Link

    National Pain Strategy. A Comprehensive Population Health-Level Strategy for Pain. Link

    Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European journal of pain. 2006 May 1;10(4):287-333. Link

     Guerje O, Von Korff M, Simon GE, Gater R. Persistent pain and well being. A World Health Organization study in primary care. JAMA. 1998;280:147-51.

     Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008 Jun 15;136(3):380-7. Link

     Torrance N, Smith BH, Bennett MI, Lee AJ. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. The Journal of Pain. 2006 Apr 1;7(4):281-9. Link

     Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ open. 2016 Jun 1;6(6):e010364. Link

     Fatoye F, Gebrye T, Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatology international. 2019 Apr 10;39(4):619-26. Link

     Toth C, Lander J, Wiebe S. The prevalence and impact of chronic pain with neuropathic pain symptoms in the general population. Pain Medicine. 2009 Jul 1;10(5):918-29. Link

    Dydyk AM, Givler A. Central Pain Syndrome. InStatPearls [Internet] 2020 Jan 14. StatPearls Publishing. Link

    Überall MA. A Review of Scientific Evidence for THC: CBD oromucosal spray (Nabiximols) in the management of chronic pain. Journal of Pain Research. 2020;13:399. Link

    NIH (2020). NIH HEAL Initiative Research Plan. Accessed 4/1/2020 from: https://Heal.Nih.Gov/About/Research-Plan#References. Link

     Breivik H, Eisenberg E, O’Brien T. The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC public health. 2013 Dec 1;13(1):1229. Link

    EuroStat. Eurostat news release. Eurostat. [Online]; March 30, 2017. Accessed 9/19/20 from: http://ec.europa.eu/eurostat/documents/2995521/7962764/1-30032017-AP-EN.pdf. Link

    Racine M, Solé E, Sánchez‐Rodríguez E, Tomé‐Pires C, Roy R, Jensen MP, Miró J, Moulin DE, Cane D. An evaluation of sex differences in patients with chronic pain undergoing an interdisciplinary pain treatment program. Pain Practice. 2020 Jan;20(1):62-74. Link

    Nijs J, D'Hondt E, Clarys P, Deliens T, Polli A, Malfliet A, Coppieters I, Willaert W, Tumkaya Yilmaz S, Elma Ö, Ickmans K. Lifestyle and chronic pain across the lifespan: an inconvenient truth?. PM&R. 2020 Apr;12(4):410-9. Link

    Treede RD. A classification of chronic pain for ICD-11. Pain,[sl].

    Filbrich L, van den Broeke EN, Legrain V, Mouraux A. The focus of spatial attention during the induction of central sensitization can modulate the subsequent development of secondary hyperalgesia. Cortex. 2020 Mar 1;124:193-203. Link

    Ahimsadasan N, Kumar A. Neuroanatomy, dorsal root ganglion. Link

    Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011 Mar 1;152(3):S2-15. Link

    Meyer RA. Peripheral neural mechanisms of nociception. Textbook of pain. 1994.

    Falling CL, Stebbings S, Baxter DG, Gearry RB, Mani R. Central sensitization inventory mediates the relationship between inflammatory bowel disease activity and worse musculoskeletal pain experiences. Pain Practice. 2020 Jan;20(1):24-33. Link

    Nijs J, Girbés EL, Lundberg M, Malfliet A, Sterling M. Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories. Manual therapy. 2015 Feb 1;20(1):216-20. Link

    Nijs J, Van Houdenhove B, Oostendorp RA. Recognition of central sensitization in patients with musculoskeletal pain: application of pain neurophysiology in manual therapy practice. Manual therapy. 2010 Apr 1;15(2):135-41. Link

    National Pain Strategy Task Force. National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. Bethesda, MD: National Institutes of Health, 2015. Link

    Van Oosterwijck J, Nijs J, Meeus M, Paul L. Evidence for central sensitization in chronic whiplash: a systematic literature review. European Journal of Pain. 2013 Mar;17(3):299-312. Link

    Roussel NA, Nijs J, Meeus M, Mylius V, Fayt C, Oostendorp R. Central sensitization and altered central pain processing in chronic low back pain: fact or myth?. The Clinical journal of pain. 2013 Jul 1;29(7):625-38. Link

    Lluch Girbés E, Nijs J, Torres-Cueco R, López Cubas C. Pain treatment for patients with osteoarthritis and central sensitization. Physical therapy. 2013 Jun 1;93(6):842-51. Link

    Ashina S, Bendtsen L, Ashina M. Pathophysiology of tension-type headache. Current pain and headache reports. 2005 Dec 1;9(6):415-22. Link

    Perrotta A, Serrao M, Sandrini G, Burstein R, Sances G, Rossi P, Bartolo M, Pierelli F, Nappi G. Sensitisation of spinal cord pain processing in medication overuse headache involves supraspinal pain control. Cephalalgia. 2010 Mar;30(3):272-84. Link

    Price DD, Staud R, Robinson ME, Mauderli AP, Cannon R, Vierck CJ. Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients. Pain. 2002 Sep 1;99(1-2):49-59. Link

    Nijs J, Meeus M, Van Oosterwijck J, Ickmans K, Moorkens G, Hans G, De Clerck LS. In the mind or in the brain? Scientific evidence for central sensitisation in chronic fatigue syndrome. European journal of clinical investigation. 2012 Feb;42(2):203-12. Link

    Meeus M, Vervisch S, De Clerck LS, Moorkens G, Hans G, Nijs J. Central sensitization in patients with rheumatoid arthritis: a systematic literature review. InSeminars in arthritis and rheumatism 2012 Feb 1 (Vol. 41, No. 4, pp. 556-567). WB Saunders. Link

    Van Wilgen CP, Konopka KH, Keizer D, Zwerver J, Dekker R. Do patients with chronic patellar tendinopathy have an altered somatosensory profile?–AQ uantitative S ensory T esting (QST) study. Scandinavian journal of medicine & science in sports. 2013 Mar;23(2):149-55. Link

    Coombes BK, Bisset L, Vicenzino B. Thermal hyperalgesia distinguishes those with severe pain and disability in unilateral lateral epicondylalgia. The Clinical journal of pain. 2012 Sep 1;28(7):595-601. Link

    Fernández-Carnero J, Fernández-de-las-Peñas C, de la Llave-Rincón AI, Ge HY, Arendt-Nielsen L. Widespread mechanical pain hypersensitivity as sign of central sensitization in unilateral epicondylalgia: a blinded, controlled study. The Clinical journal of pain. 2009 Sep 1;25(7):555-61. Link

    Lluch Girbés E, Nijs J, Torres-Cueco R, López Cubas C. Pain treatment for patients with osteoarthritis and central sensitization. Physical therapy. 2013 Jun 1;93(6):842-51. Link

    Hawk C, Whalen W, Farabaugh RJ, Daniels CJ, Minkalis AL, Taylor DN, Anderson D, Anderson K, Crivelli LS, Cark M, Barlow E. Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline. The Journal of Alternative and Complementary Medicine. 2020 Jul 30. Link

    Hawk C, Whalen W, Farabaugh RJ, Daniels CJ, Minkalis AL, Taylor DN, Anderson D, Anderson K, Crivelli LS, Cark M, Barlow E. Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline. The Journal of Alternative and Complementary Medicine. 2020 Jul 30. Link

    Nicholas MK, Linton SJ, Watson PJ, Main CJ, “Decade of the Flags” Working Group. Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal. Physical therapy. 2011 May 1;91(5):737-53. Link

    Martinez-Calderon J, Jensen MP, Morales-Asencio JM, Luque-Suarez A. Pain catastrophizing and function in individuals with chronic musculoskeletal pain. The Clinical journal of pain. 2019 Mar 1;35(3):279-93. Link

    Willett MJ, Siebertz M, Petzke F, Erlenwein J, Rushton A, Soldini E, Barbero M, Falla D. The Extent of Pain Is Associated With Signs of Central Sensitization in Patients With Hip Osteoarthritis. Pain Practice. 2020 Mar;20(3):277-88. Link

    Nijs J, Apeldoorn A, Hallegraeff H, Clark J, Smeets R, Malfliet A, Girbes EL, De Kooning M, Ickmans K. Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain physician. 2015. Link

    Nijs J, Polli A, Willaert W, Malfliet A, Huysmans E, Coppieters I. Central sensitisation: another label or useful diagnosis?. Drug and therapeutics bulletin. 2019 Apr 1;57(4):60-3. Link

    Scerbo T, Colasurdo J, Dunn S, Unger J, Nijs J, Cook C. Measurement properties of the central sensitization inventory: a systematic review. Pain Practice. 2018 Apr;18(4):544-54. Link

    Khorsan R, Coulter ID, Hawk C, Choate CG. Measures in chiropractic research: choosing patient-based outcome assessments. Journal of manipulative and physiological therapeutics. 2008 Jun 1;31(5):355-75. Link

    Nijs J, Clark J, Malfliet A, Ickmans K, Voogt L, Don S, den Bandt H, Goubert D, Kregel J, Coppieters I, Dankaerts W. In the spine or in the brain? Recent advances in pain neuroscience applied in the intervention for low back pain. Clin Exp Rheumatol. 2017 Jan 1;35(5):108-15. Link

    Nijs J, Malfliet A, Ickmans K, Baert I, Meeus M. Treatment of central sensitization in patients with ‘unexplained’chronic pain: an update. Expert opinion on pharmacotherapy. 2014 Aug 1;15(12):1671-83. Link

    Kim H, Mawla I, Lee J, Gerber J, Walker K, Kim J, Ortiz A, Chan ST, Loggia ML, Wasan AD, Edwards RR. Reduced tactile acuity in chronic low back pain is linked with structural neuroplasticity in primary somatosensory cortex and is modulated by acupuncture therapy. NeuroImage. 2020 May 5:116899. Link

    Suokas AK, Walsh DA, McWilliams DF, Condon L, Moreton B, Wylde V, Arendt-Nielsen L, Zhang W. Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis. Osteoarthritis and cartilage. 2012 Oct 1;20(10):1075-85. Link

    Lluch Girbés E, Nijs J, Torres-Cueco R, López Cubas C. Pain treatment for patients with osteoarthritis and central sensitization. Physical therapy. 2013 Jun 1;93(6):842-51. Link

    Girbés EL, Meeus M, Baert I, Nijs J. Balancing “hands-on” with “hands-off” physical therapy interventions for the treatment of central sensitization pain in osteoarthritis. Manual therapy. 2015 Apr 1;20(2):349-52. Link

    Rondanelli M, Faliva MA, Miccono A, Naso M, Nichetti M, Riva A, Guerriero F, De Gregori M, Peroni G, Perna S. Food pyramid for subjects with chronic pain: foods and dietary constituents as anti-inflammatory and antioxidant agents. Nutrition research reviews. 2018 Jun 1;31(1):131. Link

    de Almeida CC, da Silva VZ, Júnior GC, Liebano RE, Durigan JL. Transcutaneous electrical nerve stimulation and interferential current demonstrate similar effects in relieving acute and chronic pain: a systematic review with meta-analysis. Brazilian journal of physical therapy. 2018 Sep 1;22(5):347-54. Link

    Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of internal medicine. 2017 Apr 4;166(7):514-30. Link

    Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Winter C, Ferguson AJ. Noninvasive nonpharmacological treatment for chronic pain: a systematic review. Link

    Institute of Medicine. Relieving Pain in America. Washington, DC: IOM, 2011.

    Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, Van Tulder MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. Bmj. 2015 Feb 18;350. Link

    International Society for the Study of Pain. Evidence-Based Biopsychosocial Treatment of Chronic Musculoskeletal Pain. Washington DC: International Association for Pain, 2017.

    Bennell KL, Ahamed Y, Bryant C, Jull G, Hunt MA, Kenardy J, Forbes A, Harris A, Nicholas M, Metcalf B, Egerton T. A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol. BMC Musculoskeletal Disorders. 2012 Dec 1;13(1):129. Link

    Racine M, Solé E, Sánchez‐Rodríguez E, Tomé‐Pires C, Roy R, Jensen MP, Miró J, Moulin DE, Cane D. An evaluation of sex differences in patients with chronic pain undergoing an interdisciplinary pain treatment program. Pain Practice. 2020 Jan;20(1):62-74. Link

    Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Conservative Interventions Reduce Fear in Individuals With Chronic Low Back Pain: A Systematic Review. Archives of physical medicine and rehabilitation. 2020 Feb 1;101(2):329-58. Link

    Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of physical medicine and rehabilitation. 2011 Dec 1;92(12):2041-56. Link

    Globe G, Farabaugh RJ, Hawk C, Morris CE, Baker G, Whalen WM, Walters S, Kaeser M, Dehen M, Augat T. Clinical practice guideline: chiropractic care for low back pain. Journal of manipulative and physiological therapeutics. 2016 Jan 1;39(1):1-22. Link

    Farabaugh RJ, Dehen MD, Hawk C. Management of chronic spine-related conditions: consensus recommendations of a multidisciplinary panel. Journal of manipulative and physiological therapeutics. 2010 Sep 1;33(7):484-92. Link

    Eklund A, Jensen I, Lohela-Karlsson M, Hagberg J, Leboeuf-Yde C, Kongsted A, Bodin L, Axén I. The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. PLoS One. 2018 Sep 12;13(9):e0203029. Link

    Herman PM, Edgington SE, Ryan GW, Coulter ID. Prevalence and Characteristics of Chronic Spinal Pain Patients with Different Hopes (Treatment Goals) for Ongoing Chiropractic Care. The Journal of Alternative and Complementary Medicine. 2019 Oct 1;25(10):1015-25. Link

    Dehen MD, Whalen WM, Farabaugh RJ, Hawk C. Consensus terminology for stages of care: acute, chronic, recurrent, and wellness. Journal of manipulative and physiological therapeutics. 2010 Jul 1;33(6):458-63. Link

    Mazzei LG, de Cássia Bergamaschi C, Silva MT, Lopes LC. Use of IMMPACT domains in clinical trials of acupuncture for chronic pain: a protocol for a methodological survey. BMJ open. 2017 Sep 1;7(9). Link

    Paley CA, Johnson MI. Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews. Medicina. 2020 Jan;56(1):6. Link

    Haller H, Lauche R, Sundberg T, Dobos G, Cramer H. Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials. BMC musculoskeletal disorders. 2020 Dec;21(1):1-4. Link

    Koh IJ, Kang BM, Kim MS, Choi KY, Sohn S, In Y. How Does Preoperative Central Sensitization Affect Quality of Life Following Total Knee Arthroplasty?. The Journal of Arthroplasty. 2020 Apr 10. Link

    Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Manual therapy. 2009 Oct 1;14(5):531-8. Link

    Girbés EL, Meeus M, Baert I, Nijs J. Balancing “hands-on” with “hands-off” physical therapy interventions for the treatment of central sensitization pain in osteoarthritis. Manual therapy. 2015 Apr 1;20(2):349-52. Link

    Cruz EB, Canhão H, Fernandes R, Caeiro C, Branco JC, Rodrigues AM, Pimentel-Santos F, Gomes LA, Paiva S, Pinto I, Moniz R. Prognostic indicators for poor outcomes in low back pain patients consulted in primary care. Plos one. 2020 Mar 27;15(3):e0229265. Link

    Joypaul S, Kelly F, McMillan SS, King MA. Multi-disciplinary interventions for chronic pain involving education: A systematic review. PloS one. 2019 Oct 2;14(10):e0223306. Link

    Nijs J, Malfliet A, Ickmans K, Baert I, Meeus M. Treatment of central sensitization in patients with ‘unexplained’chronic pain: an update. Expert opinion on pharmacotherapy. 2014 Aug 1;15(12):1671-83. Link

    Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of physical medicine and rehabilitation. 2011 Dec 1;92(12):2041-56. Link

    Mittinty MM, Vanlint S, Stocks N, Mittinty MN, Moseley GL. Exploring effect of pain education on chronic pain patients’ expectation of recovery and pain intensity. Scandinavian journal of pain. 2018 Apr 25;18(2):211-9. Link

    Nijs J, Van Wilgen CP, Van Oosterwijck J, van Ittersum M, Meeus M. How to explain central sensitization to patients with ‘unexplained’chronic musculoskeletal pain: practice guidelines. Manual therapy. 2011 Oct 1;16(5):413-8. Link

    Hylands-White N, Duarte RV, Raphael JH. An overview of treatment approaches for chronic pain management. Rheumatology international. 2017 Jan 1;37(1):29-42. Link

    Girbés EL, Meeus M, Baert I, Nijs J. Balancing “hands-on” with “hands-off” physical therapy interventions for the treatment of central sensitization pain in osteoarthritis. Manual therapy. 2015 Apr 1;20(2):349-52. Link

    Van Damme S, Legrain V, Vogt J, Crombez G. Keeping pain in mind: a motivational account of attention to pain. Neuroscience & Biobehavioral Reviews. 2010 Feb 1;34(2):204-13. Link

    Legrain V, Mancini F, Sambo CF, Torta DM, Ronga I, Valentini E. Cognitive aspects of nociception and pain. Bridging neurophysiology with cognitive psychology. Neurophysiologie Clinique/Clinical Neurophysiology. 2012 Oct 1;42(5):325-36. Link

    Filbrich L, van den Broeke EN, Legrain V, Mouraux A. The focus of spatial attention during the induction of central sensitization can modulate the subsequent development of secondary hyperalgesia. Cortex. 2020 Mar 1;124:193-203. Link

    Sprenger C, Eippert F, Finsterbusch J, Bingel U, Rose M, Büchel C. Attention modulates spinal cord responses to pain. Current Biology. 2012 Jun 5;22(11):1019-22. Link

    Torta DM, Legrain V, Mouraux A, Valentini E. Attention to pain! A neurocognitive perspective on attentional modulation of pain in neuroimaging studies. Cortex. 2017 Apr 1;89:120-34. Link

    Ruscheweyh R, Kreusch A, Albers C, Sommer J, Marziniak M. The effect of distraction strategies on pain perception and the nociceptive flexor reflex (RIII reflex). Pain. 2011 Nov 1;152(11):2662-71. Link

    Monticone M, Ambrosini E, Vernon H, Rocca B, Finco G, Foti C, Ferrante S. Efficacy of two brief cognitive-behavioral rehabilitation programs for chronic neck pain: results of a randomized controlled pilot study. Eur J Phys Rehabil Med. 2018 Dec 1;54(6):890-9. Link

    Monticone M, Vernon H, Brunati R, Rocca B, Ferrante S. The NeckPix©: development of an evaluation tool for assessing kinesiophobia in subjects with chronic neck pain. European Spine Journal. 2015 Jan 1;24(1):72-9. Link

    Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Kantner S, Ferguson AJ. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Link

    Nijs J, Girbés EL, Lundberg M, Malfliet A, Sterling M. Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories. Manual therapy. 2015 Feb 1;20(1):216-20. Link

    Stubbs BJ, Newman JC. Ketogenic diet and adipose tissue inflammation—a simple story? Fat chance!. Nature Metabolism. 2020 Jan;2(1):3-4. Link

    Suri P, Boyko EJ, Smith NL, Jarvik JG, Williams FM, Jarvik GP, Goldberg J. Modifiable risk factors for chronic back pain: insights using the co-twin control design. The Spine Journal. 2017 Jan 1;17(1):4-14. Link

    Bennell KL, Ahamed Y, Bryant C, Jull G, Hunt MA, Kenardy J, Forbes A, Harris A, Nicholas M, Metcalf B, Egerton T. A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol. BMC Musculoskeletal Disorders. 2012 Dec 1;13(1):129. Link

    Gibbs BB, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occupational and environmental medicine. 2018 May 1;75(5):321-7. Link

    Petre B, Torbey S, Griffith JW, De Oliveira G, Herrmann K, Mansour A, Baria AT, Baliki MN, Schnitzer TJ, Apkarian AV. Smoking increases risk of pain chronification through shared corticostriatal circuitry. Human brain mapping. 2015 Feb;36(2):683-94. Link

    Haack M, Simpson N, Sethna N, Kaur S, Mullington J. Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications. Neuropsychopharmacology. 2020 Jan;45(1):205-16. Link

    Nijs J, Mairesse O, Neu D, Leysen L, Danneels L, Cagnie B, Meeus M, Moens M, Ickmans K, Goubert D. Sleep disturbances in chronic pain: neurobiology, assessment, and treatment in physical therapist practice. Physical therapy. 2018 May 1;98(5):325-35. Link

    Shi L, Chen SJ, Ma MY, Bao YP, Han Y, Wang YM, Shi J, Vitiello MV, Lu L. Sleep disturbances increase the risk of dementia: a systematic review and meta-analysis. Sleep medicine reviews. 2018 Aug 1;40:4-16. Link

    Überall MA. A Review of Scientific Evidence for THC: CBD oromucosal spray (Nabiximols) in the management of chronic pain. Journal of Pain Research. 2020;13:399. Link

    Wade DT, Robson P, House H, Makela P, Aram J. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clinical rehabilitation. 2003 Feb;17(1):21-9. Link

    Xu DH, Cullen BD, Tang M, Fang Y. The Effectiveness of topical cannabidiol oil in symptomatic relief of peripheral neuropathy of the lower extremities. Current Pharmaceutical Biotechnology. 2020 Apr 1;21(5):390-402. Link

    van de Donk T, Niesters M, Kowal MA, Olofsen E, Dahan A, van Velzen M. An experimental randomized study on the analgesic effects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain. 2019 Apr;160(4):860. Link

    Capano A, Weaver R, Burkman E. Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. Postgraduate Medicine. 2020 Jan 2;132(1):56-61. Link

    Gulbransen G, Xu W, Arroll B. Cannabidiol prescription in clinical practice: an audit on the first 400 patients in New Zealand. BJGP open. 2020 Jan 1;4(1). Link

    Rog DJ, Nurmikko TJ, Friede T, Young CA. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology. 2005 Sep 27;65(6):812-9. Link

    Ueberall MA, Essner U, Mueller-Schwefe GH. Effectiveness and tolerability of THC: CBD oromucosal spray as add-on measure in patients with severe chronic pain: analysis of 12-week open-label real-world data provided by the German Pain e-Registry. Journal of pain research. 2019;12:1577. Link

    Nijs J, Malfliet A, Ickmans K, Baert I, Meeus M. Treatment of central sensitization in patients with ‘unexplained’chronic pain: an update. Expert opinion on pharmacotherapy. 2014 Aug 1;15(12):1671-83. Link

    NIH (2020). NIH HEAL Initiative Research Plan. Accessed 4/1/20 from: https://Heal.Nih.Gov/About/Research-Plan#References. Link

    National Pain Strategy Task Force. National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. Bethesda, MD: National Institutes of Health, 2015. Link

    Centers for Disease Control and Prevention. CDC guideline for prescribing opioids for chronic pain—United States, 2016. Morbidity and Mortality Weekly Report. 2016 Mar 18;65(1):1-49.

    Deer T, Pope J, Hunter C, Falowski S, Kapural L, Kramer J, Levy R. Safety analysis of dorsal root ganglion stimulation in the treatment of chronic pain. Neuromodulation: Technology at the Neural Interface. 2020 Feb;23(2):239-44. Link

    Deer TR, Levy RM, Kramer J, Poree L, Amirdelfan K, Grigsby E, Staats P, Burton AW, Burgher AH, Obray J, Scowcroft J. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. Pain. 2017 Apr;158(4):669. Link

    Liem L, Russo M, Huygen FJ, Van Buyten JP, Smet I, Verrills P, Cousins M, Brooker C, Levy R, Deer T, Kramer J. One‐year outcomes of spinal cord stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain. Neuromodulation: Technology at the Neural Interface. 2015 Jan;18(1):41-9. Link

    Liem L, Russo M, Huygen FJ, Van Buyten JP, Smet I, Verrills P, Cousins M, Brooker C, Levy R, Deer T, Kramer J. A multicenter, prospective trial to assess the safety and performance of the spinal modulation dorsal root ganglion neurostimulator system in the treatment of chronic pain. Neuromodulation: Technology at the Neural Interface. 2013 Sep;16(5):471-82. Link

    Deer TR, Grigsby E, Weiner RL, Wilcosky B, Kramer JM. A prospective study of dorsal root ganglion stimulation for the relief of chronic pain. Neuromodulation: Technology at the Neural Interface. 2013 Jan;16(1):67-72. Link

    Morgalla MH, Fortunato M, Lepski G, Chander BS. Dorsal root ganglion stimulation (DRGS) for the treatment of chronic neuropathic pain: A single-center study with long-term prospective results in 62 cases. Pain physician. 2018 Jul 1;21(4):E377-87. Link

    Nahin RL, Sayer B, Stussman BJ, Feinberg TM. Eighteen-year trends in the prevalence of, and health care use for, noncancer pain in the United States: data from the medical expenditure panel survey. The Journal of Pain. 2019 Jul 1;20(7):796-809. Link

    Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, Kerns R, Von Korff M, Porter L, Helmick C. Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. Morbidity and Mortality Weekly Report. 2018 Sep 14;67(36):1001. Link

    Committee on Advancing Pain Research Care and Education, B. O. H. S. P., Institute of Medicine (2011). a Call for Cultural Transformation of Attitudes Toward Pain and Its Prevention and Management. J. Pain Palliat Care Pharmacother. 25 (4), 365–369. doi: 10.3109/15360288.2011.621516

    US Food and Drug Administration. FDA education blueprint for health care providers involved in the management or support of patients with pain. FDA Web site. https://www. fda. gov/downloads/Drugs/NewsEvents/UCM557071. pdf. Published May. 2017.

    Joint Commission. Joint Commission enhances pain assessment and management requirements for accredited hospitals. The Joint Commission Perspectives. 2017 Jul 3;37(7):1-4. Link

    Joint Commission Online. Revision to Pain Management Standards. Link

    Simon LS. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Journal of pain & palliative care pharmacotherapy. 2012 Jun 22;26(2):197-8. Link

    Tucker J, RE: “Chronic Pain Protocol.” Message to Tim Bertelsman regarding advice on chiropractic management of chronic pain patients via direct email on 09/28/2020.

Tim Bertelsman

Dr. Tim Bertelsman is the co-founder of ChiroUp. He graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. Dr. Bertelsman has served in several leadership positions and is the former president of the Illinois Chiropractic Society. He also received ICS Chiropractor of the Year in 2019.

Previous
Previous

Increasing Ankle Dorsiflexion is as easy as 1,2,3 (Watch Video)

Next
Next

3 Questions That Create Compliant Patients In Your Practice