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This is a very exciting time to be in the field of pain management. A plethora of new treatment options are currently being refined, introduced, or investigated to help people experiencing pain. As we transition from the opioid era of pain management, the future of treatments will encompass the diverse mechanisms and pathways of pain, from the site of injury or disease, to the spinal cord transducing the signal, to the brain processing the pain signal and creating the pain experience. This will likely represent comprehensive, patient-centered treatment provided within a team-based care model.

The ability to work is not only an important reflection of a person’s functional capacity but can also impact their sense of self-worth, independence, purpose and calling. An individual’s employment status is meaningfully linked to both one’s financial security and long-term health. The inability to attain, maintain, or return to gainful employment may cause hardship to the physical and psychosocial aspects of a person’s life. Therefore, society and the health care community together have a role in optimizing the work environment to safely accommodate people with a diverse range of abilities. When work-related injuries or illnesses occur, Occupational Medicine and Vocational Rehabilitation are instrumental in addressing the needs of our workforce. From prevention to treatment and functional assessment to restoration, these two interrelated disciplines provide a comprehensive approach to preserve job performance respectful of any limitations. This chapter introduces key concepts in the fields of Occupational Medicine and Vocational Rehabilitation, presents epidemiology of work-related hazards with evidence-based strategies for prevention and accommodation, highlights a biopsychosocial model approach to work disability, and describes rehabilitative interventions to maximize return to work.

Stiff-Person Syndrome (SPS) is a rare neurologic disorder characterized by severe and progressively worsening muscle stiffness and rigidity. SPS can be very painful due to unpredictable muscle spasms which can be triggered by various stimuli, such as noise, touch, or emotional experiences. There is thought to be an autoimmune component to the disorder. We present the case of a 59-year-old woman diagnosed with SPS who appears to have experienced a dramatic reduction in her symptoms after being treated with Low-Dose Naltrexone (LDN). Prior to this treatment regimen, she had tried many treatments with only limited derived benefit. She was started on LDN and after 6 weeks, reported reductions in pain, anxiety, depression, agoraphobia, and muscle tightness. Upon multiple follow-ups, leading up to 12 months, she continually displayed reduced symptoms and improved quality of life. We conclude that LDN may have some utility in treating and managing the symptoms of SPS. We hypothesize that this may be possible due to LDN operating via anti-inflammatory pathways as well as acting as an opioid antagonist. We assert that further research as it relates to LDN and SPS in addition to other chronic pain conditions is warranted.

Chronic pain is often managed using a multidisciplinary, biopsychosocial approach. Interventions targeting the biological, psychological, and social aspects of both the patient and the pain have been demonstrated to provide objective and subjective improvement in chronic pain symptoms. The mechanism by which pain attenuation occurs after these interventions remains to be elucidated. While there is a relatively large body of empirical literature suggesting that functional and structural changes in the peripheral and central nervous systems are key in the development and maintenance of chronic pain states, less is known about changes that take place in the nervous system as a whole after biopsychosocial interventions. Using as a model the unique case of Mr. S, a patient suffering with chronic pain for 22 years who experienced a complete resolution of pain after a lucid dream following 2 years of biopsychosocial treatments, we postulate that central nervous system (CNS) reorganization (i.e., neural plasticity) serves as a possible mechanism for the therapeutic benefit of multidisciplinary treatments, and may set a neural framework for healing, in this case via a lucid dream.