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Are Your Clients in Pain?

What’s a clinician to do when your client’s are dealing with chronic pain?

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Are Your Clients in Pain?

  1. 1. Are Your Clients in Chronic Pain ? Whats’ A Clinician To Do ??? Stanger,2018
  2. 2. Louise Stanger Ed.D, LCSW, CDWF
  3. 3. Thank you to James Flowers PhD,LPC-S
  4. 4. To close your eyes Soften Your Gaze
  5. 5. Objectives • Review and Discuss the site of Chronic Pain today • Discuss how Substance Abuse and Anxiety and Depression intertwines with Chronic Pain • Discuss the relationship of the Brain to Chronic Pain • Discuss Alternative and Complementary Strategies
  6. 6. Objectives • Describe and Discuss What is Similar and what is Different between Families who experience Chronic Pain and Families who experience Substance Abuse • Identify Evidence Based Strategies used with Chronic Pain Families • Give Case Examples
  7. 7. 100 Million- One in Ten Americans - 1.5 Billion Globally
  8. 8. Chronic Pain affects over 133 million Americans or over 1/3 of our population Annual cost of $635 million More common among women then men More common among older persons
  9. 9. Concussions Facial pain Neck Pain Accidents -Driving, Texting Exercising, Weekend Warrior Tasks Hips, Knees , Shoulders
  10. 10. Low back pain Osteoarthritis Rheumatoid Arthritis Migraines Fibromyalgia Pelvic Pain Carpel Tunnel Syndrome
  11. 11. Common Types of Chronic Pain • 28% Low Back Pain • 15% Migrane or Headache • 15 % Neck Pain • 4 % Facial Pain • #1 Cause of long term disability
  12. 12. Pain that lasting longer then 12 weeks For the most part pain has been treated in terms of body parts Scientists are now rethinking chronic pain
  13. 13. Is Chronic Pain-The Brain Game ? Neuroimaging shows that chronic pain alters the size of certain brain regions And the way certain brain regions talk to one another becomes abnormal It effects the dorsolateral prefrontal lobe - cognition motor planning and memory
  14. 14. With chronic pain the neurotransmitters Prevent certain regions from turning off when they should Result the brain is overly sensitive to pain and stimulates a feed-forward cycle that reinforces the chronic pain state
  15. 15. Young People and Chronic Pain • Treated as if Health issues can’t possibly be chronic • Are told they are too young to have Chronic Pain • Worry they will never find a romantic partner • Worry they will never finish school • Sit by and watch as others their age participate in activities that they cannot do.
  16. 16. Work and Chronic Pain • Cost estimated 62.1 billion Jama • Employers Believe: • They are unreliable • They are less productive • They use pain as a excuse
  17. 17. Pain Patient becomes out of control with medications Becomes drug seeking - quality of life decreases Medication will continue or increase despite side effects . Hyperalgesia
  18. 18. Impact of Chronic Pain on Families • Person with Pain • - Pain that does not show • -Fluctuating Activity Levels • -Isolation in home and income • -Unpredictable Mood Swing • Doubt about reality of Pain • Loss of friends, job, productivity • Loss of plans , hope for the future • Family Members • -Inability to see or feel pain • Increased responsibility for maintaining home and income • Loss of personal support system • Emotional Outbursts of person with pain’Added Daily stress • Loss of plans and hope for the future
  19. 19. Families’ Responsibilities • Responsible for daily care • Dealing with insurance and doctors • Sometimes responsible for income, food and lodging • Responsible for being Cheerleaders even when they don’t want to cheer
  20. 20. Your Clients
  21. 21. Your Clients May be Person with Chronic Pain Caretaker - Family Other Relative Employer
  22. 22. Emotional Consequences of Chronic Pain • Loss of Sexual Expression and Intimacy • 83 percent of spouses of mates with CP report Depressive symptoms • Approach -avoidance -anger guilt and hostility between couples • Pain becomes organizing force which families coals around • Perception of Pain can sustain or enhance healing
  23. 23. The Power of Language • What you say about Pain Reflects on how you feel • Affects how you feel • SELF-FULLING PROPHECIES • CATASTROPHIZING • PROJECTING • TEACHING ONE TO BE THEIR OWN CEO-
  25. 25. Chronic Pain as Homostaistis • Stabilizing force in maintaining family homeostasis • Interpersonal conflicts are overshadowed by dealing with “sick” person this yielding “sick- role “ Homeostasis” • Pain can serve as an attention getter- - a mother may feel abandoned by her grown children her chronic pain is an attention getter • A young adult child gets more attention then siblings
  26. 26. Other Considerations • Pain is never good without an audience- excused from chores, work etc • People don’t hurt as much if they have something better to do • Work and activities to set goals, not to pain tolerance • Empowerment/Goaling Process • Exercise
  27. 27. When we add Addiction & Mental Health Issues to Chronic Pain • A Losing Trifecta • Put in PBS ARTICLE
  28. 28. Efficacious Modalities Mindfulness- Meditation ACT CBT MI - SFT DBT EDMR- Havening etc
  29. 29. Trauma
  30. 30. Traumatic Injury Back& Neck Disorders Complex Regional Pain Syndrome Headaches and Migraines Opiate hyperalgesia CNS Arthritis Oro-Facial Pain Fibromyalgia Other Disabling Impairments
  31. 31. Definitions of Trauma Overwhelming experiencing that cannot be integrated and elicit animal defensive mechanisms and dysregulated arousal “A stress that causes physical or emotional harm that you cannot remove yourself from” Larke Huang , Director of Health Care Equity at SAMSHA
  32. 32. Trauma is objective What happened ( I was date raped , humiliated , I fell of a ladder, had a concussion, was in a terrible accident etc
  33. 33. Trauma is subjective : How do I perceive the situation ? Relationship to early child- hood experiences - and Alcoholism Adverse Childhood Experience- 17,000 patients -Kaiser- effects of trauma are cumulative and one of most destructive forms is recurrent calling and humiliation
  34. 34. What do your Clients Say about Trauma and Chronic Pain ???? Verbal abuse Physical abuse Witnessing a tragedy Accidents Divorce Death
  35. 35. Over Lapping Features of Chronic Pain & Addiction Trauma Loss of Control Loss of Mastery Loss of Sense of Self Cognitive Error Overinterpretation Catastrophizing Personalization Daily Life Alters Trauma Loss of Mastery Loss of Control Loss of Sense of Self Loss of Self-efficacy Cognitive Error Denial Daily Life Alters
  37. 37. As clinicians You need to know what is wrong with client Obtain consent form to speak with other professionals Be prepared to do a pain assessment Be Prepared to do a Family Map as another way in to Bio=psych Social
  38. 38. Understand the Role of Complementary Therapies Breathing Mindfulness Heart -Math
  39. 39. Qi-“Subtle breath”,Gong-“Vital energy Slow movements warm tendons, muscles and ligaments & Muscles, Promote circulation of body fluids Effective for chronic illness , emotional frustration, stress and spiritual crisis etc (NQA)
  40. 40. Mind-body practice Low Back Pain Arthritis 2011studies military
  41. 41. Music Fibromyalgia, arthritis , joint pain , nerve disorder
  42. 42. Chronic Back pain, (2010- 2012) Joint pain, (osteooarthritis) Knee and Hip pain Headaches/Migraine Fibermyalgia Detoxification
  43. 43. PT, Naturopaths, Osteopathic Physicians, Chiropractors AHRQ -Low Back Pain withers as effective as medications Headaches Neck Pain
  44. 44. Aquatic Therapy
  45. 45. Let’s Talk Food Reduce Pain and Inflammation
  46. 46. Meet Helen - 62 y.o Female Hip replacement Knee replacement’ Shoulder Constant pain-anxiety Cancer survivor Tried to commit suicide Angry Husband & Family Addicted
  47. 47. IN THE BEGINNING Not able to take breaths - use of Heart Math Self Esteem was missing Smile was gone Only memories of what once was
  48. 48. I Have Lost Relationships Money Self Esteem Ability to Walk Smile
  49. 49. Strategies 15 day detox- Pain still 20% due to Hyperalgesia Education Cognitive Behavioral Therapy Mindfulness Mediation Yoga etc - Canoeing- walking Peer Support
  50. 50. Who would of ever thought Canoeing
  51. 51. Meet Doug
  52. 52. Back Pain Severe-Not able to lift young children- possible candidate spine surgery Mother Dying -house full of edibles and pills Previous treatment for substance abuse Unemployed Stealing from wife and mother Isolating Lying Family History- Ethoh and Pills Co-Ocurring About Doug
  53. 53. What’s working!
  54. 54. High Ropes Course
  55. 55. Showing Up
  56. 56. Meet Maddi 10 operations - 6 treatment centers
  57. 57. First major accident age 14 Family History of SA , MH and Molestation Pain Body For past 9 years has been in and out of treatment centers Walking on crutches or not walking at all
  58. 58. Maddi gains trust with primary clinician Maddi gains trust with exercises Maddi Starts to talk to therapist Family is confronted with their substance abuse and their need to detach Maddi experiences a difference in family Maddi experiences a Community Integration Approach Maddi could be your next client
  59. 59. Accepted to premed
  60. 60. Families Learn • Their History • Their Ways of Communicating • To take Care of Themselves • To Discover Curiosity • To Discover Joy • To try Out New Ways of Relating
  61. 61. Families Learn • Chronic Pain , Addiction , Mental Health are all Diseases • Boundary Setting-Responding Not Reacting • Caretaking is not always helpful • Chronic Pain is 80% Emotion • Join in the Solution
  62. 62. R, L. Nahim, Estimates of pain prevalence and severity in adults, 2012, “j Pain, vol.16, no 8 pp789-80 A. May, “Structural Brain Imaging. A Window into Chronic Pain", The Neuroscientist,vol17,No 2,pp.2019-220, 2011 Napadow& R.E. Harris ,”what has functional connectivity and chemical neuroimaging in fibromyalgia taught us about the mechanisms and management of centralized pain ? Arthritis Research and Therapy .vol 16 Ingemanson, Morgan PHD , “Chronic Pain Lives in the Brin, April 17, 2017 Vox Brain Map brain/
  63. 63. Nahin, R. ,Boineau, R, Partap. S. K., Stussman, Weber, N.D. Evidence -Based Evaluation of Complementary Health Approaches for Pain Management in the Inited States , Sept. 2016 Why Goldilocks is my Rehab Heroine goldilocks-is-my-rehab-heroine
  64. 64. Nahin, R. ,Boineau, R, Partap. S. K., Stussman, Weber, N.D. Evidence -Based Evaluation of Complementary Health Approaches for Pain Management in the Inited States , Sept. 2016 Why Goldilocks is my Rehab Heroine goldilocks-is-my-rehab-heroine
  65. 65. Resources Driftwood Recovery sees-spike-in-heroin-overdoses-876423747884 Achenbach, Joel.The Washington Post, Dec.23, 2016. An opioid epidemic is what happens when only treated with pills. Gebelhoff, R. The opioid epidemic can turn into a pandemic if we are not careful. The Washington Post .Feb. 9, 2017 theory/wp/2017/02/09/the-opioid-epidemic-could-turn-into-a- pandemic-if-were-not-careful/?utm_term=.d7f5c8218e3c
  66. 66. Resources Stanger articles management-and-opioid- addiction/ Stanger, Porter, Flowers Huffington Post-Trauma and Addiction addiction-whats-the- difference_us_58d14912e4b0e0d348b347f3 Flowers Articles, james-s-flowers-phd-lpc-s-and-angela-harris-msw-candidate Stanger, news/