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Families and Chronic Pain


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Let’s talk pain - 2.

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Families and Chronic Pain

  1. 1. Let’s Talk Pain 2- Families James Flowers PHD & Louise A. Stanger Ed.D, LCSW
  2. 2. Objectives • Review and Discuss What Chronic Pain is and Acute Pain Syndrome • Review and Discuss how Substance Abuse and Mental Health intertwines with Chronic Pain • Identify and Define the Role Family has with Chronic Pain
  3. 3. 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 • Describe developmental differences
  4. 4. Objectives • Present Family Mapping as a Way into Story and a Visual Tool to help identify the alignment of Chronic Pain with SA and MH • Give Case Examples • Recommend Treatment Strategies used in Family Programs for Chronic Pain and SA -MH Clients
  5. 5. 100 Million- One in Ten Americans - 1.5 Billion Globally
  6. 6. 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
  7. 7. Chronic Pain Lasts for several weeks, months and years and can cause its own disease Pain signals are sent to the brain once the pain stops brain signals with acute pain stop With Chronic pain brain signals are sent to the brain and the signals do not stop
  8. 8. Chronic Pain Arthritis Fibromyalgia Crohn’s Disease Concussions Spine Accidents Pelvic Pain Hips, Knees, Shoulders, Spines
  9. 9. Effects of Chronic Pain • 77% report feeling depressed • 51% feel they have little or no control over their pain • 20% report sleep is disrupted due to chronic pain
  10. 10. 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.
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. Social Costs of Chronic Pain Christopher L. Edwards MD, Asst. Prof. of Psychiatry Duke University • “The social costs are invaluable.How do you estimate the loss of self worth? How do you estimate the loss of family, friends, and a sense of accomplishment.”
  16. 16. 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-
  18. 18. 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
  19. 19. 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
  20. 20. When we add Addiction & Mental Health Issues to Chronic Pain • A Losing Trifecta • Put in PBS ARTICLE
  21. 21. Trauma
  22. 22. 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
  23. 23. Trauma is objective What happened ( My father killed himself, My baby dies of SIDS, I was date raped , humiliated etc
  24. 24. 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
  25. 25. What do your Clients Say about Trauma ???? Verbal abuse Physical abuse Witnessing a tragedy Not being told about something Accidents Divorce Death
  26. 26. Getting Emotionally Hooked When I Experience X I Feel- Body Sensation I Think -Whats my go-to thought process Behavior-What do I do?
  27. 27. Invitations to Change
  28. 28. Using Portraiture Qualitative Inquiry as a way into Story
  29. 29. Family Mapping
  30. 30. Who Am I ? “I am the mirror who reflects back their pain, their fears their voices. I am the inquirer who asks difficult questions, who searches for evidence and patterns. I am the companion on the journey bringing my own story to the encounter, making possible an interpretive collaboration, I am the audience who listens , laughs , weeps an applauds. I am the spider women spinning their tales.. I am the therapist who offers cathaersis support and challenge… I am also the stage manager coordinating the intersection of three plays- the story teller, the narrator and the readers inviting your voice to the drama”
  31. 31. Conversations will be non-linear
  32. 32. Talking With Strangers Tell Me about yourself Tell Me about your family Tell me why your heart is hurting Tell me what is special about your loved one Tell me what you hope for
  33. 33. Let’s talk about Family Substance Abuse Mental Health-Anxiety Depression, Personality, Bi-Polar- Schizophrenia etc Process Disorders- Love, Sex, Shopping, Disordered Eating, Digital,Money Chronic Pain or Other Medical Religion Gender and Sexual Identity Exercise -Too Much- Too Little
  34. 34. More Questions Disordered Financial Life Over and Under Spending Shopping Gambling Workaholism Financial Betrayal in Relationships Debting
  35. 35. More Questions for Bio- Psycho-Social Marriages/Divorces Death Pregnacies- Misscarriages, Still Births, Live Births, SIDs Geography- Moves Gender preference-Sexual Identity School Legal Community LIFE IS MESSY
  36. 36. Loss and Grieving Loss -Something of Value is gone Grief = Total response to an emotional experience related to loss Breavement- Subjective response by loved one Mourning -behavioral response
  37. 37. Always Start With Identified Love One
  38. 38. Qualitative Questions Tell Me about ……….. Tell me about your Family.. Tell me about your children, family, Grandparents etc
  39. 39. Feeling Carried or Denied Gift Shame Unworthy Not Good Enough Humility I am Enough Guilt Panic, Paranoia Wisdom, Protection Embarrassment Stupid Competent Joy Hysteria Hope-Healing- Spirtuality
  40. 40. Feeling Carried or Denied Gift Anger Rage Stength-Energy, Motivation Fear Panic, Paranoia Wisdom, Protection Pain Depression-Hopelessness Healing, Growth Loneliness Isolation-Helplessness Reaching outward & Inward
  41. 41. Meet The Family Susan
  42. 42. Stole Prescription books Put Spouses medical license at risk Nodded off at Outings Emotionally unavailable to Family Embarrassed, Ashamed, In Pain-Hand and Arm
  43. 43. Whats Working? Pain Recovery Doctor Neuropsych Testing ACT, CBT , MI, SFT etc Somatic Therapies-Havening , EDMR Trauma Based Therapies Family Therapy -Couples Counseling Children -ACA
  44. 44. Gardening - Nature Exercise - Water , gym etc Massage-Acupuncture Mindful Meditation 12 Step Service Work-Gratefulness Family Therapy
  45. 45. Family Work Couples Therapy Self-Support Groups Psych0-Education Children-Education Young Adult Child -ACA , College Support Group Teen- Education & Sports Change Agreements
  46. 46. Meet Doug
  47. 47. About Doug 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 Co-Ocurring
  48. 48. What’s working!
  49. 49. Showing Up
  50. 50. Meet Ed Two Families Celebrity Personal Back Pain Opiods Marijuana
  51. 51. Celebrity Management Business, Personal, PR, Hairdresser, Stylist, Lawyer, Entourage, Security Etc Etc
  52. 52. Chad -32 y.o Motocross Accident
  53. 53. Mindfulness was key to his Recovery Battered Opiates On his own Family Not Interested
  54. 54. Meet Harriet - 62 y.o Female
  55. 55. How Harriet’s Lights Went Out Small Tumor on Cervical Spine- Operation-Radiation & Chemo Oops clipped a nerve- INTENSE PAIN = OxyContin, Xanax , Ambien on and on and on Finally ended with a Actig Fentanyal Lollipop
  56. 56. I Have Lost Relationships Family Business Insurance Money Self Esteem Ability to Walk Smile
  57. 57. Strategies 15 day detox- Pain still 20% due to Hyperalgesia Education Cognitive Behavioral Therapy Mindfulness Mediation Yoga etc Peer Support
  59. 59. 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
  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. Resources • The Extra Burdens Faced by Young People with Chronic Illness -Toni Burnard JD Psychology Today , March, 2014 • Chronic Pain and the Family -Theory Driven Approaches , Lewandowski, W , Morris R, Burke, Claire & Risko > Mental health Nursing 28:1044, 2007 • The surprising impact of Chronic Pain on Family and Money- Az Pain
  62. 62. Resources Brown, Brene- Rising Strong . Speiegel & Grau International 2015 NYC NY Brown, Brene, DaringGreatly. Gothom Books 2012 Lawrence Lightfoot,Sarah & Hoffman Jessica .TheArt and Science of Portraiture. Joey Bass. 1997 LawrenceLightfoot, S. Respect , 1998. Press Books, Mass. Lawrence, Lightfoot,S. I’ve Known Rivers , Penguin Publishing. Ny 1995 Lawrence, Lightfoot, S Growing Each Other Up, University of Chicago Press. 2016
  63. 63. Resources Center for Disease Control, March 2016 Scientific America -Crucial Conservations , May, 2016 ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction and Opioid Use,2016 Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Int Med. 2015;162(4):276-286. Centers for Disease Control and Prevention. NCHS Data Brief. Prescription opioid analgesic use among adults:United States 1999-2012 , Number 189, February,2015 2013 National Drug Student Data Bank Driftwood Recovery
  64. 64. 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 https:// epidemic-could-turn-into-a-pandemic-if-were-not-careful/? utm_term=.d7f5c8218e3c
  65. 65. Resources Stanger articles management-and-opioid-addiction/http:// 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,
  66. 66. More Resources What’s Love Got to do with it -Boundaries and Relationships -Stanger Huffington Post The Sober World- Grandmother I have Something to Tell You, Stanger& Porter The Sober World-Parents and Teens in the Midst of an Opioid Crisis, Holomback& Stanger The Sober World: Parents , Teens, Marijuana , Stanger & Porter Recovery Campus-Freshman 101, Stanger& Porter Recovery Campus-Adulting It’s Hard to do , Stanger& Porter All articles and more are available on