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Freedom From Suffering Developed By Dr. Stephen F. Grinstead © 2009, 1996 Using The Addiction-Free  Pain Management   ®  S...
Goals Of APM ™  Treatment <ul><li>Increase Effective Medication Management </li></ul><ul><ul><li>Reduction In Your Relapse...
Indicators For Success <ul><li>You Are High Prognosis If: </li></ul><ul><li>You Become Actively Involved In  Understanding...
Indicators For Failure <ul><li>You’re Low Prognosis If: </li></ul><ul><li>You Become “Maliciously Compliant” In Following ...
Road Blocks To Success
The Addiction Pain Syndrome ©  Dr. Stephen F. Grinstead, 2009, 1996 ™
Addiction-Pain Syndrome ™ Addictive Disorder Zone
Addiction-Pain Syndrome ™ Pain Disorder Zone
Addiction-Pain Syndrome ™ Addiction Pain Syndrome Zone Pain Disorder Zone Addictive Disorder Zone
Obstacles For Success  <ul><li>Failure To Recognize Coexisting Disorders </li></ul><ul><li>Family System Problems </li></u...
Obstacles For Success  <ul><li>Your Own Self Defeating Reactions </li></ul><ul><ul><li>Malicious Compliance To Keep Rx Com...
Grief Loss & Depression <ul><li>Be Aware Of Your Grieving Process </li></ul><ul><ul><li>You need a plan that instills hope...
Discussion Question <ul><li>What Are Some Common Biases Or Negative Pejorative Comments That You Have Overheard (or been o...
You Must Be Proactive <ul><li>You Must Become Knowledgeable Active Participants—Not Passive Recipients   </li></ul><ul><li...
Looking At Your Pain
Types of Pain <ul><li>Acute Pain  </li></ul><ul><li>Chronic Pain </li></ul><ul><li>Recurrent Acute Pain  </li></ul><ul><li...
What Is Acute Pain? <ul><li>A Symptom Of An Underlying Problem </li></ul><ul><li>There Is Damage To Your System </li></ul>...
What Is Chronic Pain? <ul><li>Lasts For Six Months Or More </li></ul><ul><li>The Source Is Often Ambiguous  </li></ul><ul>...
What Is Recurrent Acute Pain? AKA Breakthrough Or Pain Flare Up <ul><li>You Experience Acute Pain Episodes </li></ul><ul><...
What Is Anticipatory Pain? <ul><li>It’s A Conditioned Pain Response  (You Expect It So It Happens) </li></ul><ul><li>It Is...
What Is Neuropathic Pain? <ul><li>Definition : </li></ul><ul><ul><li>“ Neural dysfunction that persists beyond the period ...
What Is Neuropathic Pain? <ul><li>Symptoms (What It Feels Like): </li></ul><ul><ul><li>Parasthesias: tingling, itching, nu...
The Three Components Of Pain <ul><li>Biological </li></ul><ul><ul><li>A Signal That Something Is Wrong </li></ul></ul><ul>...
Pain Versus Suffering <ul><li>Pain </li></ul><ul><ul><li>Physical Sensations (or signals) That Tells  You That Something I...
Rating Your Level of Pain <ul><li>Level 1  = Barely Noticeable  </li></ul><ul><li>Level 2  = Noticeable w/ No Distress </l...
Chronic Pain Intensified Perception of Pain Stress & Muscle Tension Depression Fear Anger This Cycle Must Be Broken
Chronic Pain How This  Cycle Is Broken Relaxation/Acceptance For Stress CBT For Emotional Components Stress & Muscle Tensi...
Quiz #1
Rx Pain Medication  Abuse/Addictive Disorders
Stages of Rx Abuse/Addiction Ongoing Exposure Initial Experience Building Tolerance Addiction Death Abuse Pseudo- Addictio...
Misunderstood Terms <ul><li>Tolerance </li></ul><ul><li>Physical Dependence </li></ul><ul><li>Substance Abuse </li></ul><u...
Tolerance  <ul><li>Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminut...
Physical Dependence <ul><li>Physical dependence is a state of adaptation that is manifested by a drug class specific withd...
Substance Abuse  <ul><li>Substance abuse is the use of legal (such  as Rx, alcohol and cigarettes) and illegal (e.g. canna...
Addiction <ul><li>Addiction is a primary, chronic, neurobiologic  [Brain]  disease, with genetic, psychosocial, and enviro...
Pseudo Addiction <ul><li>Patient behaviors that may occur when pain is under treated.  Patients with unrelieved pain may b...
Addiction Vs Pseudoaddiction <ul><li>Pseudoaddiction Looks A Lot Like Addiction </li></ul><ul><li>You May Appear To Be “Dr...
Red Flags For Rx Abuse/Addiction <ul><li>Euphoria After Adapting To The Medication </li></ul><ul><li>Craving & Preoccupati...
Red Flags For Rx Abuse/Addiction <ul><li>You Fail To Fulfill Major Role Obligations </li></ul><ul><li>You Don’t Take Your ...
A ddiction-Free P ain   M anagement ® A Synergistic Treatment System
The APM ™  System <ul><li>Core Clinical Processes </li></ul><ul><ul><li>Using Thinking, Feeling, Behavior Therapy  </li></...
The Plan Analyzing  & Managing HRS Mapping HRS Identifying High Risk Situations Medication Agreement & Intervention Plan D...
Recovery Friendly Medications <ul><li>Celebrex — Pre-Operation Loading 400mg </li></ul><ul><li>All Other NSAIDS If Side-Ef...
Recovery Friendly Medications <ul><li>Medications For Neuropathic Pain </li></ul><ul><ul><li>Cymbalta®   (duloxetine hydro...
Recovery Friendly Medications <ul><li>Ecotrin (coated aspirin—acetylsalicylic acid) </li></ul><ul><li>Anticonvulsants </li...
Non-Medication Approaches <ul><li>Meditation And Relaxation </li></ul><ul><li>Emotional Management </li></ul><ul><li>Massa...
Other Non-Medication  <ul><li>Yoga/Tai Chi </li></ul><ul><li>Diet/Nutrition </li></ul><ul><li>Prayer </li></ul><ul><li>Tri...
Passive Versus Proactive Tools  <ul><li>TENS/RS Stim Units </li></ul><ul><li>DBT and CBT </li></ul><ul><li>Life Coaching  ...
Stage I Pain Management <ul><li>Multi-Disciplinary Assessments </li></ul><ul><li>Detoxification And/Or Taper As Needed </l...
Stage II Pain Management <ul><li>Continue Non-Medication Tools </li></ul><ul><li>Develop Initial Relapse & Flare Up Plans ...
Stage III Pain Management <ul><li>1. Getting A Life — Moving Beyond Pain </li></ul><ul><li>2. Resolving  Core Psychologica...
Twelve Personal Action Steps <ul><li>Avoid Elective Dental/Surgical Procedures </li></ul><ul><li>Significant Other Holds A...
Twelve Personal Action Steps <ul><li>Self-Disclose Recovery Status To Providers </li></ul><ul><li>Take Time Off To Heal—Do...
Recovery/Relapse Indicators <ul><li>Using Medication As Prescribed </li></ul><ul><li>Using Medication For Pain Relief Only...
Recovery/Relapse Indicators <ul><li>No Loss Of Control </li></ul><ul><li>No Euphoria/Intoxication </li></ul><ul><li>No Neg...
Biological Psychological Spiritual Social Pain Management Recovery Goals 25 25 25 25
Treatment Outcomes <ul><li>Effective Medication Management </li></ul><ul><ul><li>Decreasing relapse rates </li></ul></ul><...
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Freedom From Suffering Patient Education

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Freedom From Suffering Patient Education

  1. 1. Freedom From Suffering Developed By Dr. Stephen F. Grinstead © 2009, 1996 Using The Addiction-Free Pain Management ® System
  2. 2. Goals Of APM ™ Treatment <ul><li>Increase Effective Medication Management </li></ul><ul><ul><li>Reduction In Your Relapse Rates </li></ul></ul><ul><li>Increase Your Ability To Problem Solve For Effective Pain Management Solutions </li></ul><ul><ul><li>Experiment With New Pain Management Strategies </li></ul></ul><ul><ul><li>Increase Your Hope For Recovery </li></ul></ul><ul><li>Reduce Your Pain And Suffering </li></ul><ul><ul><li>Move You From Victim To Empowered </li></ul></ul>
  3. 3. Indicators For Success <ul><li>You Are High Prognosis If: </li></ul><ul><li>You Become Actively Involved In Understanding Your Pain Disorder And All Of Your Available Treatment Possibilities </li></ul><ul><li>You’re Open To Multiple Opinions & Options </li></ul><ul><li>You’re Able To Become Self-Motivated To Actively And Systematically Experiment With Both Traditional And Non-Traditional Pain Management Methods </li></ul>
  4. 4. Indicators For Failure <ul><li>You’re Low Prognosis If: </li></ul><ul><li>You Become “Maliciously Compliant” In Following Recommendations Of Only The First Professional They Consult </li></ul><ul><li>You Expect To Become Pain Free With Minimal Personal Effort </li></ul><ul><li>You Are NOT Motivated To Experiment With Both Traditional & Non-Traditional Pain Management Methods </li></ul>
  5. 5. Road Blocks To Success
  6. 6. The Addiction Pain Syndrome © Dr. Stephen F. Grinstead, 2009, 1996 ™
  7. 7. Addiction-Pain Syndrome ™ Addictive Disorder Zone
  8. 8. Addiction-Pain Syndrome ™ Pain Disorder Zone
  9. 9. Addiction-Pain Syndrome ™ Addiction Pain Syndrome Zone Pain Disorder Zone Addictive Disorder Zone
  10. 10. Obstacles For Success <ul><li>Failure To Recognize Coexisting Disorders </li></ul><ul><li>Family System Problems </li></ul><ul><ul><li>Codependency AKA Enabling Behaviors </li></ul></ul><ul><ul><li>Burn Out & Becoming Angry With You </li></ul></ul><ul><li>Judgmental Healthcare Providers </li></ul><ul><ul><li>Minimize The Seriousness Of Your Pain </li></ul></ul><ul><ul><li>Imply That “It’s All In Your Head” </li></ul></ul><ul><ul><li>Blaming You “You Did It To Yourself” </li></ul></ul>
  11. 11. Obstacles For Success <ul><li>Your Own Self Defeating Reactions </li></ul><ul><ul><li>Malicious Compliance To Keep Rx Coming </li></ul></ul><ul><ul><li>Becoming Hopeless & Helpless </li></ul></ul><ul><ul><li>Grief/Loss & Feeling Ashamed/Guilty </li></ul></ul><ul><ul><li>Depression And Other Coexisting Disorders </li></ul></ul><ul><ul><li>Treatment Resistance & Denial </li></ul></ul>
  12. 12. Grief Loss & Depression <ul><li>Be Aware Of Your Grieving Process </li></ul><ul><ul><li>You need a plan that instills hope </li></ul></ul><ul><ul><li>Shift yourself from victimized to empowered </li></ul></ul><ul><li>Be Aware Of The Signs Of Depression </li></ul><ul><ul><li>Medication management </li></ul></ul><ul><ul><li>Cognitive behavioral therapy (CBT) </li></ul></ul><ul><ul><li>Combination CBT and medication </li></ul></ul>
  13. 13. Discussion Question <ul><li>What Are Some Common Biases Or Negative Pejorative Comments That You Have Overheard (or been on the receiving end) From... </li></ul><ul><ul><li>Substance Abuse Treatment Professionals </li></ul></ul><ul><ul><li>Medical Care Providers (Doctors, Nurses, etc.) </li></ul></ul><ul><ul><li>Mental Health Professionals </li></ul></ul>
  14. 14. You Must Be Proactive <ul><li>You Must Become Knowledgeable Active Participants—Not Passive Recipients </li></ul><ul><li>You Are Always Captain Of The Team </li></ul><ul><li>Healthcare Professional: Is A Guide Or Coach </li></ul><ul><li>Insist On A Collaborative Treatment Plan </li></ul><ul><li>Develop Recovery & Relapse Prevention Plans For Both The Pain & Any Rx Abuse/Addiction </li></ul>
  15. 15. Looking At Your Pain
  16. 16. Types of Pain <ul><li>Acute Pain </li></ul><ul><li>Chronic Pain </li></ul><ul><li>Recurrent Acute Pain </li></ul><ul><li>Anticipatory Pain </li></ul><ul><li>Neuropathic Pain </li></ul>
  17. 17. What Is Acute Pain? <ul><li>A Symptom Of An Underlying Problem </li></ul><ul><li>There Is Damage To Your System </li></ul><ul><li>The Source Is Easily Identified </li></ul><ul><li>There Is A Time Limited Healing Process </li></ul><ul><li>Analgesics Or Narcotics *May* Be Used </li></ul><ul><ul><li>If you are in recovery you need to have a good medication plan or face potential relapse </li></ul></ul>
  18. 18. What Is Chronic Pain? <ul><li>Lasts For Six Months Or More </li></ul><ul><li>The Source Is Often Ambiguous </li></ul><ul><li>Your Pain Lingers Long After Initial Injury </li></ul><ul><li>It May No Longer Serve Useful Purpose </li></ul><ul><li>Treatment Is Often Confusing And Frustrating </li></ul>
  19. 19. What Is Recurrent Acute Pain? AKA Breakthrough Or Pain Flare Up <ul><li>You Experience Acute Pain Episodes </li></ul><ul><ul><li>Incident Pain: Caused by Activity or Motion </li></ul></ul><ul><ul><li>End of Dose Pain (Your Rx is wearing off) </li></ul></ul><ul><ul><li>Pain with No Identifiable Cause </li></ul></ul><ul><li>Episodes Are Usually Brief </li></ul><ul><li>Low Or Pain Free Periods Between Episodes </li></ul><ul><li>Often Associated With Identifiable Precursors </li></ul><ul><li>This Needs A Separate Treatment Plan </li></ul>
  20. 20. What Is Anticipatory Pain? <ul><li>It’s A Conditioned Pain Response (You Expect It So It Happens) </li></ul><ul><li>It Is Activated Or Turned On By </li></ul><ul><ul><li>Environmental Triggers (what’s happening around you but doesn’t really involve you) </li></ul></ul><ul><ul><li>Internal Thinking & Emotional Triggers </li></ul></ul><ul><li>You Associate It With Previous Episodes When You Were In Significant Pain </li></ul>
  21. 21. What Is Neuropathic Pain? <ul><li>Definition : </li></ul><ul><ul><li>“ Neural dysfunction that persists beyond the period of normal tissue healing” </li></ul></ul><ul><ul><li>Or think of this type of pain as damage to your nerves and pain receptors that still signal pain after everything is actually all better. </li></ul></ul>
  22. 22. What Is Neuropathic Pain? <ul><li>Symptoms (What It Feels Like): </li></ul><ul><ul><li>Parasthesias: tingling, itching, numbness </li></ul></ul><ul><ul><li>Dysesthesias: shooting, burning, stabbing, aching, electrical sensations </li></ul></ul><ul><ul><li>Allodynia: non-harmful stimulus (pain signals) perceived as painful, e.g., touch of clothing </li></ul></ul><ul><ul><li>Spatial Changes: pain perception extending beyond initial area of tissue injury, e.g., your foot is injured but you feel pain in your leg too. </li></ul></ul>
  23. 23. The Three Components Of Pain <ul><li>Biological </li></ul><ul><ul><li>A Signal That Something Is Wrong </li></ul></ul><ul><li>Psychological </li></ul><ul><ul><li>Meaning You Assign To The Pain Signal </li></ul></ul><ul><li>Social/Cultural </li></ul><ul><ul><li>Role Assigned To You By Others </li></ul></ul><ul><ul><li>Your Family & Cultural Beliefs About Pain </li></ul></ul>
  24. 24. Pain Versus Suffering <ul><li>Pain </li></ul><ul><ul><li>Physical Sensations (or signals) That Tells You That Something Is Wrong In Your Body </li></ul></ul><ul><li>Suffering </li></ul><ul><ul><li>Your Interpretation That The Sensation Is Horrible, Awful, Terrible, or Unbearable </li></ul></ul><ul><li>Pain Is Inevitable But Suffering Is Optional </li></ul>
  25. 25. Rating Your Level of Pain <ul><li>Level 1 = Barely Noticeable </li></ul><ul><li>Level 2 = Noticeable w/ No Distress </li></ul><ul><li>Level 3 = Becoming Disturbing w/ No Distress </li></ul><ul><li>Level 4 = Some Distress w/ No Coping Problems </li></ul><ul><li>Level 5 = Distress w/ Some Coping Problems </li></ul><ul><li>Level 6 = Distress w/ Significant Coping Problems </li></ul><ul><li>Level 7 = Starting To Interfere w/ Functioning </li></ul><ul><li>Level 8 = Moderate Interference w/ Functioning </li></ul><ul><li>Level 9 = Severe Interference w/ Functioning </li></ul><ul><li>Level 10 = Unable To Function At All </li></ul>
  26. 26. Chronic Pain Intensified Perception of Pain Stress & Muscle Tension Depression Fear Anger This Cycle Must Be Broken
  27. 27. Chronic Pain How This Cycle Is Broken Relaxation/Acceptance For Stress CBT For Emotional Components Stress & Muscle Tension Decreased Perception of Pain
  28. 28. Quiz #1
  29. 29. Rx Pain Medication Abuse/Addictive Disorders
  30. 30. Stages of Rx Abuse/Addiction Ongoing Exposure Initial Experience Building Tolerance Addiction Death Abuse Pseudo- Addiction Seeking Reaching
  31. 31. Misunderstood Terms <ul><li>Tolerance </li></ul><ul><li>Physical Dependence </li></ul><ul><li>Substance Abuse </li></ul><ul><li>Addiction </li></ul><ul><li>Pseudo Addiction </li></ul>Definitions developed by the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine. (Savage, Covington, Heit, et al., 2004)
  32. 32. Tolerance <ul><li>Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time. </li></ul><ul><li>In other words it take more medication to get the same level of pain relief. </li></ul>
  33. 33. Physical Dependence <ul><li>Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. </li></ul><ul><li>In other words if you stop suddenly you’ll be very uncomfortable. </li></ul>
  34. 34. Substance Abuse <ul><li>Substance abuse is the use of legal (such as Rx, alcohol and cigarettes) and illegal (e.g. cannabis) drugs in a manner which is physically harmful or damaging to a person’s ability to be able to parent or to function at work. Damage to relationships or legal consequences can also be features of substance abuse. </li></ul>
  35. 35. Addiction <ul><li>Addiction is a primary, chronic, neurobiologic [Brain] disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations [how is shows up] . It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. </li></ul>
  36. 36. Pseudo Addiction <ul><li>Patient behaviors that may occur when pain is under treated. Patients with unrelieved pain may become focused on obtaining medications, may “clock watch,” and may otherwise seem inappropriately “drug seeking.” Even such behaviors as illicit drug use and deception can occur in the patient's efforts to obtain relief. </li></ul>
  37. 37. Addiction Vs Pseudoaddiction <ul><li>Pseudoaddiction Looks A Lot Like Addiction </li></ul><ul><li>You May Appear To Be “Drug-Seeking” </li></ul><ul><li>You May Need Frequent Early Refills </li></ul><ul><li>Behaviors Are Caused By Under-Treatment </li></ul><ul><li>Your Problematic Behaviors Resolve When Your Pain Is Adequately Treated </li></ul>
  38. 38. Red Flags For Rx Abuse/Addiction <ul><li>Euphoria After Adapting To The Medication </li></ul><ul><li>Craving & Preoccupation With Medication </li></ul><ul><li>Abnormal Increased Tolerance </li></ul><ul><li>You Decrease Pain Management Activities </li></ul><ul><li>You Experience Loss Of Control </li></ul><ul><li>Using Alcohol & Other Non-Prescribed Drugs </li></ul>
  39. 39. Red Flags For Rx Abuse/Addiction <ul><li>You Fail To Fulfill Major Role Obligations </li></ul><ul><li>You Don’t Take Your Rx As Prescribed </li></ul><ul><li>Your Create Addiction-Centered Lifestyle </li></ul><ul><li>Addictive Lifestyle Losses (Biopsychosocial) </li></ul><ul><li>Continued Use/Abuse Despite Problems </li></ul><ul><li>Substance-Induced Mental Disorders (i.e., the meds are messing with your mind) </li></ul>
  40. 40. A ddiction-Free P ain M anagement ® A Synergistic Treatment System
  41. 41. The APM ™ System <ul><li>Core Clinical Processes </li></ul><ul><ul><li>Using Thinking, Feeling, Behavior Therapy </li></ul></ul><ul><li>Medication Management Components </li></ul><ul><ul><li>Using Effective Medical Interventions </li></ul></ul><ul><li>Non-Medication/Holistic Approaches </li></ul><ul><ul><li>Using A Proactive Pain Management Approach </li></ul></ul>
  42. 42. The Plan Analyzing & Managing HRS Mapping HRS Identifying High Risk Situations Medication Agreement & Intervention Plan Decision Making About Medication Understanding The Effects Of Medication Understanding The Effects Of Chronic Pain Core Clinical Processes Assess Motivate Relapse Prevention Recovery
  43. 43. Recovery Friendly Medications <ul><li>Celebrex — Pre-Operation Loading 400mg </li></ul><ul><li>All Other NSAIDS If Side-Effects Tolerated </li></ul><ul><li>Muscle Relaxants (use caution with these) </li></ul><ul><ul><li>Xyrem ® (GHB) </li></ul></ul><ul><ul><li>Skelaxin® (metaxalone) </li></ul></ul><ul><ul><li>Zanaflex® (tizanidine hydrochloride) </li></ul></ul><ul><ul><li>Robaxin® (methocarbamol) </li></ul></ul><ul><ul><li>Flexeril® (cyclobenzaprine HCl) </li></ul></ul>
  44. 44. Recovery Friendly Medications <ul><li>Medications For Neuropathic Pain </li></ul><ul><ul><li>Cymbalta® (duloxetine hydrochloride) </li></ul></ul><ul><ul><li>Lyrica (pregabalin) </li></ul></ul><ul><li>Medications For Migraines </li></ul><ul><ul><li>Topamax® (topiramate) </li></ul></ul><ul><ul><li>Triptans (serotonin receptor agonists) </li></ul></ul><ul><ul><li>IV Toradol (ketorolac) for unresponsive pain </li></ul></ul><ul><ul><li>Zanaflex® (tizanidine hydrochloride) </li></ul></ul><ul><ul><li>Celebrex ® (celecoxib) </li></ul></ul>
  45. 45. Recovery Friendly Medications <ul><li>Ecotrin (coated aspirin—acetylsalicylic acid) </li></ul><ul><li>Anticonvulsants </li></ul><ul><ul><li>Tegretol® (carbamazepine) </li></ul></ul><ul><ul><li>Depakote (divalproex sodium) </li></ul></ul><ul><li>Elavil (amitriptyline) </li></ul><ul><li>Suboxone / Buprenorphine </li></ul>
  46. 46. Non-Medication Approaches <ul><li>Meditation And Relaxation </li></ul><ul><li>Emotional Management </li></ul><ul><li>Massage Therapy </li></ul><ul><li>Physical Therapy </li></ul><ul><li>Chiropractic Treatment </li></ul><ul><li>Acupuncture </li></ul><ul><li>Biofeedback </li></ul><ul><li>Hypnosis </li></ul>
  47. 47. Other Non-Medication <ul><li>Yoga/Tai Chi </li></ul><ul><li>Diet/Nutrition </li></ul><ul><li>Prayer </li></ul><ul><li>Tribal Healing </li></ul><ul><li>Sweat Lodges </li></ul><ul><li>Talking Circles </li></ul><ul><li>Pet Therapy </li></ul><ul><li>Self-Help Groups </li></ul><ul><li>TENS Units </li></ul><ul><li>Reflexology </li></ul><ul><li>Cranial Sacral </li></ul><ul><li>Aerobics </li></ul><ul><li>Rolfing/Hellar </li></ul><ul><li>Nature </li></ul><ul><li>Hobbies </li></ul><ul><li>EMDR </li></ul>
  48. 48. Passive Versus Proactive Tools <ul><li>TENS/RS Stim Units </li></ul><ul><li>DBT and CBT </li></ul><ul><li>Life Coaching </li></ul><ul><li>Hydrotherapy </li></ul><ul><li>Rolfing/Hellar </li></ul><ul><li>Physical Therapy </li></ul><ul><li>Equine Therapy </li></ul><ul><li>Hypnosis </li></ul><ul><li>Practice Yoga/Tai Chi </li></ul><ul><li>Follow Diet/Nutrition Plan </li></ul><ul><li>Practice Sleep Hygiene </li></ul><ul><li>Participate In Aerobics </li></ul><ul><li>Swimming Regularly </li></ul><ul><li>Frequent Nature Walks </li></ul><ul><li>Walking A Labyrinth </li></ul><ul><li>Learn & Use Self-Hypnosis </li></ul>Passive Proactive
  49. 49. Stage I Pain Management <ul><li>Multi-Disciplinary Assessments </li></ul><ul><li>Detoxification And/Or Taper As Needed </li></ul><ul><li>Physiological Vs Psychological/Emotional </li></ul><ul><li>ID & Manage Resistance & Denial </li></ul><ul><ul><li>Regarding Pain Management & Medication </li></ul></ul><ul><ul><li>Regarding Secondary Gain Issues </li></ul></ul><ul><li>Introduce Non-Medication Tools </li></ul>
  50. 50. Stage II Pain Management <ul><li>Continue Non-Medication Tools </li></ul><ul><li>Develop Initial Relapse & Flare Up Plans </li></ul><ul><li>ID & Manage Your Grief/Loss Issues </li></ul><ul><li>Be Aware Of Any Trauma History </li></ul><ul><ul><li>Trauma as precursor for increased sensitivity and ineffective pain management </li></ul></ul><ul><ul><li>Trauma related to other pre-existing conditions </li></ul></ul>
  51. 51. Stage III Pain Management <ul><li>1. Getting A Life — Moving Beyond Pain </li></ul><ul><li>2. Resolving Core Psychological Issues </li></ul><ul><li>3. Resolve / Manage Trauma Symptoms </li></ul><ul><li>4. Develop An Activity Pacing Plan </li></ul><ul><li>5. Fine-Tune The Relapse/Flare Up Plans </li></ul><ul><ul><li>To address high risk pain situations </li></ul></ul><ul><ul><li>To address core psychological issues </li></ul></ul>
  52. 52. Twelve Personal Action Steps <ul><li>Avoid Elective Dental/Surgical Procedures </li></ul><ul><li>Significant Other Holds And Dispenses Rx </li></ul><ul><li>Consult With Addiction Medicine Specialist </li></ul><ul><li>Explore All Non-Chemical Modalities </li></ul><ul><li>Identify And Manage Stress </li></ul><ul><li>Augment Recovery Supportive Activities </li></ul>
  53. 53. Twelve Personal Action Steps <ul><li>Self-Disclose Recovery Status To Providers </li></ul><ul><li>Take Time Off To Heal—Don’t Overwork </li></ul><ul><li>Be Aware Of Cross-Addiction Concept </li></ul><ul><li>Identify And Cope With Depression </li></ul><ul><li>Implement Nutrition And Exercise Plan </li></ul><ul><li>Explore Past Beliefs About Pain </li></ul>
  54. 54. Recovery/Relapse Indicators <ul><li>Using Medication As Prescribed </li></ul><ul><li>Using Medication For Pain Relief Only </li></ul><ul><li>No Obsessions Or Intrusive Thoughts </li></ul><ul><li>No Compulsion To Use Inappropriately </li></ul><ul><li>No Cravings To Use Or Increase Dose </li></ul>
  55. 55. Recovery/Relapse Indicators <ul><li>No Loss Of Control </li></ul><ul><li>No Euphoria/Intoxication </li></ul><ul><li>No Negative Biological Consequences </li></ul><ul><li>No Secondary Psychosocial Problems </li></ul><ul><li>No Pain Rebound Effect, Hyperalgesia Or Abnormal Tolerance Build Up </li></ul>
  56. 56. Biological Psychological Spiritual Social Pain Management Recovery Goals 25 25 25 25
  57. 57. Treatment Outcomes <ul><li>Effective Medication Management </li></ul><ul><ul><li>Decreasing relapse rates </li></ul></ul><ul><li>Increased Ability To Problem Solve </li></ul><ul><ul><li>Improved hope for healthy pain management </li></ul></ul><ul><li>Reduced Pain And Freedom From Suffering </li></ul><ul><ul><li>Moving from victim to empowerment </li></ul></ul>

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