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Chronic Pain Management


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Chronic Pain Management

  1. 1. Addiction, Pseudo-addiction & An Integrated Approach Rory Fleming Richardson, Ph.D., ABMP, TEP Clinical Medical Psychologist & Neuropsychologist Copyright 2009, Dr Rory Fleming Richardson
  2. 2. Function is the benchmark for proper pain management. Some of the keys of pain management are the monitoring of pain, level of relief and level of function. Optimally, • pain level is low, and • Level of relief and level of function are high.
  3. 3. • Physical • Gross motor • Fine motor • Vestibular sense • Sensory function and processing • Sleep and rest • Nutrition • Activity level • Emotional • Ability to cope with stress and conflict • Absence of mood disorder • Absence of psychiatric symptoms • Playing and leisure activities
  4. 4. • Cognitive • Recall of information • Short-term memory • Long-term memory • Computation • Application of knowledge • Comparative analysis • Choice and judgment • Interpersonal • Desire to belong • Bonding • Prosody • Problem-solving • Working with others • Adapting to change to respect others • Listening • Ability to take a follower role • Ability to take a leadership role
  5. 5. Children (and I) like this one.
  6. 6. This scale I have found to be the best general scale because it also provides areas of functional interference.
  7. 7. Dependence versus Addiction Addiction to pain and anxiety medications is a major concern for health care providers. The term “Pseudo-Addiction” is used when an individuals behavior may appear to be that of an addict but, in fact, is not. In some cases, the level of maintenance medication is not high enough to provide effective relief from pain. It is also very common for individuals who are on a maintenance dosage of pain medication to be concerned about running out of the medication. In both cases, medication seeking can occur.
  8. 8. The challenge is to use all forms of pain management to provide the level of relief necessary for basic daily function and some quality of life.
  9. 9. An individual showing Pseudo-Addiction will:  not take more medications than is necessary to relieve the pain and may sometimes take less,  not take dosages which result in euphoria,  not show signs of intoxication. They will:  follow recommendations of the physician,  focus on the potential side effects of the medication,  focus on the consequences of the side effects.
  10. 10. There are behaviors that are frequently misunderstood which do not show addiction but providers are sensitive too raising concerns. The behaviors which are less likely to be indicators of addiction are:  complaining about needing a higher dosage,  hoarding drugs for periods when symptoms are increased,  acquiring similar medications from different prescribers for different purposes (i.e., a person on chronic pain medications through their PCP getting an acute pain relief medication from a dentist for dental pain).
  11. 11. Important Note: Just because a person is on chronic pain medications, does not mean that that person does not need acute pain medication for acute pain events. The chronic pain medication provides a foundation and will not cover the acute pain events. In emergency situations, it is imperative for the treating physician to know about the chronic pain management and to consult with the physician responsible for the pain management. If the patient knows of medical or dental procedures which are planned, consult with the pain management physician to plan for acute pain treatment needs.
  12. 12. Individuals who are Addicted will attempt to achieve euphoria, increase the amount used beyond a point of relieving pain, show signs of intoxication. They will not: focus on side effects, be concerned with consequences of side effects, follow physician recommendations.
  13. 13. Other addictive behaviors include: selling prescription medications, forging prescriptions, stealing another patient’s drugs, using the medication in a different way than recommended (i.e., IV, smoking, etc.) seeking pain medication from multiple providers, using different pharmacies for similar medications without knowledge of the prescribers, repeatedly losing their prescription, buying medications from street dealers, mixing medications and alcohol to attain a state of euphoria.
  14. 14. • Myoflex • Cyclobenzaprine • Valium • Zanaflex (Tizanidine) • Natural Relaxers (Passiflora, Valerian, Chamomile, Licorice, Lobelia Extract, Calcium/ Magnesium) • Hydroxyzine
  15. 15. • NAISD • Omega-3 • Aspirin • Naprosyn • Naproxen/Aleve • Ibuprophren/Advil • Acetaminophen/Tylenol • Glucosamine - Chondroitin • Bioflavonoids • Systemic Enzyme • Devil’s Claw
  16. 16. • Morphine • Methadone • Vicodin • Oxycodone • Hydrocodone • OxyContin • Kadian • MS Contin • Lyrica • Neurontin • Amitriptyline • Ultram • Transdermal Pain Patches • Natural Pain Killers (Kava Root, White Willow, Horsetail, Valerian, Cayenne Pepper) • Prescribed Medical THC
  17. 17. • Craniosacral Massage • Massage • Chiropractics • Acupressure • Acupuncture • Stretching • Yoga • Occupational Therapy • Physical Therapies • Aquatic Therapy • Traction • Hot Tub/Spa • Ultrasound • TENS Unit • Moist Heat & Ice Packs
  18. 18. • Psychotherapy & Counseling • Pacing Activities • Sleep & Sleep Treatment • Know Your Limitations • Biofeedback/Neurofeedback • Nutritional Balance • Spirituality • Psychopharmacology • Support Groups
  19. 19. • Hypnosis • Self-hypnosis • Transcendental Meditation • Breathing Exercises (i.e., Hatha Yoga) • Relaxation Techniques • Stress Management • Tai Chi & Qi Gong • Enjoyable Activities (distraction) • Spiritual Exercises & Practices
  20. 20. In some cases, surgical intervention may be considered. These can include devices delivering medicine, electric current, heat, or chemicals to numb or block pain. • Intrathecal medications: sends medicine to the area of your pain. • Electrical nerve: stimulation uses electric current to interrupt pain signals. • Nerve ablation: destroys or removes the nerves that are sending pain signals. • Chemical sympathectomy: utilizes chemicals to destroy nerves.
  21. 21. The secret to proper pain managem ent is balance.
  22. 22. Thank you!