Terri A. Lewis SIU-Carbondale, REHB Institute [email_address]
<ul><li>What is the difference between  acute  and  chronic pain ? </li></ul><ul><li>How do  medical models  exert influen...
<ul><li>How is pain  defined ? </li></ul><ul><li>Incidence   &  prevalence  in the population </li></ul><ul><li>How does c...
Pain   -  an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in...
<ul><li>Etiologic specific chronic pain   is the type of pain that results from a  specific event or illness.  </li></ul><...
<ul><li>Leading cause  of disability in this country  (Mayday Fund, 2009)  </li></ul><ul><li>Incidence > than diabetes, he...
<ul><li>Two categories, occur independently or together - </li></ul><ul><li>(a)  pain that develops due to actual damage t...
<ul><li>Crohn’s Disease </li></ul><ul><li>Spinal Pain </li></ul><ul><li>Fibromyalgia </li></ul><ul><li>Failed Back Surgery...
The chronic pain experience may be seen as the result of a dynamic interaction between pathophysiological, psychosocial, s...
<ul><li>Minorities  remain largely untreated </li></ul><ul><li>Cultural barriers to care </li></ul><ul><li>Different patte...
Acute pain  usually resolves within 3 months Chronic pain  is still present at 3 mos post onset, hardened by 6 mos
<ul><li>Four  Medical Models  of Care </li></ul><ul><li>The  Biomedical Model ,  the primary care   practice model </li></...
<ul><li>338.0  Central pain syndrome, </li></ul><ul><li>338.21 Chronic pain due to trauma, </li></ul><ul><li>338.22 Chroni...
<ul><li>Electronic health records (EHR) are  NOT  programmed with logic models for the diagnosis of  either - </li></ul><u...
<ul><li>Axis 1 – Mental Illness </li></ul><ul><li>Axis 2 – Personality Disorders, Intellectual Disability </li></ul><ul><l...
<ul><li>Mood disorder due to generalized medical condition 293.83 </li></ul><ul><li>Generalized Anxiety Disorder due to a ...
<ul><li>Borderline Personality Disorder </li></ul><ul><li>Conduct Disorder </li></ul><ul><li>Obsessive Compulsive Disorder...
<ul><li>Chronic Pain due to a general medical condition 307.89 </li></ul><ul><li>Chronic Pain NOS  338.xx </li></ul><ul><l...
<ul><li>Job loss or unemployment  </li></ul><ul><li>Loss of community/family roles and functions </li></ul><ul><li>Divorce...
<ul><li>GAF Score </li></ul><ul><li>0 – 49 Impaired </li></ul><ul><li>50 – 100 Significantly impaired </li></ul>
<ul><li>Prevention  </li></ul><ul><li>Planning for vocational support </li></ul><ul><li>Continued treatment for chronic pa...
<ul><li>Informed consent counseling </li></ul><ul><li>Prevention and psychoeducation </li></ul><ul><li>Integrated treatmen...
<ul><li>Advocacy </li></ul><ul><li>Collaboration with other professionals </li></ul><ul><li>Referral </li></ul><ul><li>Con...
<ul><li>Prevention </li></ul><ul><li>Resiliency training </li></ul><ul><li>Psychoeducation </li></ul><ul><li>Adjustment tr...
Chronic Pain
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Chronic Pain

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This presentation is for counselors who treat consumers with chronic pain

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Chronic Pain

  1. 1. Terri A. Lewis SIU-Carbondale, REHB Institute [email_address]
  2. 2. <ul><li>What is the difference between acute and chronic pain ? </li></ul><ul><li>How do medical models exert influence on the development of the disease ? </li></ul><ul><li>What are the return to work implications for treatment options, coexisting disorders? </li></ul><ul><li>How do multi-axial treatment models, frame the role for Counselors ? </li></ul>
  3. 3. <ul><li>How is pain defined ? </li></ul><ul><li>Incidence & prevalence in the population </li></ul><ul><li>How does chronic pain develop ? </li></ul><ul><li>How many syndromes are associated with chronic pain? </li></ul><ul><li>How is chronic pain classified ? </li></ul>
  4. 4. Pain - an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage . Acute pain - pain that terminates or eases when conditions of illness terminate or surgical interventions heal, generally does not persist for more than a few days, even if it recurs. Chronic pain - a state in which pain persists beyond the usual course of an acute disease or healing of an injury - may or may not be associated with an acute or chronic pathologic process, persists for three to six months or more beyond the onset of an illness or recovery from healing of surgical procedures or trauma Breakthrough pain - pain that acutely elevates in response to known or unknown stressors or reductions in medication levels between available dosages.
  5. 5. <ul><li>Etiologic specific chronic pain is the type of pain that results from a specific event or illness. </li></ul><ul><li>Neuro-biological pain is chronic pain that is persistent, residual beyond the expected healing period and becomes secondary in its’ development to the originating trigger. </li></ul><ul><li>Frequently co-morbid with the secondary development of generalized anxiety disorders, depression, and post-traumatic stress disorder </li></ul>
  6. 6. <ul><li>Leading cause of disability in this country (Mayday Fund, 2009) </li></ul><ul><li>Incidence > than diabetes, heart disease and cancer combined (American Pain Foundation [APF], 2009; McCaffery & Ferrell, 1999, 2010). </li></ul><ul><li>70 – 76 million Americans, w/ 9% reporting moderate to severe levels of intensity (National Institute of Health [NIH], 1998; Mayday Fund, 2009) </li></ul><ul><li>Economic toll of chronic pain at $100 billion a year in the United States (National Institute of Health [NIH], 1998) </li></ul>
  7. 7. <ul><li>Two categories, occur independently or together - </li></ul><ul><li>(a) pain that develops due to actual damage to peripheral nerves or the central nervous system (CNS) </li></ul><ul><li>(b) nociceptor (neural) pain resulting from nerve tissue irritation or damage in which pain mechanisms become hardened and involve related endocrine system dysfunction. </li></ul><ul><li>These may occur independently or together. </li></ul>
  8. 8. <ul><li>Crohn’s Disease </li></ul><ul><li>Spinal Pain </li></ul><ul><li>Fibromyalgia </li></ul><ul><li>Failed Back Surgery </li></ul><ul><li>Post Epidural Syndrome </li></ul><ul><li>Inflammatory disorders </li></ul><ul><li>200+ syndromes </li></ul>
  9. 9.
  10. 10. The chronic pain experience may be seen as the result of a dynamic interaction between pathophysiological, psychosocial, social, and treatment (or prolonged lack of treatment) variables.
  11. 11. <ul><li>Minorities remain largely untreated </li></ul><ul><li>Cultural barriers to care </li></ul><ul><li>Different patterns in seeking treatment </li></ul><ul><li>Effects of age bias </li></ul><ul><li>Undertreatment due to pseudoaddiction </li></ul><ul><li>Distribution of resources </li></ul><ul><li>Length of suffering avgs 5 years without intervention </li></ul><ul><li>Return to work statistics are alarming </li></ul>
  12. 12. Acute pain usually resolves within 3 months Chronic pain is still present at 3 mos post onset, hardened by 6 mos
  13. 13. <ul><li>Four Medical Models of Care </li></ul><ul><li>The Biomedical Model , the primary care practice model </li></ul><ul><li>The Sequelae of Care Biomedical model </li></ul><ul><li>The Multidisciplinary, Biobehavioral Pain Center model </li></ul><ul><li>The Biopsychosocial/Neurobehavioral model </li></ul>
  14. 14. <ul><li>338.0 Central pain syndrome, </li></ul><ul><li>338.21 Chronic pain due to trauma, </li></ul><ul><li>338.22 Chronic post-thoracotomy pain, </li></ul><ul><li>338.28 Other chronic postoperative pain, </li></ul><ul><li>338.29 Other chronic pain, </li></ul><ul><li>338.4 Chronic pain syndrome with significant psychosocial dysfunction, </li></ul><ul><li>780.96 Generalized pain. </li></ul>
  15. 15. <ul><li>Electronic health records (EHR) are NOT programmed with logic models for the diagnosis of either - </li></ul><ul><ul><li>Orphan disorders (500+) or </li></ul></ul><ul><ul><li>Chronic pain syndrome (CPS) </li></ul></ul><ul><ul><li>Counselors should be on the look out for repeated complaints of pain after even the most innocuous of triggering events…. </li></ul></ul>
  16. 16.
  17. 17. <ul><li>Axis 1 – Mental Illness </li></ul><ul><li>Axis 2 – Personality Disorders, Intellectual Disability </li></ul><ul><li>Axis 3 - General Medical Condition </li></ul><ul><li>Axis 4 – Psychosocial & Environmental Stressors </li></ul><ul><li>Axis 5 – General Assessment of Functioning </li></ul>
  18. 18.
  19. 19. <ul><li>Mood disorder due to generalized medical condition 293.83 </li></ul><ul><li>Generalized Anxiety Disorder due to a medical condition 293.84 </li></ul><ul><li>Post Traumatic Stress Disorder (PTSD), Acute or chronic 309.81 </li></ul><ul><li>Acute stress disorder 308.3 </li></ul>
  20. 20. <ul><li>Borderline Personality Disorder </li></ul><ul><li>Conduct Disorder </li></ul><ul><li>Obsessive Compulsive Disorder </li></ul><ul><li>Hypochondriasis </li></ul><ul><li>Attention seeking behavior </li></ul><ul><li>Drug seeking behavior </li></ul>
  21. 21. <ul><li>Chronic Pain due to a general medical condition 307.89 </li></ul><ul><li>Chronic Pain NOS 338.xx </li></ul><ul><li>Chronic Pain due to trauma 338.21 </li></ul><ul><li>Chronic Pain with psychosocial dysfunction 338.4 </li></ul><ul><li>Neuroendocrine disorders: </li></ul><ul><ul><li>Thyroid dysfunction; Diabetes; Low levels of testosterone; Elevated levels of cortisol and other stress hormones </li></ul></ul><ul><li>Sleep disorder due to medical condition, 327.xx </li></ul><ul><li>Substance abuse; Substance dependence (with physiological dependence or without physiological dependence); Alcohol dependence 303.90 or Alcohol Abuse 305.00; Cannabis dependence 304.30 or Cannabis abuse 305.20; Nicotine dependence 305.1; Opioid Dependence 304.00 or Opioid Abuse 305.50; Polysubstance dependence 304.80; </li></ul>
  22. 22. <ul><li>Job loss or unemployment </li></ul><ul><li>Loss of community/family roles and functions </li></ul><ul><li>Divorce and family disruption </li></ul><ul><li>Lack of family support </li></ul><ul><li>Financial stressors </li></ul><ul><li>Undertreatment of chronic pain syndrome </li></ul><ul><li>Access to care failure </li></ul>
  23. 23. <ul><li>GAF Score </li></ul><ul><li>0 – 49 Impaired </li></ul><ul><li>50 – 100 Significantly impaired </li></ul>
  24. 24. <ul><li>Prevention </li></ul><ul><li>Planning for vocational support </li></ul><ul><li>Continued treatment for chronic pain </li></ul><ul><li>Community/family supports </li></ul><ul><li>Integrated counseling modalities </li></ul><ul><ul><li>Adjustment </li></ul></ul><ul><ul><li>Medication supports </li></ul></ul><ul><ul><li>Alternative therapies </li></ul></ul><ul><ul><li>Lifestyle changes </li></ul></ul>
  25. 25.
  26. 26. <ul><li>Informed consent counseling </li></ul><ul><li>Prevention and psychoeducation </li></ul><ul><li>Integrated treatment modalities </li></ul><ul><li>Alternative therapies combined </li></ul><ul><ul><li>Meditation, biofeedback, yoga </li></ul></ul><ul><ul><li>Pain reduction tools – stimulators and pumps </li></ul></ul><ul><ul><li>Medication protocols </li></ul></ul><ul><ul><li>Stress management </li></ul></ul><ul><ul><li>Wellness medical supports </li></ul></ul>
  27. 27. <ul><li>Advocacy </li></ul><ul><li>Collaboration with other professionals </li></ul><ul><li>Referral </li></ul><ul><li>Confidentiality </li></ul><ul><li>Multicultural awareness </li></ul>
  28. 28. <ul><li>Prevention </li></ul><ul><li>Resiliency training </li></ul><ul><li>Psychoeducation </li></ul><ul><li>Adjustment training </li></ul><ul><li>Suicidal ideation & rational suicide counseling </li></ul><ul><li>Collaboration with other treatment providers </li></ul><ul><li>Advocacy </li></ul><ul><li>Access to appropriate treatment </li></ul>

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