PILL-FREE PAIN RELIEF
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PILL-FREE PAIN RELIEF PILL-FREE PAIN RELIEF
Maryjo R. Gavin, Ph.DRehabilitation PsychologistSinai-Grace HospitalFunctional Recovery ProgramApril 30, 2011
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DMCDMC
FRPFunctional Recovery Program
Maryjo Gavin Program PsychologistMaury Ellenberg Medical Director
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INTRODUCTIONSINTRODUCTIONS
Functional Recovery Program
Interdisciplinary Rehabilitation ProgramStarted in 1990Designed to help individuals with chronicpain manage their condition and return to optimal physical functioning
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ObjectivesObjectives
Discuss the differences between acute and chronic pain
Discuss the problems associated with the pharmacological management of pain
Review alternative approaches to manage and possibly alleviate chronic pain
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ReviewReview
70 million people suffer from some form of recurrent or chronic pain
25% of the populationTwo thirds of us will have an episode of
back pain at some time in our lives
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Elusive Nature of Pain Elusive Nature of Pain
Cannot be measured objectivelySubjective, Psychological experienceInfluenced by many things
ExpectationsSignificanceEmotionsContext in which it is experienced
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PAINPAIN
ACUTEACUTE CHRONICCHRONIC
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Acute verses Chronic PainAcute verses Chronic Pain
Acute PainSpecific injuryTissue damageSelf-limitingCeases once healing occurs
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Acute verses Chronic PainAcute verses Chronic Pain
Chronic PainLasts beyond six monthsPersists beyond the usual course of
acute insult, injury or disease processHurt does not equal harm
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PAIN CYCLEPAIN CYCLE
deconditioning
PAIN
inactivity
reduced flexibility
loss of strength
PHYSICAL CHANGES
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PAIN CYCLEPAIN CYCLE
anxietyisolation
depression anger
PAIN
EMOTIONAL STRESSORS
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PAIN CYCLEPAIN CYCLE
conflict
Can’t work
Reduced support
economic stress
PAIN
PSYCHOSOCIAL STRESSORS
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PAIN CYCLEPAIN CYCLE
PsychosocialStressors
PhysicalChanges
EmotionalStressors
PAIN
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OUCH!!!OUCH!!!
...MY LIFE HURTS
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Pain Medications – OTC analgesicsPain Medications – OTC analgesics
Acetaminophen (Tylenol, Tempra)
NSAIDS nonsteroidal anti-inflammatory drugs
Aspirin (Ancin, Bayer, Bufferin)Ibuprofen (Advil, Motrin)Ketoprofen (Actron, Orudis KT)Naproxen Sodium (Aleve)
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Pain Medication - OthersPain Medication - Others
Antidepressants (Tricyclics, SSRI’s)Anticonvulsants (Lyrica, Neurontin)Muscle Relaxants (Flexeril, Skelaxin)Tranquilizers (Xanex, Valium)Sedatives (Ambien, Lunesta)Others for side effects
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Pain Medications - OpioidsPain Medications - Opioids
hydrocodone (Vicodin)oxycodone (Percocet, Oxycontin)morphine (MSContin, Kadian, Avinza)codeine (Tylenol #3, #4) transdermal fentanyl (Duragesic patch)methadone (Dolophine)meperidine (Demerol)
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Problems?Problems?
Wrong TreatmentSuppresses our own endorphin systemIncreased rates of prescription drug abuse
particularly teens (2008 ONDCP report)Drug dependenceDrug addictionAccidental deaths
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Prescription Drugs- Celebrity DeathsPrescription Drugs- Celebrity Deaths
1962 Marilyn Monroe 361965 Dorothy Dandridge 421973 Howard Hughes 701977 Elvis Presley 421992 Judy Garland 472007 Anna Nicole Smith 392008 Heath Ledger 282009 Michael Jackson 50
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Not Just CelebritiesNot Just Celebrities
NCHS Data BriefIncrease in Fatal Poisonings Involving
Opioid Analgesics In the United States, 1999-2006
# of fatal poisonings tripled(4,000 to 13,800) Opioids involved in 40% of all poisoning
deaths
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Toledo Blade 04/24/2011Toledo Blade 04/24/2011
Ohio city targeted for drug intervention
Portsmouth, Ohio once thrived on its reputation for shoes and steel. Now it’s at the heart of a county, state and federal fight to stem prescription drug abuse.
In Ohio, fatal overdoses more then quadrupled in the past decade, surpassing car crashes as the leading cause of accidental death in the state.
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FDA unveils plan to curb opioid prescription drug abuse
Pharmaceutical Companies to Produce Educational Tools for Prescribers
Information on Long Acting OpioidsWhen and How to Prescribe, How to
Recognize Signs of Abuse
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SO HOW DO WE TREAT SO HOW DO WE TREAT CHRONIC PAIN?CHRONIC PAIN?
Functional Restoration
Cognitive Behavioral Therapy
Wean off of opioids
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PAIN CYCLEPAIN CYCLE
PsychosocialStressors
PhysicalChanges
EmotionalStressors
PAIN
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Cognitive Behavioral ModelCognitive Behavioral Model
A theoretical approach that acknowledges the importance of both cognitions and behaviors in the acquisition and maintenance of behavioral patterns
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Cognitive – Behavioral TreatmentCognitive – Behavioral Treatment
Patient as active participant – self responsibility model
StructuredTime limitedGoal orientedFunctionally focusedIncrease coping skills
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Cognitive/Affective/Behavioral Cognitive/Affective/Behavioral InteractionInteraction
THINK
FEEL DO
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
The first step is admitting that what we are dealing with is a chronic problem.
Take responsibility for it.
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Serenity PrayerSerenity Prayer
God, grant me the serenity to accept the things I can not change,
the courage to change the things I can
and the wisdom to know the difference.
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
Confront the Costs and Benefits
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Exercise is Good MedicineExercise is Good Medicine
Weight loss, weight maintenanceLower blood pressureReduce risk of heart disease, diabetesReduce, relieve painImprove sleepIncrease energyImprove moodBetter sex
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
EXERCISE
HURT vs HARM
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
EXERCISE
StretchingStrengtheningAerobicsBalance
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
LEARN TO RELAX
Formal relaxation
Leisure activities
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
MANAGE YOUR STRESS
Set limits with others
Become an optimist
Manage your emotions
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
QUIT SMOKING
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
GET ACTIVE
Set goals
Pace your activity
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
MAINTAIN A SUPPORT SYSTEM
Family, Friends, NeighborsChurch, Community GroupsSupport Groups (ACPA)Volunteer
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
FOCUS ON PLEASANT ACTIVITIES
The How of Happiness – Sonja Lyubomirsky
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Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain
KEEP YOUR PROBLEMS IN PERSPECTIVE
Focus on the positive and work on the things that are under your control
Pain may be inevitable but suffering is optional
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THANK YOUTHANK YOU