pill-free pain relief

PILL-FREE PAIN RELIEF PILL-FREE PAIN RELIEF

Maryjo R. Gavin, Ph.DRehabilitation PsychologistSinai-Grace HospitalFunctional Recovery ProgramApril 30, 2011

DMCDMC

FRPFunctional Recovery Program

Maryjo Gavin Program PsychologistMaury Ellenberg Medical Director

INTRODUCTIONSINTRODUCTIONS

Functional Recovery Program

Interdisciplinary Rehabilitation ProgramStarted in 1990Designed to help individuals with chronicpain manage their condition and return to optimal physical functioning

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

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

Elusive Nature of Pain Elusive Nature of Pain

Cannot be measured objectivelySubjective, Psychological experienceInfluenced by many things

ExpectationsSignificanceEmotionsContext in which it is experienced

PAINPAIN

ACUTEACUTE CHRONICCHRONIC

Acute verses Chronic PainAcute verses Chronic Pain

Acute PainSpecific injuryTissue damageSelf-limitingCeases once healing occurs

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

PAIN CYCLEPAIN CYCLE

deconditioning

PAIN

inactivity

reduced flexibility

loss of strength

PHYSICAL CHANGES

PAIN CYCLEPAIN CYCLE

anxietyisolation

depression anger

PAIN

EMOTIONAL STRESSORS

PAIN CYCLEPAIN CYCLE

conflict

Can’t work

Reduced support

economic stress

PAIN

PSYCHOSOCIAL STRESSORS

PAIN CYCLEPAIN CYCLE

PsychosocialStressors

PhysicalChanges

EmotionalStressors

PAIN

OUCH!!!OUCH!!!

...MY LIFE HURTS

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)

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

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)

Problems?Problems?

Wrong TreatmentSuppresses our own endorphin systemIncreased rates of prescription drug abuse

particularly teens (2008 ONDCP report)Drug dependenceDrug addictionAccidental deaths

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

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

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.

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

SO HOW DO WE TREAT SO HOW DO WE TREAT CHRONIC PAIN?CHRONIC PAIN?

Functional Restoration

Cognitive Behavioral Therapy

Wean off of opioids

PAIN CYCLEPAIN CYCLE

PsychosocialStressors

PhysicalChanges

EmotionalStressors

PAIN

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

Cognitive – Behavioral TreatmentCognitive – Behavioral Treatment

Patient as active participant – self responsibility model

StructuredTime limitedGoal orientedFunctionally focusedIncrease coping skills

Cognitive/Affective/Behavioral Cognitive/Affective/Behavioral InteractionInteraction

THINK

FEEL DO

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.

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.

Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain

Confront the Costs and Benefits

Exercise is Good MedicineExercise is Good Medicine

Weight loss, weight maintenanceLower blood pressureReduce risk of heart disease, diabetesReduce, relieve painImprove sleepIncrease energyImprove moodBetter sex

Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain

EXERCISE

HURT vs HARM

Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain

EXERCISE

StretchingStrengtheningAerobicsBalance

Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain

LEARN TO RELAX

Formal relaxation

Leisure activities

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

Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain

QUIT SMOKING

Practical Suggestions for the Practical Suggestions for the Management of Chronic PainManagement of Chronic Pain

GET ACTIVE

Set goals

Pace your activity

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

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

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

THANK YOUTHANK YOU