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PILL-FREE PAIN RELIEF. Maryjo R. Gavin, Ph.D Rehabilitation Psychologist Sinai-Grace Hospital Functional Recovery Program April 30, 2011. DMC. FRP. Functional Recovery Program. Maryjo Gavin Program Psychologist Maury Ellenberg Medical Director. INTRODUCTIONS. - PowerPoint PPT Presentation

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  • PILL-FREE PAIN RELIEF

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

  • DMCFRPFunctional Recovery ProgramMaryjo Gavin Program PsychologistMaury Ellenberg Medical Director

  • INTRODUCTIONSFunctional Recovery Program

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

  • ObjectivesDiscuss 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

  • Review

    70 million people suffer from some form of recurrent or chronic pain25% of the populationTwo thirds of us will have an episode of back pain at some time in our lives

  • Elusive Nature of Pain Cannot be measured objectivelySubjective, Psychological experienceInfluenced by many thingsExpectationsSignificanceEmotionsContext in which it is experienced

  • PAINACUTECHRONIC

  • Acute verses Chronic PainAcute PainSpecific injuryTissue damageSelf-limitingCeases once healing occurs

  • Acute verses Chronic PainChronic PainLasts beyond six monthsPersists beyond the usual course of acute insult, injury or disease processHurt does not equal harm

  • PAIN CYCLEPHYSICAL CHANGES

  • PAIN CYCLEEMOTIONAL STRESSORS

  • PAIN CYCLEPSYCHOSOCIAL STRESSORS

  • PAIN CYCLEPAIN

  • OUCH!!!...MY LIFE HURTS

  • Pain Medications OTC analgesicsAcetaminophen (Tylenol, Tempra)

    NSAIDS nonsteroidal anti-inflammatory drugsAspirin (Ancin, Bayer, Bufferin)Ibuprofen (Advil, Motrin)Ketoprofen (Actron, Orudis KT)Naproxen Sodium (Aleve)

  • Pain Medication - OthersAntidepressants (Tricyclics, SSRIs)Anticonvulsants (Lyrica, Neurontin)Muscle Relaxants (Flexeril, Skelaxin)Tranquilizers (Xanex, Valium)Sedatives (Ambien, Lunesta)Others for side effects

  • Pain Medications - Opioidshydrocodone (Vicodin)oxycodone (Percocet, Oxycontin)morphine (MSContin, Kadian, Avinza)codeine (Tylenol #3, #4)transdermal fentanyl (Duragesic patch)methadone (Dolophine)meperidine (Demerol)

  • Problems?Wrong TreatmentSuppresses our own endorphin systemIncreased rates of prescription drug abuse particularly teens (2008 ONDCP report)Drug dependenceDrug addictionAccidental deaths

  • Prescription Drugs- Celebrity Deaths1962 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 CelebritiesNCHS 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 04/24/2011Ohio city targeted for drug intervention

    Portsmouth, Ohio once thrived on its reputation for shoes and steel. Now its 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 abusePharmaceutical Companies to Produce Educational Tools for PrescribersInformation on Long Acting OpioidsWhen and How to Prescribe, How to Recognize Signs of Abuse

  • SO HOW DO WE TREAT CHRONIC PAIN?

    Functional Restoration

    Cognitive Behavioral Therapy

    Wean off of opioids

  • PAIN CYCLEPAIN

  • Cognitive Behavioral Model

    A theoretical approach that acknowledges the importance of both cognitions and behaviors in the acquisition and maintenance of behavioral patterns

  • Cognitive Behavioral TreatmentPatient as active participant self responsibility model StructuredTime limitedGoal orientedFunctionally focusedIncrease coping skills

  • Cognitive/Affective/Behavioral InteractionTHINKFEELDO

  • Practical Suggestions for the Management of Chronic Pain

    The first step is admitting that what we are dealing with is a chronic problem.

    Take responsibility for it.

  • Serenity PrayerGod, 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 Management of Chronic Pain

    Confront the Costs and Benefits

  • Exercise is Good MedicineWeight loss, weight maintenanceLower blood pressureReduce risk of heart disease, diabetesReduce, relieve painImprove sleepIncrease energyImprove moodBetter sex

  • Practical Suggestions for the Management of Chronic PainEXERCISE

    HURT vs HARM

  • Practical Suggestions for the Management of Chronic PainEXERCISE

    StretchingStrengtheningAerobicsBalance

  • Practical Suggestions for the Management of Chronic PainLEARN TO RELAX

    Formal relaxation

    Leisure activities

  • Practical Suggestions for the Management of Chronic PainMANAGE YOUR STRESS

    Set limits with others

    Become an optimist

    Manage your emotions

  • Practical Suggestions for the Management of Chronic Pain

    QUIT SMOKING

  • Practical Suggestions for the Management of Chronic Pain

    GET ACTIVE

    Set goals

    Pace your activity

  • Practical Suggestions for the Management of Chronic PainMAINTAIN A SUPPORT SYSTEM

    Family, Friends, NeighborsChurch, Community GroupsSupport Groups (ACPA)Volunteer

  • Practical Suggestions for the Management of Chronic Pain

    FOCUS ON PLEASANT ACTIVITIES

    The How of Happiness Sonja Lyubomirsky

  • Practical Suggestions for the Management of Chronic PainKEEP 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 YOU