Transcript PAIN - Science Mission

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
Functional Recovery Program
Interdisciplinary Rehabilitation Program
Started in 1990
Designed to help individuals with chronic
pain manage their condition and return to
optimal physical functioning
Objectives

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
Review
70 million people suffer from some form of
recurrent or chronic pain
25% of the population
Two thirds of us will have an episode of
back pain at some time in our lives
Elusive Nature of Pain
Cannot be measured objectively
 Subjective, Psychological experience
 Influenced by many things
Expectations
Significance
Emotions
Context in which it is experienced

PAIN
ACUTE
CHRONIC
Acute verses Chronic Pain
Acute Pain
Specific injury
 Tissue damage
 Self-limiting
 Ceases once healing occurs

Acute verses Chronic Pain
Chronic Pain
 Lasts beyond six months
 Persists beyond the usual course of
acute insult, injury or disease process
 Hurt does not equal harm
PAIN CYCLE
inactivityloss of strength
reduced flexibility
deconditioning
PAIN
PHYSICAL CHANGES
PAIN CYCLE
isolation
anxiety
depression
anger
PAIN
EMOTIONAL STRESSORS
PAIN CYCLE
Reduced support conflict
Can’t work
economic stress
PAIN
PSYCHOSOCIAL STRESSORS
PAIN CYCLE
Emotional
Stressors
Psychosocial
Stressors
PAIN
Physical
Changes
OUCH!!!
...MY LIFE HURTS
Pain 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 - Others
Antidepressants (Tricyclics, SSRI’s)
 Anticonvulsants (Lyrica, Neurontin)
 Muscle Relaxants (Flexeril, Skelaxin)
 Tranquilizers (Xanex, Valium)
 Sedatives (Ambien, Lunesta)
 Others for side effects

Pain Medications - Opioids
hydrocodone (Vicodin)
 oxycodone (Percocet, Oxycontin)
 morphine (MSContin, Kadian, Avinza)
 codeine (Tylenol #3, #4)
 transdermal fentanyl (Duragesic patch)
 methadone (Dolophine)
 meperidine (Demerol)

Problems?
Wrong Treatment
 Suppresses our own endorphin system
 Increased rates of prescription drug abuse
particularly teens (2008 ONDCP report)
 Drug dependence
 Drug addiction
 Accidental deaths

Prescription Drugs- Celebrity Deaths
1962 Marilyn Monroe 36
 1965 Dorothy Dandridge 42
 1973 Howard Hughes 70
 1977 Elvis Presley 42
 1992 Judy Garland 47
 2007 Anna Nicole Smith 39
 2008 Heath Ledger 28
 2009 Michael Jackson 50

Not Just Celebrities
NCHS Data Brief
Increase 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 04/24/2011
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 Opioids
 When 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 CYCLE
Emotional
Stressors
Psychosocial
Stressors
PAIN
Physical
Changes
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 Treatment
Patient as active participant – self
responsibility model
 Structured
 Time limited
 Goal oriented
 Functionally focused
 Increase coping skills

Cognitive/Affective/Behavioral
Interaction
THINK
FEEL
DO
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 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
Management of Chronic Pain
Confront the Costs and Benefits
Exercise is Good Medicine
Weight loss, weight maintenance
 Lower blood pressure
 Reduce risk of heart disease, diabetes
 Reduce, relieve pain
 Improve sleep
 Increase energy
 Improve mood
 Better sex

Practical Suggestions for the
Management of Chronic Pain
EXERCISE
HURT vs HARM
Practical Suggestions for the
Management of Chronic Pain
EXERCISE
Stretching
Strengthening
Aerobics
Balance
Practical Suggestions for the
Management of Chronic Pain
LEARN TO RELAX
Formal relaxation
Leisure activities
Practical Suggestions for the
Management of Chronic Pain
MANAGE 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 Pain
MAINTAIN A SUPPORT SYSTEM
Family, Friends, Neighbors
Church, Community Groups
Support 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 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 YOU