1. PILL-FREE PAIN RELIEF Maryjo R. Gavin, Ph.D
Rehabilitation Psychologist
Sinai-Grace Hospital
Functional Recovery Program
April 30, 2011

2. DMC FRP Functional Recovery Program Maryjo Gavin Program Psychologist
Maury Ellenberg Medical Director

3. Functional Recovery Program
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

4. 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

5. 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

6. Elusive Nature of Pain Cannot be measured objectively
Subjective, Psychological experience
Influenced by many things
Expectations
Significance
Emotions
Context in which it is experienced

7. PAIN
ACUTE
CHRONIC

8. Acute verses Chronic Pain
Acute Pain
Specific injury
Tissue damage
Self-limiting
Ceases once healing occurs

9. Acute verses Chronic Pain
Lasts beyond six months
Persists beyond the usual course of acute insult, injury or disease process
Hurt does not equal harm

10. PAIN CYCLE
PHYSICAL CHANGES

11. PAIN CYCLE
EMOTIONAL STRESSORS

12. PSYCHOSOCIAL STRESSORS
PAIN CYCLE
PSYCHOSOCIAL STRESSORS

13. PAIN CYCLE
PAIN

14. OUCH!!!
...MY LIFE HURTS

16. 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)

17. Pain Medication - Others
Antidepressants (Tricyclics, SSRI’s)
Anticonvulsants (Lyrica, Neurontin)
Muscle Relaxants (Flexeril, Skelaxin)
Tranquilizers (Xanex, Valium)
Sedatives (Ambien, Lunesta)
Others for side effects

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

19. 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

20. 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

21. Not Just Celebrities
NCHS Data Brief Increase in Fatal Poisonings Involving Opioid Analgesics In the United States, # of fatal poisonings tripled(4,000 to 13,800) Opioids involved in 40% of all poisoning deaths

22. 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.

23. 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

24. SO HOW DO WE TREAT CHRONIC PAIN?
Functional Restoration Cognitive Behavioral Therapy Wean off of opioids

25. PAIN CYCLE
PAIN

26. Cognitive Behavioral Model
A theoretical approach that acknowledges the importance of both cognitions and behaviors in the acquisition and maintenance of behavioral patterns

27. Cognitive – Behavioral Treatment
Patient as active participant – self responsibility model
Structured
Time limited
Goal oriented
Functionally focused
Increase coping skills

28. Cognitive/Affective/Behavioral Interaction
THINK
FEEL DO

29. 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.

30. 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.

31. Practical Suggestions for the Management of Chronic Pain
Confront the Costs and Benefits

32. 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

33. Practical Suggestions for the Management of Chronic Pain
EXERCISE
HURT vs HARM

34. Practical Suggestions for the Management of Chronic Pain
EXERCISE
Stretching
Strengthening
Aerobics
Balance

35. Practical Suggestions for the Management of Chronic Pain
LEARN TO RELAX
Formal relaxation
Leisure activities

36. Practical Suggestions for the Management of Chronic Pain
MANAGE YOUR STRESS
Set limits with others
Become an optimist
Manage your emotions

37. Practical Suggestions for the Management of Chronic Pain
QUIT SMOKING

38. Practical Suggestions for the Management of Chronic Pain
GET ACTIVE
Set goals
Pace your activity

39. Practical Suggestions for the Management of Chronic Pain
MAINTAIN A SUPPORT SYSTEM
Family, Friends, Neighbors
Church, Community Groups
Support Groups (ACPA)
Volunteer

40. Practical Suggestions for the Management of Chronic Pain
FOCUS ON PLEASANT ACTIVITIES
The How of Happiness – Sonja Lyubomirsky

41. 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

42. THANK YOU