PILL-FREE PAIN RELIEF

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. 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 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. 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, 1999-2006 # 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