ARCHIVED CHRONIC PAIN ARTICLES

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Chronic Pain Management and the Impact on Family and Friends

 The Family Also Needs A Bio-Psycho-Social-Spiritual Approach To Heal


I’m writing this for people who are living with someone—or care for someone—who is suffering with a chronic pain condition and they are having a hard time coping because they’re not sure how to help. Unless someone’s been in your place they have no idea how challenging this can really be.  


I’ve seen many marriages and partnerships end due to one of the partners living with an undertreated or mistreated chronic pain condition. Sometimes family members and significant others develop their own healthcare problems while trying to help someone they love cope with chronic pain. Family and significant others often get burned out, or they become frustrated and resentful towards the person living with chronic pain. A spouse can become just as hopeless and helpless as their family member who is suffering with pain and may even develop a severe depression or sleep problem.


For those of you helping someone living with a chronic pain condition who don’t have a personal experience of living with chronic pain I want to ask you to follow the steps below to see if you can develop a better understanding of what it must be like to live with chronic pain. To get the most out of this following exercise please make sure to do it when you have the time and space where you won’t be interrupted. It’s also helpful if you journal your reactions to this as soon as you’ve completed the four steps below.


Step One:  Think back to a time when you hurt yourself or had a painful condition such as a surgery, toothache, broken bone, or headache etc. 


Step Two: Try to remember what that felt like and what you wanted to do to stop the pain.


Step Three: Now imagine that you have that level of pain right now and have had it for the past six months without any relief. Every day when you woke up it was there. Every night you wonder if you’ll be able to sleep because the pain is so disturbing.


Step Four: Now imagine trying to explain this to your family and friends or your healthcare provider. What would you say? What would you want from them? Please make sure write down your reactions to this brief exercise.


What kind of healthy support can friends and family provide if a loved one is undergoing chronic pain management, experiencing significant quality of life problems and a decreased level of functioning? The most important thing is to understand what it must be like; if you answered the four questions above and reflected on what you learned, you should have a much better idea.  


Here are six additional starting points.


1. Make sure that you are practicing good self-care; take time to relax, sleep, play, eat healthy, etc.

2. Develop compassion and even empathy for your significant other—but never sympathy as that can cause even more problems. Remember the old saying “Sympathy Kills” that is often heard at Al-Anon meetings.

3. Do NOT do things for your significant other that they can and should be doing for themselves.

4. Don’t keep secrets from your significant other. This is especially true concerning medication use or abuse issues.

5. Remember the three (3) Cs of Al-Anon: You didn’t CAUSE it, you can’t CONTROL it, and you can’t CURE it.

6. Seek out a professional with experience in chronic pain and any coexisting problems for you and your family.


However, these are just starting points. In order to help someone else, you first must make sure to take care of yourself. You also need to be aware of the two major traps—enabling and resentment. Enabling is when you find yourself doing something for your friend or loved one that they can and should be doing for themselves.


When supporting someone living with chronic pain for long periods of time many people are at risk of burnout. What started as loving care and support sometimes turns into a major chore and the helper becomes angry and resentful of the person living with chronic pain. Just like many people who are living with chronic pain become isolated and depressed; many helpers also fall into these problems. 


To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com

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Defining Effective Chronic Pain Management

  

Given the biopsychosocial nature of chronic pain conditions it is imperative to utilize a multidisciplinary treatment plan for effective pain management. Living with chronic pain is very difficult. If you also have a coexisting addiction or other psychological conditions, it becomes even more challenging. People with chronic pain and coexisting disorders can become severely depressed and feel hopeless. Their self-esteem is practically non-existent and many of them lose the support of their significant others. 


Healthcare providers often become confused and frustrated when their treatment interventions are ineffective. Also, people living with chronic pain must educate themselves and be proactive consumers regarding health practitioners who claim to do pain management. Be wary, if they offer only one type of modality for addressing your pain, such as medication management, or chiropractic adjustments or acupuncture.


True multidisciplinary pain management involves interventions such as physical therapy, massage, medication management, counseling or therapy, biofeedback, occupational therapy, exercise physiology, an anesthesiologist or pharmacologist, and a case manager all at one site, at a minimum. It may also involve some type of movement therapy such as Tai Chi, classes on spiritual wellness, yoga or meditation.


Success Requires A Team Approach


In my experience, a multidisciplinary team is crucial in order to address the specific biopsychosocial needs of people living with chronic pain. In addition, the physical, psychological, and social implications of chronic pain and any coexisting condition—including the impact on family systems—must also be adequately dealt with.


Using a multidisciplinary team is crucial when treating the synergistic problems people and their families’ face that have been severely impacted by chronic pain, especially when addiction and other psychological problems are present. When these conditions coexist it creates a major challenge that must be addressed through a collaborative treatment approach. The inclusion of addiction, mental health and medical is vital to this process. 


When these coexisting conditions occur, the family problems increase synergistically. Effective treatment can be challenging and confusing for counselors, therapists and other healthcare providers, but especially for patients and their families. I have found that the strategic three-part approach mentioned in last month’s article improves treatment outcomes and gives people living with chronic pain and their families new hope.


 To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com

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Exploring The Stress Pain Connection

                                                               Remember!  

You Can’t Effectively Manage Your Pain  Without Managing Your Stress  


It is important to understand the connection between stress levels and pain symptoms, as well as how managing stress can decrease the perception of pain. Physically, chronic pain raises stress levels and drains physical energy, while psychologically it impacts the ability to think clearly, logically and rationally, as well as how effectively patients manage their feelings. Not only that, it can impact memory.  In most cases when someone learns how to lower their stress levels, they will also experience a decrease in their perception of pain. 

  

Of course, before patients can manage stress, they first need to learn how to describe their level of stress at any given time. It’s important to remember that when someone reaches the upper moderate to severe levels of stress (6-10 range or what I call the “stress reaction”) thinking, emotions and behaviors are affected. The goal is to keep the level of stress at six or below as much as possible. 


Since self-assessing levels of stress and learning how to implement simple but effective stress management tools is so important, we need an instrument, or tool, to help do that. I use the Gorski-CENAPS®Stress Thermometer below as a starting point to help patients accurately articulate their level of stress. In the next section I will take you through this exercise in the same way I do with patients.


To request the remainder of this article, please connect with me at drgrinstead@yahoo.com.

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Relapse Prevention Planning for Chronic Pain Management

Understanding What Relapse Really Is 


If you ask someone in the medical field about relapse, they most likely will say relapse is going back to an active state of a disease after a period of remission. When you ask someone recovering from inappropriate use of medications, including using alcohol or other drugs they may say it’s going back to using the substance again. 


While that definition is partially correct, it can be dangerous, especially if people thinks the only criteria for recovery is abstinence. Another common definition of relapse is that a person goes back to their addiction process. The full explanation of relapse is much more complex and must include not only maintaining abstinence or an appropriate medication management plan but also stop following their mental health treatment plan or sabotaging their chronic pain management plan. 


  • People can head back towards chemical use 
  • Start sabotaging their chronic pain plan
  • Stop following their mental health treatment plan


What many people don’t realize is that the chemical use or coming out of remission is not the beginning of a relapse. It is the final step in an ongoing relapse process. In addition, relapse is a common symptom of a medication use disorder or other chemical use disorders, and one-third to two-thirds of all recovering people in chemical recovery relapse despite their best intentions not to do so. 


If someone is also living with a coexisting disorder—e.g., chronic pain, depression, PTSD or an anxiety disorder—the instance of relapse can be even higher because these other problems can easily become a relapse justification. Fortunately, the risk of relapse can be lowered if recovering people are exposed to education and training about relapse prevention and how to deal more effectively with all of their coexisting problems. Prevention is much easier than crisis management. 


To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com

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Transcending The Bio-Medical Model

Over the past two decades I have seen that we as a nation have fallen victim to being sold the power of the pure bio-medical model for chronic pain treatment. Even though many research projects have all concluded that ethically, and for better outcomes, effective chronic pain management requires an integrated team approach. 


Many chronic pain patients have been denied integrated services with the payors saying that there is not enough research to validate paying for these services. However, this is not true. In fact, the truth is that there is no level one double blind research that demonstrates opioids are effective for chronic pain management. 


There are, however, many evidence-based and research-based studies that demonstrate that integrated services such as Cognitive Behavioral Therapy, Acupuncture, Equine Therapy and many others can demonstrate improved outcomes for chronic pain patients. Despite this insurance companies have authorized thousands upon thousands of opioid prescriptions that eventually led to the dire problem we are experiencing today including thousands of overdose deaths all around the United States.  

   

Defining The Bio-Medical Model

Part of the big picture is that opioids have proven very effective for acute pain management, such as broken bones, cuts, surgical procedures etc.  Many big companies spent a lot of money and produced credible outcome research that demonstrated opioids we're effective for treating acute pain. 

  

Some of the same big pharmaceutical companies spent millions of dollars if not more to tout using powerful opioids for chronic pain management. In one instance they purchased the right in the Journal of the American Medical Association to have the line OxyContin is not addictive, inserted. This along with the efforts of several high-powered medical doctors toured the country stating that it was a right for patience to have their chronic pain treated with opioids. At one point they spearheaded the movement to declare pain as the Fifth Vital Sign. 


During the 1990s we started to see the growth of pain clinics cropping up all over the country. Pain clinics became a very lucrative business for many physicians especially anesthesiologists.  In simple terms the bio-medical model became a combination of pills, injections, interventional pain procedures and surgeries.  This model did seem to work very well for many pain patients. Unfortunately, for over 20 percent of the population showed little or no improvement with this model. Unfortunately, in many instances the patient was blamed for it not working. 


There are many reasons why this 20 percent group of patients started over-utilizing most of the chronic pain healthcare dollars (some research shows as high as 80 percent) and they still showed little or no improvement.  Why is that? The answer is complex, but I will attempt to share why I believe this occurs.

  

Why the Bio-Medical Models Falls Short with Many Chronic Pain Patients

The major reason I see for the biomedical model failing with the 20 percent subset of chronic pain patients is their health care providers fail to identify and/or treat the coexisting disorders. Some of the common coexisting disorders that lead to poor outcomes or even treatment failure are medication misuse abuse or even addiction; depression; anxiety disorders; unresolved trauma history such as PTSD; Eating Disorders and other mood disorders. 


 To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com

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Creating An Empowerment Pain Journal

 

I would like to share with you a valuable tool I’ve developed and used with many of my chronic pain patients, as well as for myself, over the past several years. I’m using the same education information and actual worksheets I use with my patients in the remainder of this article. 


Purpose Of Journaling About Pain

When I explain this process to my patients I start with the following directions: You are about to embark on a very personal and exciting journey. The Following information contains guidance for completing your personalized empowerment pain journal which will give you the power to begin making peace with your pain, allowing you to come to understand yourself on an intimate and powerful level. Believe that you have the ability to make your pain your friend! You have the power to utilize your pain as a loving guide that will direct you on your path of happiness and peace. 


Your pain wants to teach and guide you! It has the ability to show you how to nurture yourself, how to recognize unhealthy situations, to give you the insight to create a life of love and meaning. This journal will allow you the means to gain awareness and insights into the hidden messages your pain wants to communicate. As you uncover the hidden communication within your own personal pain cycles, you will gain a new sense of freedom and empowerment. 


Goal Of Journaling About Pain

Uncovering your pain’s secret communication is of great importance. You will identify and personally connect with your pain’s triggers, patterns, and themes. You will discover your pain has a personality. You will learn it may like certain people better than others. It may prefer special foods, liquids, and exercise. It may like specific weather conditions, hot and dry or yearn for cold and damp. It might be a big fan of acupuncture or massage. It may lead you into a great relationship with people of similar struggles. 


To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.

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The Role of Spirituality in Chronic Pain Management Is Crucial

                                                                 

Chronic pain is often misunderstood and undertreated. In addition to the biopsychosocial impact a chronic pain condition frequently has on a person, a spiritual crisis often accompanies the situation as well. Long-term chronic pain is a body-mind-spiritual problem that requires a multifaceted solution. I believe that complementary spiritual practices are necessary components of any effective chronic pain management plan. 


Many people have found spiritual interventions like the traditions of prayer and meditation to contribute to the reduction of the sense of suffering. Unfortunately, in our fast-paced world and the secular treatment modality, adding a spiritual component to chronic pain management does not get enough attention. 

  

The concept of spiritual pain requires healthcare providers to go beyond the bounds of traditional clinical treatments and be prepared to devote the time required to give supportive and understanding care.  It is crucial to explore spirituality and its impact on a person’s pain in a multidimensional assessment.

   

It’s Time To Think Outside The Box

Spirituality is vital aspect of being human which is difficult to fully understand or measure using scientific methods; yet convincing evidence in medical literature supports its beneficial role in the practice of medicine. It will take many more years of study to understand exactly which aspects of spirituality hold the most benefit for health and well-being. 

 

To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.

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Moving Beyond Anticipatory Pain for Effective Pain Management

    

If you’re living with a chronic pain condition like I am you may have noticed that sometimes you are so fearful about doing even the most basic tasks of daily living, that you become immobilized. It can also manifest as overwhelming anxiety, so much so, that a phenomenon gets triggered which amplifies your perception of pain. I call this Anticipatory Pain.

  

Because you believe you are going to hurt by doing a certain activity, you can activate the physical pain system. Just by thinking about doing something that you believe will cause you to hurt, you will start to feel pain. This can happen before you even do whatever it is you already believe will cause physical pain. All you have to do is to start thinking about doing that thing.

  

Once the physical pain system is activated, the anticipatory pain reaction can make your perception of chronic pain symptoms worse. 

  

Whenever you feel the pain, you interpret it in a way that makes it feel worse, and you think about it in a way that actually does make it worse. You tell yourself that “this pain is awful and terrible,” and “I can’t handle it.” You convince yourself that “it’s hopeless, I’ll always hurt, and there’s nothing I can do about it.”

  

This way of thinking contributes to the development of emotional reactions that further intensify or amplify the pain response. The increased perception of pain causes you to keep changing your behavior in ways that create even more unnecessary limitations and mounting emotional discomfort. These reactions can make you believe you are trapped in a progressive cycle of disability.

  

Coping and Moving Beyond Anticipatory Pain

One of the most requested articles I wrote was titled “Coping with Anticipatory Pain. I believe it’s vital for us to support people to not just cope with anticipatory pain, but to move beyond it.


To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.

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Reevaluating The Bio-Medical Model

Over the past two decades I have seen that we as a nation have fallen victim to being sold the power of the pure bio-medical model for chronic pain treatment. Even though many research projects have all concluded that ethically, and for better outcomes, effective chronic pain management requires an integrated team approach. 

Many chronic pain patients have been denied integrated services with the payors saying that there is not enough research to validate paying for these services. 


However, this is not true. In fact, the truth is that there is no level one double blind research that demonstrates opioids are effective for chronic pain management. 

There are, however, many evidence-based and research-based studies that demonstrate that integrated services such as Cognitive Behavioral Therapy, Acupuncture, Equine Therapy and many others can demonstrate improved outcomes for chronic pain patients. Despite this insurance companies have authorized thousands upon thousands of opioid prescriptions that eventually led to the dire problem we are experiencing today including thousands of overdose deaths all around the United States. 


Defining The Bio-Medical Model


Part of the big picture is that opioids have proven very effective for acute pain management, such as broken bones, cuts, surgical procedures etc.  Many big companies spent a lot of money and produced credible outcome research that demonstrated opioids we're effective for treating acute pain. 


Some of the same big pharmaceutical companies spent millions of dollars if not more to tout using powerful opioids for chronic pain management. In one instance they purchased the right in the Journal of the American Medical Association to have the line OxyContin is not addictive, inserted. This along with the efforts of several high-powered medical doctors toured the country stating that it was a right for patience to have their chronic pain treated with opioids. At one point they spearheaded the movement to declare pain as the Fifth Vital Sign. 


During the 1990s we started to see the growth of pain clinics cropping up all over the country. Pain clinics became a very lucrative business for many physicians especially anesthesiologists.  In simple terms the bio-medical model became a combination of pills, injections, interventional pain procedures and surgeries.  This model did seem to work very well for many pain patients. Unfortunately, for over 20 percent of the population showed little or no improvement with this model. Unfortunately, in many instances the patient was blamed for it not working. 


There are many reasons why this 20 percent group of patients started over-utilizing most of the chronic pain healthcare dollars (some research shows as high as 80 percent) and they still showed little or no improvement.  Why is that? The answer is complex, but I will attempt to share why I believe this occurs.


To  request  the remainder of this article, please connect with me at drgrinstead@yahoo.com.

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