Objectives. Chronic Pain & Depression: A Roller Coaster Ride. Gauging Your Comfort Level. The Roller Coaster of Pain. Impact Study
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1 Objectives ChronicPain&Depression: ARollerCoasterRide LoriHiga,RNBC,BSN RitaHaverkamp,MSN,PMHCNSBC,CNS BytheendofthisWebinaryouwillbeableto: Understandsomehistoryofpainmedication prescribingpractices Helppatienttobeagoodselfadvocate Discusstreatmentoptionswithpatients Understandyourrolewithchronicpainpatients 2 TheRollerCoasterofPain GaugingYourComfortLevel. Uncomfortable Dread Uneasy Very comfortable Relaxed AtEase Very experienced Comfortable Neutral Couldusemoretips 3 4 ChronicPainMysteries ImpactStudy Manypatientsnevergetaclearanswerasto why theyhurt Chronicpainsensitizespeopletopainstimuli chronicpaincausesotherpaintohurtmore Chronicpainincreasesriskofdepression VALIDATE,VALIDATE,VALIDATE 50%ofIMPACTparticipantshadfunctional impairmentfrompain Only50%ofthosewithpersistentpain receivedanalgesics Painanddepressioninteractandcontribute todisabilityorchronicpain Painlimitsdepressiontreatmentresponse 5 6 1
2 ofdepressionimprovespain OutcomesinPatientswithArthritisand Depression Arthritis Interference With Daily Activities (0-10) 6 Estimates Usual Care Intervention Baseline 3 months F/U 6 months F/U 12 months F/U Linetal.JAMA, DISCUSSION Howdoesyourownexperience(orlackof experience)withpainimpacthowyou providesupportforapatientwithpain? Bias&BeliefsaboutPain Whatbiasdoespatienthaveaboutpain? Howdoesculture,age,personalbeliefs impacthowpatientmanagespain? Whatbiasorbelief doyouasaclinicianhave aboutpain? 9 10 Identifyand Pain&Depression Follow-up Care & Treat to & Relapse
3 Pain&Depression Don targueaboutwhatcamefirst... Depressionandanxietyarecommonandcan exacerbatepain Paincomplaintscanbeawayto communicatepsychologicaldistress Persistentpaincanexacerbatedepression CreateaPartnership Educatepatients Allpainisreal patienttobean activepartner Explainprovider srole FocusonfunctionalImpairment DescribingPain Identifypainintensity 110painscale Typesofpain sharp, tingling,throbbing Painhistory Howlong?Whendiditstart? history Whathasbeentried?Didithelp? Whatnonmedicationandmedicationhasbeen tried? Follow-up Care & Treat to & Relapse ChangesinDefinitions DSM5haseliminatedcategoriesthatdefine substanceabuseanddependenceby combiningthemintoasinglediagnostic entityofsubstanceusedisorder. Thedisorderismeasuredonacontinuum frommildtosevere. Terminology Painkiller Negativeusebymediainreportsofopioid addictionandoverdose.bestreplacewithpainreliever. Addiction Frequentlymisusedbythoseuntrainedtomake thediagnosis,notallthatabuseareaddicted. Narcotic Shouldnotbeusedinclinicalsettingorin educationcontextd/temotionalassociationandcrime, addictionanddeath.replacewithopioid. Drugseeking shouldbereplacedwithreliefseeking. Addictive Falsewhendescribingasubstance.Addiction resideswithinthepersonandnotthesubstance used. 10. Federation of State Medical Boards. Model Policy for the Use of Opioid Analgesics in the of Chronic Pain. Washington, DC: Federation of State Medical Boards; Prince V. Pain management in patients with substance-use disorders. In: Chronic Illnesses I, II, and III PSAP-VII, Book 5. Lenexa, KS: American College of Clinical Pharmacology; Utah Department of Health. Utah Clinical Guidelines on Prescribing Opioids for of Pain. Salt Lake City, UT: Utah Department of Health;
4 EducatingPatients Follow-up Care & Treat to & Relapse UniversityofWashington ChronicPainandDepression Bodilyachesandpainsareacommonsymptomof depression Studiesshowthatpeoplewithmoresevere depressionfeelmoreintensepain Notknownhoworifdepressionandchronicpainare linked,buttheillnessesareknowntooccurtogether Chronicpaincanworsendepressionsymptomsandis ariskfactorforsuicideinpeoplewhoaredepressed PainisREAL Intheirbrain,butnotin theirhead TheKeyofChronicPain Management Theultimategoalofchronicpaincareisnot reducingpain,butimprovinglife Ifthepatient spainisreduced,butthe patient slifedoesnotmoveforward,then thetreatmenthasnotsucceeded Ifthepatient slifemovesforward,evenif painintensityisnotreduced,thenthe treatmenthassucceeded Option,idea,solution,election,alternative, preference,possibility ScopeofPractice GatherInformationaboutpain,treatments, function ReadthePCPnotewithpatienttoexplain treatment Usescreeners Providewrittenmaterialonuseof medications Behavioralactivation
5 MessagestoPatientsaboutHowto UsePainMedications Regulartimesratherthanasneededorwhen painishigh Use/changeonedrugatatime Becarefulwithtotaldoses Startlowbutgototargetdoses Giveadequatetrial WecantalktoPCPaboutchangingtreatment ifnoeffectaftera710daytrial AbriefHistoryofPrescribingPain Medications Ahistoryofprescribing painmedication Whyregulationshave recentlychanged PainMedicationCategories Acetaminophen NonsteroidalAntiinflammatoryDrugs (NSAIDS),Aspirin Antidepressants Opioids Adjuvantmedicationsanticonvulsants, stimulants,antidepressants Cannabis BoomorBust ActivityPatterns Pacing doalittle,thenrest Ptwilloverdo,leadingthemtopain bust Makeactivityconsistent Lessdependentonpt feeling doalittleeachday WindowsofPainRelief Worktowardsconcentratingactivityanddecreasing painfora windowoftime Concentratemedicationpeaksactivate duringthat windowoftime Breakingdowna24hourdaytosmallerparts, lookingfortargetsof12hours OF ProblemSolvingTherapy Solutionfocused canbedirectedtowardwayspainhasaffected theirlife Centeredondevelopingandimproving copingskills Improveabilitytohandleupsettinglife experienceswhichcouldbecontributingto pain Focusesontheproblemsinthemoment
6 CognitiveBehavioralTherapyfor ChronicPain Selfmanagementfocused Modifyingthoughts,feelingsandbehaviors Thoughtsaboutpaincanbechanged Promoteschangeofthoughtsandbehavior Relaxation Videovisual,audioandbodyrelaxationguide Relaxationfornaturalpainrelief Music,prayer,gardening,goingforawalk, talkingwithafriendonthephone Deepbreathing,guidedimagery,selftalk, mindfulnessmeditation OtherModalities Acupuncture Massage Therapeutictouch Alternativeoptions RoutinesareImportanttoGood Health Highlyoverlooked,butsoimportant. Sleep Diet Exercise Socialization Care&Support Takingmedications WhatisYourRole? FollowupandTreatto Providesupport Teachthepatienttobeagoodselfadvocate Provideclarity Provideaplan Follow-up Care & Treat to & Relapse
7 CasePresentation PainScale 78y.o,caucasian,male Depressionhx: PHQ9:20 Originallystartedat20mg.Ptfeltbetterbutnotably irritableashewastitratingoffcigarettesandphq9:14, increasedto30mgandphq9camedownto8. Paindescription:tinglingsharppaininhandsandfeet.Grimaces whentouchessilverware, I mscaredtopickupmysilverware myhandshurtsomuch. Painatnight8/10,can tsleep painwakeshimup From Krebs et al., 2009 PainDistortsMemory Providepatientswithtoolstomonitorpain Identifywhichperiodofpaintheyare reportingon,now? Vs.past(lastweek,amonthago,ayearago) Writethingsdownforthemtoreferto Measureit IstreatmentWorking?.PainRating 110painscaleinlastweek 0isnopainatall10beingtheworstpainyou veever feltor10iswe resendingyoutotheerrightnowit sso severe Howmuchpainareyouinrightnowsitting? Whatarepatient snonverbalsignsofpain? Whatwashighestlevelofpainlastweek? Whatwaslowestlevelofpainlastweek? Whatwasyouraveragelevelofpainlastweek? Measure theirfunction Howisitworking? Painfunction Measuringpainimprovementthroughfunction Whatdidyoudothisweekthatyouweren tabletodolast week? Compareandcontrastlastweektothisweek Basedonintervention afterstartofxtreatment Lookforcorrelationsbetweenintervention seffectivenessand functionalimprovement Howmuchhaspaininterferedwithyourqualityoflife duringthelastweek? Work,sleep,activity,relationships,exercise,pleasurable activities 41 TheAmericanAcademyofPain Medicine Toolstousewithpatientsavailable: 42 Daily Activity Checklist (PDF) Prepare For Your Healthcare Visit (PDF) ACPA MedCard (PDF) Pain Log (Online Tool) Pain Log (PDF) CARE Card (PDF) Follow-Up From Your Visit (PDF) Quality of Life Scale - Graphical Format (PDF) Quality of Life Scale - Text Format (PDF) 7
8 RelapsePlans RelapsePlans Addresspainmanagementhereaswellas depressionmanagement Follow-up Care & Treat to & Relapse Thingsthathavehelpedtoimprovetheir functioning Painmedicationsandroutinesfortakingthem Painsymptomsthatindicaterelapse Discussion Whatwillyouaddto yourtoolbox? ManagingtheRollerCoasterRide Youcanhelppatientshaveasmootherpain managementplanwithlessupanddowns, lessrunarounds,andmoredirection TheKeyofChronicPain Management Theultimategoalofchronicpaincareisnot reducingpain,butimprovinglife Ifthepatient spainisreduced,butthe patient slifedoesnotmoveforward,then thetreatmenthasnotsucceeded Ifthepatient slifemovesforward,evenif painintensityisnotreduced,thenthe treatmenthassucceeded PrepareforFollowupCaseCall Wednesday,February10th,2016 9:00AM 10:30AMAK 10:00AM 11:30AMPST 11:00AM 12:30PMMST Casepresentationform
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