Chronic Pain Management: A Working Model for PSR and Multidisciplinary Treatment THOMAS SPENCER, LPCC, THERAPIST, SFCGC GAIL DOBISH, LISW, CLINICAL SERVICES SUPERVISOR, SFCGC gail.dobish@pmsnm.org JUNE 11, 2015
CURRENT SOCIAL CONTEXT SUGGESTING NEED FOR CHRONIC PAIN MANAGEMENT CLASS The Centers for Disease Control and Prevention (CDC) has declared overdosing from prescription painkillers an Epidemic in the US Nearly 15,000 people die in the US every year of overdoses involving prescription painkillers 46 people die every day from an overdose of prescription painkillers In 2012, health care providers in the US wrote 259 million prescriptions for painkillers enough for every American adult to have a bottle of pills Prescription painkiller overdose rates quadrupled since 1990 SLIDE 2 JUNE 11, 2015
IDENTIFIED NEED FOR CHRONIC PAIN MANAGEMENT PROGRAM IN NEW MEXICO New Mexico has consistently ranked first or second in per capita prescription overdose deaths, nationally. New Mexico s overdose death rate is, at minimum, roughly 5 times the national average. Factors increasing possibility of overdosing are: History of substance abuse Diagnosis of Severe Mental Illness Co-Occurring Diagnosis 33% increase in overdose possibility for people with breathing problems SLIDE 3 JUNE 11, 2015
IDENTIFIED NEED FOR CHRONIC PAIN MANAGEMENT PROGRAM IN NEW MEXICO, CONTINUED Factors increasing possibility of overdosing, continued: Patients who are also prescribed benzodiazepines Patients who are also abusing alcohol New Mexico consistently ranks 1 or 2 per capita in the Nation for Alcohol and non-prescription drug-related deaths and problems. New Mexico also ranks extremely high per capita for diagnoses of Mental Health problems and Severe Mental Illness SLIDE 4 JUNE 11, 2015
IDENTIFIED NEED FOR CHRONIC PAIN MANAGEMENT PROGRAM AMONG SFCGC CLIENTS Current research suggests multidisciplinary team approach is most effective for treating chronic pain (University of Washington and Mayo Clinic) 145 patients currently receiving medication management services for chronic pain management at SFCGC, many of them rely exclusively on medications for managing pain A great many other clients at SFCGC are receiving pain medication from doctors at outside sources. Many of these clients are not abusing their prescriptions, but the risk for addiction or abuse is always there. SLIDE 5 JUNE 11, 2015
WHY CHRONIC PAIN MANAGEMENT CLASS IS ESPECIALLY APPROPRIATE FOR PSR Current research suggests multidisciplinary team approach is most effective for treating chronic pain PSR can link clients to additional resources at clinic and in community. Chronic Pain is extremely isolating and tends to increase depression and suicidality SLIDE 6 JUNE 11, 2015
WHY CHRONIC PAIN MANAGEMENT CLASS IS APPROPRIATE FOR PSR, CONTINUED PSR s is designed to address the following areas that relate to clients suffering with Chronic Pain: Nutrition, Health and Personal Care Personal Safety Awareness of Community Resources Consumer Empowerment Self-management Social/Communication Problem-solving Skills Therapeutic Socialization Harm Reduction SLIDE 7 JUNE 11, 2015
BIOLOGICAL CONTEXT Reward pathway of the brain gets hijacked by continued opiate use even if used as prescribed Although highly effective for acute pain, opiates lose their efficacy for treating pain over time Complex Opioid Dependency Secondary to Chronic Pain Rebound headaches in migraine sufferers who are taking opiate pain medication SLIDE 8 JUNE 11, 2015
OBJECTIVES OF CHRONIC PAIN MANAGEMENT CLASS Introduce a multidisciplinary approach to chronic pain management Support and assist our clients in expanding their understanding of chronic pain and the variety of management strategies immediately available to them Minimize harm for pain patients by reducing risk of escalating dependency and potential opioid overdose in the future Reduce suffering of pain patients while increasing life satisfaction by teaching useful skills for pain management SLIDE 9 JUNE 11, 2015
GOALS OF CHRONIC PAIN MANAGEMENT CLASS Clients will become more physically active as a result of learning safe and appropriate exercises Clients will gain awareness of the relationship between stress and pain and learn to distinguish between pain and suffering Clients will learn and begin to practice stress reduction skills Clients will become more aware of pain triggers and begin exploring ways to minimize impact on their pain experience Clients will enjoy socialization and support of peers and decrease social isolation Clients will be linked to complimentary services within the agency as needed SLIDE 10 JUNE 11, 2015
STRUCTURE OF CHRONIC PAIN MANAGEMENT CLASS Class meets for 12 weeks for 1 ½ hours per week First half of the class is psychoeducational, following curriculum we developed, with experiential mindfulness component comprising second half Medical director meets with the class at least once to talk about medications and the body, integrated pain management, pain medication safety, answer questions about pain medications, and introduce clients to safe and effective physical exercises. SLIDE 11 JUNE 11, 2015
TOPICS COVERED IN CHRONIC PAIN MANAGEMENT CLASS Introduction to chronic pain and pain management Chronic pain and emotions The mind-body connection Power of the mind Adopting healthy attitudes Caring for yourself Interacting with family and friends Managing stress Chronic pain and addiction Physical exercises for chronic pain clients Pain medications, how they work and safety concerns SLIDE 12 JUNE 11, 2015
MINDFULNESS COMPONENT Every class includes a mindfulness practice component, based largely on work of Jon Kabat-Zinn and Marsha Linnehan Last 30 minutes of each class devoted to practicing a mindfulness skill Clients are encouraged to practice skills between classes SLIDE 13 JUNE 11, 2015
OUR EXPERIENCE / CLIENT EXPERIENCE Working model that continues to evolve and be modified Though mandated, clients generally like the class and express satisfaction upon completion Social component appears to be more important than we previously recognized Allowed us to expand PSR base and bring in previously unserved or underserved clients into expanded services SLIDE 14 JUNE 11, 2015
OUR EXPERIENCE / CLIENT EXPERIENCE CONT. We may have underestimated the sensitivity and emotional intensity of the topic initially Mixed reception to exercise component Low client participation in journaling component Mindfulness component well received with favorable client response Working with chronic pain clients takes time Outcomes based on client feedback SLIDE 15 JUNE 11, 2015
THOUGHTS ABOUT CHANGES FOR THE FUTURE Distribute narcon/naloxone kits and train clients in proper use Enhance exercise component Ongoing class or non-psr psychotherapy/support group for all pain management clients being discussed SLIDE 16 JUNE 11, 2015
RESOURCES FOR CHRONIC PAIN CLASS Mayo Clinic Guide to Pain Relief, Bruce and Hooten Managing Pain Before it Manages You, Caudill SAMSHA tip 54, managing Chronic Pain in Adults With or in Recovery From Substance use Disorders Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, pain and Illness, Jon Kabat-Zinn Mindfulness instruction CD s by Jon Kabat-Zinn (www.mindfulnesscds.com) Dialectical Behavior Therapy, Cathy Moonshine; Dialectical Behavior Therapy, Marsh Linehan Resistance Band Workbook, Illustrated Step by Step Guide, Dr. Karl Knopf Strength Band Training, Phil Page and Todd Ellenbecker SLIDE 17 JUNE 11, 2015
ADDITIONAL CHRONIC PAIN MANAGEMENT RESOURCES Centers for Disease Control and Prevention: http://www.cdc.gov/ Chronic Pain Anonymous: www.chronicpainanonymous.org American Chronic Pain Association: www.theacpa.org First Step to Active Health Program: http://www.thera-bandacademy.com/tbaportal/first-step-to-active-health http://firststeptoactivehealth.com/ Guided Imagery CD s by Belleruth Naparstek: www.healthjourneys.com Pain Edu: Improving Treatment Through Education: www.painedu.org SLIDE 18 JUNE 11, 2015