THE UNMET NEED CHRONIC PAIN AND CHRONIC ILLNESS DEL WORLEY, MC, LPC, LISAC SOUTHWEST INSTITUTE FOR GROUP AND FAMILY THERAPY
Chronic pain was originally defined as pain that has lasted 6 months or longer. More recently it has been defined as pain that persists longer than the temporal course of natural healing that is associated with a particular type of injury or disease process.
It is important to note that pain is subjective in nature and is defined by the person experiencing it, and the medical community's understanding of chronic pain now includes the impact that the mind has in processing and interpreting pain signals
Opioids Opioid medications provide short, intermediate and long acting analgesia depending upon the specific properties of the medication and whether it is formulated as an extended release drug. Although opioids are strong analgesics, they do not provide complete analgesia regardless of whether the pain is acute or chronic in origin. When opioids are used for prolonged periods drug tolerance, chemical dependency and (rarely) addiction may occur. Chemical dependency is common among opioid therapy after continuous administration; however, drug tolerance is not well studied in patients on long term opioid therapy.
Non-steroidal anti-inflammatory drugs The other major group of analgesics are Non-steroidal antiinflammatory drugs (NSAID). This class of medications includes acetaminophen which may be administered as a single medication or in combination with other analgesics. The use of selective NSAIDs designated as selective COX-2 inhibitors have significant cardiovascular and cerebrovascular risks which have limited their utilization.
Antidepressants and Antiepileptic drugs Some antidepressant and antiepileptic drugs are used in chronic pain management and act primarily within the pain pathways of the central nervous system Drugs such as Gabapentin have been widely prescribed for the off-label use of pain control. The list of side effects for these classes of drugs are typically much longer than opiate or NSAID treatments for chronic pain, and many antiepileptics cannot be suddenly stopped without the risk of seizure.
Interventional therapy Injections, Neuromodulation and Neuroablative Therapy may be used to target either the tissue structures and organ/systems responsible for persistent pain. These include TENS units, implanted neurostimulators, and surgical cutting of nerves.
Physical medicine and rehabilitation There are other modalities used in the treatment of chronic pain. These include: physical modalities such as thermal agents and electrotherapy. complementary and alternative medicine, therapeutic exercise and behavioral therapy
None of these, not even behavioral therapy, meets the needs of the person suffering from chronic pain because they only address the pain, not the psychological effects of the pain on the exterior and interior life of the sufferer
Why psychotherapy? Chronic pain adversely affects quality of life for people with pain that includes their performance on the job, relationships with others, doing their normal activities, and emotionally. Chronic illness also affects the quality of life even if there is not pain.
Survey of CP sufferers 72% have been experiencing pain for more than 3 years, including34% who have had chronic pain for over 10 years 76% experience pain daily, including 48% who say it is ever present 26% rate their pain as very severe; 34% of those whose pain is ever present rate it as very severe More importantly, nearly half say their pain is not under control in particular, those whose pain is ever present, men, and the middle-aged. 47% say their pain is not under control 59% of those whose pain is ever present say it is not under control 55% of those 35 to 50 say it is not under control 7 Roper Public Affairs & Media
Survey of CP sufferers 51% of those employed say it adversely affects their productivity at work and 41% their ability to put in a full day s work One fourth say it has an unfavorable effect on their relationship with either their spouse/partner, children/grandchildren or close friends Over half report that their pain prevents them from doing a wide variety of their normal activities, especially those whose pain is ever present, women, and 30 to 64 year olds Two thirds say pain causes them irritable behavior and stress; for over half (52%), pain causes a loss of desire or motivation. Those most affected emotionally are those whose pain is ever present, 35 to 64 year olds, and women 8 Roper Public Affairs & Media
THE GOAL OF CHRONIC PAIN/CHRONIC ILLNESS THERAPY IS TO RELIEVE THE DYSFUNCTION CREATED BY CHRONIC PAIN AND OR CHRONIC ILLNESS AND RESTORE PERSPECTIVE IN THE LIVES OF CLIENTS AND THEIR FAMILIES.
TREATMENT INCLUDES A consultation to assess the individual needs and goals of the patient. Individual sessions, usually 6 to 12 sessions, which include education, guided imagery, and therapy.. Referrals to community support groups for chronic pain, family issues, grief support and other issues.
TREATMENT OBJECTIVES Address the effect the pain and/or illness is having on the patient s life and ability to function and effect improvement in functioning. 1. most chronically ill people are shamed by the medical professionals who are supposed to help them 2. Most family members are at a loss to help and often react like the families of addicts
TREATMENT OBJECTIVES Assess and appropriately treat depression, anger, loss, shame, and grief. 1. What are the injunctions around being ill or in pain? 2. What is the payoff for being debilitated by illness and pain? 3. What is the family game around the pain or illness?
TREATMENT OBJECTIVES Introduce appropriate alternative pain relief therapies through education, bibliotherapy, and exercises. Massage Meditation techniques Hypnosis Acupuncture Chiropractic Nutritional therapies Exercise Energy therapies To name a few
TREATMENT OBJECTIVES Relieve pain and stress through use of guided imagery, relaxation techniques and building partnership with the body.
TREATMENT OBJECTIVES Assess substance dependency and eliminate dependence on psychoactive drugs if a problem exists
RECOVERY INTERVENTIONS 1. FIRST STEP: Ask the client HOW IS THE PAIN RUNNING YOUR LIFE? HOW IS YOUR FOCUS ON THE PAIN MAKING YOUR LIFE UNMANAGEABLE? WHAT ARE YOUR LOSSES FROM THE PAIN OR CONDITION? WHAT ARE THE BENEFITS, IF ANY?
2. RECOGNIZING YOU ARE NOT THE CONDITION OR DISEASE: Have the client DRAW A PICTURE OF IT NAME IT DIALOG WITH IT WRITE A FAIRY TALE ABOUT IT
RECOVERY INTERVENTIONS 3. FACING THE FEELINGS: Help the client work through these LOSS ANGER FEAR GUILT SHAME GRIEF
RECOVERY INTERVENTIONS 4. DEVELOP A RELATIOSNHIP WITH YOUR BODY: Encourage the client to LISTEN TO IT DIALOG WITH IT EXPRESS GRATITUTE TOWARD HIS OR HER BODY
RECOVERY INTERVENTIONS 5. EXPLORE ALTERNATIVE PAIN CONTROL METHODS: MEDITATION HYPNOSIS GUIDED IMAGERY EXERCISE ACUPUNCTURE MASSAGE BIOFEEDBACK TENS UNITS THOUGHT FIELD THERAPY OR EFT AND MANY OTHERS
RECOVERY INTERVENTIONS 6. PRACTICE PAIN RELEASE AND HEALING DAILY: Long term care MEDITATE DAILY JOURNAL OR DIALOG WITH THE BODY DAILY PARTICIPATE IN A WEEKLY SUPPORT GROUP SEE HANDOUT