freedom from suffering patient education

Freedom FromFreedom From

SufferingSuffering

Developed By Dr. Stephen F. Grinstead © 2009, 1996Developed By Dr. Stephen F. Grinstead © 2009, 1996

Using The Addiction-Free Using The Addiction-Free Pain ManagementPain Management

® ® SystemSystem

Freedom From Suffering Slide Freedom From Suffering Slide 22Copyright Dr. Grinstead 2009, 1996Copyright Dr. Grinstead 2009, 1996CENAPS®CENAPS® APM™APM™

Goals Of APMGoals Of APM™™ Treatment Treatment Increase Effective Medication ManagementIncrease Effective Medication Management

— Reduction In Your Relapse RatesReduction In Your Relapse Rates Increase Your Ability To Increase Your Ability To Problem Solve For Problem Solve For

Effective Pain Management SolutionsEffective Pain Management Solutions— Experiment With New Pain Management StrategiesExperiment With New Pain Management Strategies— Increase Your Hope For RecoveryIncrease Your Hope For Recovery

Reduce Your Pain And SufferingReduce Your Pain And Suffering— Move You From Victim To EmpoweredMove You From Victim To Empowered


Indicators For SuccessIndicators For Success

You Are High Prognosis If:You Are High Prognosis If: You Become Actively Involved In You Become Actively Involved In

Understanding Your Pain Disorder And Understanding Your Pain Disorder And AllAll Of Your Available Treatment Possibilities Of Your Available Treatment Possibilities

You’re Open To Multiple Opinions & OptionsYou’re Open To Multiple Opinions & Options You’re Able To Become You’re Able To Become Self-Motivated Self-Motivated To To

Actively And Systematically Experiment Actively And Systematically Experiment With Both Traditional And Non-Traditional With Both Traditional And Non-Traditional Pain Management MethodsPain Management Methods


Indicators For FailureIndicators For Failure

You’re Low Prognosis If:You’re Low Prognosis If: You Become “Maliciously Compliant” In You Become “Maliciously Compliant” In

Following Recommendations Of Only Following Recommendations Of Only The First Professional They ConsultThe First Professional They Consult

You Expect To Become Pain Free You Expect To Become Pain Free With Minimal Personal EffortWith Minimal Personal Effort

You AreYou Are NOTNOT Motivated Motivated To Experiment To Experiment With Both Traditional & Non-Traditional With Both Traditional & Non-Traditional Pain Management MethodsPain Management Methods

Road BlocksRoad Blocks

To Success To Success

The Addiction The Addiction

Pain SyndromePain Syndrome©© Dr. Stephen F. Grinstead, 2009, 1996 Dr. Stephen F. Grinstead, 2009, 1996

™™

Addiction-Pain SyndromeAddiction-Pain Syndrome™™

AddictiveDisorder

Zone


PainDisorder

Zone


PainDisorder

Zone

AddictiveDisorder

Zone

AddictionAddictionPainPain

SyndromeSyndromeZoneZone


Obstacles For Success Obstacles For Success Failure To Recognize Coexisting DisordersFailure To Recognize Coexisting Disorders Family System ProblemsFamily System Problems

— Codependency AKA Enabling BehaviorsCodependency AKA Enabling Behaviors— Burn Out & Becoming Angry With YouBurn Out & Becoming Angry With You

Judgmental Healthcare ProvidersJudgmental Healthcare Providers— Minimize The Seriousness Of Your PainMinimize The Seriousness Of Your Pain— Imply That “It’s All In Your Head”Imply That “It’s All In Your Head”— Blaming You “You Did It To Yourself”Blaming You “You Did It To Yourself”


Obstacles For Success Obstacles For Success Your Own Self Defeating ReactionsYour Own Self Defeating Reactions

— Malicious Compliance To Keep Rx ComingMalicious Compliance To Keep Rx Coming— Becoming Hopeless & HelplessBecoming Hopeless & Helpless— Grief/Loss & Feeling Ashamed/GuiltyGrief/Loss & Feeling Ashamed/Guilty— Depression And Other Coexisting DisordersDepression And Other Coexisting Disorders— Treatment Resistance & Denial Treatment Resistance & Denial


Grief Loss & DepressionGrief Loss & Depression

Be Aware Of Your Grieving ProcessBe Aware Of Your Grieving Process— You need a plan that instills hopeYou need a plan that instills hope— Shift yourself from victimized to empoweredShift yourself from victimized to empowered

Be Aware Of The Signs Of DepressionBe Aware Of The Signs Of Depression— Medication managementMedication management— Cognitive behavioral therapy (CBT)Cognitive behavioral therapy (CBT)— Combination CBT and medicationCombination CBT and medication


Discussion QuestionDiscussion Question

What Are Some Common Biases Or What Are Some Common Biases Or Negative Pejorative Comments That You Negative Pejorative Comments That You Have Overheard (or been on the receiving Have Overheard (or been on the receiving end) From...end) From...— Substance Abuse Treatment ProfessionalsSubstance Abuse Treatment Professionals— Medical Care Providers (Doctors, Nurses, etc.)Medical Care Providers (Doctors, Nurses, etc.)— Mental Health ProfessionalsMental Health Professionals


You Must Be ProactiveYou Must Be Proactive You Must Become Knowledgeable Active You Must Become Knowledgeable Active

Participants—Not Passive RecipientsParticipants—Not Passive Recipients You Are Always Captain Of The TeamYou Are Always Captain Of The Team Healthcare Professional: Is A Guide Or CoachHealthcare Professional: Is A Guide Or Coach Insist On A Collaborative Treatment PlanInsist On A Collaborative Treatment Plan Develop Recovery & Relapse Prevention Plans Develop Recovery & Relapse Prevention Plans

For Both The Pain & Any Rx Abuse/AddictionFor Both The Pain & Any Rx Abuse/Addiction

Looking AtLooking At

Your PainYour Pain


Types of PainTypes of Pain

Acute Pain Acute Pain Chronic PainChronic Pain Recurrent Acute Pain Recurrent Acute Pain Anticipatory PainAnticipatory Pain Neuropathic Pain Neuropathic Pain


What Is Acute Pain?What Is Acute Pain?

A Symptom Of An Underlying ProblemA Symptom Of An Underlying Problem There Is Damage To Your SystemThere Is Damage To Your System The Source Is Easily IdentifiedThe Source Is Easily Identified There Is A Time Limited Healing ProcessThere Is A Time Limited Healing Process Analgesics Or Narcotics *May* Be UsedAnalgesics Or Narcotics *May* Be Used

— If you are in recovery you need to have a good If you are in recovery you need to have a good medication plan or face potential relapsemedication plan or face potential relapse


What Is Chronic Pain?What Is Chronic Pain?

Lasts For Six Months Or MoreLasts For Six Months Or More The Source Is Often Ambiguous The Source Is Often Ambiguous Your Pain Lingers Long After Initial InjuryYour Pain Lingers Long After Initial Injury It May No Longer Serve Useful PurposeIt May No Longer Serve Useful Purpose Treatment Is Often Confusing And Frustrating Treatment Is Often Confusing And Frustrating

What Is Recurrent Acute Pain?What Is Recurrent Acute Pain?AKA Breakthrough Or Pain Flare UpAKA Breakthrough Or Pain Flare Up

You Experience Acute Pain EpisodesYou Experience Acute Pain Episodes— Incident Pain: Caused by Activity or MotionIncident Pain: Caused by Activity or Motion— End of Dose Pain (Your Rx is wearing off)End of Dose Pain (Your Rx is wearing off)— Pain with No Identifiable CausePain with No Identifiable Cause

Episodes Are Usually BriefEpisodes Are Usually Brief Low Or Pain Free Periods Between EpisodesLow Or Pain Free Periods Between Episodes Often Associated With Identifiable Precursors Often Associated With Identifiable Precursors This Needs A Separate Treatment PlanThis Needs A Separate Treatment Plan


What Is Anticipatory Pain?What Is Anticipatory Pain? It’s A Conditioned Pain Response It’s A Conditioned Pain Response

(You Expect It So It Happens)(You Expect It So It Happens) It Is Activated Or Turned On By It Is Activated Or Turned On By

— Environmental Triggers (what’s happening Environmental Triggers (what’s happening around you but doesn’t really involve you) around you but doesn’t really involve you)

— Internal Thinking & Emotional TriggersInternal Thinking & Emotional Triggers You Associate It With Previous Episodes You Associate It With Previous Episodes

When You Were In Significant PainWhen You Were In Significant Pain


What Is Neuropathic Pain?What Is Neuropathic Pain?

DefinitionDefinition::— ““Neural dysfunction that persists beyond Neural dysfunction that persists beyond

the period of normal tissue healing” the period of normal tissue healing” — Or think of this type of pain as damage Or think of this type of pain as damage

to your nerves and pain receptors that to your nerves and pain receptors that still signal pain after everything is still signal pain after everything is actually all better.actually all better.


What Is Neuropathic Pain?What Is Neuropathic Pain? Symptoms (What It Feels Like):Symptoms (What It Feels Like):

— Parasthesias: tingling, itching, numbnessParasthesias: tingling, itching, numbness— Dysesthesias: shooting, burning, stabbing, Dysesthesias: shooting, burning, stabbing,

aching, electrical sensationsaching, electrical sensations— Allodynia: non-harmful stimulus (pain signals) Allodynia: non-harmful stimulus (pain signals)

perceived as painful, e.g., touch of clothingperceived as painful, e.g., touch of clothing— Spatial Changes: pain perception extending Spatial Changes: pain perception extending

beyond initial area of tissue injury, e.g., your foot beyond initial area of tissue injury, e.g., your foot is injured but you feel pain in your leg too.is injured but you feel pain in your leg too.


The Three Components Of PainThe Three Components Of Pain BiologicalBiological

— A Signal That Something Is WrongA Signal That Something Is Wrong PsychologicalPsychological

— Meaning You Assign To The Pain SignalMeaning You Assign To The Pain Signal Social/CulturalSocial/Cultural

— Role Assigned To You By OthersRole Assigned To You By Others— Your Family & Cultural Beliefs About PainYour Family & Cultural Beliefs About Pain


Pain Versus SufferingPain Versus Suffering PainPain

— Physical Sensations (or signals) That Tells Physical Sensations (or signals) That Tells You That Something Is Wrong In Your BodyYou That Something Is Wrong In Your Body

SufferingSuffering — Your Interpretation That The Sensation Is Your Interpretation That The Sensation Is

Horrible, Awful, Terrible, or UnbearableHorrible, Awful, Terrible, or Unbearable

Pain Is Inevitable But Suffering Is OptionalPain Is Inevitable But Suffering Is Optional

Rating Your Level of PainRating Your Level of PainLevel 1 = Barely Noticeable Level 1 = Barely Noticeable Level 2 = Noticeable w/ No DistressLevel 2 = Noticeable w/ No DistressLevel 3 = Becoming Disturbing w/ No DistressLevel 3 = Becoming Disturbing w/ No DistressLevel 4 = Some Distress w/ No Coping ProblemsLevel 4 = Some Distress w/ No Coping ProblemsLevel 5 = Distress w/ Some Coping ProblemsLevel 5 = Distress w/ Some Coping ProblemsLevel 6 = Distress w/ Significant Coping ProblemsLevel 6 = Distress w/ Significant Coping ProblemsLevel 7 = Starting To Interfere w/ FunctioningLevel 7 = Starting To Interfere w/ FunctioningLevel 8 = Moderate Interference w/ FunctioningLevel 8 = Moderate Interference w/ FunctioningLevel 9 = Severe Interference w/ FunctioningLevel 9 = Severe Interference w/ FunctioningLevel 10 = Unable To Function At AllLevel 10 = Unable To Function At All

Chronic PainChronic Pain

Stress & Muscle TensionStress & Muscle Tension

DepressionDepressionFearFearAngerAnger

This CycleThis CycleMust BeMust BeBrokenBroken

Intensified Perception of Pain

Relaxation/Acceptance For StressCBT For Emotional Components

Chronic PainChronic Pain

Stress & Muscle TensionStress & Muscle Tension

How This How This Cycle IsCycle IsBrokenBroken

Decreased Perception of Pain


Quiz #1Quiz #1

Rx Pain Medication Rx Pain Medication

Abuse/Addictive Abuse/Addictive

DisordersDisorders


OngoingOngoing

ExposureExposure

InitialInitial

ExperienceExperience

BuildingBuilding

ToleranceTolerance

AddictionAddiction

DeathDeath

AbuseAbuse

Pseudo-Addiction

Stages of Rx Abuse/AddictionStages of Rx Abuse/Addiction

SeekingSeeking

ReachingReaching

Misunderstood TermsMisunderstood Terms

ToleranceTolerance Physical DependencePhysical Dependence Substance AbuseSubstance Abuse AddictionAddiction Pseudo AddictionPseudo Addiction

Definitions developed by the American Academy of Pain Medicine, the Definitions developed by the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine. American Pain Society, and the American Society of Addiction Medicine.

(Savage, Covington, Heit, et al., 2004)(Savage, Covington, Heit, et al., 2004)


Tolerance Tolerance

Tolerance is a state of adaptation in Tolerance is a state of adaptation in which exposure to a drug induces which exposure to a drug induces changes that result in a diminution of one changes that result in a diminution of one or more of the drug's effects over time.or more of the drug's effects over time.

In other words it take more medication to In other words it take more medication to get the same level of pain relief.get the same level of pain relief.


Physical DependencePhysical Dependence Physical dependence is a state of Physical dependence is a state of

adaptation that is manifested by a drug adaptation that is manifested by a drug class specific withdrawal syndrome that class specific withdrawal syndrome that can be produced by abrupt cessation, can be produced by abrupt cessation, rapid dose reduction, decreasing blood rapid dose reduction, decreasing blood level of the drug, and/or administration level of the drug, and/or administration of an antagonist.of an antagonist.

In other words if you stop suddenly In other words if you stop suddenly you’ll be very uncomfortable.you’ll be very uncomfortable.


Substance Abuse Substance Abuse

Substance abuse is the use of legal (such Substance abuse is the use of legal (such as Rx, alcohol and cigarettes) and illegal as Rx, alcohol and cigarettes) and illegal (e.g. cannabis) drugs in a manner which is (e.g. cannabis) drugs in a manner which is physically harmful or damaging to a physically harmful or damaging to a person’s ability to be able to parent or to person’s ability to be able to parent or to function at work. Damage to relationships or function at work. Damage to relationships or legal consequences can also be features of legal consequences can also be features of substance abuse.substance abuse.


AddictionAddiction

Addiction is a primary, chronic, Addiction is a primary, chronic, neurobiologic neurobiologic [Brain] [Brain] disease, with genetic, disease, with genetic, psychosocial, and environmental factors psychosocial, and environmental factors influencing its development and influencing its development and manifestations manifestations [how is shows up][how is shows up].. It is It is characterized by behaviors that include one characterized by behaviors that include one or more of the following: impaired control or more of the following: impaired control over drug use, compulsive use, continued over drug use, compulsive use, continued use despite harm, and craving. use despite harm, and craving.


Pseudo AddictionPseudo Addiction

Patient behaviors that may occur when pain Patient behaviors that may occur when pain is under treated. Patients with unrelieved is under treated. Patients with unrelieved pain may become focused on obtaining pain may become focused on obtaining medications, may “clock watch,” and may medications, may “clock watch,” and may otherwise seem inappropriately “drug otherwise seem inappropriately “drug seeking.” Even such behaviors as illicit seeking.” Even such behaviors as illicit drug use and deception can occur in the drug use and deception can occur in the patient's efforts to obtain relief. patient's efforts to obtain relief.


Addiction Vs PseudoaddictionAddiction Vs Pseudoaddiction

Pseudoaddiction Looks A Lot Like AddictionPseudoaddiction Looks A Lot Like Addiction You May Appear To Be “Drug-Seeking”You May Appear To Be “Drug-Seeking” You May Need Frequent Early Refills You May Need Frequent Early Refills Behaviors Are Caused By Under-TreatmentBehaviors Are Caused By Under-Treatment Your Problematic Behaviors Resolve Your Problematic Behaviors Resolve

When Your Pain Is Adequately TreatedWhen Your Pain Is Adequately Treated


Red Flags For Rx Abuse/AddictionRed Flags For Rx Abuse/Addiction

Euphoria After Adapting To The MedicationEuphoria After Adapting To The Medication Craving & Preoccupation With MedicationCraving & Preoccupation With Medication Abnormal Increased Tolerance Abnormal Increased Tolerance You Decrease Pain Management ActivitiesYou Decrease Pain Management Activities You Experience Loss Of Control You Experience Loss Of Control Using Alcohol & Other Non-Prescribed DrugsUsing Alcohol & Other Non-Prescribed Drugs


Red Flags For Rx Abuse/AddictionRed Flags For Rx Abuse/Addiction You Fail To Fulfill Major Role ObligationsYou Fail To Fulfill Major Role Obligations You Don’t Take Your Rx As PrescribedYou Don’t Take Your Rx As Prescribed Your Create Addiction-Centered LifestyleYour Create Addiction-Centered Lifestyle Addictive Lifestyle Losses Addictive Lifestyle Losses (Biopsychosocial)(Biopsychosocial) Continued Use/Abuse Despite ProblemsContinued Use/Abuse Despite Problems Substance-Induced Mental Disorders (i.e., Substance-Induced Mental Disorders (i.e.,

the meds are messing with your mind)the meds are messing with your mind)

AAddiction-Freeddiction-Free

PPainain

MManagementanagement®®

A Synergistic Treatment SystemA Synergistic Treatment System


The APMThe APM™™ System System

Core Clinical ProcessesCore Clinical Processes— Using Thinking, Feeling, Behavior Therapy Using Thinking, Feeling, Behavior Therapy

Medication Management ComponentsMedication Management Components— Using Effective Medical InterventionsUsing Effective Medical Interventions

Non-Medication/Holistic ApproachesNon-Medication/Holistic Approaches— Using A Proactive Pain Management ApproachUsing A Proactive Pain Management Approach

TheThePlanPlan

Analyzing Analyzing & Managing HRS& Managing HRS

Mapping HRSMapping HRS

Identifying High Risk SituationsIdentifying High Risk Situations

Medication Agreement & Intervention PlanMedication Agreement & Intervention Plan

Decision Making About MedicationDecision Making About Medication

Understanding The Effects Of MedicationUnderstanding The Effects Of Medication

Understanding The Effects Of Chronic PainUnderstanding The Effects Of Chronic Pain

Core ClinicalCore ClinicalProcessesProcesses

Ass

ess

Mot

ivat

e

Rel

apse

Pre

vent

ion

Rec

over

y


Recovery Friendly MedicationsRecovery Friendly Medications Celebrex — Pre-Operation Loading 400mgCelebrex — Pre-Operation Loading 400mg All Other NSAIDS If Side-Effects ToleratedAll Other NSAIDS If Side-Effects Tolerated Muscle Relaxants (use caution with these)Muscle Relaxants (use caution with these)

— Xyrem ® (GHB)Xyrem ® (GHB)— Skelaxin® (metaxalone)Skelaxin® (metaxalone)— Zanaflex® (tizanidine hydrochloride)Zanaflex® (tizanidine hydrochloride)— Robaxin®Robaxin® (methocarbamol)(methocarbamol)— Flexeril® (cyclobenzaprine HCl)Flexeril® (cyclobenzaprine HCl)


Recovery Friendly MedicationsRecovery Friendly Medications Medications For Neuropathic PainMedications For Neuropathic Pain

— Cymbalta®Cymbalta® (duloxetine hydrochloride)(duloxetine hydrochloride)— LyricaLyrica (pregabalin)(pregabalin)

Medications For Migraines Medications For Migraines — Topamax® (topiramate)Topamax® (topiramate)— Triptans (serotonin receptor agonists)Triptans (serotonin receptor agonists)— IV Toradol (ketorolac) for unresponsive painIV Toradol (ketorolac) for unresponsive pain— Zanaflex® (tizanidine hydrochloride)Zanaflex® (tizanidine hydrochloride)— Celebrex ® (celecoxib)Celebrex ® (celecoxib)


Recovery Friendly MedicationsRecovery Friendly Medications Ecotrin (coated aspirin—acetylsalicylic acid)Ecotrin (coated aspirin—acetylsalicylic acid) AnticonvulsantsAnticonvulsants

— Tegretol®Tegretol® (carbamazepine)(carbamazepine)

— Depakote (divalproex sodium) Depakote (divalproex sodium)

Elavil (amitriptyline) Elavil (amitriptyline) Suboxone / Buprenorphine Suboxone / Buprenorphine


Non-Medication ApproachesNon-Medication Approaches

Meditation And RelaxationMeditation And Relaxation Emotional ManagementEmotional Management Massage TherapyMassage Therapy Physical TherapyPhysical Therapy Chiropractic TreatmentChiropractic Treatment AcupunctureAcupuncture BiofeedbackBiofeedback HypnosisHypnosis


Other Non-Medication Other Non-Medication Yoga/Tai ChiYoga/Tai ChiDiet/NutritionDiet/NutritionPrayerPrayerTribal HealingTribal HealingSweat LodgesSweat LodgesTalking Circles Talking Circles Pet TherapyPet TherapySelf-Help GroupsSelf-Help Groups

TENS UnitsTENS UnitsReflexologyReflexologyCranial Sacral Cranial Sacral AerobicsAerobicsRolfing/HellarRolfing/HellarNatureNatureHobbiesHobbiesEMDREMDR

Passive Versus Proactive Tools Passive Versus Proactive Tools

TENS/RS Stim UnitsTENS/RS Stim Units DBT and CBTDBT and CBT Life Coaching Life Coaching HydrotherapyHydrotherapy Rolfing/HellarRolfing/Hellar Physical TherapyPhysical Therapy Equine TherapyEquine Therapy HypnosisHypnosis

Practice Yoga/Tai ChiPractice Yoga/Tai Chi Follow Diet/Nutrition PlanFollow Diet/Nutrition Plan Practice Sleep Hygiene Practice Sleep Hygiene Participate In AerobicsParticipate In Aerobics Swimming RegularlySwimming Regularly Frequent Nature WalksFrequent Nature Walks Walking A Labyrinth Walking A Labyrinth Learn & Use Self-Learn & Use Self-HypnosisHypnosis

PassivePassive ProactivProactivee


Stage I Pain ManagementStage I Pain Management Multi-Disciplinary AssessmentsMulti-Disciplinary Assessments Detoxification And/Or Taper As NeededDetoxification And/Or Taper As Needed Physiological Vs Psychological/EmotionalPhysiological Vs Psychological/Emotional ID & Manage Resistance & DenialID & Manage Resistance & Denial

— Regarding Pain Management & MedicationRegarding Pain Management & Medication— Regarding Secondary Gain IssuesRegarding Secondary Gain Issues

Introduce Non-Medication ToolsIntroduce Non-Medication Tools


Stage II Pain ManagementStage II Pain Management

Continue Non-Medication ToolsContinue Non-Medication Tools Develop Initial Relapse & Flare Up PlansDevelop Initial Relapse & Flare Up Plans ID & Manage Your Grief/Loss IssuesID & Manage Your Grief/Loss Issues Be Aware Of Any Trauma HistoryBe Aware Of Any Trauma History

— Trauma as precursor for increased sensitivity Trauma as precursor for increased sensitivity and ineffective pain management and ineffective pain management

— Trauma related to other pre-existing conditionsTrauma related to other pre-existing conditions


Stage III Pain ManagementStage III Pain Management

1.1. Getting A Life — Moving Beyond PainGetting A Life — Moving Beyond Pain2.2. Resolving Resolving Core Psychological IssuesCore Psychological Issues3.3. Resolve / Manage Resolve / Manage Trauma SymptomsTrauma Symptoms4.4. Develop An Develop An Activity Pacing PlanActivity Pacing Plan5.5. Fine-Tune The Fine-Tune The Relapse/Flare Up PlansRelapse/Flare Up Plans

—To address high risk pain situationsTo address high risk pain situations—To address core psychological issuesTo address core psychological issues


Twelve Personal Action StepsTwelve Personal Action Steps

Avoid Elective Dental/Surgical ProceduresAvoid Elective Dental/Surgical Procedures Significant Other Holds And Dispenses Rx Significant Other Holds And Dispenses Rx Consult With Addiction Medicine SpecialistConsult With Addiction Medicine Specialist Explore All Non-Chemical ModalitiesExplore All Non-Chemical Modalities Identify And Manage StressIdentify And Manage Stress Augment Recovery Supportive ActivitiesAugment Recovery Supportive Activities


Twelve Personal Action StepsTwelve Personal Action Steps

Self-Disclose Recovery Status To ProvidersSelf-Disclose Recovery Status To Providers Take Time Off To Heal—Don’t OverworkTake Time Off To Heal—Don’t Overwork Be Aware Of Cross-Addiction ConceptBe Aware Of Cross-Addiction Concept Identify And Cope With DepressionIdentify And Cope With Depression Implement Nutrition And Exercise PlanImplement Nutrition And Exercise Plan Explore Past Beliefs About PainExplore Past Beliefs About Pain


Recovery/Relapse IndicatorsRecovery/Relapse Indicators

Using Medication As PrescribedUsing Medication As Prescribed Using Medication For Pain Relief OnlyUsing Medication For Pain Relief Only No Obsessions Or Intrusive ThoughtsNo Obsessions Or Intrusive Thoughts No Compulsion To Use Inappropriately No Compulsion To Use Inappropriately No Cravings To Use Or Increase DoseNo Cravings To Use Or Increase Dose


Recovery/Relapse IndicatorsRecovery/Relapse Indicators

No Loss Of ControlNo Loss Of Control No Euphoria/IntoxicationNo Euphoria/Intoxication No Negative Biological ConsequencesNo Negative Biological Consequences No Secondary Psychosocial ProblemsNo Secondary Psychosocial Problems No Pain Rebound Effect, Hyperalgesia No Pain Rebound Effect, Hyperalgesia

Or Abnormal Tolerance Build UpOr Abnormal Tolerance Build Up

Biological Psychological

SpiritualSocial

Pain Management Recovery GoalsPain Management Recovery Goals

2525 2525

25252525


Treatment OutcomesTreatment Outcomes

Effective Medication ManagementEffective Medication Management— Decreasing relapse ratesDecreasing relapse rates

Increased Ability To Problem SolveIncreased Ability To Problem Solve— Improved hope for healthy pain managementImproved hope for healthy pain management

Reduced Pain And Reduced Pain And Freedom From SufferingFreedom From Suffering— Moving from victim to empowermentMoving from victim to empowerment

freedom from suffering patient education

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