freedom from suffering workshop for san diego conference

© Dr. Stephen F. Grinstead, 2012, 1996

Freedom from Suffering

A Journey of Hope

Seven Strategic Steps For

Effective Pain Management

Developed & Presented By: Dr. Stephen F. GrinsteadDeveloper of the Addiction-Free Pain Management® System


Freedom from Suffering

It’s a Right and A Responsibility


Opening Icebreaker Exercise

Stand Up & Introduce Yourself To Two Or Three People That You Don’t Know Very WellShare With Those People

Why you’re at this workshopYour experience with chronic pain Your primary goals for this workshop

Come Back Together For Group Discussion

© Dr. Stephen F. Grinstead, 20112 1996

Question One

Are We Managing Pain?

But Fueling Addiction?


Question Two

Are We Treating the Addiction?

But Sabotaging the Pain Management?


Question Three

Is It Addiction?

Or Pseudoaddiction?

What I’m

Offering

Today is a

Road Map


Cost of Chronic Pain Management

Chronic pain is a major public health problem in AmericaChronic pain management costs the nation an estimated $560 to $635 billion each year in medical treatment and lost productivity

This equals about $2,000 for everyone living in the United States

Chronic pain affects an estimated 116 million Americans

This is more than the number of Americans affected by heart disease, diabetes, and cancer combined

Source: Institute of Medicine (IOM) Report, June 29, 2011 — Relieving Pain in America


A Road

Map F

or

The

Journ

eyWakin

g Up

From

The

Chronic

Pain

Trance

Lookin

g At T

he

Relatio

nship

With

Pain

Designin

g The

Pain M

anagement

Plan

Making

Decisions

About

Medicatio

nPla

n for

Managing

Stuck

Poin

ts

Developin

g The

Balance

Points

Freedom From Suffering

A Journey of Hope

Effective Pain Management

Is a Right and a Responsibility


Step 1: A Roadmap For Your Journey

Developing a support systemProfessional Guides and CoachesPersonal Guides and CoachesThe Pain Management Plan


Step 2: Waking Up From The TranceExploring the chronic pain trance

Looking at the depression barrierIdentify & manage the inner saboteur


The Chronic Pain TranceWhat is the chronic pain trance?

Automatic and unconscious coping stylesDeveloping a hopeless/helpless mindsetThe quest for the “FIX”

Breaking the chronic pain tranceRecognition is the first part of the solution“You can’t think your way out of a problem you behaved your way into” Dr. Stephen CoveyUsing cognitive-behavioral restructuring (TFUAR)


The Depression BarrierThere’s a difference between depression and situational triggered feeling down or blueDepression is very common for people in chronic painDepression and isolation: The deadly duoUnderstanding depression symptomsCommon depression management toolsDeveloping a depression management plan


Common Depression SymptomsA significantly depressed mood or

absence of moodInability to experience pleasure or feel interest Inexplicable crying spells, sadness and/or irritabilityInsomnia (difficulty) or hypersomnia (oversleeping)A substantial change in appetite, eating or weight


Common Depression SymptomsFatigue or energy loss

Diminished ability to concentrate or make decisionsFeelings of hopelessness or worthlessnessA lack of sexual desireInappropriate feelings of guilt or self-criticismSuicidal thoughts, feelings or behaviors


Depression Management ToolsEliminate the use of alcohol and other

drugs (other than appropriate prescriptions)Exercise or engage in some form of physical activity every day, such as walking Eat a proper, well-balanced dietMake sure to get an adequate amount of sleep. Seek emotional support from friends and family Focus on positive aspects of your life Pace yourself, modify your schedule, set realistic goals


Depression Management ToolsEliminate or reduce unnecessary tasks

Reduce or eliminate nicotine, caffeine, and sugar Consult with a physician if you are experiencing any medical problems Consult with a dentist if you are experiencing any dental problems Avoid isolation and build a healthy support systemDevelop an attitude of gratitude


Develop A Depression Management PlanMedication management—many

depression medications also help pain managementEngage in cognitive behavioral therapy (CBT)Combination of CBT and medication management is needed for moderate to severe depressionA proactive plan with at least four or five action steps

What Is The Inner Saboteur?


Internal Conflict

Mistaken Thoughts, Beliefs,

Opinions & Conclusions

The Inner Saboteur

Monkey Mind

The Committee


Inner Saboteur orDefense/Denial


DenialIs an automatic & unconscious reactionThat operates as a defense Against the pain of recognizing serious

problems

It’s A Normal Part of the Human Condition


Different Levels Of DenialLack of Information — Wrong information about addiction and pain.

Conscious Defensiveness — Know that something is wrong but don’t want to face the pain of knowing.

Total Denial — Unconscious defense mechanism to guard against pain and helplessness.

Delusional — Deeply entrenched mistaken beliefs held in spite of overwhelming evidence to contrary.


Big 5 Pain Denial PatternsAvoidance

I will do anything to not talk about my pain management problem.Types of Avoidance include distraction, saying nothing, uproar, & playing dumb.

Total DenialNo not me! I don’t have a problem with pain!

MinimizingMy pain is not that big of a deal!


10 Pounds

1

5

10

How Bad Does It Have To Get Before You Take

Authentic Action?

100 Pounds

1000 + Pounds


Big 5 Pain Denial PatternsBlaming

If I can prove that my problems with pain management aren’t my fault, then I won’t have to deal with them!

RationalizingIf I can find good enough reasons for my problems with pain management, I won’t have to deal with them!


You Can’t Think Your Way Out Of A Problem That You Behaved Your Way Into

Dr. Stephen Covey


Small 7 Pain Denial PatternsComparing

If others are worse off than me, it proves I don’t have serious problem!

ComplianceI pretend to give you what you want so you’ll leave me alone!

ManipulatingI play the game to convince others to do all the work.

Flight Into HealthFeeling better means that I’m cured!


Small 7 Pain Denial PatternsFear of Change OR Recovery By Fear

If I don’t focus on having a problem with my pain I won’t know how else to relate!

Diagnosing Myself as Beyond HelpSince nothing I do has ever worked for my pain management, I shouldn’t have to try anymore.

I Have the Right to be This Way – It’s My Body

I have the right to do whatever I want to do or don’t want to do with my body and for my pain management. No one has the right to tell me different!


Step 3: Exploring The Relationship With Pain

Understanding pain and the pain systemThe Bio-Psycho-Social components of painThe spiritual aspects of chronic pain managementPain effects the whole personCommon coexisting problems with chronic pain


Types of Pain

Acute Pain Chronic PainRecurrent Acute Pain Anticipatory PainNeuropathic Pain


Three Components Of Pain Management

BiologicalA signal that something is wrong

PsychologicalMeaning individual assigns to pain signal

Social/CulturalRole assigned to the person in painFamily & cultural beliefs about pain


Spiritual Aspects Of Chronic Pain Management

Spirituality versus religionReligion prepares for the next lifeSpirituality prepares for this life

Spirituality is a complex and multidimensional part of the human experience. Spirituality involves beliefs, perceptions, thinking, feeling, experiential and behavioral aspects.


Biological

Pain Affects The Whole Person


Psychological



Social




Bio

SocialPsycho

Spiritual

Common Co-occurring Problems

Trauma Problems(PTSD)

Severe Sleep Problems

Cognitive Impairment

Depression

Anxiety Problems

Eating Problems

Addiction


Exploring Pain Versus Suffering

Changing the perception of pain—pain vs sufferingAll about anticipatory painRole of stress management in chronic pain managementUsing a pain scale


Pain Versus Suffering

Pain — Physical sensations that tell us something is wrong

Suffering — Psychological interpretation that the sensation is awful, terrible, or unbearable

Pain is inevitable, but suffering is optional

Freedom From SufferingIt’s Your Right and Your Responsibility


Anticipatory Pain

Conditioned pain responses (Felt sense experiences or memories of pain)Activated by

Environmental triggersInternal psychological/emotional triggers

Often associated with previous pain flare up episodesYou get what you expect!


Pain Scale1 2 3 4 5 60 7 8 9 10

No Pain Distressful Pain Agonizing Pain

Stress And Chronic Pain

Low Stress Zero To Three

Moderate Stress Four To Six

High Stress Seven To Ten

The Stress Thermometer

Relaxation321

654

987

201510

Relaxed – Nearly Asleep

Relaxed – Not Focused

Relaxed – Focused

Focused & Active

Function With No Effort

Function With Effort

Inability to Focus - Spacey

Driven / Defensive

Over React

Loss of Control

Dissociation

Psychosis / Collapse

Functional Stress

Stress Reaction

Trauma Reaction


Verbalizing The Levels of Pain1 = Barely Noticeable 2 = Noticeable w/ No Distress3 = Becoming Disturbing w/ No Distress4 = Some Distress w/ No Coping

Problems5 = Distress w/ Some Coping Problems6 = Distress w/ Significant Coping

Problems7 = Starting To Interfere w/ Functioning8 = Moderate Interference w/

Functioning9 = Severe Interference w/ Functioning10 = Unable To Function At All


Step 4: Designing The Pain Management Plan

What is effective chronic pain management?

Safer medication management plans

Developing a pain flare up plan

Non-medication pain management plan


Step 5– Making Decisions About Medication

Defining misunderstood terms

The Addiction-Pain Syndrome™

Prescription drugs of abuse

Red Flags for abuse/addiction

Making a medication management agreement


Misunderstood Terms

Tolerance

Physical Dependence

Addiction

Pseudo Addiction

Definitions developed by the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine. (Savage, Covington, Heit, et al., 2004)


Tolerance

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

Earth Language: When you first used your medication it only took one or two pills to get relief and now it takes four or five.


Physical Dependence

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

Earth Language: When your body gets used to taking a medication on an ongoing basis and your brain adapts to that being the normal stat—then when you stop taking it suddenly you’ll get sick or go into what is called withdrawal. For example a diabetic who is taking daily insulin then stops suddenly one day—they will get sick.


Addiction

A primary, chronic, neurobiologic disease, with genetic, psychosocial, [spiritual] and environ-mental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Earth Language: When you are taking the medication for reasons other than physical pain relief and won’t or can’t stop taking it even when experiencing bad problems—then you’re addicted to the medication.


Pseudo Addiction

Behaviors that may occur when pain is not being adequately addressed. Patients with unrelieved pain may become focused on obtaining medications, may "clock watch," and may otherwise seem inappropriately "drug seeking." Even behaviors such as illicit drug use and deception can occur in the patient's efforts to obtain relief.


Addiction versus Pseudoaddiction

Earth Language: Pseudoaddiction looks a lot like addiction

You may appear to be “Drug-Seeking”

You may need frequent early refills

These behaviors are caused by under-treatment or mistreatment

Problematic behaviors disappear when your pain is adequately managed

The Addiction Pain Syndrome TM



Addiction-Pain Syndrome™

AddictiveDisorder

Zone


PainDisorder

Zone




AddictiveDisorder

Zone

PainDisorder

Zone

AddictionPain

SyndromeZone



Looking For “Red Flags”

Is your stress, depression, isolation increasing?Do you experience cravings or preoccupation with your pain medication?Are all medications being taken as prescribed?Is there a reduction in your non-pharmacological pain management interventions?Are you experiencing any negative consequences associated with your medication use?



Are you honest with your support group about all medications, (including alcohol)?Do you use more than one prescriber for pain meds?Are you considering any elective medical or dental surgeries in the near future? Are you resistant to non-narcotic medications or referrals to non-medication pain management?



Are you using non-prescribed substances including alcohol and/or other drugs i.e., marijuana, over-the-counter analgesics, methamphetamine, etc.?Is your quality of life and/or relationships are being negatively impacted by your use of pain medication?Do you experience withdrawal symptoms if you go too long between doses or stop your medication abruptly?Do you have a history—or family history—of alcoholism or other drug addiction?



Do your family members or friends report concerns about your use of pain medication?Are you unable to fulfill major obligations with family, friends, and/or work due to your use of medication?Are you resistant to sign consent to release forms allowing your provider to discuss your treatment with other healthcare providers you have been seeing?Are you more concerned about your medication than your pain condition?


Medication Management Agreement

Abstain from inappropriate medication

Limited to a specific period of time

Consequences if unable to comply

Random drug level screening

Using an addiction medicine specialist if indicated

Signature and witnessing


Step 6 – Plan For Managing Stuck Points

Moving From…Hopeless to HopefulDemoralized to RevitalizedVictim to Victorious Powerless to EmpoweredSurviving to Thriving


Step 7 – Finding The Five Balance Points

Positive Self-TalkAppropriate Emotional Expression Healthy Support NetworkSpirituality/HumilityEffective Pain Management

Today well lived makes

every yesterday a dream of happiness and every tomorrow a vision of hope

Sanskrit Proverb


Final Call To Action

Answer these questions:What is the most important thing that you learned in this training?What are you going to do differently

as a result of what you learned? What could stop you from following through and how can you overcome any obstacles?

Giving feedback and saying goodbye.


Web Site Resources

www.freedomfromsuffering.netwww.addiction-free.comwww.cenaps.comwww.chronicpainanonymous.orgwww.tgorski.comwww.relapse.org

This Is Only The Beginning

freedom from suffering workshop for san diego conference

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