Upload
stepehn-grinstead
View
110
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Dr. Grinstead Presents Freedom From Suffering for the Freedom Recovery Conference for the Military
Citation preview
© 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
© Dr. Stephen F. Grinstead, 2012, 1996
Freedom from Suffering
It’s a Right and A Responsibility
© Dr. Stephen F. Grinstead, 2012, 1996
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?
© Dr. Stephen F. Grinstead, 20112 1996
Question Two
Are We Treating the Addiction?
But Sabotaging the Pain Management?
© Dr. Stephen F. Grinstead, 20112 1996
Question Three
Is It Addiction?
Or Pseudoaddiction?
What I’m
Offering
Today is a
Road Map
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
Step 1: A Roadmap For Your Journey
Developing a support systemProfessional Guides and CoachesPersonal Guides and CoachesThe Pain Management Plan
© Dr. Stephen F. Grinstead, 2012, 1996
Step 2: Waking Up From The TranceExploring the chronic pain trance
Looking at the depression barrierIdentify & manage the inner saboteur
© Dr. Stephen F. Grinstead, 2012, 1996
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)
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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?
© Dr. Stephen F. Grinstead, 2011, 1996
Internal Conflict
Mistaken Thoughts, Beliefs,
Opinions & Conclusions
The Inner Saboteur
Monkey Mind
The Committee
© Dr. Stephen F. Grinstead, 2012, 1996
Inner Saboteur orDefense/Denial
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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.
© Dr. Stephen F. Grinstead, 2012, 1996
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!
© Dr. Stephen F. Grinstead, 2012, 1996
10 Pounds
1
5
10
How Bad Does It Have To Get Before You Take
Authentic Action?
100 Pounds
1000 + Pounds
© Dr. Stephen F. Grinstead, 2012, 1996
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!
© Dr. Stephen F. Grinstead, 2012, 1996
You Can’t Think Your Way Out Of A Problem That You Behaved Your Way Into
Dr. Stephen Covey
© Dr. Stephen F. Grinstead, 2012, 1996
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!
© Dr. Stephen F. Grinstead, 2012, 1996
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!
© Dr. Stephen F. Grinstead, 2011, 1996
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
© Dr. Stephen F. Grinstead, 2011, 1996
Types of Pain
Acute Pain Chronic PainRecurrent Acute Pain Anticipatory PainNeuropathic Pain
© Dr. Stephen F. Grinstead, 2011, 1996
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
© Dr. Stephen F. Grinstead, 2011, 1996
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.
© Dr. Stephen F. Grinstead, 2011, 1996
Biological
Pain Affects The Whole Person
© Dr. Stephen F. Grinstead, 2011, 1996
Psychological
Pain Affects The Whole Person
© Dr. Stephen F. Grinstead, 2011, 1996
Social
Pain Affects The Whole Person
© Dr. Stephen F. Grinstead, 2011, 1996
Pain Affects The Whole Person
Bio
SocialPsycho
Spiritual
Common Co-occurring Problems
Trauma Problems(PTSD)
Severe Sleep Problems
Cognitive Impairment
Depression
Anxiety Problems
Eating Problems
Addiction
© Dr. Stephen F. Grinstead, 2011, 1996
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
© Dr. Stephen F. Grinstead, 2011, 1996
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
© Dr. Stephen F. Grinstead, 2011, 1996
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!
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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)
© Dr. Stephen F. Grinstead, 2012, 1996
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.
© Dr. Stephen F. Grinstead, 2012, 1996
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.
© Dr. Stephen F. Grinstead, 2012, 1996
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.
© Dr. Stephen F. Grinstead, 2012, 1996
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.
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
© Dr. Stephen F. Grinstead, 2012, 1996
Addiction-Pain Syndrome™
AddictiveDisorder
Zone
© Dr. Stephen F. Grinstead, 2012, 1996
PainDisorder
Zone
Addiction-Pain Syndrome™
© Dr. Stephen F. Grinstead, 2012, 1996
Addiction-Pain Syndrome™
AddictiveDisorder
Zone
PainDisorder
Zone
AddictionPain
SyndromeZone
© Dr. Stephen F. Grinstead, 2012, 1996
© Dr. Stephen F. Grinstead, 2012, 1996
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?
© Dr. Stephen F. Grinstead, 2012, 1996
Looking For “Red Flags”
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?
© Dr. Stephen F. Grinstead, 2012, 1996
Looking For “Red Flags”
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?
© Dr. Stephen F. Grinstead, 2012, 1996
Looking For “Red Flags”
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?
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
Step 6 – Plan For Managing Stuck Points
Moving From…Hopeless to HopefulDemoralized to RevitalizedVictim to Victorious Powerless to EmpoweredSurviving to Thriving
© Dr. Stephen F. Grinstead, 2012, 1996
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
© Dr. Stephen F. Grinstead, 2012, 1996
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.
© Dr. Stephen F. Grinstead, 2012, 1996
Web Site Resources
www.freedomfromsuffering.netwww.addiction-free.comwww.cenaps.comwww.chronicpainanonymous.orgwww.tgorski.comwww.relapse.org
This Is Only The Beginning