Effective Chronic Pain Management and Depression Issues

Psychological problems can develop as a direct result of living with chronic pain and/or long-term pain medication treatment. These problems are serious and often sabotage peoples’ ability to receive adequate pain management treatment.

There are four major areas that tend to impact chronic pain patients the most:

Depression

Irrational thinking patterns and the resultant uncomfortable emotions

Anxiety and Trauma Disorders

Sleep Disorders

Of these four the one that causes the biggest problems for the most people—and sometimes gets under-diagnosed and/or under-treated—is Clinical Depression. Therefore is important to focus on understanding and managing depression to obtain effective chronic pain management.

Hitting the Wall Called Depression

There are several types of clinical depression that involve disturbances in mood, concentration, self-confidence, sleep, appetite, activity and behavior as well as disruptions in friendships, family, work and/or school. A clinical depression is different than the experiences of sadness, disappointment and grief familiar to everyone, which makes it difficult to determine when professional help is necessary.

To learn more about the role of depression in chronic pain management please check out my article The Role of Clinical Depression in Chronic Pain Management that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are in recovery and want to learn how to develop a plan for managing your pain and medication effectively go to our Publications page and check out my book the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To learn about my upcoming trainings you can check out our Calendar page.

Chronic Pain Management for Neuropathic Symptoms

One of the more challenging types of chronic pain involves neuropathic (burning, tingling, shooting, etc, nerve pain) symptoms that opiates do NOT adequately address. A report came out in October 2007 published by Science Daily that discussed why painkillers don't work for neuropathic pain from fibromyalgia and states in part: "When the painkillers cannot bind to the receptors, they cannot alleviate the patient's pain as effectively, Harris says. The reduced availability of the receptors could result from a reduced number of opioid receptors, enhanced release of endogenous opioids (opioids, such as endorphins, that are produced naturally by the body), or both, Harris says." To read the complete report, please Click Here.

Neuropathic pain is frequent for diabetics, fibromyalgia, and shingles. Many pain management providers have tried alternative (“off-label”) medications such as Neurontin (Gabapentin) with varying degrees of success. Unfortunately, this medication sometimes causes significant side effects for many people. Fortunately, there are other medication choices such as pregabalin (Lyrica).

For example, I just came across a report presented at the American Society of Anesthesiologists (ASA) 2008 Annual Meeting regarding the Perioperative (the time period surrounding a patient's surgical procedure; this commonly includes ward admission, anesthesia, surgery, and recovery) administration of pregabalin significantly decreases the incidence of neuropathic pain at 3 and 6 months after total knee arthroplasty (TKA), according to research. The report concluded that this procedure significantly reduced the patients’ pain. To see the entire report please Click Here.

In June of 2008 the Food and Drug Administration (FDA) approved duloxetine HCl delayed-release capsules (Cymbalta) for the management of fibromyalgia. Previously, only pregabalin (Lyrica; Pfizer, Inc) was approved to treat this painful condition. Some see this as a major victory in validating fibromyalgia as a legitimate diagnosis while others see this as a greed-driven pharmaceutical ploy. Having worked with many patients who were diagnosed and living with the pain and problems of fibromyalgia I am firmly in the first camp.

To read more about this topic please go to our 2008 Research Archive and scroll down to the Cymbalta posting. Also, near the end of the page is a posting titled Neuropathic Pain Management.

To learn more about effective chronic pain management check out my article The Right to Quality Chronic Pain Management that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are in recovery and want to learn how to develop a plan for managing your pain and medication effectively go to our Publications page and check out my book the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To check out my upcoming trainings you can check out our Calendar page.

Problems with Chronic Pain Management and Prescription Medication

Chronic pain managemebt is a serious health crisis facing many people. They can be under-medicated, over-medicated or sometimes just misdiagnosed. They may also have co-existing disorders such as an addiction that must be taken into account. No matter what a person decides regarding the question of whether or not to use prescription drugs to manage their pain, they must look at the whole picture – not just the use of pain meds. In my experience people who look at the biological, psychological and social aspects of their pain condition, and address each area, have much more favorable treatment outcomes.

Unfortunately, we live in a quick fix society. When something goes wrong we look for the fastest way to remedy the situation. When we have a headache we “pop a pill” and the problem is solved. If you watched any amount of TV the past few years you may have noticed a significant increase in commercials hyping prescription medication. Many people are demanding specific medications that they saw on TV with the mistaken belief that—if it’s advertised on TV it much be safe; for example the commercials advertising Lunesta, a sleep medication. After all how can such a cute butterfly be dangerous?

So it’s not surprising when our back starts hurting again using medication to escape from the pain is our primary concern. Our medical system is designed for crisis, or symptom management. Rarely do we look for the underlying reasons for our headache or back pain. Using the “Band-Aid” approach of taking a pill seems quicker, cheaper, and easier—but is it really?

People undergoing chronic pain management experience three major types of pain:

(a) physical or biological;
(b) psychological, which includes thinking and emotions; and
(c) the social and cultural, which influence the perception of pain.

Medication is only effective for physical or biological pain. When people use medication for the other aspects of pain, it can often lead to addiction.

I want to introduce the idea sometimes it is possible to treat a chronic pain management condition without taking medications. It’s important to remember that if a person has a condition where they need to take appropriate chronic pain management medication that they still need to incorporate nonpharmacological interventions that are appropriate for them. The main point I want to make here is that there are as many types of pain interventions as your imagination will allow, and your mind is open to.

Although managing pain without pills can be a very desirable goal, in some cases there needs to be an “appropriate” medication chronic pain management plan. This plan should be a collaborative process with a professional who understands the biopsychosocial nature of pain and the very real risks of dependency or addiction. In addition to the psychological treatment plan and the medication management plan we need to explore non-pharmacological modalities such as acupuncture, chiropractic, massage therapy, hydrotherapy, biofeedback, etc. As you can see this is anything but a “quick fix.”

To learn more about effective chronic pain management—especially when other coexisting disorders are present—please check out my article The Need for Multidisciplinary Chronic Pain Management, that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To learn about my upcoming trainings you can check out our Calendar page.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Seven Steps Towards Effective Chronic Pain Management

Below are seven strategic steps that I believe are necessary for people undergoing chronic pain management to learn in order to overcome obstacles for obtaining appropriate and effective chronic pain management. The rational and more in depth explanation for each of the following steps can be found in my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System.

1. Developing an Initial Multidisciplinary Pain Management Plan: The first step of effective pain management is utilizing a multidisciplinary assessment protocol. The patient needs to objectively examine their current pain management program. They should list each of the medications and non-pharmacological pain management interventions they are currently using and answer pertinent questions about each one. They also need to list their professional and personal support system, identifying the strengths and weaknesses of each.
2. Looking At Pain Objectively: This component explores how to increase the patients’ understanding of their pain and how to use that knowledge to improve their pain management. They need to learn the different aspects of pain—acute and chronic—and the bio-psycho-social components of pain as well as the difference between pain and suffering. They should learn about the stress-pain connection and how to rate their stress and pain levels accurately. Finally they need to explore how their thinking, emotions, behaviors, and social relationships change when they’re having a “bad” pain day.
3. Understanding and Managing Depression: Since depression frequently affects people in chronic pain, in this component patients need objective and easy to understand information about depression and what constitutes effective depression management. They should learn how to accurately rate the type and level of depression symptoms they experience and then develop their own personal six-step depression management plan.
4. Exploring Effective Use of Medication: This component starts with educating patients about some common, and possibly misunderstood, terms like medication abuse, dependency, pseudo addiction, and addiction. Patients need to learn how to use a Red Flags checklist to see if they have a problematic relationship with their pain medication. They also need to learn the role of denial and finally explore the benefits and disadvantages of using appropriate pain medication.
5. Developing An Effective Chronic Pain Management Plan: In this component patients are exposed to the concept of a Pain Management Agreement and how to deal with urges/cravings that could tempt them to use pain medication in an inappropriate manner. They should develop a nonpharmacological (non-medication) pain management plan and learn to utilize a pain journaling process to increase their pain management skills.
6. Exploring Biological versus Psychological/Emotional Symptoms: This component focuses on explaining ascending versus descending pain signals and exploring and scoring the patients’ biological and psychological/emotional pain symptoms. Patients also need to look at how their TFUARs (thinking, feeling, urges, actions, and social reactions) change on a bad pain day and how to manage their TFUARs more effectively.
7. Finalizing the Pain Management Plan: This component ties everything together by teaching patients to identify and rate their bio-psycho-social-spiritual pain management goals. Then they should learn how to improve their existing pain management foundation and test this new plan to make sure it is effective.

If you want to learn more about effective pain management for someone undergoing chronic pain management with coexisting disorders including addiction please check out my article The Need for Multidisciplinary Chronic Pain Management, that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To learn about my upcoming trainings you can check out our Calendar page.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Looking Objectively at Pain for Effective Chronic Pain Management

Pain Is a Signal That Communicates Information

The easiest way to understand pain is to recognize that every time you feel pain your body is attempting to tell you that something is wrong. Pain sensations are critical to human survival. Without pain you would have no way of knowing that something is wrong with your body. So without pain you would be unable to take action to correct the problem or situation that is causing your pain.

What Is Your Pain Trying To Tell You?

Whenever you are experiencing pain, it’s always helpful to ask: “What is my pain trying to tell me?” I believe that pain is trying to tell you that something is wrong and that you had better find out what exactly is wrong and find a way to fix it. To understand the language of pain, you must learn to understand how the pain echoes and reverberates between the physical, psychological, and social dimensions of the human condition. Pain is truly a total human experience that affects all aspects of human functioning.

Knowledge is power. Once you know what is really going on with your body and mind you can start to take action to effectively manage your pain. In fact, you need to stop believing pain is your enemy and begin to embrace it as your friend. I know this is easier said than done. Many of my patients have looked at me like I’m crazy when I tell them they must make peace with their pain and that pain is really their friend. They tell me—very strongly in some cases—that they can’t buy it, but nevertheless it is true. Below are three very important tips I give all my patients and also practice myself.

1. Stop Believing Pain Is Your Enemy!
2. Make Peace With Your Pain!
3. Start Embracing Pain As Your Friend!

To learn about the importance of treating the whole person for effective chronic pain management please check out my article The Need for Multidisciplinary Chronic Pain Management, that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To learn about my upcoming trainings you can check out our Calendar page.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

The Chronic Pain Management Trance

Sometimes people undergoing chronic pain management drop into a deep dark trance, especially if they don’t receive appropriate help early on. Pain, especially chronic pain, is an emotional condition as well as a physical sensation. It is a complex experience that affects thought, mood, and behavior and can lead to isolation, immobility, and sometimes drug dependence or addiction. A quick response is necessary to lessen the risk of these horrible consequences.

Reveille — it’s time to wake up!

I remember my days in the U.S. Marine Corps when every morning we were woke up with a bugle playing Reveille; which comes from the French for “wake up.” If only waking up from the chronic pain trance was as simple as responding to a bugle call.

In some ways the chronic pain trance resembles depression, and the relationship between the two is very intimate. Pain is depressing, and depression can cause and even intensify pain. People living with chronic pain have three times the average risk of developing coexisting psychological disorders—usually mood or anxiety disorders—and depressed people have three times the average risk of developing chronic pain.

Clinical Depression is the number one psychological (mood) disorder that causes the biggest problems for the most people living with chronic pain—and it often gets under-diagnosed and/or under-treated. A variety of recent medical studies have drawn a strong association between chronic pain and a diagnosis of major depression. The two conditions seem to go hand-in-hand in a large percentage of unfortunate patients who suffer the debilitating effects of both chronically painful conditions and persistent mood problems.

Researchers still cannot determine whether there is a cause-and-effect relationship between chronic pain and depression, and if there is, which condition causes the other. Some research suggests that insufficiently treated, ongoing pain may cause changes in the chemical environment of the brain, thereby increasing the likelihood of depression.

Similarly, other research suggests that insufficiently treated, ongoing depression causes changes in the chemical environment of the brain such that it increases an individual’s perception of painful sensations. Regardless of the etiology, concurrent treatment is necessary for successful treatment outcomes.

To better understand the importance of addressing depression in chronic pain management please check out my article, Depression Management with the Chronic Pain Patient, that you can download for free on our Ariticles page. To learn about my upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

From Denial to Effective Chronic Pain Management

Learning to identify and manage denial is a necessary first step for people undergoing chronic pain management who want to learn how to develop and implement an effective chronic pain management plan. There are some people undergoing chronic pain management treatment who have experienced significant problems related to living with chronic pain, but who honestly don’t believe—or don’t want to believe—that their decisions and behaviors are undermining what could be an effective chronic pain management plan.

A major obstacle to recognizing these self-sabotaging behaviors and achieving effective chronic pain management treatment is the denial system—a psychological defense mechanism that protects us from devastating pain and problems that is automatic and unconscious. Remember that this system of defense was developed to protect us from being overwhelmed by what I call Painful Reality.

There are situations when denial can help us cope with painful reality; e.g., the death of a loved one, an unforeseen medical crisis, etc. Unfortunately, denial can also prevent us from looking at or dealing with a situation that is causing life-damaging consequences.

If we don’t realize how serious our problem really is, it can be extremely difficult for us to find a solution. For example, many people have a mistaken belief that “I can’t be addicted because I’m in pain and a doctor gave me the medication.” This can be a type of denial if in fact they have been abusing or are addicted to their chronic pain management medication and experiencing life-damaging consequences. Denial can be even subtler than this. It can also lead people to behave in ways that are inconsistent with appropriate treatment recommendations.

There are four levels of denial. The first is a lack of information—in this case, what ineffective pain management or medication abuse/addiction really is. The above example demonstrates this first level—the mistaken belief that because a doctor prescribed the chronic pain management medication, there won’t be an addiction problem. The solution here is education and up-to-date information about addiction. It is crucial for people undergoing chronic pain management treatment to learn as much as possible about effective chronic pain management, pain disorders, and substance use disorders—i.e., prescription drug abuse or prescription drug addiction.

The second level of denial is conscious defensiveness. At this level we know that something is wrong, but we don’t want to look at the problem and face the pain of knowing. The solution is to recognize that there is an inner conflict occurring where one part of us knows there’s a problem, but another part doesn’t want to admit it. To resolve this conflict we must be willing to listen to the part that knows the truth and take action. The old saying “the truth will set you free” is certainly relevant in this case.

The third level is denial as an unconscious defense mechanism. We get to this level when we have stayed in the inner conflict, mentioned above, and the defensive voice keeps winning. Once this happens, denial becomes an automatic and unconscious defense mechanism. The solution is much more difficult. It usually takes an outside intervention, or what is called a motivational crisis, to break through this defense and allow us to know the truth, and then start addressing the problem. For some of my patients this motivational crisis was generated when their treating physicians became concerned about their mismanaged chronic pain or use/abuse of pain medication. For others it was family members intervening and urging them to seek help.

The fourth level is denial as a delusional system, which is the toughest level to address. This delusion is a mistaken belief that is firmly held to be true despite convincing evidence that it is not true. If someone was experiencing denial at this level, they probably wouldn’t be open to reading this blog. People at this level of denial usually need long-term psychotherapy to resolve their delusional system.

To learn more about chronic pain management and denial please check out my article From Denial to Effective Pain Management that you can download for free on our Article page. You can also check out my article Managing Pain Medication in Recovery.

To check out my upcoming trainings you can check out our Calendar page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people in chronic pain or are living with chronic pain and have any resistance or denial and want to learn how to develop a plan for helping to identify and manage denial please go to our Publications page and check out my book the Denial Management Counseling for Effective Pain Management Workbook. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

Positive Use of Avoidance in Chronic Pain Management

Avoidance by Distraction

I believe that it's important to note that the psychological defense mechanism called denial can be problematic, but what may surprise you is that at times it can also be helpful. When denial is automatic and unconscious it can lead to life-damaging consequences and prevent people from taking needed action. However, some of the denial patterns can also be used strategically to help overcome problems.

One of these helpful patterns is a type of the avoidance denial pattern called Avoidance by Distraction. This denial pattern can be used in a very positive way to help someone with their pain management. For example I treated one patient who learned to use this distraction tactic to focus on being present with her grandchildren instead of being overly caught up in her suffering. She discovered that when she was truly present with one of her grandchildren she did not notice her pain as much. “Those who have something better to do don't suffer as much.” –- W. Fordyce, Ph.D.

Unfortunately, some people take distraction to the extreme and cause even more damage to their bodies, as well as significantly increasing their pain levels. The goal here is to help people learn to focus their attention on something more interesting and positive than suffering. Positive results will manifest when people undergoing chronic pain management learn to utilize this particular intervention, along with proper activity pacing as well. Some people need to learn to slow down or take it easy, while others need to increase their activity levels and push themselves a little more.

To learn more about chronic pain management and changing your perception of pain please check out my article Coping with Anticipatory Pain , that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you or a loved one is undergoing chronic pain management, especially if you're in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To learn about my upcoming trainings you can check out our Calendar page.

Making Important Decisions About Chronic Pain Management

The initial decision to seek help is the most crucial point in the treatment process for someone experience quality of life problems due to ineffective chronic pain management. Finding treatment providers who are willing to work with people—not on people—is essential. It is crucial to find doctors, therapists, or counselors who are willing to see the chronic pain management patient as a whole person, and not just their pain condition or list of symptoms.

Making an Empowered Decision

I often ask my patients to ask themselves the five questions below and answering as completely and truthfully as possible to assist them to make their decision to start the an effective treatment process. I invite them to share their answers to these questions with someone they trust—as well as someone who will be honest with them—to obtain an accurate reality check.

1. What is the best that will happen if I continue using my pain medication and/or managing my pain the way I have been doing?
2. What is the worst that will happen if I continue using my pain medication and/or managing my pain the way I have been doing?
3. What is the worst that will happen if I decide to start on this APM recovery journey?
4. What is the best that will happen if I decide to start on this APM recovery journey?
5. Am I willing to make a commitment to complete this APM process and develop a plan to overcome any resistance or obstacles? Please explain why or why not!
   

Once someone has fully answered these five questions they will have the information they need to make an empowered decision and the beginning of an action plan to move them forward. It is imperative that they not do this work alone for many reasons. The most important is that many people in chronic pain management, or who suffer from substance abuse/dependency often isolate themselves. Another reason is that you deserve to have support when dealing with this problem.

The Addiction-Free Pain Management® (APM) treatment process requires a tremendous amount of hard work and self-honesty, as well as allowing other people to join their team who are willing—and able—to support them in a healthy way.

If someone is currently using their pain medication problematically or experiencing negative consequences from the medication, they may need detoxification treatment or a medication taper before starting the APM™ process. Some chronic pain management patients may not have reached the abuse or dependency stages yet, but they too can benefit from the APM™ process so they do not have to experience the painful ramifications of a full blown addictive disorder.

To read more about the importance of using a team approach for chronic pain management please check out my article The Need for Multidisciplinary Chronic Pain Management, that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To learn about my upcoming trainings you can check out our Calendar page.

Nonpharmacological Chronic Pain Management

Nonpharmacological (non-medication based) treatments have proven effective for many pain conditions. For example, recent studies have shown that endorphins mediate the analgesic effects of acupuncture and placebos as well. Still to be discovered is the mechanism by which hypnosis accomplishes its analgesic effects.
The Addiction-Free Pain Management® System uses both of the components that were described earlier along with the nonpharmacological processes briefly described below. You will be provided with a more extensive overview of these and more nonpharmacological approaches in a later chapter. Since each of you has your own unique problems, different combinations will be needed for each person.
Please find below a starting point for developing your own nonpharmacological chronic pain management plan.

1. Breathing & Relaxation: When you are in a pain flare up your body’s automatic reaction often includes a reflexive tensing response. This can lead to your being unable to relax the locus of the pain, which results in increased muscle tension in these areas. You need to consciously practice relaxing the affected muscles. This enables you to modulate your pain levels and bring the pain under your control without needing to increase your medication. Using deep slow breathing can help you soften and relax your over-tense muscles.
2. Increasing Activity/Fitness: When you experience pain flare ups, you may become very sedentary, with strong avoidance tendencies for many types of activities. The two primary reasons for this are the pain itself, and your own predictions (anticipatory pain) regarding the negative impact of activity. Therefore, it is crucial to return to more normal levels of activities and then slowly increase your stamina for physical activities. The goal is to extinguish conditioned avoidance patterns.
3. Diffusing/Reducing Emotional Over-reactivity: When you are experiencing intense uncomfortable emotions—especially about being in pain—your pain levels actually intensify. Your emotions become like an amplifier circuit that increases the “volume” of your pain. You need to practice specific methods of reducing this automatic process that occurs in the face of stressful triggers. You need to realize that you may not be able to eliminate these problematic emotional triggers, but what you can learn are different methods of reacting and managing your feelings.
4. External Focusing/Distraction: The more you focus on your pain, the more you actually intensify your experience of the pain. You need to learn to shift and manipulate your focus of attention in a positive way, which will minimize your experience of the pain. This can be accomplished by changing how you think and feel about your pain. You can then find pleasant activities or tasks to take your focus off of your pain.
   Using Anything That Works: There are numerous interventions that you can attempt when your pain flares up. In addition to those listed above you can use breathing, muscle relaxation, visual imagery, music, cold/heat, stretching, massage therapy, stress management, acupuncture, acupressure, TENS Unit, journaling, hydrotherapy, etc.
5. My Personal Plan: Try to imagine yourself in a situation when you are experiencing a pain flare up and you need to intervene in a positive and proactive manner. Then using the above interventions as a starting point, please list your step-by step action plan—your plan should have at least four (4) interventions—again, the more the better.

Another useful nonpharmacological intervention is learning to manage Anticipatory Pain. To learn more about chronic pain management and changing your perception of pain please check out my article Coping with Anticipatory Pain , that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you or a loved one is undergoing chronic pain management, especially if you're in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my books; especially the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To learn about my upcoming trainings you can check out our Calendar page. To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.

Chronic Pain Management Clinical Philosophy

I want to list below the Seven Point Clinical Philosophy of Pain Management that I developed for our Addiction-Free Pain Management® Centers of Excellence in the United States. I would like to suggest that all treatment programs develop similar philosophies for effective pain management.

1. We believe that each patient’s report of pain is valid. Our approach to assisting the patient is driven by this basic assumption.
2. We treat each patient with dignity, acknowledging their perception of pain and accepting their cultural, spiritual, and psychological values as their reality.
3. Our primary goal is to assist the patient in wisely and skillfully managing their pain experiences, based upon the patient’s stated desire for pain relief.
4. Given the nature of our focus—working with patients addicted to mood altering chemicals—addressing both patients’ pain and their addiction becomes a delicate balance. We will therefore work to complete a comprehensive pain assessment with reassessment at regular intervals taking into account a patient’s progress. This can only be accomplished using a multidisciplinary team approach.
5. Pain will be a component of the patient’s interdisciplinary treatment plan. We educate all clinicians to assure competence in dealing with the addicted patient whose treatment is complicated by coexisting pain issues.
6. Our role is that of advocate for the patient to assist him/her in achieving their recovery goal while providing relief of pain.
7. We have a committee for ongoing examination of our work treating patients with acute and/or chronic pain. If we determine that we are unable to adequately and safely treat a patient with co-occurring pain issues we will offer resources to the patient that may better address his/her pain needs.
   

To learn more about the importance and prerogative of obtaining effective chronic pain management please check out my article The right to Quality Chronic Pain Management that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression, addiction and other coexisting psychological disorders effectively please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here. Also, please check out my Addiction-Free Pain Management® Workbook. To purchase this workbook please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To learn about my upcoming trainings you can check out our Calendar page.

Roadblocks to Effective Chronic Pain Management

Living with chronic is a major challenge for most people—I know it is for me. One of the reasons so many people struggle concerns not identifying all the coexisting conditions or problems that could be interfering with effective chronic pain management. I cover these in-depth in my publications (e.g., Managing Pain and Coexisting Disorders and the Addiction-Free Pain Management® Recovery Guide) and in my article entitled Overcoming Obstacles for Effective Pain Management that you can download for free on our Article Page.

I want to just post the bulleted highlights of that article here.

The Problem

* Undiagnosed Coexisting Disorders
* The Denial Blindfold
* The Depression and Isolation Pit

The Solution

* Knowledge is Power
* Pain is our Friend—not our Enemy
* Treating the Bio-Psycho-Social Components of Pain
* The Addiction-Free Pain Management® System

You can learn more about the Addiction-Free Pain Management® System at our website http://www.addiction-free.com/ If you are working with people in chronic pain and want to learn how to develop a plan for managing their pain and coexisting psychological disorders including depression or addiction effectively please go to our Publications page and check out my book the Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To listen to a recent radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.