The Need for Multidisciplinary Chronic Pain Treatment - Part 2

Dr. Steven Grinstead
Relapse Prevention Expert, Author & Senior Consultant Trainer for Gorski-CENAPS® Corporation

In Part One of this article you learned about the importance of utilizing a multidisciplinary team for effective chronic pain management. You also saw the importance of using collaboration instead of competition and the need to work with pain patients not on them. You also reviewed the first Addiction-Free Pain Management® treatment component—Medication Management. In this section you will learn about the remaining two components starting with teaching people to cope with the psychological and emotional components of their pain.

Cognitive Behavioral Treatment

This component consists of the eight Core Clinical Exercises from the Addiction-Free Pain Management® Workbook. The major purpose of each of the workbook exercises is not for the patient to just “fill out the forms;” the goal is to increase their understanding about their condition and show them what it takes to heal all of the biopsychosocial areas of their lives. For patients to obtain the most benefit they need to process each of these exercises with a clinician who uses a combination of Cognitive Behavioral and Rational Emotive therapy interventions. What follows is a brief description of each of these eight exercises.

Exercise One: Understanding Your Pain—Many chronic pain patients don’t have the words necessary to accurately describe the symptoms they are experiencing. Therefore in this exercise patients review and analyze a list of common symptoms that people who live with chronic pain experience and then they are asked to identify the ones that affect their own lives. Next they learn to differentiate between their physical (ascending) pain symptoms and their psychological/emotional (descending) pain symptoms. They also examine their TFUARs (Thinking, Feelings, Urges, Actions, and the Reactions of others) and how they change when they experience a bad pain day.

Exercise Two: The Effects of Prescription and/or Other Drugs—Often chronic pain patients use a variety of different medications to treat chronic pain and the underlying medical disorders that are causing the pain. In Exercise Two patients explore the benefits they experienced from using problematic pain medication (including alcohol) and other drugs and what they wanted to get from using the chemicals. They also identify the problems that they experienced as a result of problematic pain medication (including alcohol) and other drug use.

Exercise Three: Decision Making About Pain Medication—In this exercise patients look at the reasons why they started using problematic pain medication (including alcohol) and other drugs, make an assessment of life damaging problems they experienced as a result of using chemicals, and explore reasons for deciding to do something different.

Exercise Four: Finding the Solution—In this exercise patients define what their medication management and recovery plan will include. They complete and sign a medication management agreement that details their adherence to this commitment. Next they develop a relapse prevention intervention plan that describes the responsibilities for themselves, their counselor, and three significant others to stop a relapse process quickly should it occur. Finally they develop a personal craving management plan and a pain flare up plan to support them if they feel tempted to deviate from their medication management agreement.

Exercise Five: Identifying and Personalizing High Risk Situations—It is important for patients to learn how to identify the immediate high risk situations that can cause chemical use and ineffective pain management in spite of their commitment not to. In this exercise they are instructed to review a list of common High Risk Situations that can activate the urge to use/abuse problematic pain medication (including alcohol or other drugs) and/or sabotage their effective pain management program. Next they are asked to identify and personalize their own most important (critical) High Risk Situation and write a personal title and description for use in self-monitoring.
Exercise Six: High Risk Situation Mapping—Patients are asked to describe one past situation in which they experienced their immediate high risk situation in recovery and managed it poorly. This situation map is used to help them identify the pattern of self-defeating behaviors that drive their relapse process. Next they identify one past situation in which they experienced their immediate high risk situation in recovery and managed it effectively. This situation is used to identify new and more effective ways of coping with their high risk situation. These new behaviors become the foundation for Future High Risk Situation management and recovery planning.

Exercise Seven: Analyzing and Managing High Risk Situations—In this exercise patients are asked to analyze the immediate high risk situation they are learning to manage. Here they identify the irrational (addictive) thoughts, unmanageable feelings, self-destructive urges, self-defeating (addictive) actions, and reactions of others (TFUARs), that drive their high risk situation. They learn how to manage this kind of high-risk situation more appropriately by identifying three points where they can use more effective ways of thinking, feeling, and acting to avoid relapse. They are encouraged to apply these new ways of coping to future high-risk situations.

Exercise Eight: Recovery Planning—Patients develop a schedule of recovery activities that support the ongoing identification and effective management of their high risk situations. They are instructed to write a schedule of recovery activities and explore how each activity can be adapted to help them identify and manage their high risk situations.

Summarizing the Core Clinical Exercises—The first two exercises in the workbook are data gathering or assessment instruments focusing on pain. Exercises three and four are motivational with a goal to help patients make better choices with their pain management and develop a plan to implement more effective pain management strategies. Exercises five, six, seven, and eight are relapse prevention counseling exercises, and the goal of exercise eight is to develop a recovery plan to address future high risk situations for pain and addiction.

Nonpharmacological Interventions

Nonpharmacological treatments have proven effective for some pain conditions. 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.

For optimal effectiveness, an Addiction-Free Pain Management® treatment plan uses both Medication Management and Cognitive Behavioral interventions described above along with the Nonpharmacological Processes. Since each patient has problems and needs that are unique to them, different combinations of the above interventions will be necessary. The treatment team collaborates with the patient to decide how to strategically combine these three components.

In the table below is a brief list of some the nonpharmacological interventions that can be utilized. It’s important to remember that the only limitation to the types of interventions possible is the clinician or patient’s imagination.

Exercise and Stretching Cognitive Restructuring
Diet/Nutrition TENS Unit
Physical Therapy Reflexology
Yoga PA / AA /NA-type 12-Step Mtgs
Meditation Cranial Sacral Therapy
Hydrotherapy Acupuncture
Talking Circles Rolfing or Heller Work
Sweat Lodges Tai Chi or Qui Gong
Hydrotherapy Biofeedback
Hypnosis and Self-Hypnosis Neuro Linguistic Programming
Family/Couples Therapy Art Therapy i.e., collage, pottery
Sleep Therapy Chiropractic
Traditional Native Tribal Healing Volunteer Work

Chronic pain patients have a much better chance of quality recovery when their healthcare providers use a combination of Medication Management Components, the APM™ Core Clinical Exercises, and appropriate Nonpharmacological Treatment Processes. It is the healthcare providers’ responsibility to be aware of all potential resources in their communities. For more information about Addiction-Free Pain Management® please check out the remainder of our website www.addiction-free.com.or feel free to contact us at (916) 575-9961.