101 -Preventing Vulnerabilities: Pain Management
Counselor Toolbox

 
 
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Pain, Moods and Management
Dr. Dawn-Elise Snipes PhD, LPC-MHSM, LMHC
Executive Director, AllCEUs
Host, Counselor Toolbox and Happiness Isn't Brain Surgery with Doc Snipes
President, Recovery and Resilience International

Counseling CEUs can be earned for this podcast at: https://www.allceus.com/member/cart/index/product/id/616/c/

Objectives
~    Characteristics of pain
~    Effects of pain
~    Depression
~    Anxiety
~    Guilt
~    Lowered Self Esteem
~    Lethargy
~    Circadian Rhythm Disruption
~    Understanding Your Pain
~    Exacerbating factors
~    Mitigating factors

Objectives
~    Medical Interventions
~    Tylenol
~    NSAIDS
~    Opiates
~    Muscle Relaxants
~    Nerve Blocks
~    Accupuncture/Accupressure
~    Nonmedical Interventions
~    Guided Imagery
~    Radical Acceptance
~    Stretching/Balancing Exercises
~    Ice or Heat Packs
~    Massage
~    TENS units
~    Stress Management

Characteristics of Pain
~    Everyone has pain sometimes
~    Our bodies are incredibly resilient
~    Knowing your pain can help your doctor/physical therapist
~    Acute or Chronic
~    Stabbing, aching, throbbing, burning…
~    Constant or intermittent
~    Stationary or radiating
~    Any numbness

Effects of Pain
~    Depression
~    Fatigue
~    Sleep Disturbances
~    Hopelessness/Helplessness
~    Negative thoughts -> Stress ->  Serotonin -> Pain
~    Interventions
~    Mindfulness
~    Good sleep habits
~    Circadian rhythm maintenance
~    Identify the things you CAN control and that are GOOD
~    Eat healthfully to support Serotonin functioning

Effects of Pain
~    Anxiety
~    Things wont get better
~    It is getting worse
~    Consequences of pain (lost job, relationships, fitness…)
~    Interventions
~    Avoid caffeine and nicotine
~    Educate yourself about the disorder and the PROBABILITY things will get worse
~    Keep a log of the good and bad days
~    Practice distress tolerance skills
~    Use the Challenging Questions Worksheet to address anxiety provoking thoughts

Effects of Pain
~    Guilt
~    Self anger for not being able to…
~¬†¬† ¬†Can cause you to lash out at others‚ÄĒpush them away so you don‚Äôt disappoint them like you disappointed yourself
~    Interventions
~    Think about how you would want your child or best friend to feel if they were in your position
~    Get rid of the shoulds
~    Focus on the things that you CAN do
~    Decide whether it is worth using your energy to be mad at yourself (and the world)

Effects of Pain
~    Grief
~    Stages: Denial, Anger, Bargaining, Depression, Acceptance
~    Interventions
~    Work through the stages of grief for each of the losses because of the pain (Physical, self-concept, job, freedom (driving/mobility), dreams…)

Effects of Pain
~    Self-Esteem
~    How you feel about the difference between who you want to be and who you are
~    Interventions
~    Make a list of the positive things about you
~    Identify 1 or 2 goals you can work toward
~    Celebrate small things
~    Silence the inner critic

Effects of Pain
~    Circadian Rhythm Disruption
~    Not getting out of bed
~    Staying inside in the dark
~    Sleeping too much
~    Interventions
~    Get out of bed at roughly the same time each morning
~¬†¬† ¬†Get dressed in ‚Äúday-clothes‚ÄĚ
~¬†¬† ¬†Turn on lights and sit in front of a window or get outside to get your ‚Äúday-clock‚ÄĚ started
~    If you must take a nap, keep it under 45 minutes to avoid messing up your sleep schedule

Understanding Your Pain
~    Exacerbating factors
~    Emotional
~    Mental
~    Physical
~    Environmental
~    Social
~¬†¬† ¬†Mitigating factors ‚Äď Do these
~    Emotional
~    Mental
~    Physical
~    Environmental
~    Social

Medical Interventions
~    Tylenol and NSAIDS (Over the counter)
~    Opiates
~    Provide relief by attaching to opioid receptors
~    Body stops making natural (endogenous) opioids when flooded with prescription opiates
~    Over time body reduces amount of opiate being let through (tolerance) (after only several days)
~    When you stop taking prescription opioids the body takes a few days to start making natural opioids again so pain threshold is markedly decreased

Medical Interventions
~    Muscle Relaxants (Flexeril, Soma(abusable))
~    Gabapentin (Neurontin)
~    SSRIs (Cymbalta)
~    Nerve Blocks
~    Accupuncture/Accupressure

http://www.webmd.com/pain-management/features/acupuncture-pain-killer#1
Arch Intern Med. 2012;172(19):1444-1453. Acupuncture for Chronic PainIndividual Patient Data Meta-analysis  http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1357513

Nonmedical Interventions
~    Guided Imagery
~    Color Imagery: Think of a color that you associate with pain, such as red, and picture the painful area of your body as red. Imagine shrinking, fading or dispersing the red.
~    Symbol Imagery: Think about how the pain feels. Does it feel like a knife sticking in your joint? If so, imagine you are pulling the knife out of your joint and throwing it away
~    Scenic Imagery: Imagine a place that is calming to you using all of your senses

Nonmedical Interventions
~    Mindfulness
~    Alternate focus: Stop thinking about the pain and how to relieve it
~    Deep relaxation breathing through the pain
~    Distractions
~    One moment at a time

Nonmedical Interventions
~    Radical Acceptance
~    Life can be worth living even with painful events
~    Rejecting reality does not change reality.
~    Changing reality requires first accepting reality.
~    Pain can’t be avoided; it is nature’s way of signaling that something is wrong.
~    Rejecting reality turns pain into suffering.
~    Refusing to accept reality can keep you stuck in unhappiness, bitterness, anger, sadness, shame, or other painful emotions.

Nonmedical Interventions
~    Stretching/Balancing Exercises
~    Chest/Upper Back
~    Right/Left Back/Chest
~    Abs/Lower Back
~    Ice or Heat Packs
~    Massage
~    TENS units
~    Improve sleep
~    Do more things you enjoy

Nonmedical Interventions
~    Stress Management
~    Stress causes
~    Digestive upset/pain
~    Back pain
~    Migraines/headaches
~    Jaw pain
~    Interventions
~    Meditation
~    Distract Don’t React
~    Identify your most important values, decide whether stressing over [this] gets you closer to or further away from your goals/calues

Summary
~    Pain is inevitable
~    It impacts your
~    Mood
~    Thoughts
~    Behaviors
~    Relationships
~    Addressing pain will help reduce related
~    Anxiety
~    Depression
~    Anger
Summary
~    Pain Management
~    Medical
~    Nonmedical
~    Pain management requires a comprehensive approach addressing
~    Physical causes of pain
~    Mood
~    Social supports
~    Sleep