Preventing Vulnerabilities Pain Management
Counselor Toolbox for Mental Health...

 
 
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Pain, Moods and Management
Dr. Dawn-Elise Snipes PhD, LPC-MHSM, LMHC
Executive Director, AllCEUs
Host, Counselor Toolbox
President, Recovery and Resilience International

CEUs are available as part of a larger course here: 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—push them away so you don’t 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 “day-clothes”
– Turn on lights and sit in front of a window or get outside to get your “day-clock” 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 – 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