The Center for Disease Control and Prevention has recently published a guideline to limit the prescription of opioids for chronic pain. They report that:

From 1999 to 2014, more than 165,000 persons died from overdose related to opioid pain medication in the United States. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication. Non pharmacologic therapy and non opioid pharmacologic therapy are preferred for chronic pain. Patients with pain should receive treatment that provides the greatest benefits relative to risks. The contextual evidence review found that many non pharmacologic therapies, including physical therapy, weight loss for knee osteoarthritis, psychological therapies such as CBT, and certain interventions can ameliorate chronic pain. In summary, evidence on long-term opioid therapy for chronic pain outside of end-of-life care remains limited, with insufficient evidence to determine long-term benefits versus no opioid therapy, though evidence suggests risk for serious harms that appears to be dose-dependent.

ACIS offers an innovative, multi-disciplinary, pain management therapy.

Treatment is based on the “Addiction-Free Pain Management™ System” developed by Dr. Stephen Grinstead. This treatment model helps chronic pain patients manage their pain in a safe, recovery-oriented manner, while improving their overall quality of life.

Cognitive-behavioral therapy(CBT) helps a person focus on his or her current problems and how to solve them. The counselor helps the client learn how to identify distorted or unhelpful thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly. CBT teaches relaxation techniques, stress management, and other ways to help cope with pain. Physical, psychological, and social factors all play a role in pain management.

Cognitive-behavioral therapy is based on the idea that thought and behavior patterns can affect symptoms and disability, and may be obstacles to recovery. For example, when you feel a familiar type of pain starting or getting worse, you probably have a sense of how it will progress. If you are used to the pain being severe or long-lasting, you may expect the pain to become more intense. This thinking may make you feel out of control or helpless. A stress response like this can trigger physical changes in your body, such as a rise in blood pressure, the release of stress hormones, muscle tension, and more pain.

You can expect to attend several sessions with a counselor, each lasting an hour. Sometimes therapy takes place in a group setting. You will be taught specific exercises that increase your ability to cope and your feelings of control. Your counselor will give you homework to encourage you to change the way you respond to your symptoms. You will then practice changing a certain behavior until the next session.

Three Main Stages of Treatment:

• Evaluation & understanding of the pain process
• Learning non-pharmaceutical approaches to pain while decreasing dependence on pain medications
• Development of a pain management plan, including ways to identify and cope with high-risk pain situations and related emotional issues
  

Treatment Goals are as follows:

• Evaluate for addiction versus pseudo-addiction
• Determine pain etiology
• Effective medication management
• Restore physical fitness to maximum level
• Decrease stress
• Increase ability to problem solve
• Treat depression, anxiety, grief and loss
• Relapse prevention
  

Treatment Components may include:

• Physical Management of Pain:
  1. Comprehensive pain assessment
  2. Comprehensive nutrition assessment
  3. Red Flags Checklist – appropriate v. addictive use of pain medication
  4. Contact all prescribing physicians
  5. Develop one pain medication plan
  6. Explore non-narcotic alternatives
  7. Osteopathic manipulations
  8. Trigger point compressions
  9. Physical therapy
  10. TENS unit

• Cognitive/ Psychological Management of Pain:
  1. Psychiatric consultation
  2. Pain education sessions
  3. Pain journaling
  4. Addiction information sessions
  5. Positive self-talk/affirmations
  6. Impulse control
  7. Relapse prevention
  8. Group therapy
  9. Individual cognitive therapy
  10. Pain processing group
  11. Pain workbook sessions
  12. Stress management
  13. Chronic pain anonymous support group

• Non-Pharmaceutical Approaches:
  1. Biofeedback
  2. Acupuncture
  3. Yoga
  4. Reike
  5. Expressive arts
  6. Art therapy
  7. Music therapy
  8. Movement therapy
  9. Walking groups/walking meditation

As a commitment to therapy, patients are asked to provide consent for the therapists to speak to all prescribing professionals, attempt to eliminate all addictive substances and instead try non-pharmaceutical approaches to managing pain. In addition, a family session with a counselor is strongly encouraged.

 

In order to achieve the best quality of life and level of functioning, people living with chronic pain must learn as much as they can about the subject of pain and what constitutes effective pain management. I know that pain is a signal that tells us there is damage or something wrong with our system. However, with some chronic pain conditions, the system (including the brain) gets altered. The pain system gets turned on and cannot be turned off. Dr. Stephen Grinstead, PhD calls this the “hijacked” brain or what is often referred to as Neuroplasticity (also called brain plasticity, cortical plasticity or cortical re-mapping). A surprising consequence of neuroplasticity is that the brain activity associated with a given function can move to a different location as a consequence of normal experience or brain damage/recovery. In the case of chronic pain this can mean that pain signals keep occurring despite lack of a trigger or tissue damage.

According to research published in Annals of the New York Academy of Sciences 933:175-184 (2001) Spinal Cord Neuroplasticity following Repeated Opioid Exposure and Its Relation to Pathological Pain; convincing evidence has accumulated that indicates there are neuroplastic changes within the spinal cord in response to repeated exposure to opioids. Such neuroplastic changes occur at both cellular and intracellular levels. Unfortunately, most pain conditions in this country are treated with opiates — some research shows as high as 90 percent of people undergoing pain management are prescribed opiates. With so many people living with chronic pain and using opiates, these neuroplastic changes need to be better understood.

I use simple language and metaphors or visual images when educating patients. Many people may not understand the term Neuroplasticity so I use the metaphor of the hijacked brain. I tell them the reality of neuroplasticity science is much more complex, but in essence what happens is that the brain forms pathways (called neuro-networks) that eventually become super Highways — in other words the new neuro-network becomes more complex and elaborate. In order to replace pain behaviors or suffering with reduction or elimination of pain, new brain pathways need to be developed. Terry Gorski uses the example of living in a rural area with an outhouse over a hundred yards from the back door. Between the back door and the outhouse is a field of heavy vegetation that is very hard to walk through. On the first trip it takes a long time and is very difficult but some of the vegetation is getting ramped down just a little so the trip back is not quite as hard. After several trips it gets much easier.

I expand this metaphor by saying treatment is like gaining access to landscaping equipment that will assist you in putting in a paved path to your goal — effective pain management. It is crucial to develop new ways of thinking, more effective methods of managing painful emotions and new ways of behaving that will improve pain management and quality of life. To do this, new neuro-pathways need to be generated and used over and over until the highway is built. Unfortunately, there are many obstacles that can get in the way and detour people back to the old highways.

The Addiction-Free Pain Management® (APM) System is designed to assist people in building these new brain pathways to address obstacles to effective pain management. One of the most common are pain flare ups caused by painful or stressful situations. For example, the APM™ Workbook helps people identify and develop management strategies for high risk situations and pain flare ups. The APM Recovery Guide: Managing Pain & Medication in Recovery was developed to educate people about chronic pain and coexisting disorders including addiction and how to more effectively complete the APM™ Workbook. These are but two of the tools that can help people take back their hijacked brain — knowledge combined with action is power!

 

What To Expect After Treatment

Cognitive-behavioral skills can change the way your mind influences your body. When you shift your thinking away from the pain and change your focus to more positive aspects of your life, you change the way your body responds to the anticipated pain and stress.

Why It Is Done

The goal of cognitive-behavioral therapy is to change the way you think about pain so that your body and mind respond better when you have episodes of pain. Therapy focuses on changing your thoughts about illness and then helping you adopt positive ways of coping with illness.

How Well It Works

CBT can be helpful for chronic pain by changing the way you think about pain. It also teaches you how to become more active, because pain can also improve with appropriate physical activity, such as walking or swimming.