Welcome
To the April 2009 Issue of “Chronic Pain Solutions,” our Addiction-Free Pain Management® Newsletter which will keep you apprised of our projects, the latest news stories and research we have on our website as well as upcoming events and trainings.
The Question of the Month for April is from a reader who has had migraine and cluster headaches for the past three years. The question of how to manage these debilitating headaches is one many people struggle with every day. We hope the answer below facilitates a better understanding of the problem.
The March 31st training Are We Managing Pain or Fueling Addiction was well attended by a number of agencies in the Sacramento area and individuals looking for better ways to help their clients. They were an interactive, fun group of people. Our host site, The Sierra Health Foundation, was a spectacular venue.
Early registration for our next training, The Addiction-Free Pain Management® Certification (20 CEUS), co-sponsored with NCADD Sacramento and the Azure Acers Program and being held on May 18-19th, is being extended until April 22nd. Not only that, if you call Ellen at 916-575-9961 and register by April 22nd you will receive the early registration rate of $295, plus a $20 discount when you mention you are a Chronic Pain Solutions subscriber.
We hope that this incentive, along with the important skills you will gain, will encourage you to join us. But if you can’t, please pass our newsletter on to your colleagues who might be interested. If someone you refer signs up for the Certification Training, you will receive a Referral Gift with our thanks! Just have them mention your name when they register.
Don’t forget, If you live near Ft. Myers, Florida, or plan on attending the 8th Annual Addiction Conference, (May 25-29, 2009), Dr. Grinstead and Dr. Shari Corbitt will be presenting a training based on their new book Eating Addiction Relapse Prevention Workbook that came out in late 2008. They will be teaching participants how to adapt the proven Gorski-CENAPS® relapse prevention protocols to eating addiction clients.
Thank you for your continued interest. Your input is always appreciated. On the Contact Us page feel free to email any questions or comments.
Gorski-CENAPS® Corporation News
E-Learning Recovery Based Education — Terry Gorski recently announced his dynamic E-Learning Web-based Recovery Education and Self-Application System. Last year he began working with Wayne Blampied, and created the first version of a cutting edge web-based recovery education sessions with daily self-application inventories. Please take a few minutes to review a trial version at the CENAPS®
Website.
This program does not replace the need for clinical staff, but makes them more effective by allowing them to quickly and easily monitor the progress and problems of each client in how they understand and use the course information. This frees the clinical staff from repetitive educational tasks and allows them up to spend more time helping clients apply vital recovery information to their lives.
Mr. Gorski wants to offer our subscribers the
FREE use of this state-of-the-art addiction education and self-awareness program for one full year. In this way you can directly experience the power of it for yourself. Please contact Wayne at 905-497-1268 for a free activation code.
Mr. Gorski will continue his mission in Relapse Prevention, but In light of the economy will be offering a LIMITED number of Relapse Prevention Workshops this year.
The Relapse Prevention Counseling Training (20 Hours) teaches advanced clinical skills for the identification and management of high-risk situations that can cause relapse in early recovery before a stable recovery program has been fully established. The training uses a strategic RPC Treatment Plan for managing high-risk situations that is based on proven research-based cognitive-behavioral therapy procedures. (See March 12-14 and May 1-2, 2009 for trainings in PA and NY)
The Relapse Prevention Therapy Training (44 hours) on May 4-8, 2009 teaches advanced clinical skills training for professional clinicians who want to learn powerful approaches for supporting clients to identify and manage the core personality and life-style warning signs that lead to someone becoming dysfunctional in recovery and eventually relapsing. In its eighth revision and streamlined to be administered in a limited number of sessions, this training forms a foundation for clients to deal with the chronic, physical and emotional pain that often precedes relapse.
This RPT Certification is being taught by Mr. Gorski and Dr. Stephen F. Grinstead, which gives participants an excellent opportunity to learn from the developer of these two powerful models – Terence T. Gorski, world recognized in Relapse Prevention and Dr. Stephen F. Grinstead, developer of the APM System.
You can register for the Tampa, Florida training by calling CENAPS® at (352) 596-8000. Keep in mind there are only 24 spaces left for this event.
APM Coaching Groups
This year, we hope to assist treatment programs around the country in the continuing care of people with chronic pain and coexisting disorders including addiction. They have unique health care challenges that the traditional client with only an addictive disorder does not. To that end, we have developed Addiction-Free Pain Management® Continuing Care Coaching: a year long, three-phase process offered through a conference call format to provide clients with the most flexibility as they return to their families and community.
After they leave residential or outpatient treatment, our program can support them to continue the improvements they have made and increase their quality of life by implementing the pain management and relapse prevention protocols developed by Dr. Stephen Grinstead.
If you are someone you know is living with chronic pain and may be struggling with pain medication issues but does not want to leave their home environment, we also have our APM Relapse Prevention Coaching Program. Just because people choose not to enter an in-patient or out-patient program, doesn’t mean they are not ready to take responsibility for getting well.
They can become active participants in their healing by participating in our 14-Week tele-coaching program. They will learn specific pain management skills to help them to recover their health and regain their independence using Dr. Grinstead’s Addiction-Free Pain Management® Workbook and the APM Recovery Guide.
Please check out our Coaching
Questionnaire
which is the first step of deciding if someone is ready for APM Relapse Prevention Coaching.
You can also call us directly for a confidential interview at 916-575-9961.
From Our Readers
Question:
I've been living with migraine and cluster headaches for the past three years. I have a really caring doctor but I'm not sure she is really helping me anymore. At first the drugs she gave me really helped and I was able to function. But now I'm having two or three headaches a week and the drugs don't seem to be helping anymore even though I take a lot. I try to take my meds as prescribed but sometimes that just doesn't help and I need more. I'm starting to feel like I'm always going to have to suffer.
Note: Dr. Grinstead contacted this individual and discovered that she started on Vicodin—1-2 tablets every 4-6 hours as needed for pain—and is now on Percodan (a combination of Aspirin and Oxycodone)—1-2 tablets every 4-6 hours as needed for pain—but she sometimes takes up to 15-20 tablets per day depending on her headache pain. She has another doctor who gave her a second prescription and neither doctor knows about the other.
Answer:
Dear Fear of Suffering,
First of all I'm really glad that you con-tacted us. Treating migraines and other types of headaches with opiates is often contraindicated and in fact can lead to what is called “rebound headaches.” I also appreciate your honesty, but at the same time want to caution you about getting the same medication from two different pro-viders, which can cause problems for you both medically and legally. I encourage you to find a Physician who specializes in treating migraines so you can get this handled. Also, please take some time to reflect and be honest with yourself about the danger of using multiple prescribers.
Many people experiencing frequent headaches, especially migraines, don't realize that the medication they take can actually be increasing the frequency and even severity of their pain. We posted research last December found on Medscape and originally published in the Journal Headache. Here are some of those highlights:
Narcotics Should Not Be First Choice for Pain Relief
Investigators surveyed 120,000 individuals to identify a sample of patients with migraine to be followed up annually for 5 years. They studied more than 8200 patients with episodic migraine.
Using logistic and linear regression, researchers modeled the probability that patients would transition from episodic to transformed migraine in relation-ship to medication use. They made adjustments for sex, headache frequency, severity, and use of prevention meds.
Dr. Lipton and his team found that baseline headache frequency was a risk factor for transformed migraine. Using acetaminophen as the reference group, researchers found that patients who used medications containing barbiturates or opiates were at increased risk for transformed migraine.
As anyone who has ever experienced a migraine headache knows it can be extremely debilitating. Unless a migraine sufferer goes to a treatment provider who understands appropriate treatment interventions for this condition, they can run the risk of unnecessary pain and suffering, including potential prescription drug addiction. Many people are pre-scribed opiates even though they are not FDA approved for migraines.
Medications used to treat migraines fall into two broad categories:
- Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms that have already begun.
- Preventive medications. These types of drugs are taken regularly, often on a daily basis, to reduce the severity or frequency of migraines.
In the realm of migraine treatment, little emphasis is placed on whether the medications have been specifically FDA approved for the treatment of migraine since so few are FDA approved for the prevention of migraine. In fact, there is not a single medication that was originally developed for migraine prevention. All were originally developed for other purposes. When it comes to treating migraine attacks (acute treatment), however, this is not the case. There are seven triptans (Imitrex, Maxalt, Zomig, Amerge, Axert, Frova, and Relpax) that were developed for and FDA approved as migraine abortive (management) medications. These medications work to actually stop the migrainous process in the brain and stop the migraine attack and its associated symptoms.
Ergotamine medications (used as vasoconstrictors for migraine prevention and are sometimes mixed with caffeine) such as DHE and Migranal; they are also FDA approved for migraine treatment as is Midrin (a combination of acetaminophen, dichloralphenazone, and isometheptene). The issue here is not so much FDA approval of acute medications, but the difference between using “generic pain medications” as opposed to migraine-specific medications. It’s been my experience that when patients use opiates or other non-FDA approved medications for ongoing migraine treatment they often experience problems. Migraine patients need to be proactive and see healthcare providers who specialize in migraine treatment.
I also want to recommend our
APM Module Two: Examining Your Potential Medication Management Problems, so you can discover the reasons behind your use of potentially addictive pain medication.
In this Module the Red Flags Checklist will help you to see how problematic your use of pain medication is. If you are serious about improving your health, there is an APM Medication Management Agreement for you to sign and share with your healthcare providers and significant others. It is also an opportunity to see if denial (which is a normal part of the human condition) is preventing you from following this plan. Finally you will develop a Safety Plan that is designed to help you adhere to your Medication Management Agreement and includes a Personalized Craving Management Plan.
For a brief overview of some of the information in Module Two you can read the article Managing Pain Medication in Recovery we posted on our website. It can also be purchased directly from Herald House Publishing.
I hope this information was helpful for you and that you begin to take the steps necessary to manage your headaches so you can improve your health and quality of life.
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