Serving People with Chronic Pain & Coexisting Disorders

Posted on Friday, December the 28th at 7:16pm

By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

I am excited to introduce you to my new book, Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management™ (APM) System.  It presents the past eleven years of innovative growth and improvements in the APM System as well as the evolution of the Gorski-CENAPS^® Relapse Prevention Counseling Model.  Some of these improvements covered in the book include the latest additions to the Relapse Prevention Counseling process as well as the following APM modifications:

• Updated explanations of different types of pain and the pain system

·         Explanation of the revised process that helps patients differentiate between the biological and psychological/emotional components of pain

• The addition of craving management and pain flare up planning
• A revised APM High Risk Situation List
• Updated high risk situation identification and management processes
• The transition from Abstinence Contracting to a more appropriate APM Medication Management Agreement; and
• An improved Pain Medication Problem Checklist exercise.

While the vast majority of people with chronic pain may safely use pain medication, what may not be evident is that as many as 12 million people taking prescription drugs also suffer from coexisting abuse or addiction problems.  Often this problem only comes to the public’s awareness when a nationally recognized personality is “caught” in the pain/addiction trap.  But individually, many people all throughout the United States know at least one person within their circle that has had or is having problems with their prescription drug use for pain management.

In my work I have seen recovering people relapse and some who died as a result of a chronic pain condition that was neglected or ineffectively treated.  As someone who has their own personal experience of living with chronic pain, I was determined to develop a treatment system to address this challenge.  The primary goal of Managing Pain and Coexisting Disorders is to share what I have learned through research and working with people over the past two decades in order to give new hope to those suffering with chronic pain and other accompanying disorders.   

This book looks at the two major initial obstacles to effective treatment:

1.      The Denial system.  If patients don’t know they have a problem it can be extremely difficult to help them find a solution.  I discuss how to help a patient work through their denial in order for treatment to be effective.

2.      Depression and the feeling of hopelessness.  I address the specific needs of this under-served population and how to more effectively help them heal.

You will see that once these initial obstacles are identified and patients become motivated, you can then implement a multidisciplinary treatment plan that requires a three part approach:

(1)    A medication management plan—that is developed in consultation with an addiction medicine specialist.  

(2)    A cognitive-behavioral treatment plan—that addresses the psychological (cognitive and emotional) components of pain and supports changing the resultant self-defeating behaviors.

(3)    A non-pharmacological pain management plan—that includes a tool box of safer chemical-free ways to manage chronic pain and pain flare ups. 

To help you implement a multidisciplinary integrated pain management approach, this book describes a strategic combination of all three of these components working together.  With the proper treatment plan and positive support, patients with chronic pain and coexisting disorders can have successful treatment outcomes. 

This book also demonstrates how two of my former patients completed each of the exercises in the Addiction-Free Pain Management Workbook.  The book is laid out in ten chapters that are designed to assist healthcare providers achieve better treatment outcomes.  I have listed the titles and a very brief description of each chapter below.  Each chapter ends with a specific call to action for the reader.

• Chapter One—The Addiction Pain Syndrome:  Explains the synergistic affect of living with chronic pain and a coexisting disorder.  It includes in-depth education about pain (acute and chronic), the pain system, the pain spiral, anticipatory pain, substance abuse, addiction and pseudoaddiction.
• Chapter Two—The Addiction-Free Pain Management™ System:  Demonstrates how the APM System effectively addresses the synergistic symptoms of the addictive disorder and pain disorder concurrently.  This is accomplished in part by explaining how to utilize the core components of APM and the CENAPS^® Developmental Model of Recovery.
• Chapter Three—Building Therapeutic Relationships:  Describes the importance of developing good working relationships with patients and implementing a respect-centered approach using the Formula for Success. This chapter introduces two of my former patients, Dean and Jean, and explains how the APM treatment approach was implemented with them as you progress through the remainder of the book.
• Chapter Four—Identification And Assessment:  Explains in-depth and accurate assessments for people suffering from both addiction and a coexisting chronic pain disorder, as well as other problems such as Clinical Depression, trauma conditions (e.g., PTSD), and Sleep Disorders.  It also covers the stress/pain connection and the importance of teaching stress management.
• Chapter Five—The Effects Of Prescription And/Or Other Drugs:  Addresses the biological, psychological, and social components of chronic pain and coexisting disorders as well as the pros and cons of medication management.  You also learn how to guide patients through a strategic decision making process regarding medication and pain management.
• Chapter Six—Early Treatment Approaches:  Describes the APM early treatment approaches by looking at the detoxification—or medication taper—process and its impact on pain management.  It also focuses on developing personalized relapse intervention, craving management and pain flare up plans.
• Chapter Seven—Utilizing Non-Pharmacological Treatment Processes.  Describes this important component in a patient’s overall pain management plan and also covers Denial Management Counseling (DMC) for patients that have high levels of denial and treatment resistance.  This chapter also outlines the importance of the diet, nutrition, and exercise triad for more effective recovery and pain management.
• Chapter Eight—Reciprocal Relapse Prevention:  Demonstrates relapse prevention protocols and recovery planning work.  The focus is on identifying and personalizing patients’ current high risk situations and teaching them how to develop high risk situation maps.
• Chapter Nine—The TFUAR Process And Recovery Planning:  Managing high risk situations using the TFUAR Process (Thinking-Feeling-Urges-Actions-Reactions) and Recovery Planning Exercise from the APM Workbook.  The focus is on analyzing and managing high risk situations, then developing a recovery plan designed to identify and manage future high risk situations and preventing future relapse or pain flare ups.  
• Chapter Ten—Measuring Treatment Effectiveness:  Describes self-evaluation outcomes from the final exercise in the Addiction-Free Pain Management™ Workbook, which is designed to help patients see how much they have benefited from the work they have done.  This is also a useful tool for clinicians to demonstrate the effectiveness of the APM treatment process.