The Core Clinical Components of Addiction-Free Pain Managementâ„¢

Posted on Friday, December the 28th at 7:20pm

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

Addiction-free Pain Management™ (APM) has an eight part core clinical protocol for treating chemically dependent people who have coexisting chronic pain disorders. We call each part of the APM Protocol a clinical exercise. To make consistent implementation of the process easier, faster, and more effective, the Addiction-Free Pain Management™ Workbook was developed. It provides exercises related to each core clinical component. What follows is a brief description of each of these eight exercises.

External Awareness

Leads To Internal Cognitive/Affective Restructuring

The major purpose of each of the workbook exercises is not for you to just “fill out the forms;” the goal is to increase your understanding about your condition and learn what it takes to heal all of the biopsychosocial areas of your life.

Exercise One: Understanding Your Pain

Many of you may not have the words necessary to accurately describe the symptoms you are experiencing. Therefore in this exercise you have an opportunity to review and analyze a list of common symptoms that people who live with chronic pain experience and then you are asked to identify the ones that affect their own life and rate their intensity (severity) on a 0 to 10 pain scale. Next you learn to differentiate between your physical (ascending) pain symptoms and your psychological/emotional (descending) pain symptoms. You also examine their TFUARs (Thinking, Feelings, Urges, Actions, and Reactions of others) and how they change when you experience a bad pain day.

Exercise Two: The Effects Of Prescription And/Or Other Drugs

Many people living with chronic pain use a variety of different medications to treat the pain and the underlying medical disorders that are causing the pain. In Exercise Two you explore the benefits you experienced from using problematic pain medication (including alcohol) and other drugs and what you wanted to get from using the chemicals. You also identify the problems that you experienced as a result of problematic pain medication (including alcohol) and other drug use.

Exercise Three: Decision Making About Pain Medication

In this exercise you explore the reasons why you started using problematic pain medication (including alcohol) and other drugs, make an assessment of life damaging problems you experienced as a result of using chemicals, and explore reasons for deciding to do something different.

Exercise Four: Finding The Solution

In this clinical exercise you are asked to define what your medication management and recovery plan will include. You complete and sign a medication management agreement that details your adherence to this commitment. Next you develop a relapse prevention intervention plan that describes the responsibilities for you, your counselor, and three significant others to stop a relapse process quickly should it occur. Finally you develop a personal craving management plan and a pain flare up plan to support you if you feel tempted to deviate from your medication management agreement.

Exercise Five: Identifying & Personalizing High Risk Situations

In this clinical Exercise you learn to identify the immediate high risk situations that can cause chemical use and ineffective pain management in spite of your commitment. You review a list of common High Risk Situations that can activate the urge to use/abuse problematic pain medication (including alcohol or other drugs) and/or sabotage your effective pain management program. Next you are asked to identify and personalize your own most important (critical) High Risk Situation and write a personal title and description for use in self-monitoring.

Exercise Six: High Risk Situation Mapping

In this exercise you are asked to describe one past situation in which you experienced your immediate high risk situation and managed it poorly. This situation map is used to help you identify the pattern of self-defeating behaviors that drive a relapse process. Next you identify one past situation in which you experienced your immediate high risk situation and managed it effectively. This situation is used to identify new and even more effective ways of coping with your high risk situation. These new behaviors become the foundation for your Future High Risk Situation management and recovery planning.

Exercise Seven: Analyzing And Managing High Risk Situations

Here you are asked to analyze the immediate high risk situation you are learning to manage. You get to identify the irrational (addictive) thoughts, unmanageable feelings, self-destructive urges, self-defeating (addictive) actions, and reactions of others (TFUARs) that drive your high risk situation. You learn how to manage this kind of high-risk situation more appropriately by identifying three points where you can use more effective ways of thinking, feeling, and acting to avoid relapse. You are encouraged to apply these new ways of coping to future high-risk situations.

Exercise Eight: Recovery Planning

In this exercise you develop a schedule of recovery activities that support the ongoing identification and effective management of your high risk situations. You are instructed to write a schedule of recovery activities and explore how each activity can be adapted to help you identify and manage your personal high risk situations.

Summarizing The Core Clinical Exercises

The first two exercises in the workbook are data gathering or assessment instruments focusing on pain. Exercises three and four are motivational with a goal to help you make better choices with your pain management and develop a plan to implement more effective pain management strategies. Exercises five, six, seven, and eight are relapse prevention counseling exercises, and the goal of exercise eight is to develop a recovery plan to address future high risk situations for pain and addiction. Please see the chart below for a final summary of all of these core clinical exercises.