I just got back from Sierra Tucson where I spent three days training their treatment team in Addiction-Free Pain Management™ (APM). The team have already been using my books and it was exciting to see how committed they were to implementing the APM™ system in their new pain program. Their treatment team members are very motivated and have superb clinical skills.

My hat is off to the Sierra Tucson team. They did an excellent job during the training. They had great comments, questions and observations that we all learned from. The individual and group exercises augmented their motivation and competence in helping people with chronic pain and coexisting disorders, including addiction. Many Sierra Tucson team members also live with chronic pain and it was gratifying to see them integrate what they were learning so they could improve their own pain management. Since some team members are also in recovery, it is essential that they have safe ways to manage their pain and avoid relapse. I feel very confident that when I refer someone with chronic pain and addiction to Sierra Tucson, they will be getting the best possible treatment available. I’m looking forward to an ongoing collaboration to help them continue to build a state-of-the-art pain management treatment program.

Like all of my APM™ trainings there is a combination of lecturing, then demonstration on how to implement the different components of the APM System. Finally, the participants practice the new clinical skill. To make the training process even more effective, I teach participants how to put themselves in the role of a person with chronic pain and addiction. In this role they take turns as clinician and client to practice each exercise in the Addiction-Free Pain Management™ Workbook.

In order to get the most out of my trainings, participants go through four steps:

1. Learn the principals and practical exercises in the APM™ System
2. Integrate the principals and exercises into their own clinical and personal style so they make it a habitual part of their clinical practice.
3. Develop ways to adapt and modify the system so it can be integrated into the setting they are working in order to improve treatment outcomes.
4. Individualize the processes for each patient they work with in order to improve their quality of life.

Many years ago I learned the value of showing up as a contribution instead of a complaint. When life gets rough many of us start complaining; at least I know I do. One day I was going on and on to a good friend of mine who, after listening for awhile, asked me if I would be willing to make a list of all the things in my life I was grateful for instead of just complaining. I was very surprised as I went through this exercise and had about 50 things I was grateful for. I thought it was a great list. My friend didn’t. He asked me to triple that list. At first I couldn’t understand how I could find that many things to be grateful for, but with his support and coaching I finally did it. I was amazed and the problems I had been complaining about no longer seemed so bad. He even gave me a bumper sticker that said “Attitude of Gratitude.”

About ten years later I ran across a book Simple Abundance Journal of Gratitude by Sara Ban Breathnach. The journal asked readers to write down at least five things each day that they were grateful for and at the end of the month summarize the results. The first time I did it I made sure to complete an entire year. Then I pulled away for a few more years.

I started writing another gratitude list because I caught myself complaining and remembered my old friend’s advice. I wrote my lists for just over a year and then stopped again. Almost two years ago I ran across one of my old Gratitude Journals and decided that I want this to be an ongoing part of my life. Now what I do is list five to ten things a day I’m grateful for and at the end of the month I list my top twenty for the month. At the end of the year I put my entire top twenty for each month in the same document. I then choose my top twenty for the entire year after reviewing every single entry I wrote that year.

The most interesting thing about my end of year process was that I was feeling very sad and grieving the recent death of my father. As I started going back over the year I noticed many of my gratitudes were about my relationship with my father and how we were much closer than any other time in my life. My mood and energy started shifting the more I read. By the time I made my top twenty list for 2007 I was again centered, peaceful and happy.

I have worked with many pain patients over the years that I taught this process to. Those who wrote daily gratitude lists reported that it was almost impossible for them to be in gratitude and suffering at the same time—most of the time they chose gratitude. I would like to encourage those of you reading this blog to try writing daily gratitude lists for at least a couple of months and see what happens for you. I would love to hear about your experience.

People in chronic pain pay a high price. That price tag involves both money and human misery. Up until very recently people in this country had no idea how expensive and wide spread the “silent” epidemic of chronic pain really was. In 1999 I joined the International Association for the Study of Pain (IASP) to begin researching the true extent of the problem. In the Untied States alone it was estimated that over 83 million people were living and suffering with chronic pain. Other interesting statistics jumped out at me. For example the United States spent over $70 billion dollars between treatments for chronic pain and lost productivity because of it. Other research indicated the costs to be much higher.

As we fast forward to 2005 that cost rose to over $120 billion dollars for treatment and lost productivity – and that was for just four types of chronic pain: (1) Carpal Tunnel Syndrome; (2) Low Back Pain; (3) Migraine; and (4) Osteoarthritis. As future research will no doubt demonstrate, the costs continue to rise. In 2008 many people with chronic pain will not receive adequate treatment and will develop secondary coexisting problems because of mismanaged or under treated chronic pain.

The “cost” for people with chronic pain is not only measured in lost productivity in the marketplace, or in lost salaries, but it also impacts families, friends, jobs, mental health and even their lives. People can become so depressed that they see no other alternative except suicide. Many significant others who become primary caregivers want to be helpful, but as the pain lingers on they burn out and feel frustrated, even hopeless.

About 10 percent of people taking mood-altering medication for chronic pain will develop substance use disorders including abuse, dependence, pseudoaddiction, and addiction. When they go into a pain management program the focus is on the physical pain, but those programs don’t know what to do when patients act out from an addiction and often discharge them. If a person goes into an addiction treatment program, the entire focus is on the addictive disorder and often the pain is not adequately addressed. Collaborative multidisciplinary treatment interventions are a must for this population.

I believe that anyone with chronic pain and other disorders deserves effective and compassionate treatment. It does not matter whether they have an addictive disorder or other psychological problems—they need and should get help. I’ve spent almost a quarter of a century studying and working with people with chronic pain and coexisting disorders and I’m here to tell you that effective, concurrent treatment is possible. That’s why I developed the Addiction-Free Pain Management™ System, published books on the subject, and train healthcare providers on how to deliver a collaborative integrated pain management approach.

For a number of years the focus has been to blame the patient or the physician, as the expanding war on pain management prescription drugs attests to. If we start demanding effective, multidisciplinary pain management for people living with chronic pain, we can begin to lower the financial and human-misery price tag. We all know someone; a loved one, friend, colleague or an acquaintance who has had some kind of mismanaged chronic pain and suffered because of it. Are you willing to join me in lobbying our representatives to push for better treatment and urge them to stop the war on pain management that the DEA is currently waging? Please write letters or make phone calls and let your voices be heard. http://www.house.gov/writerep