Understanding that irrational thinking and the self-defeating behaviors will sabotage effective chronic pain management is crucial in order to improve the way people manage their chronic pain condition. The following information was adapted from the Addiction-Free Pain Management® Recovery Guide© by Dr. Stephen F. Grinstead—the TFUAR (thinking, feelings, urges, actions, and reactions of and to others) concept listed below is part of the Gorski-CENAPS® Model. Below are some basic principles that can help you to better understand how the TFUAR process works. The main premise is:

Thoughts cause Feelings. Whenever we think about something we automatically react by having a feeling or an emotion.

Thoughts and Feelings work together to cause Urges. Your way of thinking causes you to feel certain feelings. These feelings, in turn, reinforce the way that you are thinking. These thoughts and feelings work together to create an urge, or impulse, to do something. An urge is a desire that may be rational or irrational. Sometimes the irrational urge is to isolate and give into your depression. At other times you might be tempted to use inappropriate chronic pain management medication, including alcohol or other drugs, even though you know that it will hurt you, which is also called craving. Other times you want to use self-defeating behaviors that at some level you know will not be good for you and could worsen your depression.

Urges plus decisions cause Actions. A decision is a choice. A choice is specific way of thinking that causes you to commit to one way of doing things while refusing to do anything else. The space between the urge and the action is always filled with a decision. This decision may be an automatic and unconscious choice that you have learned to make without having to think about it, or this decision can be based upon a conscious choice that result from carefully reflecting upon the situation and the options available for dealing with it.

Actions cause reactions from other people. Your actions affect other people and cause them to react to you. It is helpful to think about your behavior like invitations that you give to other people to treat you in certain ways. Some behaviors invite people to be nice to you and to treat you with respect. Other behaviors invite people to argue and fight with you or to put you down. In every social situation you share a part of the responsibility for what happens because you are constantly inviting people to respond to you by the actions you take and how you react to what other people do. Sometimes these reactions help you manage your pain more effectively, but at other times it leads to increased stress levels that cause you to making poor decisions.

The Four Steps of the Impulse Control Process

Pause and notice the urge without doing anything about it;

Relax by taking a deep breath, slowly exhaling, and consciously imagining the stress draining from your body;

Reflect upon what you are experiencing by asking yourself: “What do I have an urge to do? What has happened when I have done similar things in the past? What is likely to happen if I do that now?”; and then

Decide what you are going to do about the urge. Make a conscious choice instead of acting out in an automatic an unconscious way. When making the choice about what you are going to do remind yourself that you will be responsible for both the action that you choose to take and its consequences).

Remember: Impulse control lives in the space between the urge and the action.

Once people know more about this information it can help them have improved chronic pain management. To learn about the psychological components of an effective chronic pain management plan please read my article The Psychological Components of Pain that you can download for free on our Article page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders including depression or addiction please go to our Publications page and check out my book the Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here.  If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

I just spent the past week at Valley Forge Medical Center (VFMC) — our first Addiction-Free Pain Management® Center of Excellence.  In addition to conducting a three day staff training, I also had time to sit in on patient groups and talk one to one with several of VFMC’s chronic pain management patients.  One common theme for most of the pain patients was shame about letting “this” happen to them.  It was exciting to listen to more senior patients explain to their new peers that they aren’t “bad” because they started having problems with their chronic pain management medications that they are experiencing a medical phenomenon.

I have trained the staff at VFMC over the last two years on ways to de-pathologize addiction and denial for more effective chronic pain management outcomes.  One of the ways we do this is to educate the patients about the process they go through before reaching prescription drug addiction or pseudoaddiction.  Part of this is to give them accurate definitions of common misunderstood terms.

There is quite a bit of confusion and mislabeling of people on long-term use of chronic pain management medication.  Many patients are identified or labeled as “addicts” when in fact they are definitely not.  To help clarify this issue a consensus document was developed in 2004 by the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine.  They agreed upon the following definitions for physical dependence, tolerance, addiction, and pseudo addiction:

Physical Dependence

 Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.

Tolerance

 Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution (lessening) of one or more of the drug’s effects over time.

Addiction Versus Pseudoaddiction

Addiction

Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations.  It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Pseudoaddiction

The term pseudoaddiction has developed over the past several years in an attempt to explain and understand how some chronic pain patients exhibit many red flags that look like addition.  Pseudoaddiction is a term which has been used to describe patient behaviors that may occur when pain is undertreated.  Patients with unrelieved pain may become focused on obtaining medications, may clock watch, and may otherwise seem inappropriately drug seeking.  Even such behaviors as illicit drug use and deception can occur in the patient’s efforts to obtain relief.  Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when the pain is effectively treated.

The other educational component that is really helpful any chronic pain management patients is telling them about the hijacked brain.  With some chronic pain management conditions the system (including the brain) gets altered.  The pain system gets turned on and cannot be turned off.  I call 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.

To learn more about the hijacked brain and chronic pain management please read my article Chronic Pain and the Hijacked Brain that you can download for free on our Ariticles page.

If you would like attend one of my upcoming trainings please check out our Calendar page.

Today I want to aknowledge Valley Forge Medical Center (VFMC) as they have demonstrated exemplary Addiction-Free Pain Management® (APM) treatment services and met the rigorous standards through the use of the APM Center of Excellence Protocols and the Gorski-CENAPS Developmental Model of Treatment.  An informal ceremony will be held on June 9 at Valley Forge Medical Center, 1033 W. Germantown Pike in Norristown PA 19403.

Tracey Vawter, Director of Planning, stated, “We are elated to be receiving the first APM certification and designation in the country as a “Center of Excellence”. The APM program has had a huge and positive impact on our treatment program. This is a highly effective, comprehensive approach to treating individuals with chronic pain and coexisting disorders, which is something we’re seeing more of at our hospital. Our staff has worked hard over the past year to achieve this one of a kind certification and we are grateful to Dr. Grinstead for his consulting, teaching, and guidance.”

VFMC is also hosting the 3-day Addiction-Free Pain Management® training on June 10-13, 2009 that is open to the Public and will teach healthcare professionals how to work more effectively with people living with chronic pain and other co-existing disorders by concurrently addressing the addictive disorder, coexisting psychological disorder and chronic pain, thereby improving treatment outcomes. After attending the APM Training, participants can complete an optional Competency Certification which will position them for success in the chemical dependency and behavioral health field.

To view the entire press release about VFMC’s accomplishment please visit 24-7 Press Release.com

To learn about the importance of utilizing a mulidisciplinary approach for chronic pain management please check out my article The Need For Multidisciplinary Chronic Pain Treatment that you can download for free on our Ariticles page.

You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you or a loved one is undergoing chronic pain management, especially if you’re in recovery or believe you may have a medication or other mental health problem and you want to learn more effective chronic pain management tools, please go to our Publications page and check out my book the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. To purchase this book please Click Here.

To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.

To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to this interview.