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December 2008

Quote Of The Month
“Remember this: As much as things change, a few things do remain constant: honor, truth, integrity, and love. Proclaim their importance by modeling them in your dealings with everyone.”
~ John Baldoni

Training Calendar
Since 1996 Dr. Grinstead has continually worked to enhance the Addiction-Free Pain Management® System to provide a treatment approach that would support professionals to more effectively serve people with chronic pain and coexisting disorders. His research based interventions and protocols have been implemented by multi-disciplinary treatment teams across the nation and presented to more than 10,000 training participants throughout the United States and Canada.

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January 23, 2009
Laredo, TX

Gorski-CENAPS® Relapse Prevention Counseling

Sponsor: South Texas Council on Alcohol and Drug Abuse
Contact: (956) 791-6141
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February 7, 2009
Capitola, CA

Managing Resistance & Denial in Chemically Dependent Abusive/Violent Clients

Sponsor: Simply Your Best
Contact: (831) 464-2376
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February 27, 2009
San Diego, CA

Are We Managing Pain or Fueling Addiction

Sponsor: NCADD - San Diego
Contact: NCADD Website
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April 2, 2009
Philadelphia, PA

Are We Managing Pain or Fueling Addiction

Sponsor: Ben Franklin Institute
Contact: (480) 563-1192
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April 17, 2009
Kansas City, MO

Managing Pain & Coexisting Disorders

Sponsor: ReDiscover
Contact: Michael Grimes at
(816) 554-5535
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May 1-2, 2009
New York, NY

Gorski-CENAPS® Relapse Prevention Certification School

Sponsor: The Resource Training Center
Contact: Donna Mae at
(888) 482-0055
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Go the Calendar page for more information. For additional details about specific trainings go to our website or call (916) 575-9961 to discuss consul-tation, training or coaching services for your agency.

New Article
Below we've included a brief introduction from the newest article on our website. For the complete content please visit the articles page.

Overcoming Obstacles for Effective Pain Management:

Before looking at ways to overcome the obstacles to effective pain management, it's important to explore what those obstacles are in order to develop the best plan possible. Managing a pain condition is often very challenging, and it becomes even more so when a coexisting disorder is also present. In fact, one of the biggest problems is not identifying coexisting psychological disorders which include addiction . . .

Training Opportunity
On January 23rd, 2009 Dr. Grinstead will be presenting a One Day overview of Gorski-CENAPS® Relapse Prevention Counseling to the The South Texas Council on Alcohol and Drug Abuse (STCADA) in Laredo, Texas. STCADA will be training their staff in the Gorski-CENAPS® Developmental Model of relapse prevention. This is a 7 CEU hour training and the public is invited to participate. Hope to see you there!

STCADA is a community-based regional outreach & referral agency providing substance abuse(drugs, alcohol) prevention, intervention, education and treatment services to the general population of Webb, Zapata, Jim Hogg, and Starr Counties. The Agency also offers support services to HIV positive individuals and conducts educational outreach in the region's colonias about the links between substance abuse and HIV. STCADA conducts substance abuse prevention programs in schools throughout the region and disseminates information in the community on the dangers of substance abuse.

Never worry about the size of your Christmas tree. In the eyes of children, they are all 30 feet tall.
~Larry Wilde

Christmas is the season for kindling the fire of hospitality in the hall, the genial flame of charity in the heart.
~Washington Irving

Welcome

To the December Issue of “Chronic Pain Solutions,” our Addiction-Free Pain Management® Newsletter. We want to wish all of our subscribers a very Merry Christmas and a Successful, Prosperous 2009. A big thank you as well for your continued support in 2008.

We also want to acknowledge the many participants who have attended Addiction-Free Pain Management® trainings around the country this year. It is gratifying to see the interest in the APM Treatment System increase, knowing that it means more and more people in pain will be helped.

To our new subscribers, “Chronic Pain Solutions” will keep you apprised of our projects, the latest news stories and research we have on our website regarding pain management and the coexisting disorders that accompany someone living with chronic pain, as well as new events and trainings.

This month we would like to call your attention to Dr. Grinstead’s latest publication—the Addiction-Free Pain Management® Module Four: A Guide for Managing Pain Medication in Recovery . One of the most common addiction relapse triggers for people in recovery is mismanaged pain and inappropriate pain medication management. In this newest module people in recovery will have an opportunity to learn how to use a recovery oriented approach to pain medication management. The Module covers misunderstood terms, the benefits and disadvantages of using pain medication, a detailed pain history story and developing an effective pain medication management plan. There will also be a review of a Recovery/Relapse Indicator Checklist, as well as a final call to action.

Anyone in recovery facing medical issues requiring the use of pain medication would be well advised to complete the exercises detailed in Module Four with a trusted healthcare provider in order to protect their recovery and their health.

As always, your input is always appreciated. From the Contact Us page feel free to email any questions or comments. This month’s Question looks at the challenges of and treatment options for Migraine Headaches.

News From The Gorski-CENAPS® Corporation
As we all know, many people relapse as a result of chronic pain disorders. This is especially true as a large number of the recovering community is entering the senior years of their lives. Starting in 1996 the Gorski-CENAPS® Corporation has included the Addiction-Free Pain Management® System as an integral component of relapse prevention in both publications and clinical skills trainings.

This month we want to highlight the Relapse Prevention Therapy School scheduled for May 4-8, 2009, in Tampa, Florida . This training forms a foundation for people to deal with the chronic, physical and emotional pain that often precedes relapse. This course is in its eighth revision and has been streamlined to be administered in a limited number of sessions. Space is limited for this training so it important to register soon. For more information or to register please contact CENAPS at (352) 596-8000 or email tresa@cenaps.com. You can also learn more on our Training Calendar

Offering RPT education classes and personal consultation along with the most advanced addiction free pain management methods can expand a clinical private practice or the referral base of a treatment program. These are options that can provide professionals with the tools they need to expand their services and by doing so not just survive, but thrive during these economic hard times.

The major highlight of this Relapse Prevention Therapy Certification Training is that it’s taught by Terence T. Gorski and Dr. Stephen F. Grinstead. This is 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 Addiction-Free Pain Management® System. For more information or to register for this event, please visit the CENAPS® website or call the CENAPS® office at 352-596-8000.

APM Coaching Groups
Even though the economic news from Washington is bleak, our challenge for treatment providers everywhere continues to be how to provide cost-effective avenues of treatment for those who need it and want it. Census in treatment centers around the country is down, and even in good economic times, many people choose not to go into a residential or even an outpatient treatment program. But their quality of life will continue to deteriorate unless they seek help.

If you or your colleagues know of someone in this position, they may benefit from our APM Relapse Prevention Coaching Services. The program is designed to guide people who are living with chronic pain and may be struggling
with pain medication issues to become active participants in their healing process. They will learn a strategic set of new pain management protocols that will help them to recover their health and regain their independence, thereby improving the quality of their life. Most importantly, participants will discover a light at the end of the long dark tunnel their life of pain has become.

We have developed a Coaching Questionnaire that helps people see if the APM Relapse Prevention Coaching is an appropriate path for them, or they can call us directly for a confidential interview at 916-575-9961.

Dr. Grinstead and his team also offer APM Continuing Care Coaching Services to assist individuals leaving in-patient treatment for chronic pain and co-existing disorders to set APM goals and implement specific actions plans to facilitate their continued recovery. If you have any questions please give us a call at the above number.

News and Research
Multidisciplinary Chronic Pain Management: Each month I post three news and research type articles that usually focus on how to obtain better outcomes for chronic pain management. I have always been an advocate of using a team approach so in this article I want to build the case for utilizing a multidisciplinary approach for chronic pain management. One source I came upon was the American Chronic Pain Association. On their website I found . . .

Cognitive Behavioral Therapy for Chronic Pain Management: About a third of the Addiction-Free Pain Management® System includes cognitive behavioral therapy (CBT) interventions. To give you an overview of CBT for chronic pain management I want to include excerpts from a report by Shannon Erstad, MBA/MPH. You can review her entire report that includes a great PDF Download . . .

Some Medications Lead to Rebound Headaches: Many people experiencing frequent headaches, especially migraines, don’t realize that the medication they use to help them can actually be increasing the frequency and even severity of their pain. I found an interesting report on the Medscape Website (www.medscape.com) entitled “Barbiturates and Opiates Increase Risk for Chronic Migraine” December 4, 2008 . . .

Visit our website to see the complete stories as well as an archive of past research.

From Our Readers
Question: What can be done for migraine headaches?

Answer: In my research I have found the following interventions have proven successful with varying degrees of success for migraine headache management. Of course, each person should work closely with their healthcare providers to determine what works best for their individual condition.

Migraine Pain-Relieving Medications: For best results, take pain-relieving drugs as soon as you experience any signs or symptoms. It may help if you rest or sleep in a dark room after taking them:

Nonsteroidal anti-inflammatory drugs (NSAIDs) — Such as ibuprofen (Advil, Motrin, others) or aspirin, may help relieve mild migraines. Drugs marketed specifically for migraines, such as the combination of acetaminophen, aspirin and caffeine (Excedrin Migraine), may also ease moderate migraines, but aren't effective alone for severe migraines. If over-the-counter medications don't help, your doctor may suggest a stronger, prescription-only version of the same drug. If taken too often or for long periods of time, NSAIDs can lead to ulcers, gastrointestinal bleeding and rebound headaches.

Triptans — For many people with severe migraine attacks, triptans are the drug of choice. They are effective in relieving the pain, nausea and sensitivity to light and sound that are associated with migraines. Sumatriptan (Imitrex) was the first drug specifically developed to treat migraines. Related medications include rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), almotriptan (Axert), frovatriptan (Frova) and eletriptan (Relpax).

Ergots — Ergotamine (Ergomar) has been in use for more than 60 years and was a common prescription for migraine before triptans were introduced. It is less expensive, but also less effective than triptans. Dihydroergotamine is an ergot derivative that is more effective and has fewer side effects.

Anti-nausea medications — Since migraine attacks often come with nausea with or without vomiting, medication for these symptoms may be given, such as: metoclopramide (oral) or prochlorperazine (oral or rectal suppository) and are usually combined with other migraine medications.

Butalbital combinations — Medications that combine the sedative butalbital with aspirin or acetaminophen are sometimes used to treat migraine attacks. Some combinations also include caffeine or codeine. However, these have a high risk of rebound headaches and withdrawal symptoms and accordingly should be used infrequently.

Non-pharmacological — Research based interventions to try include acupuncture, stress management, and chiropractic adjustments, especially the activator method.

Opiates are contraindicated for migraine headaches so you want to be cautious if they are recommended to you. To learn more about this topic please go to our research page and scroll down to the posting titled Information and Guidelines for Migraine Management that you can download for free on our News & Research 2008 Archive .