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November 2008

Quote Of The Month
“I am done with great things and big plans, great institutions and big success. I am for those tiny, invisible loving human forces that work from individual to individual, creeping through the crannies of the world like so many rootlets, which, if given time, will rend the hardest monuments of pride.”
~ William James (1842-1910)

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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Nov. 7, 2008
Los Angeles, CA

The Role of MFTs in Chronic Pain Management - Thought Leaders in Mental Health Workshop

Sponsor: California Assoc. of Marriage and Family Therapists
Contact: (858) 292-2638
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Nov. 10, 2008
Philadelphia, PA

Are We Managing Pain or Fueling the Addiction?

Sponsor: Valley Forge
Medical Center
Contact: (610) 539-8525 #216
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Nov. 12-14, 2008
Tampa, Florida

Nov. 19-21, 2008
Dallas, Texas

Addiction-Free Pain Management® 20 CEU Hour
Certification School

Sponsor: The Institute of Chemical Dependency Studies
Contact: (866) 523-2669
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Dec. 1-5, 2008
Ft. Lauderdale, FL

Presenters:
Terence T. Gorski
Dr. Stephen F. Grinstead

Gorski-CENAPS® Relapse Prevention Therapy
Advanced Certification School

Sponsor: CENAPS®
Contact: 352-596-8000
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Feb. 27, 2009
San Diego, CA

The National Council on Alcoholism and Drug Dependence
Annual Conference

Sponsor: NCADD San Diego
To Register: Visit NCADD
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Check out 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.

From Our Readers
Question: I'm a newly married woman in my early twenties and was diagnosed with Fibromyalgia six months ago. (We later found that she was married a little over a year ago.) My husband doesn't believe I really have a problem and thinks that I just want drugs.

I also get the feeling that my doctor doesn't really understand and is hesitant to keep refilling my prescription for pain medication. (She was prescribed Vicodin by her family physician who was the one who initially diagnosed her.)

My husband has told my mom and dad that I have a drug problem and need help and now everyone wants me to check in to a drug program. I'm really mad at them because they just don't understand how bad my pain really is. How can I get them off my back and stop my pain problem? I'm just so frustrated I can't see straight.

Answer: Dear Frustrated, First of all I want to assure you that in my experience and from my research Fibromyalgia is real and can be very painful, as well as physically draining. There are some people who doubt that Fibromyalgia is a real health condition with genuine concerns associated with it. But it is, in fact many healthcare providers see it as a type of soft-tissue rheumatism.

I would encourage you to ask your doctor for a referral to someone who specializes in treating Fibromyalgia who will give you a complete workup and treatment plan. Secondly, I can understand why your doctor may be concerned about continuing to prescribe Vicodin as the medical literature is clear that other treatment plans can be much more effective. Also, some people can develop a tolerance to opiates like Vicodin and eventually end up abusing or even becoming addicted.

The good news is that over the past several years we have seen more evidence that a multidisciplinary approach is the best way to obtain positive treatment outcomes for Fibromyalgia. Non-opiate medications are often used to treat the neuropathic (burning type) pain including Lyrica since 2007. In June of 2008 the Food and Drug Administration (FDA) approved duloxetine HCl delayed-release capsules (Cymbalta) for the management of fibromyalgia. Previously, only pregabalin (Lyrica; Pfizer, Inc) was approved by the FDA to treat this painful condition.

Below are some basic tips for managing Fibromyalgia.

  • Aerobic exercise, such as swimming and walking, improves muscle fitness and reduces muscle pain and tenderness.
  • Heat and massage may also give short-term relief.
  • Antidepressant medications may help elevate mood, improve quality of sleep, and relax muscles.
  • Many people greatly benefit from a combination of exercise, medication, physical therapy, and relaxation.

Welcome
To the November Issue of Chronic Pain Solutions. With the election behind us we are facing renewed challenges in the addiction treatment field. But skills training and continuing education is never a wasted effort. There are still some opportunities in the next 2 months to train your staff or yourself in the Addiction-Free Pain Management® System in order to help people who are still suffering with pain and co-existing disorders, including addiction, that we hope you will take advantage of.

With “Chronic Pain Solutions” we will keep you apprised on 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 upcoming events and trainings.

Your input is always appreciated. From the Contact Us page feel free to email any questions or comments. A thank you goes out to our readers for adding to our answer to “Desperate in Canada” which were passed on. We want to especially acknowledge Dr. Grinstead's colleague Barbara St. Marie, PhDc, for her insightful input. This month’s Question looks at the challenge of Fibromyalgia.

Last month we announced the publication of: The Eating Addiction Relapse Prevention Workbook for Compulsive Overeaters, Binge Eaters, and Food Addicts, and The Eating Addiction High Risk Situation List Pamphlet written by Dr. Stephen F. Grinstead and Dr. Shari Stillman-Corbitt, Clinical Director of Sierra Tucson Treatment Center. These are available through our publisher's website, Herald House Independence Press

The authors are now in the process of developing a skills training for clinicians whose clients have developed a self-destructive pattern of using the process of eating to cope with their problems instead of using food for fuel. The training will take professionals through a strategic step-by-step process designed to show them ways to assist their clients as they identify and manage high risk situations that could lead to a relapse back into an active eating addiction.

Participants of the training will also learn eclectic methods that are flexible enough to include treatment approaches such as effective decision making, identifying past patterns and role models, building self esteem, grief and loss issues, and shame reduction. Finally, particpants will be exposed to proven relapse prevention methods, such as the ones developed by the Gorski-CENAPS® Corporation that are modified for use with this population. The above will be accomplished using a combination of lectures, discussions, demonstrations, and experiential exercises.

Gorski-CENAPS® Corporation
This month we want to focus on Terence T. Gorski’s Relapse Prevention model and the upcoming 5 Day Relapse Prevention Therapy Advanced Certification School in Fort Lauderdale Florida that Mr. Gorski will be personally instructing with Dr. Steve Grinstead on December 1-5, 2008.

The RPT 5 Day Certification School is designed to teach participants advanced clinical skills for dealing with the personality and lifestyle problems that can cause relapse after extended periods of recovery. This training will provide an in-depth assessment process utilizing a detailed psycho social history to identify experiences that create mistaken beliefs.

Participants will learn how to assess the recurring patterns of self-defeating behaviors that are activated by mistaken beliefs, and how to work with clients in changing the underlying belief systems so they can interrupt the cycle of self-defeating behaviors. The training is highly experiential in nature. Participants will work extensively in small groups, will complete structured homework assignments, and engage in structured role-playing exercises.

The experiential nature of this training means that participants should have a stable personal recovery, have well-developed therapeutic communication skills, and be comfortable with professional and personal self-disclosure, as needed, in the training. It is not recommended that people experiencing serious current personal problems attend this training.

Mr. Gorski & Dr. Grinstead will personally present all lectures and demonstrations and facilitate the small group experiential exercises. This training experience is guaranteed to produce an in-depth change in your understanding of how help clients change self-defeating personality and lifestyle patterns. Each person completing RPT learns how to identify key or critical warning signs and how to use specific skills or tools to manage those warning signs in a way that stops the progressive pattern of self-defeating thinking and behavior.

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

If you have been a subscriber to “Chronic Pain Solutions” you know the Addiction-Free Pain Management® (APM) philosophy is a biopsychosocial, multidisciplinary treatment approach. To support clients leaving treatment centers, Dr. Grinstead and his team are offering APM Continuing Care Coaching Services to assist individuals living with chronic pain and coexisting disorders including prescription drug abuse or addiction to set APM goals and implement specific actions plans to facilitate their continued recovery. APM Continuing Care Coaching is offered in three Phases over the course of one year.

However, many people chose not to go into a residential or even an outpatient treatment program. They may be good candidates for APM Relapse Prevention Coaching Services that begins with a 50 minute intake session and consists of 13 tele-coaching sessions followed by an exit interview. We have developed a Coaching Questionnaire that helps clients to see if Coaching is an appropriate path for them.

The Addiction-Free Pain Management® Workbook and the APM Recovery Guide are integral components of both the Continuing Care and The APM Relapse Prevention Coaching Programs. After program completion and for an additional fee, participants will have an opportunity to build upon all they have learned with a 4-session APM Process Coaching program, followed by on-going APM Life Coaching for people who are ready to create a new life plan and take action to achieve it.

If you have any questions about our Coaching Programs or would like more information, please give us a call at (916) 575-9961.

Training Opportunities
On November 10, 2008 our APM COE Licensee Valley Forge Medical Center will be training their staff with a presentation called: Are We Managing Pain or Fueling the Addiction? This is a 7 CEU hour training and also opened to the public. Hope to see you there!

We're excited about the continued interest in the Addiction-Free Pain Management® Trainings being sponsored in collaboration with the Institute of Chemical Dependency Studies and the Gorski-CENAPS® Corporation. There is still time to register for either the Tampa, FL or the Dallas, TX trainings. To register email anne@cdstudies.com or call 866-523-2669. You can also download a Registration Application and fax it to 512-246-8692 or register on ICDS website.

If you're interested, ICDS's Recovery Today magazIne is a great resource which you can receive free with an on-line subscription. Also, a great place to visit is Mr. Gorski's site. His Links page lists quite a number of resources to aid in addiction research.

News and Research
The Role of Opioids in Chronic Pain Management: Last month I posted two research articles illustrating the risks or problems of using opiates for chronic pain management. This month I want to present the other side of this ongoing controversy about the role of opioid medications. The following information was presented at the American Pain Society's Annual Meeting in Tampa in May 2008.

Opioid Abuse Risks versus Analgesic Benefits in Chronic Pain Management Challenges faced by physicians and patients in weighing the risks and benefits of opioid pain killers for non-cancer chronic pain was the focus of the address by Srinivasa Raja, MD, professor of anesthesiology at the Johns Hopkins University School of Medicine. Research reported at the meeting this year showed that, contrary to widespread belief even among physicians and other health care professionals, fewer than 3% of patients with no history of drug abuse who are prescribed opioids for chronic pain will show signs of possible drug abuse or dependence, Raja said. . .

The High Cost of Chronic Pain Management: For years the numbers of people experiencing chronic pain have been increasing significantly. According to the International Association for the Study of Pain in 1999 there were approximately 86 million Americans suffering from chronic pain and over $70 Billion was spent in direct medical treatment that year. In 2003, according to Peter D. Hart Research Associates, the number increased to over 117 million adults—about a 35 percent increase.

In 2005 the Health and Productivity Journal (Vol. 2, No.2) reported well over $100 Billion being spent for direct medical care and over $70 Billion in lost productivity. A September 2008 report by the Healthcare Intelligence Network posted the following research summary—Relieving the Costs and Consequences of Chronic Pain: A Best Practice Multimodal Approach. . .

Nerve Stimulation Therapy for Chronic Headache Pain: When it comes to estimating the number of chronic headaches in the United States, several studies have shown that roughly 45 million Americans suffer from them per year. There is an average of 20 million females in America that experience chronic headaches and an average of 25 million males. This represents a prevalence of chronic headaches that is roughly 1 out of every six people. Percentage-wise, 6.54 percent of all Americans experience the agony of a chronic headache condition.

That being said, most people seeking medical help are often prescribed medication. Below I have listed some of the different types of medication for chronic headache pain that was copied from the National Pain Foundation website . . .

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

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.

Harm Reduction vs. Abstinence for Addiction Recovery: Having worked in the addiction treatment field for over 25 years I recognize the importance of abstinence for quality long-term recovery. However, when it comes to helping someone transition from addictive use to total abstinence, it's not normally that simple.

Sometimes a transitional harm reduction approach is necessary to help the person with an addictive disorder to get and stay sober. I am not talking about controlled drinking/using, which received a lot of press during the 1980's. That didn't work. What I am talking about is a developmental process of shifting from active addiction to total abstinence using a step-by-step transitional approach . . .