Rick Meyers, RN, CHPN, BCIM Cheryl Meyers, LCSW, MAC Mid-Valley Pain Clinic Salem, OR

Size: px
Start display at page:

Download "Rick Meyers, RN, CHPN, BCIM Cheryl Meyers, LCSW, MAC Mid-Valley Pain Clinic Salem, OR"

Transcription

1 Rick Meyers, RN, CHPN, BCIM Cheryl Meyers, LCSW, MAC Mid-Valley Pain Clinic Salem, OR

2 How do we think of pain? Tissue Damage or Injury (Pain Stimulus) Pain Transmission Pain Reception Assumptions of this model: Pain is a nociceptive phenomenon Tissue damage=pain Pain=Tissue damage Pain level is relative to tissue damage When pain stimulus abates, pain reception abates

3 The pain experience is much more complex Intrapersonal (psychological) Suffering Interpersonal (social) Pain Physical (biological)

4 The Acute Pain Model Acute Treatment --Acute injury-disease

5 This is the picture of chronic pain. Chronic Pain changes the nature of an individual; who they are. Acute Treatment -Pain

6 This situation is also worsened by the expectations of the medical system Symptom Cannot be measured of observed Diagnostics Unreliable, irrelevant and not indicated Diagnosis Ambiguous or unacceptable Treatment Ineffective and risky Cure unobtainable

7 What can this lead to? Loss of acceptance and power They haven t looked hard enough My Doctor has information and a cure, but won t give it to me My pain would be cured if only they would

8 What can this lead to? Change in life direction I will start when my pain is diagnosed/controlled/cured. I have been trying to get for years I want to but my pain is too bad

9 What can this lead to? Focus on the past and future This all started because. If wouldn t have happened, I wouldn t have pain. Someday I will when the pain is controlled.

10 Another consideration with Chronic Pain Depression, Bipolar Disorder Insomnia, Hypersomnolence, Chronic fatigue Sleep, energy level Mood Eating Obesity, Anorexia Pain PTSD, Chemical coping, Anxiety disorders Tolerance for stressors Memory, thought Fibro Fog

11 But what if.. Mood Sleep, energy Eating Tolerance for stressors Memory Pain

12 Consider the following pain conditions Fibromyalgia Chronic Pelvic Pain IBS Non-specific back pain Chronic headache CRPS All can be managed vs. cured All resist diagnostics All respond poorly to interventions All respond poorly to opiates Many people have the other symptoms in this constellation prior to pain

13 What are some of the predisposing factors to chronic pain? History of abuse - especially sexual abuse in youth Depression / Anxiety / Anger History of addiction or chemical coping Eating disorders Sleep disorders / Chronic fatigue Post traumatic stress disorder Lack of involvement in self care Psychosocial chaos Somatization / catastrophizing Chronically painful condition *****

14 Because of the variety of impacts, areas of effect and etiology, chronic pain is almost always associated with A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms. psychiatric comorbidities

15 These factors demonstrate that chronic pain must be treated from the mental health aspect

16 Multidisciplinary Pain Treatment If any one of these dimensions are ignored, it will seriously impact the prognosis for recovery or prevention. Intrapersonal (psychological) Interpersonal (social) Physical (biological)

17 Pain as Chronic Illness. What are the goals of multidisciplinary treatment? How successful is this approach? What is the care provider s role in the multidisciplinary approach?

18 What is Multidisciplinary Pain Management? A program based on addressing all areas in which chronic pain syndrome acts. A program based team concept of care, behavioral therapies, patient education. It includes care with goals of Medical management including psychiatric Psychological conditioning Physical conditioning Patient education

19 Multidisciplinary Pain Treatment Intrapersonal Interpersonal Physical Mental Health/CBT/Spiritual care Relaxation / Stress Management Complimentary Medicine Education Non Pharmacological Intervention Physical Therapy, Stretching Pain Medicine including psychiatry Interventional Medicine Primary Care Medicine

20 CBT-ACT Treatment Acceptance and Commitment Therapy Cognitive behavioral therapy based on acceptance of circumstances as they are now without judgment while moving toward value based goals. Shift focus away from fixing the problem and towards coexisting with the problem, giving power and responsibility back to the patient and moving focus away from past and future.

21 What is the general strategy for Multidisciplinary Pain Management? Control pain as much as possible using every available technique. Manage pain which cannot be controlled. Live a full life with the pain which escapes control and management. The serenity creed for chronic pain

22 What are the goals of Multidisciplinary Pain Management? Assist patient to reset goals from control to management. Reset expectations Encourage acceptance Assist with medical management of chronic pain using best practice guidelines. Educate patients about pain in general, and how chronic pain differs. Acute pain is grief; Chronic pain is depression

23 What are the goals of Multidisciplinary Pain Management? Educate patients about their pain: Return focus of control back to patients. Education about non-medical, nonpharmaceutical interventions. Education about the significant overlay of mind and body related to pain. Make patients specialists about their own pain.

24 What are the goals of Multidisciplinary Pain Management? Assist patients in understanding appropriate use of the medical system for chronic pain with focus on: Primary care Acute care Medications and medical interventions Assist patients in life rehabilitation, identifying and undoing the life effects of chronic pain.

25 What are the goals of Multidisciplinary Pain Management? Assist patients in learning effective communication techniques to use when working with the medical system and others. Preserve or improve patient-provider relationships. Preserve or improve relationships with family/friends.

26 How effective is this approach? Measurement of effectiveness Pain score? Subjective measure / difficult to quantify Improved function? How is function measured? Cost effective? Direct health care costs Indirect societal costs Unquantifiable costs of human suffering Comparison of complications and adverse events?

27 How effective is medication for LBP? Medication for treatment of chronic LBP Long term opioids +/- adjuncts reduce pain 30-40% (4) (5) 100mg Oxycontin / day for a year = $ % may have aberrant drug taking behaviors (10) Numerous risks and significant side effects Use of medication and health care increases

28 How effective is the multidisciplinary approach for LBP? Multidisciplinary pain management of LBP Pain reduced by average 37% (8) (9) Prescription pain medication down 63% (8) Very minimal side effects or complications 43% average functional improvement (8) 30-40% decrease in health care utilization (8)

29 How effective is this approach for fibromyalgia?

30 How effective are multidisciplinary interventions for fibromyalgia? Strong Evidence for Efficacy Cardiovascular exercise: efficacy not maintained if exercise stops CBT: improvement often sustained for months Patient education: group format using lectures, written materials, demonstrations; improvement sustained for 3 to 12 months Multidisciplinary therapy, such as exercise and CBT or education and exercise.

31 How effective are multidisciplinary interventions for fibromyalgia? Moderate Evidence for Efficacy Strength training, acupuncture, hypnotherapy, biofeedback, balneotherapy Weak Evidence for Efficacy Chiropractic, manual, and massage therapy; electrotherapy, ultrasound No Evidence for Efficacy Tender (trigger) point injections, flexibility exercise

32 Introduce the topic of multidisciplinary treatment early in the treatment course. My Doctor is saying that it is all in my head!! My Doctor doesn t believe that I really hurt! My Doctor has given up on me. My Doctor thinks I am crazy! *****

33 Parting thoughts.. Understand that even though there may not be any injury, disease or diagnosis explaining the pain, the patient s experience is real. Establish a partnership with the patient, set clear goals and expectations. Be willing to spend time listening, be available to communicate.

34 Have hope, share hope.

35 References 1. National Center for Health Statistics. Vital health statistics: Reporting chronic pain episodes on health surveys. In: Centers for Disease Control: US Department of Health and Human Services, ed. Vol Series 6: Cognition and survey measurement, Smith BH, Elliot AM and Hannaford PC. Is chronic Pain a distinct diagnosis in primary care? Evidence arising from the Royal College of General Practitioners Oral Contraception study. Fam Pract. Feb ( 1 ): Fishman P, Von Korff M, Lozano P, and Hecht J. Chronic care costs in managed care. Health Affairs ( 3 ): Turk DC. Clinical effectiveness and cost effectiveness of treatments for chronic pain patients, Clin J Pain 2002; 18: Collins SL, Moore A, McQuay HJ, et al. Antidepressants and anticonvulsants for diabetic neuropathy and post herpetic neuralgia: A quantitative systematic review. J Pain Symptom Manage 2000;20: Lehmann TR, Spratt KF, Tozzi JE, et al. Long-term follow-up of lower lumbar fusion patients. Spine 1987;12: Fritzell P, Olle H, Wessbery P, et al. Lumbar fusion versus nonsurgical treatment for chronic low back pain: A multicenter randomized controlled trial from the Swedish lumbar spine study group. Spine 2001; Flor H, Fydrich T, Turk DC. Efficacy of multidisciplinary pain treatment centers: A meta-analytic review. Pain 1992;49: Hoffman BM, Papas RK, Chatkoff KD, et al. Meta- analysis of psychological intervention s for chronic low back pain. Health Psych 2007;26: Michna E, Jamison RN, Pham L-D, et al. Urine toxicology screening among chronic pain patients on opioid therapy: Frequency and predictability of abnormal findings. Clin J Pain, 2007; 23: Rivero-Arias O, et al. Surgical stabilization of the spine compared with a programme of intensive rehabilitation for the management of patients with chronic low back pain: cost utility analysis based on a randomized controlled trial. BMJ May 28, 2005;330: Shaughnessy AF, Rehabilitation vs. spinal fusion for chronic low back pain. Am Fam Phys Oct 1, Malter AD, McNeney B, Loeser JD, et al. 5-year reoperation rates after different types of lumbar spine surgery. Spine 1998; 23:

36 References 1. National Center for Health Statistics. Vital health statistics: Reporting chronic pain episodes on health surveys. In: Centers for Disease Control: US Department of Health and Human Services, ed. Vol Series 6: Cognition and survey measurement, 1992 Suggested Reading Marwan N. Baliki, Dante R. Chialvo, Paul Y. Geha, Robert M. Levy, R. Norman Harden, Todd B. Parrish and A. Vania Apkarian Chronic Pain and the Emotional Brain: Specific Brain Activity Associated with Spontaneous Fluctuations of Intensity of Chronic Pain. The Journal of Neuroscience, November 22, 2006, 26(47): ; doi: /jneurosci Continuing education course on the psychological management of chronic pain Cochran, R T. Curing Chronic Pain Stories of Hope and Healing. Providence house publishers 2009

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource

DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource E-Resource March, 2015 DEPRESSION Depression Assessment PHQ-9 Screening tool Depression treatment Treatment flow chart Medications Patient Resource Depression affects approximately 20% of the general population

More information

Treatment of Chronic Pain: Our Approach

Treatment of Chronic Pain: Our Approach Treatment of Chronic Pain: Our Approach Today s webinar was coordinated by the National Association of Community Health Centers, a partner with the SAMHSA-HRSA Center for Integrated Health Solutions SAMHSA

More information

Addiction Medicine for FP / GP. Dr. Francisco Ward, DABPMR/PM SetonPainRehab.com setonpr@gmail.com

Addiction Medicine for FP / GP. Dr. Francisco Ward, DABPMR/PM SetonPainRehab.com setonpr@gmail.com Addiction Medicine for FP / GP Dr. Francisco Ward, DABPMR/PM SetonPainRehab.com setonpr@gmail.com S Disease of Chemical Addiction Short Definition of Addiction (ASAM): Addiction is a primary, chronic disease

More information

Psychology Externship Program

Psychology Externship Program Psychology Externship Program The Washington VA Medical Center (VAMC) is a state-of-the-art facility located in Washington, D.C., N.W., and is accredited by the Joint Commission on the Accreditation of

More information

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1 What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated

More information

The Chemical Coper Steven D. Passik, PhD

The Chemical Coper Steven D. Passik, PhD The Chemical Coper Steven D. Passik, PhD Associate Attending Psychologist Memorial Sloan Kettering Cancer Center New York, NY The Opioid Pendulum Avoidance Even dying people at risk of addiction Balance

More information

HAWAII BOARD OF MEDICAL EXAMINERS PAIN MANAGEMENT GUIDELINES

HAWAII BOARD OF MEDICAL EXAMINERS PAIN MANAGEMENT GUIDELINES Pursuant to section 453-1.5, Hawaii Revised Statutes, the Board of Medical Examiners ("Board") has established guidelines for physicians with respect to the care and treatment of patients with severe acute

More information

Understanding. Depression. The Road to Feeling Better Helping Yourself. Your Treatment Options A Note for Family Members

Understanding. Depression. The Road to Feeling Better Helping Yourself. Your Treatment Options A Note for Family Members TM Understanding Depression The Road to Feeling Better Helping Yourself Your Treatment Options A Note for Family Members Understanding Depression Depression is a biological illness. It affects more than

More information

UNDERSTANDING CO-OCCURRING DISORDERS. Frances A. Campbell MSN, PMH CNS-BC, CARN Michael Beatty, LCSW, NCGC-1 Bridge To Hope November 18, 2015

UNDERSTANDING CO-OCCURRING DISORDERS. Frances A. Campbell MSN, PMH CNS-BC, CARN Michael Beatty, LCSW, NCGC-1 Bridge To Hope November 18, 2015 UNDERSTANDING CO-OCCURRING DISORDERS Frances A. Campbell MSN, PMH CNS-BC, CARN Michael Beatty, LCSW, NCGC-1 Bridge To Hope November 18, 2015 CO-OCCURRING DISORDERS What does it really mean CO-OCCURRING

More information

Test Content Outline Effective Date: June 9, 2014. Pain Management Nursing Board Certification Examination

Test Content Outline Effective Date: June 9, 2014. Pain Management Nursing Board Certification Examination Pain Management Nursing Board Certification Examination There are 175 questions on this examination. Of these, 150 are scored questions and 25 are pretest questions that are not scored. Pretest questions

More information

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Section I: Preamble The New Hampshire Medical Society believes that principles

More information

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION Effective June 13, 2010 02-313, 02-373, 02-380, 02-383, 02-396 Chapter 21 page 1 02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 313 BOARD OF DENTAL EXAMINERS 373 BOARD OF LICENSURE IN MEDICINE

More information

Focus on Assessment. Teaching Pain Assessment and Management: Pearls for Caring for Patients with Pain. #1. Pain is a Universal Experience.

Focus on Assessment. Teaching Pain Assessment and Management: Pearls for Caring for Patients with Pain. #1. Pain is a Universal Experience. Teaching Pain Assessment and Management: Pearls for Caring for Patients with Pain Jennifer Parsons, FNP Duke Pain Medicine Adaptive Teaches us about our environment Demands attention Can be all consuming

More information

IMR ISSUES, DECISIONS AND RATIONALES The Final Determination was based on decisions for the disputed items/services set forth below:

IMR ISSUES, DECISIONS AND RATIONALES The Final Determination was based on decisions for the disputed items/services set forth below: Case Number: CM13-0018009 Date Assigned: 10/11/2013 Date of Injury: 06/11/2004 Decision Date: 01/13/2014 UR Denial Date: 08/16/2013 Priority: Standard Application Received: 08/29/2013 HOW THE IMR FINAL

More information

Michigan Department of Licensing and Regulatory Affairs Pain and Symptom Management Speakers Bureau

Michigan Department of Licensing and Regulatory Affairs Pain and Symptom Management Speakers Bureau Michigan Department of Licensing and Regulatory Affairs Pain and Symptom Management Speakers Bureau Are you looking for a speaker to present at your conference, ground rounds, or brown bag lunch? If you

More information

Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:

Bipolar Disorder. Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include: Bipolar Disorder What is bipolar disorder? Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic

More information

OVERVIEW OF COGNITIVE BEHAVIORAL THERAPY. 1 Overview of Cognitive Behavioral Therapy

OVERVIEW OF COGNITIVE BEHAVIORAL THERAPY. 1 Overview of Cognitive Behavioral Therapy OVERVIEW OF COGNITIVE BEHAVIORAL THERAPY 1 Overview of Cognitive Behavioral Therapy TABLE OF CONTENTS Introduction 3 What is Cognitive-Behavioral Therapy? 4 CBT is an Effective Therapy 7 Addictions Treated

More information

Table of Contents. Preface...xv. Part I: Introduction to Mental Health Disorders and Depression

Table of Contents. Preface...xv. Part I: Introduction to Mental Health Disorders and Depression Table of Contents Visit www.healthreferenceseries.com to view A Contents Guide to the Health Reference Series, a listing of more than 16,000 topics and the volumes in which they are covered. Preface...xv

More information

PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain

PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain P a g e 1 PROTOCOL SYNOPSIS Evaluation of long-term opioid efficacy for chronic pain Clinical Phase 4 Study Centers Study Period 25 U.S. sites identified and reviewed by the Steering Committee and Contract

More information

Depression and Mental Health:

Depression and Mental Health: Depression and Mental Health: A Psychiatrist s Perspective Peter M. Lake, MD Medical Director Rogers Memorial Hospital Oconomowoc Depression The Intersection of Hope, Medicine and Research Marquette University

More information

DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE

DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE 1 DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE ASSESSMENT/PROBLEM RECOGNITION 1. Did the staff and physician seek and document risk factors for depression and any history of depression? 2. Did staff

More information

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Although prescription pain medications are intended to improve the lives of people with pain, their increased use and misuse

More information

[KQ 804] FEBRUARY 2007 Sub. Code: 9105

[KQ 804] FEBRUARY 2007 Sub. Code: 9105 [KQ 804] FEBRUARY 2007 Sub. Code: 9105 (Revised Regulations) Theory : Two hours and forty minutes Q.P. Code: 419105 Maximum : 100 marks Theory : 80 marks M.C.Q. : Twenty minutes M.C.Q. : 20 marks 1. A

More information

CONSENT FORM FOR PSYCHIATRIC DRUG TREATMENT

CONSENT FORM FOR PSYCHIATRIC DRUG TREATMENT CONSENT FORM FOR PSYCHIATRIC DRUG TREATMENT This form has been adapted from: A Model Consent Form for Psychiatric Drug Treatment DOI: 10.1177/0022167800401006 Journal of Humanistic Psychology 2000; 40;

More information

Assessment of depression in adults in primary care

Assessment of depression in adults in primary care Assessment of depression in adults in primary care Adapted from: Identification of Common Mental Disorders and Management of Depression in Primary care. New Zealand Guidelines Group 1 The questions and

More information

Managing Chronic Pain

Managing Chronic Pain Managing Chronic Pain Chronic pain can cripple the body, mind and spirit. Feeling broken? You may benefit from Cleveland Clinic s Section of Pain Medicine, which tailors comprehensive, innovative treatment

More information

If the only tool you have is a hammer, you tend to see every problem as a nail.

If the only tool you have is a hammer, you tend to see every problem as a nail. How do we approach addiction? ADDICTION 101 A basic primer on addiction If the only tool you have is a hammer, you tend to see every problem as a nail. (Abraham Maslow) Definition of addiction Alcoholism

More information

Caring for depression

Caring for depression Caring for depression Aetna Health Connections SM Disease Management Program Get information. Get help. Get better. 21.05.300.1 B (6/08) Get back to being you How this guide can help you Having an ongoing

More information

Tension-type headache Non-pharmacological and pharmacological treatment

Tension-type headache Non-pharmacological and pharmacological treatment Danish Headache Center Tension-type headache Non-pharmacological and pharmacological treatment Lars Bendtsen Associate professor, MD, PhD, Dr Med Sci Danish Headache Center, Department of Neurology Glostrup

More information

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Section I: Preamble The Michigan Boards of Medicine and Osteopathic Medicine & Surgery recognize that principles of quality

More information

PAIN MANAGEMENT AT UM/SYLVESTER

PAIN MANAGEMENT AT UM/SYLVESTER PAIN MANAGEMENT AT UM/SYLVESTER W HAT IS THE PURPOSE OF THIS BROCHURE? We created this brochure for patients receiving care from the University of Miami Sylvester Comprehensive Cancer Center and their

More information

Capacity to Care: Building Competency in Geriatric Mental Health Care Evidence Based Practices & Psychosocial Interventions

Capacity to Care: Building Competency in Geriatric Mental Health Care Evidence Based Practices & Psychosocial Interventions Capacity to Care: Building Competency in Geriatric Mental Health Care Evidence Based Practices & Psychosocial Interventions Nancy P. Kropf School of Social Work Georgia State University Define Evidence

More information

When is psychological therapy warranted for patients with mental health problems?

When is psychological therapy warranted for patients with mental health problems? The Guidelines Advisory Committee (GAC) is empowered by the Ministry of Health and Long-Term Care and the Ontario Medical Association to promote evidence-based health care in Ontario, by encouraging physicians

More information

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí=

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= `çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= Overview: Common Mental What are they? Disorders Why are they important? How do they affect

More information

Fact Sheet. Queensland Spinal Cord Injuries Service. Pain Management Following Spinal Cord Injury for Health Professionals

Fact Sheet. Queensland Spinal Cord Injuries Service. Pain Management Following Spinal Cord Injury for Health Professionals Pain Management Following Injury for Health Professionals and Introduction Pain is a common problem following SCI. In the case where a person with SCI does have pain, there are treatments available that

More information

Depression Assessment & Treatment

Depression Assessment & Treatment Depressive Symptoms? Administer depression screening tool: PSC Depression Assessment & Treatment Yes Positive screen Safety Screen (see Appendix): Administer every visit Neglect/Abuse? Thoughts of hurting

More information

Non-epileptic seizures

Non-epileptic seizures Non-epileptic seizures a short guide for patients and families Information for patients Department of Neurology Royal Hallamshire Hospital What are non-epileptic seizures? In a seizure people lose control

More information

Medical marijuana for pain and anxiety: A primer for methadone physicians. Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015

Medical marijuana for pain and anxiety: A primer for methadone physicians. Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015 Medical marijuana for pain and anxiety: A primer for methadone physicians Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015 Conflict of interest statement No conflict of interest to

More information

FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma

FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma FRN Research Report January 2012: Treatment Outcomes for Opiate Addiction at La Paloma Background A growing opiate abuse epidemic has highlighted the need for effective treatment options. This study documents

More information

Spinal cord stimulation

Spinal cord stimulation Spinal cord stimulation This leaflet aims to answer your questions about having spinal cord stimulation. It explains the benefits, risks and alternatives, as well as what you can expect when you come to

More information

Appendix to Tennessee Department of Health: Tennessee Clinical Practice Guidelines for Outpatient Management of Chronic Non- Malignant Pain

Appendix to Tennessee Department of Health: Tennessee Clinical Practice Guidelines for Outpatient Management of Chronic Non- Malignant Pain Appendix to Tennessee Department of Health: Tennessee Clinical Practice Guidelines for Outpatient Management of Chronic Non- Malignant Pain Division of Workers Compensation 04.01.2015 Background Opioids

More information

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN Janice K. Brewer Governor Arizona State Board of Nursing 4747 North 7 th Street, Suite 200 Phoenix, AZ 85014-3655 Phone (602) 889-5150 Fax - (602) 889-5155 E-Mail: arizona@azbn.gov Home Page: http://www.azbn.gov

More information

Bipolar Disorder. in Children and Teens. Does your child go through intense mood changes? Does your child have

Bipolar Disorder. in Children and Teens. Does your child go through intense mood changes? Does your child have Bipolar Disorder in Children and Teens Does your child go through intense mood changes? Does your child have extreme behavior changes too? Does your child get too excited or silly sometimes? Do you notice

More information

MQAC Rules for the Management of Chronic Non-Cancer Pain

MQAC Rules for the Management of Chronic Non-Cancer Pain MQAC Rules for the Management of Chronic Non-Cancer Pain Effective January 2, 2012 246-919-850 Pain management Intent. These rules govern the use of opioids in the treatment of patients for chronic noncancer

More information

Challenges to Detection and Management of PTSD in Primary Care

Challenges to Detection and Management of PTSD in Primary Care Challenges to Detection and Management of PTSD in Primary Care Karen H. Seal, MD, MPH University of California, San Francisco San Francisco VA Medical Center General Internal Medicine Section PTSD is Prevalent

More information

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S.

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S. High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty

More information

MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT

MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT MOVING TOWARD EVIDENCE-BASED PRACTICE FOR ADDICTION TREATMENT June, 2014 Dean L. Babcock, LCAC, LCSW Associate Vice President Eskenazi Health Midtown Community Mental Health Centers Why is Evidence-Based

More information

A systematic review of focused topics for the management of spinal cord injury and impairment

A systematic review of focused topics for the management of spinal cord injury and impairment A systematic review of focused topics for the management of spinal cord injury and impairment icahe, University of South Australia For the NZ Spinal Cord Impairment Strategy Introduction This was the third

More information

Substance Abuse Issues in Pain Management

Substance Abuse Issues in Pain Management Substance Abuse Issues in Pain Management Steven D. Passik, PhD Associate Attending Psychologist Memorial Sloan Kettering Cancer Center New York, NY Opioid Rhetoric: From Complete Avoidance to Complete

More information

opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 Ranked #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380

opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 Ranked #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380 opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 ed #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380 effects of alcohol in the brain 100 Top 30 698 heroin addiction 100

More information

http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx

http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx Alcohol Abuse By Neva K.Gulsby, PA-C, and Bonnie A. Dadig, EdD, PA-C Posted on: April 18, 2013 Excessive

More information

How To Treat Pain With Pain Management

How To Treat Pain With Pain Management SUTTER PHYSICIANS ALLIANCE (SPA) 2800 L Street, 7 th Floor Sacramento, CA 95816 SPA PCP Treatment & Referral Guidelines Pain Management Developed June 1, 2003 Revised - (Format Revisions) November 13,

More information

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN MANAGEMENT OF CHRONIC NON MALIGNANT PAIN Introduction The Manitoba Prescribing Practices Program (MPPP) recognizes the important role served by physicians in relieving pain and suffering and acknowledges

More information

Depression & Multiple Sclerosis

Depression & Multiple Sclerosis Depression & Multiple Sclerosis Managing specific issues Aaron, diagnosed in 1995. The words depressed and depression are used so casually in everyday conversation that their meaning has become murky.

More information

Professional Reference Series Depression and Anxiety, Volume 1. Depression and Anxiety Prevention for Older Adults

Professional Reference Series Depression and Anxiety, Volume 1. Depression and Anxiety Prevention for Older Adults Professional Reference Series Depression and Anxiety, Volume 1 Depression and Anxiety Prevention for Older Adults TA C M I S S I O N The mission of the Older Americans Substance Abuse and Mental Health

More information

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES PURPOSE: The goal of this document is to describe the

More information

California Society of Addiction Medicine (CSAM) Consumer Q&As

California Society of Addiction Medicine (CSAM) Consumer Q&As C o n s u m e r Q & A 1 California Society of Addiction Medicine (CSAM) Consumer Q&As Q: Is addiction a disease? A: Addiction is a chronic disorder, like heart disease or diabetes. A chronic disorder is

More information

Guidance on competencies for management of Cancer Pain in adults

Guidance on competencies for management of Cancer Pain in adults Guidance on competencies for management of Cancer Pain in adults Endorsed by: Contents Introduction A: Core competencies for practitioners in Pain Medicine B: Competencies for practitioners in Pain Medicine

More information

The Chiropractic Profession s Role in Helping to Meet Vermont's Health Care Reform Goals. Better care Better health Lower costs

The Chiropractic Profession s Role in Helping to Meet Vermont's Health Care Reform Goals. Better care Better health Lower costs The Chiropractic Profession s Role in Helping to Meet Vermont's Health Care Reform Goals Better care Better health Lower costs Chiropractic Abstract: Chiropractic is now more than a century old, and it

More information

How To Write An Opiate Prescription Guideline

How To Write An Opiate Prescription Guideline Guidelines for Prescription of Opioid Medications for Acute and Chronic Pain developed and adopted by the Physician Advisory Committee Adopted by the Administrator of the Oklahoma Workers' Compensation

More information

Guidelines for Use of Controlled Substances for the Treatment of Pain

Guidelines for Use of Controlled Substances for the Treatment of Pain 1.0 Purpose: Use of Controlled Substances for the Treatment of Pain The Physicians Advisory Committee for Controlled Substances of the Medical Society of Delaware supports the Federation of State Medical

More information

Integrative Pain Management. The Goal of Integrative Pain Management. If pain is not treated what can happen?

Integrative Pain Management. The Goal of Integrative Pain Management. If pain is not treated what can happen? IPM ASPMN National Conference March 24-27, 2007 Addison, Texas Cynthia Knorr-Mulder APRN, NP-C, CHt Nurse Practitioner Northern New Jersey www.integrative-medicine.biz Integrative pain management is a

More information

Registered Charity No. 5365

Registered Charity No. 5365 THE MULTIPLE SCLEROSIS SOCIETY OF IRELAND Dartmouth House, Grand Parade, Dublin 6. Telephone: (01) 269 4599. Fax: (01) 269 3746 MS Helpline: 1850 233 233 E-mail: mscontact@ms-society.ie www.ms-society.ie

More information

THE COMMONWEALTH OF MASSACHUSETTS Department of Industrial Accidents

THE COMMONWEALTH OF MASSACHUSETTS Department of Industrial Accidents THE COMMONWEALTH OF MASSACHUSETTS Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, Massachusetts 02114-2017 DEVAL L. PATRICK Governor PHILIP L. HILLMAN Director TIMOTHY P. MURRAY

More information

See also www.thiswayup.org.au/clinic for an online treatment course.

See also www.thiswayup.org.au/clinic for an online treatment course. Depression What is depression? Depression is one of the common human emotional states. It is common to experience feelings of sadness and tiredness in response to life events, such as losses or disappointments.

More information

Managing depression after stroke. Presented by Maree Hackett

Managing depression after stroke. Presented by Maree Hackett Managing depression after stroke Presented by Maree Hackett After stroke Physical changes We can see these Depression Emotionalism Anxiety Confusion Communication problems What is depression? Category

More information

Meditation as Viable

Meditation as Viable "Treatment of the Relapse Process using Mindfulness and Meditation as Viable Techniques" Christopher Shea, MA, CRAT, CAC-AD, LCC Adjunct Professor, Towson University Dir. Campus Ministry, St. Mary's Ryken

More information

FACT SHEET 4. Bipolar Disorder. What Is Bipolar Disorder?

FACT SHEET 4. Bipolar Disorder. What Is Bipolar Disorder? FACT SHEET 4 What Is? Bipolar disorder, also known as manic depression, affects about 1 percent of the general population. Bipolar disorder is a psychiatric disorder that causes extreme mood swings that

More information

Depression in Older Persons

Depression in Older Persons Depression in Older Persons How common is depression in later life? Depression affects more than 6.5 million of the 35 million Americans aged 65 or older. Most people in this stage of life with depression

More information

What you should know about treating your pain with opioids. Important information on the safe use of opioid pain medicine.

What you should know about treating your pain with opioids. Important information on the safe use of opioid pain medicine. What you should know about treating your pain with opioids Important information on the safe use of opioid pain medicine. If your healthcare provider has determined that opioid therapy is right for you,

More information

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City

Depression and its Treatment in Older Adults. Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City Depression and its Treatment in Older Adults Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City What is Depression? Everyday use of the word Clinically significant depressive symptoms : more severe,

More information

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction Frequently Asked Questions What is Naltrexone? Naltrexone is a prescription drug that effectively blocks the effects of heroin, alcohol,

More information

North Bay Regional Health Centre

North Bay Regional Health Centre Addictions and Mental Health Division Programs Central Intake Referral Form The Central Intake Referral Form is used in the District of Nipissing by the North Bay Regional Health Centre s Addictions and

More information

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015 The Clinical Level of Care Guidelines contained on the following pages have been developed as a guide to assist care managers, physicians and providers in making medical necessity decisions about the least

More information

Patients are still addicted Buprenorphine is simply a substitute for heroin or

Patients are still addicted Buprenorphine is simply a substitute for heroin or BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module VI: Myths About the Use of Medication in Recovery Patients are still addicted Buprenorphine is simply a substitute

More information

Alberta s chiropractors: Spine care experts Patient satisfaction and research synopsis

Alberta s chiropractors: Spine care experts Patient satisfaction and research synopsis www.albertachiro.com 11203 70 Street NW Edmonton, AB T5B 1T1 Telephone: 780.420.0932 Fax: 780.425.6583 Alberta s chiropractors: Spine care experts Patient satisfaction and research synopsis Chiropractic

More information

33 % of whiplash patients develop. headaches originating from the upper. cervical spine

33 % of whiplash patients develop. headaches originating from the upper. cervical spine 33 % of whiplash patients develop headaches originating from the upper cervical spine - Dr Nikolai Bogduk Spine, 1995 1 Physical Treatments for Headache: A Structured Review Headache: The Journal of Head

More information

Medical College of Georgia Augusta, Georgia School of Medicine Competency based Objectives

Medical College of Georgia Augusta, Georgia School of Medicine Competency based Objectives Medical College of Georgia Augusta, Georgia School of Medicine Competency based Objectives Medical Knowledge Goal Statement: Medical students are expected to master a foundation of clinical knowledge with

More information

Integrative Therapies and Preconception Health. Debbie Ringdahl DNP, RN, CNM

Integrative Therapies and Preconception Health. Debbie Ringdahl DNP, RN, CNM Integrative Therapies and Preconception Health Debbie Ringdahl DNP, RN, CNM Definitions Preconception Health primary care? CAM complementary (together with) and alternative medicine (in place of) Integrative

More information

Co-Occurring Substance Use and Mental Health Disorders. Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs

Co-Occurring Substance Use and Mental Health Disorders. Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs Co-Occurring Substance Use and Mental Health Disorders Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs Introduction Overview of the evolving field of Co-Occurring Disorders Addiction and

More information

A Sierra Tucson Report. Best Practices of Top Psychiatric Hospitals

A Sierra Tucson Report. Best Practices of Top Psychiatric Hospitals A Sierra Tucson Report Best Practices of Top Psychiatric Hospitals 0 Introduction Since the day Sierra Tucson opened for business in 1981, we have placed great importance on adhering to the highest standards

More information

Borderline Personality Disorder and Treatment Options

Borderline Personality Disorder and Treatment Options Borderline Personality Disorder and Treatment Options MELISSA BUDZINSKI, LCSW VICE PRESIDENT, CLINICAL SERVICES 2014 Horizon Mental Health Management, LLC. All rights reserved. Objectives Define Borderline

More information

Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers

Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers SUPPLEMENT 1: (Supplementary Material for online publication) Antipsychotic drug prescription for patients with dementia in long-term care. A practice guideline for physicians and caregivers About this

More information

Addiction: Disease or Choice?

Addiction: Disease or Choice? Addiction: Disease or Choice? Presented by Michael Coughlin RN October 18, 2012 Introduced by Melanie Willows B.Sc. M.D. C.C.F.P. C.A.S.A.M. C.C.S.A.M. Assistant Professor University Of Ottawa Clinical

More information

Diagnosis: Appropriate diagnosis is made according to diagnostic criteria in the current Diagnostic and Statistical Manual of Mental Disorders.

Diagnosis: Appropriate diagnosis is made according to diagnostic criteria in the current Diagnostic and Statistical Manual of Mental Disorders. Page 1 of 6 Approved: Mary Engrav, MD Date: 05/27/2015 Description: Eating disorders are illnesses having to do with disturbances in eating behaviors, especially the consuming of food in inappropriate

More information

REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD

REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD What is Rehabilitation Medicine? Rehabilitation Medicine (RM) is the medical specialty with rehabilitation as its primary strategy. It provides services

More information

1695 N.W. 9th Avenue, Suite 3302H Miami, FL. 33136. Days and Hours: Monday Friday 8:30a.m. 6:00p.m. (305) 355 9028 (JMH, Downtown)

1695 N.W. 9th Avenue, Suite 3302H Miami, FL. 33136. Days and Hours: Monday Friday 8:30a.m. 6:00p.m. (305) 355 9028 (JMH, Downtown) UNIVERSITY OF MIAMI, LEONARD M. MILLER SCHOOL OF MEDICINE CLINICAL NEUROPSYCHOLOGY UHEALTH PSYCHIATRY AT MENTAL HEALTH HOSPITAL CENTER 1695 N.W. 9th Avenue, Suite 3302H Miami, FL. 33136 Days and Hours:

More information

Hospice and Palliative Medicine

Hospice and Palliative Medicine Hospice and Palliative Medicine Maintenance of Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills

More information

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN Doug Ducey Governor Arizona State Board of Nursing 4747 North 7 th Street, Suite 200 Phoenix, AZ 85014-3655 Phone (602) 771-7800 Fax - (602) 771-7888 E-Mail: arizona@azbn.gov Home Page: www.azbn.gov Joey

More information

Substance Addiction. A Chronic Brain Disease

Substance Addiction. A Chronic Brain Disease Substance Addiction A Chronic Brain Disease What you will Learn Addiction is a Brain Disease Understand the Structure and Pathways Associated with changes in the brain. Addiction is a Chronic Condition

More information

Produced and Published by The Cabin Chiang Mai, Alcohol and Drug Rehab Centre. Copyright 2013. and How is it Treated?

Produced and Published by The Cabin Chiang Mai, Alcohol and Drug Rehab Centre. Copyright 2013. and How is it Treated? and How is it Treated? 1 About this book This E-book has been produced as a guide to help explain some of the fundamental things you need to understand about addiction and its treatment, starting with

More information

PTSD, Opioid Dependence, and EMDR: Treatment Considerations for Chronic Pain Patients

PTSD, Opioid Dependence, and EMDR: Treatment Considerations for Chronic Pain Patients PTSD, Opioid Dependence, and EMDR: Treatment Considerations for Chronic Pain Patients W. Allen Hume, Ph.D.,C.D.P. Licensed Psychologist www.drallenhume.com October 2, 2007 COD client with PTSD seeking

More information

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths Joanna G Katzman, M.D., M.S.P.H Director, UNM Pain Center Associate Professor,

More information

Traumatic Stress. and Substance Use Problems

Traumatic Stress. and Substance Use Problems Traumatic Stress and Substance Use Problems The relation between substance use and trauma Research demonstrates a strong link between exposure to traumatic events and substance use problems. Many people

More information

Topics In Addictions and Mental Health: Concurrent disorders and Community resources. Laurence Bosley, MD, FRCPC

Topics In Addictions and Mental Health: Concurrent disorders and Community resources. Laurence Bosley, MD, FRCPC Topics In Addictions and Mental Health: Concurrent disorders and Community resources Laurence Bosley, MD, FRCPC Overview Understanding concurrent disorders. Developing approaches to treatment Definitions

More information

Care Manager Resources: Common Questions & Answers about Treatments for Depression

Care Manager Resources: Common Questions & Answers about Treatments for Depression Care Manager Resources: Common Questions & Answers about Treatments for Depression Questions about Medications 1. How do antidepressants work? Antidepressants help restore the correct balance of certain

More information

Chronic Low Back Pain

Chronic Low Back Pain Chronic Low Back Pain North American Spine Society Public Education Series What is Chronic Pain? Low back pain is considered to be chronic if it has been present for longer than three months. Chronic low

More information

Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace

Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace Antidepressant Skills @ Work Dealing with Mood Problems in the Workplace Dr. Joti Samra PhD, R.Psych. Adjunct Professor & Research Scientist CARMHA www.carmha.ca Dr. Merv Gilbert PhD, R.Psych. Principal

More information

information for service providers Schizophrenia & Substance Use

information for service providers Schizophrenia & Substance Use information for service providers Schizophrenia & Substance Use Schizophrenia and Substance Use Index 2 2 3 5 6 7 8 9 How prevalent are substance use disorders among people with schizophrenia? How prevalent

More information

Serious Mental Illness: Symptoms, Treatment and Causes of Relapse

Serious Mental Illness: Symptoms, Treatment and Causes of Relapse Serious Mental Illness: Symptoms, Treatment and Causes of Relapse Bipolar Disorder, Schizophrenia and Schizoaffective Disorder Symptoms and Prevalence of Bipolar Disorder Bipolar disorder, formerly known

More information