Robert Umlauf – Integrated Chronic Pain Management: Mental Health Interventions that Counteract Opiate Addiction

Outline

CHRONIC PAIN: NEUROPHYSIOLOGICAL FACTORS, EXPERIENCES, AND PAIN BEHAVIORS

• How time from onset and type of pain play a role
• Pain Egg and nociception
• Psychophysiology of pain as a PERCEPTION
• Smoke Alarm metaphor: acute vs. chronic pain
• Autonomic systems and power of retraining
• Pain vs. Suffering
• Historical predictors of developing chronic pain syndromes

OPIATE USE IN THE USA

• Pain Clinic History and shift towards increase in opiate prescribing
• What influences the drive toward increased prescribing?
• CDC Guidelines on opioid prescribing
• Opiate overdose deaths and addiction
• Screening tools for opiate abuse potential

PSYCHOLOGICAL ASSESSMENT IN PAIN POPULATIONS INCLUDING DIFFERENTIAL DIAGNOSES: LIMITS AND CONCERNS

• Use of tests and their limits
  • MMPI-2-RF
  • BBHI-2
  • CES-D
  • BDI
  • Additional tests
• Intake interview components
• Primary Care coordination: strategy for collaboration with other professionals
• Tools to assess and treat mental processes that exacerbate pain

INTERVENTIONS: TALK THERAPY IS NOT ENOUGH- PAIN PATIENTS NEED SKILLS

• Manage mood and set goals by adapting:
  • CBT
  • ACT
  • Other therapies
• Educate: “Harm Alarm” retrain perceptions
• Self-regulation: including mindfulness
• Biofeedback: simple techniques ANYONE can use
• Cognitive reframes for Pain Management
• PACE: including behavioral monitor and  tracking scales for self-regulation
• Motivational Interviewing: adaptations for chronic pain treatment
• Heal the past: Sarno’s model
• Sleep
  • Behavioral tools
  • Sleep hygiene
  • Sleep restriction
  • Environmental factors
• Apps for Pain Management
  • B2R
  • Pedometer

INTEGRATIVE OPTIONS

• Alternative/Integrative Medicine
• Recent medical advances in pain treatment
• Psychotropics and antidepressants
  • SNRI’s: first line
  • Low-dose TCA’s and sleep: be careful!
  • Avoid the Benzo’s!
• Nutrition, Diet and Supplements: evidence-based suggestions
• Acupuncture: NIH consensus conference data
  • Provider skill is a major factor in outcomes
  • MRI data and common pathways for healing
• Hands-on Options
  • Physical Therapy, Exercise and Rehabilitation
  • Chiropractic, Osteopathy and Manipulation therapies
  • Massage, Deep Tissue therapies
  • Other modalities: Rolfing, Craniosacral, Myofascial Release, Dry needle, etc.

INCORPORATE NEW SKILLS

• Self-regulation exercises
• Biofeedback lab
• Challenge that catastrophic pain belief