DiscoverCounselor Toolbox PodcastBiopsychosocial Impact of Pain and Strategies for Prevention and Intervention
Biopsychosocial Impact of Pain and Strategies for Prevention and Intervention

Biopsychosocial Impact of Pain and Strategies for Prevention and Intervention

Update: 2019-10-241
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435 – Biopsychosocial Impact and Strategies for Prevention and Intervention

Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC

Executive Director, AllCEUs

Podcast Host: Counselor Toolbox and Case Management Toolbox


Sponsored by TherapyNotes.com

Manage your practice securely and efficiently. Two free weeks of TherapyNotes with coupon code “CEU”


Objectives

– Review the following effects of pain

– Depression

– Anxiety

– Circadian Rhythm Disruption

– Grief

– Self Esteem problems

– Explore mitigating and exacerbating factors

– Identify primary, secondary and tertiary prevention activities

Characteristics of Pain

– Everyone has pain sometimes

– Our bodies are incredibly resilient

– Knowing your pain can help your care team.

– Acute or Chronic

– Stabbing, aching, throbbing, burning…

– Constant or intermittent

– Stationary or radiating

– Any numbness


Prevention

– Primary –Prevent the pain from happening

– Secondary –Prevent the pain from getting worse

– Tertiary –Prevent the pain from causing other problems like depression, anxiety, addiction

Primary Prevention

– Proper ergonomics/form at work, home, in bed and at the gym

– Exercise bilaterally

– Stretch frequently

– Don’t overtrain

– Gradually increase activity by time not quantity

– Eat a healthy diet with omega3s, anthocyanins


Secondary Prevention

Managing Pain

– Pain interferes with enjoyment of life

– Pain management can improve quality of life

– The first step is diagnosis

– Assessing your pain

– Keeping track

– Descriptive language

– Numerical Scales

– Verbal Scales

– Visual Scales

Understanding Your Pain


– Exacerbating factors—Makes it worse

– Emotional

– Mental

– Physical

– Environmental

– Social

– Mitigating factors – Helps You Feel Better

– Emotional

– Mental

– Physical

– Environmental

– Social


Mapping a Treatment Plan

– Complex equation

– Some treatment might involve a team of professionals

– Pain therapy goals

– Multimodal approach

– Treatment interference

– Holistic/complementary care

– Treat the cause

Mapping a Treatment Plan (Cont’d)

– Available treatment options include:

– Pharmacotherapy

– Psychosocial Interventions

– Rehabilitation Techniques

– Complementary & Alternative Medicine (CAM)

– Injection/Infusion

– Implantable Devices and Surgical Interventions


Pharmacotherapy

– Using medicine to control pain

– OTC or Prescription

– Special programs available to assist people who cannot afford their medication

– 3 Classes of Analgesics

– Non-Opiods

– Opiods

– Adjuvant Analgesics


Medical Interventions for Pain

– Tylenol and NSAIDS (Over the counter)

– Opiates

– Provide relief by attaching to opioid receptors

– Body stops making natural (endogenous) opioids when flooded with prescription opiates

– Over time body reduces amount of opiate being let through (tolerance) (after only several days)

– When you stop taking prescription opioids the body takes a few days to start making natural opioids again so pain threshold is markedly decreased


Adjuvant Analgesics

– Corticosteroids

– Muscle Relaxants

– Topical Analgesics

– Local Anesthetics

– Drugs for Anxiety, Depression (Serotonin) and Sleep (cortisol, GABA and Serotonin)

Complimentary Therapies

– Mind-Body Interventions

– Prayer, Guided Imagery, Pilates

– Biologically Based Therapies

– Aromatherapy, Dietary Supplements/Nutrition

– Manipulative and Body-Based Methods

– Chiropractic Care, Massage, TENS, Dry Needling, PT

– Energy Therapies

– Qigong, Healing Touch, Reiki, Therapeutic Touch, Accupuncture

Complimentary Therapies cont…

– Guided Imagery

– Color Imagery: Think of a color that you associate with pain, such as red, and picture the painful area of your body as red. Imagine shrinking, fading or dispersing the red.

– Symbol Imagery: Think about how the pain feels. Does it feel like a knife sticking in your joint- If so, imagine you are pulling the knife out of your joint and throwing it away

– Scenic Imagery: Imagine a place that is calming to you using all of your senses

Tertiary Interventions

Effects of Pain and Chronic Illness


– Depression

– Fatigue

– Sleep Disturbances

– Hopelessness/Helplessness

– Negative thoughts -> Stress -> Serotonin -> Pain

– Interventions

– Mindfulness

– Good sleep habits

– Circadian rhythm maintenance

– Identify the things you CAN control and that are GOOD

– Eat healthfully to support Serotonin functioning


Emotional Effects of Pain


– Anxiety

– Things won’t get better

– It is getting worse

– Consequences of pain (lost job, relationships, fitness…)

– Interventions

– Avoid caffeine and nicotine

– Educate yourself about the disorder and the PROBABILITY things will get worse

– Keep a log of the good and bad days

– Practice distress tolerance skills

– Use the Challenging Questions Worksheet to address anxiety provoking thoughts


Effects of Pain


– Guilt

– Self anger for not being able to…

– Can cause you to lash out at others—push them away so you don’t disappoint them like you disappointed yourself

– Interventions

– Think about how you would want your child or best friend to feel if they were in your position

– Get rid of the shoulds

– Focus on the things that you CAN do

– Decide whether it is worth using your energy to be mad at yourself (and the world)


Effects of Pain


– Grief

– Stages: Denial, Anger, Bargaining, Depression, Acceptance

– Interventions

– Work through the stages of grief for each of the losses because of the pain (Physical, self-concept, job, freedom (driving/mobility), dreams…)


Mood Interventions for Pain


– Mindfulness

– Alternate focus: Stop thinking about the pain and how to relieve it

– Deep relaxation breathing through the pain

– Distractions

– One moment at a time

– Radical Acceptance

– Life can be worth living even with painful events. Live in the And.

– Rejecting reality does not change reality.

– Changing reality requires first accepting reality.

– Pain can’t be avoided

– Refusing to accept reality can keep you stuck in unhappiness, bitterness, anger, sadness, shame, or other painful emotions.


Mood Interventions cont…


– Stress Management

– Stress causes

– Digestive upset/pain

– Back pain

– Migraines/headaches

– Jaw pain

– Interventions

– Meditation

– Distract Don’t React

– Identify your most important values, decide whether stressing over [this] gets you closer to or further away from your goals/values


Effects of Pain

– Social Support Loss

– Changes in activities (pain, exhaustion, med. side effects)

– Withdrawal

– Supports who don’t understand

– Pushing away supports through helplessness and complaining

– Interventions

– Modify activities or develop new mutually enjoyable activities

– Join a support group and address mood issues

– Address cognitive distortions

– Practice radical acceptance and living in the And

Effects of Pain


– Self-Esteem

– How you feel about the difference between who you want to be and who you are

– Interventions

– Make a list of the positive things about you

– Identify 1 or 2 goals you can work toward

– Celebrate small things

– Silence the inner critic


Physical Effects of Pain

– Problems

– Sedentariness

– Weight gain

– Reduced libido (HPA-Axis, exhaustion, pain itself)

– Interventions

– Work with your doc to identify ways to move (PT)

– Work with a nutritionist to eat an anti-inflammatory diet that will not pack on the pounds

– Address emotional eating


Physical Effects of Pain cont…


– Circadian Rhythm Disruption

– Not getting out of bed

– Staying inside in the dark

– Sleeping too much

– Interventions

– Get out of bed at roughly the same time each morning

– Get dressed in “day-clothes”

– Turn on lights and sit in front of a window or get outside to get your “day-clock” started

– If you must take a nap, keep it under 45 minutes to avoid messing up your sleep schedule

Summary

– Pain is inevitable

– Many people struggle with chronic conditions including TMJ, migraines, depression, fibromyalgia and pain.

– It impacts your

– Mood

– Thoughts

– Behaviors

– Relationships

– Addressing pain will help reduce related

– Anxiety

– Depression

– Anger

Summary

– Pain Management

– Medical

– Nonmedical

– Pain management requires a comprehensive approach addressing

– Physical causes of pain

– Mood

– Social supports

– Sleep

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Biopsychosocial Impact of Pain and Strategies for Prevention and Intervention

Biopsychosocial Impact of Pain and Strategies for Prevention and Intervention

Charles Snipes