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Materials Created By: Durham Interdisciplinary Pain Clinic (DIPC) of the Durham VA Health Care SystemFunding Provided By: VISN 6 Mid-Atlantic Research, Education and Clinic Center (MIRECC) Veteran's Guide to Effective Chronic Pain Management

Goals for Today 2 Basic ways to manage pain and improve function 3 Understand pain and its impact on your life 4 Tips to help you communicate with medical provider(s) 1 Define pain (acute and chronic)

Define Pain

DEFINING PAIN Definition and Prevalence Experience Unpleasant Damage Subjective http://www.iasp-pain.org/ International Association for the Study of Pain (IASP): “An unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

DEFINE PAIN Acute Pain vs. Chronic Pain Acute Pain Chronic Pain Lasts less than 6 months Lasts more than 6 months Symptom (of tissue damage) Becomes the illness vs. symptom of something else Expected to go away No known cure / Focus on function Useful signal something’s wrong Signal is no longer helpful as a warning sign Rest often recommended Rest (too much) can make things worseLess (short-term, limited) life disruptionMore (long-term, ongoing) life disruption

THE IMPACT OF PAIN: Biopsychosocial Model The Pain Cycle Time off work, money worries, relationship concerns Persistent pain Being less active Loss of fitness, weak muscles and joint tissues Lack of energy, tiredness Stress, anxiety, fear, anger, frustration Depression, mood swings Negative thoughts, fears about pain and the future

DEFINE PAIN The Pain Experience Pain messages received Signal is connected to many parts of the brain – centers for sleep, appetite, memory, learned behavior, anxiety, and mood Nerves send pain messages Pain messages can be modified Messages can be “wound up” or “wound down” by signals from the brain Pain sources Adapted from The British Pain Society (2010)

DEFINE PAIN The Pain Experience Gate Control Theory Information from the brain (thoughts) can open or close the gate Gate Open: More Pain Gate Closed: Less Pain Brain Spinal Cord Pain Signal (Melzack & Wall, 1965)

Social Family / friends to help? Do others do things for you that you could do? Activity Too much / too little? Unhealthy coping tools? Emotional Fear pain flares or avoid things because of pain? Anger, sadness, loneliness Mental Attention: Is pain always the focus? Beliefs: Do you feel pain is uncontrollable? PhysicalBody ChangeMuscle TensionGATE CONTROL THEORYOpening the “Gate” (More Pain)

Social Family / friends help when needed Others encourage you to stay active and healthy Activity Pacing strategies Healthy coping tools and work / life balance Emotional Calm and hopeful Able to relax and prevent major mood swings due to pain Mental Attention: Helpful distraction tools? Beliefs: Do you believe you can control (and predict) pain? PhysicalPT, stretching, exercise, massageHeat/Cold, TENS unit, medicationGATE CONTROL THEORYClosing the “Gate” (Less Pain)

Manage Pain

MANAGE PAIN The Chronic Pain Experience Everyone’s Pain is Different increase from “usual” pain level and may vary in how long it lasts Flare-up present about ½ the day or more Continuous Location Initial cause Perceived severity, etc . Chronic Pain Pattern

MANAGE PAIN Veteran-Centered Treatment FOUNDATION Health Behaviors & Self-Care INDIVIDUALIZED PLAN Medications Surgical Physical Medicine Psychological / Behavioral Stimulation Specialty Pain Clinic

MANAGE PAIN Health Risks of Long-Term Opioid Use Health Risks CDC Guideline for Prescribing Opioids for Chronic Pain (3/16/16) Risk of Increasing Dosage Risks / Benefits of Continued Use Death Accidental overdose Tolerance / Dependence Hyperalgesia (more sensitive to pain) Weaker immune system Sexual dysfunctionConstipation

MANAGE PAIN Change Your Thinking: Self-Care and Management What can I do today to help manage my pain? How can I still do things important to me even if pain is there? What has helped me get through a bad pain day in the past?

MANAGE PAIN Our Response to Pain Matters Increase Pain Unhealthy Responses Thoughts My life is controlled by my pain. No one understands what I’m going through. Behaviors Inactivity Isolating from others Not taking care of oneself Decrease Pain Healthy Responses ThoughtsI am having a bad pain day, but I can still get things done.When I have felt pain like this in the past, it was helpful to apply a hot compress.BehaviorsDoing things you enjoyBeing physically activeTaking care of yourself (physically & mentally)

MANAGE PAIN Self-Care Strategies Stress (Manage Stress) Relaxation: meditation, prayer, reading a book Staying active: walking, social activities, volunteering Sleep (Improve Sleep) Consistent wake time and rise time Bed only for sleeping No alcohol / caffeine close to bedtime Use CPAP if prescribed Healthy Weight (Eat Healthier)Limit sugary drinks and alcoholAdd more fruits / vegetables / waterEat at restaurants less often

Understand Pain

UNDERSTAND PAIN How We Move Matters: Introduction to Time-Based Pacing Alternate Between Active and Rest Time (Cycle) After I walk for 10 minutes and rest for 15 minutes, I walk again for another 10 minutes. Over time, the more cycles of walking and resting I do the more overall walking I can accomplish. Find Your Rest Time If I rest for 15 minutes, I can start walking again without experiencing a pain-flare up. Find Your Active Time I can walk for 10 minutes before a pain flare-up.

Communicate Effectively

COMMUNICATE EFFECTIVELY 10 Tips to Get the Most Out of Your Doctor’s Visit 1 Prepare for the visit 2 Be clear and to the point 3 Know your healthcare team 4 Take medicines as prescribed 5 Be honest and open 6 Listen carefully and take notes7Ask about timing of expected results 8Phone Calls: Plan your message ahead 9Ask About Follow-Up: when, triggers10Arrive early (parking, check-in, etc.)In using these tips, we hope that you and your provider are able to communicate more effectively to reach pain-related goals. Used with permission from Dr. MJ Mariano, Puget Sound VA

Today's Summary 1 Understand our pain better 2 Be an active part of our own pain management 3 Team up with providers and communicate well We can live better with pain if we do a few things: