at Central City Concern Rachel Solotaroff MD MCR Medical Director Central City Concern April 29 2014 2 RecoveryBased Pain Management Combine activitybased and mindfulnessbased approaches ID: 1043465
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1. 1Recovery based Pain Management at Central City ConcernRachel Solotaroff, MD, MCRMedical Director, Central City ConcernApril 29, 2014
2. 2Recovery-Based Pain ManagementCombine activity-based and mindfulness-based approachesProvide education and services to enable new choicesUtilize supportive and positive peer relationshipsFoundational concepts of Hope, Power and ResponsibilityIndex the program to the need and readiness of the individualIntegrated MH, SA and primary careUtilize medication-assisted treatment
3. 11/12/20103 Level One Level ThreeHot Sauce/SuboxoneWeekly AcupunctureRENEWMonthly Group Visits with OT/PCP Behavioral Health Assessment Monthly “Activity Groups”Primary Care Onlyq 2-3 mo visitsChronic Pain Recovery PyramidLevel TwoLow addiction risk:Good self-managementGood supportGood function/activityLow addiction risk BUT:Low self-managementLow social supportsLow function/activityHigh addiction risk:Brief relapse Early RecoveryMinimal supportGraduation Criteria:-- Level 3: completion of Hot Sauce-- Level 2: Progress toward goals Engaged in Behavioral health (if nec) Reduction in opiate dosageRisk Management-- UDS – q 3 months-- pill count – q 6 months-- ADR’s – q 3 months-- PDMP: annuallyRisk Stratification Method for Chronic Pain and COT
4. How Does Risk Stratification Occur?4Controlled Substances Review Committee:Reviews all episodes of serious misuse or misconductReviews all requested new starts on chronic opiate therapyProvides guidance for complex pain management casesBenefits:Provides uniform, standardized approach to prescribingPCP’s relieved at no longer having to “go at it alone”; “makes being strict less personal”; “enables discussions around public health concerns”
5. 11/12/20105 Income & Employment Volunteering,Training, JobsCP Identified at Intake:-- ROI’s-- CP acknowledgemt-- BH Screen:ORTPHQGAD-7 PTSD Screen OTAssessCSRC Reviews Data and recommends:-- No Controlled Substances + Care Plan Recs -- OR ---- Controlled Substances + Level of Care + Care Plan Recs: Hot Sauce/Suboxone (Level 3) RENEW Provider Groups (Level 2) Primary Care Only (Level 1) Other recs such as BH, medication regiment, monitoring guidelines, etc.Behavioral Health Chronic Pain Recovery Program Road Map PCP Appt #1PCP Appt #24 weeksIf + BH ScreenH&P, Record Review, UDS, OPDMP query
6. Thank you!rachel.solotaroff@ccconcern.org6
7. Hot Sauce Model and Curriculum712-week Level One A&D group, in primary care settingFacilitated by CADCSupport and clinical supervision from outpatient A&D programBy referral only (controlled substance agreement violation, early recovery, otherwise high risk)Zero tolerance for absences, dirty UDS
8. Hot Sauce Model and CurriculumTopicKey Concept1Goals of Hot SauceWhat is AddictionBenefits/Dangers of Chronic Opiate TxSelf-care, self-growth, self-love are necessary for recovery and pain management2Creating SupportRecovery is more than not doing drugs. Pain management is more than taking chronic opiates3Recovery/Pain Management Thinking(Cravings and Triggers)Our thoughts, feelings and attitudes generate actions4Containing PainComplementary medicine options are useful for pain management5Handling StressDemonstrate what you do to decrease stress6Stages of ChangeWhat changes have improved your mind, body and spirit?
9. Hot Sauce Model and CurriculumTopicKey Concept712 Step Groups and Other Support GroupsBeing able to learn from other people, being able to help others8Pain and the BrainPain and the brain are connected. Relaxation, Qi Gong, meditation decrease pain9Relapse Prevention(esp. violation of controlled substances agreement)Truthfully take the time to think things through thoroughly10Partnership with Your DoctorDo I believe my doctor wants me to get better?11Raising the Bar“I am not my disease”12What Has Been Learned?Do you use methods to manage pain and have a good life?“I love the life I live and I live the life I love” -- Muddy Waters
10. RENEW Model and Curriculum1012 Monthly groups in primary care settingFacilitated by Occupational Therapist or other QMHPSupport and clinical supervision from Behavioral Health Medical DirectorPCP may attend group, or may see patients individually after group for brief medication management visitFocus on mindfulness and activity-based approaches to managing painPatients encouraged to come to at least one “Wellness Group” per month in addition to their group provider visist
11. 11RENEW Model and CurriculumTopicTopic1Pros and ConsWhat is Chronic Pain7Treatment for InsomniaHow to fix your Sleep Position2Mindfulness and Non-judgmental Stance, Body ImageDeep Breathing8Health and Nutrition3Communicating about Chronic PainPain Scale, Pain Journal (and homework)9Time Management TipsLife Pie Chart4Treatments for Chronic PainChronic Pain Interventions: Stress Reduction10Barriers to FitnessTai ChiQiGong5The Role of Anticipatory PainPacing, Adapting and Delegating11Effective use of distractionIncrease blocking messages Aromatherapy6Unhelpful Thinking StylesAffirmationsLow Cost and No Cost Pleasurable Activities List12GraduationBook Lists
12. 11/12/201012