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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

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– 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

– 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

– 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
– 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
– Pain Management
– Medical
– Nonmedical
– Pain management requires a comprehensive approach addressing
– Physical causes of pain
– Mood
– Social supports
– Sleep