Terri A. LewisSIU-Carbondale, REHB [email protected]
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What is the difference between acute and
chronic pain?
How do medical models exert influence on the
development of the disease ?
What are the return to work implications for
treatment options, coexisting disorders?
How do multi-axial treatment models, frame
the role for Counselors?2
How is pain defined?
Incidence & prevalence in the population
How does chronic pain develop?
How many syndromes are associated with
chronic pain?
How is chronic pain classified?
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Pain - an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
Acute pain - pain that terminates or eases when conditions of illness terminate or surgical interventions heal, generally does not persist for more than a few days, even if it recurs. Chronic pain - a state in which pain persists beyond the usual course of an acute disease or healing of an injury - may or may not be associated with an acute or chronic pathologic process, persists for three to six months or more beyond the onset of an illness or recovery from healing of surgical procedures or trauma
Breakthrough pain - pain that acutely elevates in response to known or unknown stressors or reductions in medication levels between available dosages.
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Etiologic specific chronic pain is the type of pain that
results from a specific event or illness.
Neuro-biological pain is chronic pain that is
persistent, residual beyond the expected healing
period and becomes secondary in its’ development to
the originating trigger.
Frequently co-morbid with the secondary
development of generalized anxiety disorders,
depression, and post-traumatic stress disorder5
Leading cause of disability in this country (Mayday Fund, 2009)
Incidence > than diabetes, heart disease and cancer
combined (American Pain Foundation [APF], 2009; McCaffery & Ferrell, 1999, 2010).
70 – 76 million Americans, w/ 9% reporting
moderate to severe levels of intensity (National Institute of Health
[NIH], 1998; Mayday Fund, 2009)
Economic toll of chronic pain at $100 billion a year
in the United States (National Institute of Health [NIH], 1998)
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Two categories, occur independently or together -
(a) pain that develops due to actual damage to peripheral nerves or the central nervous system (CNS)
(b) nociceptor (neural) pain resulting from nerve tissue irritation or damage in which pain mechanisms become hardened and involve related endocrine system dysfunction.
These may occur independently or together.7
Crohn’s Disease Spinal Pain Fibromyalgia Failed Back
Surgery Post Epidural
Syndrome Inflammatory
disorders 200+ syndromes
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The chronic pain experience may be seen as the result of a dynamic interaction between pathophysiological, psychosocial,
social, and treatment (or prolonged lack of treatment) variables.
Minorities remain largely untreated Cultural barriers to care Different patterns in seeking treatment Effects of age bias Undertreatment due to
pseudoaddiction Distribution of resources Length of suffering avgs 5 years without
intervention Return to work statistics are alarming
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Acute pain usually resolves within 3 monthsChronic pain is still present at 3 mos post onset, hardened by 6 mos
Four Medical Models of Care
The Biomedical Model, the primary care practice model
The Sequelae of Care Biomedical model
The Multidisciplinary, Biobehavioral Pain Center model
The Biopsychosocial/Neurobehavioral model
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338.0 Central pain syndrome,
338.21 Chronic pain due to trauma,
338.22 Chronic post-thoracotomy pain,
338.28 Other chronic postoperative pain,
338.29 Other chronic pain,
338.4 Chronic pain syndrome with
significant psychosocial dysfunction,
780.96 Generalized pain.14
Electronic health records (EHR) are NOT programmed with logic models for the diagnosis of either - Orphan disorders (500+) or Chronic pain syndrome (CPS) Counselors should be on the look out
for repeated complaints of pain after even the most innocuous of triggering events….
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Axis 1 – Mental Illness
Axis 2 – Personality Disorders, Intellectual
Disability
Axis 3 - General Medical Condition
Axis 4 – Psychosocial & Environmental
Stressors
Axis 5 – General Assessment of Functioning
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Mood disorder due to generalized
medical condition 293.83
Generalized Anxiety Disorder due to a
medical condition 293.84
Post Traumatic Stress Disorder (PTSD),
Acute or chronic 309.81
Acute stress disorder 308.3 19
Borderline Personality DisorderConduct DisorderObsessive Compulsive DisorderHypochondriasisAttention seeking behaviorDrug seeking behavior
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Chronic Pain due to a general medical condition 307.89
Chronic Pain NOS 338.xx
Chronic Pain due to trauma 338.21
Chronic Pain with psychosocial dysfunction 338.4
Neuroendocrine disorders:
Thyroid dysfunction; Diabetes; Low levels of testosterone; Elevated
levels of cortisol and other stress hormones
Sleep disorder due to medical condition, 327.xx
Substance abuse; Substance dependence (with physiological dependence or
without physiological dependence); Alcohol dependence 303.90 or Alcohol
Abuse 305.00; Cannabis dependence 304.30 or Cannabis abuse 305.20;
Nicotine dependence 305.1; Opioid Dependence 304.00 or Opioid Abuse
305.50; Polysubstance dependence 304.80; 21
Job loss or unemployment
Loss of community/family roles and
functions
Divorce and family disruption
Lack of family support
Financial stressors
Undertreatment of chronic pain syndrome
Access to care failure 22
GAF Score
0 – 49 Impaired
50 – 100 Significantly impaired
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Prevention Planning for vocational supportContinued treatment for chronic painCommunity/family supports Integrated counseling modalities
Adjustment Medication supports Alternative therapies Lifestyle changes
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Informed consent counseling Prevention and psychoeducation Integrated treatment modalities Alternative therapies combined
Meditation, biofeedback, yoga Pain reduction tools – stimulators and
pumps Medication protocols Stress management Wellness medical supports
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AdvocacyCollaboration with other
professionalsReferralConfidentialityMulticultural awareness
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Prevention Resiliency training Psychoeducation Adjustment training Suicidal ideation & rational suicide
counseling Collaboration with other treatment
providers Advocacy Access to appropriate treatment
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