What is a clinician to do?

1. Is Your Client in Chronic Pain ?-What’s A Clinician To Do ?
2019-Drs. Stanger & Flowers

2. Louise Stanger Ed.D, LCSW,
CDWF, CIP
Founder All About Interventions
Author-The Definitive Guide to
Addiction Intervention, 2018 &
Falling Up- A Memoir 2016
Speaker-Trainer-Consultant
Family Programs
www.allaboutinterventions.com
619-507-1699
Clinician-Interventionist

3. James S. Flowers
PhD, LPC-S
Founder and CEO, Kemah Palms Recovery
Founder and CEO, Cypress Lakes Lodge
Founder and CEO, J Flowers Health Institute
Anthony Fry
Director of Business Development
(713) 515-3467
Anthony.fry@kemahpalms.com
Kyle Infante
Chief Marketing Officer
(214) 226 - 7422
Kyle.infante@cypresslakeslodge.com
Joshua Walker
Vice President, Relationship Management
(720) 338-0658
Joshua@jflowershealth.com

4. Objectives
Discuss Chronic Pain and
Chronic Pain Syndrome
Demonstrate the Interplay of
Mental Health Problems with
Chronic Pain
Reveal how our Brain Tricks us
with Chronic Pain
Present Evidence Based
strategies that are effective
with Chronic Pain

5. Objectives
Identify what is Unique about
Chronic Pain Families
Identify How to Work with
Clients and their families
Introduce Family mapping as a
Way Into Story
Present Strategies for Clients &
Families that have SA, MH, and
CP

7. 100 Million- One in Ten
Americans - 1.5 Billion Globally

8. Chronic Pain
Chronic Pain affects over
133 million Americans or
over 1/3 of our population
Annual cost of $635 million
More common among
women then men
More common among older
persons

9. Chronic Pain
Arthritis
Fibromyalgia
Crohn’s Disease
Concussions
Spine
Accidents
Pelvic Pain
Hips, Knees, Shoulders, Spines

10. #1 Cause of Long Term Disability
Concussions
Facial pain
Neck Pain
Accidents -Driving, Texting
Exercising, Weekend
Warrior Tasks
Hips, Knees , Shoulders

11. More Types of Chronic Pain
• 28% Low Back Pain
• 15% Migrane or Headache
• 15 % Neck Pain
• 4 % Facial Pain
• #1 Cause of long term
disability

14. But what exactly is Chronic Pain?
Pain that lasting longer then
12 weeks
For the most part pain has
been treated in terms of
body parts

16. All Pain is Real>>>>

17. Emotions Drive
Chronic Pain

18. Dr. Steven Haines

19. With chronic pain the
neurotransmitters neurotransmitters
Prevent certain regions
from turning off when they
should
Result the brain is overly
sensitive to pain and
stimulates a feed-forward
cycle that reinforces the
chronic pain state

20. Neurotags and Pain
Descartes and our Brain
Attachment Theory < Pain and
The Brain

21. Is Chronic Pain-The Brain Game ?
Neuroimaging shows that
chronic pain alters the size of
certain brain regions
And the way certain brain
regions talk to one another
becomes abnormal
It effects the dorsolateral
prefrontal lobe - cognition
motor planning and memory

24. Effects of Chronic Pain
• 77% report feeling depressed
• 51% feel they have little or no
control over their pain
• 20% report sleep is disrupted
due to chronic pain

25. Young People and Chronic
Pain
• Treated as if Health issues
can’t possibly be chronic
• Are told they are too young to
have Chronic Pain
• Worry they will never find a
romantic partner
• Worry they will never finish
school
• Sit by and watch as others
their age participate in
activities that they cannot do.

26. Work and Chronic Pain
• Cost estimated 62.1 billion
Jama
• Employers Believe:
• They are unreliable
• They are less productive
• They use pain as a excuse

27. Chronic Pain and Addiction
Pain Patient becomes out of
control with medications
Becomes drug seeking -
quality of life decreases
Medication will continue or
increase despite side
effects .
Hyperalgesia

28. Pain Holds Us Hostage

29. Pain- Substance Misuse- Brain -Attachment

30. Over Lapping Features of Chronic
Pain & Addiction
Trauma
Loss of Control
Loss of Mastery
Loss of Sense of Self
Cognitive Error
Overinterpretation
Catastrophe
Personalization
Daily Life Alters
Trauma
Loss of Mastery
Loss of Control
Loss of Sense of Self
Loss of Self-efficacy
Cognitive Error
Denial
Daily Life Alters

31. Trauma

32. Pain becomes the organizing force that
Families Coalesce Around

33. Impact of Chronic Pain On
Identified Loved One
Pain Does not Show
Doubt about Pain
Fluctuating Activity Levels
Unpredictable Mood Swings
Isolation
Loss of Friends, relationships
(sexual etc) and productivity

34. It is difficult to Explain Chronic
Pain to Families, Friends etc
They cannot Hear. Pain does not
have a weight or height or
length
75% of all marriages end in the
US in divorce when one partner
experiences a chronic illness

35. Impact of Chronic Pain on
Families
Increased responsibility for
maintaining home and income
Increased responsibility for
transporting to Doctors etc
Inability to Truly understand
pain

36. Frazzled- Bewildered- ConFused- Angry- Mad- Sad

37. Impact on Families
Loss of Intimacy
Loss of Future Plans
Irritably
Powerlessness

38. Chronic Pain Families
Armed with Medical knowledge
Intimidated by Medical
Feel, Guilt, Shame,Confusion
Dr. Knows Best

39. Families are Fractured from
Anxiety Depression, Addiction and Chronic Pain

40. Families’ Responsibilities
• Responsible for daily care
• Dealing with insurance and
doctors
• Sometimes responsible for
income, food and lodging
• Responsible for being
Cheerleaders even when they
don’t want to cheer

41. Family Mapping
A Way Into

42. The Power of Language
• What you say about Pain
Reflects on how you feel
• Affects how you feel
• SELF-FULLING PROPHECIES
• CATASTROPHIZING
• PROJECTING
• TEACHING ONE TO BE
THEIR OWN CEO-

43. Pain Requires an Audience
• Pain is never good without an
audience- excused from
chores, work etc
• People don’t hurt as much if
they have something better to
do
• Work and activities to set
goals, not to pain tolerance
• Empowerment/Goaling
Process
• Exercise

44. Families Learn
• Their History
• Their Ways of Communicating
• To take Care of Themselves
• To Discover Curiosity
• To Discover Joy
• To try Out New Ways of
Relating

45. “YOU CANNOT HEAL WHEN
YOU ARE STRESSED ALL THE
TIME. “

47. QIGONG
Qi-“Subtle
breath”,Gong-“Vital energy
Slow movements warm
tendons, muscles and
ligaments & Muscles, Promote
circulation of body fluids
Effective for chronic illness ,
emotional frustration, stress
and spiritual crisis etc (NQA)

48. YOGA
Mind-body practice
Low Back Pain
Arthritis
2011studies
military

49. Music
Fibromyalgia, arthritis , joint pain , nerve disorder

50. Accupuncture
Chronic Back pain,
(2010-2012)
Joint pain, (osteooarthritis)
Knee and Hip pain
Headaches/Migraine
Fibermyalgia
Detoxification

51. Spinal Manipulation
PT, Naturopaths,
Osteopathic Physicians,
Chiropractors
AHRQ -Low Back Pain
withers as effective as
medications
Headaches
Neck Pain

52. Aquatic Therapy

54. Food
Reduce Pain and Inflammation

56. Thom

57. Maddi
10 operations - 6 treatment centers

58. Meet Sally

59. Meet Renee

60. Meet George

61. 11 Tips to help a Loved one
Ask Questions
Attend-Learn about Condition -
Get Consent form from Dr
Understand MRIs are over given
Learn about Pain management
Strategies
Try the Pain Management
Strategies they can be helpful
for everyone

62. 11 tips to Help Clients help
Loved Ones
Collaborate in Goal setting
Boundaries
Share Activities
Communicate-Be Direct, honest
Encourage
Find Time to Laugh

63. Compassionate Directness
Practice

65. Resources
Haines, Steve. Pain is Really Strange (2015)
“Tame the Beast” - Professor Lorimar Mosely & David Moen
https://youtu.be/ikUzvSph7Z4
Impact on Chronic pain-healthtalk.org
Wolters Kluewer Health : Lippincott Williams and Wilkins Does
Chronic Pain Run in Families July 6, 2016
Campbell, Paul, Jordan Kelvin P, Smith, Blair H,Scotland,Dunn,
Kate M. Pain. Jan. 2018

66. Resources
Stanger articles https://www.allaboutinterventions.com/pain-
management-and-opioid-addiction/http://
www.huffingtonpost.com/entry/
Stanger, Porter, Flowers Huffington Post-Trauma and
Addiction http://www.huffingtonpost.com/entry/trauma-
addiction-whats-the-difference_us_58d14912e4b0e0d348b347f3
Flowers Articles,https://www.thriveglobal.com/authors/3611-
james-s-flowers-phd-lpc-s-and-angela-harris-msw-candidate
Stanger,https://www.allaboutinterventions.com/current-news/

67. Resources-Pain and The Brain
R, L. Nahim, Estimates of pain prevalence and severity in adults, 2012,
“j Pain, vol.16, no 8 pp789-80
A. May, “Structural Brain Imaging. A Window into Chronic Pain", The
Neuroscientist,vol17,No 2,pp.2019-220, 2011
Napadow& R.E. Harris ,”what has functional connectivity and
chemical neuroimaging in fibromyalgia taught us about the
mechanisms and management of centralized pain ? Arthritis Research
and Therapy .vol 16
Ingemanson, Morgan PHD , “Chronic Pain Lives in the Brin, April 17,
2017 Vox Brain Map http://evoxbrainmap.com/chronic-pain-lives-
brain/

68. Resources-Complementary
Therapies and
Nahin, R. ,Boineau, R, Partap. S. K.,
Stussman, Weber, N.D. Evidence -Based
Evaluation of Complementary Health
Approaches for Pain Management in the
Inited States , Sept. 2016
Why Goldilocks is my Rehab Heroine
https://meduim.com/cheryllee-98816/why-
goldilocks-is-my-rehab-heroine

69. Resources
Prevalence of Chronic pain Among Adults CDC Sept. 14,
2018 https://www.cdc.gov/mmwr/volumes/67/wr/
mm6736a2.htm
10 Tips To help A Loved One in Pain-Survive and Thrive
Pohl, Mel. A Day Without Pain. Central Recovery Press
Pohl, Mel. Pain Recovery. How to Find Balance, Reduce
Suffering from Chronic Pain. 2008 .Central Recovery Press

70. Resources
• The Extra Burdens Faced by Young People with
Chronic Illness -Toni Burnard JD Psychology Today ,
March, 2014
• Chronic Pain and the Family -Theory Driven
Approaches , Lewandowski, W , Morris R, Burke,
Claire & Risko > Mental health Nursing 28:1044, 2007
• The surprising impact of Chronic Pain on Family and
Money- Az Pain

71. Resources-Family Mapping
Brown, Brene- Rising Strong . Speiegel & Grau International 2015 NYC NY
Brown, Brene, DaringGreatly. Gothom Books 2012
Lawrence Lightfoot,Sarah & Hoffman Jessica .TheArt and Science of
Portraiture. Joey Bass. 1997
LawrenceLightfoot, S. Respect , 1998. Press Books, Mass.
Lawrence, Lightfoot,S. I’ve Known Rivers , Penguin Publishing. Ny 1995
Lawrence, Lightfoot, S Growing Each Other Up, University of Chicago Press.
2016

72. Resources About The
Opioid Epidemic
http://www.nbcnews.com/nightly-news/video/louisville-kentucky-
sees-spike-in-heroin-overdoses-876423747884
Achenbach, Joel.The Washington Post, Dec.23, 2016. An opioid
epidemic is what happens when only treated with pills.
Gebelhoff, R. The opioid epidemic can turn into a pandemic if we are
not careful. The Washington Post .Feb. 9, 2017 https://
www.washingtonpost.com/news/in-theory/wp/2017/02/09/the-opioid-
epidemic-could-turn-into-a-pandemic-if-were-not-careful/?
utm_term=.d7f5c8218e3c