1 recovery based pain management at central city concern rachel solotaroff, md, mcr medical...
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RECOVERY BASED PAIN MANAGEMENT AT CENTRAL CITY CONCERN
Rachel Solotaroff, MD, MCRMedical Director, Central City ConcernApril 29, 2014
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Recovery-Based Pain Management
Combine activity-based and mindfulness-based approaches
Provide education and services to enable new choices
Utilize supportive and positive peer relationships
Foundational concepts of Hope, Power and Responsibility
Index the program to the need and readiness of the individual
Integrated MH, SA and primary care
Utilize medication-assisted treatment
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Level One
Level ThreeHot
Sauce/Suboxone
Weekly
Acupuncture
RENEW
Monthly Group Visits with OT/PCP
Behavioral Health Assessment
Monthly “Activity Groups”
Primary Care Only
q 2-3 mo visits
Chronic Pain Recovery Pyramid
Level Two
Low addiction risk:• Good self-management• Good support• Good function/activity
Low addiction risk BUT:• Low self-management• Low social supports• Low function/activity
High addiction risk:• Brief relapse • Early Recovery• Minimal support
Graduation Criteria:-- Level 3: completion of Hot Sauce-- Level 2:
Progress toward goals Engaged in Behavioral health (if nec) Reduction in opiate dosage
Risk Management-- UDS – q 3 months-- pill count – q 6 months-- ADR’s – q 3 months-- PDMP: annually
Risk Stratification Method for Chronic Pain and COT
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How Does Risk Stratification Occur?
Controlled Substances Review Committee:• Reviews all episodes of serious misuse or
misconduct• Reviews all requested new starts on chronic
opiate therapy• Provides guidance for complex pain management
cases Benefits:
Provides uniform, standardized approach to prescribing
PCP’s relieved at no longer having to “go at it alone”; “makes being strict less personal”; “enables discussions around public health concerns”
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Income &
Employment
Volunteering,Training, Jobs
CP Identified at Intake:
-- ROI’s
-- CP acknowledgemt
-- BH Screen:
• ORT
• PHQ
• GAD-7
• PTSD Screen
OT
Assess
CSRC 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 #1
PCP Appt #2
4 weeks
If + BH Screen
H&P, Record Review, UDS, OPDMP query
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Hot Sauce Model and Curriculum 12-week Level One A&D group, in primary care
setting Facilitated by CADC Support and clinical supervision from outpatient
A&D program By referral only (controlled substance
agreement violation, early recovery, otherwise high risk)
Zero tolerance for absences, dirty UDS
Hot Sauce Model and Curriculum
Topic Key Concept
1 Goals of Hot SauceWhat is AddictionBenefits/Dangers of Chronic Opiate Tx
Self-care, self-growth, self-love are necessary for recovery and pain management
2 Creating Support Recovery is more than not doing drugs. Pain management is more than taking chronic opiates
3 Recovery/Pain Management Thinking(Cravings and Triggers)
Our thoughts, feelings and attitudes generate actions
4 Containing Pain Complementary medicine options are useful for pain management
5 Handling Stress Demonstrate what you do to decrease stress
6 Stages of Change What changes have improved your mind, body and spirit?
Hot Sauce Model and Curriculum
Topic Key Concept
7 12 Step Groups and Other Support Groups
Being able to learn from other people, being able to help others
8 Pain and the Brain Pain and the brain are connected. Relaxation, Qi Gong, meditation decrease pain
9 Relapse Prevention(esp. violation of controlled substances agreement)
Truthfully take the time to think things through thoroughly
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Partnership with Your Doctor Do I believe my doctor wants me to get better?
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Raising the Bar “I am not my disease”
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What 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
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RENEW Model and Curriculum 12 Monthly groups in primary care setting Facilitated by Occupational Therapist or other
QMHP Support and clinical supervision from
Behavioral Health Medical Director PCP may attend group, or may see patients
individually after group for brief medication management visit
Focus on mindfulness and activity-based approaches to managing pain
Patients encouraged to come to at least one “Wellness Group” per month in addition to their group provider visist
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RENEW Model and CurriculumTopic Topic
1 Pros and ConsWhat is Chronic Pain
7 Treatment for InsomniaHow to fix your Sleep Position
2 Mindfulness and Non-judgmental Stance, Body ImageDeep Breathing
8 Health and Nutrition
3 Communicating about Chronic PainPain Scale, Pain Journal (and homework)
9 Time Management TipsLife Pie Chart
4 Treatments for Chronic PainChronic Pain Interventions: Stress Reduction
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Barriers to FitnessTai ChiQiGong
5 The Role of Anticipatory PainPacing, Adapting and Delegating
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Effective use of distractionIncrease blocking messages Aromatherapy
6 Unhelpful Thinking StylesAffirmationsLow Cost and No Cost Pleasurable Activities List
12 GraduationBook Lists
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