1. Vista Resources: Opiate Oversight Committee (OOC) Submit cases to your peers for support and guidance around complex issues Finding Wellness Amidst Chronic Pain (FWACP) Group (6 week program, TE to Sethness, PsyD) CAM Clinic (Acupuncture, Massage, Chiropractic, Naturopathy) Other MH Groups (Depression, DBT, Seeking Safety, Choices for Change) Community Resources: YMCA Center for Wellbeing Physical Therapy Finley Center A HUGE Topic: There is a difference between pain and suffering. We can think of pain as medical, a message from the body. We can think of suffering as emotional, as how we respond to our pain. If we can work to limit the suffering, we can help patients focus on acceptance around the pain they experience. Communication of your concern is very important when discussing appropriate medical intervention. Many of the treatment standards are being updated to help patients find alternative routes for treatment other than opiates/medications. For those already on high regimens, support and clear communication are necessary to begin the delicate process of lowering dosages. Remember, not all chronic pain patients have substance use disorders and many have been following prescribed regimens for years (compliant and now suffering as a result). Additional Co-Occurring Considerations: Involve genetic, medical, environmental, and social influences Pain & Suffering (1) C.L.I.P.S. Updated 20 January 2016 Sethness, Hansen, Addison Anxiety Depression Family history Trauma & PTSD (during injury or other) Treatment History Stressful life events Poor social support Serious medical illness Substance Abuse Medication Compliance? Grief for Loss of Functioning

2. Possible Interventions: Alternative medicine practices to alleviate aspects of both pain &suffering (i.e. CAM clinic, QiGong, Tai Chi, Therapy, nutrition, etc.) Engage patient in behavior change discussions that promote validation, behavioral activation, mindfulness practices, coping skills, and increased relationship support. Referral to Behavioral Health for therapy/group services or call (x3600) to initiate more immediate mental health intervention through our warm handoff system. Trial other meds (consult with psychiatry for additional recommendations) Remember that many people placed on high levels of pain medications were prescribed these regimens by trained providers that encouraged and supported these practices. Some patients must make a very large perspective shift in order to understand the need to change something that they might have been told over and over again for years. With support and consistent communication, these changes can be made over time. Think holistically – what aspects of the person’s life can be improved to help with overall wellbeing (and in turn, their experience of chronic pain in their lives). Think of the process of coping with chronic pain as one that typically includes a significant grieving period. Much change is expected, and this may take time and support with many different interventions to help facilitate all aspects of settling into a new way of living. It is not so clear to define whether a person is struggling with addiction, chronic pain, mental illness, or some combination. This takes time, patience, and listening. Be gentle with these patients; use your resources (consultation, CURES, referrals, referencing the guidelines, OOC); and remember that this is a process that often requires many visits to unfold. Non Opioid Treatment for CP(2) C.L.I.P.S.