1. Coping with KT By Sibelia L. Chaiyahat, MSW, LCSW Life Enrichment Services Portland, Oregon Qualifications: mental health clinician, 15 year old son w/ KT The Swirls of Pain by Sittidet Chaiyahat

2. KT has some challenges Physical differences Pain Mobility Clothing/shoe adjustments/needs Depression Need good medical treatment/insurance Complicated, hard to explain and understand Financial or employment issues Intimacy Travel Bleeding/leaking PTSD or anxiety from medical trauma

3. How to stay emotionally healthy? Know and understand KT Awareness of these challenges especially depression and pain Know resources – treatments, accommodations, etc. Take good care of yourself (emotionally and physically) Have a good support circle Keep trying things, don't give up

4. Depression: Symptoms Persistant feelings of sadness (may be crying spells) Loss of interest or pleasure in things Changes in appetite Loss of energy, increased fatigue Changes in sleep patterns Restlessness, irritability, anger Feelings of worthlessness, guilt Difficulty concentration or making decisions Thoughts of death or suicide Somatic (headaches, nausea, pain) Isolation, social withdrawl Lack of motivation

5. Depression: What causes it? Personality characteristics- low self esteem, easily overwhelmed, pessimistic Biochemistry – serotonin and norepinephrine Genetics- runs in the family Environment – abuse, neglect, violence, poverty, disaster, accidents Multiple extreme stressors (chronic illness, caregivers)

6. Chronic Pain: What is it? Chronic pain is pain that continues a month or more beyond the usual recovery period for an injury or illness or that goes on for months or years due to a chronic condition. The pain is usually not constant but can interfere with daily life at all levels. (The American Pain Association) Suffering – The state of severe distress associated with events that threaten the intactness of the person.

7. Social-Psychological Impact of Chronic Pain Lack of motivation, interest, and pleasure Decreased ability to cope w/ stressors Social withdrawl and isolation Loss of self esteem Increased tendency to worry Cognitive problems- concentration, memory, processing information Relationship problems Loss of work or income Pseudoaddiction (inadequatly treated can lead to manipulative behavior)

8. Social-Psychological Impact of Difference in Physical Appearance Negative body image Depression Social, sexual, and professional difficulties Prejudice and Intolerance Negative response from people

9. Depression and Pain Depression Pain Other issues: Poor body image Hard to get around No shoes fit No insurance Lack of medical care Hard for others to understand Difficulty keeping work Lack of intimacy Hard to travel

10. Treatment Options for Depression and Chronic Pain Over the counter (NSAIDS, etc) Anti-depressants Anti-convulsants Talk therapy (CBT, DBT) Mindfulness or meditation Peer support groups Biofeedback Accupuncture Massage or other body work Opiods Medical Marijuana (inhale, topical, edible) Topical pain cream, patch, etc. Surgery, amputation

11. Treatment for Depression and Chronic Pain Hot tub, hot bath or shower Exercise or physical therapy Structure and activities Music, art therapy Writing, journaling, blogging Electrical Stimulation (TENS) Topical pain relievers Service animal Self hypnosis Mirror therapy or virtual visual feedback Manage your acute pain Do not give up on managing your pain!!!

12. Coping with KT Stay active and busy Get out of the house Be with other people Do things you enjoy Love and accept yourself and KT Spiritual practice and community Pets Learn specific coping skills that work for you Surround yourself with empathy, love, support, and validation Volunteer to help others

13. Coping with KT Get good sleep Take care of your body Eat well Try to think positive, avoid catastrophizing or other negative thinking patterns Exercise your brain (chronic pain can atrophy pre frontal cortex) Spend time in nature Laugh, watch comedy shows, be around funny people

14. What have you found successful? Share some stories

15. References www.nimh.nih.gov National Institute of Public Health www.nimh.nih.gov www.theacpa.org American Chronic Pain Associateion