Category: Chronic Pain

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Using Mindfulness with Opioid Addicted Chronic Pain Patients

00Addiction, Chronic Pain, Featured news, Health, Mindfulness, Therapy August, 17

Source: frankieleon at flickr, Creative Commons

In March 2016, legislative bodies in Maine put a bill forward to combat the state’s rising opioid addiction problem. New restrictions on opioids for chronic pain require doctors to limit prescriptions to just 15 days, and to encourage doctors to consider non-medicinal forms of treatment.

Treatment of chronic pain involves a delicate balance between managing pain relief and risk of drug addiction or abuse. Opiates have been used for centuries to treat acute and chronic pain. There is little debate over the short-term benefits of medication, but their use for chronic, non-malignant pain is controversial.

Chronic pain is a debilitating lifelong illness, affecting more than six million Canadians. The National Institute of Health defines chronic pain as lasting for at least six months, and creating both physical and mental strain on the victim’s quality of life. Patients may experience fear, depression, hopelessness, and anxiety in coping with their pain.

At the annual 2013 American Psychiatric Association meeting, pain specialists debated how to properly treat chronic pain and explored new forms of non-medicinal treatment.

Jennifer Potter from the Department of Psychiatry at the University of Texas advocates continued use of opioid prescriptions, but cautions doctors to examine potential risk factors for substance abuse.

“The vast majority of people with chronic pain do not go on to develop an opioid addiction, so it’s important for patients to understand that if this medication benefits you, it’s not necessarily a concern. We can’t let our response to the rise in prescription drug abuse to be denying access to all people in pain who can benefit from opioids.”

But a 2015 study by Kevin Vowles and colleagues from the University of New Mexico found that, on average, 25% of chronic pain patients experience opioid misuse and 10% have an opioid addiction. So, we also need non-medicinal treatment options to care for lifelong pain.

“Patients with substance abuse issues can be treated for pain in a variety of ways that don’t involve opioids,” says Sean Mackey, Chief of the Pain Management Division at Stanford University and Associate Professor of Anaesthesia and Pain Management.

One alternative way to approach chronic pain is through mindfulness, described as the process of paying active, open attention to the present moment. When a person is mindful, they observe their own thoughts and feelings from a distance, without judging them as good or bad.

Mindfulness is based on acceptance of one’s current state, and is becoming increasingly popular among patients as a way to help with pain symptoms.

Jon Kabat-Zinn, founding Executive Director of the Center for Mindfulness at the University of Massachusetts, advocates for mindfulness-based strategies to be incorporated into chronic pain treatment programs.

Kabat-Zinn created the popular Mindfulness Based Stress Reduction approach designed to treat chronically ill patients responding poorly to medication. The eight-week stress reduction program involves both mindfulness practice and yoga, and is effective in alleviating pain and in decreasing mood disturbance and stress.

A study by Natalia Morone and colleagues at the VA Pittsburgh Healthcare System showed the benefits of mindfulness in older adults with chronic low back pain by looking at diary entries of participants throughout an eight-week mindfulness treatment program. They found that treatment improved attention, sleep, pain coping, and pain reduction through meditation.

Some participants gained better awareness of their body throughout treatment:

“It felt good to realize [through mindfulness] that I can co-exist with my pain. Being mindful helped me realize that in my angry reaction to my back pain, I was neglecting my whole body. I saw my body only through my pain, which caused me to hate my body over time. I can now see myself outside of my body, and am working day by day with my meditation to become a happier person living with chronic pain.”

The authors also found that practicing mindfulness helped participants create vivid imagery to enhance their mood and decrease pain. One patient noted:

“I hear a sound in the distance and felt it was bearing my pain away, replacing it with a joyful ‘lifting’ of my spirits.”

While no miracle treatment exists, mindfulness can help improve patient quality of life.

–Lauren Goldberg, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. Muller, The Trauma and Mental Health Report. 

Copyright Robert T. Muller

This article was originally published on Psychology Today

One Woman’s Suicide Reignites Right-to-Die Debate

One Woman’s Suicide Reignites Right-to-Die Debate

00Aging, Chronic Pain, Dementia, Featured news, Law and Crime, Philosophy, Suicide October, 15

Source: torbakhopper/Flickr

“I will take my life today around noon. It is time. Dementia is taking its toll and I have nearly lost myself.”

Gillian Bennett chose the right to die in the backyard of her home on Bowen Island. On August 18th, 2014, wrapped in the arms of her husband of 60 years, she said goodbye with a tumbler of whiskey and a lethal dose of barbiturates.

At age 85, Bennett had been living with dementia for over three years. During her lucid moments, she would ruminate on the impact of her suffering on family, and the burden she would become on the healthcare system at large.

Bennett wanted to live and die with dignity; she viewed spending her remaining days in a nursing home as anything but.

The retired psychotherapist voiced her wish to end her life on her own terms before losing “an indefinite number of years of being a vegetable in a hospital setting, eating up the country’s money but having not the faintest idea of who [she is].” Her family and friends supported her decision.

“In our family it is recognized that any adult has the right to make her own decision.”

Bennett’s conversations became the inspiration for deadatnoon.com, a website that hosts her goodbye letter. In it, Bennett explains her reasoning for wanting to die on her own terms and makes a plea to re-open the debate on assisted suicide for the elderly and terminally ill.

Every day Bennett felt she was losing another part of herself. Small lapses in memory were followed by an inability to keep the days straight and a decline in physical capacity. Soon, she would not have been competent enough to make decisions about her life. She wanted out before that happened.

She considered three options. The first was to “have a minder care for [her] mindless body” despite financial hardship on her family. The second, to settle into a federally funded facility at a cost to the country of $50,000 to $75,000 per year. The third, to end her life “before her mind [was] gone.”

She felt compelled to choose the third, dismissing the other options as “ludicrous, wasteful, and unfair.” At the end of her four-page letter, she encouraged readers to consider the ethics of assisted suicide.

Canadians are familiar with the debate on euthanasia. Beginning with the landmark Rodriguez v. British Columbia decision, euthanasia has been revisited by the courts many times.

In 1991, Sue Rodriguez, who was suffering from ALS, attempted to petition the Supreme Court of Canada to allow assistance in ending her life. The court refused her request.

Despite the decision, she passed away with the aid of an unknown doctor in 1994.

A similar ruling was made in the Robert Latimer case. Latimer was convicted of second-degree murder in 1997 after killing his severely mentally disabled daughter, Tracy, whose condition left her in constant, unmanageable pain.

In 2011, the B.C. Supreme Court ruled that the ban on assisted suicide was unconstitutional following a challenge from another ALS sufferer, Gloria Taylor. The federal government appealed the ruling and, in 2013, the B.C. Court of Appeal upheld the ban.

Bennett’s decision to end her life revived the debate. In February of 2015, the ban was struck down again by the Supreme Court of Canada. Federal and provincial government has been given twelve months to create legislation in response to the ruling. 

Bennett, a woman who saw life as “a party she was dropped into”, made it clear she felt she was losing nothing by committing suicide. Described as smart, funny, and irreverent, she faced death the way she lived life.  

“Each of us is born uniquely and dies uniquely. I think of dying as a final adventure with a predictably abrupt end. I know when it’s time to leave and I do not find it scary.”

– Magdelena Belanger, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today