Services

Pain Management Options provides medical and behavioral health services for individuals with chronic pain whose use of opioid analgesics has become counter-productive. We also medically treat patients with dependence or addiction to opioids.

Our interdisciplinary programs involve evidence-based treatment modalities in combination with safe medications and buprenorphine/naloxone assisted detoxification to eliminate opioid use and improve overall physical functioning and mental well-being.

The physician, psychologist and staff are specialists in the management of chronic pain. Working together as a team, they quickly assess your condition and develop a comprehensive treatment plan.

Medication Assisted Transition

It is important to have a clear understanding of all your options. Consulting with an experienced physician is a critical element in providing the patient with treatment tailored to their needs. The complications of long term analgesic (prescription painkiller) use may be a factor in managing chronic pain.

According to research posted in the American Journal of Therapy in 2005, patients who failed to achieve lasting analgesia (pain relief) with long-term opioid therapy have achieved benefit using sublingual buprenorphine, a partial mu agonist. The medication was investigated in an open-label (i.e. no placebo) study with 95 consecutive patients who were referred by local pain clinics for detoxification from long-term opiate analgesic therapy (mean 8.8 years) due to increasing pain levels, and worsening function. In addition, 8 percent of the patients had a diagnosis of addiction to opioids. (Addiction is characterized by compulsive use of medications, an inability to self regulate consumption, in addition to the physiologic dependence that is characterized by withdrawal from abruptly stopping medication. Many patients experience dependence without addiction) This study showed that after discontinuing from all opioid analgesics for a minimum of 12 hours, patients received low doses of sublingual buprenorphine or Suboxone (buprenorphine/naloxone). The daily sublingual buprenorphine dose ranged from 4 to 16 mg (mean, 8 mg) for an average duration of 8.8 months. Eighty-six percent of patients experienced moderate-to-substantial pain relief, improved mood and functioning.

Being the first oral formulation of buprenorphine that has been approved in the U.S., physicians can now prescribe buprenorphine in their offices for people who are dependent or addicted to opiates such as opiate pain medication, heroin, or methadone. Buprenorphine is an effective medication for opiate addiction which does not require daily or weekly visits to a clinic. Buprenorphine can eliminate withdrawal symptoms, and has analgesic properties. Some patients choose to continue buprenorphine for a period of time, while others transition off of opioids altogether.

Subutex and Suboxone are the brand names for sublingual buprenorphine for the treatment of opiate dependence. Both medications contain the same active ingredient: Buprenorphine Hydrochloride. Subutex contains only Buprenorphine Hydrochloride which was developed as the initial product.

Suboxone contains an additional ingredient called Naloxone, however minimal naloxone is absorbed when placed under the tounge. Primarily the naloxone is present to reduce the likelyhood the drug would be reconstituted for injection in an abuse scenario, as the Naloxone would render a person ill if injected.

Incidentally, This medication is also being used very effectively by many physicians as an analgesic for people living with chronic pain. It is important to remember that medication is not FDA approved for the treatment of chronic pain, and therefore this is an "off label use", and is only one method of treatment for effective chronic pain management. Physicians have the authority to prescribe medications beyond the FDA approved indication, so long as there is some evidence to support that use in research literature. It is alsl crucial to develop non-medication based treatment interventions, as well as learning to treat the psychological/emotional components of chronic pain. A interdisciplinary team approach always gives the best treatment outcomes.

For someone with chronic pain who has developed an dependence, this medication has the advantage of stablizing intermittent withdrawal. It is also important to help people differentiate between the physiological and psychological/emotional components of their pain. Once that is done, then cognitive behavioral approaches can help people manage the psychological components more effectively.

Physical Therapy

Physical Therapy is the art and science of helping someone restore motion. Whether relating to tapping your toes or the ability to run a marathon, the body must move. If it becomes difficult to move, physical therapists are here to help you. With skillful assessment of nerves, muscles, ligaments and joints, they can establish a safe treatment plan to get you back on track. Our physical therapist has more than 13 year working with cronic pain patients.

Your treatment is specifically focused on your functional goals and how to get there.
Initial testing and screening will allow us to develop the best plan of care with you.
We treat the whole person, not just the symptoms. Depending on your needs, exercises may address relaxation, posture, positioning, mechanics, flexibility, strength, endurance, coordination and balance.

Behavioral Medicine

Behavioral Medicine maybe one of the most important pieces of the puzzle. At Pain management Options behavioral science is tailored to each treatment plan.

Our psychologist and clinicians work closely with the doctor and physical therapist to deliver comprehensive care.

Cognitive Behavioral Therapy (CBT)/ Biofeedback

Cognitive Behavioral Therapy (CBT) has been demonstrated repeatedly to be an efficacious treatment for chronic pain. Over the course of individual sessions, maladaptive thoughts concerning pain and disability, ability will be identified and modified through cognitive restructuring techniques. Brief CBT as a central element of treatment for chronic pain has been well-supported in the literature. In addition to identifying maladaptive thoughts through daily logs and individual sessions, cognitive restructuring involves working with patients to adopt more reasonable and adaptive thoughts that promote self-efficacy and improve pain management.

Biofeedback has been empirically demonstrated to be moderately successful as a means of teaching chronic pain patients to manage their pain . Coupled with CBT and an interdisciplinary process, the science of biofeedback has been determined to have even greater efficacy. It provides an avenue to explore physical reactions to thoughts and emotions, and their relationships to physiological functioning. Chronic pain is not just a physical ailment that can be treated by solely physical approaches. Pain encompasses all aspects of the patient’s life. Working in conjunction with the other disciplines of this program, biofeedback gives patients an opportunity to learn how to manage the physical manifestations of their psychological status.

Biofeedback works through three components; the biofeedback equipment, the trained therapist, and the willing patient. Biofeedback is implemented by trained licensed mental health counselors under the supervision of Dr. Robinson. Individual sessions are provided 1-2 times per week. Finally, one or more family/social support psychoeducational sessions is provided.

Group Sessions

Individuals suffering from chronic pain frequently suffer from alienation and estrangement from family, friends and coworkers as a result of their condition. Group sessions provide vital social support as well as serve as an efficient means for disseminating educational information important for the development of self-management strategies for chronic pain . Furthermore, the impact that group members have on one another in terms of encouragement and support cannot be underestimated.

Groups consist of a maximum of 7 patients, thereby ensuring that each patient’s needs are addressed in group sessions. Patients attend a Pain Education group as well as a Chemical Dependence (CD)/Cognitive Behavior Therapy (CBT) group weekly. The program is designed to initially begin with a CBT component to maximize patient engagement. Given the intersection between the patients’ pain, opioid dependence, and emotional responses to their chronic pain, groups will typically address a combination of all of these related issues.