Session 9: Understanding Your Treatment Plan
I. Review of Homework – How Can I Be More Assertive?
II. Problems with Physicians
III. Expectations and Wants
IV. How to Improve Communication with Doctors?
V. Medications
VI. Homework – Questions for the Doc.
VII. Relaxation Technique – Taking Control
Session 9: Understanding Your Treatment Plan
I. Review of Homework – How Can I Be More Assertive?
II. Problems with Physicians:
People who have chronic pain often have feelings about problems with their physician. Sometimes this can cause the doctor-patient relationship to deteriorate.

What are some problems that come up when talking with physicians?
III. Expectations and Wants:
Both health care professionals and patients want the process to follow this path.

Diagnosis it
Treat it
Illness Gone

This is the way the medical model is supposed to work and it usually does work. However, when dealing with chronic pain diagnosis is hard to make and often the patient does not get better. The process often follows this path instead.
Health Professionals
Avoid Patient
Decrease Communication
IV. How to Improve Communication with Doctors
1. Be organized, clear, and complete in information given.

a. Have ideas about what you want to get out of your visit.
b. Ask questions (have a list).
c. Make sure you understand answers, ask if you don’t, clarify what you think the doctor is saying.
d. If you have a lot of questions, let receptionist know and schedule accordingly.

2. Communicate about Medications

a. Tell the doctor all the medications you are taking.
b. Ask about side effects.
c. How long to take it.
d. When will I know it is working?
e. What happens if I don’t take it?

3. Keep a diary or log of:

a. Sleeping patterns
b. Medication usage
c. Any other activities you think would be beneficial in helping your doctor with your treatment plan
V. Medications:
A. Time Contingent Use of Pain Medications
B. Terms Used By Doctors When Discussing Pain Medication

Tolerance. Tolerance means that after you have taken a particular medication for a while, your body gets used to it, and it becomes less effective. This may happen with opioid and tranquilizing medication.

Physical Dependency. You can become physically dependant on opiates, minor tranquilizers, and sleeping pills. Without the drug, your body goes into a state of withdrawal that is quite uncomfortable and sometimes dangerous.

Psychological Dependency. This type of dependency may take the form of drug craving and thoughts such as “I can’t live without my medication.” Once you come to rely on medication, it is hard to manage without it. This may also include intense anxiety at running out of medication and being left to suffer.

Addiction. Being physically or psychologically dependant on medication does not mean you are addicted. Addiction is often associated with legal problems, which include getting prescriptions from many different physicians, forging prescriptions, and using medications for purposes other than pain control.

Adverse Effects. Almost all medications have some side effects. The side effects associated with certain pain medications include drowsiness, nausea, constipation, unpleasant mood changes, dizziness, dry mouth, stomachaches, nightmares, sweating, difficulty urinating, weight gain, and problems with concentration and memory. These side effects usually disappear when you stop taking the drugs.

Illusion of Helping. Medications for pain are not always helpful. Opioids and tranquilizers can deceive both the patient and the physician by creating an illusion of helping.
C. Classes of Pain Medication

Opioid Analgesics

Drugs in the opiate family include Codeine, Darvocet, Demerol, Dilaudid, Methadone, Oxycontin, Oramorph SR, Percocet, Talwin, Tylox, and Vicodin. The administration of opioids for chronic pain is restricted because of tolerance and dependency. In some cases, patients can mange well with regular opioids, while in others the need for the drug may add to the pain problem. There are also combination drugs such as Norco and Lortab that combine opiods with NSAIDS (see below).

Nonopioid Analgesics

For the majority of pain problems, aspirin, acetaminophen (Tylenol), and ibuprofen are useful analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDS: Ansaid, Clinoril, Dolobid, Feldene, Motrine, and Naprosyn) help reduce pain and inflammation. Although in large doses these medications can lead to stomach problems and other side effects, they are generally safe if taken as directed. When these drugs are taken on a regular schedule rather than when pain demands, a small amount is usually needed and pain is more effectively relieved.

Sedatives and Hypnotic Drugs

These drugs (including Valium, Xanax, and other barbiturates) are given to help patients sleep, but this effect tends to wear off over time. If taken in increasing amounts, these agents can lead to dependency and addiction, and interfere with intellectual functioning.


The role of antidepressant medication in chronic pain is not fully understood; however, these medications (including Desyrel, Elavil, Pamelor, and Sinequan) can be highly beneficial to certain persons with chronic pain, often reestablishing a normal sleep pattern, producing an improved sense of well being, and relieving pain. In low doses they are safe and do not loose their effectiveness.

Other Medications

Other medications prescribed for persons with chronic pain include muscle relaxants, antipsychotic drugs, and antiepileptic medications. Unfortunately, some of these medications have limited benefit.

Note: If you have specific questions about medications, ask your physician or pharmacist. It is important for you to know what medications you are taking, what the side effects are, and how they will benefit you.

Jamison, R. J. (1996). Learning to Master Your Chronic Pain. Sarasota, FL:

Professional Resource Press.
VI. Homework – Questions for the Doc.
Questions for the Doc.
Write down a list of questions that you would like to ask your doctor at your next visit.

Write down a list of questions that you would like to ask another health care provider at your next visit. Health Care Provider

VII. Relaxation Technique – Taking Control
1. Find a comfortable position, lying down the floor or sit up straight in your chair with your arms and legs uncrossed.

2. Close your eyes, and begin noticing your breathing. Try to notice each breath and nothing else.

3. As you exhale, say to yourself the word “one.” Keep saying “one” with each exhalation.

4. When you feel sufficiently relaxed, turn your attention from your breathing to a situation you find stressful or difficult.

5. See yourself handling that stressful situation successfully and confidently. See yourself saying and doing the appropriate thing to succeed. See yourself smiling, standing, or sitting erectly.

6. Now visualize yourself hesitating or making a small error, uncertain for a moment. But then you go on, confidently finishing the task, looking satisfied. You remind yourself, “I can handle this, I’m in control.”

7. Notice your breathing again. When you are ready open your eyes.
Davis, M., Robbins Eshelman, E., & McKay, M. (2000). The Relaxation and Stress Reduction Workbook 5th Edition. Oakland, CA: New Harbinger Publications, Inc.
Death of a Painkiller?
2009-12-22 15:37:24

When an advisory panel to the Food and Drug Administration (FDA) recommended a ban on acetaminophen-containing pain relievers in June 2009, the response was quick and angry. We were deluged with consumer calls, says FDA spokeswoman Karen Riley. Why the outcry? The panel had suggested that the FDA remove acetaminophen from all prescription drugs, including Percocet and Vicodin, two of the most popular painkillers in the world. The panel also advised lowering the amount of acetaminophen in over-the-counter medications like Tylenol from 500 milligrams to 325, which would cap the maximum daily dose at 2,600 milligrams. The reason: Every year, about 400 Americans die and 42,000 more visit the ER because of acetaminophen overdoses, which can lead to liver damage.

The Sound of Music Eases Pain
2009-12-22 14:55:35
Researchers at Glasgow Caledonian University in Scotland found that people who were listening to their favorite music felt less pain and could stand pain for a longer period.
Running Barefoot Eases Pain
2009-12-22 14:54:49
Scientists have found that those who run barefoot, or in minimal footwear, have a very different stride from their shoe-wearing peers. The sneaker-less tend to avoid "heel-striking," and instead land on the ball of the foot or the middle of the foot. By landing on the middle or front of the foot, barefoot runners have almost no impact collision, much less than most shod runners generate when they heel-strike.