Age-Competency Assessment. Survey of mental health professionals in VA Network 16 regarding competency to address the mental health needs of older veterans.  The project is described in Molinari, V., Kier, F.J., & Kunik, M.E. (2001). Obtaining age-related mental health competency: What is needed? Educational Gerontology, 28, 1-10.

Age-Specific Role Competency Curriculum for Substance Abuse Treatment Staff.  Large canvas bag packed with in-service and self-study training materials on age role competencies to meet JCAHO and CARF standards.  Developed by Jefferson D. Parker, Ph.D.; Catherine Shaw, Psy.D.; Evelina Ward, RN; G.V. “Sonny” Montgomery VA Medical Center, Jackson.

Anger Management Patient Handbook and Instructor’s Guide. An 8-session cognitive-behavioral workbook for group treatment.  Great for a new group.  Developed by Eddy White, LCSW; Fayetteville VA Medical Center.

Coping with Chronic Pain. A short video describing group treatment approach for chronic pain management.  Good introduction to pain management.  Developed by Jeffrey West, Ph.D.; New Orleans VA Medical Center.

Community Reinforcement and Family Training – Support and Prevention (CRAFT-SP) manual. This family education manual is adapted from earlier work on the CRAFT model by Dr. Robert Meyers.  The program is designed to aide family members in improving their relationship with the addict/user, while encouraging the individual to seek treatment.  Developed by Steven M. Scruggs, Psy.D., Oklahoma City; Robert J. Meyers, PhD, University of New Mexico. Center on Alcoholism, Substance Abuse and Addictions; and Rebecca Kayo, PhD, University of Oklahoma Health Sciences Center.

Day Treatment Center Newsletters: Togetherness, Acceptance & Respect. A collection of eight psychoeducational newsletters for veterans with chronic mental illness, including schizophrenia and related disorders. Developed by Quang (Charlie) Nguyen, PhD; Ellen Flood, LCSW; Cynthia Andrus, RN, MSN; Jennie Hall, MD; Carol Beckwith, RN; Jocelyn Ulanday, MD; Audrey Dawkins-Oliver, LCSW; Diana Willis, PA-C; Michael E. DeBakey VA Medical Center, Houston.

Discontinuing Your Medication for Depression patient brochure.  A brief take-home guide for patients who are discontinuing their antidepressants.  Content covers withdrawal symptoms and warnings of signs of returning depression.  Developed by JoAnn Kirchner, MD; Kathy Henderson, MD; Maga Jackson-Triche, MD; and VISN 16 Mental Health Product Line.

Gambling Education Workbook. An 8-session gambling education workbook and resource guide that integrates cognitive-behavioral and 12-step approaches.  Great for Substance Abuse Treatment Programs.  Developed by Jefferson Parker, Ph.D.; Randy Burke, Ph.D.; Paul Matens, LCSW; and Frances Hill; G.V. “Sonny” Montgomery VA Medical Center, Jackson.

Guidelines for Monitoring Antipsychotic Side-Effects. Pocket brochures provide basic information for monitoring antipsychotic side-effects.  Includes a PowerPoint presentation on CD that describes the project with facility-specific baseline monitoring data.  Developed by Teresa Hudson, Pharm.D.; Kathy Henderson, M.D.; Central Arkansas Healthcare System VA Medial Center, North Little Rock.

The Healing Circle: Addressing Culture, Spirituality, Sobriety, and Traditions of Native American Veterans.  This video illustrates how treatment for substance abuse is made more culturally relevant for Native Americans in recovery.  The video demonstrates a Healing Circle, powwow, and seat lodge.  Developed by Susan Vaughn, MSW, & Helen Engebretson, MSW; Oklahoma City.

Health Promotion Materials for PTSD Veterans. A resource manual and series of PowerPoint presentations developed to be used in conjunction with a group intervention to focus on disease processes and problems common in the PTSD veteran population. Developed by Cynthia Helwig, N.P.; Leslie Root, Ph.D.; Gulf Coast VA Healthcare System, VA Medical Center, Gulfport.

Helping Dementia Caregivers. An interactive CD-ROM that illustrates effective behavioral management skills to caregivers through a series of video clips. Useful for self-study or group formats.  Developed by Tom Teasdale, Dr.PH; Michael E. DeBakey VA Medical Center, Houston.

HIV Medication Adherence Intervention. A report on the effect of various strategies (pillboxes, reminders, etc) to improve HIV medication adherence.  Developed by Michael Kauth, Ph.D.; and Trevor Hart, B.A.; New Orleans VA Medical Center.

Insomnia: Difficulty Falling Asleep or Staying Asleep, and Quality of Sleep brochure.  A brief overview of causes of insomnia and tips for sleeping better.  Includes a sleep log.  Developed by JoAnn Kirchner, MD; Kathy Henderson, MD; and VISN 16 Mental Health Product Line.

Keeping the Mind & Body Well.  A 28-minute videotape and brochure to promote disease prevention and wellness among veterans.  Wonderful for waiting rooms.  Developed by Mertis Scott, MSN, CFNP; G.V. “Sonny” Montgomery VA Medical Center, Jackson.

Managing Disruptive Behavior in Dementia Patients: A training tool for clinical nurse assistants. An instructional CD-ROM that models ineffective, effective, and preventive behavioral management skills to long-term care nursing staff through a series of video clips with actors. Developed by Tom Teasdale, Dr.PH; Michael E. DeBakey VA Medical Center.

New! Making the Invisible Visible: Clinical Guide for Recognizing Traumatic Brain Injury in Veterans. Graphically powerful staff brochure designed to increase clinician awareness about and screening for traumatic brain injury in returning veterans.  Screening questions and “next step” recommendations included.  Developed by Kimberly A. Arlinghaus, MD; Helene K. Henson, MD; Stephanie Sneed, MD; and Janet Hickey, MD; Michael E. DeBakey VA Medical Center, Houston.

Messing with Your Habit: A Tobacco Use Reduction Program. A patient-guided CD-ROM program that uses the Stages of Change model to identify patients’ their readiness to stop smoking.  Developed by Dona Zanotti, Ph.D.; John Tassey, Ph.D.; Oklahoma City VA Medical Center.  Also available at http://w3.ouhsc.edu/besmokefree/

Playing It Safer Workbook.  A 4-session behaioral skills-based group program to reduce HIV sexual risk. Good for Substance Abuse Treatment Programs.  Developed by Dana Ross, PhD, MPH; and Randy S. Burke, PhD; G.V. “Sonny” Montgomery VA Medical Center, Jackson.

PTSD Families Matter. A 29-minute videotape for veterans with PTSD and their families. Great as introduction to PTSD programs or to send home with veterans.  Developed by Pamela Abrams, LCSW; Tom Freeman, MD; Central Arkansas Healthcare System VA Medical Center, North Little Rock.

Quitting It All: Tobacco Cessation for Chemical Dependence and Dual Diagnosis Treatment Programs.  A 90-minute, single-session program to address nicotine dependence.  Includes workbook, facilitator’s guide, and relaxation tape.  Developed Theodore V. Cooper, Ph.D.; Randy S. Burke, Ph.D.; G.V. “Sonny” Montgomery VA Medical Center, Jackson.

NEW! Relaxation Enhancement Therapist Manual / Stress-for-Less Patient Manual.  This is a step-by-step guide for teach relaxation skills using breathing control, muscle relaxation, and guided imagery in a group format.  Relaxation logs and instructions for audio recording personal relaxation tapes are included. Developed by C. Laurel Franklin, PhD; Shelia Corrigan, PhD; Stephanie Repasky, PsyD; Karin E. Thompson, PhD; Madeline Uddo, PhD; & Jessica Walton, MS; Southeast Louisiana Veterans Health Care System, New Orleans.

SAFE Program Manual-Revised. An 18-session workshop and resource guide for educating families of veterans with chronic mental illness.  Very helpful if starting family services for first time. Developed by Michelle Sherman, Ph.D.; Oklahoma City VA Medical Center.  Also available for downloading at w3.ouhsc.edu/safeprogram

Treating Chronic Pain in Substance Abusing Patients: An Interactive Primer.  A comprehensive, interactive CD primer on managing chronic pain in substance abusing patients, including medication pocket guides and assessment and intervention resources.  Developed by Gabriel Tan, Ph.D.; Deacon Staggs, MD; Serena Chu, Ph.D.; Bilal F. Shanti, MD; Quang (Charlie) Nguyen, Ph.D.; Jaime Rhudy, Ph.D.; Rebecca Kayo, Ph.D.; Mobeen N. Choudhri, MD; John Ramirez; Michael E. DeBakey VA Medical Center, Houston.

Us and Them: The Experience of Mental Health Stigma.  This PowerPoint program on CD and manual provides a facilitator-guided presentation for a medical center staff to challenge their beliefs about mental illness and promote greater sensitivity.  Developed by Michelle Sherman, Ph.D.; Oklahoma City VA Medical Center.

Veterans Helping Veterans: Key Insights for PTSD Recovery. A 23-minute audio CD to promote treatment involvement and adherence via testimonials by combat veterans in PTSD treatment.  Very moving.  Developed by Kathleen O. Reyntjens, Ph.D.; Leslie Root, Ph.D.; Gulf Coast VA Healthcare System, VA Medical Center, Gulfport.

Videos/CDs from previous MIRECC conferences:

A Stress Reaction Model: From Stress to PTSD. Presentation from MIRECC PTSD conference: Living in the Age of Trauma: Impact on Children and Adults by Matthew J. Friedman, MD, Executive Director, National Centers for PTSD, White River Junction, Vermont. January 17, 2003. CD-ROM (72 min.). Continuing Education Credit will be awarded for this program through September 20, 2005.

Traumatic Grief Treatment: An Overview. Presentation from MIRECC PTSD conference: Living in the Age of Trauma: Impact on Children and Adults by M. Katherine Shear, MD, University of Pittsburgh School of Medicine. January 17, 2003. CD-ROM (63 min.) Continuing Education Credit will be awarded for this program through September 20, 2005.

Treatment of Nightmares and Insomnia Related PTSD. Presentation from MIRECC PTSD conference: Living in the Age of Trauma: Impact on Children and Adults by Murray A. Raskind, MD, Professor and Vice-Chair, Dept. of Psychiatry and Behavioral Sciences, University of Washington School of Medicine. January 17, 2003. CD-ROM (50 min.). Continuing Education Credit will be awarded for this program through September 20, 2005.

Does chronic back pain prevent you from leading a normal life?

Learn about screening, treatment and management of back pain. Also learn about care for the back, avoiding injuries and the different ways to treat back pain.

This is an information rich session where you can also have questions answered.

This session will be presented by Bilal F. Shanti, MD., Interventional Pain
Physician of Omnia Pain Consultants.

Seating is limited. Please call 602.923.5700 to register and save your seat.

Refreshments will be served!

When: Wednesday, August 12 2009

Time: Registration 6:00, Session 6:30

Where: PVH Outpatient Lobby

Cost: FREE

Location:

Street: 3929 E. Bell Rd.
City: Phoenix
State: Arizona
Country: USA

For more information, contact: Luis Gonzalez
602.923.5672

The summer has gone by all too quickly, but much to my surprise I got much more accomplished around my house than I thought possible. At the beginning of the summer the projects that needed to be completed seemed all but impossible.  Although much still needs to be done, several large projects have been completed much to my satisfaction and surprise. I wish I could take credit for this accomplishment. I could not possibly have completed these tasks alone. The arrival of my daughter who just completed her
Master’s Degree and one of my sons who came home for a lengthy visit after
completing a college summer school course made all the difference. With their help
our finished attic is again habitable, all the leaders and gutters have been thoroughly
cleaned, and other assorted tasks and errands have been dispatched with great
efficiency. Given my work schedule these projects and others seemed daunting.
With the proper assistance they were not only manageable, but were completed with
success.

Is it really any different when a pain practitioner treats a challenging patient?
Many of our patients have numerous and multifaceted problems. They are far more
complex than the code books and manuals would lead one to believe. Such patients
suffer from chronic pain, often quite severe, almost all have had to modify their activities
greatly, and quite a few have actually lost their jobs and face the real possibility of
financial hardship. Many have become depressed, often requiring medication and
counseling. Quite a few have had great difficulty with interpersonal relationships,
some even having to endure the stress and pain of divorce. When such patients come
for treatment the possibility of success can seem remote indeed. However, through
teamwork such patients can make real progress resulting in an outcome that is
not only desirable but actually attainable. How is one to know when and how to
assemble an effective team and to monitor progress? This multidisciplinary approach
can be quite successful, but where does one start? For example, when does the internist
refer a patient for acupuncture? What is the best way for a chiropractor to coordinate
care with a neurologist? What is the role of a psychologist or counselor in the

treatment of patients with chronic pain?
Every situation is different necessitating individualized treatment.
I truly believe the Academy can be a tremendous resource for virtually every
clinician charged with the treatment of patients suffering from chronic pain. Not
only are the didactic sessions at the annual meeting useful, but the interactions among
professionals of many different disciplines in the exhibit hall, the restaurants, and in
other informal gatherings can enrich the knowledge base of each pain practitioner.
The networking that occurs through the Academy has been a particularly useful way
for me to treat many of my patients. I’m sure each and every pain practitioner can derive
great benefit from such collaborations.

The teamwork thus engendered can make an impossible task one that is manageable,
albeit difficult.

Pain practitioners face many challenges in the years to come. They must be aware of
new trends in the treatment of pain, as well as the ever evolving regulations governing that treatment. They need to keep themselves healthy and avoid “burn out” in order to be
able to best treat patients and stay balanced.

Well-trained professionals should derive satisfaction from their work and be able to
provide for their families. Together we can accomplish this and much more.
Learn all you can about multidisciplinary pain treatment! Our Academy can help
through its annual meeting, audio tapes, textbook and other educational materials.
Communicate with other members, whether to discuss difficult cases, to ask advice or just to socialize. In numbers there is strength. Our Academy is made up of thousands of highly talented professionals. Let’s learn from each other; teach each other; be there for each other! Remember it is your Academy. Make it work for you! Together we can do great things. The health and well-being of our patients depend on it.

GUILT AND PAIN

If you are the type of a ‘guilt accumulator’ in the past, and you are a chronic pain patient, you will be easily trapped into feeling increasing amounts of guilt. If you are not the type of person who accumulates guilt, you will now have some difficulty avoiding it. It may become your friend for a while. The circumstances surrounding living with a person with chronic pain provide many possibilities for thinking or feeling that you have not done the best thing in a given situation. Feeling guilty is an acquired trait. We are not born with that trait. Depression walks hand-in-hand with feeling guilty. Often times, depression accompanies chronic pain and the treating one may improve the other.

Resolutions for Guilt:

• Accept guilt as a normal human feeling over which you have minimal control.

• Get busy and find an activity you like to get your mind off the guilt

• Exercise and get involved in gardening, biking, swimming or volunteering. The bottom line, do something you like for the present instead of dwelling about the past.

• Eat healthy and take vitamins

• Avoid alcohol

• Ask for professional help and don’t be shy of asking for antidepressants.

• Sleep well and avoid stimulants. Schedule your guilt time – only feel guilty on Sundays!

FATIGUE AND PAIN

Chronic pain can be related to significant fatigue. A chronic pain patient can suffer from chronic fatigue for several reasons: medications effect, lack of sleep, depressed mood, financial worries, anger, frustration, and de-conditioning. The responsibility of caring for an individual in pain and searching for a cure is often a 24-hour job as well. Some simulated it to the care of a new baby.

Examples of Fatigue:

• Hours and days are spent searching for the right doctor with the magic bullet

• Much energy is spent just keeping life going on day-to-day basis

• The person with pain is tired secondary to poor sleep hygiene and inability to find a restful position away from a nagging pain

• Rest is difficult due to racing thoughts and worries regarding unsolved

problems including financial strains.

• You begin to feel more aches and pains brought on by stress and chronic

tension.

• Even pleasurable habits such as sex may cost a chronic pain patient much with worsening of pain and decreased physical activity for few days.

Resolutions for Fatigue:

• Utilize relaxation techniques to deal with sleep issues and with fatigue.

Psychologists render wonderful services in this area.

• Delegate and share responsibilities. Others should contribute and help with life stressors. Talk about your chronic pain; that will ventilate away your stresses

• Exercise on a regular basis to recondition the body and improve stamina. A simple walk around the block can do wonders

• Structure your time, allowing a period each day to be by and for yourself.

• Avoid stimulants like coffee and tea around bed time and to give your

energy. Instead, drink plenty of water

• Eat healthy and natural fresh foods. Avoid meats and eat more fish. Make

sure your take your vitamins.

• Avoid alcohol and liquor to deal with fatigue. Also avoid energy pills.

Effective Communication

1- We spend 70% of our waking hours communicating with each other. This includes reading, listening, writing, and speaking. If this communication becomes defective, it will definitely lead to stress.

2- The most important factor in communication is the ability to make a message be clearly understood.

3- Today, the English language has about 600,000 words. An educated adult uses only 2000 of these daily.

4- Language is “what” part of message is there. Manner is “how” we deliver or say the message verbally. Body language is “how” we say the message other than vocally. Symbolic communication is through dressing, hairstyle, appearance, and others.

5- To communicate perfectly: be concise, to the point, express clearly, change the tone of your voice to emphasize, use appropriate body gestures, be forceful and definite rather than hesitant and apologetic, do not talk in circles, explain unclear words, ask if others understand, help others participate, listen actively, keep your feelings under check, do not react to feelings of others, listen and understand rather than prepare for a remark or a question, respect others’ opinions, try to see the others point of view, and be able to be silent. Look into their eyes.

6- If you want to say no, say it with respect, with no feeling of guilt or anger. Be assertive rather than aggressive, don’t say “I, and I” frequently, have a firm posture, maintain eye contact, and get feedback pauses from others.

7- Your rights are: to change your mind, make mistakes, say, “I don’t understand”, say, “I don’t know”, and offer no excuses for your behavior.

8- A person who is confident and assertive does the following: looks in people’s eyes, uses hand to talk in a polite and appropriate way, uses his/her voice steadily, does not talk much of him/herself, keeps emotions under control, uses short sentences, expresses clearly, does not intimidate others, respects others’ opinions, and takes criticism positively. Positive criticism is always acceptable.

9- Because of the advent and progress in telecommunication and computers, we are becoming more and more isolated as a society. This computer technology will put tremendous stress on us to communicate adequately. Those used to communicating via computers will have difficult times in real life.

10- The speed of human verbal communication cannot compete with the speed of computer. This puts undue stress on us. There is less and less time to think.

11- People are using more and more acronyms, symbols, and abbreviations in computer communication. These cannot be used verbally and pause a Problem

12- We have to take the progress of computer to our advantage: take what is good and leave out what is detrimental and bad for our communication and expression.

Humans go beyond borders to obtain relief of their pain. Sometimes that means doing drugs and consuming alcohol and liquor. The relief, unfortunately, is short-lived and when the physical pain is relieved, the emotional pain can be taxing. Coping with chronic pain by using illicit drug and drinking alcohol is a losing battle. It will temporarily “fix the problem” but will damage several other areas. This is in addition to the deleterious effects of alcohol and drugs such as Heroin and Cocaine on health, the brain, and the heart. Also there is evidence these interfere with pain medications and complicate things with your physician. Remember you signed a pain agreement stating you will not use any illicit substances or alcohol.

The negative effects of addiction are long lasting, if the patient over-lives that. Addiction is defined as a pathological, almost obsessive-compulsive disorder, where you know these substances cause harm you, nevertheless, you continue using them despite the presence of adequate pain relief and analgesia. Addiction is not as common as we may think. Using more medications does not mean the patient is addicted: increased use of pain medications because the patient has now increased physical activity, or there is recurrence of the disease causing worsening of the pain, may justify increasing pain medications.

To cope with pain, street drugs are never a good idea. The patient will develop tolerance, and he/she will need more and more drugs to achieve the same initial effect of relief.

There has been significant debate about the medicinal use for marijuana for pain relief and in chronic illness, such as in cancer and with chemotherapy. The controversy that is ongoing. For now it is not legal to use it.

Some of the negative effects of drugs and alcohol, other than health problems and financial ruin, fatigue, confusion, loss of interest in usual hobbies or people, emotional flatness, memory issues, interference with sleep, and increasing irritability and anger. Homicide, suicide and auto accidents are higher as well.

How to Resolve Drug/Alcohol Abuse:

• If you suspect drug or alcohol abuse, get help as soon as possible. Consult your physician or a psychologist, AA, or the county for further help.

• ‘Detoxification’ is an integral part of the treatment; the sooner, the better.

• Avoid encouraging the use of medication for pain relief or for other effects: e.g., sedation, sleep, or ‘relaxation’

• Avoid the use of “prn medications” and use medications that are long-acting. This can be done with consultation of your physician.

• Invest your time in constructive things rather than destructive habits.

• Learn coping skills and relaxation techniques.

• Improve your spirituality and fill in the blanks in your personality and life.