Long-Term Disability (LTD) & Chronic Pain – Grillo Law


Long-Term Disability (LTD) & Chronic Pain

Grillo Law Personal Injury Lawyers

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Canada September 20 2021

Patients battling chronic pain know that pain is not their sole problem. It can make it challenging to work out, take care of one’s family or household, and most importantly, make it difficult to work. Such restrictions associated with chronic pain are part of a long suffering period, and there’s no simple way to quantify the pain you may be experiencing.

Many chronic pain patients are concerned that they may not get off work on any disability benefits. Fortunately, you can apply for LTD benefits or payments if you are a worker who can’t work because of the discomfort associated with chronic pain. If you intend to fight for your LTD benefits case, there are essential facts you should know.

Understanding chronic pain

Well, chronic pain is characterized as pain that persists longer than usual following a severe accident or illness, usually more than three months. The pain can be localized, impacting only one body part such as joints, head, or back. On the other hand, there are chronic patients with nerve or muscular discomforts throughout their bodies.

As mentioned earlier, the pain may be caused by sickness, accident, or for no reason at all. In such situations, patients and their healthcare providers may experience worry and frustration as they try to uncover solutions to such challenging health issues.

Causes of chronic pain

Here are the most prevalent medical issues associated with chronic pain syndrome.

Fibromyalgia: This health condition is frequently associated with tiredness, changes in sleep, mood, and memory. The most common symptoms including widespread muscular tenderness and soreness. Talk therapy, medication, and reduction of stress can help manage these symptoms.

Rheumatoid arthritis: Most joints, particularly those in your feet and hands, are affected by this inflammatory disease. With rheumatoid arthritis, your immune system destroys its tissues, such as joints. In extreme conditions, your internal organs may also be attacked. The inflammation linked to rheumatoid arthritis can lead to joint deformities and bone degeneration. 

Diabetes: This is a disorder in which the blood glucose level is abnormally high, and it’s also referred to as blood sugar. Note that blood glucose originates from the food you eat and is your body’s source of energy. A pancreatic hormone known as insulin facilitates glucose absorption into your body cells, where it’s used as energy. People with diabetes can develop what’s widely known as diabetic neuropathy or simply have pain, a debilitating condition.

Other causes of chronic pain include back pain, migraines, chronic headache, irritable bowel syndrome, and endometriosis in women. As mentioned earlier, chronic pain can also be caused by severe injuries sustained from an accident. 

How does LTD work?

Chronic pain can make it difficult for a patient to work. For those who work in physically demanding professions, chronic pain can restrict their ability to move around or carry items. For other patients who work in sedentary positions, chronic pain can limit their ability to remain seated for a long time.

If you cannot work because of your disability, applying for long-term disability benefits can help you financially during this challenging period. 

Easy Habits That Can Improve Your Mental Health – WebMD


Easy Habits That Can Improve Your Mental Health

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Medically Reviewed by Michael W. Smith, MD on August 20, 2021

Bust the Blues


Sometimes you need a mental lift. There are some simple steps you can take to build a “happiness habit” that may help get you through a tough spell. These pick-me-ups aren’t meant to replace treatment for serious depression, acute anxiety, or other clinical issues. If you need help, tell your doctor or a trusted friend or family member.

Curb Clutter


It just sits there doing nothing. And that’s the problem. Studies have found that when you’re surrounded by stuff, the visual chaos goes straight to your brain. It distracts you and gets in the way of your ability to process info. Other research has shown a cluttered home amps up the stress hormone cortisol, especially in women. Make a plan right now to banish or sort your clutter. Then call a charity to set a date for pickup.

Buy Yourself Something Nice


It doesn’t have to be a spree for fancy electronics or a new designer wardrobe. Sure, the something nice can perk you up for the moment. But research shows the real magic of so-called retail therapy is the sense of control you have over your environment when you make your own choices. So try a little smart shopping to help snap you out of short-term sadness. Just make sure your picks fit your budget, too.  

Ticket to Read


The fastest ticket out of a bad mood is still the simplest: a riveting read. Studies have linked reading to improvements in depression symptoms, as well as mental flexibility and brain function. Make sure it’s a pleasure read — not the news, your computer manual, or even your latest book club pick. Find a book you’ve wanted to check out or a juicy magazine. Sock away at least 30 minutes every day to read in peace.

Pet a Furry Friend


In one study, college students who chilled for just 10 minutes with a good-natured dog or cat had sharply lowered cortisol, a major stress hormone. Many college campuses have started “pet-to-de-stress” programs. You don’t need to be in school to get these warm fuzzies, though. Spend extra quality time with your own pet, or volunteer at a shelter or adoption event to make some new furry friends to cuddle and play with.

Catch a Groovy Beat


Yes, classical music can relax you and ease tension. But what if your listening tastes are more high-energy? An Italian study found quick tempos can help calm you, too. It just happens when the music stops. After listening to fast-paced songs, the subjects’ blood pressures and heart rates mellowed. So whether your jam is Mozart or classic rock, crank it up.

Pile a Power Plate


A healthy dish can banish the blues, with fast and lasting results. One study looked at young adults with diets rich in fruits, veggies, and lean meats over just a few weeks. They reported less depression than a group that didn’t eat as well. Studies have shown that the Mediterranean diet, which counts grains and olive oil as staples, can ease depression in older adults. (Exercise and sharing meals are key parts of this diet, too.)

Try Acupressure


To practice this ancient Chinese healing art, you press certain spots on your body to release tension. It can lessen anxiety and improve your blood flow. Try this simple move called yin tang, which refers to the middle point between your eyebrows. Sit back and relax. Place your thumb or forefinger between your brows. Press in small, gentle circles for 5 to 10 minutes. Repeat several times during the day.  

Find Your Flow


“Flow” is your state of mind when you do something that challenges and fulfills you, without too much pressure on your performance. Note the highlights of your day or week. When did you feel “in the zone”? Hint: Passive entertainment like bingeing a TV show or playing computer games aren’t flow. Think dancing, cooking, painting, even housecleaning — pursuits that absorb you and put your worries aside. Make plenty of time for them.

Walk in Nature


Ecotherapy explores how quality nature time eases stress, anxiety, and depression. A 2015 study found people who take nature walks have lower activity in the parts of the brain where negative thoughts can spool. Start with a stroll close to home or an easy trail for about a half-hour several times a week. If you’re game, build up to longer-term “forest bathing” (the Japanese take on nature immersion). It works if you take a friend, too.

Find Nature Stand-Ins


Even if you’re stuck inside or the weather’s crummy, natural stimuli can have a similar calming effect. A study found that it can lift your spirits to listen to nature sounds and even just look at pictures of pretty outdoor settings or dream destinations. Researchers think it’s the literal “outside” focus that can bust a mental funk by taking your mind off negative things.

There’s an App for It


In the ever-evolving world of electronic mental health tools, you never need an appointment. An app on your smartphone can’t diagnose or treat a condition like depression or anxiety. But it may make you aware of your emotions, which can help you manage them. You can download uplifting podcasts, audiobooks, and apps for pick-me-ups while you drive, wait in line, or take a walk.

Keep Up Your Support System


When you feel down, it’s easy to think others should know how you feel. But you need to be the one to keep the lines open. Make time for friends and family. Offer to help them out when you can — some research suggests it can be more uplifting to give support than to get it. And while some experts say it’s best to meet up in person, don’t hesitate to draw on electronic tools like Skype, online chat, and texts to stay close if needed.

Find Something Funny


Whether you get tickled by silly videos of people falling down, witty British comedy, or a friend who tells hilarious stories, find the things that make you laugh. Humor essay books, funny podcasts, or jokes from magazines are great sources, too. Studies show laughter — and the distraction it brings — is one of the best mood lifters around.


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Emergency Department Care for Patients with Chronic Pain – rsdsa


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Emergency Department Care for Patients with Chronic Pain
Monday, September 27 at 7p EasternJoin us on Monday, September 27th as our Facebook Lives return! We’ll be joined by Francesca L. Beaudoin MD, PhD as she talks about emergency department care for patients with chronic pain.
Dr. Beaudoin is an Associate Professor and Interim Chair of the Department of Epidemiology, and an Associate Professor of Emergency Medicine and Health Services, Policy and Practice. Dr. Beaudoin is a board-certified practicing emergency physician and clinical epidemiologist with expertise in opioid use disorders and adverse post-traumatic health outcomes, particularly pain and substance use.
She is Principal Investigator of multiple federal and private grant awards including “Implementing Statewide Emergency Department Care Pathways for Addiction Recovery after Opioid Overdose (R01CE003149)” and a large clinical trial of “ED-based behavioral interventions following opioid overdose: The impact of peer navigation on treatment engagement, relapse, and recovery” (Arnold Ventures Foundation). 
Dr. Beaudoin has written and implemented practice management policies for health care systems on pain management and opioid prescribing, and has served as a member of the Food and Drug Administration Anesthetic and Analgesic Drug Products Advisory Committee. She has partnered with small businesses to innovate new approaches to solving key public health problems such as the opioid epidemic and was the PI of a NIH STTR award to help develop and evaluate a mobile peer recovery support application. 
She collaborates with state stakeholders such as the Rhode Island Department of Health and the Governor’s Task Force on Opioid Overdoses and is a Senior Medical Advisor to the Institute for Clinical and Economic Review (ICER).Join the Hopkins Family for the 3rd Annual Flame Out – Walk to Extinguish RSD/CRPS in Oakhurst, New Jersey
DATE: This Sunday, September 12th, 2021 (Rain or Shine)
TIME: Pre-registration begins at 9:00 am. Walk starts at 10 am.
LOCATION: Joe Palaia Park, Dow Ave & Whalepond Rd (entrance nearest Deal Rd), Oakhurst, NJ 07755
Online Registration closes this Friday, September 10th. Walk-ins Welcome!
WAIVER: All participants must sign our waiver.
When you join or donate to the 3rd Annual Flame Out Walk, the funds you raise support our mission.

When You Live in a Constant State of Pain – The Mighty

When You Live in a Constant State of Pain

Tara Clifton  •  FollowNovember 5, 2018

Chronic pain is the most complex and difficult feeling to describe. It is my constant feeling. It is the same as asking someone to describe how breathing and blinking feels. It is less of a feeling, it is more of a state of existing.

Every time I go to the doctor or emergency room, they ask me to rate my pain on a scale of one to 10 and describe it. It is almost impossible to remember the last time I had a pain-free day, I have days that are manageable but not close to pain-free. This makes it impossible to rate my pain, if I have no “one” on my scale. I have days with less pain to compare it to but that is the extent of my ranking ability. Chronic pain patients cannot be asked to identify their pain the same way as people without. It is totally different. It is comparing a child who has not had a true meal in months and is legitimately starving to death to someone who had to fast for 12 hours. It is simply not the same.

When they ask me to describe it, I have to hold back laughter. It feels like my life, it feels like my existence. It feels like staying at home on a Friday night when all of my friends go out and have fun. It feels like blinking back tears when the elevator is broken and I have to climb six floors to go to my apartment, knowing I will move as slowly as possible and still hurt after.

It feels like having scars from a heating pad burn my skin from using it for hours on end. It feels like an overbearing parents or controlling partner that I constantly have to check in with and see if I am allowed to do something. It feels like the worst day of the flu but you are expected to continuing living your life. Nobody cares that you have the flu and you need to stop complaining because “everyone has aches and pains.”

My life exists in a constant state of pain. My body is constantly hurting. My mind is constantly hurting from being held back from my dreams because of my body’s limitations. When I am asked to describe it, I cannot express it in words like “throbbing, aching, stabbing, or burning” because that isn’t what it is. Those terms express a surface level pain. It is the way that you describe a burn from a stove or a sprained ankle. This pain is constant. It feels like the worst leg cramp of your life but lasts for hours on end. It feels like my knees are going to give out on me at any second because I am pushing myself to be on the same level as my peers. It feels like there is something inside of me trying to claw its way out of my abdomen. It feels like I ran into a brick wall repeatedly. These are feelings most people cannot fathom.

Since most people cannot fathom the idea of being in pain all of the time, not showing it, and continuing to go about your daily life they just chose to ignore it. Whether that is to protect themselves against the idea that a loved one could hurt that much and they can’t help or it is out of disbelief because they cannot see the condition causing the pain, it is a reality for millions of people.

Understand why it is difficult to explain to people without chronic pain. Believe people can still be hurting even if you don’t see them struggling. Be there for them when nobody else is. Try to be understanding when they may be short tempered with you. Understand that chronic pain is terrifying and isolating because there is no promise that we will ever feel better. Give us hope that even if there is no promise of a pain free day, there is the promise of people that love and care.

Twenty-five ‘Scary’ Side-effects of Chronic Pain We Don’t Talk About – The Mighty

25 'Scary' Side Effects of Chronic Pain We Don't Talk About
Chronic Pain

25 ‘Scary’ Side Effects of Chronic Pain We Don’t Talk About

Paige Wyant  •  FollowNovember 5, 2018

As those who live with it know, chronic pain can result in so many more symptoms and side effects than “just” pain. Pain conditions can have an impact on just about every part of your life, thus provoking a wide range of emotions.

Living with a chronic, unpredictable condition that is tough to manage can naturally affect your mental and emotional health – and one of the most common side effects pain warriors experience is fear. Many may understandably feel scared and anxious about their health, and worry about what their future might look like.

To help others better understand why those with pain conditions might struggle with feelings of fear, we asked our Mighty community to share a “scary” side effect of chronic pain they experience, and how they cope with it. If the following sound familiar to you, know you’re not alone.

Here’s what our community shared with us:

  1. You get so used to being in pain you don’t always have a firm grasp on what’s serious pain anymore. I just got a stress fracture in a new surgical area but I never felt the pain was high enough to be concerned over. Thankfully I’ve learned over the years to err on the side of caution and check with my doctors more often than I’d personally prefer. But every time it turns out to be something serious, it drives home the fact that to me… that serious problem presented as only minor pain.” – Amber R.
  2. If I’m this sick and have this many complications at at 29 years old, what will 39…49… 59 look like for me? It’s scary.” – Stephanie B.
  3. The toll it can take on my overall mental health. In the middle of a flare, days can blend together and I start feeling pretty depressed. I have to be extra intentional about interacting with others and getting outside of my head.” – Laura F.
  4. The fact that no one can see what I’m going through, and that it will never go away. Pain caused by central nervous system disorders can’t be seen, there’s no evidence, so the only person who knows what I’m going through is me. That isolation scares me.” – Amy C.
  5. Unknowingly lashing out at loved ones and friends when I’m in a pain flare. I don’t even know I’m doing it at the time, and when all is said and done I’ve usually hurt someone’s feelings. Relationships can suffer because of pain.” – Kathryn M.
  6. CollapsingI hate it. It just happens in a flash and I can’t always feel it coming first. My biggest fear happened recently – my pain surged, my legs collapsed, and I fell flat on my butt in a crowded room. I have never been so embarrassed.” – Katelyn I.
  7. There are times when I cannot get out of bed. I can barely move at all, including my jaw to be able to eat or take meds. To cope, I focus on what I need to do to improve my situation. I slowly do gentle stretching exercises starting with my fingers and working to other joints. When I’m able to move enough, I get a protein shake from the mini fridge next to my bed and drink it through a straw, which I keep on my nightstand. Usually by that time I am able to open my jaw enough to take medications. Then I take deep breaths and remind myself the symptoms are temporary while I wait for the meds to kick in.” – Jackie R.
  8. Trying to keep my job for the health benefits when I can barely function.” – Ceil B.
  9. The financial repercussions. Not being able to work full-time, plus medical expenses and raising three girls on my husband’s salary is scary. I don’t know how people do it. I’m not depressed – I’ve been there – I know what it is, but some days I feel like they’d all be better off without the burden of my health issues. It’s just exhausting, and frustrating, and infuriating… all the time.” – Jen M.S.
  10. Forgetting for that split second that you can no longer accomplish a certain natural action of your body, and making it hurt worse. The forgetting of some things is very scary, very. I think our minds need to over compensate in other areas, so we simply become forgetful. For me, very very scary, especially at first. And looking back and realizing things that occurred before I was diagnosed were signals. Scary stuff.” – Sky C.
  11. Wondering if this is the way it will be forever or if this is only the tip of the iceberg and it will get worse. Is my 10 today the same as my 10 next month?” – Sarah E.
  12. My memory loss. Ever since I was diagnosed with fibromyalgia, my memory has been getting progressively worse. I’ll forget what I’m doing as I’m doing them. I’ll forget what I’m saying mid sentence. It’s scary because I’m 18. It shouldn’t be this way. I cope by writing everything that is important down and making sure that I’ve got notes and lists of everything.” – Abi S.
  13. “Not being able to be the mom I want to be. Feeling like I’m not enough for my kids physically, emotionally, or financially. I’m not just a single mom but a solo mom to my youngest since his ‘father’ isn’t involved at all. And I’m the primary parent to my oldest.” – Sarah N.M.
  14. The doctors’ inability to help me manage it. There are so many laws governing what pain medicines can be given and for how long that it’s almost impossible to get effective pain management. It seems like doctors are now trained to assume everyone (especially those with relatively invisible illnesses like EDS) is seeking pain meds for an addiction. This results in an environment that discourages those who have legitimate pain from asking for the help they need. I’m literally terrified to ask for pain medicine, and usually my husband has to speak up for me or encourage me to seek the help I need.” – LeAnn H.
  15. Suicidal thoughts. Before the pain I loved life and the future but now I’m scared of it all driving me into some pretty dark places. Spending time cuddling with the kids and cats helps temporarily.” – Shayla F.W.
  16. Symptoms that mimic stroke or heart attack. I have lost feeling on the entire left side of my body, lost my ability to speak, and also had severe chest pain due to the various chronic conditions I have. It is always difficult to decide if I need to go to the emergency room, or if my symptoms are ‘normal.’” – Lisabeth B.D.P.
  17. Fear of the unknown for me. My pain changes day to day with EDS and has gotten significantly worse while moving to more and more joints and organs of my body over the last few years alone. I fear not knowing how much pain there will be in 10 or 20 years, when at 30 I’m already not sure what tomorrow’s pain will look like. I have to remind myself every day that God is in control and I only need to take things one day at a time.” – Meg S.
  18. When I get a different answer every time I go to the doctors of what is exactly wrong.” – Samantha K.
  19. “The times when I’m incoherent and on the verge of losing consciousness due to how severe my illnesses are. I purposefully avoid medications that alter my mental state because they cause me such great anxiety, but, when I am in a long bout of severe pain, my mind and body can no longer handle it and so I succumb to being unconscious and it is terrifying. Waking up and not knowing where you are or what happened. How long you were out. I cope by staying away from social situations and staying home so if I do pass out I’m in a safe environment and less embarrassed.” – Caitlin M.
  20. Feeling like I’ll never reach my potential because the pain limits me more than I want to admit.” – Jacqueline B.
  21. Applying for SSD and getting denied, after giving 30 years in service to this country in the Corps and government agencies. Now a SSA bureaucrat tells me I’m not disabled enough. Financial ruin because I can barely get out of bed in the morning due to the pain. As a single parent, just trying to grocery shop is something I have to mentally gear up for for hours because I dread the pain. I feel deserted by friends, family and my government. Literally don’t know where to turn. That’s my scary…” – Jim R.
  22. Making plans and not knowing if you’ll be able to come through. The feeling of letting people down can be as just as bad as the pain itself, knowing others are counting on you… but you just push through and pray you don’t collapse for good.” – Erica F.
  23. I never know what I’m able to do. I can be OK one day trying to catch up on all that I’ve slacked on. Then be completely debilitated crying for two weeks.” – Nikki D.
  24. Watching the symptoms evolve in our daughter is by far the scariest and hardest thing about this condition for me. I know exactly what’s she’s in for and I can only pray that early diagnosis will give her an easier future.” – Crystal F.
  25. The worst part of my Ehlers-Danlos syndrome and all the other things that seem to come with it is guilt. Mostly, I feel guilty of the toll this has brought to my family. The guilt doesn’t seem to end there though. It trickles into every aspect of life itself. Guilt of the day going by with nothing productive done. Guilt that I’m not the mom and wife I used to be. Guilt that my family isn’t nourished with healthy meals because I haven’t been able to cook for so long. Guilt that my children are showing the exact same symptoms of this genetic illness. Guilt that my brother [died by] suicide over this same illness. Guilt that we didn’t have answers sooner. The list could go on and on. Chronic illness never ends, not even if we are tired and are begging for it to go away. The only way I know how to deal with it, is to take one day at a time. Every day I try and remain hopeful and remind myself that I’m not the only one fighting chronic illness and every day I just try and do what I can.” – Melissa D.

If you struggle with fear and anxiety because of chronic pain, you’re not alone. Below are stories from our community on coping with several of the most common sources of fear pain warriors face.

To Those With Chronic Pain Afraid to Plan for Your Future

8 Ways to Cope With Loneliness and Isolation When You Have a Chronic Illness

How to Hold Onto Hope When You Have Chronic Pain

5 Tips for Adjusting Your Lifestyle When You’re a Parent With Chronic Pain

AACIPM is Promoting Pain & Self Care Awareness Month – AACIPM


TwitterLinkedInEmailWebsiteAACIPM is Promoting Pain and Self Care Awareness Month in September
Health Care Includes Self Care™

To promote both Pain Awareness Month and Self Care Awareness Month, AACIPM will be collaborating with many partners to spread awareness and deepen connections and understanding across the stakeholders.

Join us in our efforts to build awareness by registering for the webinars included within this newsletter, by sending us relevant resources on pain and self care for our repository, and by sharing the information (more to come soon!) with your interested networks.

We’ll be participating in IM4US 2021 Conference on September 24, co-moderating an amazing panel of people making positive differences in the lives of people who are underserved. We’ll share more details in coming issues about our presentation Advancing Integrative Pain Management Through Collaboration and Advocacy.

We have also developed a webinar, Bridging Self Care and Comprehensive Pain Management in Program and Payment Designs, to be held on September 28 from 1-2pm ET (free registration). Read the summary below for more information about this important webinar designed in collaboration with Midwest Business Group on HealthThe Pain Community, and University of Vermont Comprehensive Pain Program hosted on KnoWEwell Live.

Also, to keep connecting those dots, read Duke’s case study on University of Vermont Medical Center, which you’ll find below in this newsletter. There are several people from the UVMMC team and Blue Cross and Blue Shield of Vermont who will be participating!

Lastly, we are also building a new repository of resources and kindly request any resources you can share that would be relevant. Watch your inbox for more information coming soon!Register for Sept. 28 WebinarUniversity Improves Care in Rural Communities with New Integrative Pain Management Curriculum 
AACIPM director talked with Dr. John Maye, Professor and Pain Management Concentration Director for the University of South Florida, College of Nursing. While Dr. Maye was serving as the Director of Research for a pain management clinic and providing care to wounded warriors at Walter Reed National Military Medical Center, his thoughts and knowledge related to pain management and opioid administration were transformed. These experiences became the driving force behind the creation of the Advanced Pain Management Fellowship and the Integrative Pain Management Graduate Certificate at USF.

Given the deficit of specialized pain management providers in rural America, health care providers employed in these areas may find the program particularly beneficial.

Dr. Maye, you’ve been involved with AACIPM efforts for many years.  What does integrative pain management mean to you?

“Integrative pain management is when an individual or institution can move beyond the traditional views of pain as an interpretation or modulation of a nociceptive impulse. Pain evolves not only from tissue damaging stimuli, but may also serve as a consequence of the way stress, sleep, and central autonomic nervous system tone impact brain function. Pain is a complex phenomenon that is mediated through mechanisms that involve more than the traditional views of tissue damage. These traditional views of aligning pain only with tissue damaging stimuli are limiting and may be the driving force behind economic costs associated with the treatment of pain to be estimated at $560-635 billion annually.”

“In 2011, the Institute of Medicine (IOM) recommended the government support substantial improvements in patient and professional education regarding pain. This recommendation included both undergraduate and graduate curricula change to improve pain management education for all health care professionals. To date, there has been some movement toward improving pain education in health care, but there is still a huge deficit with regard to appreciating that the pain experience for a patient is greater than the sum of its parts.”

Click button below to read more about this program, anticipated to greatly improve the quality of life and access to pain management to underserved patients in rural communities.  Read MoreDuke Releases Case Study on Comprehensive Pain Program Using Unique Bundled Payment Arrangement 
AACIPM is pleased to share that the Duke-Margolis Center for Health Policy and the Duke Department of Orthopaedic Surgery have released the second of four case studies emanating from their 2020-21 Roundtable on Integrated Pain Management. Their second case study features the University of Vermont Medical Center’s Comprehensive Pain Program (CPP), which was established in 2017 to improve treatment options for patients struggling with opioid use for musculoskeletal pain conditions. The program developed a customized intensive outpatient program that includes an array of integrative therapies to optimize patients’ function and maximize their well-being, supported by a unique bundled payment arrangement developed in partnership with Blue Cross and Blue Shield of Vermont. The case study details the program’s novel bundled payment arrangement, highlights the program’s history and implementation, and describes key factors that have contributed to the program’s success. Duke will be releasing the remaining two case studies in the coming months.
Duke’s in-person Roundtable that spurred the creation of this series of case studies took place in February 2020 and included participation from numerous AACIPM leaders and experts. Further background on this Roundtable can be found on Duke’s website and AACIPM’s website, including reflections from AACIPM’s Advisory Committee member, Adam Seidner, MD, MPH, Chief Medical Officer, The Hartford.Read Duke’s Case Study on UVMMCNational Updates from Congress and HHS
CARA 3.0 Begins Long Journey Toward Passage
The House of Representatives has begun work on the third iteration of the Comprehensive Addiction and Recovery Act, known this time around as the CARA 3.0 Act of 2021. The House introduced CARA 3.0, also known as HR 4341, in July, and the bill already has 47 cosponsors and has been referred simultaneously to six different committees for consideration. While the Senate introduced their own version of CARA 3.0 (S 987) in March, almost no action has been taken on that version of the bill.NIH HEAL Initiative Introduces New Community Partner CommitteeA subcommittee of Multidisciplinary Working Group

The NIH HEAL Initiative, a trans-NIH effort to improve prevention and treatment strategies for opioid misuse and addiction and to enhance pain management, has announced the creation of the HEAL Community Partner Committee made up of people with lived experience, advocates, and/or family members of someone with pain or addiction. A subcommittee of the HEAL Multidisciplinary Working Group, who advises the initiative on research directions and activities, the new committee will provide input on key issues faced by individuals affected by pain conditions or opioid use disorder to ensure the relevance and generalizability of HEAL-supported research.

The Community Partner Committee includes Christin Veasley of the Chronic Pain Research Alliance, a long-time AACIPM partner, as well as representatives from Family and Medical Counseling Services, the Addiction Policy Forum, the Georgia Council on Substance Abuse, Faces & Voices of Recovery, and two additional advocates representing people living with pain. NIH HEAL Initiative Multi-Disciplinary Working Group Meets September 1-2On September 1 and 2, the NIH HEAL Initiative will convene a meeting of the Multi-Disciplinary Working Group (MDWG) to share updates, progress, and activities of the initiative, as well as trends in opioid misuse, overdose, and addiction. A discussion with members of the MDWG will follow these presentations.A videocast link will be available to view the open session of the meeting on September 1 (day 1). Please visit the NIH HEAL Initiative website for the meeting agenda and videocast link.  NAM Releases Podcast on Racism and the American Opioid Epidemic
Aimed at combatting the fractured approach to addressing the opioid crisis, which often targets small portions of the crisis rather than taking a holistic view, the National Academy of Medicine and the Aspen Institute launched the Action Collaborative on Countering the U.S. Opioid Epidemic in early 2021. Through convenings, publications, strategic partnerships, webinars, this podcast, and other outlets the experts who comprise the Action Collaborative aim to uplift established evidence, promote best practices, identify research gaps, and identify collaborative approaches to countering the opioid crisis. In August, the Collaborative focused on the intersection of systemic racism, policy, and healthcare. Previous episodes have explored the interplay between the opioid epidemic and COVID-19 pandemic and the role of stigma in treating substance use disorder. You will find the audio podcasts, as well as written transcripts, here.CMS Still Accepting Comments on 2022 Physician Fee Schedule
As announced last month, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining changes to the Medicare Physician Fee Schedule (PFS) and other Medicare Part B payments for Calendar Year (CY) 2022. The proposed rule contains many pain-specific provisions and presents an exciting opportunity for advocates to provide information that could substantially impact CMS payment structure in regard to pain management. Comments to the proposed rule change will be accepted through September 13, 2021.

AACIPM is currently drafting a group sign-on response to this proposal, coordinating with the many groups and individuals who expressed interest after receiving our initial alert. If you have interest in reviewing and signing on to our letter, please contact Amy Goldstein no later than September 6th.Partner Educational Opportunities
New Study Proves Benefits of Teaching Patients Self Care, Provider Education Available

A recent study of 263 adults with chronic low-back pain has shown that patients who take a single 2-hour pain relief skills class show clinically meaningful reductions in pain catastrophizing scores at their three-month follow-up visits. The course, Empowered Relief™, includes pain neuroscience education, mindfulness principles, and CBT skills (identifying distressing thoughts and emotions, cognitive reframing, a relaxation response exercise, and a self-soothing action plan).

Empowered Relief™ is an evidence-based, single-session pain class that rapidly equip patients with self-care pain management skills. An online workshop will be held on October 8-9, 2021 to certify practitioners to provide this type of patient education. Developed by pain psychologist Beth Darnall, PhD, this program has been embedded into clinical care pathways at Stanford University since 2013 and was recently expanded after initial successes thanks to funding from the National Institutes of Health. The program is open to clinicians of all disciplines and is intended to enable participants to immediately implement their new skills into their clinic or research study.

Register for the October 8-9 workshop.

MassPI to Hold Pain Education Webinar on Today’s Changing Tide

On October 14, 2021, MassPI will hold their fall pain education webinar, Steering the Course of Pain Management in Today’s Changing Tide. Featuring Keynote Speaker Lynn Webster, MD, in addition to experts focusing on opioid moderatism, pathways for innovation in pain treatment, and leveraging technology to enhance equitable access, the conference offers four nationally certified continuing education credits to physicians, nurses, pharmacists, psychologists, and social workers.

Register here for the October 14 webinar.

AIHM Wellness Webinar – Whole Body Approach to Low Back Pain

On September 3, AIHM will present Whole Body Approach to Low Back Pain, from their Wellness Webinar series. Joshua Rubinstein, MD, Clinical Sciences chair of the naturopathic medicine program at Bastyr University, will look at some of the major factors contributing to low back pain. This will include an overview of some of the major biomechanical and postural reasons folks develop low back pain.  Dr. Rubinstein will review some of the major exercises he recommends to address these contributing factors. We will also look at nutritional strategies to support connective tissue (joints and skin) throughout the body.

Register for free for the September 3 webinar.Message from the Director
I hope this issue finds everyone well as many of us are experiencing back to school along with the busy transition into an even busier fall calendar. 

I am really excited for AACIPM to be sharing our focus on Pain and Self Care Awareness Month in September – and beyond. Most of us engaged with AACIPM understand that health care includes self care. It’s not something separate but is becoming increasingly more understood as part of Whole Health Care. 

Our aim is to do what we’ve always done best – Connect the Dots!  There are so many evidence-informed self management activities for pain, and there are more and more examples in program and payment designs showing the efficacy and value of this approach to care for people with pain.

Join us in our efforts to bridge deeper understanding and build awareness across the many stakeholders invested in whole person, comprehensive integrative pain management. You can do this by registering for the Sept. 28 webinar with Midwest Business Group on Health (see the first entry above), and watching your inbox for more additions to the repository for pain and self care on our website (under development). We’ll also be at IM4US 2021 on Sept. 24, co-moderating an amazing panel, titled, Advancing Integrative Pain Management Through Collaboration and Advocacy.

Onward and Upward!
AmyRelevant Reading
This Drug Helped My Chronic Pain – But It’s Also Killing People, Vice, August 26

How to Exercise for Psoriatic Arthritis Pain Relief, Self, August 25

Association Between Sleep Quality and Pain Intensity in Mild Patients with COPD: A Community Study, DovePress, August 25
Psychosocial and cardiometabolic predictors of chronic pain onset in Native Americans, Pain, August 24
The pain switch, MIT Technology Review, August 24

Delta opioid receptor regulation of calcitonin gene–related peptide dynamics in the trigeminal complex, PAIN, August 2021

Psychotropic Medications May Significantly Reduce Chronic Pain in Pediatric Patients, Clinical Pain Advisor, August 19
CME – Fibromyalgia: What It Is and How to Treat It, Psychiatric Times, August 18
Efficacy of Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome, Annals of Internal Medicine, August 17
The Pain Medicine Fellowship Telehealth Education Collaborative, Pain Medicine, August 17
Chronic Pain Among Service Members, Rand Corp., August

Pain Perception Training May Help With Back Pain in Hypermobile EDS, Ehlers-Danlos News, August 9
Why Migraine Sufferers May Want to Eat More Fish, New York Times, August 7
4 Things the Chronically Ill Wish Others Understood, Psychology Today, August 5
Hierarchical clustering by patient-reported pain distribution alone identifies distinct chronic pain subgroups differing by pain intensity, quality, and clinical outcomes, PLOS One, August 4
Chronic pain sufferers silenced by pandemic, Hippocratic Post, August 3

CDC Opioid Prescribing Guideline Updates Are in the Works: Will the Changes be Enough?, Practical Pain Management, August 3
Peripheral nerve stimulation for chronic low back pain may reduce pain, disability, Orthopedics Today, August 2

Association between widespread pain and dementia, Alzheimer’s disease and stroke: a cohort study from the Framingham Heart Study, Regional Anesthesia & Pain Medicine, August 2
Women’s chronic pain is often dismissed as being ‘dramatic’ – which can ruin health and lives, Insider, July 31

Study: 7 in 10 chronic pain sufferers delayed seeking medical advice during the pandemic, News Medical Life Sciences, July 31
90% of US primary care offers lower pain relief doses to Black patients, Medical News Today, July 30
What to Expect in Thoracic Outlet Syndrome Physical Therapy, Very Well Health, July 30
90% of US primary care offers lower pain relief doses to Black patients, Medical News Today, July 30
How Virtual Reality Is About to Revolutionize Healthcare, Bloomberg, July 30
Patient Preference and Risk Assessment in Opioid Prescribing Disparities, JAMA Netw Open, July 29

US service members suffer chronic pain at rate much higher than civilian population, report says, Stars and Stripes, July 6Feedback
We welcome your input! What do you like? Do you have a contribution for an upcoming newsletter? Send us your comments, suggestions, or contributions.SUBSCRIBE TO THIS NEWSLETTER

Slideshow: Causes of Fatigue and Sleepiness and How to Fight Them – WebMD


Slideshow: Causes of Fatigue and Sleepiness and How to Fight Them

Medically Reviewed by Jennifer Robinson, MD on February 17, 2020

Fatigue Cause No. 1: Not Enough Sleep


It may seem obvious but you could be getting too little sleep. That can negatively affect your concentration and health. Adults should get seven to eight hours every night. 

Fix: Make sleep a priority and keep a regular schedule. Ban laptops, cell phones, and televisions from your bedroom. Still having trouble? Seek help from a doctor. You may have a sleep disorder.

Fatigue Cause No. 2: Sleep Apnea


Some people think they’re sleeping enough, but sleep apnea gets in the way. It briefly stops your breathing throughout the night. Each interruption wakes you for a moment, but you may not be aware of it. The result: you’re sleep-deprived despite spending eight hours in bed. Your doctor may order a sleep study to check for this. 

Fix: Lose weight if you’re overweight, quit smoking, and you may need a CPAP device to help keep your airway passages open while you sleep.

Fatigue Cause No. 3: Not Enough Fuel


Eating too little causes fatigue, but eating the wrong foods can also be a problem. Eating a balanced diet helps keep your blood sugar in a normal range and prevents that sluggish feeling when your blood sugar drops.

Fix: Always eat breakfast and try to include protein and complex carbs in every meal. For example, eat eggs with whole-grain toast. Also eat small meals and snacks throughout the day for sustained energy.

Fatigue Cause No. 4: Anemia


Anemia is one of the leading causes of fatigue in women. Menstrual blood loss can cause an iron deficiency, putting women at risk. Red blood cells (shown here) are needed because they carry oxygen to your tissues and organs.

Fix: For anemia caused by an iron deficiency, taking iron supplements and eating iron-rich foods, such as lean meat, liver, shellfish, beans, and enriched cereal, can help.

Fatigue Cause No. 5: Depression


You may think of depression as an emotional disorder, but it contributes to many physical symptoms, as well. Fatigue, headaches, and loss of appetite are among the most common symptoms. If you feel tired and “down” for more than a few weeks, see your doctor.

Fix: Depression responds well to talk therapy and/or medication.

Fatigue Cause No. 6: Hypothyroidism


The thyroid is a small gland at the base of your neck. It controls your metabolism, the speed at which your body converts fuel into energy. When the gland is underactive and the metabolism functions too slowly, you may feel sluggish and put on weight.

Fix: If a blood test confirms your thyroid hormones are low, synthetic hormones can bring you up to speed.

Fatigue Cause No. 7: Caffeine Overload


Caffeine can improve alertness and concentration in moderate doses. But too much can increase heart rate, blood pressure, and jitteriness. And research indicates too much actually causes fatigue in some people.

Fix: Gradually cut back on coffee, tea, chocolate, soft drinks, and any medications that contain caffeine. Stopping suddenly can cause caffeine withdrawal and more fatigue.

Fatigue Cause No. 8: Hidden UTI


If you’ve ever had a urinary tract infection (UTI), you’re probably familiar with the burning pain and sense of urgency. But the infection does not always announce itself with such obvious symptoms. In some cases, fatigue may be the only sign. A urine test can quickly confirm a UTI.

Fix: Antibiotics are the cure for UTIs, and the fatigue will usually vanish within a week.

Fatigue Cause No. 9: Diabetes


In people with diabetes, abnormally high levels of sugar remain in the bloodstream instead of entering the body’s cells, where it would be converted into energy. The result is a body that runs out of steam despite having enough to eat. If you have persistent, unexplained fatigue, ask your doctor about being tested for diabetes.

Fix: Treatments for diabetes may include lifestyle changes such as diet and exercise, insulin therapy, and medications to help the body process sugar.

Fatigue Cause No. 10: Dehydration


Your fatigue can be a sign of dehydration. Whether you’re working out or working a desk job, your body needs water to work well and keep cool. If you’re thirsty, you’re already dehydrated.

Fix: Drink water throughout the day so your urine is light colored. Have at least two cups of water an hour or more before a planned physical activity. Then, sip throughout your workout, and afterward drink another two cups.

Fatigue Cause No. 11: Heart Disease


When fatigue strikes during everyday activities, such as cleaning the house or weeding the yard, it can be a sign that your heart is no longer up to the job. If you notice it’s becoming increasingly difficult to finish tasks that were once easy, talk to your doctor about heart disease.

Fix: Lifestyle changes, medication, and therapeutic procedures can get heart disease under control and restore your energy.

Fatigue Cause No. 12: Shift Work Sleep Disorder


Working nights or rotating shifts can disrupt your internal clock. You may feel tired when you need to be awake. And you may have trouble sleeping during the day.

Fix: Limit your exposure to daylight when you need to rest. Make your room dark, quiet, and cool. Still having sleep issues? Talk with your doctor. Supplements and medications may help.

Fatigue Cause No. 13: Food Allergies


Some doctors believe hidden food allergies can make you sleepy. If your fatigue intensifies after meals, you could have a mild intolerance to something you’re eating — not enough to cause itching or hives, just enough to make you tired.

Fix: Try eliminating foods one at a time to see if your fatigue improves. You can also ask your doctor about a food allergy test.

Fatigue Cause No. 14: CFS and Fibromyalgia


If your fatigue lasts more than six months and is so severe that you can’t manage your daily activities, chronic fatigue syndrome or fibromyalgia are a possibility. Both can have various symptoms, but persistent, unexplained exhaustion is a main one.

Fix: While there’s no quick fix for CFS or fibromyalgia, patients often benefit from changing their daily schedule, learning better sleep habits, and starting a gentle exercise program.

Fast Fix for Mild Fatigue


If you have mild fatigue that isn’t linked to any medical condition, the solution may be exercise. Research suggests healthy but tired adults can get a significant energy boost from a modest workout program. In one study, participants rode a stationary bike for 20 minutes at a mild pace. Doing this just three times a week was enough to fight fatigue.


Why You Snore and How to Stop

couple spooning in bed1 / 16Sources

This tool does not provide medical advice. See additional information.


COVID Long Haulers Prescribed Opioids at Higher Rates – PPM – Practical Pain Management


COVID Long Haulers Prescribed Opioids at Higher Rates

COVID-19 long hauler grateful after getting vaccine | wcnc.com

August 23, 2021

With multisystem symptoms and no clear treatment path, post COVID syndrome continues to challenge clinicians. Could the resulting prescribing exacerbate the existing opioid crisis?By Jennifer Lutz

with Lillie Rosenthal, DO

Opioid-related overdoses have drastically risen during the COVID-19 pandemic, in some moments outpacing deaths caused by the virus itself.And while these illnesses ravage communities, another chronic concern looms: a growing number of COVID survivors are being identified as long haulers, and those suffering from this post COVID syndrome are experiencing a constellation of symptoms.2

To further complicate matters, researchers recently found that that COVID long haulers are being prescribed opioids at higher rates than those without a previous COVID-19 diagnosis.3 The unknown outcomes of post COVID syndrome and the increased propensity of providers to prescribe opioids to these individuals could push the opioid crisis to the brink.

COVID long haulers are being prescribed opioids at higher rates than those without a previous COVID-19 diagnosis. (Image: iStock)

Post COVID Syndrome, Pain, and Opioids

The new research, published in Nature, used VHA electronic databases to identify 6-month outcomes after incidence of COVID-19 infection. The study is one of the largest to date and incorporated 379 diagnostic categories, 380 medication categories, and laboratory abnormalities from 62 different lab tests. Concerning medication, the researchers found an increase in the prescription of both opioids and benzodiazepines. Opioids were prescribed to COVID long haulers at an extra 9 times per 1,000 patients. Benzodiazepines were prescribed an extra 22 times per 1,000 patients. It is also well known that co-prescribing of benzodiazepines and opioids can present risks to the patient and that drug monitoring must be part of the treatment plan.

This prescribing-up trend contrasts with nationwide decreases in opioid prescriptions among the general patient population(as well as decreased benzodiazepine prescribing). “Providers really don’t know what long-haulers syndrome is, what causes it, or how to treat it. Unfortunately, when we don’t know, we generally do the most because we’re at a loss. We tend to think more is better, but often, it isn’t,” says Lillie Rosenthal, DO, a board-certified physical medicine and rehabilitation physicianwho has been treating people with chronic pain and post COVID syndrome.

Treatment options are often best assigned to a specific diagnosis but post COVID syndrome encompasses a broad range of symptoms, including but not limited to: shortness of breath, coughing, brain fog, joint pain, body aches, headache, sleep difficulties, anxiety, depression, chest pain, and gastrointestinal problems.5,6 Without available resources or directives, clinicians may more readily resort to higher risk treatments, such as opioids and benzodiazepines. “Doctors are trying to be compassionate but potentially doing harm,” says Dr. Rosenthal.

Such compassion could soon lead to a spike in opioid use disorder (OUD). When looking at population size, an April 2021 analysis by the UK Office of National Statistics (ONS) reported that 13.7% of patients who tested positive for the novel coronavirus reported at least one symptom of post-COVID syndrome 12-weeks after initial infection.7 An early prevalence analysis in the US, published by researchers at Columbia University Medical Center in New York, reported that among those people who had been hospitalized for COVID-19, between32.6% and 87.4% of themreported at least one symptom persisting after several months.2And while the VHA data review noted above had its limitations (including a mostly male population, despite more women suffering as long haulers), it highlights an important issue. It is hoped that this new information on opioid and benzodiazepine prescribing will alert providers before the problem outpaces the solution.

Treating Chronic Pain in COVID Long Haulers and Limiting Opioid Prescriptions

When it comes to pain, individuals with post COVID symptoms face a particular challenge. Not only can the cause of pain vary based on the individual response to COVID and what systems the virus affected but intensive care is shown to increase pain incidence after infection.8 Additionally, comorbidities (which are more common in COVID survivors) can further complicate pain.8

Clinicians who are not pain specialists should be aware that the chronification of pain involves neurological, hormonal, and neurochemical changes in both the central and peripheral nervous systems. In other words, the experience of COVID long haulers may not be much different than that of other people living with chronic pain.

“Let’s take the COVID factor out for a moment and treat the pain in a similar way to other chronic pain,” suggests Dr. Rosenthal. “We need to get more granular as to where exactly the pain is coming from.” Long haulers may share a common precipitating (or worsening) factor, but pain management should involve comprehensive treatment in response to the patient profile. “We need to stick with basics and start with a comprehensive nonpharmacological approach,” she notes.

When treating chronic pain in general or due to post COVID infection, it’s important for clinicians to approach the problem systematically.For instance, consider:

  • Where is the pain coming from? Is it headache pain, joint pain, specific muscle pain, back pain, neurogenic pain, or all-over muscle pain, such as in fibromyalgia?
  • How does the pain feel? Different pain sensations should be treated differently. Is the pain aching, shooting, burning, squeezing, stiffness, stinging, or throbbing?
  • How frequent is the pain? Is the pain persistent or does it come and go? Do certain activities increase or alleviate pain?
  • What treatments/medications has the patient tried in the past? Understanding what treatments have and have not helped before, can point providers in the right direction – including where to refer if a specialist is needed.

Opioids can be like “nuclear arms and should be used thoughtfully with a consideration of the side effects,” suggests Dr. Rosenthal. In the case of chronic pain, a biopsychosocial approach continues to show efficacy across a broad patient population.10 Adds Dr. Rosenthal, “It’s not just a COVID patient in front of you, it’s a person and this is an opportunity to optimize their health. We can be as specific as possible to the type of pain, and still be multifactorial.”

While post COVID syndrome is new and remains without formal diagnostic criteria, chronic pain is not – and the lessons learned on treating pain, when it comes to opioids for instance, are not, says Dr. Rosenthal. When faced with such unchartered waters, focusing on what is known may just separate compassionate care from compassionate harm.View SourcesLast updated on: August 23, 2021

Webinar Series for September 2021 – ACPA Ten Steps from Patient to Person – 3 September 2021 #painawarenessmonth

Hi there,

You are invited to a Zoom webinar.
When: Sep 3, 2021 04:00 PM Pacific Time (US and Canada)
Topic: ACPA Ten Steps from Patient to Person – Kathy Sapp, CEO of ACPA

Register in advance for this webinar:

After registering, you will receive a confirmation email containing information about joining the webinar.