People with chronic pain or illnesses can experience a variety of emotions including anxiety, grief, guilt, depression and anger. Accepting the condition and integrating it into daily life requires dealing with the losses and resentments and deciding how to live a meaningful life despite the condition.

1. Hosted By:
Dr. Dawn-Elise “Doc” Snipes

2. Living with Pain and
Chronic Illness
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
Host, Counselor Toolbox
President, Recovery and Resilience International

3. Objectives
 Prevalence and characteristics of chronic illness
 Characteristics of pain
 Effects of pain and chronic illness and possible
interventions
 Depression
 Anxiety
 Guilt

4. Chronic Illness: The New Normal
 About half of all American adults have a chronic illness
according to the National Health Council
http://www.nationalhealthcouncil.org/sites/default/files/NHC_Files/Pdf_Files/AboutChronicDisease.pdf
 Chronic Illnesses include (but are not limited to)
 Asthma
 Cancer
 Chronic pain
 Diabetes
 Fibromyalgia
 Heart disease or high blood pressure
 Lupus
 Lyme Disease
 Mental Illness (Anxiety, depression, PTSD)

5. Characteristics of Pain
 Everyone has pain sometimes
 Our bodies are incredibly resilient
 Knowing your pain can help your care team.
 Acute or Chronic
 Stabbing, aching, throbbing, burning…
 Constant or intermittent
 Stationary or radiating
 Any numbness

6. Effects of Pain and Chronic Illness
 Depression
 Fatigue
 Sleep Disturbances
 Hopelessness/Helplessness
 Negative thoughts -> Stress -> Serotonin -> Pain
 Interventions
 Mindfulness
 Good sleep habits
 Circadian rhythm maintenance
 Identify the things you CAN control and that are GOOD
 Eat healthfully to support Serotonin functioning

7. Effects of Pain and Chronic Illness
 Anxiety
 Things wont get better
 It is getting worse
 Consequences of pain (lost job, relationships, fitness…)
 Interventions
 Avoid caffeine and nicotine
 Educate yourself about the disorder and the PROBABILITY
things will get worse
 Keep a log of the good and bad days
 Practice distress tolerance skills
 Use the Challenging Questions Worksheet to address anxiety
provoking thoughts

8. Effects of Pain and Chronic Illness
 Guilt
 Self anger for not being able to…
 Can cause you to lash out at others—push them away so you
don’t disappoint them like you disappointed yourself
 Interventions
 Think about how you would want your child or best friend to
feel if they were in your position
 Get rid of the shoulds
 Focus on the things that you CAN do
 Decide whether it is worth using your energy to be mad at
yourself (and the world)

9. Summary
 Everyone experiences pain sometimes
 Pain indicates that something may be wrong
 People who experience chronic pain/illness, or an
extended bout of pain (such as after shoulder surgery)
may experience feelings of depression, anxiety and guilt.
 There are many different ways to address these feelings
 Anxiety/fear and anger are your body’s response to some
sort of physical, social or self-concept threat.
 Guilt is anger directed toward yourself
 Depression is a sense of hopelessness and helplessness
that arises when the pain doesn’t seem to remit.
Happiness Isn’t Brain Surgery is an educational podcast and not a replacement for medical
advice. All health decisions should be made in conjunction with your healthcare provider.

10. Connect With Us
Happiness Isn't Brain Surgery with Doc Snipes https://docsnipes.com
Subscribe to the podcast
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https://youtube.com/allceuseducation
Join our Facebook Group
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Additional Resources
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11. Hosted By:
Dr. Dawn-Elise “Doc” Snipes

12. Living with Pain and
Chronic Illness
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
Host, Counselor Toolbox
President, Recovery and Resilience International

13. Objectives
 Review the following effects of pain
 Grief
 Self Esteem problems
 Circacdian Rhythm Disruption
 Explore mitigating and exacerbating factors

14. Effects of Pain and Chronic Illness
 Grief
 Stages: Denial, Anger, Bargaining, Depression,
Acceptance
 Interventions
 Work through the stages of grief for each of the losses
because of the pain (Physical, self-concept, job,
freedom (driving/mobility), dreams…)

15. Effects of Pain and Chronic Illness
 Self-Esteem
 How you feel about the difference between who you
want to be and who you are
 Interventions
 Make a list of the positive things about you
 Identify 1 or 2 goals you can work toward
 Celebrate small things
 Silence the inner critic

16. Effects of Pain and Chronic Illness
 Circadian Rhythm Disruption
 Not getting out of bed
 Staying inside in the dark
 Sleeping too much
 Interventions
 Get out of bed at roughly the same time each morning
 Get dressed in “day-clothes”
 Turn on lights and sit in front of a window or get outside to
get your “day-clock” started
 If you must take a nap, keep it under 45 minutes to avoid
messing up your sleep schedule

17. Understanding Your Pain or Chronic Illness
 Exacerbating factors
 Emotional
 Mental
 Physical
 Environmental
 Social
 Mitigating factors – Do these
 Emotional
 Mental
 Physical
 Environmental
 Social

18. Summary
 Grief
 is a complex emotion that accompanies any type of loss
 Not everyone goes through all the phases
 Many people between anger and depression
 Acceptance does not mean liking it, it means incorporating
it into your life narrative
 Self-esteem can fall when a chronic illness or pain
keeps you from doing things that are important to you
 Circadian Rhythm Disruption can happen whenever
 You are sleeping too much or too little
 Your body isn’t getting the wake up signals

19. Summary
 Exacerbating factors make your problem worse and can
include
 Poor ergonomics
 Poor sleep
 Reducing opiates (Temporary)
 Stress
 Mitigating Factors
 Yoga/Stretching
 Frequent movement
 Massage
 Heat/Ice
Happiness Isn’t Brain Surgery is an educational podcast and not a replacement for medical
advice. All health decisions should be made in conjunction with your healthcare provider.

20. Connect With Us
Happiness Isn't Brain Surgery with Doc Snipes https://docsnipes.com
Subscribe to the podcast
Subscribe to our YouTube Channel
https://youtube.com/allceuseducation
Join our Facebook Group
https://docsnipes.com/Facebook
Join our Community & Access
Additional Resources
https://docsnipes.com

21. Hosted By:
Dr. Dawn-Elise “Doc” Snipes

22. Living with Pain and
Chronic Illness
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
Host, Counselor Toolbox
President, Recovery and Resilience International

23. Objectives
 Review medical and nonmedical interventions for
pain
Note: Any pain intervention should be cleared by your doctor or care
team.

24. Medical Interventions for Pain
 Tylenol and NSAIDS (Over the counter)
 Opiates
 Provide relief by attaching to opioid receptors
 Body stops making natural (endogenous) opioids when
flooded with prescription opiates
 Over time body reduces amount of opiate being let
through (tolerance) (after only several days)
 When you stop taking prescription opioids the body
takes a few days to start making natural opioids again
so pain threshold is markedly decreased

25. Medical Interventions for Pain
 Muscle Relaxants (Flexeril, Soma)
 Gabapentin (Neurontin)
 SSRIs (Cymbalta)
 Nerve Blocks
 Accupuncture/Accupressure
http://www.webmd.com/pain-management/features/acupuncture-pain-killer#1
Arch Intern Med. 2012;172(19):1444-1453. Acupuncture for Chronic PainIndividual Patient Data
Meta-analysis http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1357513

26. Nonmedical Interventions for Pain and
Chronic Illness
 Guided Imagery
 Color Imagery: Think of a color that you associate with
pain, such as red, and picture the painful area of your body
as red. Imagine shrinking, fading or dispersing the red.
 Symbol Imagery: Think about how the pain feels. Does it
feel like a knife sticking in your joint? If so, imagine you are
pulling the knife out of your joint and throwing it away
 Scenic Imagery: Imagine a place that is calming to you using
all of your senses

27. Nonmedical Interventions for Pain and
Chronic Illness
 Mindfulness
 Alternate focus: Stop thinking about the pain and how to
relieve it
 Deep relaxation breathing through the pain
 Distractions
 One moment at a time

28. Nonmedical Interventions for Pain and
Chronic Illness
 Radical Acceptance
 Life can be worth living even with painful events
 Rejecting reality does not change reality.
 Changing reality requires first accepting reality.
 Pain can’t be avoided; it is nature’s way of signaling
that something is wrong.
 Rejecting reality turns pain into suffering.
 Refusing to accept reality can keep you stuck in
unhappiness, bitterness, anger, sadness, shame, or
other painful emotions.

29. Nonmedical Interventions cont…
 Stretching/Balancing Exercises
 Chest/Upper Back
 Right/Left Back/Chest
 Abs/Lower Back
 Ice or Heat Packs
 Massage
 TENS units
 Improve sleep
 Do more things you enjoy

30. Nonmedical Interventions cont…
 Stress Management
 Stress causes
 Digestive upset/pain
 Back pain
 Migraines/headaches
 Jaw pain
 Interventions
Meditation
Distract Don’t React
Identify your most important values, decide whether
stressing over [this] gets you closer to or further away
from your goals/values

31. Summary
 Pain is inevitable
 Many people struggle with chronic conditions including
TMJ, migraines, depression, fibromyalgia and pain.
 It impacts your
 Mood
 Thoughts
 Behaviors
 Relationships
 Addressing pain will help reduce related
 Anxiety
 Depression
 Anger

32. Summary
 Pain Management
 Medical
 Nonmedical
 Pain management requires a comprehensive approach
addressing
 Physical causes of pain
 Mood
 Social supports
 Sleep
Happiness Isn’t Brain Surgery is an educational podcast and not a replacement for medical
advice. All health decisions should be made in conjunction with your healthcare provider.

33. Connect With Us
Happiness Isn't Brain Surgery with Doc Snipes https://docsnipes.com
Subscribe to the podcast
Subscribe to our YouTube Channel
https://youtube.com/allceuseducation
Join our Facebook Group
https://docsnipes.com/Facebook
Join our Community & Access
Additional Resources
https://docsnipes.com