12 REINFORCE RESOURCES

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Reducing opioids and using a set of skills and strategies for effective
pain management is a lifelong process. Health care professionals have
an important role to provide information and resources to patients for
self-management of their health. Many resources assist with ongoing self-
management of pain and opioids, from support organizations to peer
support groups. This chapter includes a review of resources, along with
ideas for further exploration.

SUPPORT ORGANIZATIONS AND PEER SUPPORT

Many major organizations provide information that is helpful and hopeful to

people managing pain and opioids. These organizations provide unique plat-
forms to bring together people with a common goal of living better despite
pain, whether they are in the same geographic area or scattered across
the globe. Disorder-specific organizations focus on temporomandibular
joint disease, complex regional pain syndrome, migraines, endometriosis,

https://doi.org/10.1037/0000209-013
Chronic Pain and Opioid Management: Strategies for Integrated Treatment,
by J. L. Murphy and S. Rafie
Copyright © 2021 by the American Psychological Association. All rights reserved.

165
 166  •  Chronic Pain and Opioid Management

and others. Organizations often provide educational content for people with
pain who use opioids and their loved ones, and they create avenues for
peer support group formation. Some of these groups may be formed locally;
others can be held virtually to expand to a broader reach. Organizations
have trained group facilitators who hold meetings across the country. Orga-
nizations may also provide resources that benefit providers who are seeking
education related to pain, opioids, substance use, and medication safety,
which may also help address concerns voiced by prescribers (Martino et al.,
2020).
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Organizations with resources and support for people with chronic pain
include the following:

• American Chronic Pain Association (https://www.theacpa.org/)

• U.S. Pain Foundation (https://uspainfoundation.org/)
• Pain Connection (https://painconnection.org/)
• Reflex Sympathetic Dystrophy Syndrome Association (https://rsds.org/)
• For Grace (http://www.forgrace.org/)
• Chronic Pain Self-Management Program (https://www.selfmanagement
resource.com/programs/small-group/chronic-pain-self-management/)
• My Migraine Team (https://www.mymigraineteam.com/)

Organizations with resources and support for people struggling with opioids
include the following:

• Substance Abuse and Mental Health Services Administration (https://

www.samhsa.gov/ or 1-800-662-HELP)
• Shatterproof: Stronger than Addiction (https://www.shatterproof.org/)
• SMART Recovery: Self-Management and Recovery Training (https://
www.smartrecovery.org/)
• National Institute on Drug Abuse (https://www.drugabuse.gov/)
• Prescribe to Prevent (https://prescribetoprevent.org/)

LOCAL ACTIVITY GROUPS AND CLASSES

Local groups can be a source of building a great support network within

the community that focuses on self-management of health goals. Groups
may be formed through mutual acquaintances, mutual health conditions, or
common interests. Individuals who seek additional motivation or account-
ability for maintaining physical activities may find that walking groups or
exercise classes provide necessary structure and the opportunity for social-
ization. Individuals seeking increased social connection may find groups
 Reinforce Resources  •  167

that meet to participate in shared interests and hobbies, such as crafting or

fishing. Adaptive activity groups, which modify or adapt activities depending
on the needs of participants, can also be found. Local activity groups and
classes that are commonly available include the following:

• gyms and YMCA

• walking groups found online (e.g., https://www.meetup.com/)
• hobby groups found from community advertising (e.g., at crafts stores
or sports stores)
• recreational classes found through the library
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• social groups found in the newspaper

• spiritual groups

SUPPORT FROM LOVED ONES

An important area for providers to discuss with patients is support from

close relationships, such as a spouse, partner, sibling, parent, or friend. The
people dearest to the patient hold great potential to provide consistent
support throughout the journey with pain and opioids. However, relation-
ships may have become strained if the patient has a history of poor coping
and maladaptive behaviors, and family systems can become highly compli-
cated when pain and opioids are involved. Loved ones can be both helpful
and harmful, the latter occurring often without intent. For support to be
effective, loved ones must understand what chronic pain is and is not, the
role of opioids in pain management, reasonable expectations for treatments,
and how to support the patient in a way that is therapeutic. Loved ones can
also play an important role in helping patients remain accountable and on
track toward their goals. Thus, social support can and should be an integral
part of the treatment and maintenance plan.
The following strategies are effective ways for health care providers to
help patients enhance social support:

• Identify how relationships may have been affected by past coping

behaviors identify elements of healthy relationships.

• Provide educational materials to the patient regarding chronic pain and

opioids that can also be shared with family.

• Encourage patients to share what they learn in treatment with close

family and friends who also need to learn more about pain, opioids, and
expectations for treatment outcomes.
 168  •  Chronic Pain and Opioid Management

• Discuss how close friends or family members can help with accountability
for taking medications as prescribed and maintaining use of active pain-
management skills.

• Discuss ways in which loved ones may intend to help but work against
patients’ personal goals.

• Encourage an identified support person to attend a booster visit.

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PSYCHOLOGICAL SUPPORT AND COUNSELING

Over the course of treatment, it may become apparent to the health care
provider that other factors are involved in the patient’s overall functioning.
As has been discussed at length, multimorbidities are commonplace within
this population. Psychiatric issues such as posttraumatic stress disorder and
substance use disorders all closely interact with functioning and progress,
as do issues such as insomnia. It is important that providers address comor-
bidities appropriately, including an evaluation for acuity level to determine
treatment needs.
The following strategies may be used by providers to help patients find
psychological support and improve their mental health:

• Recommend relevant self-help resources.

• Provide the National Crisis Hotline number so that patients can reach out
for additional support any time by calling 1-800-273-TALK (8255).

• Consider recommending a 12-step program for individuals who are

considering initiating or maintaining abstinence from alcohol or other
drugs.

• Refer patients to a pain psychology therapist to address comorbid chronic

pain, insomnia, and mood symptoms.

• Refer patients to a primary care or general mental health provider for

outpatient psychotherapy to address posttraumatic stress disorder or
mild-to-moderate mood disorders.

• Consider referring patients to a psychiatrist for medication management.

• Suggest secondary-level, intensive outpatient programs for co-occurring

disorders, substance use disorders, and moderate-to-severe mood disorders.

• Engage tertiary-level, psychiatric or medical inpatient hospitalization for

acute crises.
 Reinforce Resources  •  169

TECH TOOLS

Technology provides a vast number of tools that can be useful for main­
taining progress both during and after treatment, many of which are
no cost or low cost. The opportunity to reach support via the internet
and utilize health-focused applications enhances the person’s ability to
self-manage their pain and opioids. Given that technology is ever-changing
and continuously evolving, the resources shared here are general and should
guide health care providers to appropriate tools to recommend to patients.
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Technology tools and resources include the following:

• audio and video recordings and smart device applications to guide

relaxation practice
• fitness trackers to monitor physical activity
• smart pill boxes that track adherence to prescribed medication regimens
• online support groups
• motivational videos that inspire mind over matter, perseverance, and
personal growth
• virtual reality platforms to assist with relaxation, physical engagement,
and education
• smart device applications for tracking activities, exercise, mood, and
other health goals
• alarms as daily reminders for regular movement, relaxation, and other
goals
• medication alarms to stay on schedule, if prescribed to take opioids on
a schedule
• forums for communicating directly with other people with pain

CONCLUSION

The most effective outcomes often come from using a multifaceted approach
that combines all of the pieces we have available into the best puzzle we can
create. Fortunately, abundant resources are available help patients maxi-
mize their use of integrated strategies for pain and opioid management.
Technology-based options, such as applications that can be used anywhere
to encourage the use of relaxation techniques and activity engagement,
have proved to be especially helpful. In addition, loved ones and peers are
key in recovery and rehabilitation; their involvement should be encouraged.
Patients and health care providers should work together to evaluate what is
needed to optimize the chances for success.