The

Intractable Pain

Patient’s Handbook

for Survival

by

Forest Tennant, MD, DrPH

The

Intractable Pain

Patient’s Handbook

for Survival !

by !

Forest Tennant, MD, DrPH !!!!!!!!!!!!!

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ABOUT THE AUTHOR

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!

AN INTRODUCTORY WORD FROM THE AUTHOR

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DEDICATION

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IMPORTANT NOTICE

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CONTENTS !

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YOU'RE A RARE BIRD

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ACCEPT YOUR PLIGHT

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A NEW ATTITUDE: PAIN IS YOUR ENEMY – NOT YOUR SYMPTOM

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DEVELOP A SURVIVOR MENTALITY

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YOUR CLOSE AND LOVED ADVOCATE AND CONFIDANT

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you possess medical records and an advocate to vouch for your legitimacy, do not expect any physician,

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MAKE AN INVENTORY OF PAIN TRIGGERS

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DON'T BUY THE "MAGIC BULLET" CRAZE

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MAKE AN INVENTORY OF PAIN RELIEVERS

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ATTACK IP FROM MANY DIRECTIONS AT THE SAME TIME

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KNOW YOUR CAUSE OF BY ITS MEDICAL NAME

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COMPLICATIONS OF INTRACTABLE PAIN

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TABLE OF COMMON CAUSES !! D%(30!H0)030'4+($3!

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CARDIAC-ADRENAL-PAIN SYNDROME

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BLOOD PRESSURE AND PULSE RATE - CRITICAL MEASUREMENTS

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%'011E'0!N!%EG10!P$3(+$'![$'!4+N*$P0!E10T!2*0&!4'0!3$V!dE(+0!(30_%031(I0!43H!R43!U0!$U+4(30H!4+!P$1+!

%*4'P4R(01T!>!'0R$PP03H!&$E!R*0R\!&$E'!%EG10!43H!UG$$H!%'011E'0!H4(G&T!f$E!%4'+(REG4'G&!300H!+$!R*0R\!

(+!HE'(3)!4!%4(3![G4'0!$'!U'04\+*'$E)*!0%(1$H0!+$!G0+!&$E!\3$V!oE1+!*$V!PER*!H43)0'!&$E!P4&!U0!(3!HE'(3)!

4![G4'0T!/$'!0_4P%G05!([!+*0![G4'0!H'(I01!E%!&$E'!%EG10!'4+0!4U$I0!M,-!%0'!P(3E+05!&$E!4'0!4+!10'($E1!'(1\!

[$'!4!*04'+!4++4R\!$'!1+'$\0T!>!*4I0!$U10'I0H!4!3EPU0'!$[!>8!%4+(03+1!V*$!H0I0G$%!43)(34!X10I0'0!*04'+!

%4(3Z!HE'(3)!%4(3![G4'01!43H!'0dE('0!3(+'$)G&R0'(30T!W10!&$E'!%EG10!'4+0!43H!UG$$H!%'011E'0!+$!4HoE1+!&$E'!

P0H(R4+($3T!=GV4&1!G0+!&$E'!P0H(R4G!%'4R+(+($30'1!\3$V!V*4+!&$E'!%EG10!43H!UG$$H!%'011E'0!'04H(3)1!4'0!

'E33(3)!4+!*$P0T!>8!+*4+!R4E101!UG$$H!%'011E'0!+$!0G0I4+0!V(GG!3$+!'01%$3H!V0GG!+$!+*0!*()*!UG$$H!%'011E'0!

H'E)1!E10H![$'!$'H(34'&!*()*!UG$$H!%'011E'0!+'04+P03+T!c3G&!4H0dE4+0!%4(3!R$3+'$G!V(GG! G$V0'!*()*!UG$$H!

%'011E'0!R4E10H!U&!%4(3T!

TABLE OF COMPLICATIONS !! 2=#9f#=<7>=!X*()*!%EG10!'4+0Z!

!! 9c<6c?;!7;/>#>;?#>;D!X4H'034G5!+*&'$(H5!$I4'&5!+01+(RG05!%(+E(+4'&Z!

!! 9;=<2!=22=#^!

!! D2<c^;!

!! cD2;c8c<cD>D!

!! 2cc29!7;#=f!

!! AcDD!$[!A>@>7c!

!! 7;8<;DD>c?!

!! K;>F92!F=>?!

!! 7>=@;2;D!

!! 9f8;<2;?D>c?!

!! 9f8;<A>8>7;6>=!

!! 6;6c<f!AcDD!n!#c?#;?2<=2>c?!

!! >?Dc6?>=!

!! 6WD#A;!K=D2>?F!

!! /=2>FW;!

!! >66W?;!>68=><6;?2!e!>?/;#2>c?D!

!! K;>F92!AcDD!e!D2=<:=2>c?!K>29!?c!#c?2<cA!

203343+!N!>3+'4R+4UG0!84(3!84+(03+]1!943HU$$\![$'!DE'I(I4G!!",--.! M-

NECESSITY FOR OPIOID DRUGS

=![E3H4P03+4G! [4R+!4U$E+!$%($(H1! (1! +*4+! +*0&!4'0!+*0!$3G&!P0H(R4+($3!+*4+!V(GG! +'EG&!R$3+'$G! >8T!K*&p!

2*0!30'I$E1!1&1+0P!*41!1%0R([(R!%4(3!'0G(0[!+'())0'!%$(3+1!1R(03+([(R4GG&!\3$V3!41!$%($(H!'0R0%+$'1T!?4+E'4G!

%4(3!'0G(0[!(3!+*0!U$H&!(1!R4E10H!U&!4!)'$E%!$[!R*0P(R4G1!\3$V3!R$GG0R+(I0G&!41!03H$'%*(31!V*(R*!4++4R*!

43H!4R+(I4+0!+*010!'0R0%+$'1T!D(3R0!+*010!%4(3!'0G(0[!1(+01!'0R0(I0!03H$'%*(31!+*0&!4'0!*03R0!R4GG0H!h'0N

R0%+$'1Th! ;3H$'%*(3! (1! 1$! RG$10G&! '0G4+0H! +$!P$'%*(30! +*4+! +*0! 34P0! 03H$'%*(3! (1! H0'(I0H! ['$P! h03H5h!

V*(R*!(1!A4+(3![$'!h(3!+*0!U$H&h!43H!h$'%*(3h!V*(R*!(1!+*0!G41+!%4'+!$[!+*0!V$'H!P$'%*(30T!

2*0!F$HN)(I03!%$%%&!%G43+! (1! +*0!1$E'R0! [$'!P$1+!P0H(R(34G!$%($(H1! (3RGEH(3)!$%(EP5!P$'%*(305!R$N

H0(305!43H!*&H'$P$'%*$305!4P$3)!$+*0'1T!/E3H4P03+4GG&5!$%($(H!H'E)1!4'0!34+E'4G!%G43+!$'!*0'U4G!R$PN

%$E3H1T! #$310dE03+G&5! +*0&! 4'0! dE(+0! 14[0! V*03! +4\03! 4+! %'$%0'! H$14)01! 43H! %'01R'(U0H! U&! 4!

\3$VG0H)04UG0!%*&1(R(43T!?$!$+*0'!RG411!$[!H'E)1!3$V!$'!(3!+*0![E+E'0!V(GG!G(\0G&!'0G(0I0!%4(3!G(\0!$%($(H1!

1(3R0!+*0!34+E'4G!03H$'%*(31!(3!+*0!U'4(3!43H!$%(EP!%$%%&!%G43+!H0'(I4+(I01!4'0!01103+(4GG&!$30!43H!+*0!

14P0T! 2*0&! H$! 3$+! R4E10! +(11E0! H4P4)0! G(\0!P43&! $+*0'!P0H(R(34G1! (3RGEH(3)! 4GR$*$G5! 41%('(35! 4R0+4N

P(3$%*035!43H!43+(N(3[G4PP4+$'&!4)03+15!UE+!+*0&!R43!%'$HER0!10H4+($35!(P%4('P03+5!$I0'H$105!43H!*$'N

P$30!H0%G0+($3T!9(1+$'(R4GG&5! +*0&!*4I0!U003!V(H0G&! E10H! 1(3R0! +*0!;)&%+(43!0P%('0! 43H!U&!4HI43R0H!

1$R(0+(01!4GG!$I0'!+*0!V$'GH!V*$!R4'0H!4U$E+!+*0!'0G(0[!$[!1E[[0'(3)!43H!%4(3!4P$3)!+*0('!(3*4U(+43+1T!!

BIAS AGAINST OPIOIDS

>8!%4+(03+1!*4I0!+$!U0!4V4'0!$[!+*0!*(1+$'&5!U(415!14[0+&5!43H!+'E0!0[[0R+(I03011!$[!$%($(H1!1(3R0!P43&!

%4'+(01!(3!P$H0'3!1$R(0+&!*4I0!U003!43H!R$3+(3E0!+$!U0!$3!4!R4P%4()3!+$!U43!$'!'01+'(R+!+*0('!E10T!;I0'&!

>8!%4+(03+!V(GG!*4I0!+$!R$31+43+G&![4R0!43!()3$'43+!U(41!4)4(31+!$%($(H1T!@(41!43H!()3$'43R0!P4&!U0!+*'$V3!

(3! &$E'! [4R0!U&! [4P(G&5! ['(03H15! H$R+$'15! 3E'1015! )$I0'3P03+!$[[(R(4G15! 0P%G$&0'15! 43H!&$E'!*04G+*!%G43T!

2*0!V$'1+!$[[03H0'15!(3!P&!0_%0'(03R05!4'0!+*0!P03+4G!*04G+*!(3HE1+'&!43H!+*0!10GG0'1!$[!3$3N$%($(H!%4(3!

+'04+P03+1T!D(P%G&!%E+5!%4'+(01!V*$!*4I0!4![(343R(4G!(3+0'01+!(3!\00%(3)!%4+(03+1!(3!E3R$3+'$GG0H!%4(3!R$3N

+(3E4GG&!U4HNP$E+*!$%($(H1T!!@0!%'0%4'0H!+$!0HER4+0!4GG!R$P0'15!43H!4U$I0!4GG5!'0P0PU0'!+*4+!>8!'0dE('01!

$%($(H1![$'!R$3+'$GT!2*0'0!(1!3$!$%+($3T!

K*&!+*0!U(41p!c%($(H1!V$'\!+$$!V0GG!43H!+*0'0!(1!3$!1EU1+(+E+0T!2*0&!)(I0!43!>8!%4+(03+!4!P043(3)[EG5!

0_+03H0H5! dE4G(+&! $[! G([0T! >! 3$V! *4I0! >8! %4+(03+1! V*$! *4I0! 14[0G&! 43H! 0[[0R+(I0G&! +4\03! *()*! H$101! $[!

$%($(H1! [$'!$I0'!,-!R$3+(3E$E1!&04'1T!#E''03+!P0H(R4G!\3$VG0H)0! (3H(R4+01! +*4+! >8!%4+(03+1!R43!*4I0!4!

[4('G&!3$'P4G!G([01%43!([!+*0&!*4I0!4RR011!+$!4!H$14)0!$[!$%($(H1!V*(R*!0[[0R+(I0G&!R$3+'$G1!+*0('!%4(3T!

2*0!'04G!P$+(I4+($3!U0*(3H!$%($(H!U(41! (1!P$30&T!2*0&!4'0!0_%031(I0!+'04+P03+1![$'!*04G+*!%G431! (3N

RGEH(3)!)$I0'3P03+!%G431T!!K*03!>8!(1!%'$%0'G&!+'04+0H!V(+*!$%($(H15!+*0!%4+(03+!3$!G$3)0'!*41!+$!*43)!$E+!

(3!0P0')03R&! '$$P1!$'!*$1%(+4G15!E3H0')$!1E')0'&5!$'!)$!V*(P%0'(3)! +$!4!P03+4G!*04G+*!RG(3(R! [$'! hH0N

%'011($3h!oE1+!+$!)0+!4!G(++G0!'0G(0[T!=HH(+($34GG&5!&$E!H$!3$+!*4I0!+$!1$4\!&$E'10G[!(3!4GR$*$G5!UE&!*0'$(3!['$P!

H'E)!H04G0'15!$'!U0R$P0!+*0!30()*U$'*$$H!%$+*04HT!>!*4I0!*04'H!P43&!4!)$I0'3P03+!'0)EG4+$'5!*04G+*!

%G43!UE'04ER'4+5!43H!0I03!1$P0!$[!P&![0GG$V!H$R+$'1!%'$RG4(P!+$!P0!+*4+!+*0&!V$EGH!G(\0!+$!100!4GG!>8!%4N

+(03+1!H0%'(I0H!$[!$%($(H1T!/$'+E34+0G&5!+*010!4++(+EH01!43H!U(4101!4'0!1G$VG&!H(14%%04'(3)5!UE+!4GV4&1!U0!

4V4'0!+*4+!+*0&!0_(1+T!

8G0410!\3$V!4U$E+!+*0!U())01+!'4R\0+!43H!['4EH!)$(3)!$3! (3!P0H(R(30!+$H4&T!@0G(0I0! (+!$'!3$+5!1$P0!

P0H(R4G!*ER\1+0'1!4'0!RG4(P(3)! +*4+!$%($(H1!R4E10!%4(35!43H!&$E'!%4(3!V(GG!)$!4V4&! ([!&$E! oE1+!H0+$_([&5!

1+$%!$%($(H15!$'!)0+!%1&R*$G$)(R4G!*0G%ss!K*4+!E++0'!H(1'0)4'H![$'!1R(03R0!43H!1E[[0'(3)s!

>3!43$+*0'!10R+($3!$[!+*(1!943HU$$\!+*0'0!(1!4!10R+($3!$3!1E%%$'+!)'$E%1!43H!4HI$R4R&T!;I0'&!>8!%4N

+(03+!1*$EGH!o$(3!1$P0!1E%%$'+!)'$E%!43H!U43H!V(+*!$+*0'!%4+(03+15![4P(G(015!43H!4HI$R4+01!V*$!1E%%$'+!

203343+!N!>3+'4R+4UG0!84(3!84+(03+]1!943HU$$\![$'!DE'I(I4G!!",--.! MM

%EUG(R!4RR011!+$!$%($(H!%4(3!'0G(0I0'1!43H!1E%%$'+!%*&1(R(43!'()*+1!+$!%'01R'(U0!$%($(H1T!>!4P!$3G&!4UG0!+$!

V'(+0!+*(1!943HU$$\!U0R4E10!$[!%$G(+(R4G!%'011E'0!0_0'+0H!(3!'0R03+!&04'1!$3!G0)(1G4+(I0!43H!)$I0'3P03+!

'0)EG4+$'&!4)03R(01!U&!)'$E%1!$[!>8!%4+(03+15![4P(G(015!4HI$R4+015!43H!H$R+$'1T!?0I0'!+4\0!&$E'!1E%%G&!$[!

$%($(H1![$'!)'43+0HT!2*0&!V$'\!+$$!V0GG!43H!*4I0!+$$!P43&![(343R(4G!030P(01T!!2*0!G([0!&$E!14I0!P4&!U0!

&$E'!$V3T!!

FIRST STEP OPIOIDS

K*03! &$E! [('1+! 1+4'+! $%($(H1! [$'! +'04+N

P03+5!&$E!V(GG! 1+4'+!V(+*!$30! G(1+0H! (3! +*0!

h/('1+!D+0%!24UG0Th!2*010!$%($(H1!R43!U0!

+4\03! 41! 300H0H5! $'! $3! 4! '0)EG4'! U41(1T!

2*(1! )'$E%! $[! $%($(H1! *4I0! [0V! 1(H0! 0[N

[0R+1!43H!R'04+0!G(++G0!H0%03H03R0T!D$P0!

R$3+4(3! 4R0+4P(3$%*035! (UE%'$[035! 41%(N

'(35! $'! $+*0'! %$+03+(4+$'1!V*(R*! 4'0! R$PN

%$E3H1!+*4+!P4\0!+*0!$%($(H!4R+!1+'$3)0'!

43H! G41+! G$3)0'T!D$P0!%4+(03+1!P4&! '0dE('0! +V$!$[! +*0! h/('1+!D+0%h! $%($(H1!V*(R*!P4&!U0!4! %'0[0'4UG0!

+'04+P03+!4%%'$4R*!+$!+*0!hD0R$3H!D+0%!c%($(H1Th!/('1+!D+0%!$%($(H1!4'0!1*$'+N4R+(3)!(3!+*4+!+*0&!E1E4GG&!

%'$I(H0!%4(3!'0G(0[![$'!$3G&!4U$E+!,!+$!C!*$E'1T!

@0[$'0!)$(3)!+$!D+0%!2V$!$%($(H1!%4+(03+1!1*$EGH!4++0P%+!+$!R$3+'$G!+*0('!%4(3!V(+*!4!D+0%!c30!$%($(H!

R$E%G0H!V(+*!$30!$'!P$'0!$[! +*0!43R(GG4'&!P0H(R4+($31!43H!+'04+P03+1! G(1+0H! (3!+*(1!943HU$$\T!:()$'$E1!

4++0P%+1!1*$EGH!U0!P4H0!+$!4I$(H!D+0%!2V$!$%($(H15!1(3R0!+*0&!P4&!%'$HER0!R$P%G(R4+($31T!!

STEP TWO OPIOIDS

>[! D+0%! c30! $%($(H1! [4(G! +$! 4H0dE4+0G&! R$3+'$G!

%4(35!43!>8!%4+(03+!V(GG!*4I0!+$!'01$'+!+$!D+0%!2V$!

$%($(H1T! 2*0&! 4'0! PER*! P$'0! %$+03+! +*43! D+0%!

c30! $%($(H1T! 2*0&! 4'0! E1E4GG&! '0dE('0H! ([! %4(3! (1!

10I0'0!43H!R$31+43+!g!P043(3)!(+!30I0'!)$01!4V4&!

HE'(3)!+*0!03+('0!,CN*$E'!H4&!E3G011!+*0!%4+(03+!(1!

41G00%T! 84+(03+1! V(+*! +*0! hR4'H(4RN4H'034GN

1&3H'$P0h!V(GG! E1E4GG&! '0dE('0!D+0%!2V$!$%($(H1T!W3[$'+E34+0G&5! +*010!$%($(H1!P4&! R4E10!R$31+(%4+($35!

*$'P$30!R*43)015!43H!V0()*+!)4(3T!84+(03+1!V*$!PE1+!+4\0!+*0P!PE1+! G04'3!43H!%'4R+(R0!P041E'01!+$!

P(3(P(`0!R$P%G(R4+($31T!D$P0!D+0%!2V$!$%($(H1!4'0!$[+03!'0[0''0H!+$!41!G$3)N4R+(3)5!1(3R0!+*0&!'0P4(3!(3!

+*0!UG$$H!43H!R$3+'$G!%4(3![$'!10I0'4G!*$E'1T!

A$3)N4R+(3)!$%($(H!%'$HER+15!(3RGEH(3)!P$'%*(305!P0+*4H$305!$_&R$H$305!43H!$_&P$'%*$305!4'0!+$!U0!

+4\03!$3!4!'0)EG4'5![(_0H!1R*0HEG0T!70%03H(3)!$3!+*0!$%($(H5!+*0!+(P0!(3+0'I4G!V(GG!U0!0I0'&!O5!j5!M,5!$'!,C!

*$E'1T!>8!%4+(03+1!1*$EGH!H(1R(%G(30!+*0P10GI01!+$!+4\0!+*0('!G$3)N4R+(3)!$%($(H!$3!4![(_0H5!'0)EG4'!1R*0HN

EG0!1ER*!41!V*03!+*0&![('1+!4V4\05!3$$35! G4+0!4[+0'3$$35!43H!oE1+!U0[$'0!U0H+(P0T!!2*0&!4'0!?c2!+$!U0!

+4\03!41!300H0H5!43H!V*03!%4+(03+1!4++0P%+!+$!+4\0!+*0P!+*(1!V4&5!+*0&!1$$3![(3H!+*4+!+*0('!%4(3!(1!3$+!

V0GGNR$3+'$GG0HT!643&!%4+(03+1!V(GG!4G1$!300H!+$!E10!D+0%!c30!$%($(H1!HE'(3)!%4(3![G4'01!$'!U'04\+*'$E)*!

%4(3T

FIRST STEP OPIOIDS c8>c>7!! ! #c66c?!2<=7;!?=6;D!9&H'$R$H$30! ! :(R$H(3l5!A$'+4Ul5!?$'R$l!!8'$%$_&%*030! ! 74'I$3l5!74'I$R0+l5!74'I$3N?l!2'4P4H$G! ! WG+'4Pl!#$H0(30! ! ;P%('(3l5!/($'(34Gl!7(*&H'$R$H0(30!! 843G$'l!803+4`$R(30! ! 24GV(3l!?4GUE%*(30! ! ?EU4(3l!@E+$'%*43$G D+4H$Gl

STEP TWO OPIOIDS c8>c>7! #c66c?!2<=7;!?=6;D!60+*4H$30! 60+*4H$10l5!7$G$%*(30l!6$'%*(30! ^4H(43l5!=I(3`4l!c_&R$H$30! c_&#$3+(3l!/03+43&G!! 7E'4)01(Rl!A0I$'%*43$G! A0I$H'$P$'43l!c_&P$'%*$30! c%434!;<l!

203343+!N!>3+'4R+4UG0!84(3!84+(03+]1!943HU$$\![$'!DE'I(I4G!!",--.! M,

D$P0!$[!+*0!4U$I0!4'0!3$V!%'$HER0H!(3!I0'&!(33$I4+(I0![$'PEG4+($31T!/03+43&G!(1!4!1\(3!%4+R*!43H!+*0!

P$'%*(30![$'PEG4+($31!G(1+0H!(3!+*0!24UG0!4R+!G(\0!4!%EP%!(3!+*0!(3+01+(30!%'$I(H(3)!%4(3!'0G(0[![$'!41!G$3)!

41!M,!+$!,C!*$E'1T!

BREAKTHROUGH PAIN

D$P0!D+0%!2V$!$%($(H1!4'0!G$3)N4R+(3)!43H!

%'01R'(U0H! +$! 1E%%'011! %4(3! 43H! %$11(UG&! %'0N

I03+! %4(3! ['$P! 0I03! $RRE''(3)T! W3[$'+E34+0G&5!

+*0&! P4&! 3$+! +$+4GG&! H$! +*0! o$U5! 43H! %4(3! V(GG!

[G4'0! $'! hU'04\+*'$E)*h! +*0! U4''(0'! $[! +*0! G$3)N

4R+(3)! $%($(HT! =! 10I0'0! U'04\+*'$E)*! $'! [G4'0!

0%(1$H0! R43!H(14UG0! &$E!43H! 103H! &$E! +$! U0H!

$'! V$'10! g! +$! +*0! 0P0')03R&! '$$PT! >[! &$E'!

%EG10!'4+0!$'!UG$$H!%'011E'0!'(101!+$$!*()*!HE'N

(3)! 4! U'04\+*'$E)*! 0%(1$H05! &$E! P4&! 0I03!

*4I0!4!*04'+!4++4R\!$'!1+'$\0!+*4+!R$EGH!U0![4+4GT!

#$310dE03+G&5! P$1+! 10I0'0! >8! %4+(03+1! V(GG!

300H!+$!P41+0'!+*0!E10!$[!4!G$3)N4R+(3)!$%($(H!43H!$30!$'!P$'0!U'04\+*'$E)*!$%($(H1T!!

<4%(H!U'04\+*'$E)*!%4(3!'0G(0[!V(+*(3!a!+$!Ma!P(3E+01!(1!+*0!)$4G!$[!+*0!E10!$[!4!U'04\+*'$E)*!$%($(H!

P0H(R4+($3T!2$!4R*(0I0!+*(1!'4%(H!4R+($35!U'04\+*'$E)*!$%($(H1!1*$EGH!U0!+4\03!41!4!G(dE(H5!G$GG(%$%5!(3o0RN

+($35!$'!1E%%$1(+$'&T!2*0&!4'0!R$PP$3G&!'0[0''0H!+$!41!h1*$'+N4R+(3)h!$%($(H1!U0R4E10!+*0&!P4&!$3G&!4R+!

[$'!M!+$!B!*$E'1T

DON'T DEPEND ON ONE FAVORITE OPIOID OR ROUTE OF DELIVERY

c30!$[!+*0!U())01+!P(1+4\01!43!>8!%4+(03+!P4\01!(1!+$!)0+!+$$!H0%03H03+!$3!4![4I$'(+0!$%($(H!1ER*!41!

[03+43&G5!P0%0'(H(305!$'!$_&R$H$30!$'!+*0!V4&!(+!(1!H0G(I0'0H5!1ER*!41!43!(3o0R+($3!$'!G$GG(%$%T!K*&p!f$E!

P4&!0I03+E4GG&!)0+! +$G0'43+! +$! +*0!$%($(H!43H!*4I0! +$!1V(+R*T!=G1$5!P43&!4'0!0_+'0P0G&!0_%031(I0!43H!

*04G+*!(31E'43R0!%G431!1(P%G&!V(GG!3$+!%4&![$'!+*0PT!2*0('!%$1(+($3!(1!+*4+!+*0!$GH0'!)030'(R!$%($(H1!1ER*!41!

P$'%*(305!P0+*4H$305!*&H'$R$H$305!P0%0'(H(305!43H!*&H'$P$'%*$30!4'0!)$$H!03$E)*![$'!%4(3!R$3+'$GT!!

f$E!PE1+!(H03+([&!10I0'4G!$%($(H1!+*4+!4'0!0[[0R+(I0![$'!&$ET!7$!3$+!%G43!$3!)0++(3)!+*0!$30!&$E!P$1+!

V43+T!#$1+![4R+$'1!*4I0!1(P%G&!E1*0'0H!(3!4!1(+E4+($3!+*4+!*41!%'(R0H!1$P0!$[!+*0!D+0%!2V$!43H!U'04\N

+*'$E)*!$%($(H1!$E+!$[!'43)0T!

f$E!1*$EGH! (PP0H(4+0G&! G$$\!4+! +*0! G(1+1!$[!$%($(H1! (3! +*(1!943HU$$\!43H!H0+0'P(30!V*(R*!$301!&$E!

*4I0!43H!*4I0!3$+!+'(0HT!!=+!4!P(3(PEP5!&$E!1*$EGH!(H03+([&![$E'!+*4+!&$E!R43!+4\0!43H!V*(R*!4'0!0[[0RN

+(I0T!=G1$5!H$!3$+!)0+!&$E'!*04'+!10+!$3!'$E+0!$[!4HP(3(1+'4+($3!1ER*!41!4!G$GG(%$%!$'!(3o0R+($3T!/$'!1E'I(I4G5!

&$E!PE1+!G04'3!V*4+!&$E'!*04G+*!%G43!V(GG!%4&![$'T!!7$!3$+!0_%0R+!&$E'!*04G+*!%G43!+$!)(I0!&$E!4!1%0R(4G!

0_R0%+($3! +$! +*0('! E1E4G! $%($(H1! 43H! R$1+1! %$G(R&T! >+! (1! E1E4GG&! 4! U4H! (H04! +$! +4\0!U'43H!34P0!$%($(H1T!

K*&p!D$$30'!$'!G4+0'!&$E'!*04G+*!(31E'43R0!V(GG!G(\0G&!H(14GG$V!U'43H!34P01T!!

ANCILLARY MEDICATIONS

>3!4HH(+($3!+$!$%($(H15!+*0'0!4'0!4HH(+($34G!P0H(R4+($31!+*4+!4GP$1+!4GG!>8!%4+(03+1!V(GG!'0dE('0T!c30!(1!4!

1G00%(3)!4(H5!43H!+*0!$+*0'!(1!4!PE1RG0!'0G4_43+T!9$'P$30!'0%G4R0P03+!$[!4H'034G!*$'P$3015!+*&'$(H5!01N

BREAKTHROUGH OPIOIDS c8>c>7!! ! #c66c?!2<=7;!?=6;D!

/03+43&G!2'431PER$14G!!XhG$GG(%$%h!$'!UERR4G!+4UG0+Z! =R+(dl5!/03+$'4l!

9&H'$P$'%*$30!XG(dE(H5!(3o0R+($35!$'!1E%%$1(+$'&Z! 7(G4EH(Hl!!

60%0'(H(30!XG(dE(H!$'!(3o0R+($3Z! 70P0'$Gl!

c_&R$H$30!XG(dE(HZ! ! c_&H$10l!

6$'%*(30!XG(dE(H5!(3o0R+($35!$'!1E%%$1(+$'&Z! ! ! <$_43$Gl!

c_&P$'%*$30!X+4UG0+Z! ! c%434l!

9&H'$R$H$30!XG(dE(HZ! ! 2E11($30_l!

203343+!N!>3+'4R+4UG0!84(3!84+(03+]1!943HU$$\![$'!DE'I(I4G!!",--.! MB

+'$)035!$'! +01+$1+0'$30!P4&!4G1$!U0!'0dE('0H!41!%4(3!43He$'!$%($(H!P0H(R4+($31!P4&!H0%G0+0!+*0PT!f$E!

P4&!4G1$!300H!P0H(4+($3![$'!34E1045!R$31+(%4+($35!$'!V0()*+!R$3+'$GT!

SLEEP

>8!43H! (+1!4RR$P%43&(3)!*()*!%EG10!'4+0!\00%!>8!%4N

+(03+1!4V4\0T!f$E!V(GG!G(\0G&!300H!4!1G00%!4(H5!43H!10I0'4G!

$[! +*0! [4I$'(+01! $[! >8! %4+(03+1! 4'0! G(1+0H! (3! +*0! 24UG0T!

D$P0!43+(H0%'01143+15!V*(R*!4R+(I4+0!10'$+$3(3!4'0!G(\0H!

U&!%4+(03+1!43H!%*&1(R(431!U0R4E10!+*0&!411(1+!1G00%!43H!

H0%'011($3!4+!+*0!14P0!+(P0T!/E'+*0'P$'05!10'$+$3(3!P4&!

%'$P$+0!30E'$)0301(1!$'!*04G(3)!$[!30'I01T!

>8!%4+(03+1!4GG!0_%0R+!O!+$!j!*$E'1!$[!1G00%!G(\0!4!3$'N

P4G!%0'1$3T!7c!?c2!0_%0R+!+*(1T!f$E!V(GG!G(\0G&!3$+!U0!4UG0!+$!1G00%!P$'0!+*43!4U$E+!C!*$E'1!4+!4!+(P0T!

643&!>8!%4+(03+1!R433$+!1G00%!$I0'!,!+$!B!*$E'1!4+!4!1+'0+R*T!2*(1!(1!%4'+(REG4'G&!+'E0!([!&$E!*4I0!H4P4)0H!

&$E'!1%(305!*(%15!\30015!$'!30'I01! (3!&$E'!4'P1!$'! G0)1T!K*&p!>[!&$E!1G00%!+$$! G$3)!$3!+*010!H4P4)0H!

+(11E015!&$E!P4&!R'E1*!+*0P!43H!%'$HER0!P$'0!%4(3T!f$E'!U$H&!V43+1!&$E!+$!4V4\0!['0dE03+G&!1$!&$E!

4I$(H!1G00%(3)!(3!$30!%$1(+($3!43H!R'E1*!+(11E01!V*(R*!P4&!(3R'0410!&$E'!%4(3T!

>8!%4+(03+1!300H!+$!+4\0!+*0('!G41+!H4(G&!$%($(H!H$10!V(+*(3!M!*$E'!U0[$'0!U0H+(P0T!K*03!&$E!4V4\0!(3!

+*0!3()*+5!&$E!1*$EGH!)0+!$E+!$[!U0H5!1+'0+R*5!43H!E10!+*0!'01+'$$P!U0[$'0!'0+E'3(3)!+$!U0HT!>[!&$E!*4I0!

%4(3!HE'(3)!+*0!3()*+5!+4\0!4!H$10!$[!&$E'!U'04\+*'$E)*!$%($(HT!

MUSCLE RELAXANT-ANTI-ANXIETY AGENTS

2*0! 10I0'0! %4(3! 43H! *()*! %EG10! '4+0! $[! >8! R4E101!

43_(0+&!43H!PE1RG0!R$3+'4R+($3T!=!*()*!%EG10! '4+0!P4&!

P4\0! &$E! [00G! o(++0'&! $'! 30'I$E1T! >3! 4HH(+($35! &$E!P4&!

*4I0!43!(3oE'&!+*4+!P4&!R4E10!PE1RG0!R$3+'4R+($3T!6$1+!

>8!%4+(03+1![(3H!+*4+!4!PE1RG0!'0G4_43+!%'$I(H01!R$31(HN

0'4UG0! 4HH(+($34G! %4(3! '0G(0[! 43H! R$P[$'+T! /$'! '041$31!

+*4+! 4'0! 3$+! %4'+(REG4'G&! RG04'! +$!P05! 1$P0!PE1RG0! '0N

G4_43+1!4'0!3$+! 0[[0R+(I0! (3! >8!%4+(03+1T!=G+*$E)*!%*4'N

P4R$G$)(R4GG&! RG411([(0H! 41! 43+(N43_(0+&! 4)03+15! 1$P0!

4'0!0[[0R+(I0!(3!'0HER(3)!*()*!%EG10!'4+01!43H!PE1RG0!1%41P1T!2*$10!PE1RG0!'0G4_43+N43+(N43_(0+&!4)03+1!

+*4+!*4I0!%'$I03!+$!U0!%$%EG4'!V(+*!P43&!>8!%4+(03+1!4'0!G(1+0H!(3!+*0!24UG0T!7$!3$+!+4\0!P$'0!+*43!$30!$[!

+*0!4)03+1!(3!+*0!24UG0!$3!+*0!14P0!H4&T!2*0!u!M!R4E10!$[!10H4+($35![4GG15!43H!4RR(H03+1!(3!>8!%4+(03+1!(1!

$I0'H$10!$[!+*(1!)'$E%!$[!4)03+1T!

NERVE BLOCKERS

2*0'0!4'0!30V!H'E)1![$'!%4(3!'0G(0[!+*4+!4R+!U&!UG$R\(3)!+*0!

0G0R+'(R(+&! (3! 30'I01T! 84(3! +*4+! (1! R4E10H! U&! 30'I0! H4P4)0! (3!

+*0! G0)15! 4'P5! R*01+! V4GG5! 4UH$P035! $'! %0GI(1! (1! $[+03! R4GG0H!

h30E'$%4+*(R! %4(3Th! 2*010! 4)03+1! R43! U0! E10H! V(+*! $%($(H15!

43H!P43&!%4+(03+1!R43!E10! +*010!V(+*!4!D+0%!c30!$%($(H!43H!

4I$(H!+*0!30R011(+&!$[!D+0%!2V$!$%($(H1T!>3!P(GH0'![$'P1!$[!R*'$3(R!%4(35!+*010!4)03+1!P4&!V$'\!1$!V0GG!

+*4+!$%($(H1!4'0!3$+!0I03!30R0114'&T! >8!%4+(03+1!R43!1$P0+(P01! '0HER0! +*0('!$%($(H!H$14)0!V(+*! +*010!

SOME SLEEP AIDS IP PATIENTS FIND EFFECTIVE

=>7! ! #c66c?!2<=7;!?=6;!#*G$'4G!9&H'4+0!! D$P3$+0l!2'(4`$G4P! ! 94GR($3l!20P4`0%4P! ! <01+$'(Gl!!i$G%(H0P! ! =PU(03l!=P(+'(%+&G(30! ! ;G4I(Gl!

MUSCLE RELAXANT–ANTI-ANXIETYAGENTS

=F;?2!! #c66c?!2<=7;!?=6;!#4'(1$%'$H$G! ! D$P4l!#&RG$U03`4%'(30! /G0_0'(Gl!60+*$R4'U4P$G!! <$U4_(3l!7(4`0%4P! ! :4G(EPl!#G$34`0%4P! ! ^G$3$%(3l!A$'4`0%4P =+(I43l

NERVE BLOCKERS ?;<:;!! #c66c?!2<=7;!@Ac#^;<D! ?=6;!7EG$_0+(30! #&PU4G+4l!8'0)4U4G(3 A&'(R4l

203343+!N!>3+'4R+4UG0!84(3!84+(03+]1!943HU$$\![$'!DE'I(I4G!!",--.! MC

4)03+1T! D$P0! $[! +*0! $GH0'! 43+(H0%'01143+1! 43H! 43+(N10(`E'0! H'E)1! 4'0! 30'I0! UG$R\0'15! 43H! +*0&! *4I0!

U003!0_+031(I0G&!E10H![$'!%4(3!'0G(0[T!2*0!+V$!30V01+!$3!+*0!P4'\0+5!*$V0I0'5!4'0!)030'4GG&!1E%0'($'5!43H!

+*0&!4'0!+*0!$3G&!$301!>!3$V!'0R$PP03HT

NUTRITIONAL AND HORMONAL AGENTS

>8!%4+(03+1!PE1+!4GG!+4\0!1$P0!3E+'(+($34G!43H!*$'P$34G!4)03+1T!>8!H0%G0+01!+*0!U$H&!$[!R0'+4(3!3E+'(N

+($34G! 1EU1+43R01! 43H! *$'P$301T! >[! +*010! 4'0! H0%G0+0H5! %4(3!V$'10315! 43H! +*0! %4+(03+! V(GG! 0_%0'(03R0!

P$'0![4+()E05!(31$P3(45!43H!H0%'011($3T!>8!%4+(03+1!1*$EGH!'04H!4U$E+!I4'($E1!H(0+4'&!1E%%G0P03+1!43H!

+'&!$301!+*4+!*4I0!43!4%%04GT!=+!+*(1!+(P05!+*0'0!(1!3$!P4'\0+0H!I(+4P(35!P(30'4G5!*0'U5!$'!4P(3$!4R(H!+*4+!>!

'01+'(R+!$'!R$3H0P3T!90'0!4'0!P&!P(3(P4G!'0R$PP03H4+($315![$'!4GG!>8!%4+(03+1T!

MT! 74(G&!PEG+(%G0NI(+4P(3NP(30'4G!+4UG0+!$'!R4%1EG0T!

,T! #4GR(EP5!P4)301(EP5!43H!I(+4P(3!7T![$'!$1+0$%$'$1(1!%'0I03+($3T!

BT! 8'0)303$G$30!a-!+$!M--P)!4!H4&T!2*(1!(1!+*0!U41(R!4H'034G!*$'P$30!43H!30'I0!*04G0'T!

TOPICAL MEDICATIONS

2$!4R*(0I0!U0++0'!%4(3!'0G(0[!43H!%'$P$+0!*04G(3)5! >8!%4+(03+1!P4&![(3H!$30!$'!P$'0!+$%(R4G!P0H(R4N

+($315!V*(R*!4'0!'EUU0H!(3+$!+*0!1\(3!$I0'!%4(3[EG!4'0415!+$!U0!0[[0R+(I0T!2*010!4)03+1!4'0!\3$V3!41!h+$%(N

R4Gh! U0R4E10! +*0&! )$! $3! +$%! $[! +*0! 1\(3T! D(3R0! >8! %4+(03+1! *4I0! +(11E0! H4P4)0! 43H! 1R4''(3)5! (3+0'34G!

P0H(R4+($31!P4&!3$+!4GV4&1! '04R*! +*0!H4P4)0H!30'I01!U0R4E10!UG$$H!I0110G1! (3! +*0!H4P4)0H! +(11E0!

4'04!P4&!4G1$!U0!H4P4)0HT!#$310dE03+G&5!+$%(R4G!P0H(R4+($31!P4&!U0!4UG0!+$!%030+'4+0!(3+$!H4P4)0H!

4'041!U&!H([[E1($3T!

2*0!G(1+!$[!+$%(R4G!P0H(R4+($31!U0(3)!E10H!43H!'0104'R*0H!+*'$E)*$E+!+*0!R$E3+'&!(1!+$$!G$3)!+$![EGG&!G(1+!

*0'0T!>8!%4+(03+1!4'0!03R$E'4)0H!+$!41\!+*0('!%*4'P4R(1+!$'!$+*0'!>8!%4+(03+1!([!+*0&!'0R$PP03H!4!1%0R([(R!

+$%(R4G!P0H(R4+($3T!2*03! +'&! (+T!2$%(R4G!P0H(R4+($31!*4I0!01103+(4GG&!3$!%0'P4303+!1(H0!0[[0R+15!1$!&$E!

R43!0_%0'(P03+!14[0G&T!2*0!P$1+!R$31(1+03+!+$%(R4G!%4(3!'0G(0I0'1!(3!P&!0_%0'(03R0!*4I0!U003!P$'%*(30!

43H!R4'(1$%'$H$GT!2*0! [$'PEG4! (1! +$!R'E1*! +4UG0+1!$[!P0H(R4+($3!43H!H(11$GI0!$30!$'! +V$! +4UG0+1! (3!$30!

$E3R0!$[!R$GH!R'04PT!=%%G&!41!$[+03!41!30R0114'&![$'!%4(3!R$3+'$GT!

=3!0_R0GG03+!+$%(R4G!%4(3!'0G(0I0'!(1!G(H$R4(305!V*(R*!(1!RG411([(0H!41!4!+$%(R4G!4301+*0+(RT!>+!(1!4I4(G4UG0!

41!4!%4+R*!XA(H$H0'PZT!2*(1!%4+R*!%'$HER01!0_R0GG03+!%4(3!'0G(0[![$'!4U$E+!M,!*$E'1T!>+!R43!U0!%G4R0H!$3!

+*0!30R\5!U4R\5!*(%5!\300!$'!$+*0'!U$H&!4'04! +*4+! (1!%4(3[EGT!W3G011!43! >8!%4+(03+!*41!%4(3!H00%! (3! +*0!

U$H&! 1ER*! 41! 4UH$P(34G! 4H*01($315! +*0&! R43! E1E4GG&! )0+! )$$H! '0G(0[! ['$P! +*0! G(H$R4(30! %4+R*T! 2*010!

%4+R*01!4'0!%4'+(REG4'G&!0[[0R+(I0!([!+*0'0!(1!4!%4(3![G4'0!$'!&$E!*4I0!h$I0'H$30h!(+!43H!R4E10H!1$P0!4HH(N

+($34G!H(1R$P[$'+!(3!4!o$(3+5!U4R\5!$'!1%(30!4'04!U&!$I0'N0_0'R(10T!

CONSTIPATION

2*(1!+'$EUG01$P0!%'$UG0P!$[+03!'01EG+1!['$P!$%($(H!H'E)1!43H!(34R+(I(+&T!2$!*0G%!%'0I03+!(+5!H'(3\!O!+$!j!

)G41101!$[![GE(H1!4!H4&!43H!+4\0!1$P0![(U0'!1E%%G0P03+1!V*(R*!R43!U0!%E'R*410H!$I0'N+*0NR$E3+0'!4+!43&!

)'$R0'&!$'!H'E)!1+$'0T!643&!$I0'N+*0NR$E3+0'! G4_4+(I01!4'0!0[[0R+(I0T!>!*4I0!3$+!$U10'I0H! +*4+!$30! [(U0'!

%'$HER+! (1!1E%0'($'! +$!$+*0'1T!2*0'0[$'05! (+! (1!4!%0'1$34G!R*$(R0T! >!*4I0!1E'I0&0H!%4+(03+1! '0%04+0HG&! +$!

H0+0'P(30!4!R$31031E1!$3!G4_4+(I015!UE+!+*0'0!(1!3$!4)'00P03+!4P$3)!>8!%4+(03+1!41!+$!V*(R*!$301!4'0!

U01+T!

>[![GE(H1!43H!3$3N%'01R'(%+($35!$I0'N+*0NR$E3+0'!G4_4+(I01!H$!3$+!H$!+*0!o$U5!+*0'0!4'0!4!3EPU0'!$[!%'0N

1R'(%+($3!G4_4+(I01T!D(P%G&!41\!4!%*&1(R(43!+$!)(I0!&$E!4!%'01R'(%+($3T!f$E!P4&!*4I0!+$!+'&!10I0'4G!+$!10++G0!

203343+!N!>3+'4R+4UG0!84(3!84+(03+]1!943HU$$\![$'!DE'I(I4G!!",--.! Ma

$3!$30!&$E![(3H!P$1+!0[[0R+(I0T!>!*4I0![$E3H!+*4+!P&!>8!%4+(03+1!V(+*!10I0'0!R$31+(%4+($3!4GP$1+!4GV4&1!

'01%$3H!+$!%$G&0+*&G030!)G&R$G!XFG&R$A4_l5!6('4A4_l5!F$Af2;AflZ5!$'!4!G(R$'(R0!%'$HER+!R4GG0H!;I4RNWN

F03lT

NEUROGENESIS: KEY TO CURE

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STRETCHING EXERCISES

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DEALING WITH YOUR FAMILY AND LOVED ONES

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WORK WITH YOUR HEALTH INSURANCE PLAN

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=)03R&T!=GP$1+!4GG!D+4+01!3$V!*4I0!+*010T!D4HG&5!1$P0!>8!%4+(03+1!*4I0!*4H!+$!03G(1+!+*0!10'I(R01!$[!43!

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FINDING A DOCTOR TO TREAT IP

=1!$[!&0+5![0V!67b1!(3!+*0!W3(+0H!D+4+01!1%0R(4G(`0!(3!>8T!2*0'0!(1!3$!@$4'H!R0'+([(R4+($3![$'!(+5!43H!3$!

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%0'($H!$[! +(P0T! >8!%4+(03+1! +*'$E)*$E+! +*0!R$E3+'&!1+(GG!*4I0!)'04+!H([[(REG+&!$U+4(3(3)!03$E)*!$%($(H1! [$'!

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+($3![$'!+*0!2'04+P03+!$[!84(3T!2*(1!(1!+*0!$3G&!$')43(`4+($3!$[!V*(R*!>!4P!4V4'0!+*4+!1%0R(4G(`01!(3!%G4R(3)!

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STRESS CONTROL: MAINTAIN YOUR SPACE

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+($3!$E+!$[!&$E'!G([0T!2*(1!P()*+!U0!4!P4''(4)0!%4'+30'!$'!4!'0G4+(I0T!/$'!0_4P%G0!$30!$[!+*0!)'04+01+!43H!

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1+43H5!'0G4_5!$'!R$3+'$G!&$E'!+(P0T!!

TRAVEL AND WALKING TIPS

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P03+!+*0&!R43!+'4I0G!43H!V4G\T!

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+'04+0H!V(+*!*()*!H$10!$%($(H1![$'!$I0'!,-!&04'1T!=3H!+*0&!4'0!1+(GG!)$(3)!1+'$3)!V(+*!4GG!+*0('!P03+4G![4REGN

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Now for the do's and don'ts:

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&$E'!1E(+R410T!#'(+(R4GQ!When traveling do not remove medication from the bottle or container that

has a pharmacy label that shows your name, your doctor's name, and name of medication. If you

remove your medication from its issued container and authorities in an air or seaport find it, they

will likely confiscate it as they should.!

PREVENTING DEMENTIA AND MENTAL DETERIORATION

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TOOTH DECAY AND OSTEOPOROSIS

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! ! ! ! :(+4P(3!7!g!O--!E3(+1!

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POTENTIATORS: WHAT ARE THEY AND HOW TO USE THEM

2*0!+0'P!h%$+03+(4+$'h!(1!$30!E10H!U&!%*&1(R(431!43H!%*4'P4R(1+1!+$!(3H(R4+0!+*4+!$30!P0H(R4G!4)03+!

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WEIGHT GAIN

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CUTTING DOWN AND WITHDRAWING FROM OPIOIDS

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Here are absolute DON'TS

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+($31T!

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&$E!1EHH03G&!1+$%!&$E'!P0H(R4+($3T!!

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CT! 7$!3$+!G0+!43&U$H&!%E+!&$E!(3!4!*$1%(+4G!+$!hH0+$_([&h!$'!+4\0!&$E!$[[!&$E'!P0H(R4+($3T!7$!(+!1G$VG&!

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INTERVENTIONS – A NEW TERM IN PAIN TREATMENT

2*0!+0'P!(3+0'I03+($3!(1!3$V!4!+0'P!+*4+!(1!E10H!+$!H01R'(U0!4!10+!$[!%'$R0HE'01!+*4+!P4&!%0'P4303+G&!

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+'$GG0H!%4(3!P0431!&$E'!*$'P$301!43H!(PPE30!1&1+0P!4'0!(3!)$$H!1*4%0!+$!*0G%!&$E!*04GT!643&!>8!%4N

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+($3T!c3G&!43!()3$'43+!$'!U(410H!%'4R+(+($30'!V(GG!0I03!1E))01+!&$E!1+$%!&$E'!P0H(R4+($3!+$!*4I0!1E')0'&!$'!

43!(3+0'I03+($3T!2E'3!43H!'E3!['$P!43&!%'4R+(+($30'!V*$!P4&!1E))01+!+*(1T!

IMPLANTED OPIOID PUMPS AND ELECTRICAL STIMULATORS

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[(3H!&$E!R433$+!4H0dE4+0G&! R$3+'$G! &$E'!%4(3!V(+*! +*0!D+0%!c305!D+0%!2V$5!43H!@'04\+*'$E)*!c%($(H1!

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HORMONE REPLACEMENT AND TREATMENTS

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QUALITY OF LIFE

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PLANTS, PETS, AND MUSIC

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GETTING YOUR MEDICATIONS IN THE HOSPITAL

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YOU NEED A MINISTER AND LAWYER

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ADVOCACY GROUPS

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HUMOR AND MOTIVATION – KEEP SMILING

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SELF CHECK FOR OVER-MEDICATION

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KEEP A ONE WEEK RESERVE OF MEDICATION

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NEVER RUN OUT OF MEDICATION

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YOUR MEDICAL RECORDS AND MRI'S

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DON'T BE A SOAP OPERA

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MILESTONE: PAIN FREE HOURS

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203343+!N!>3+'4R+4UG0!84(3!84+(03+]1!943HU$$\![$'!DE'I(I4G!!",--.! B,

APPENDIX

Inventory of Pain Triggers

!

203343+!N!>3+'4R+4UG0!84(3!84+(03+]1!943HU$$\![$'!DE'I(I4G!!",--.! BB

Inventory of Pain Relievers

!

203343+!N!>3+'4R+4UG0!84(3!84+(03+]1!943HU$$\![$'!DE'I(I4G!!",--.! BC

!

DIET FOR WEIGHT CONTROL

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.T!!NOQ!!8$+4+$!e!<(R0!e!@0431!e!#$'3!e!8041!! ! !jT!!NOQ!!2$'+(GG41!e!@'04H!e!841+4!e!#'4R\0'1!e!#0'04G!e!D%4)*0++(!!

LT!!NOQ!!>R0!#'04P!e!f$)E'+!e!8(0!e!#4\0!e!841+'(01!e!#43H&!e!#*$R$G4+0!!

M-T!NO FRIED FOODSQ!!;4+!F'(GG0H!e!@'$(G0H!e!8$4R*0H!e!<$41+0H!!

MMT!/c<!D?=#^D!WD;!8<c2;>?!c<!=AAcK;7!:;F;2=@A;D!!M,T!DRINK 64oz. OF WATER DAILY!!

203343+!N!>3+'4R+4UG0!84(3!84+(03+]1!943HU$$\![$'!DE'I(I4G!!",--.! Ba

Schematic for Neurogenesis

!!

Schematic for Basic Stretch & Hold for IP Due to Spine Degeneration

!!