Pain Recovery At Las Vegas Recovery Center

The multidisciplinary treatment team will review the client’s progress regularly and staff will report progress to the workman’s compensation case manager. Our clinicians will set up treatment goals, which are regularly reviewed in these multidisciplinary staff meetings. Return to work may be one of the goals of the treatment plan if feasible. We will address any fears or uncertainty about returning to work in coordination with the case manager. Discharge planning is crucial in the early stages of treatment. The multidisciplinary treatment team will facilitate appropriate levels of care upon discharge. Referrals will be made to applicable service providers upon discharge. We will consult with the case manager about this process prior to completion.

Pain Recovery at Las Vegas Recovery Center

Family Renewal Program We have found that chronic

pain like addiction needs to be addressed with family as well as the client. LVRC provides a monthly Family Renewal Program designed to educate and provide tools for the family to begin their own process of recovery. We also provide a weekly support group to provide identification and support for the family to find freedom from enabling and codependency. LVRC recognizes family involvement as critical for successful outcomes. Our staff will do everything we can to ensure that family members participate in this important program.

Las Vegas Recovery Center is a private, free-standing, chemical dependency and chronic pain facility licensed by the State of Nevada and accredited by The Joint Commission. The facility was established in 2003 and is dedicated to providing a complete continuum of care to clients and their families in a beautiful, confidential, and secure environment.

LVRC Chronic Pain Rehabilitation Staff Frank Szabo LADC, Senior Vice President of Clinical Services

Stephanie Jordan, OMD, PsyD, Acupuncturist

Mel Pohl MD, FASAM, Medical Director

Susan Rocchio, LMT, Massage Therapist

Lori Konopa-Berbano, RN, Director of Nursing

Rich Bakir, DC, Chiropractor

Dan Shiode, Ph.D., Clinical Psychologist

Monica Serna, RD, Consulting Dietician

Robert Hunter, Ph.D., Clinical Psychologist

Scott Pensivy, PT, ATC, Physical Therapist

John Lanzillotta, PA-C

Counselors, nurses, Yoga instructor, Chi Kung instructor, and consulting psychiatrist.

For more information about our chronic pain program or any of the other programs we offer, please call to speak with an admissions specialist at 702-515-1374.

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as Vegas Recovery Center (LVRC) provides services for those suffering from chronic pain and abuse/dependence on drugs. Approximately 50 million Americans—one in six people—suffer from chronic pain. Nationwide, chronic pain causes more disability than cancer and heart disease combined and costs $550 million annually in lost workdays and $20 billion overall. The costs of pain are not reserved for the individual; families suffer as well. There are numerous pharmacological and non-pharmacological treatments for chronic pain; however there is no “one-size-fits all” course of treatment. Las Vegas Recovery Center is providing a solution to this complex situation through our unique and comprehensive opioid-free Chronic Pain Rehabilitation Program.

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Pain Management vs. Pain Recovery

widely accepted course of pain management treatment is opioid pain medication. Painkillers can be quite effective in diminishing pain, but for some, there is a risk of developing chemical dependency. Over time, with some patients, the amount of opioid pain medication is increased with initial pain relief, but not prolonged pain resolution. With these people, the dose continues to escalate with continued unrelenting pain and decreasing function. Our program will safely detoxify someone from his/her opioids and other habit-forming medications and then begin to treat his/her physical and emotional pain that usually accompanies years of suffering. Our multidisciplinary team will review a potential pain client candidate to determine if we are the appropriate facility for that client. LVRC is proud to introduce the concept of pain recovery, which reduces the physical symptoms of pain and teaches clients how to eliminate emotional suffering.

Pain Recovery

Pain Recovery Medically Managed Withdrawal

(Detoxification) LVRC treats complicated drug dependencies in this program. The withdrawal process is medically managed under the supervision of the medical director, physician assistant, and nursing staff. During this part of treatment, clients are emotionally supported and their physical symptoms are minimized whenever possible with the support of medication. Certain substances can cause significant and difficult withdrawal symptoms. Las Vegas Recovery Center is one of the few residential facilities, nationwide, that has a license to dispense methadone as part of the withdrawal process. We are experienced in detoxification from high doses of methadone (>100mg/day), which we have found responds best to relatively rapid weaning off methadone (10–40mg per day as tolerated). We also have the ability to prescribe buprenorphine (Subutex) to ease the symptoms of withdrawal. We use opioids only through the detoxification phase— everyone who enters our pain rehabilitation program is free of opioids and other mood-altering habit-forming drugs including, sedatives, hypnotics, stimulants, and alcohol.

Chronic Pain Rehabilitation

The focus of Las Vegas Recovery Center’s Chronic Pain Rehabilitation Program is to reduce pain and increase function thus improving the quality of life—all without opioid pain medication. This is a four-week inpatient functional restoration program, which begins after medically managed withdrawal is complete.

Program includes • • • • • • •

Functional Evaluation Psychosocial History Physical Therapy (8 sessions) Interferential Device: nerve and muscle stimulation (as indicated) Biofeedback (as indicated) Chiropractic (primary assessment followed by visits 3 times per week) Pilates (as indicated)

• • • • • •

Acupuncture (weekly) Yoga (weekly) Reiki (weekly) Massage Therapy (weekly) Exercise and stretching groups (daily) Intense individual and group counseling regarding pain, medication dependence, and the addiction-pain syndrome

At Las Vegas Recovery Center, we typically see clients with identifiable pain generators such as musculoskeletal pain, fibromyalgia, complex regional pain syndrome, Crohn’s Disease, headaches, back and neck pain, with and without disc disease, residual post-surgical pain, and many other conditions associated with chronic pain. Typically, there are two types of chronic pain clients:

A. Those who are taking opioids and have become tolerant to the effects of their medications, but are using the medications as prescribed and display little in the way of addictive behaviors. Clients in this class will benefit from physical modalities and learning about their emotional responses to pain, which increase suffering. They also benefit from withdrawal of opioids with a reduced pain level due to the decrease of opioid-induced hyperalgesia.** In our program, these clients will have an opportunity to be in groups with others who have suffered similarly. The group support and milieu have proven invaluable in helping these clients change their attitudes and behaviors with respect to their chronic pain.

B. Those with serious pain generators who clearly are taking excessive amounts of opioid analgesics and often other addictive substances (benzodiazepines, sedative-hypnotics including carisopradol (Soma), stimulants, alcohol) and who demonstrate typical addictive behaviors. These behaviors include preoccupation with the drug, loss of control,

**Opioid-induced hyperalgesia occurs in a percentage of people on chronic opioids. It refers to increased pain caused by opioid medications. The proper treatment of this condition is discontinuing opioids medications and treating residual pain with other modalities.

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(cont.) inability to limit intake, compulsive use, and continued use despite significant harm to family, job, emotional

well-being, and health. These clients may be acquiring medications from multiple sources, legal and illegal.

When we work with a client and his/her family prior to admission, it is important to clearly explain the nature of the treatment program. This is communicated verbally and information is also sent usually via email. We encourage the client and family to review these documents and ask any questions they may have prior to admission. A member of our medical staff will interview the potential client by phone as part of a pre-admission pain assessment. We will NEVER tell a potential client that we can take away his/her pain. We explain that the goals of our program are to reduce pain and improve function. It is important to understand that we will not force someone to identify as an addict. Through the process of treatment, pain clients may ultimately find that their thoughts, feelings, emotions, and behaviors are similar to those of an addict. Those in category A may be resistant to chemical dependency groups, assignments, and twelve-step meetings, but these groups are mandatory and will address many relevant issues for these clients. We expose our pain clients to a variety of ideas to help them better understand themselves. We also understand this topic can become a focal point for some, and we aim to tailor each program to maximize the clients’ willing participation and reduce distractions. We will help them see that medicating feelings does not instantly give them a diagnosis of addiction, though they often do meet DSM-IV criteria for substance dependence. In our experience, clients who have depended on opioid medications for years, associated with a work-related injury, are often reluctant to give up the only thing in their lives that seems to help. Educational efforts start prior to admission to help the client and family understand the principles of opioid-induced hyperalgesia and chronic withdrawal in patients on opioids. The milieu provides a community environment where some of the clients have had similar experiences and expectations, but have some measure of improvement over the course of their stay at Las Vegas Recovery Center. This enables a new client to compare and contrast his/her experience and to positively project a future without medications.

Addiction is a chronic, relapsing

brain disease characterized by compulsive drug seeking and use, despite harmful consequences. In fact, a person could have addiction without yet developing tolerance or dependence. Addiction is best diagnosed by observing drugusing behavior over a period of time— until then, we can conclude that there is “problematic use,” which may end up evolving into addiction.

Drug dependence (a synonym

for addiction) is really a syndrome of behaviors involving continued problematic use of mood-altering substances over a continuous period of time. Symptoms include problems with controlling use, thus having an unpredictable outcome once they begin using a substance. Furthermore, addicts try to cut down or stop, but are unable to “stay stopped.” They are preoccupied with the drug and keep using it even though it causes problems for them and those who care for them. They don’t do the things they used to and “chase the high,” that is, spend excessive time and energy getting the drug and using it.

Disabled clients present a unique set of challenges in treatment. Often these clients are adversarial, angry, and involved in litigation. Our approach is even-handed—presenting that we are partners with the workman’s compensation company and will facilitate resolution of negative feelings, which ironically, are actually causing more pain. Individuals respond to rewards, and it is our clinical policy, through the use of well-utilized cognitive behavioral therapy techniques, to help the client reframe his/her experience of pain and suffering. Clients are rewarded for increased function by each and every staff member in the center—very little attention is paid directly to the pain complaints, though we grade pain three times a day using a traditional ten-point scale, as well as the Pain Outcome Profile, which is administered weekly.