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Handouts


 

Handouts by Dr. Rotchford

Dr. Rotchford's Handouts are for established patients, families, friends, as well as the general public.   Scroll below to review the following 6 general topic areas for Dr. Rotchford’s Handouts:

  1. Pain Management – A host of helpful and informative topics
  2. Addictions and Substance Use Disorders– with multiple subcategories based on substance or addiction involved.  Dr. Rotchford is particularly skilled in recognizing and managing opioid use disorders.
  3. Acupuncture– Brief Introduction  Dr. Rotchford a longtime Fellow of the American Academy of Medical Acupuncture.
  4. Brain Health -  A special area of interest for Dr. Rotchford’s throughout his medical education and career
  5. Anxiety and Post Traumatic Stress Disorder (PTSD) – Very pertinent for care specializing in pain management and addiction medicine.
  6. General Health Issues related to a specialized practiced in Addiction Medicine, Pain Management, Acupuncture, Brain Health, Preventive Medicine, etc.
  7. Pain Management Related

1A:  General

 

Some suggestions for pain management related to degenerative changes and osteoporosis. by Dr. Rotchford 2019

**** Ecentre online pain course: https://ecentreclinic.org/?q=PainCourse This internet-based pain management program stands the test of time and is available online for free. It provides a basic and refresher course for anyone dealing with chronic complex pain. This is a great place to start. Classes start every other month or so.

"Mystery of Chronic Pain" A Ted Talk by Dr. Krane reviews the evidence for considering chronic non-cancerous pain a disease unto itself.
Pain Catastrophizing This is a link to an article from Practical Pain Management. While written for clinicians I expect it to be helpful for most patients. Be aware that addressing these patterns through effective behavioral interventions has been shown to change brains in ways consistent with improved pain management.
Interdisciplinary Pain Restoration Program - This link is to a slide set presented by a highly specialized pain management program in the Bay area.
While directed to clinicians my expectation is that some patients will find it helpful for it lays out some of the basics.
"The OPAS Experience" - an article in the Pain Practitioner - 2007 Dr. Rotchford
Syllabus Regarding the basics of Chronic Pain and its Management Dr. Rotchford The syllabus was written for a college course provided on the subject.

1B:  Some Specific Pain Conditions or treatments: Also see above references regarding Acupuncture, Brain Health, medical cannabis etc.
Neuropathies - A Brief Overview by Dr. Rotchford
Ketamine and Low Dose therapy for Pain, Depression, PTSD, and... by J. K. Rotchford, M.D. 2018.
Ultra Low-Dose Naltrexone in helping with pain management by J. K. Rotchford, M.D. 2019
Osteoarthritis - A discussion of options to consider using the knee osteoarthritis as an example by J.K. Rotchford 2019 revised

Pain Questionnaire used routinely by Dr. Rotchford

The following are a few references that Dr. Rotchford recommends to look over:
Books to Know - This is a compendium of books about behavioral ways to better manage pain. If you think you've tried it all. Please think again.
Change your Brain, Change your Pain by Mark Grant, M.A. 2011 - This book is consistent with Dr. Rotchford's approach to chronic pain problems. While emphasizing behavioral approaches the author clearly recognizes the importance of a "both/and" approach rather than simple either/or approaches. Dr. Rotchford recommends EMDR for any patient who has chronic pain and particularly those with known history of trauma or positive response to medical cannabis. The hitch is to find qualified practitioners and secondly to get payment for same through third parties. There is a helpful CD included that promotes some of the brain changes discussed within the book. It's available online for around $40.
Patient Self-Help Resources by Forrest Tennant, M.D.
Neuroplastic Brain and Body
Neuroplastic Transformation: Your Brain on Pain is a Workbook these clinicians have published.
Managing Pain before it Manages You by M. Caudill, M.D - Available online for purchase.- I consider this the "standard" workbook for behavioral management of pain.

The Divided Mind by John Sarno, M.D., who has written a number of books on the interplay between pain and emotional states, particularly anger and unexpressed rage. Practical suggestions are eventually provided and it is an eye opener for many who continue to believe that pain is simply a matter of what the x-ray or other bio-markers reveal. Please see the Anger Appreciation handout below.
Dr. Rotchford has different opinions from those of Dr. Sarno. While it is understandable to be critical of the lack of the formal appreciation of emotional stressors as potential explanations for many patient symptoms, Dr. Rotchford does not agree that contrasting psychological vs. physical vs. spiritual vs. energetic vs. cultural explanations is the best way to proceed. Dr. Rotchford finds these models are constructs. He believes the "truth" often lies outside of our man-made constructs, however appealing and effective our constructs may be. The history of medicine is that our best "constructs" often change over time. Nonetheless, Dr. Rotchford values Dr. Sarno's approach, because it is relatively safe and can be quite effective. There is also a definite value in appreciating how the unconscious "mind," however it is understood or defined (The "mind" is a "construct" too), along with the measurable functions and physiology of the central nervous system, has a predominate role in the understanding and management of painful conditions. Lastly, it is Dr. Rotchford's opinion that "either/or" ways of thinking and responding, while they are sometimes effective, are not often as effective as "both/and ways" of thinking and responding. This is particularly true when managing complex diseases, particularly those that affect the central nervous system. The following are additional resources related to "Sarno" interventions.
Daily Study Guide for TMS Patients
A 20-20 segment reviewing Sarno approaches
Sarno HBP Disk 1
Sarno HBP Disk 2
Sarno HBP Disk 3
Sarno HBP Disk 4

Pain Management - A recent CME update for physicians - While this link was intended for physicians, I think it might be helpful for some to read in order to view the current "party line" as it relates to pain managment.
Dr. Ready's Slide Set: Dr. Ready is currently my "Guru" when it comes to headache/migraine management. In 2016 he gave a presentation which was not only entertaining but very informative. I'm please to be able to provide a link to his slide set for managing intractable headaches.


1C: Opioids in Chronic Pain Management

Opioids in Chronic Pain Management - A Guide for Patients - 2018 Dr. Rotchford This is a small book written to lay it out for patients as well as colleagues as to some of the basics when considering the use of opioids in chronic pain management.
Managing Acute Pain in Patients on Buprenorphine & Managing Acute Pain in Patients Prescribed Methadone - These 2 handouts were written by Dr. Rotchford and are intended primarily for clinicians. Patients may find them informative as well. Patients who use buprenorphine and methadone for opiate use disorders or for chronic pain are advised to only use opioids as specifically directed by a physician. Every attempt to diagnose the source of the pain is indicated and without a clear source of acute and serious tissue injury or damage, opiates or other controlled substances are best avoided. In cases where a clear cause of pain is not present every attempt to avoid pain pills is best. Exceptions might be when one is dealing with a potentially life threatening problem such as a heart attack. In brief, patients on buprenorphine, whenever reasonable, must be provided options for pain management that do not involve opioids or other controlled substances.
The Role of Buprenorphine in Pain Management by Gregory Rudolf, M.D. This is a link to a slide presentation intended for clinicians about the use of buprenorphine in pain management.
Washington State Guideline on Prescribing Opioids for Pain (2015 revised)
Methadone and Pain Centers in Western Washington - Please look under new patients tab for other regional providers.
Ultra Low-Dose Naltrexone to Improve Opioid Analgesia - A novel approach with references. Also quite safe.

1D:  Medical Cannabis For Pain etc.

Medical Cannabis - Initial Medical Consultation - 2018 Available online at Amazon.com by J.K. Rotchford, M.D.
Medical Cannabis Syllabus by J. K. Rotchford, M.D. This is the old handout provided prior to the publication of the above book. Some more details are provided.
Clinical Experience with Medical Cannabis - A Physician's Observations. by J. K. Rotchford, M.D. An article written for publications
Current Washington State Law: SECOND SUBSTITUTE SENATE BILL 5052
Marijuana Abuse - A Public Health Issue - J. K. Rotchford, M.D. A published letter to the editor.

 

  1. Addiction Medicine & Substance Use Disorders Related: General, Family & Al-Anon, Alcohol, Opiates, Marijuana, Tobacco

2A:  General Substance Use Disorders issues

What Promotes Recovery From Addictions (Substance Use Disorders) - Dr. Rotchford
Series of Podcasts from Hazelden Betty Ford : Given the complexity of human nature and substance use disorders, there is value in reviewing multiple perspectives. While Dr. Rotchford does not agree with some of the perspectives presented in these podcasts, he does respect the value of these perspectives and the professionals who share them. He is thankful to have his patients and others having ready access to valuable information and help. Take a look!
Medical Use of Addictive Substances - A brief review of some basic principles in caring for patients with addictive substances. New May 2016
Self- Medicating - Dr. Rotchford
Comorbid Substance Use Disorders: Primer for Pain Management This was a review article publish in Practical Pain Management in March of 2016. It reviews the importance of recognizing and treating substance use disorders when managing pain. It also reviews some of the "soft" variables when it comes to patients being addicted to opioids when they are being prescribed for pain. Dr. Rotchford keeps it simpler: If a patient meets formal criteria for being opiate dependent (addicted) they need to be treated as such with proper medical and behavioral care for both opioid addiction and chronic pain management.
American Society of Addiction Medicine (ASAM) Informative handouts and links to governmental and other online resources.
AAAP Online Resources for Patients & Family wonderful online page with references for patients and family from The American Academy of Addiction Psychiatry
How to recover from Marijuana and other Addictions - A Quitter's Guide by J. K. Rotchford, M.D.
Nutritional Issues for Addictions by Dr. Rotchford
The New York Times is dead wrong about drug addiction
Informal Review of Opiate Dependence (Addiction) in Pain Patients on Chronic Opioid Therapy (COAT) by J. K. Rotchford, M.D
Debate/Discussion related to above manuscript - Presented at 2013 AAAP Annual Poster Presentation.
The Genetics, Neurogenetics, and Pharmacogenetics of Addiction - A published Review
The Irrationality of 12 step programs in recovery - An article in the Atlantic - April-2015. Dr. Rotchford firmly believes in the benefits of 12 step programs but feels the perspectives in this article are worth sharing and being aware of.
Missing the Diagnosis of Opioid Use Disorders in Pain Patients who are on chronic opioid therapy. [video: takes time to load] This formal talk was delivered by Dr. Rotchford to faculty and students at St. Charles University Faculty of Medicine in Prague, the Czech Republic in the Spring of 2015. The previous link takes some time for the talk to load. When you hear Dr. Rotchford say "Ahoi" it is up and running.
OPAS Controlled Substance Agreement
Look Below under Pain Management for information regarding the use of buprenorphine and methadone with regard to effective pain management.

 2B: Family and Alanon Related Issues

 

Family Therapy - A presentation with references at Free By The Sea - December 2018, J.K. Rotchford, M.D.
Help for Family Members please see syllabus below for more detailed information. J.K. Rotchford, M.D.
Syllabus for Family Members J.K. Rotchford, M.D.
Adult Children of Alcoholics J.K. Rotchford, M.D.

 

2C: Alcohol Use Disorder

The Active Ingredients of Effective Alcohol Addiction Treatment - A Primer
The National Institute of Alcohol Abuse and Alcoholism (NIAAA) This is a link to handout with links and information from the NIAAA. There is much in the way of proven effective therapy for those with alcohol use disorders.
Personalized Disease Monitoring - Progression monitoring
The Stages of Alcohol Recovery
The Facts about Alcohol - National Council on Alcohol & Drug Dependence
The Effects of Alcohol on the Body
How Much Alcohol is Safe
Ethyl-Glucuronide Urine Test - An introduction for patients J. K. Rotchford, M.D.

 

2D. Opioid Use Disorder

General Opioid Information J.K. Rotchford, M.D.
OPIDEMIC.HELP - This website leads you to links that explore the opioid abuse epidemic in the United States and provides new perspectives and insights. This is possibly the most comprehensive online resource currently available on the subject.
Probuphine - A game changer for opioid use disorders?! by Dr. Rotchford
What you need to know about Probuphine - A Patient's Guide
Probuphine - A medication guide for patients
Probuphine - Technical information, More than most patients want?!
Clinical Topics on Opioid Addiction - series of videos by Dr. Rotchford
American Society of Addiction Medicine's Guideline - This is the current consensus on Medication Assisted Treatment (MAT) of opioid use disorders.
The Role of Maintenance Treatment in Opiate Addiction - A scholarly review
Agonist Therapy (Buprenorphine & Methadone Therapy) J.K. Rotchford, M.D.
Long Term Agonist Therapy for Opiate Use Disorders - How long do I have to be on buprenorphine or other opiates? J.K. Rotchford, M.D.
Tapering off of buprenorphine and buprenorphine maintenance. Understandably, one often asks whether it is safe to taper off of buprenorphine. The link provides evidence for significant relapse rates in those with moderate to severe opioid use disorders who stop using buprenorphine. Note: Most of these studies simply use clean urines or treatment retention as indicators of successful outcomes. In other words they just monitor fairly gross indicators of disease activity and consequences. I believe that if more sensitive quality of life measures were looked at there would no longer be any question as to the long term benefits of ongoing agonist therapy - Whether patients with moderate-severe opioid use disorders can ever do best on an abstinence based program is lacking evidence. I think the odds are similar to an insulin dependent person being able to eventually get off of insulin and thrive. Perhaps, 5-10% can get by without agonist therapy but it remains whether their health is as good as it could be as with agonist therapy. Close long term monitoring is warranted. Abstinence in addiction is not by itself a favorable outcome. It is only because it often is a strong "surrogate" marker and a rather objective one at that. In most substance use disorders abstinence is highly associated with good outcomes. In the case of opioid use disorders this is not the case.
Recovery from Opiate Addictions - a time line
Buprenorphine Patient Syllabus - J.K. Rotchford, M.D. Includes basic handouts and forms to get started with using buprenorphine through OPAS and Dr. Rotchford.
A Complex Pain Patient who is Opiate Addicted - Published Case Report by J.K. Rotchford, M.D.
Formal Criteria for Making the Diagnosis of Opiate Addiction
Naltrexone to treat Opiate Addiction J.K. Rotchford, M.D.
The Facts about Naltrexone
Memo Regarding Specialized Care in Pain & Addiction through OPAS J.K. Rotchford. This handout has references and pertinent information regarding the Washington State Guidelines and how they pertain to proper pain management in patients with co-morbid opioid use disorders. It also provides suggestions on obtaining and promoting necessary specialized care in the fields of pain management of addictive disorders.
Toolkit for Preventing Opioid Overdoses - A good review and recently updated in 2016.

 

2E:  Marijuana/Cannabis Use Disorder

How to recover from Marijuana and other Addictions - A Quitter's Guide by J. K. Rotchford, M.D.

2F: Tobacco Use Disorder

Basic advice/support from OPAS - Even for those not interested in stopping smoking. by J.K. Rotchford, M.D.
Pros and Cons of Smoking Cessation - Designed for those ambivalent about stopping by J.K. Rotchford, M.D.
Package Plan for Smoking Cessation - Designed for patients of J.K. Rotchford, M.D.

  1. Acupuncture Related
    Acupuncture- A Brief Introduction - Dr. Rotchford
    Indications for Acupuncture- Dr. Rotchford
    Diet to Strengthen one's Center - Dr. Rotchford

 

  1. Brain and Central Nervous System (DNS) Health - General

Brain Health 101 by Dr. Rotchford - A good and relatively comprehensive menu to help assure good Brain Health.
Neuropathies Brief introduction by Dr. Rotchford with suggestions on how best to proceed.
Transcranial Magnetic Stimulation (TMS) 2019 by Dr. Rotchford. Please click on the link particularly if you have a mood disorder.


  1. POST TRAUMATIC STRESS DISORDER (PTSD) AND ANXIETY

Calming Trauma - How understanding the brain can help Dawn McClelland, PhD
PTSD - A Primer for Patients by J.K. Rotchford, M.D. 2016.
Dealing with the Effects of Trauma - This is a great resource for lists of behavioral ways to more effectively reduce anxiety and feel safer.
Ketamine and Low Dose therapy for Pain, Depression, PTSD, and... by J. K. Rotchford, M.D. 2015.
Anxiety - A discussion - By J.K. Rotchford, M.D. Using anxiety as an example, a very brief review of the role of diagnoses, scientific methodology, and cultural factors and how they influence our therapeutic options. 2016
4 Simple Things to do to Eliminate Anxiety - Amen Clinic

  1. GENERAL

Anger Appreciation - By J. K. Rotchford, M.D.
Anger issues in those with pain management or addiction concerns - by J. K. Rotchford, M.D.
ADD Questionnaire - OPAS
Advice for Adults with ADHD - ADD resources newsletter
Management of Adult ADHD with 50 Tips - Edward Hallowell, M.D.
The Blame Shame Game – J.K. Rotchford, M.D. 2020 in process.

Behavioral Change Plans - J. K. Rotchford, M.D. An introduction to the value of having a plan.
Discussion for patients with life threatening cancer by J. K. Rotchford, M.D.
Eating Disorders - This is a Nat. Inst. of Mental Health brochure dating from 2011. Another more recent one available online?
Gender and Pain Experiences Some references and discussion about the effects of hormones etc. on the pain experience.
Grief and Grieving - 2016 Discussion by J. K. Rotchford, M.D.
Osteoporosis and Osteopenia - 2019 by J. K. Rotchford, M.D.
Sleep and Tips for same - 2018 by J.K. Rotchford, M.D. et al.
Testosterone Replacement Discussion A referenced article from Life Extension 2016
Trust - Making it a Non-Issue - J.K. Rotchford, M.D.
You Can’t Always Get What You Want - J.K. Rotchford, M.D. 2017 with some minor edits in 2019


For other articles of possible interest please look at the bottom of Dr. Rotchford’s  Curriculum Vitae (Resume).

Location
J. Kimber Rotchford, MD
1233 Lawrence Street, Suite 102
Port Townsend, WA 98367
Phone: 360-385-4843
Fax: 360-379-1441
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360-385-4843