Handouts by Dr. Rotchford

Dr. Rotchford's Handouts are online and in print. Users, patients, families and friends find Dr. Rotchford's Handouts  helpful.

Dr. Rotchford’s Handouts

Note:  The following are for educational purposes only and are not for commercial use. If you are interested in distribution or commercial use please contact authors.

General Topics
1. Acupuncture – Brief Introduction
2. Addiction – Substance Use Disorder
     General Addiction Issues
     Family and Al-Anon
     Alcohol Abuse
     Opioid Abuse
     Marijuana Abuse and Medical Marijuana
     Tobacco Abuse
3. Health of Brain and Central Nervous System CNS
4. Pain Management 
5. Anxiety and Post Traumatic Stress Disorder PTSD
6. General Issues

1. Acupuncture Related:  
Acupuncture - A Brief Introduction  - Dr. Rotchford
2. Addiction Related: General, Family & Al-Anon, Alcohol, Opiates, Marijuana, Tobacco
General Addiction issues
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
Nutritional Issues  for Addictions by Dr. Rotchford
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. Charle's 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.  
Look Below under Pain Management for information regarding the use of buprenorphine and methadone in effective pain management.

Family and Alanon Related Issues
Help for Family Members   please see syllabus 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.
Alcohol Addiction
Personalized Disease monitoring  -  Progression monitoring
The Facts about Alcohol - National Council on Alcohol & Drug Dependence
Ethyl-Glucuronide Urine Test -  An introduction for patients J. K. Rotchford, M.D.

Opioid Addiction
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 -  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.
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.     
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.
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.
OPIOIDDOCS.COM -  Emergency Protocols for Opioid Overdose. Recovery for addicts. Help for families, friends. Support for medical responders.

Marijuana/Cannabis Addiction

Medical Cannabis
Medical Cannabis Syllabus  by J. K. Rotchford, M.D.
Currrent Washington State Law:  SECOND SUBSTITUTE SENATE BILL 5052
Marijuana Abuse - A Public Health Issue  -  J. K. Rotchford, M.D.

Tobacco Addiction
Basic advice/support from OPAS  - Even for those not interested in stopping smoking. by J.K. Rotchford, M.D.
Pros and Cons of Quitting Smoking  - A handout to help you in the "deciding process”

3. 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.

4. Pain Management Related
A Ted Talk by Dr. Krane titled  " Mystery of Chronic Pain " reviews the evidence for considering chronic non-cancerous pain a disease unto itself.
There are a number of online references.  Here are just a few 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 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 Pain Toolkit - online Free
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.
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.          
These 2 link are intended primarily for clinicians; however, 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 for pain as directed by a physician. Every attempt to diagnose the source of the pain is indicated and without a clear source of 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 should be provided options for pain management that do not involve opiates or other controlled substances whenever it is possible or reasonable. The following is a link to a slide presentation intended for clinicians about the use of buprenorphine in pain management:  The Role of Buprenorphine in Pain Management  by Gregory Rudolf, M.D.
Specific for Migraines & Headaches in General
Dr. Ready's Slide Set :   Dr. Ready is currently my "Guru" when it comes to headache management.  At the 2016 he gave a presentation which not only entertaining was so very informative.  I'm please to be able to provide a link to his slide set for managing intractable headaches.

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.
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
A Patient Asks Dr. Rotchford what to do about 

Anger Appreciation  - By J. K. Rotchford, M.D.
Advice for Adults with ADHD  - ADD resources newsletter
Breath2Relax – an outstanding application (APP) developed by the U.S. government to help soldiers manage their stress through deep breathing.  Diaphragmatic breathing exercises have been proven improve resilience and decrease the body's 'fight-or-flight' (stress) response.  
Management of Adult ADHD with 50 tips  - Edward Hallowell, M.D.
Behavioral Change Plans  -  J. K. Rotchford, M.D. An introduction to the value of having a plan.
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.
Testosterone Replacement Discussion  A referenced article from Life Extension 2016
T2 Mood Tracker -  Time to start tracking your mood..for better and for worse.
Trust -  Making it a Non-Issue  - By Dr. Rotchford.
For other articles please look under the Resume tab at the end for other articles and papers written by Dr. Rotchford.
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