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.
– Brief Introduction
2. Addiction –
Substance Use Disorder
General Addiction Issues
Family and Al-Anon
Marijuana Abuse and Medical Marijuana
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:
2. Addiction Related:
General, Family & Al-Anon, Alcohol, Opiates, Marijuana, Tobacco
General Addiction issues
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.
Look Below under Pain Management for information regarding the use of buprenorphine and methadone in effective pain management.
Family and Alanon Related Issues
- 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.
- Technical information, More than most patients want?!
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.
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.
- Emergency Protocols for Opioid Overdose. Recovery for addicts. Help for families, friends. Support for medical responders.
3. Brain and Central Nervous System (DNS) Health - General
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.
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
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.
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.
5. POST TRAUMATIC STRESS DISORDER (PTSD) AND ANXIETY
- How understanding the brain can help Dawn McClelland, PhD
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
– 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.
- This is a Nat. Inst. of Mental Health brochure dating from 2011. Another more recent one available online?
T2 Mood Tracker
- Time to start tracking your mood..for better and for worse.
For other articles please look under the Resume
tab at the end for other articles and papers written by Dr. Rotchford.