All Posts tagged chronic pain

Meadows Edge’s Gretchen Anderson: Finding New Ways to Deliver Care

Gretchen Anderson

Gretchen Anderson is the clinical director of Continuum at Meadows Edge, and is passionate about finding new ways of reaching those who need care.

Gretchen’s first experience in healthcare was volunteer work in her home state of Minnesota. After doing her undergrad studies at the University of New Mexico, she worked in a residential facility for adolescents and debated between going into either nursing or social work.

She chose the latter, and obtained a Masters of Social Work from Highlands University in New Mexico. “I’ve always had a kind of nurturing sensibility and I like to problem solve, so this field was a natural fit for me.”

After relocating to Rhode Island, Gretchen worked at Butler Hospital for 11 years as a social services clinician, a position that provided important training for her current role. “My experiences at Butler made me a better clinician, but it also helped me to understand healthcare structures and the importance of making sure other clinicians have the support they need.”

She started at Meadows Edge in October 2016. As clinical director, she is responsible for ensuring that the Center is following state regulations and policies, improving care in current programs and looking at implementation of new programs, among many other things.

But unlike most clinical directors, Gretchen also keeps up with an assigned caseload of patients in addition to her administrative duties. “It keeps me grounded and focused on a day-to-day basis, and it helps me to think creatively about the different systems we need to develop to offer better services.” When seeing patients, she is very holistic in her approach to care, and tries to meet people where they are at, whether involvement with legal issues, family issues or personal issues.

The variety is an aspect of the position Gretchen greatly enjoys. “My duties can range from going outside and sweeping the front porch to triaging an acute patient situation.”

What does Gretchen feel sets Continuum at Meadows Edge apart? “The talented staff and the accessibility of appointments. We have doctors and a nurse prescriber that are available to meet with our patients, and we’re usually able to give someone an intake in the first 24 hours, which is not typically the case everywhere.”

Looking to the future of Meadows Edge, Gretchen is exploring the possibility expanding intensive outpatient hours to Saturdays and extending their successful pain program. “We have a long history of solid clinical expertise; my job is to look at better ways of delivering care and reducing the stigma surrounding substance use treatment.”

Outside of work, Gretchen likes outdoor activities and spending time with family.


Opioid Dependence: Addiction or Chronic Pain?

This article, written by Catherine Degood, DO, was originally posted in the Rhode Island Family Medicine Spring 2016 issue.


As primary care physicians when we encounter a patient requesting opioids for pain we ask ourselves, is this patient really benefiting from the medication or is there a larger problem? My goal is to help providers better understand the complex biopsychosocial nature of chronic pain.

Many of us will experience some degree of chronic pain as defined as pain lasting longer than 12 weeks by the NIH. It is not entirely known how acute pain develops into a more complex chronic pain syndrome. With acute pain there is an initial pain signal- whether visceral, somatic, or neuropathic- consistent with tissue damage. The central nervous system then interprets the pain signal to elicit a protective response. With repetition the pain signal can either be increased (sensitized) or be decreased (desensitized) by the individual’s central nervous system.   The increasing or decreasing of pain signals has a both an intrinsic component (think naturally occurring endorphins) and a behavioral component which can be learned (think Lamaze/hypnobirthing).

When working with chronic pain it is important to understand the interconnection of behaviors, emotions, medications and changes in activity level that patients experience as a reaction to their pain. These factors can all contribute to the sensitizing effect on the central nervous system and therefore the worsening of pain. We call this the chronic pain cycle:


Why does an individual’s pain system become sensitized or desensitized? While there are still many unknowns there are common psychosocial factors often associated with chronic pain: personality disorders, depression, anxiety disorders, somatoform disorders, substance use disorders and a history of growing up in family with substance, physical, emotional or sexual abuse. Other contributors can be chemical (for example opioid hyperalgesia), behavioral (belief systems or expectations about managing pain and stress), physical (deconditioning) and social (loss of income and resultant financial stress) which can all play a role in developing a chronic pain syndrome.

Maladaptive and illness-focused expectations frequently seen in patients with chronic pain include

  • Believing that medication is the only thing one can do for pain
  • Not recognizing the connection between emotion and pain
  • Feeling one has no control over their pain
  • Undergoing multiple procedures and tests looking for a cause and a “cure”
  • Feeling trapped in a sick role/seeing oneself as totally disabled because of pain
  • Feeling others are responsible for one’s pain and suffering
  • Fear that any movement will worsen pain

We may promote these unhelpful expectations in our primary care offices. Many of us feel inadequately trained and lack sufficient resources to manage chronic pain patients. The medical system has moved from the collaborative multidisciplinary pain clinics of the 1980s to the primary care physician directing the pharmaceutical and procedural treatments of today. But focusing only on biomedical and pharmacological management of pain disempowers patients and frequently worsens their chronic pain. This may be why they rarely seem to get better in our offices!   In addition to medication and procedural interventions, many patients require targeted behavioral interventions and a structured physical rehabilitation plan.

At Continuum Behavioral Health the most common pain scenario we see is an individual physically dependent on opioids who is significantly deconditioned and with a strong belief that opioid medications are the only thing they can do to improve their pain. We integrate a combination of Cognitive Behavioral Therapy, buprenorphine if needed, and encourage starting a gentle exercise program to develop pain management skills. Buprenorphine is a partial agonist at the opioid receptor with a favorable safety and side effect profile to the traditional full opioid agonists. The goals of treatment are improved physical and emotional functioning, increased effective strategies for managing pain, and reduced pain intensity.

If a patient has red flags for developing a more complex chronic pain issue consider referral to a behavioral based pain program. Even for the patient that refuses a referral there are many useful books, websites, physical therapists and individual counselors that can help people develop skills to manage their pain. For patients that you do prescribe narcotics utilize a pain contract that includes, as criteria for being prescribed medication, the patient’s involvement in efforts to manage their pain.

For more information or to refer a patient to Continuum for chronic pain feel free to call (401) 294-6170.