Prescription opioids are sometimes used to treat moderate-to-severe pain. Because prescription opioids have a number of serious side effects, it is important for you to ask questions and learn more about the benefits and risks of opioids. Make sure youre getting care that is safe, effective, and right for you. This article provides information about nonopioid alternative treatments to manage pain. You and your healthcare practitioner can develop a course of treatment that uses multiple methods and modalities, including prescription medications such as opioids, and discuss the advantages and disadvantages of each approach. Pain management requires attention to biological, psychological, and environmental factors. Before deciding with your healthcare practitioner about how to treat your pain, you should consider options so that your treatment provides the greatest benefit with the lowest risk.Treatments provided by Licensed Healthcare ProvidersPhysical therapy (PT) and occupational therapy (OT). PT helps to increase flexibility and range of motion which can provide pain relief. PT can also restore or maintain your ability to move and walk. OT helps improve your ability to perform activities of daily living, such as dressing, bathing, and eating. Massage therapy. Therapeutic massage may relieve pain by relaxing painful muscles, tendons, and joints; relieving stress and anxiety; and possibly impeding pain messages to and from the brain. Acupuncture. Acupuncture is based on traditional Chinese medical concepts and modern medical techniques and provides pain relief with no side-effects by stimulating the bodys pain-relieving endorphins. Techniques may include inserting extremely fine needles into the skin at specific points on the body. Chiropractic care. Chiropractic physicians treat and rehabilitate pain, diseases and conditions using manual, mechanical, electrical, natural methods, physical therapy, nutrition and acupuncture.  Chiropractors practice a hands-on, prescription drug-free approach to health care that includes patient examination, diagnosis and treatment. Osteopathic Manipulative Treatment (OMT). Osteopathic physicians (DO) are educated, trained, and licensed physicians, but also receive additional training in OMT. OMT is a set of hands-on techniques used by osteopathic physicians to diagnose, treat, and prevent illness or injury. OMT is often used to treat pain but can also be used to promote healing, increase overall mobility, and treat other health problems. Behavioral interventions. Mental health professionals can offer many avenues for pain relief and management. For example, they can help you reframe negative thinking patterns about your pain that may be interfering with your ability to function well in life, work, and relationships. Behavioral interventions can allow you to better manage your pain by changing behavior patterns. Topical treatments and medications. Topical Agents, including Anesthetics, NSAIDs, Muscle Relaxers, and Neuropathic Agents, can be applied directly to the affected areas to provide needed pain relief and typically have a minimal risk of side-effects due to low absorption of the medication into the blood stream. Compounded topicals prepared by a pharmacist can be customized to the patients specific needs. Interventional pain management. Interventional procedures might include an injection of an anesthetic medicine or steroid around nerves, tendons, joints or muscles; spinal cord stimulation; insertion of a drug delivery system; or a procedure to stop a nerve from working for a long period of time. Non-opioid anesthesia. Non-opioid anesthesia. Non-opioid anesthesia refers to the anesthetic technique of using medications to provide anesthesia and post-operative pain relief in a way that does not require opioids. Anesthesiologists can replace opioids with other medications selected for their ability to block surgical and post-surgical pain. By replacing opioids and incorporating the variety of anesthetic and analgesic medications that block the process of pain, anesthesia providers can provide a safer anesthetic that avoids the adverse effects of opioids. Discuss these alternatives with your healthcare practitioner and talk about the advantages and disadvantages of the specific options being considered. Different approaches work better on different types of pain. Some treatments for pain can have undesirable side effects while others may provide benefits beyond pain relief. Depending on your insurance coverage, some options may not be covered, resulting in substantial out-of-pocket costs. Other options may require a significant time commitment due to the number of treatments or the time required for the treatment. Good communication between you and your healthcare practitioner is essential in building the best pain management plan for you. Information on Nonopioid Alternatives for the Treatment of Pain When you are selecting a healthcare practitioner, you can verify their license and find more information at: https://appsmqa.doh.state.fl.us/MQASearchServices/ Home You can find more information at these links. National Institutes of Health: https://nccih.nih.gov/health/pain/chronic.htm Centers for Disease Control and Prevention:  https://www.cdc.gov/drugoverdose/

Take Time to Grieve Avow provides guidance and support to families, relatives, friends and professional caregivers experiencing the loss through death of a significant relationship. Trained and experienced bereavement staff offer free programs to residents and visitors to the Collier County area. Understanding the ProcessUnderstanding the Process Loss through death can be one of lifes most difficult emotional challenges. Feelings may range from extreme loneliness and lack of energy to anxious activity, confusion and various physical symptoms. Few of us know what to expect and what to do. The grieving process may include some or all of the following: Shock and denial. Because of our own natural defense mechanisms, the announcement that a death has occurred is often shocking. It may take time for the reality of the tragedy to become clear. A sense of the unreality of death may recur throughout the grief process. Panic. When we lose a significant relationship, our emotional stability is disrupted and we may feel out of control. Preoccupation with the loss may cause us to question what our next actions will be or to feel panicky. Guilt. It is natural for us to have wanted everything done to save the person who has died. As we wonder what else might have been done, we may feel guilty. Anger. A need to find someone to blame for the loss is common. A feeling of hostility toward physicians, nurses, family members and God may develop. Loneliness. Bereavement can result in a feeling of emptiness and aloneness. When family and friends leave after the funeral, an even greater isolation may be experienced. Page 1Page Sleep, appetite and physical changes. Any combination of increased or decreased sleeping and eating may occur. A feeling of being tired, weak or hollow may also be experienced. Resistance to illness is low, making diet, rest, activity and expression very important. Readjustment. Eventually, the loss diminishes and reinvestment in life occurs. Allowing time to feel all normal feelings of grief and to express that grief helps the bereaved person become ready to live a new life and make plans for the future. Feelings    Sadness    Anger    Guilt    Anxiety    Loneliness    Fatigue    Helplessness    Shock    Yearning    Emancipation Physical    Relief    Numbness    Hollowness in stomach    Tightness in chest or throat    Sense of depersonalization (nothings seems real)    Breathlessness    Weakness    Lack of energy    Dry mouth 2 Symptoms of Grief Cognitive    Disbelief    Confusion    Preoccupation    Sense of presence    Visions/hallucinations Behavioral    Sleep disturbance    Appetite disturbance    Absent-mindedness    Social withdrawal    Dreams of the deceased    Avoidance of reminders    Searching, calling out    Restless over-activity    Crying    Visiting places or carrying     objects as reminders    Treasuring objects of the  deceased Page Things You Might Experience You can expect that your grief will probably:   Take much longer than most people think it will/should.   Take more energy than you ever would have imagined.   Involve many changes and be continually developing.   Show itself in all spheres of your life: psychological, social and physical.   Entail mourning not only for the actual person you have lost but also for all the hopes, dreams and unfulfilled expectations you held for that person, and for the needs that will go unmet because of the death.   Involve a wide variety of feelings and reactions, not solely those that are generally thought of as grief, such as depression and sadness. You may have some identity confusion as a result of this major loss and of the reactions you are experiencing that may be quite different for you. You may:   Grieve for many things both symbolic and tangible, not just the death alone.   Have a combination of anger and depression, such as irritability, frustration, annoyance, or intolerance.   Feel some anger and guilt, or at least some manifestation of these emotions.   Lack self esteem.   Experience grief spasms: acute upsurges of grief that occur suddenly with no warning.   Have trouble thinking and making decisions.   Feel as if you are going crazy.   Find yourself having a number of physical reactions.   Find that there are certain dates, events, stimuli or even experiences that bring upsurges of grief.   Begin a search for meaning and question your religion and/or philosophy of life. Society may:     Have unrealistic expectations about your mourning and may respond inappropriately to you. 3Page Is There a Right Way to Grieve? This is a normal question. Each person has his or her own way and pace, but there are common reactions people seem to have. The following are natural responses to grieving loss. 4    Am I doing this right?     How should I feel?    I seem to have no control.    Im so relieved its over.    I hurt so much I ache.    Its as if Im on the outside looking    on as the world goes by.    I cant concentrate and Im     absentminded.    This cant be real.    My throat feels tight.    My chest feels heavy.    What do I have to live for?    Sometimes I get so angry.    I cry at unexpected times.    I dont want to be around others.    I dont want people seeing me     when Im sad.    What am I going to do?    Im not hungry anymore.    I seem to be eating all of the time.    I sometimes feel or hear the     presence of him/her.    I feel so empty.    I dont like making decisions alone.    I feel numb.    Im so lonely. Page Keys to Grief Release Expression take the time to be purposeful    Writing    Drawing    Artistry    Talking    Rituals    Memory box    Shrine    Plant a tree in memory of    Donation in memory of    Memorial service on special date    Wear black, mourning jewelry, armband    Hang a wreath    Sobbing (use a towel)    Humor and laughter Reminiscing and relationship examination Redefinition    Of self    Of roles    Of terms    Strength as courage not stoicism     Sobbing as courageous not falling apart Reading Seeking others support Belief examination Meditation/Prayer/Affirmations Giving self permission Balancing    Wallowing with staying busy    Expression with withdrawal    Solitude with social    Relief with sorrow    Reminiscing with planning the futureSteps to Survival 1. Recognize the loss.  For awhile, you are numb. It has happened - try not to avoid it. 2. Be with the pain.  Youre hurting. Admit it. To feel pain after loss is normal. It is proof that you are alive; proof that you are able to respond. 3. You are not alone.  Loss is part of life. Everyone experiences it. 4. Youre a beautiful, worthwhile person.  You are much more than the emotional wound you are presently feeling. 5. You will survive.  Believe that you will heal. 6. Give yourself time to heal.  The greater the loss, the more time it will take. 7. Healing has progressions and regressions.  Healing and growth are not smooth upward progressions, but are full of ups and downs - dramatic leaps and depressing backslides. 8. Tomorrow will come.  Your life has been full of positive experiences. They will return. 9. Take good care of yourself.  Get plenty of rest. Stick to a schedule. Plan your days. Activity will give you a sense of order. 10. Keep decision-making to a minimum.  Expect your judgment to be clouded for awhile. You are going through change; dont make more decisions than you have to. 11. Seek comfort from others.  Its human and courageous. 12. Surround yourself with living things.  A new plant, a pet, a bowl of fresh fruit. Reaffirm your beliefs.  Use your faith right now. Explore it, lean on it, grow. 14. Recognize that weekends and holidays are the worst. Schedule activities you particularly enjoy. 15. Suicidal thoughts: these may arise - they are a symptom of pain. If you feel that they are getting out of control, seek professional help. 16. Do your mourning now. Allow yourself to be with your pain. It will pass sooner. Postponed grief can return to hound you. Grief feelings will be expressed one way or another. 17. Be gentle with yourself. You have suffered a disabling emotional wound. Treat yourself with care. 18. Let yourself heal completely. Give yourself time. You are a convalescent right now. Dont jump into new things too quickly. 19. If mementos are helpful to you, use them. If they bind you to a dead past, however, get rid of them. Before you say hello, you must say goodbye. 20. Anticipate a positive outcome. Pain is acceptable - it tells us we are hurting. But it is not a welcome long-term visitor. 21. It is OK to feel depressed. Crying is cleansing - a wonderful release. Be with these feelings for awhile. 22. Its OK to feel anger. Everyone acts angry at the loss of love. Channel it wisely and it will go away as you heal. Hit a pillow. Kick a bed. Yell and scream when youre alone. Run. Play hard games. Hit a punching bag. Play the piano. 23. Good eating habits help the healing process. Make sure you are nourished. 24. Youre vulnerable. Your resistance will be low. Invite help only from those who are trustworthy. Beware of the rebound. Theres a hole in your life. Be careful about rushing to fill it. 26. Beware of addictive activities. Alcohol, drugs, food, and diversions can all momentarily help us escape from pain. These never help us to heal. 27. Set a time limit on mourning. Remaining distraught for a long time is no proof that youre really loved. Real love is self-supporting. 28. Keep a journal. Putting your thoughts and feelings on paper is a good way to get them out. You can also refer back and see just how far you have come. 29. Heal at your own pace. Never compare yourself to another grieving person. Each of us has our own time clock. 30. You will grow. As you work through your sadness, you will grow. You may begin to understand that change and separation are a natural part of living. You are a better person for having loved. 31. Begin to look to the future. Begin to experiment with new lifestyles - new ways of filling the day. They might even turn out to be fun. 32. Give yourself praise. You are a richer, deeper, wiser person for having survived your grief. 33. Be open. Be open to new people, places, ideas, and experiences, but dont forget to build on the past. Dont throw out what has been worthwhile to you. Small changes are the best at first. 34. Begin to give of yourself. Giving can bring you the greatest joy. It is healing. 10 Grief Journal Today I felt so lonely. After allowing myself to cry, I called a friend. Now I feel less alone. Steps to Survival, continued...Page Grief Work Grief work begins when the honeymoon period is over, the friends have stopped calling, and everyone thinks you should be over it; things are supposed to be back to normal. Its at this point that real grieving begins. One common definition of grief work is summarized by the acronym T.E.A.R.: T =   To accept the reality of the loss. E  =   Experience the pain of the loss. A   =   Adjust to the new environment without your loved one. R   =   Reinvest in a new reality. Grief is Not an Enemy Grief is not an enemy it is a friend. It is a natural process of walking through hurt and growing because of the walk. Let it happen. Stand up tall to your friends and to yourself and say, Dont take my grief away from me. I deserve it, and I am going to have it. Doug Manning 11 35. Expect relapses. There will always be certain things that trigger sadness again. This is normal. 36. Alone does not mean lonely. Solitude can be creative, restful, and even fun. You can learn to enjoy it. 37. Enjoy your freedom. You are now in control. Make the most of your choices. You can even learn to take risks. 38. Celebrate your survival! LOSS = PAIN = GROWTH

Chances are you have heard that many older charitably minded people can benefit from making gifts directly from their individual retirement accounts (IRAs). Technically known as a qualified charitable distribution (QCD), this strategy is often informally referred to as an IRA charitable rollover.The primary benefits of an IRA charitable rollover are familiar to many. If a donor has reached the age of 70, he or she can make a gift from an IRA directly to a charitable organization without the amount of the distribution being treated as taxable income to the donoreffectively making the distribution a deductible gift. Furthermore, if the donor has reached the age at which he or she must take a required minimum distribution (RMD) from qualified retirement plans, a gift directly from an IRA reduces the amount of the RMD that otherwise would be taxable income on a dollar-for-dollar basis up to a maximum of $100,000 per taxpayer per year.These benefits have proved to be the headline grabbers, and rightfully so. There are, though, additional, often overlooked, benefits of IRA rollovers. Among those is the ability of a QCD to help many donors avoid additional tax on their Social Security benefits. Heres why: Up to 85% of Social Security benefits can be taxable, and the portion that is taxable is determined by the amount of other income the taxpayer has.A distribution from a retirement plan to a taxpayer is generally taxable and gets added to other income in determining how much of the taxpayers Social Security benefits gets taxed. Unless the recipient is already subject to the 85% maximum, more of the recipients Social Security benefits will be subject to taxeven if the recipient uses the distribution to make a charitable gift.A QCD, however, goes directly to the charitable organization without being considered distributed to the taxpayer and, therefore, does not increase the portion of Social Security benefits that are taxable. If you are intending to make charitable gifts and are old enough to make qualified charitable distributions, you will likely be well served by using QCDs to fund your philanthropic goals. Check with your financial advisor to determine your eligibility to make a QCD.