…Where seldom is heard a discouraging word

by Dee Emmerson, TCC Writer

The old ballad, “Home, Home on the Range” paints a picture of buffalo, deer and antelope roaming under never-cloudy skies-an idealistic view that omitted any mention of human interaction. The recurring theme did, however, allude to something we get from people or give away generously: discouragement.

If you live with complicated pain, you’re personally familiar with being downhearted about your situation. Maybe you’ve become more discouraged when you felt your needs were not respected or when someone told you there were no more solutions.

If we could create the perfect world of chronic pain that can’t be eliminated, it might include a battalion of encouragers-friends who provide support and assistance, caregivers that add a caveat to “no more solutions”-but we’re going to keep you in mind as medical techniques advance, those who say thank you or I’m thinking about you, and individuals who recognize our strengths and remind us of them (because what we’re good at is often eclipsed by our pain).

And where, you might ask, do we gather such an army?

1. Encourage encouragement. What we give to others is often returned. We can thank others, offer assistance, give positive feedback and acknowledge their strengths. The power of one person can start a movement.

2. Choose friends. We probably think of friendship as a natural progression from acquaintance to best friend, but making thoughtful choices when it comes to friendships can mean the difference between our own ascent or descent- inspired or bored, boosted or diminished, talents in action or dormant, reassurance or despair.

3. Respect resources. Do we take our time for granted? Our bodies? Our relationships? Those hours scanning social media outlets when we could be enjoying a live-person conversation are never recovered. While we don’t choose our family members, they can be the closest allies we have. Peace talks have a much higher success rate than wars. Our body and mind are the most trustworthy investments available; what we put in we get out: nutrition produces a sharp mind and immune system, aerobic movement strengthens heart and muscles, stretching/strengthening results in good posture and efficient blood/air flow.

4. Be what you want. I once listened to a radio program caller describe how her Grandmother had failed to be a good grandmother-example after example of what she did or didn’t do-and how it was the source of everything in the caller’s life that didn’t work. The doctor on the helping end was having none of it. “So, you can’t be who you want to be because your Grandmother isn’t who you think she should be?” This stopped the caller’s tirade for a moment, so the doctor went on to explain that not being who she wanted to be because her grandmother wasn’t who she was supposed to be could be remedied. “How?” the caller wanted to know. “Be your own Grandma,” the doctor said matter-of-factly. The next few minutes he helped her translate all the bad behavior and neglect into actions she could take to be a “better Grandmother” to herself. For those of us who are discouraged by others’ deeds and words, this story might help us create our own solutions.

RELATED: Five Ways to Improve Your Self-Efficacy

An army of encouragers-what a positive impact on our world of pain! Not sympathy, but encouragement. Reassurance of our personal strengths, support to build on our values, and empathy that envisions growth. What can we do today to reset our focus from being fixed to becoming our own agent of change.

If you live with pain, a Coach can help you discover strategies to manage or reduce your pain. Or, Coaching may be the perfect avocation for you to help others. TCC®U trains coaches and prepares students for national certification.

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Politicians, pharmaceutical companies, physicians, patients, attorneys, law enforcement and the common citizen have all weighed in on the public health emergency we know as the opioid crisis. Yet one demographic with significant input into this issue has received little or no mention in the discourse of chronic pain patients and opioids: the 65 million and growing population of family caregivers.

Serving as a caregiver for my wife for more than 30 years, I’ve handled enough opioids that their street value easily runs into the millions. A car accident in college left her severely disabled with massive orthopedic trauma, eventually costing her both legs. The number of major surgeries she’s endured has soared to at least 78, and she’s undergone twice that number of smaller procedures such as nerve blocks, infusions, etc.

The amount of pain my wife lives with is staggering, and she’s done it since Reagan’s first administration. Managing the pain continues to be a moving target for her, as well as the physicians who’ve treated her. She is currently working with her fourth pain specialist. A few of her doctors throughout the years overshot the mark and prescribed massive and dangerous amounts of opioids, sometimes resulting in seizures and even respiratory arrest. For most of those frightening events, I was the only one present to assist her and call for help.

As the government tackles America’s opioid crisis, one of the challenges will be ensuring appropriate access for patients requiring these medications while also providing better insight, guidelines and engagement to prescribing physicians.

An additional yet unaddressed challenge remains the involvement of family caregivers. I regularly engage with pharmacists, physicians, nurses, hospital staff and a patient with significant health issues as I act on behalf of my wife. I alone know her complete patient history, which covers more than 80 physicians in 12 hospitals. On any given day, I, like millions of my fellow family caregivers across America, regularly perform tasks normally handled by trained medical staff. None of us has attended “Caregiver University,” and we struggle daily to wrap our arms around an often-impossible set of circumstances, many of which regularly involve opioids.

When writing the countless prescriptions handed to me on my wife’s behalf, not one physician, physician assistant or nurse has ever taken seconds to say to me, “Hey, she’s got chronic pain issues, and is taking a significant amount of medication for an unforeseeable amount of time. You might want to seek some counseling and/or support groups for yourself through this journey.”

Chronic pain is a family issue. It affects all significant (and a few insignificant) relationships of the person in pain. Treating someone in chronic pain is also a family issue. When opioids are introduced or removed, the patient is better served when the family caregiver possesses the necessary resources to care for their own emotional well-being through what will inevitably be a rocky journey.

RELATED: Caregiving and Laughter

The challenge of helping individuals with severe pain often leads physicians to overextend the dosage or, due to fear of over-prescribing, provide too little. Either way, significant attention is required on the caregiver’s part to better understand what these drugs will do to their loved one. Behavior changes, mood swings, erratic actions and dependency can erupt at blinding speed. The voice of the patient can easily be muffled by the receptors’ demand, created by long-term opioid use. When that happens, it’s far too easy for caregivers to step into the role of enabler. Counseling, support groups and other means of education equip caregivers to better understand this journey and not fall into traps that lead to narcotics abuse or jeopardize their loved ones’ health.

All caregivers suffer from the “three I’s”: We lose our independence, we lose our identity and we become isolated. In that isolation, caregivers not only lose themselves but can easily journey down a path of bad decisions. If, while caring for someone who regularly takes opioids, the caregiver suffers from back pains from constant lifting, what stops the caregiver from helping themselves to something that will make them feel better? These are not rare events. The scenarios extend into the horizon, and with the massive population of aging Baby Boomers, the frequency and challenges will only increase.

Opioids provide a necessary function for many people in chronic pain, and special care should be extended to help provide a safer and better quality of life for these individuals. The person picking up those medications at the pharmacy, helping organize the meds and providing transportation back and forth to the physician’s office also deserves a safer and better quality of life.

I encourage prescribing physicians to take an extra couple of minutes to offer guidance, support and resources to the weary soul pushing the wheelchair or standing in the exam room corner. It can prevent more heartbreak than they will ever know. Addressing the challenges and pitfalls while educating caregivers about the impact of opioids on their own lives shines light on the path toward healthiness; healthy caregivers make better caregivers.

Peter Rosenberger is a 30-year caregiver, radio host, author, speaker and advocate for caregivers. He hosts a weekly radio show on the topic, syndicated nationally and broadcasted worldwide. Rosenberger is the author of Hope for the Caregiver (2015) and Seven Caregiver Landmines and How You Can Avoid Them (2016).

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Spring 2017

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A new peripheral nerve stimulation system is providing long-lasting pain relief for patients with phantom limb pain.

On May 4, 2014, David Nipple was riding his motorcycle near his former home in Franklin, Tennessee, when the intoxicated driver of a Chevrolet Tahoe crossed into his lane and hit him. Nipple’s left leg was severed above his knee at the scene. He was taken to a Nashville hospital for acute care, although medical workers didn’t think he’d make it. Fortunately, he survived; however, Nipple’s new life was marked by excruciating phantom limb pain.

“It felt like my leg was reliving the accident,” he says. “I felt tons of pressure pushing my left foot to the right, and the femur being pushed to the left, just as it happened during the accident.”

Nipple says at that time his pain level was at a 10. It was so bad that he sometimes couldn’t sleep-for days. He found most pain medications ineffective and was reluctant to take them anyway. He assumed he would have to live with the pain.

Then one day, nearly a year after his accident, Nipple came across a Facebook post about a clinical trial for those suffering from phantom limb pain. Curious, he filled out the application and was accepted into the trial. Thankfully, he went on to experience significant pain relief as a result.

A New Method of Nerve Stimulation

The clinical trial Nipple participated in was for SPRINT PNS, a peripheral nerve stimulation system. Unlike spinal cord stimulators, which stimulate centrally at the spine, the SPRINT system focuses on peripheral nerves, where it is able to have a greater impact on nearby sources of pain.

“We’re doing something a little different in targeting the peripheral nerves in the area causing the pain,” says Maria Bennett, president, CEO and founder of SPRINT’s creator, SPR Therapeutics. “The spinal cord stimulators work more centrally, which often means patients with phantom limb pain are going to receive less relief.”

Until the introduction of peripheral nerve stimulators, the only option for locally applying nerve stimulation was through the adaptation of spinal cord stimulator leads, says Christopher Gilmore, MD, one of the physicians involved in the SPRINT clinical trial. This method posed problems, however.

“Ergonomically, the spinal cord stimulator leads aren’t designed to be used there, so we received suboptimal results,” he says. “But now, with a device like SPRINT, we have a much more ergonomic and specific therapy for peripheral stimulation, and I think that dedication to the periphery is what is allowing us to see long-term results with these devices.”

Bennett explains that SPRINT does not require a permanent implant, but rather is applied through a thread-like wire that is pre-loaded into a needle. The needle introducer goes through the skin and deploys the wire in proximity to the target nerve that’s causing the pain, and the needle is then removed. A portion of the wire stays inside the body, and a portion of it exits the body and is connected to an external stimulator that’s worn on the skin. After that, patients go home with the system. The doctor can program three different modes for them to use within their therapeutic range-low, medium or high.

Patients with phantom limb pain who have participated in the trial have seen significant improvements in their pain. Nipple, who was treated by Dr. Gilmore during the trial, says his pain went from a 10 to a 2.

“In a case just recently, one of our team members saw a woman who had had amputation pain for decades, and it was the first time in decades she experienced relief from pain,” says Bennett.

According to Bennett, this system can address both phantom limb pain and residual limb pain. “We have done a significant amount of research in lower extremity amputees, folks who have had amputation below the knee,” she says. “Traditional systems have had some success in residual limb pain, but it’s been very difficult to have any sort of relief in phantom limb pain. SPRINT is a device that treats both.”

While SPRINT’s main advantage is targeted pain relief, it does have other benefits. Unlike spinal cord stimulators, which require permanent implantation, this system is inserted subcutaneously and is removed after approximately 60 days of use.

“This therapy doesn’t require anything to be permanently implanted,” says Dr. Gilmore. “That means patients don’t have to fully commit to a permanently implanted device.”

Despite the short-term use of the device, the SPRINT system has shown long-lasting outcomes. “The results of the study demonstrate that the pain relief far outlasts the duration of the temporary implant,” says Dr. Gilmore. “The patients not only realized significant pain relief when the system was on, but there was also a carryover of sustained pain relief that occurred after the device was removed.”

Dr. Gilmore points out that the patients he treated during the trial ranged from those who had undergone previous interventions that had failed to those who had only been exposed to conventional medical management. He says he has seen the long-term pain relief in patients last for many months-and even years, in some cases.

“Patients report significant pain relief, but pain can be subjective,” says Bennett. “So the most compelling data has been related to how the device has impacted patients’ quality of life.”

Bennett says it has also been important to evaluate how the system affects patients’ abilities to wear prosthetics without any pain. “The SPRINT System is designed to be used early after amputation, in an attempt to help patients be active earlier and adapt faster to prosthetics,” she says.

The Veterans Administration in Richmond, Virginia, initiated a study on the SPRINT device in acute amputee pain immediately following amputation and has started using the device for those undergoing amputations.

“Earlier intervention is always better-especially earlier in the pain cycle,” says Bennett. “If you can use it earlier, there’s a greater likelihood of having that carryover effect.”

Nipple received treatment with the SPRINT device in 2015, before he received his prosthetic. And now, about two years following his treatment, he’s still experiencing reduced pain. “My pain level has remained where it was when it dropped during the treatment,” he says. “I’ve been impressed. I’ve had a couple of experiences where the pain came back, but it didn’t last. I’ve got no complaints.”

Patients can undergo a second treatment period with the device if their pain returns.

The large majority of patients in the studies have had favorable responses, but due to each patient’s individual pathology and anatomy, it can be difficult to predict a patient’s outcome. Both Bennett and Dr. Gilmore point out that the temporary nature of the device makes it less risky for a patient to try. Because it’s a short-term treatment-and less expensive and invasive than a spinal cord stimulator-it doesn’t require as costly or permanent a commitment.

SPR Therapeutics received FDA approval for the device last year and is now engaged in a limited launch of the device.

In addition to phantom limb pain, SPRINT has also been used to manage lower back pain, post-stroke shoulder pain, peripheral neuropathic pain and pain following knee-replacement surgery.

“There are patients who didn’t think they could be helped who are now getting back to normal lives,” says Bennett.

“With the pain that hit me before the therapy, I didn’t want to do anything, ” Nipple says. “Sometimes I would just sit there crying. But now that’s changed. I can get out. I sleep better. I can enjoy my life more since I’m not in agony over phantom pain. I ride a Spider now (a three-wheeled motorcycle)-I have 23,000 miles on it and rode it all the way to Wisconsin. If I were still having the phantom pain issues, there’s no way I could’ve done that. I’m able to live my life again.”

If you suffer from Phantom Limb Pain and want to learn more about treatment options, contact us at 336-765-6181.

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Many people with pain are so overwhelmed that they can’t function well- physically, emotionally and/or cognitively. A major contributing factor to this “meltdown” is a hyperaroused nervous system, which manifests as feelings of anxiety and stress. If it were possible to look at the nervous system of almost anyone suffering from chronic pain, you would see that it’s all revved up and unable to rest. There’s a torrent of chatter flying between the amygdala, the hippocampus, the insular cortex and other parts of the brain. Mental and emotional alarm bells are ringing louder and more often than they should, and the parts of the brain that should say “shhh” and calm things down aren’t doing the job very well.

In a healthy body, there’s a system of checks and balances, with some brain structures amplifying sensations/emotions, and others quieting them. The system is flexible, allowing for sudden increases in physical and/or emotional demands and easing back to calm.

But when you’re in chronic pain, the brain is thrown into panic mode and overwhelmed, struggling to manage pain until the body’s system calms down. So examining stress-the experience of it, the way your mind and body respond to what is happening-is an important aspect of how to control chronic pain.

The Need to Recalibrate

Stress triggers at least two bodily systems: the nervous system and the endocrine system. These two physiologic systems, in turn, trigger the body’s immune system.

The autonomic nervous system (which controls heartbeat, body temperature and digestion) is divided into two branches: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). These branches are opposites in that one revs things up, while the other calms them down. However, because chronic pain is a stressful experience, people can become trapped in a nearly perpetual state of fight-or-flight. Caught in the storm, they cannot be calmed.

The Stressed-Out “Pain Brain”

The stress felt by chronic pain patients may be directly related to the physical pain. But emotional stress is almost always present as well, due to frustrations, fears and the difficulties associated with constant pain. And when a healthy brain is physically altered and becomes a “pain brain,” thinking may prove difficult, increasing mental stress.

Inside the stressed-out pain patient, the amygdala is hyper-stimulated and sees bad news everywhere, part of the reason that people in pain can find themselves awash in negative emotions like anger, fear and depression.

Normally, other areas of the brain, like the anterior cingulate cortex (ACC), help restrain the amygdala, making sure that your emotions don’t run away with you. Unfortunately, the changes that produce the “pain brain” interfere with the ACC’s ability to regulate the amygdala, so negative feelings can flow unrestrained.

Further triggering the troubled amygdala is the insular cortex (IC). The IC, another key processor of pain information, eggs on the amygdala even more, increasing and perpetuating feelings of fear.

Making matters worse, the stress of chronic pain hammers the hippocampus, the portion of the brain that helps regulate learning and memory. When chronic pain upsets the hippocampus, it can make learning new things difficult, or even impact memory.

These physical changes have been studied using brain-imaging techniques that track the parts of the brain that light up when subjects engage in various tasks. It is clear that physical changes to the brain make it difficult for those in chronic pain to control their emotions, make decisions, focus, reason things through and much more.

How to Control Chronic Pain by Finding the Calm

Calming the storm of the stressed “pain brain” is critical to effective pain management. The more techniques you learn, the more empowered you will be. Here’s a brief look at each; you can read the entire chapter in Conquer Your Chronic Pain: A Life-Changing Drug-Free Approach for Relief, Recovery, and Restoration for more info.

1. STILL MEDITATION

Meditation calms the brain and decreases anxiety, depression and other destructive feelings that contribute to hyper-arousal and amplify pain.

Get comfy on a chair or floor, close your eyes, take a deep breath and slowly exhale. Focus on the present moment. The idea is to give your mind a rest from its daily patterns of thinking, analyzing, remembering and planning and to minimize the anxiety, anger, depression and other feelings that contribute to your pain. Focus on something else, something mundane so your mind won’t be too busy but engaged enough to block your regular thinking patterns. Most people focus on breathing. As you become more comfortable with the process, try to meditate for longer periods, and perhaps add an extra session at another time during the day to help you “unplug” or get through a rough moment.

Meditation can help control fear. Listen to your body. When in pain, notice how fast your heart is beating. How’s your breathing? Try a few minutes of meditation to slow your heart rate and breathing.

2. ACTIVE MEDITATION

Active meditation means meditating while engaging in some type of physical movement. Done in conjunction with the right kind of activity in the right environment, active meditation can do much to quiet a hyper-aroused, stressed-out nervous system.

A classic example of active meditation is walking. Focusing on the act of walking, just like focusing on your breath, will help you clear away the distractions, reduce negative thinking and calm your mind. Be mindful of how each body part feels, and how all parts contribute to the movement.

Even without meditation, walking can help improve your psychological and physical states. Consider your outdoor time as therapeutic.

3. BREATHING EXERCISES

Your breath is one of the best tools for managing stress and pain; there is no medicine or surgery more effective at “calming the storm” than proper breathing. Slow, rhythmic breathing soothes. The physical rhythms of the diaphragm moving up and down and the lungs expanding and contracting, along with the audible whisper of air flowing in and out of your nose, can be the calming “music” that gets you through the storm.

Listen to your breath as you inhale and exhale at a leisurely pace … one, two, five, even ten times at a stretch. This simple breathing exercise will do much to calm your nervous system.

Remember that you can consciously control the quality and length of your breath to calm life’s storms.

Here are a few types of breathing exercises:

Diaphragmatic Breathing

The goal here is to relax the belly when you inhale. Lie flat, relax your abdomen and slowly inhale, allowing your belly to expand. Then, allow your belly to fall slowly as you exhale. If you tense your abdomen for a few breathing cycles, then relax it for a few, you’ll notice how much easier it is to breathe when it’s relaxed and your diaphragm does the “breathing work” for you. Diaphragmatic breathing maximizes the amount of oxygen that goes into your bloodstream, interrupts the fight-or-flight response and encourages your body’s relaxation response.

Try diaphragmatic breathing a few minutes each day, focusing on your belly as it moves up and down. Listen to the air passing in and out through your nostrils. Don’t worry if your mind wanders; just bring your attention back to breathing.

If you find yourself becoming angry or tense, try placing your hand on your belly so you can feel the in-and-out motion as you breathe. Concentrate on your breath, inviting negative emotions to drift away.

4-7-8 Breathing

Sit up or lie down, but keep your back straight. Place the tip of your tongue against the back of your upper front teeth. Relax the rest of your tongue. Then keep your tongue in this position and open your mouth, holding it open as you exhale. Listen to the “whooshing” sound your breath makes as it exits.

Close your mouth and inhale through your nose, quietly, to the count of 4.

Stop inhaling and hold your breath to the count of 7.

Now breathe out through your mouth as described, with the tip of your tongue against your back teeth, emptying your lungs to the count of 8.

Count silently and be aware of your breath moving in and out of your nose, throat and lungs. Just a few rounds should be all it takes to achieve a sense of calm. Then, over the course of a month or two, you can gradually build up to a maximum of eight rounds at a sitting.

Sun and Moon Breathing

This time-honored exercise uses touch to focus on breathing. Using your left index finger, gently close your right nostril, and exhale through your left nostril. Then inhale through your left nostril.

Release your right nostril and, using your left thumb, gently close your left nostril while exhaling through the right nostril. Then inhale through the right nostril.

Alternate nostrils, gently exhaling and inhaling. Continue for several minutes. Try closing your eyes and focusing on the breath as it leaves and then enters through the open nostril. Feel the air move through your nostril and down into your lungs.

4. ART THERAPY

It sounds simple, but art therapy is powerful. The act of creating is a form of meditation, clearing the mind and quieting the storm. For some, a breakthrough comes from examining what was drawn, then using it as a clue to guide treatment. Anyone can put colors and shapes on paper, and what counts is using art as a “mirror” to see inside yourself and recognize and release hidden emotions that may be contributing to your pain.

The US military recently discovered the power of art therapy for treating PTSD. Creating art helps unlock and release unexpressed emotions, making it easier to process feelings meaningfully.

Although you can certainly do art projects on your own, powerful emotional healing can result from working with a trained art therapist, often in a group setting.

One of my favorite projects is The Mask. A person is given a mask that covers the face. Then he or she is asked to paint the outside of the mask to represent the way he thinks others see him, while painting the inside as he sees himself. I’m often surprised at the differences between one side of the mask and the other. In one case, the outside of the mask was brightly colored, friendly and smiling, while the inside looked like there were spikes plunging into the patient’s head. This was the first time this stoic and uncomplaining patient revealed his inner pain-even to himself!

Making a mandala, or circle, is an ancient therapeutic art project. The circle, a symbol of wholeness, harmony and the rhythms of nature/life cycle, has no beginning or end, no angles or hard edges. Many cultures and religions, including Native Americans, Hindus and Buddhists, have used circles to draw spiritual energy, speed healing and aid meditation.

Don’t want to paint, draw or sculpt? Gather images from magazines that trigger emotional responses and that represent how you feel or what you love. No matter the form, art therapy can help release feelings by making an end-run around subconscious barriers erected to hold those terrible feelings at bay.

5. YOGA

Yoga is an effective tool for managing stress. The combination of postures, breathing and meditative practice induces parasympathetic relaxation. Scientific studies show that yoga triggers long-term neuroplastic brain changes, in part through epigenetic changes to genes involved in regulating the body’s stress response. In other words, yoga alters the stress response for the better on the genetic level. These changes are also linked to the aging process and may be a way of increasing longevity.

You may find yoga tricky if you’re suffering from chronic pain, as some poses may be difficult or impossible, but be aware that there are many kinds of yoga classes. Gentle yoga involves easy stretches and mild poses. Restorative yoga utilizes bolsters, blankets, blocks and other props that support you and bring about maximum relaxation.

Think of yoga as therapy, rather than a group exercise. Your goal is to reduce anxiety, lower stress and calm your “pain brain.” Find a teacher who can help you get started simply, and work around any limitations.

6. EMDR

EMDR (eye movement desensitization and reprocessing) is a well-researched and effective treatment for trauma that helps the mind process traumatic memories in a way that leads to peaceful resolution.

This relatively new therapy uses rhythmic eye movements to help reduce the power of emotionally charged memories linked to trauma and PTSD. The therapy consists of bringing to mind a troubling memory or thought as the patient carefully watches the therapist’s finger moving back and forth across her face. Forcing the brain to focus on two things at once-reliving the memory and watching the finger-for several thirty-second sessions helps the brain process the memory and reduce its “punch.”

EMDR was created by psychologist Francine Shapiro in the late 1980s as a treatment for overwhelmed brains unable to cope with the consequences of traumatic experiences. The therapy is performed by mental health practitioners who have been specifically trained in the technique.

7. MOVING ON

Much of what we’ve talked about in this chapter has to do with setting aside negative thinking and calming the storm within. Read more of Dr. Abaci’s book to learn what to do with the negative thoughts that still remain, and how to reframe them in a way that removes their sting and replaces them with positive thoughts.

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“How do I find a pain doctor?”

It’s the question we hear the most. Whether it’s from someone first experiencing pain or someone looking for a specialist, many chronic pain sufferers are seeking the right physician for them.

Here’s advice on recognizing the need for a pain doctor, finding a pain management specialist and knowing what questions to ask:

Why seek a pain management specialist

Pain management specialists have special training in evaluating, diagnosing, and treating all types of pain, including acute pain, chronic pain and cancer pain. As the field of medicine learns more about the complexities of pain, it has become more important than ever to have physicians with specialized knowledge and skills to treat all pain conditions.

In addition, the wide variety of treatments available is constantly growing and changing. With an increasing number of new and complex drugs, techniques, and technologies becoming available every year, a pain management physician is uniquely trained to use this new knowledge safely and effectively to help his or her patients.

Finally, a pain management specialist plays an important role in coordinating additional care such as physical therapy, psychological therapy, and rehabilitation programs in order to offer patients a comprehensive treatment plan with a multidisciplinary approach to the treatment of their pain.

Five ways to find a pain management specialist

1. Ask your general practitioner for a pain management physician referral

One of the best ways to find a pain physician is to be referred by your primary care physician. Your local primary care physician probably knows you best and is also connected to a local physician’s network. So, he or she can make recommendations based on your individual needs and the doctors in your area.

Most pain physicians work closely with their patients’ primary care physicians to ensure good communication, which in turn helps provide the optimum treatment for their patients.

2. Talk to friends

Personal referrals often provide the best leads. Even if someone does not share your pain condition, they may know of someone who does. Ask questions to make sure the recommended physician is a good fit for you.

3. Consult pain advocacy organizations

Many pain advocacy organization websites offer physician directories as well as resources, programs, advocacy and support groups for all kinds of pain conditions. Here are a few organizations that may be helpful to you:

– American Chronic Pain Association
– US Pain Foundation
– Power of Pain Foundation

4. Contact a pain coach

If you know or work with a pain coach, like Take Courage Coaching, ask about a pain management specialist that might be right for you. Many pain management coaches work closely with physicians and may be able to provide referrals.

[Related – Is Pain Management Coaching Right for You?]

5. Use online resources

By searching online directories, you can find a pain management specialist near you. You can also find condition-specific groups, organizations, clinics and centers that can lead you to the right pain physician.

Here are some resources and directories:

– PainPathways pain resources
– US News & World Report directory of pain management specialists
– Healthgrades pain medicine directory

Questions to ask a potential pain management specialist

It’s important to find someone who has the training and experience to help you with your particular pain issue and with whom you feel a comfortable rapport. Here are some questions to ask:

– How were you trained and are you board certified in pain management? – Do you have experience with my pain condition and what types of treatments do you offer? – Do you only perform procedures or do you use a multidisciplinary approach to pain management? – What types of treatments do you recommend aside from medications or opioids? – What is your overall pain management philosophy? – How can you be reached if questions or problems arise?

Once you find the right pain doctor, take the next step by reading Making the Most of Your Doctor Visit and Ten Techniques to Help Improve the Relationship with Your Doctor.

Finding a pain management specialist is a lot like making a big purchase, do your research, use your network and ask questions to make sure you feel comfortable with your decision. To schedule an appointment with someone on our team, visit:https://carolinaspaininstitute.com/new-patients/

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PAIN IS A MULTIDIMENSIONAL EXPERIENCE THAT AFFECTS AN INDIVIDUAL’S PHYSIOLOGICAL, PSYCHOLOGICAL AND SOCIAL FUNCTIONING. WHEN PAIN CONTINUES BEYOND THE BODY’S ABILITY TO HEAL AND BECOMES CHRONIC, THE OVERWHELMING STRESS THAT CAN DEVELOP IN EACH OF THESE AREAS OF FUNCTIONING MAY EXACERBATE THE PERCEPTION OF PAIN,CONTRIBUTING TO PROLONGATION AND INCREASED ACUITY.

¹AS A RESULT, THE PAIN MANAGEMENT COMMUNITY HAS COME TO RECOGNIZE THE NEED FOR MORE COMPREHENSIVE AND INTEGRATIVE NON-PHARMACOLOGICAL ADJUNCTIVE APPROACHES, SUCH AS ART THERAPY.

WHAT IS ART THERAPY?

Used clinically for over a century, art therapy uses creative expression to promote emotional, mental and physical well-being. Grounded in the belief that the creative process is inherently healing, the practice of art therapy also includes psychodynamic, humanistic, learning and developmental, educational, cognitive behavioral and other therapeutic approaches. Art therapists are master’s-level clinicians who are trained in psychology, mental health counseling and the visual arts. They assist individuals and groups in using artistic media and techniques as an outlet for self-expression and exploration, offering an alternative form of communication and meaning making.

A primary goal of the art therapist is to provide a safe and stimulating environment in which prior artistic experience is not needed in order to benefit from the creative process. This process, as well as the art materials and final products that emerge, help individuals accomplish a variety of therapeutic tasks. For some, art therapy provides relaxation and stress relief, increases socialization and improves motor skills. The process of art therapy also affords people in pain an opportunity to try something new, examine their thoughts and feelings, resolve inner conflicts, improve self-awareness and self-esteem, manage maladaptive behaviors and mental health issues, and cope with physical and psychological trauma.

Art therapy, which may be long or short term depending on the needs of the client, is offered to individuals of all ages, in a number of settings including hospitals, mental health and rehabilitation clinics, schools and community agencies. Art therapists may provide an array of materials for painting, drawing, collaging, sculpting, photography and more. Art projects are based on an individual’s needs and preferences.

ART THERAPY & CHRONIC PAIN

Art therapy is a mind-body therapy that recognizes the important ways in which psychological, emotional and social factors can influence physical health. Often used as complementary or integrative therapy to conventional chronic pain regimens, art therapy can be a useful adjunct in improving many aspects of the chronic pain experience.

ART AS COMMUNICATION

The visual arts can be a valuable tool in conveying aspects of an illness that are often too difficult to verbalize. When used as a means of communication between patient and health care provider, the arts have the potential to improve the medical assessment process, thereby enhancing overall quality of treatment. This concept has been demonstrated by a number of researchers who have found that patients’ pain drawings can help providers assess perceptions of illness and consequent physical and emotional functioning.^2-4 For example, researchers who have looked at artwork and accompanying comments from individuals with chronic pain have identified a number of important themes that characterize the chronic pain experience. Such themes include hopefulness, pain as a journey, gaining pain and losing self, redefinition of self,2 fighting against the “pain identity,”facing new limitations and boundaries and working toward adjustment and acceptance.3

In addition to helping healthcare providers to appreciate nuances about the chronic pain experience that might otherwise go undetected, an individual’s artwork can also help to improve personal relationships. As an “invisible illness,” chronic pain can often be isolating. Using art making to depict hardships honors the individual’s experience and provides a catalyst to new knowledge and understanding on the part of family, friends and caregivers.

ART AS SYMPTOM RELIEF

Pain is largely characterized by the amount of attention it demands of the senses; therefore, focusing on art making can modulate the pain experience by diverting attention toward other sensory modalities. Yet, if attention is directed toward other sensory modalities, overall attentional capacity is lessened and an individual is less able to process painful stimuli.^4-5

Researchers in this area have found that the act of participating in art making has the potential to distract from, and thus alleviate, perception of physical pain.^{3, 6-8} Individuals who were interviewed regarding their experience with chronic pain reported a decrease in their perceptions of pain while participating in art therapy. One interviewee described her experience of painting as “… a whole time when I’m not involved with my pain, nor do I have the pain.”³ Another interviewee described art therapy as an “escape” from her agitation, irritation and pain.³

Art therapy has also been found to be effective in addressing the types of psychosocial symptoms that may exacerbate perceptions of pain. Research shows improved mood⁹ and interpersonal dynamics,¹⁰ as well as decreased stress, anxiety and depression11after participating in art therapy.

ART AS INSIGHT

Art therapy provides an outlet for self-expression and is therefore transformative, providing endless opportunities for growth. Whether pounding clay, finding the right shade of sky blue, uncovering personal symbols or sharing one’s story, the tasks involved in art therapy encourage new awareness and insight. In using art therapy with chronic pain, these insights can serve as a catalyst for change – inspiring new perceptions of personal abilities and thereby promoting the acceptance and adjustment needed for self-management.

ART AS PERSONAL FULFILLMENT

Living with chronic pain presents daily challenges and may cause an individual to feel a lack of personal control. Art therapy addresses this issue by using interventions that promote opportunities for problem-solving, decision-making and personal empowerment. The art therapist and client work together to identify and build upon sources of inspiration that will spark the creative process and lead to production of a satisfying final product that highlights the client’s unique strengths. It is no wonder then that many art therapy clients find benefits in continuing the creative process at home and within their communities.

THE FUTURE OF ART THERAPY WITH CHRONIC PAIN SUFFERERS

Research proves that art therapy can be used to address chronic pain issues on a number of levels. As pain specialists continue to broaden their search for effective therapies, integrative interventions like art therapy will continue to serve as a valuable outlet for managing the chronic pain – while offering people in pain a deeper insight into their experience.

ABOUT THE ART: Molly O’Neill Haaga created this artwork in response to her research involving art therapy clients who were experiencing chronic pain. Reflective art making served as an additional way to analyze the narrative data she was gathering and allowed for development of kinesthetic and sensorial understanding, central to examination of the chronic pain experience.

ABOUT THE AUTHOR: Molly O’Neill Haaga, MA, ATR, is a registered art therapist and mental health counselor. As an art therapy educator and doctoral student, she has focused her research on the psychosocial implications of medical illness and the role of art therapy in assessment, treatment and management of medically related issues. Her current research study, Art Therapy and Chronic Pain, aims to examine the effectiveness of art therapy in addressing both the psychosocial and physiological dimensions of the chronic pain experience. www.arttherapyandchronicpainstudy.com/ {PP}

Sources

1. Loeser, J.D., & Melzack, R. (1999). Pain: an overview. Lancet, 353(9164), 1607-1609.
2. Henare, D., Hocking, C., & Smythe, L. (2003). Chronic pain: Gaining understanding through the used of art. The British Journal of Occupational Therapy, 66(11), 511-518.
3. Haaga, M. (2012). Art therapy and the chronic pain experience: A pilot study. Manuscript in preparation.
4. DePalma, M., & Weisse, C. (1997). Psychological influences on pain perception and non-pharmacologic approaches to the treatment of pain. Journal Of Hand Therapy: Official Journal Of The American Society Of Hand Therapists, 10(2), 183-191.
5. Villemure, C., & Bushnell, M. (2002). Cognitive modulation of pain: how do attention and emotion influence pain processing? Pain, 95(3), 195-199. doi:10.1016/S0304-3959(02)00007-6
6. Trauger-Querry, B., & Haghighi, K. (1999). Balancing the focus: Art and music therapy for pain control and symptom management in hospice care. Hospice Journal, 14(1), 25-38. doi:10.1300/J011v14n01_03
7. Russell, J. (1995). Art therapy on a hospital burn unit: A step towards healing and recovery. Art Therapy, 12(1), 39-45.
8. Ferszt, G.G., Massotti, E., Williams, J., & Miller, J. R. (2000). The impact of an art program on an inpatient oncology unit. Illness, Crisis, & Loss, 8(2), 189-199.
9. De Petrillo, L. & Winner, E. (2005). Does art improve mood? A test of a key assumptions underlying art therapy. Art therapy: Journal of the American Art Therapy Association, 22(4), 205-212.

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The truth about the trouble down under.

During her twenties, when Rebecca Spencer was getting ready for a first date, she had more on her mind than selecting an outfit to complement her curly red hair and spitfire personality. She found herself worrying about what type of restaurant her date would take her to and, specifically, what food would be on the menu.

“I was always anxious about going to dinner with someone new,” says Spencer, who at 36 is now married and expecting her second child. “I worried whether I would have access to a bathroom and stressed over what I could order that wouldn’t give me diarrhea.”

Spencer says she has long suffered from what she describes as a “nervous stomach.” In college she developed vicious cycles of diarrhea and constipation in response to certain foods and hormones – a hallmark of a common condition affecting the large intestines, known as irritable bowel syndrome (IBS). It is estimated that IBS affects up to 15 percent of the United States population, making it the most common intestinal disorder for which a patient is referred to a gastroenterologist.

Although it can appear at any age, IBS often begins in the teens or early adulthood and is twice as common in women as men. Some IBS sufferers have constipation, others have diarrhea, and many experience both. Though IBS is considered a lifelong condition and has no cure, it does not tend to worsen over time, cause ongoing inflammation or increase the risk for colorectal cancer. Over time, IBS may improve as patients learn to avoid triggers and control stimulating factors, such as diet and stress.

WHAT CAUSES IBS?

The exact cause of IBS is unknown and may vary from person to person. Sometimes IBS can occur after an infection, but there can be other external triggers. It’s theorized that the signals between the intestines and the brain become more active during stressful times, causing the intestines to squeeze and contract more. Certain foods, hormonal shifts and some antibiotics may trigger symptoms and pain.

“Many of my IBS symptoms are directly tied to hormones,” says Spencer. “Even when I developed a diet and medication regimen to help reduce the number of painful bouts of IBS I experienced, I still would have an episode the weekend before my menstrual cycle. It was like clockwork.”

Curtis Weaver, MD, a gastroenterology fellow at the University of Rochester/Strong Memorial Hospital in Rochester, New York, explains that many theories exist about the exact cause of IBS, and studies are continuously being funded to learn more about the condition.

“It is likely that what we consider to be IBS is really a number of different conditions with different causes,” says Dr. Weaver. “As we learn more about the underlying etiologies, we hope to improve the treatments.”

SYMPTOMS

IBS may cause abdominal pain and cramping, excessive gas, mucus in the stool, bloating, constipation and diarrhea. Typically, pain relief is often reported following a bowel movement. Most symptoms can be managed without medication, but it’s important to seek medical treatment when symptoms interfere with daily life.

“In general, most cases of IBS can be diagnosed and treated by the patient’s primary care physician,” says Dr. Weaver. “A patient may be referred to a gastroenterologist if the patient has severe symptoms, symptoms that do not respond to basic treatment or ‘red flag’ symptoms, such as unintentional weight loss, blood in the stool, fever or chills.”

Spencer was referred to a gastroenterologist when she received an IBS diagnosis from her primary care doctor. She was prescribed a medication to help prevent diarrhea, but she could not tolerate the side effects. So, through trial and error, she discovered a regimen of supplements that has proven to be highly effective in preventing constipation and avoiding diarrhea – painful IBS episodes she compares to labor pains.

“It’s violent,” says Spencer. “It’s like my intestines are twisting, and I feel intense sharp, stabbing and cramping pain. I would feel it begin in my right lower abdomen, and relief would only come after the 30- minute episode of diarrhea had ended.” For Spencer and many others like her, painful diarrhea is a dramatic ending to a several-day period of constipation.

For Spencer, episodes of diarrhea would always occur after a meal. Her symptoms are controlled now, but she previously experienced painful diarrhea twice a week, with constipation between bouts. She says the constipation was uncomfortable and led to painful hemorrhoids.

DIAGNOSING IBS

If someone suspects IBS is responsible for ongoing bouts of constipation and/or diarrhea, a visit to the doctor is recommended.

“Someone with IBS-like symptoms that affect or impair their normal activities should see a doctor in order to receive an initial diagnosis and to rule out other causes for the symptoms,” says Dr. Weaver.

There is no definitive test for IBS, which is often diagnosed based on medical history and a physical exam. In some cases, a battery of tests may be performed to rule out other conditions that are directly testable. Doctors may also use what is known as the Rome III criteria to more accurately pinpoint a diagnosis.

“In order to fit the criteria for IBS,” says Dr. Weaver, “a patient must have abdominal pain or discomfort at least three days out of a month for at least three months, associated with at least two of the following: improvement in pain with passage of stool, onset of pain associated with change in frequency of stools, or onset of pain associated with change in form and/or appearance of stool. Depending on the symptoms and the patient’s medical history, the patient’s physician may also check blood work or imaging studies, or refer the patient to a specialist to evaluate and rule out other possible causes of the patient’s symptoms.”

IBS RELIEF

For Spencer, preventing IBS episodes is a matter of taking Colace, a stool softener, along with a fiber supplement such as Fibercon or Metamucil. The fiber helps to bulk up her stool, making diarrhea less common, and increasing dietary fiber helps prevent constipation. Spencer says she also has learned to eliminate certain foods.

“I avoid heavy dairy, heavy cheeses and greasy, fatty foods,” she says.

For people like Spencer who experience consecutive days of constipation, a new drug received FDA approval in August 2012. It provides relief by encouraging more frequent bowel movements and may ease associated abdominal pain. Linzess, developed by Ironwood Pharmaceuticals and Forest Laboratories, Inc., comes in capsule form and is taken once daily on an empty stomach.

“I think it’s well recognized that these patients are suffering and that there’s a need for more effective therapy,” says Thomas McCourt, chief commercial officer with Ironwood Pharmaceuticals. “I think what we’re seeing [with Linzess] is a tremendous opportunity to improve both the abdominal pain as well as the constipation.” Other commonly prescribed medications for IBS include antidiarrheal or antispasmodic drugs, as well as some classes of antibiotics.

DIET & LIFESTYLE

Most IBS symptoms can be controlled with diet and lifestyle changes. Certain foods trigger IBS flare-ups, and stress is definitely considered to be an overriding roadblock to wellness. A few lifestyle changes and awareness of triggers can result in significant improvement.

“Keeping a record of foods eaten, with symptoms noted, may allow someone to figure out which foods are more problematic for them,” says Sandra Meyerowitz, MPH, registered dietitian and owner of Nutrition Work in Louisville, Kentucky. “Although this can be time-consuming, it would be a worthwhile exercise to decrease the constipation [and other symptoms] and possibly reveal some trigger foods.”

People with IBS, especially those with constipation, should avoid starchy foods and caffeine, according to Meyerowitz, and choose a diet rich in whole grains, fresh fruits, vegetables, beans, nuts and seeds. She also places an emphasis on increasing fiber and fluids.

In addition to changing her diet and adding the right supplements, Spencer has learned that an active lifestyle is mandatory for reducing stress and for keeping her bowels regular.

“The key is to stay regular so you don’t set yourself up to get constipated, which then causes painful diarrhea,” says Spencer.

“Above all else,” she adds, “don’t be embarrassed to talk to your doctor. Your physician’s input can be an invaluable resource to regaining a full and active life where you make the decisions for the day, not your bowels!”

Dr. Weaver agrees that prevention is key to IBS control.

“Once the diagnosis of IBS is made, prevention is definitely the best treatment,” says Dr. Weaver. “Dietary changes to avoid specific triggers, adding fiber supplements and regular physical activity can all help to prevent acute exacerbations of symptoms. Also, recognizing that symptoms are often related to stress and anxiety allows patients to learn certain relaxation techniques and coping mechanisms to avoid acute episodes.”

If you suffer from constant belly discomfort, call the experts at Carolinas Pain Institute and schedule an appointment with Dr. Leonardo Kapural who specializes in chronic abdominal pain.

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