Chronic Pain Management

707-624-3328: wwww.kp.org/vacaville/painmanagement

*Come Every Week, Be On Time (>15 minutes late, please reschedule)

*Be Active and Involved

*Respect Others and Shared Information

*Dress Comfortably, Be Comfortable, Be Kind & Courteous with Any Self Selected Odor Use

*Knowledge is Treatment

*Noticing, Pacing, Helpful Tools

*Session 2:

*Pain Physiology, Tissue Issues & Brain Mapping

*Neurotags/Brain Bundling & Central Sensitization

*Thoughts, Emotions and Behavior Change

*Relaxation, Meditation & Pain Experience

*Online Resources (See packet)

*Noticing

*Notice your symptoms

*Notice things that make symptoms worse or better

*Tracking safe/threatening activity

*Pacing

*Find your baseline and respectfully nudge it

*Stay sore but safe

*Movement Practice:

*Diaphragmatic Breathing + Relaxation 4-7-8 Breathing

*An unpleasant sensory or emotional experience associated with actual or potential tissue damage, OR described in terms of such damage.

*Pain is a NORMAL human experience designed to protect our wellbeing and elicit change

*Multisystem process

*Can ABSOLUTELY change

*Acute Pain (duration less than 3 - 6 months)

* Identifiable damage or injury (i.e. broken bone, ankle sprain)

* Serves as a temporary warning sign

* Heals in about 3-6 months

* Treatment: Rest, appropriate reintroduction to function

*Chronic pain (duration more than 3 – 6 months)

* Pain ≠ further damage

* No longer serves a clear biological purpose: Warning sign

* Continues or gets worse over time

* Treatment: Keep functional

* * X-Rays and MRIs: Do not explain the continued pain & the impairments you experience.

*Acute vs Chronic

Butler & Moseley, Explain Pain Workbook

*This is the old way of thinking

*We have to move away from this

*Pain = damage

*Chronic pain must mean persistent damage or tissue not healing

*Pain is an input

*Simple transmission

*Nociceptors = fancy word for stimulus input from the body to the brain that indicate potential danger/alarm signals

*Does not guarantee a pain result!

*>400 nerves in a human body= 45 miles =100 billion synapses

*~25% blood flow is distributed to nerves

*We have enough electricity running in our body at any given time to power a light bulb

*Sensors on nerves turnover every 24-48 hours

*Please understand that your brain is 100% in control of what is happening with your pain experience

*Acute or chronic

*Your brain will make a logical decision on pain response with reference to:

*Cumulative previous experience

*Knowledge

*Perceived threat

*Stimulus will be evaluated by the brain

*The brain will then establish and execute a pain response if threat/perceived threat is valid

*Red: Afferent/Sensory information TO the brain

*Blue: Efferent/Action information FROM the brain

*Pain ≠ Tissue damage

*Tissue damage ≠ Pain

*Intensity of Pain ≠ Extent of damage

*Tissues Heal <6 months

*1 in 3-4 people have lasting pain beyond tissue healing

*The more we know about our pain process the faster we can start to move out of it

*Remember: Everyone’s pain is unique and based on experience and knowledge

* ABSOLUTELY NOT!!

*Your pain is 100% real and in some circumstances REAL BAD

*Acute vs Chronic

Butler & Moseley, Explain Pain Workbook

*Mechanical or Movement Dysfunction

*Most people have some sort of mechanical dysfunction (back to norms with imaging)

*Many do not have pain

*Some have progressive pain experience over time

*Multiple micro trauma over time

*An unpleasant sensory or emotional experience associated with actual or potential tissue damage

*Pain is a NORMAL human experience designed to protect our wellbeing and elicit change

*Based on perceived threat

*Multisystem process

*Can ABSOLUTELY change

*Pain is not a true reflection of your tissue state of health

*Agonizing Foot Pain

*Toothache

*Add imaging with story

*80% of people experience back pain

*Up to 64% of people without pain have bulging disk(s)

*Low back pain:

*Majority have degenerative changes on imaging ages 20+

*Bulging discs are often 50% smaller than initial scan 2 months later and fully resolved in 9 months

*Consider the supine vs other positions for scans

*40% of individual have disc protrusions with NO Pain

*80% NFL /85% NBA who under go back surgery return to play

*Majority of post op patients DO NOT need to restrict movement

*Some findings are so common in healthy volunteers that they must be interpreted within the clinical context.

*Among those aged under 40 years with no back pain, MRI will find that:

*~50% have disk degeneration

*~40% have a bulging disk

*~30% have disk height loss, signal loss or protrusion

*Among those aged over 60 years with no back pain, an x-ray will find that:

* ~90% have disk degeneration

* ~80% have disk height loss

* ~40% have facet degeneration

* ~30% have spondylolisthesis* On Kaiser imaging

*Rotator Cuff:

*1 in 3 people 30+ have abnormal findings on imaging

*2 in 3 people 70+ have abnormal findings on imaging

*After successful surgical intervention >2 to 3 people have abnormal findings on diagnostic imaging

*Knee:

*Only 50% arthritic knees have pain

*Some have NO ACL and don’t know it

*1 in 3 collegiate basketball players have abnormal findings on diagnostic imaging with no symptoms

*Imaging results frequently do not correlate with your pain

*Otherwise known as the virtual body imprint in/on the brain

Butler & Moseley, Explain Pain

*Don’t wait to feel better to do, Do to feel better

*Minding your thresholds

*Refresh your homunculus

*Anything new can be perceived

by the brain as a threat/danger

*Pelvis Only

Institute of Physical Art, Specialized Educational Services

Institute of Physical Art, Specialized Educational Services

*Circles, diagonals, both at the same time or individually

*Your choice, As tolerated

*Belly or Abdominal Breathing

Institute of Physical Art, Specialized Educational Services

*Relaxation

*4-7-8 Breathing

* In for 4 seconds, Hold for 7 seconds and Exhale for 8 seconds

*KNOW PAIN, KNOW GAIN

*KNOW PAIN or NO GAIN

*If you have been practicing, your brain is already changing: it takes ~8 weeks to identify a lasting change in a neural pathway

*

Knowing is not enough, we must apply. Willing is not enough, we must do. -Bruce Lee

Know Apply Pain

*Movement exercises as tolerated :

*Pelvic clocks

*Scapular clocks

*Diaphragmatic breathing

* 4/7/8 Breathing

707-624-3328: wwww.kp.org/vacaville/painmanagement