Understanding Chronic Pain:A Multidisciplinary Approach

Chronic Conditions Management

KAISER PERMANENTE - SAN JOSE

ACUTE vs CHRONIC

Is temporary and heals over time

Has a known cause

• Broken Bones

• Toothaches

• Cuts & scratches

• Childbirth

Signals that your body has an injury

Treatment is effective

Needs temporary inactivity for healing

Others are supportive and understanding

Pain lasts >6 months and no known cure

Symptoms are constant or keep recurring

Cause may or may not be known

Chronic pain can be confusing or frustrating

Increased muscle tension increases pain (guarding)

Physical activity/movement is necessary

Others may not be sympathetic or understanding

Kaiser San Jose

Chronic Pain Treatment Model:

TEAM Approach

San Jose CPP Team

MIND BODY CONNECTION

Culture of Chronic Pain

BioPsychoSocial Interactions of Pain

Physical

Responses

Thoughts,

Emotions,

Behaviors

Relationships

Body Systems

Autonomic Nervous System

Fight, Flight & Freeze

Acute Stress Chronic Stress

Rest, Relax & Recover

Fight/Flight/Freeze Response

(Sympathetic Nervous System)

Stress Hormones Levels

Inflammation

Blood pressure

Heart rate and pulse

Shallow or chest breathing

Muscle Contraction/Tension

Blood Sugar Levels

Blood Vessel Size (Vasoconstriction)

Skin Temperature

Cognitive Functioning

Digestive Action

Decreased Libido

Rest/Digest Response

(Parasympathetic Nervous System)

Stress Hormones Levels

Heart rate and pulse

Blood pressure

Chest breathing and more abdominal breathing

Inflammation

Muscle Contraction/Tension

Blood Sugar Levels

Blood Vessel Size (Vasodilation)

Skin Temperature

Cognitive Functioning (improved memory & recall)

Digestive Action

Normal Libido

Stress vs Relaxation Response

MOVEMENT SCIENCE

Hypersensitivity(takes less to set it off)

Firing Level

Normal Excited Level

Takes longer to alarm

Firing Level

Normal Excited Level

Extra Sensitive

Takes less to alarm

How to make it better

EDUCATION MOVEMENT

▪ Brain Scan without Pain

▪ Brain Scan Before Pain Education

▪ Brain Scan After Pain Education

RED = Pain

Know Pain, Know Gain!!!FMRI of the brain before & after pain education

Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology

education: fMRI evaluation of a single patient with chronic low back pain. Aust J Physiother. 2005;51(1):49-52.

Moving differently

Turn head to the right Turn trunk to the left

PAIN MEDICATION

▪ Opiates & Narcotics▪ (e.g. hydrocodone/APAP, morphine)

▪ NSAIDS▪ (e.g. ibuprofen, naproxen)

▪ Muscle Relaxants▪ (e.g. cyclobenzaprine, baclofen)

▪ TCA▪ (e.g. nortriptyline, amitriptyline)

▪ SNRI(e.g. venlafaxine, duloxetine)

▪ SSRI(e.g. fluoxetine, sertraline)

▪ Anti-Convulsants▪ (e.g. gabapentin, topiramate)

▪ Topicals▪ (e.g. lidocaine cream, diclofenac cream)

Types of Pain Medications

Kaiser San Jose

Chronic Pain Treatment Model:

TEAM Approach

Cognitive Behavioral

Therapy and/or

Psychoeducation

Complementary

& Alternative

Medicine

Physical

Therapy

Pharmacologic

and

Interventional

Management

Patient

Self

Care

CARE MANAGEMENT

WHAT’S NEXT?Schedule a Follow Up

▪ PHYSICIAN ONLY EVALUATION▪ Assessment of medication and/or procedure▪ 45 – 60 mins

▪ PSYCHOLOGIST & PHYSICAL THERAPIST EVALUATIONS:▪ Pain physician feels medications/procedures/etc. are already optimal▪ Assessment of any factors in life that may be impacting pain condition▪ 45 – 60 mins

▪ TEAM EVALUATION:▪ Thorough evaluations by physician, psychologist, physical therapist, pharmacist and nurse ▪ 4 hour appointment

▪ Education Level Classes▪ Movement, Medications, Nutrition – see flyers

Program Overview – 8 week program

Physical Therapist

led units

Psychologist

led units

Session 1 Setting the Foundation Biopsychosocial

Session 2 Nerve Sensitivity Values and Goals

Session 3 Pacing Pacing

Session 4 Get Moving Thoughts I (Awareness Training)

Session 5 Neuroplasticity Thoughts I (Awareness +Values+ Action)

Session 6 Brain’s Map of the Body Communication

Session 7 Emotions and Balance Sleep

Session 8 Self Help Tools Relapse Prevention

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Resources

▪ Healthy Living Center (408) 972-3340 M - F 7am-7pm & Sat 8:30am-5pm

▪ Kaiser Wellness Coaching 1-866-251-4514

▪ Kaiser's Chronic Pain Resources: http://healthengagement.kaiserpermanente.org/wellness-topics/pain/

▪ Kaiser's Guided Meditation to Ease Pain: http://74.62.111.169/kaiser/easePain_flash.asp

▪ Kaiser Telepsychiatry: https://lookinside.kaiserpermanente.org/mental-health-care-just-a-call-away/

▪ Kaiser Podcasts: (sleep, stress, fibromyalgia, etc.)

▪ Tympani Center SJSU: (408) 283-9036

▪ Apps: Insight Timer, CBT-I Coach & Curable ▪ Books & CDs