Chronic Pain Management - Kaiser Permanente
Transcript of Chronic Pain Management - Kaiser Permanente
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