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Chronic Pain RN Health Educator - Patient Skills

The document provides a comprehensive overview of pain management, highlighting the importance of a multifaceted approach that includes medication, behavioral therapies, interventions, integrative treatments, and movement therapies. It emphasizes understanding pain as a holistic experience affecting various aspects of life and outlines various methods and tools available for effectively managing chronic pain. It also stresses the significance of awareness regarding opioid risks and the importance of utilizing complementary approaches such as acupuncture, yoga, and dietary modifications to enhance overall quality of life.

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Table of Contents Overview: Pain Management Pain: Medication Management Pain: Behavioral Therapies Pain: Interventions & Devices Pain: Integrative Treatments Pain: Movement Therapies Pain: Medically Assisted Treatment
Overview: Pain Management
Overview: Pain Management Managing Chronic Pain – The Big Picture Behavioral Therapies • Individual Therapy • Health Pain Group • PTSD, Stress, Depression Group • Social Engagement Plan • Chronic Pain CBT • Acceptance and Commitment Therapy Procedures Devices • Injections: Joint, Trigger Point, Epidurals • TENS Machine • Specialty Treatment: Orthopedics, Neurosurgery, Pain Clinics • RICE: Rest, Ice, Compression, Elevation Medication • NSAID/Acetaminophen • Anticonvulsants • Antidepressants • Topical: Lidocaine/Capsaicin • Immune modulators • Muscle relaxants • Buprenorphine • Lowest Possible Opioid Dose If Opioids Are Part of Treatment Plan ★ Set a goal to improve function ★ Understand overdose risk and have a Naloxone Rescue Kit ★ Risk of dependence ★ Opioid Hyperalgesia ★ Digestion Challenges Tip: Managing Pain We can not cure pain but we can manage it. Managing pain is like having four flat tires you have to fill all the tires to make a full life. Movement Therapies • Physical/Occupational Therapy • Graded activity exposure • Exercise/Endurance • Warm Pool/Pool Exercise Integrative Therapies • Massage, Counterstrain • Chiropractic, Acupuncture • Supplements, Anti-inflammatory diet • Yoga, Tai Chi, Qigong • Mindfulness
Overview: Pain Management Understanding Pain the Basics… Pain is in the brain, not your head We can unwire the pain brain… We can help our brain have less pain or more pain Pain impacts the whole person • Fight/Flight/Stress • Pain with movement • Change is diet • Sexual health • Medication impacts e.g. constipation • Immune response • Insomnia • Concentration • Depression • Anxiety • Fear about future • Beliefs about self • Emotional overwhelm • Fear of movement • Thinking & attitude • Family relationships • Difficulty keeping appointments • People not understanding • Social isolation • Loneliness • Challenges working Biologically Psychologically Socially ★ You are not making up your pain. ★ All sensations are created in the brain. ★ When pain is chronic it is an illness to itself. ★ Neuroplasticity is how the brain re-wires & pain rewires the brain. The brain can become wired for pain. 1. Practice pain tolerance 2. Exercise regularly 3. Improve your sleep 4. Set personal goals 5. Manage your stress 6. Take medications as prescribed. 1. Stress and poor diet 2. Not exercising 3. Poor sleep 4. Over reliance on medications 5. Depression, Anxiety or other Mental Health challenges 6. Social Isolation While we can’t stop all pain we can help our brain rewire away from pain. Three Basic Tools… 1. Accept some pain, 2. Strengthen your body, 3. Manage your pain (not control pain). + Increases Pain- Decreases Pain
Overview: Pain Management Opioid Overdose Deaths In California Stopping Opiate Related Deaths – By Reducing Risks ★ Opiate related deaths are occurring in all groups, ages and demographics and due to fluctuations in opiate metabolism even people on a steady dose are at risk. ★ If you know the risks (do not drink, eliminate benzodiazepines), keep doses in a healthy range and have a Neloxone rescue kit you can take opioids safely.
Overview: Pain Management Pain Matters: Reducing Risk Managing Pain Managing pain requires more then medications it requires an integrative approach. Medications are one tool in the tool kit. Learning skills, understanding pain and building a plan can help you take your power and life back from pain. One in 10 Americans Experience Chronic Pain. Effective pain management of pain can improve quality of life and reduce pain. While opiate deaths are rising. There have been increased tools and skills for managing pain. It is possible to manage pain while reducing risks.
Overview: Pain Management Naloxone Rescue and Safety Advice for Patients and Families
Overview: Pain Management Naloxone Rescue and Safety Advice for Patients and Families
Pain: Medication Management
Pain: Medication Management
Pain: Medication Management Pain Medications and Pain Pathway ★ Pain medications, physical therapy and behavioral health intervention effect different parts of the pain pathway. ★ Not all medications treat all kinds of pain. ★ Finding the right combination of medications, developing functional goals and other interventions can help your pain. Pain Transmission: Pain has to be transmitted up the spinal-chord to reach the brain. Multiple medications impact pain transmission. ★ Nerve Blocks: Nerve blocking injections can block pain information locally reaching the spinal chord. ★ SSRIs: Increase serotonin which helps the brain perceive less pain and help the brain tell the body to turn off the pain signals. ★ Alpha 2 Agonists: Were first found to treat hypertension/high blood pressure but have been found to have an impact on pain. Pain Perception: Multiple medications can effect pain perception and pain in the brain. ★ Tricyclics (TCA): Medications help the brain produce and perceive less pain. ★ SSRIs: Increase serotonin which helps the brain perceive less pain and help the brain tell the body to turn off the pain signals. ★ Alpha 2 Agonists: Were first found to treat hypertension/high blood pressure but have been found to have an impact on pain. ★ Opiate Medications: Opiate medications work on the internal opioid system and effect pain perception through slowing down the functioning in the brain. Pain Signal from Pain Source: Pain can be generated from a local source in a body part. There are medications that help block the signals from the body getting to the spinal chord. ★ Anticonvulsant Medications: Slow the firing of pain neurons and reduce the pain signal getting to the brain. ★ Capsaicin: Creams that use capsaicin can block the communication of pain from the skin to the spinal chord. ★ Local Anesthetics: These medications can reduce pain signal from tissue near the surface of the body. ★ NSAIDs: Reduce inflammation in the body and reduce the pain signal to the brain.
Pain: Behavioral Therapies
Pain: Behavioral Therapies
Pain: Behavioral Therapies
Pain: Behavioral Therapies
Pain: Interventions and Devices
Pain: Interventions and Devices Some people benefit from pain interventions. Interventional medicine uses tools that interrupt the flow of pain on the pain pathway. Interventional Medicine and Pain Trigger point injection (TPI) may be an option for treating pain in some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax Nerve blocks can be temporary or longer-lasting. Health care providers may give them with local anesthesia after numbing where the needle enters the skin. They can also block pain signals to an area by deliberately cutting or destroying certain nerves surgically. Nerve blocks can health with lower back pain, facial pain, arthritis, headaches and chronic regional pain syndrome. ★ Sympathetic blockade The health care provider gives a drug to block pain from the sympathetic nervous system in one particular area. ★ Neurectomy A damaged peripheral nerve is surgically destroyed. ★ Rhizotomy The surgeon destroys the root of the nerves that extend from the spine. ★ Epidural analgesia or anesthesia The health care provider may inject medicine outside the spinal cord. ★ Spinal anesthesia or analgesia The health care provider may inject medicine in the fluid surrounding the spinal cord. ★ Peripheral nerve blockade The health care provider may inject medicine around a target nerve. Non-Surgical Interventions Surgical Interventions
Pain: Interventions and Devices TENS, or transcutaneous electrical nerve stimulation, is a back pain treatment that uses low voltage electric current to relieve pain. TENS is typically done with a TENS unit, a small battery-operated device. The device can be hooked to a belt and is connected to two electrodes Pain Medicine Device - TENS TENS – What does the research say? ★ TENS can help relieve pain in a flare up and can reduce pain in the moment. ★ TENS has limited impact on stopping pain in the long-term but it can be an effective part of providing pain relief.
Pain:IntegrativeTreatments
Pain: Integrative Treatments People have used complementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Chiropractic How it Works… Chiropractic: In Depth | NCCIH – https://nccih.nih.gov/health/chiropractic/introduction Chiropractic is based on the notion that the relationship between the body's structure (primarily that of the spine) and its function (as coordinated by the nervous system) affects health. Spinal adjustment/manipulation is a core treatment in chiropractic care, but it is not synonymous with chiropractic. ☀ Studies have shown that spinal manipulation can provide mild-to- moderate relief from low-back pain and appears to be as effective as conventional medical treatments. ☀ Results from one trial that examined long-term effects in more than 600 people with low-back pain suggest that chiropractic care involving spinal manipulation is at least as effective as conventional medical care for up to 18 months. What the Research Says…
Pain: Integrative Treatments People have used complementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Acupuncture How it Works… Acupuncture: In Depth | NCCIH – https://nccih.nih.gov/health/acupuncture/introduction Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. It is one of the practices used in traditional Chinese medicine. ☀ Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. ☀ It also may help reduce the frequency of tension headaches and prevent migraine headaches. ☀ Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. ☀ Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious side effects. What the Research Says…
Pain: Integrative Treatments People have used complementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Massage Therapy How it Works… Massage: In Depth | NCCIH – https://nccih.nih.gov/health/acupuncture/introduction ✙ The term “massage therapy” includes many techniques, and the type of massage given usually depends on your needs and physical condition. ✙ Massage therapy dates back thousands of years. References to massage appear in ancient writings from China, Japan, India, and Egypt. ✙ In general, massage therapists work on muscle and other soft tissue to help you feel better. ✙ In Swedish massage, the therapist uses long strokes, kneading, deep circular movements, vibration, and tapping ☀ A lot of the scientific research on massage therapy is preliminary or conflicting, but much of the evidence points toward beneficial effects on pain and other symptoms associated with a number of different conditions. ☀ Much of the evidence suggests that these effects are short term and that people need to keep getting massages for the benefits to continue. ☀ A 2008 research review and 2011 NCCIH-funded clinical trial concluded that massage may be useful for chronic low-back pain. ☀ Massage may help with chronic neck pain, a 2009 NCCIH-funded clinical trial reported. ☀ Massage may help with pain due to osteoarthritis of the knee, according to a 2012 NCCIH- funded study. What the Research Says…
Pain: Integrative Treatments People have used complementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Yoga How it Works… Yoga: In Depth | NCCIH – https://nccih.nih.gov/health/acupuncture/introduction Yoga is a mind and body practice with historical origins in ancient Indian philosophy. Like other meditative movement practices used for health purposes, various styles of yoga typically combine physical postures, breathing techniques, and meditation or relaxation. ☀ One NCCIH-funded study of 90 people with chronic low-back pain found that participants who practiced Iyengar yoga had significantly less disability, pain, and depression after 6 months. ☀ In a 2011 study, also funded by NCCIH, researchers compared yoga with conventional stretching exercises or a self-care book in 228 adults with chronic low-back pain. The results showed that both yoga and stretching were more effective than a self-care book for improving function and reducing symptoms due to chronic low-back pain. ☀ Conclusions from another 2011 study of 313 adults with chronic or recurring low-back pain suggested that 12 weekly yoga classes resulted in better function than usual medical care. What the Research Says…
Pain: Integrative Treatments People have used complementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Anti-Inflammatory Diet How it Works… Ricker, M. A., & Haas, W. C. (2017). Anti-Inflammatory Diet in Clinical Practice: A Review. Nutrition in Clinical Practice, 32(3), 318-325. ★ There has been an increase in the research regarding the impact of acute and chronic inflammation on health and disease. Specific foods are now known to exert strong effects on inflammatory pathways within the body. ★ Carefully selecting foods that are anti-inflammatory in nature while avoiding foods that are proinflammatory is central to an anti-inflammatory diet plan. ★ Ultimately, the plan models a pattern of eating that (1) focuses on eating whole, plant- based foods that are rich in healthy fats and phytonutrients and (2) maintains a stable glycemic response. ☀ A study of black cumin experimental group (n = 30) and control group (n = 30). This study found a significant but small reduction in pain after 30 days of daily ingestion. ☀ The types of omega-3s found in seafood and fish oil may be modestly helpful in relieving symptoms of rheumatoid arthritis and decreasing patients’ need for nonsteroidal anti- inflammatory drugs. ☀ While research is still early there are solid theoretical reasons that reducing inflammation could reduced pain. Inflammation is a primary driver in many forms of pain ☀ Salmon, tuna, trout, mackerel and herring are high in these fats. Soy-based foods, walnuts, pecans and ground flaxseed are also good sources of omega-3 fats. Colorful fruits and vegetables, such as leafy greens, avocados, beets and berries, are rich in antioxidants. What the Research Says…
Pain: Integrative Treatments People have used complementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Tai Chi and Qi Gong How it Works… Tai Chi and Qi Gong: In Depth | NCCIH – https://nccih.nih.gov/health/taichi/introduction.htm Tai chi and qi gong are centuries-old, related mind and body practices. They involve certain postures and gentle movements with mental focus, breathing, and relaxation. In contrast to qi gong, tai chi movements, if practiced quickly, can be a form of combat or self-defense. ☀ Practicing tai chi may help to improve balance and stability in older people and in those with Parkinson’s disease, reduce back pain and pain from knee osteoarthritis, and improve quality of life in people with heart disease, cancer, and other chronic illnesses. ☀ Tai chi and qi gong may ease fibromyalgia pain and promote general quality of life. Tai chi also may improve reasoning ability in older people. ☀ Qi gong may reduce chronic neck pain, but study results are mixed. ☀ Results of a 2012 randomized clinical trial with 100 participants suggested that practicing qi gong reduced pain and improved sleep, the ability to do daily activities, and mental function. The researchers also observed that most improvements were still apparent after 6 months. ☀ In people who had low-back pain for at least 3 months, a program of tai chi exercises reduced their pain and improved their functioning. What the Research Says…
Pain: Integrative Treatments People have used complementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Meditation How it Works… Meditation: In Depth | NCCIH – https://nccih.nih.gov/health/meditation/overview.htm ★ Meditation is a mind and body practice that has a long history of use for increasing calmness and physical relaxation, improving psychological balance, coping with illness, and enhancing overall health and well-being. ★ There are many types of meditation, but most have four elements in common: a quiet location with as few distractions as possible; a specific, comfortable posture (sitting, lying down, walking, or in other positions); a focus of attention (a specially chosen word or set of words, an object, or the sensations of the breath); and an open attitude (letting distractions come and go naturally without judging them). ☀A small 2016 study funded in part by the National Center for Complementary and Integrative Health (NCCIH) found that mindfulness meditation does help to control pain and doesn’t use the brain’s naturally occurring opiates to do so. ☀This suggests that combining mindfulness with pain medications and other approaches that rely on the brain’s opioid activity may be particularly effective for reducing pain. ☀In another 2016 NCCIH-funded study, adults aged 20 to 70 who had chronic low-back pain received either mindfulness-based stress reduction (MBSR) training, cognitive-behavioral therapy (CBT), or usual care. The MBSR and CBT participants had a similar level of improvement, and it was greater than those who got usual care, including long after the training ended. ☀The researchers found that participants in the MBSR and CBT groups had greater improvement in functional limitation and back pain at 26 and 52 weeks compared with those who had usual care. What the Research Says…
Pain: Movement Therapies
★ Help our body regain strength or build strength that has deconditioned due to pain ★ Rebalance muscle patterns that can cause pain ★ Move more efficiently and with less pain ★ Develop healthier relationship with our body ★ Help you move with out or less fear and have better balance ★ Movement therapies can help rewire the brain away from pain. ★ By growing new brain paths ★ Developing new skills ★ Reducing pain through understanding pain neuroscience. ★ Learn to use movement aids like canes, walkers or bars in home ★ Get the right assistive devices for your life ★ Pool and water strengthening classes ★ Devices like TENS that can reduce pain ★ Mirror therapies or ways to reduce headaches ★ Hand therapy Pain: Movement Based Therapies Movement Therapy Chronic Pain Pain changes how we move. It changes how we feel in our body and how we do daily activities. Movement therapies can transform pain in multiple ways.
Pain: Movement Based Therapies Physical Therapy: How it Works ★ Physical therapists partner with patients, their families, and other health care professionals to manage pain, often reducing living a more functional enjoyable life with less medication or side effects ★ Physical Therapy helps to reduce pain and improve function in low back pain and can improve global well- being and physical function in fibromyalgia. Avoid surgery. If physical therapy helps you eliminate pain or heal from an injury, surgery may not be needed. And even if surgery is required, you may benefit from pre-surgery physical therapy. Recover from a stroke. It’s common to lose some degree of function and movement after stroke. Physical therapy helps strengthen weakened parts of the body and improve gait and balance. Improve your balance and prevent falls . When you begin physical therapy, you will get screened for fall risk. If you’re at high risk for falls, therapists will provide exercises that safely and carefully challenge your balance as a way to mimic real-life situations. Improve mobility. If you’re having trouble standing, walking or moving— no matter your age—physical therapy can help. Stretching and strengthening exercises help restore your ability to move. Recover from or prevent a sports injury. Physical therapists understand how different sports can increase your risk for specific types of injuries (such as stress fractures for distance runners). Reduce or eliminate pain Therapeutic exercises and manual therapy techniques such as joint and soft tissue mobilization or treatments such as ultrasound, taping or electrical stimulation can help relieve pain and restore muscle and joint function to reduce pain. https://www.burke.org/blog/2015/10/10-reasons-why-physical-therapy-is-beneficial/58
Pain: Movement Based Therapies Occupational Therapy: How it Works ★ The primary goal of occupational therapy is to enable people to participate in the occupations of everyday life. ★ Occupational therapists who work with people of all ages and abilities to do the things they need and want to in all aspects of life, e.g. taking care of oneself and others, working, volunteering & participating in interests. ★ Occupational therapists call these things “occupations”. http://aboutoccupationaltherapy.com.au/what-does-an-ot-do/ Daily Life: Pain impacts our activities of daily living. Self- care activities such as showering, dressing, grooming and eating. Occupational therapy can help Different Abilities: Occupational therapists work with people who experience difficulties present in both physical disability and mental health services. Functioning: Household and community functioning: Home maintenance, driving, budgeting, shopping and community mobility Work (paid and unpaid): Participating in employment and volunteer activities Social participation: Interacting positively with others in the community Education: Activities which allow a person to participate effectively in a learning environment Assistive Devices: Occupational therapists are also able to assess and recommend assistive technology and/or environmental modifications that will assist individuals to engage in the occupations of everyday life. Leisure and Play: We need to have a life that matters to us even when we have pain. Occupational therapy can help you find ways to do what you enjoy. Occupational Therapists: are experts in the relationships between what people do and their health and well-being, and work with people to help make every day living easier.
Pain: Movement Based Therapies ★ Pain changes how we move. ★ Research shows that people who exercise regularly are better able to cope with pain and the stress of chronic pain. People with chronic pain can begin to fear and avoid moving. ★ The fear of avoiding can lead to people deconditioning. When the body deconditions we have more pain. ★ On a good day there is a tendency to do too much and end up down with pain for days. This can lead to more fear of movement and more deconditioning. Pain Benefits of Exercise Start Where You Are: Starting to exercise does not have to be hard. Even short amounts of walking or moving can change your health. Do what works for you. Anaerobic Exercise Weightlifting Sprinting Interval Training Climbing Aerobic Exercise Walking Jogging, Biking Swimming Elliptical Stretching Yoga, PT Exercises Gentle Stretching Range of Motion Exercise Helps Mood/Depression Anxiety/Stress Chronic Pain Physical Health Sleep
Pain: Medically Assisted Treatment
Pain: Medically Assisted Treatment Buprenorphine: Is an opioid medication that treats pain and opioid addiction. Buprenorphine is a safer medication then many opiates and reduces risk of overdose. It also does not impact thinking to the same degree as other opiate medications making it easier for people to lead their lives. People who take buprenorphine report improvement in the quality of their lives. Medically assisted treatment Medically Assisted Treatment (MAT) – Is medication management of opiate use disorder. The medications used in treating opiate use disorder also can help treat pain. All people who take opiates experience tolerance and withdraw. Opiate use disorder happens to people in all walks of life. Medically Assisted Treatment uses medications to help reduce withdraw, manage pain and save lives. Methadone: Is a long acting opioid medication that helps treat both pain and opiate use disorder. It is a long-acting opiate medication. This medication can not be prescribed for opiate use disorder in primary care and needs to be administered in a treatment facility. Methadone has been found to reduce risk of overdose and help maintain quality of life. Naltrexone: Is non-addictive and works by blocking the heightened euphoric response to opiate medications. This medication can help reduce cravings as well as manage pain.
Pain: Medically Assisted Treatment Medically assisted treatment While medically assisted treatment can be effective with out counseling, It is still suggested that those receiving medically assisted treatment attend counseling groups or individual counseling. Medically Assisted Treatment helps manage opioid withdraw and reduces the risk of overdose.
Chronic Pain RN Health Educator - Patient Skills

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Chronic Pain RN Health Educator - Patient Skills

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    Overview: Pain Management Managing Chronic Pain – The Big Picture Behavioral Therapies • IndividualTherapy • Health Pain Group • PTSD, Stress, Depression Group • Social Engagement Plan • Chronic Pain CBT • Acceptance and Commitment Therapy Procedures Devices • Injections: Joint, Trigger Point, Epidurals • TENS Machine • Specialty Treatment: Orthopedics, Neurosurgery, Pain Clinics • RICE: Rest, Ice, Compression, Elevation Medication • NSAID/Acetaminophen • Anticonvulsants • Antidepressants • Topical: Lidocaine/Capsaicin • Immune modulators • Muscle relaxants • Buprenorphine • Lowest Possible Opioid Dose If Opioids Are Part of Treatment Plan ★ Set a goal to improve function ★ Understand overdose risk and have a Naloxone Rescue Kit ★ Risk of dependence ★ Opioid Hyperalgesia ★ Digestion Challenges Tip: Managing Pain We can not cure pain but we can manage it. Managing pain is like having four flat tires you have to fill all the tires to make a full life. Movement Therapies • Physical/Occupational Therapy • Graded activity exposure • Exercise/Endurance • Warm Pool/Pool Exercise Integrative Therapies • Massage, Counterstrain • Chiropractic, Acupuncture • Supplements, Anti-inflammatory diet • Yoga, Tai Chi, Qigong • Mindfulness
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    Overview: Pain Management Understanding Pain the Basics… Pain is in the brain, not your head We can unwire the pain brain… We can help our brain have less pain or more pain Pain impacts the whole person • Fight/Flight/Stress • Pain with movement •Change is diet • Sexual health • Medication impacts e.g. constipation • Immune response • Insomnia • Concentration • Depression • Anxiety • Fear about future • Beliefs about self • Emotional overwhelm • Fear of movement • Thinking & attitude • Family relationships • Difficulty keeping appointments • People not understanding • Social isolation • Loneliness • Challenges working Biologically Psychologically Socially ★ You are not making up your pain. ★ All sensations are created in the brain. ★ When pain is chronic it is an illness to itself. ★ Neuroplasticity is how the brain re-wires & pain rewires the brain. The brain can become wired for pain. 1. Practice pain tolerance 2. Exercise regularly 3. Improve your sleep 4. Set personal goals 5. Manage your stress 6. Take medications as prescribed. 1. Stress and poor diet 2. Not exercising 3. Poor sleep 4. Over reliance on medications 5. Depression, Anxiety or other Mental Health challenges 6. Social Isolation While we can’t stop all pain we can help our brain rewire away from pain. Three Basic Tools… 1. Accept some pain, 2. Strengthen your body, 3. Manage your pain (not control pain). + Increases Pain- Decreases Pain
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    Overview: Pain Management Pain Matters: Reducing Risk Managing Pain Managing pain requires more then medications it requires an integrative approach. Medications are one tool in the tool kit. Learning skills, understanding pain and building a plan can help you take your power and life back from pain. One in 10Americans Experience Chronic Pain. Effective pain management of pain can improve quality of life and reduce pain. While opiate deaths are rising. There have been increased tools and skills for managing pain. It is possible to manage pain while reducing risks.
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    Overview: Pain Management Naloxone Rescue andSafety Advice for Patients and Families
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    Overview: Pain Management Naloxone Rescue andSafety Advice for Patients and Families
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    Pain: Medication Management Pain Medications andPain Pathway ★ Pain medications, physical therapy and behavioral health intervention effect different parts of the pain pathway. ★ Not all medications treat all kinds of pain. ★ Finding the right combination of medications, developing functional goals and other interventions can help your pain. Pain Transmission: Pain has to be transmitted up the spinal-chord to reach the brain. Multiple medications impact pain transmission. ★ Nerve Blocks: Nerve blocking injections can block pain information locally reaching the spinal chord. ★ SSRIs: Increase serotonin which helps the brain perceive less pain and help the brain tell the body to turn off the pain signals. ★ Alpha 2 Agonists: Were first found to treat hypertension/high blood pressure but have been found to have an impact on pain. Pain Perception: Multiple medications can effect pain perception and pain in the brain. ★ Tricyclics (TCA): Medications help the brain produce and perceive less pain. ★ SSRIs: Increase serotonin which helps the brain perceive less pain and help the brain tell the body to turn off the pain signals. ★ Alpha 2 Agonists: Were first found to treat hypertension/high blood pressure but have been found to have an impact on pain. ★ Opiate Medications: Opiate medications work on the internal opioid system and effect pain perception through slowing down the functioning in the brain. Pain Signal from Pain Source: Pain can be generated from a local source in a body part. There are medications that help block the signals from the body getting to the spinal chord. ★ Anticonvulsant Medications: Slow the firing of pain neurons and reduce the pain signal getting to the brain. ★ Capsaicin: Creams that use capsaicin can block the communication of pain from the skin to the spinal chord. ★ Local Anesthetics: These medications can reduce pain signal from tissue near the surface of the body. ★ NSAIDs: Reduce inflammation in the body and reduce the pain signal to the brain.
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    Pain: Interventions and Devices Some people benefit from pain interventions. Interventional medicine uses tools that interrupt the flow of pain on the pain pathway. Interventional Medicine andPain Trigger point injection (TPI) may be an option for treating pain in some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax Nerve blocks can be temporary or longer-lasting. Health care providers may give them with local anesthesia after numbing where the needle enters the skin. They can also block pain signals to an area by deliberately cutting or destroying certain nerves surgically. Nerve blocks can health with lower back pain, facial pain, arthritis, headaches and chronic regional pain syndrome. ★ Sympathetic blockade The health care provider gives a drug to block pain from the sympathetic nervous system in one particular area. ★ Neurectomy A damaged peripheral nerve is surgically destroyed. ★ Rhizotomy The surgeon destroys the root of the nerves that extend from the spine. ★ Epidural analgesia or anesthesia The health care provider may inject medicine outside the spinal cord. ★ Spinal anesthesia or analgesia The health care provider may inject medicine in the fluid surrounding the spinal cord. ★ Peripheral nerve blockade The health care provider may inject medicine around a target nerve. Non-Surgical Interventions Surgical Interventions
  • 27.
    Pain: Interventions and Devices TENS, or transcutaneouselectrical nerve stimulation, is a back pain treatment that uses low voltage electric current to relieve pain. TENS is typically done with a TENS unit, a small battery-operated device. The device can be hooked to a belt and is connected to two electrodes Pain Medicine Device - TENS TENS – What does the research say? ★ TENS can help relieve pain in a flare up and can reduce pain in the moment. ★ TENS has limited impact on stopping pain in the long-term but it can be an effective part of providing pain relief.
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    Pain: Integrative Treatments People have usedcomplementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Chiropractic How it Works… Chiropractic: In Depth | NCCIH – https://nccih.nih.gov/health/chiropractic/introduction Chiropractic is based on the notion that the relationship between the body's structure (primarily that of the spine) and its function (as coordinated by the nervous system) affects health. Spinal adjustment/manipulation is a core treatment in chiropractic care, but it is not synonymous with chiropractic. ☀ Studies have shown that spinal manipulation can provide mild-to- moderate relief from low-back pain and appears to be as effective as conventional medical treatments. ☀ Results from one trial that examined long-term effects in more than 600 people with low-back pain suggest that chiropractic care involving spinal manipulation is at least as effective as conventional medical care for up to 18 months. What the Research Says…
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    Pain: Integrative Treatments People have usedcomplementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Acupuncture How it Works… Acupuncture: In Depth | NCCIH – https://nccih.nih.gov/health/acupuncture/introduction Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. It is one of the practices used in traditional Chinese medicine. ☀ Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. ☀ It also may help reduce the frequency of tension headaches and prevent migraine headaches. ☀ Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. ☀ Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious side effects. What the Research Says…
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    Pain: Integrative Treatments People have usedcomplementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Massage Therapy How it Works… Massage: In Depth | NCCIH – https://nccih.nih.gov/health/acupuncture/introduction ✙ The term “massage therapy” includes many techniques, and the type of massage given usually depends on your needs and physical condition. ✙ Massage therapy dates back thousands of years. References to massage appear in ancient writings from China, Japan, India, and Egypt. ✙ In general, massage therapists work on muscle and other soft tissue to help you feel better. ✙ In Swedish massage, the therapist uses long strokes, kneading, deep circular movements, vibration, and tapping ☀ A lot of the scientific research on massage therapy is preliminary or conflicting, but much of the evidence points toward beneficial effects on pain and other symptoms associated with a number of different conditions. ☀ Much of the evidence suggests that these effects are short term and that people need to keep getting massages for the benefits to continue. ☀ A 2008 research review and 2011 NCCIH-funded clinical trial concluded that massage may be useful for chronic low-back pain. ☀ Massage may help with chronic neck pain, a 2009 NCCIH-funded clinical trial reported. ☀ Massage may help with pain due to osteoarthritis of the knee, according to a 2012 NCCIH- funded study. What the Research Says…
  • 32.
    Pain: Integrative Treatments People have usedcomplementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Yoga How it Works… Yoga: In Depth | NCCIH – https://nccih.nih.gov/health/acupuncture/introduction Yoga is a mind and body practice with historical origins in ancient Indian philosophy. Like other meditative movement practices used for health purposes, various styles of yoga typically combine physical postures, breathing techniques, and meditation or relaxation. ☀ One NCCIH-funded study of 90 people with chronic low-back pain found that participants who practiced Iyengar yoga had significantly less disability, pain, and depression after 6 months. ☀ In a 2011 study, also funded by NCCIH, researchers compared yoga with conventional stretching exercises or a self-care book in 228 adults with chronic low-back pain. The results showed that both yoga and stretching were more effective than a self-care book for improving function and reducing symptoms due to chronic low-back pain. ☀ Conclusions from another 2011 study of 313 adults with chronic or recurring low-back pain suggested that 12 weekly yoga classes resulted in better function than usual medical care. What the Research Says…
  • 33.
    Pain: Integrative Treatments People have usedcomplementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Anti-Inflammatory Diet How it Works… Ricker, M. A., & Haas, W. C. (2017). Anti-Inflammatory Diet in Clinical Practice: A Review. Nutrition in Clinical Practice, 32(3), 318-325. ★ There has been an increase in the research regarding the impact of acute and chronic inflammation on health and disease. Specific foods are now known to exert strong effects on inflammatory pathways within the body. ★ Carefully selecting foods that are anti-inflammatory in nature while avoiding foods that are proinflammatory is central to an anti-inflammatory diet plan. ★ Ultimately, the plan models a pattern of eating that (1) focuses on eating whole, plant- based foods that are rich in healthy fats and phytonutrients and (2) maintains a stable glycemic response. ☀ A study of black cumin experimental group (n = 30) and control group (n = 30). This study found a significant but small reduction in pain after 30 days of daily ingestion. ☀ The types of omega-3s found in seafood and fish oil may be modestly helpful in relieving symptoms of rheumatoid arthritis and decreasing patients’ need for nonsteroidal anti- inflammatory drugs. ☀ While research is still early there are solid theoretical reasons that reducing inflammation could reduced pain. Inflammation is a primary driver in many forms of pain ☀ Salmon, tuna, trout, mackerel and herring are high in these fats. Soy-based foods, walnuts, pecans and ground flaxseed are also good sources of omega-3 fats. Colorful fruits and vegetables, such as leafy greens, avocados, beets and berries, are rich in antioxidants. What the Research Says…
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    Pain: Integrative Treatments People have usedcomplementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Tai Chi and Qi Gong How it Works… Tai Chi and Qi Gong: In Depth | NCCIH – https://nccih.nih.gov/health/taichi/introduction.htm Tai chi and qi gong are centuries-old, related mind and body practices. They involve certain postures and gentle movements with mental focus, breathing, and relaxation. In contrast to qi gong, tai chi movements, if practiced quickly, can be a form of combat or self-defense. ☀ Practicing tai chi may help to improve balance and stability in older people and in those with Parkinson’s disease, reduce back pain and pain from knee osteoarthritis, and improve quality of life in people with heart disease, cancer, and other chronic illnesses. ☀ Tai chi and qi gong may ease fibromyalgia pain and promote general quality of life. Tai chi also may improve reasoning ability in older people. ☀ Qi gong may reduce chronic neck pain, but study results are mixed. ☀ Results of a 2012 randomized clinical trial with 100 participants suggested that practicing qi gong reduced pain and improved sleep, the ability to do daily activities, and mental function. The researchers also observed that most improvements were still apparent after 6 months. ☀ In people who had low-back pain for at least 3 months, a program of tai chi exercises reduced their pain and improved their functioning. What the Research Says…
  • 35.
    Pain: Integrative Treatments People have usedcomplementary and alternative medicine (CAM) practices for thousands of years in pursuit of health and well-being. CAM therapies and medical systems are widely used and available in the United States. They include diverse products and practices such as dietary supplements and botanicals, traditional Chinese medicine, acupuncture, mind-body medicine, and therapeutic massage. (National Institute for Health) Meditation How it Works… Meditation: In Depth | NCCIH – https://nccih.nih.gov/health/meditation/overview.htm ★ Meditation is a mind and body practice that has a long history of use for increasing calmness and physical relaxation, improving psychological balance, coping with illness, and enhancing overall health and well-being. ★ There are many types of meditation, but most have four elements in common: a quiet location with as few distractions as possible; a specific, comfortable posture (sitting, lying down, walking, or in other positions); a focus of attention (a specially chosen word or set of words, an object, or the sensations of the breath); and an open attitude (letting distractions come and go naturally without judging them). ☀A small 2016 study funded in part by the National Center for Complementary and Integrative Health (NCCIH) found that mindfulness meditation does help to control pain and doesn’t use the brain’s naturally occurring opiates to do so. ☀This suggests that combining mindfulness with pain medications and other approaches that rely on the brain’s opioid activity may be particularly effective for reducing pain. ☀In another 2016 NCCIH-funded study, adults aged 20 to 70 who had chronic low-back pain received either mindfulness-based stress reduction (MBSR) training, cognitive-behavioral therapy (CBT), or usual care. The MBSR and CBT participants had a similar level of improvement, and it was greater than those who got usual care, including long after the training ended. ☀The researchers found that participants in the MBSR and CBT groups had greater improvement in functional limitation and back pain at 26 and 52 weeks compared with those who had usual care. What the Research Says…
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    ★ Help ourbody regain strength or build strength that has deconditioned due to pain ★ Rebalance muscle patterns that can cause pain ★ Move more efficiently and with less pain ★ Develop healthier relationship with our body ★ Help you move with out or less fear and have better balance ★ Movement therapies can help rewire the brain away from pain. ★ By growing new brain paths ★ Developing new skills ★ Reducing pain through understanding pain neuroscience. ★ Learn to use movement aids like canes, walkers or bars in home ★ Get the right assistive devices for your life ★ Pool and water strengthening classes ★ Devices like TENS that can reduce pain ★ Mirror therapies or ways to reduce headaches ★ Hand therapy Pain: Movement Based Therapies Movement Therapy Chronic Pain Pain changes how we move. It changes how we feel in our body and how we do daily activities. Movement therapies can transform pain in multiple ways.
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    Pain: Movement Based Therapies Physical Therapy: Howit Works ★ Physical therapists partner with patients, their families, and other health care professionals to manage pain, often reducing living a more functional enjoyable life with less medication or side effects ★ Physical Therapy helps to reduce pain and improve function in low back pain and can improve global well- being and physical function in fibromyalgia. Avoid surgery. If physical therapy helps you eliminate pain or heal from an injury, surgery may not be needed. And even if surgery is required, you may benefit from pre-surgery physical therapy. Recover from a stroke. It’s common to lose some degree of function and movement after stroke. Physical therapy helps strengthen weakened parts of the body and improve gait and balance. Improve your balance and prevent falls . When you begin physical therapy, you will get screened for fall risk. If you’re at high risk for falls, therapists will provide exercises that safely and carefully challenge your balance as a way to mimic real-life situations. Improve mobility. If you’re having trouble standing, walking or moving— no matter your age—physical therapy can help. Stretching and strengthening exercises help restore your ability to move. Recover from or prevent a sports injury. Physical therapists understand how different sports can increase your risk for specific types of injuries (such as stress fractures for distance runners). Reduce or eliminate pain Therapeutic exercises and manual therapy techniques such as joint and soft tissue mobilization or treatments such as ultrasound, taping or electrical stimulation can help relieve pain and restore muscle and joint function to reduce pain. https://www.burke.org/blog/2015/10/10-reasons-why-physical-therapy-is-beneficial/58
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    Pain: Movement Based Therapies Occupational Therapy: Howit Works ★ The primary goal of occupational therapy is to enable people to participate in the occupations of everyday life. ★ Occupational therapists who work with people of all ages and abilities to do the things they need and want to in all aspects of life, e.g. taking care of oneself and others, working, volunteering & participating in interests. ★ Occupational therapists call these things “occupations”. http://aboutoccupationaltherapy.com.au/what-does-an-ot-do/ Daily Life: Pain impacts our activities of daily living. Self- care activities such as showering, dressing, grooming and eating. Occupational therapy can help Different Abilities: Occupational therapists work with people who experience difficulties present in both physical disability and mental health services. Functioning: Household and community functioning: Home maintenance, driving, budgeting, shopping and community mobility Work (paid and unpaid): Participating in employment and volunteer activities Social participation: Interacting positively with others in the community Education: Activities which allow a person to participate effectively in a learning environment Assistive Devices: Occupational therapists are also able to assess and recommend assistive technology and/or environmental modifications that will assist individuals to engage in the occupations of everyday life. Leisure and Play: We need to have a life that matters to us even when we have pain. Occupational therapy can help you find ways to do what you enjoy. Occupational Therapists: are experts in the relationships between what people do and their health and well-being, and work with people to help make every day living easier.
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    Pain: Movement Based Therapies ★ Pain changes how we move. ★ Research shows that people who exercise regularly are better able to cope with pain and the stress of chronic pain. People with chronic pain can begin to fear and avoid moving. ★The fear of avoiding can lead to people deconditioning. When the body deconditions we have more pain. ★ On a good day there is a tendency to do too much and end up down with pain for days. This can lead to more fear of movement and more deconditioning. Pain Benefits of Exercise Start Where You Are: Starting to exercise does not have to be hard. Even short amounts of walking or moving can change your health. Do what works for you. Anaerobic Exercise Weightlifting Sprinting Interval Training Climbing Aerobic Exercise Walking Jogging, Biking Swimming Elliptical Stretching Yoga, PT Exercises Gentle Stretching Range of Motion Exercise Helps Mood/Depression Anxiety/Stress Chronic Pain Physical Health Sleep
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    Pain: Medically Assisted Treatment Buprenorphine: Is an opioid medication that treats pain and opioid addiction. Buprenorphine is a safer medication then many opiates and reduces risk of overdose. It also does not impact thinking to the same degree as other opiate medications making it easier for people to lead their lives. People who take buprenorphine report improvement in the quality of their lives. Medically assistedtreatment Medically Assisted Treatment (MAT) – Is medication management of opiate use disorder. The medications used in treating opiate use disorder also can help treat pain. All people who take opiates experience tolerance and withdraw. Opiate use disorder happens to people in all walks of life. Medically Assisted Treatment uses medications to help reduce withdraw, manage pain and save lives. Methadone: Is a long acting opioid medication that helps treat both pain and opiate use disorder. It is a long-acting opiate medication. This medication can not be prescribed for opiate use disorder in primary care and needs to be administered in a treatment facility. Methadone has been found to reduce risk of overdose and help maintain quality of life. Naltrexone: Is non-addictive and works by blocking the heightened euphoric response to opiate medications. This medication can help reduce cravings as well as manage pain.
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    Pain: Medically Assisted Treatment Medically assisted treatment Whilemedically assisted treatment can be effective with out counseling, It is still suggested that those receiving medically assisted treatment attend counseling groups or individual counseling. Medically Assisted Treatment helps manage opioid withdraw and reduces the risk of overdose.