PAIN MANAGEMENTMontana University System Wellness

Neal Andrews & Cristin Stokes

September 2014

PREDICTION: PAIN

PREDICTION: PAIN• Around 100 million Americans affected by some sort of chronic pain.

• Arthritis affects 27 million Americans

• $128 Billion a year in health care and lost wages/productivity.

• Women over age 55 most susceptible.

• Pain is subjective, pain thresholds vary, and thus pain is hard to measure or quantify.

• Undertreatment of chronic pain creates large costs to the healthcare system and the U.S. economy; we spend more than $560 billion in the U.S. each year on chronic pain-related healthcare costs.

• 77% of survey respondents said they had employed a medical or health professional to help with their pain. Good job!

• Untreated pain can change brain chemistry and regular CNS pathways, disrupting normal psychological and social functions. Serious physical and emotional burdens can result.

WHAT ARE WE TALKING ABOUT?

• There are a lot of drug options available, and new drugs are being developed all the time.

• Talk with your doctor

• Drugs come with side effects

• We can’t heal everyone’s pain in a one hour webinar, but we’ll focus on non-drug strategies and resources you can utilize as part of your Pain Management Plan.

• You’re not alone!

WHERE DOES IT HURT?

• Early results from MUS Population Well-Being Assessment.• Headache 19%

• Arthritis 11%

• Joint Pain 16%

• Chronic Pain 6%

• Back Health* 8% High Risk, 20% Moderate Risk• *Higher than national averages

WHERE DOES IT HURT?

UNDERSTANDING AND TRACKING

• Pain is subjective, and people’s pain tolerances vary.

• Tracking and/or journaling about pain helps you and your health care provider better understand which modalities are effective.

TYPES OF PAIN• Acute

• Keeps us safe!

• Acute pain signals the brain that there is a danger or problem

• Subsides when injury is healed

• < 3-6 months

• Chronic

• Pain that persists continuously after an injury has healed, or source of pain removed.

• Neural pain pathways do not “quiet down”

• Neurons in the spinal cord become hyperactive

• Pain messages processed differently in the brain

• Even the touch of a feather can be perceived as exceedingly painful

• Potentially permanent structural changes in brain areas involved in pain perception

• > 3-6 months

TYPES OF PAIN

• Nociceptive: What we typically think of when we consider pain (i.e. paper cut, stubbed toe)

• Neuropathic: Caused by disease in the nervous system (i.e. diabetic neuropathy)

• Inflammatory: Caused by release of mediators at site of injury or by autoimmune condition

• Often involved with nociceptive & neuropathic

• Other: cancer pain, migraines, fibromyalgia, etc.

PAIN AND INFLAMMATION

• Inflammation is the body’s natural response to injury and disease.

• Swelling

• Stiffness

• Redness

• Heat

• PAIN

• Protects the body and begins the healing process

• Induced by chemical messengers (enzymes such as COX-2, proinflammatory cytokines, reactive oxygen species, etc)

• Post injury or trauma, managing inflammation is tied to managing pain.

PAIN AND INFLAMMATION

• -ITIS: inflammation of. Usually chronic.• Arthritis

• Bursitis

• Tendonitis

• Bronchitis

EAT RIGHT

• COX-1 and COX-2 mediators

• Responsible for production of prostaglandins

• “Good”prostaglandins

• “Bad” prostaglandins = pain & inflammation

• Certain foods can decrease the activity of COX-2 & production of “bad” prostaglandins

• Example: Oleocanthal in olive oil works in the same way as NSAIDS (ibuprofen)

• Prostaglandins derived from fatty acids

• Diet can be an important tool for treatment of inflammation, particularly in inflammatory diseases such as rheumatoid arthritis, MS, inflammatory bowel disease

EAT RIGHT

• Foods that demonstrate anti-inflammatory properties

• Omega-3 fatty acids

• Increase “good” prostaglandin production

• Fatty fish (salmon, tuna, sardines, mackerel), walnuts & walnut oil, ground flaxseed, canola oil

• Tart cherries, apples, blueberries, raspberries

• Ginger

• Turmeric - curcuminoids

• Olive oil

• Onion

EAT RIGHT

• Foods that demonstrate pro-inflammatory properties

• Omega – 6 fatty acids

• Increase production of “bad” prostaglandins

• Vegetable oils, processed foods

• Trans fats

• High glycemic foods (i.e. refined grains)

• Whole food, plant based diet can aid in healing and help to decrease pain

• Many antioxidants & phytochemicals intimately tied to inflammatory processes

• Vegetables, fruits, whole grains, plant proteins

• More omega-3 fatty acids; fewer omega-6 fatty acids

MOVE IT!

• The overwhelming theme in the treatment of most persons with chronic pain is to keep as physically active as possible. In fact, advancement of activity levels and education is recommended, as inactivity is detrimental despite the temporary relief of symptoms that often accompanies it.

• There is strong evidence that exercise programs are beneficial for persons with chronic pain. After consultation with a physician and/or physical therapist, a therapeutic exercise program should be initiated at the start of any chronic pain treatment program. Such programs should emphasize education, independence, and the importance of an on-going self-directed exercise regimen.

• From American Chronic Pain Association www.theacpa.org

MOVE IT!

• Movement naturally lubricates joints.

• Movement causes the release of synovial fluid, which lubricates and brings nutrition to the joint.

• Every joint has a natural range of motion (ROM). Movement through a full ROM allows for correct movement patterns, full recruitment of associated musculature, and minimizes compensation patterns which can lead to overuse, injury, and more pain.

• These reasons are why most physical therapy programs begin with trying to increase ROM in the affected areas.

MOVE IT!

• Resistance Training• Lack of strength can lead to many causes of pain.

• Lack of core strength may lead to lower back complications.

• Lack of mobility + lack of strength = Decay.

MOVE IT!

• Persons with chronic pain can become discouraged when their pain temporarily increases due to therapeutic exercise, and they will sometimes terminate treatment too early before achieving maximal benefit. A flare-up of pain with exercise should be expected even with safe exercise, but can also be due to poor body mechanics, guarded or stiff movement, high levels of demand on an injured site, or compensatory movements. It is important to have a health care professional knowledgeable about treating chronic pain to assist not only with setting up a graded and careful exercise program, but also to assist with distinguishing new symptoms that may signify problems from the “good” discomfort that normally goes along with an increasing exercise program.

• From ACPA

MOVE IT!

• More Exercise Benefits• Mood boosting

• Increased Circulation (Healing)

• Stress Relief

• Can enhance sleep

• Exercise sends signal to body, “Hey, I need you. Let’s do this.”

• Growth & Renewal

• Mind/Body connection• For more reading, check out Younger Next Year, Chris Crowley & Henry Lodge

COOL OUT

• Stress can exacerbate pain and decrease our ability to deal with pain

• Tense muscles can contribute to migraines/headaches, muscle knots, etc.

• Anxiety tied closely to GI function

• Positive emotions result in diminished perception of pain

• Bottom line: Stress management is a vital component to pain management!• Watch our archived stress management webinar:

http://wellness.mus.edu/Webinars.asp

COMPLEMENTARY & ALTERNATIVE MEDICINE

COMPLEMENTARY & ALTERNATIVE MEDICINE

• Acupuncture

• Research evidence supports acupuncture for treatment of low-back pain, neck pain, osteoarthritis pain, and reduction in frequency of tension headaches and migraines

• Chiropractic treatment/spinal manipulation

• Studies support efficacy for acute & chronic low back and neck pain

• Covered by MUS insurance

• Massage

• Transcutaneous electrotherapy

• Tai Chi

• Yoga

• Mind-Body Techniques

• Meditation, guided imagery, biofeedback, hypnosis, relaxation

COMPLEMENTARY & ALTERNATIVE MEDICINE

• Hot & Cold Therapy

• ICE-R

• Ice, Compression, Elevation & Rest for acute injury and anti-inflammation

• Heat

• For therapeutic modality

• Increases circulation

• Aids in mobility

• Relieves muscle tension, stiffness, soreness

PSYCHOLOGICAL TREATMENT

• Mental health counseling

• Aimed at improving coping mechanisms

• Chronic pain associated with increased risk of depression

• 25-50% of people who experience chronic pain also report being depressed

• MUS insurance plan members eligible for 4 free mental health counseling sessions per plan year

QUICK HELP LISTS FOR TOP 3

• Headache• Treatment depends on type of headache. Causes of headache are numerous. Can

be a symptom of some other condition, or like much low-back pain, there is no clear cause.

• General recommendations for both tension & migraine headache prevention

• Keep a headache diary to identify triggers; then avoid the triggers

• Stay hydrated

• Limit caffeine/keep intake consistent

• Reduce stress

• Evaluate work posture and take breaks from screen time

• Don’t skip meals

• Get adequate sleep

• Don’t overuse headache medications due to risk of rebound headaches

QUICK HELP LISTS FOR TOP 3

• Joint Pain/Arthritis • Move, move, move

• Appropriate exercises

• Work on ROM

• Anti-inflammatory diet

• Physical or Occupational Therapy

• Complementary & Alternative Treatments

• Massage & Self Massage

• Heat

• Meditation

QUICK HELP LISTS FOR TOP 3

• Spine: Low Back & Neck• Move, move, move

• Increase Hip and Shoulder mobility

• Strengthen Core (low-back)

• Utilize correct movement patterns—especially correct lifting techniques

• Heat is a great tool for neck & back pain relief

• For intense and/or chronic pain, get it diagnosed!

KEEP CALM & CARRY ON!

• You are not alone!• Have a support team, including family, friends, and medical or health

professionals.

• There are many forms of treatment & strategies. Track, journal, and pick the ones that work best for you!

• Have a plan, work the plan.

RESOURCES

• American Chronic Pain Association (ACPA)

• www.theacpa.org

• Mayo Clinic

• www.mayoclinic.org

• Arthritis Foundation

• www.arthritis.org

• Pain Matters, premiers on Discovery Channel November 16th.

• Watch it online now at www.painmattersfilm.com

UP NEXT

• Fall Wellcheck Tour!

• “I don’t have Time for this Webinar!”

• Time Management Webinar

• Thursday, November 18th

• Incentive Program, you just earned 5 points!