Put a L.I.D. on Pain …Naturally - ASPMN Conference Documents/Handouts/Fri… · • Supports...

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© 2015, Karen Kowal, RN, LMT, NCBTMB

Copyright © MEDINC Edu 2015

Put a L.I.D. on Pain …Naturally

The many Issues of Pain & Importance of Management


The 25 year journey

“Is Pain a Public Health Crisis?”


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Nursing Role: CAM & Pain Management

Multimodal Therapies to Manage pain ‐More than Just Opioids

• On front line of healthcare• All nurses are pain management nurses

– Rest– Ice and/or heat– Repositioning– Topical OTC medications– Diversion

• Music, reading, prayer, meditation• Acupressure, simple relaxation techniques, yoga, aromatherapy,trial OTC pain meds

– Referral for PT, acupuncture, massage, home exercise programs – ASPMN June 17, 2015 Statement Paper


5 Pillars of CAM / CIM


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Science of Thermal Therapy


• Decreases pain (Gate Theory ‐ 1965 Melzack & Wall) suggests that the spinal cord contains a neurological “gate” that either block pain signals or allows them to continue on to the brain. Unlike an actual gate, which opens and closes to allow things to pass through, the "gate" in the spinal cord operates by differentiatingbetween the types of fibers carrying pain signals. Pain signals traveling via small nerve fibers are allowed to pass through, signals sent by large nerve fibers are blocked.

• Accelerates healing

– Increases blood flow (vasodilation), capillary pressure and Oxygen profusion)

– Increases concentration of WBC’s and antibodies to injured area

• Supports immune system

– Facilitates movement of cellular debris /increased cell membrane permeability

– Lymphatic response is increased


Science of Thermal Therapy

• COMFORT

– Decreases stress, anxiety, tension & sympathetic nervous system activity

– Relaxation Response

– Improves sleep

– Activated heat receptors that block chemical messengers causing pain detections

– Triggers release of endorphins, oxytocin and more

• Improves ROM & flexibility

– Softens connective tissue, moves ground substance from ‘gel to sol’ consistency (fascia, tendons, ligaments, etc)

– Softens, relaxes, lengthens muscle fibers

– Helps soften scar tissue

– Treats fascial planes ‐ Decreases pain patterns

• Emotional & Psychological benefits

• Self‐Care ‐Weight provides conforming gentle compression, acupressure

• Self‐Care ‐ Counter‐pressure

• Use for general or specific treatment anywhere, anytime

A Self‐Care Modality combining …Stretching techniques with heat

Specific positioning

Acupressure

Counter‐pressure

Sequencing techniques

Directed /shearing compressions (broad / specific)

Exhaling during relaxed stretches will enhance outcome!


How Putting a L..I.D. on Pain Works

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L.I.D. …Why it makes sense!

• LOCATION– Position pillow on you … or you on pillow– Locate tender, stiff or painful region– Move so heat touches tender points– Position is dependent on accessing cause of pain– Hit the ‘spot’ and instant relief!!!!

• Impingement• Congestion• Adhesions• Trigger Points• Muscle spasms• Attachment of tendons / ligaments / periosteum


• INTENSITY – Stretch, rock or lean towards flax pillow to access specifictender point / region

– Go slowly– Use your breath ‐ exhale with the ‘stretch’– Relax as guarding & tense muscles counterproductive– Do not take into deep pain…maintain the ‘yummy’ factor

• DURATION– Compression & heat eliminates pain, restoring ROM– Do not bounce or go fast– Repeat over area several times– Repeat as needed


L.I.D. …a Self‐Care Option

Heat, ‘Yummy Factor’ & Self‐Care

• Heat – focuses on relief

• Finding the culprit

• ‘Yummy Factor’ is positive

• Validates

• Supports Self‐Care


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• Shift from only biomedical and disease‐centered focus

– Pharmaceutical

– Surgical interventions / approaches

– Referral to rehab or specialists

• …to Increased focus Integrating approaches)

– Wellness

– Prevention

– Improving QOL

– Holistic approach

– Living with chronic conditions

– Teaching / encouraging lifestyle changes

Trends Today


Self‐Management …the new paradigm of care

• Patient self‐management is inevitable

• Provider’s role is a partnership with patient

• Professionals are experts about diseases

• Patients are experts about their own lives

• Clinical outcomes are dependent on

patient actions

• Shift to teaching self‐management & Self‐Care


Integrated Interventions

• Samueli Institute and Health Forum – “2010Complementary and Alternative MedicineSurvey of Hospitals”

• 42 questions, mailed to 5,838 USA hospitals

• 714 responses (12%)

• 42% of the 714 hospitals offer CAM


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Survey Says…42% Offer CAM Options

• Outpatient

– Massage – 64%

– Acupuncture – 42%

– Guided imagery – 32%

• Inpatient

– Pet therapy – 51%

– Massage Therapy 44%

– Music/art therapy – 37%


Top CAM services in Outpatient & Inpatient care

• CAM services more on outpatient basis

• Focus on

– preventive care

– chronic ailments

• Downside

– self‐directed

– lack of true integration into patients’ course ofcare

– communication gap between CAM provider &patient’s PM


Identify need for safe, cost‐effective non‐pharm intervention for pain management

Back Pain, FMS & Menopause Symptoms

– Insurance claims reviewed / 4yr in State of WA


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What Does Massage Do?

• Massage used

– to relieve common symptoms of many types ofarthritis

– reducing pain and stiffness

– easing anxiety

– improving ROM

– promotes restful sleep


Massage Therapy & Bodywork

• Licensing

– 46 states – 250 – 1000 hrs requirement

– 3 of these States have 2 tier requirements

– 6 states by municipality

• Liability Insurance

• Ongoing CE’s for License Renewal Required

• AMTA Professional Organization

• Massage as a health‐care practice ‐ in flux


Massage TherapyRegulation

• Board of Massage and Bodywork Therapy• Board of Registration of Massage Therapy• Department of Financial & Professional Regulation• Department of Health• Department of Health & Services• Department of Health and Mental Hygiene• Department of Licensing and Regulatory Affairs• Department of Labor & Industries• Department of Public Health• Division of Occupations & Professions• Division of Professional Registration• Health and Human Services Regulation & Licensing – Credentialing Division• Massage Licensing Division• Massage Therapy Council• New Jersey Board of Nursing• Offices of Massage Therapy Registration• State Board of Massage Therapy


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Massage

• The four main outcomes for massage:• Relaxation/pleasure• Stress management• Pain management• Functional movement support.

• The three main approaches to care:• Palliative• Condition Management• Therapeutic Change.


Massage Trends…a shift in perspective

• Moving away from TP and ‘Deep Massage’• Dermoneuromodulation (DNM)

– dermo (skin)– neuro (nervous system) – modulation (change)

• Gentle method to resolve pain, regain function• Developed by Diane Jacobs, PT (Canada) specializing inpain science

• Touching the skin to interact with the nervous system and effect change.

• DNM is a pain‐free technique that places little physicaldemand on the client or the therapist


Massage Therapy Challenges

• Challenge is separating skills– Medical

– Specific

– ‘Spa’

– Energy work

– ‘Sham’ techniques

– Poorly defined for public understanding

– Especially critical as often patient‐directed

– Some offer ‘placebo’ affects?

– Research slowly increasing… but challenged


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1. Traps, Levator Scapulaand those tension‐filled shoulders!

• Fibromyalgia (FMS)

• RSS

• Computer‐strain injury

• Whiplash

• Arthritis

• Positioning / support

• Agitation ‐ Autism/Alzheimer’s/TBI

• Post‐Op spinal surgeryCopyright © MEDINC Edu 2015


2. Above the Shoulders

• TMJ pain and release

• Masseter release

• Dental pain

• Ear pain

• Bell’s Palsy

• Stroke / positioning


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3. Cervical Region

• Support / recliner/ car

• Whiplash

• Sleeping position

• Create gentle traction

• Improve airway



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4. Anterior Chest, Pecs

• Fibromyalgia

• Asthma / congestion

• Post whiplash

• Post‐op breast surgery

• Reduce constriction, contraction

• Improved respirations (abdominal breathing)Copyright © MEDINC Edu 2015


5. Shoulder Girdle


• Rotator cuff injury

• Pre & Post‐op rehab

• Arthritis

• Painful adhesions

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6. Mid‐Thoracic, Medial scapulae

• Painful mid‐back

• Frozen shoulder

• Medial scapular pain

• Thoracic stretches

• Spasms / fractured ribsCopyright © MEDINC Edu 2015


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7. Lats, Serratus & Teres

• Post fractured ribs

• Frozen shoulder

• Adhesions

• Strain / spasm



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8. Sacrum, Pelvis Rim & SI Joint

• Counter‐pressure support over sacrum

• Chronic LBP ‐low back pain

• SI joint pain

• Sacral pain



9. Coccyx, Piriformis, Hamstrings


• Coccyx trauma/inflammation

• Piriformis syndrome pain

• Hamstring spasm/pain

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11. Tensor Fascia Latae & IT Band


• Hip pain / Trochanter

• Tight IT Band

• Triggerpoint release


12. Shin Splints and Ankles


• Shin splints

• Edema lower extremities

• Sprains/strains/FX rehab

• Reduced ROM

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• Ear pain• Cervical• Sternum• Over heart• Axillary• Scapula• Piriformis / Ischial Tuberosity• Coccyx• IT Band• Anterior leg & ankle


Comfort Heart for Drug‐Free Relief

• Cardio‐Thoracic ‐ Post‐Op & home care• Seniors with chronic pain ‐ hot/cold & breathe work• Halo Traction ‐ post‐op pain & support• Sickle Cell Pain ‐ heat + compression• Hospice & End‐of Life ‐ pain, comfort & warmth• Family Caregivers ‐ pain, stress• Oncology Dept ‐ pain, positioning• Alzheimer’s & dementia ‐ pain, agitation, gentle ‘restraints’• Autism ‐ agitation, behavioral interventions

Are you interested in Research? Contact [email protected] Include the focus of your

research and receive a product you wish to test for a nominal cost. We ask to receive feedback about the outcome of your results and research.


Studies & Research

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More Research is Needed…

PTSDLabor & DeliverySickle CellMigrainesEmergency RoomTeaching Self‐Care with Heat – Group sessionsHospiceCancer Heat over tumor with Flax Pillows Chronic SinusFibromyalgiaRaynaud’s… and so much more!

Are you interested in Research? Contact [email protected] Include the focus of your research

and receive a product you wish to test at a nominal cost. We ask to receive feedback about the outcome of your results and research.


• Microwave– Know power, read directions

– Length of time for heating

– Pros & cons

– DO NOT OVER HEAT!!!!!

• Hot towel cabi– Know proper specs

– Pros & cons

– 160 ° constant Temp


Heating Protocol

ACCAHC.ORG

• councils of colleges and schools, accreditingagencies, and certification & testing organizations

• licensed & accredited integrative professions

– acupuncture & Oriental medicine

– chiropractic

– home birth midwifery

– massage therapy

– naturopathic medicine


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PAINS Never Only Opioids(a Publication)

• Policy Brief and PainRecommendations– Members of ACCAHC’s Task Force on Integrative Pain Care

– 40‐organization coalition

• The Case for Early Use of NonPharmacologicalApproaches and Practitioners in the Treatment of Patients with Pain


Karen Kowal, RN, LMT, NCBTMB

Creator of Thermal Connective Tissue Release Therapy

[email protected] www.KarenKowal.com

MEDINC EDUCATION Cell – 314‐378‐2613

2644 Georgia Arnold, MO 63010

#451143‐09 NCBTMB Nationally Approved CE Provider FL CE #50‐11827

If interested in a small free sample for your Thermal Therapy Research, please submit your concept as “RESEARCH REQUEST” to Mother Earth Pillows® at [email protected]

or call 800‐344‐2072


References

• Andrade, C, Clifford, P: 2001, Outcome‐Based Massage. Lippincott Williams & Wilkins, Philadelphia, PA

• Biel, Andrew: 2010, Trail Guide to the Body . Books of Discovery, Winnipeg, Canada

• Blatman, MD, Ekvall, B: 2006, The Winner’s Guide to Pain Relief. Danua Press, Cincinnati, OH

• Born, B: 2005, The Essential Massage Companion. Concepts Born, Berkley, MI

• Clay, J. Pounds, D: 2003, Basic Clinical Massage Therapy: Integrating Anatomy and Treatment.Lippincott Williams & Wilkins, Philadelphia

• Fowlie, L: 2006: An Introduction to Heat & Cold as Therapy. Curties‐Overzet, Toronto, ON

• Juhan, D: 1987, Job’s Body, A Handbook for Bodywork. Tation Hill Press, Barrytown, NY

• Nelson A, Kokkonen J: 2007, Stretching Anatomy. Human Kinetics, Champaign, IL

• Takahashi, T: 1994, Atlas of the Human Body. HarperCollins, NY, NY

• Travell & Simons’ : 1999, Myofascial Pain and Dysfunction: The Trigger Point Manual, vol 1.Maryland, Williams & Wilkins

• www.centerforpaintreatment.com ‐ Stretches developed by founder of The Academy forMyofascial Trigger Point Therapy, Tasso Spanos.

• http://theintegratorblog.com/ Newsletter for all updates about CAM/CIM info, research, legislature, conferences, breaking news

• http://accahc.org/ Information, policies for adaptation by Medical Centers for CAM Acupuncture/Oriental Medicine, Chiropractic, Midwifery. Massage Therapy & Naturopathy

• http://gilhedley.com/ Ph.D., founder of Integral Anatomy /YouTube ‐ Somanaut Channel


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Thank you!

“In my experience, the ‘Holy Grail’ of healthcare must be and CAN be Healthcare Professionals offering, encouraging & supporting integrated options for patient care which are Holistic in nature. Education about Self‐Care options and techniques will empower the individual to become increasingly active in their own recovery and healthy lifestyle. Health costs can be contained, safety increased, greater comfort attained as the quality of life is improved.” Karen Kowal


Put a L.I.D. on Pain …Naturally - ASPMN Conference Documents/Handouts/Fri… · • Supports...

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Transcript of Put a L.I.D. on Pain …Naturally - ASPMN Conference Documents/Handouts/Fri… · • Supports...