The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20,...
Transcript of The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20,...
![Page 1: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/1.jpg)
![Page 2: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/2.jpg)
The Evolution of Pain Management
October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, Neil Pearson, PT
New Science, Emerging Knowledge
![Page 3: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/3.jpg)
3
Session Overview and Objectives
Overview
• Current State - Mike
• Impact and Pain Centred Life - Mike
• Emerging Knowledge – Gillian
• Neuroplasticity and Brain perception - Gillian
• Function Driven Recovery - Gillian
• Emerging Self-Management Knowledge, Technology and Approaches – Neil
![Page 4: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/4.jpg)
4
Enduring Beliefs
1. Pain is an inevitable part of the human condition “Patient” – derived from the Latin word “patiens” which means
“one who suffers”
2. Pain is “natural” – therefore beneficial 3. Pain is essential for diagnosis – only a symptom 4. Ongoing pain means tissue damage 5. Patients with chronic pain are malingerers or have
purely psychological problems 6. Concerns/fears about opioids
![Page 5: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/5.jpg)
5
The Current State
1. Pain – acute and chronic – inadequately addressed due to cultural, attitudinal, educational, political, religious and logistical reasons
2. Inadequately treated pain has major physiological, psychological, economic and social ramifications
3. Within the capacity of most developed and some developing countries to significantly improve the treatment of pain.
“Pain Management: A Fundamental Human Right” Frank Brennan, Daniel B. Carr, Michael Cousins in Pain Medicine Vol. 105., No 1, pp 205 - 221 July 2007.
![Page 6: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/6.jpg)
6
Prevalence of Chronic Pain in Canada. Pain Res Manage 2011;16(6):445-450
![Page 7: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/7.jpg)
7
Prevalence of Chronic Pain in Canada. Pain Res Manage 2011;16(6):445-450
![Page 8: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/8.jpg)
8
Prevalence of Chronic Pain in Canada. Pain Res Manage 2011;16(6):445-450
![Page 9: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/9.jpg)
9
Prevalence of Chronic Pain in Canada. Pain Res Manage 2011;16(6):445-450
![Page 10: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/10.jpg)
10
Prevalence of Chronic Pain in Canada. Pain Res Manage 2011;16(6):445-450
![Page 11: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/11.jpg)
11
Prevalence of Chronic Pain in Canada. Pain Res Manage 2011;16(6):445-450
![Page 12: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/12.jpg)
12
People in Pain
Diverse Population:
Chronic Disease eg Cardiac disease, Diabetes, Osteoarthritis
Chronic Post Surgical Pain
Chronic Pain Post Injury eg Whiplash, Spinal Cord Injury
Chronic Headaches eg Tension, Migraine, Cluster.
Neuropathic Pain eg Post Herpetic Neuralgia, Trigemminal Neualgia
Complex Regional pain Syndrome
Recurrent Abdominal pain
Fibromyalgia
Back Pain
Post trauma/burns/stroke
Cancer
![Page 13: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/13.jpg)
13
Consequences
Person with pain:
Job loss, financial strain
Inactive, weight gain, secondary health problems
Lowest Q of Life scores of any chronic disease
Family/interpersonal distress/isolated
Depression and anxiety (5X)
Suicide (2X)
Addiction/Substance abuse
![Page 14: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/14.jpg)
14
Consequences
Society: Increase healthcare consumption • 4x GP visits
• 2x hospital admissions and LOS
• Use ED for treatment (esp. no GP or marginalized)
• More drugs and surgeries/procedures
Lost productivity
Increased benefit payments
Lost tax revenue
Familial breakdown
Social issues: drug trade as source of pain relief, homelessness, poverty
![Page 15: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/15.jpg)
15
Chronic Pain Impact
• Chronic pain is of high prevalence • Chronic pain has huge impact. • Affects all aspects of biopsychosocial function.
![Page 16: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/16.jpg)
16
![Page 17: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/17.jpg)
17
Needs A different Understanding and Approach
![Page 18: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/18.jpg)
18 Subatomic Particles
Atoms
Molecules
Organelles
Cells
Tissues
Organ/Organ systems
Person
Two person
Family
Community
Culture
Society/Nation
Biosphere
WesternHealthcare
HierarchyofNaturalSystems
Pa7entpresenta7on
RadiologyNCSBloodtestsPharmacologySurgeryNerveblocks
Self‐managementC.B.T.A.C.TRelaxa7onBiofeedbackLaughterYoga
![Page 19: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/19.jpg)
![Page 20: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/20.jpg)
20
![Page 21: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/21.jpg)
21
![Page 22: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/22.jpg)
22
![Page 23: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/23.jpg)
23
![Page 24: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/24.jpg)
24
Understanding Pain
Through advances in basic science and clinical research over the last two decades we have come to understand:- • Chronic or persistant pain is a disease in
its own right. • Pathophysiological changes are
occurring within the nervous system and the brain.
![Page 25: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/25.jpg)
25
Understanding Pain
The pain system is an alarm system
It can warn you when you have been damaged.
It can warn you when you are approaching damage.
![Page 26: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/26.jpg)
26
Understanding Pain
The system can also warn you if you are in a situation similar to past experience in which you experienced pain.
It responds to the warning.
![Page 27: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/27.jpg)
27
PAIN EXPERIENCE
When your brain automatically concludes …
That there is no threat you get no pain.
Increased threat increased pain.
Immediate need for action increased pain
![Page 28: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/28.jpg)
28
Danger Signals in the Brain
When you feel pain, between 200 and 400 areas of your brain become active.
Your brain has over 10 BILLION neurons, each one connecting to up to 5,000 other neurons.
![Page 29: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/29.jpg)
29
THE BRAIN
Many parts of the brain are involved:
Movement areas Thinking/reasoning/belief areas Memory areas Learning areas Emotional areas Autonomic centres Immune systems
![Page 30: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/30.jpg)
30
Acute pain versus chronic pain
Useful alarm system when it is acute pain as it concludes that danger to your tissues exists and that action is required in terms of rest and remedies to help healing.
Not the same for ongoing chronic pain. Car Alarm
![Page 31: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/31.jpg)
31
![Page 32: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/32.jpg)
32
One month later
![Page 33: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/33.jpg)
33
No One Ever Told You #2
Chronic Pain is NOT
an accurate indication
of what is happening in your body
![Page 34: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/34.jpg)
34
![Page 35: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/35.jpg)
35
Understanding Pain
THE NERVOUS SYSTEM CHANGES
It is an adaptable system
Always changing - never static.
Changing in response to inputs
Neuroplasticity
![Page 36: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/36.jpg)
36
Understanding Neuroplasticity
Darwin
• It is not the strongest of the species that survives, nor the most intelligent, but rather the one most adaptable to change.
![Page 37: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/37.jpg)
37
Understanding Neuroplasticity
Expert has practiced for >10 000 hours.
After 10 000 hours it comes naturally without effort. Years down the line very little change or stimulation of other nervous
pathways and possible a factor in development of dementia.
Surge in interest in Brain Training (See Posit Science)
Learning a new language or instrument later on in life is really difficult but helps prevent dementia.
![Page 38: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/38.jpg)
38
![Page 39: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/39.jpg)
39
Maladaptive and Good Neuroplasticity
“ The Brain That Changes Itself” Norman Doidge Many examples of maladaptive and
good neuroplastic changes.
![Page 40: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/40.jpg)
40
Increased Pain Traffic
• Recruitment of receptors to transmit pain • Nerves fire off aberrant discharges • Increased traffic in pain nerves. • Traffic not inhibited at spinal cord • Spinal cord pain pathway remains open/on. • Brain changes • Like the expert, a learnt pain path develops
![Page 41: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/41.jpg)
41
Increased Pain Traffic • Recruitment of non-pain receptors to transmit pain • Increased traffic in pain nerves. • Traffic not inhibited at spinal cord • Spinal cord pain pathway remains open/on
• Brain changes: Decreased grey matter (nerve cell bodies) Decreased Descending Inhibition of Pain Altered Perception.
![Page 42: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/42.jpg)
42
Processing System
The brain deciphers all information. Can it get it wrong?
![Page 43: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/43.jpg)
43
The brain’s automatic abilities
The phaonmneal pweor of the hmuan mnid. Can you blveiee taht you can aulaclty uesdnatnrd waht you are rdanieg? It deosn’t mttaer in waht oredr the ltteers in a wrod are, the olny iprmoatnt tihng is taht the frsit and lsat ltter be in the rghit pclae. Tihs is bcuseae the huamn mnid does not raed ervey lteter by istlef, but the wrod as a wlhoe.
Waht we pecvriee is not aywlas atrccuae.
![Page 44: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/44.jpg)
44
![Page 45: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/45.jpg)
45
![Page 46: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/46.jpg)
46
Take a look at the picture? What do you see?
Research has shown that young children cannot identify the intimate couple
because they do not have prior memory associated with such a scenario.
Children see nine dolphins.
![Page 47: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/47.jpg)
47
Processing Nerve Signals
If you can change how your brain decides to see this picture can you change how your brain decides to perceive pain signals?
![Page 48: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/48.jpg)
48
fMRI
• Numerous regions of the brain are involved in the interpretation of the 'pain experience’
![Page 49: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/49.jpg)
49
![Page 50: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/50.jpg)
50
THE GOOD NEWS
Neuroplastic changes
are not permanent
![Page 51: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/51.jpg)
51
No One Ever Told You #1
Your nervous system has the power to change your nervous system.
YOU can change pain!
![Page 52: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/52.jpg)
52
Good Neuroplasticity
Nerves learn whatever we can practice. When you take the system off alert, the neurons will
start to return to normal activity. Sensors are replaced every 3-4 days. Virtual brain maps change all through life. The pain killing neurotransmitters you produce are far
more powerful than the danger chemicals sending signals to your spinal cord and brain.
Self-management techniques work.
![Page 53: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/53.jpg)
53
Recovery Principles
• Acceptance
![Page 54: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/54.jpg)
54
![Page 55: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/55.jpg)
55
Recovery Principles
• Acceptance and willingness for change. • Self Management Approaches
![Page 56: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/56.jpg)
56
![Page 57: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/57.jpg)
57 © Neil Pearson Physiotherapist Corporation
2012
![Page 58: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/58.jpg)
58
Pain Self-Management
Active Strategies with short term benefits
• Breathing techniques • Restoring body awareness/body image • Relaxation techniques • Mindfulness • Meditation
![Page 59: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/59.jpg)
59
Pain Self-Management
Active Strategies with longer term benefits
• Yoga • Tai Chi • Qi gong • Focused exercise programs
![Page 60: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/60.jpg)
60
Recovery Principles • Acceptance and willingness for change. • Self Management Approaches • Paced Physiotherapy with cardio • Mind Body Techniques • Sleep Hygiene, Good Nutrition, Fun. • Medications (30% in 30%) in chronic pain • All need to function together • It takes effort to create change just like learning
a new language when you are older.
![Page 61: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/61.jpg)
61
fMRI
• Numerous regions of the brain are involved in the interpretation of the 'pain experience’
• fMRI studies of endogenous pain processing include placebo, empathy, attention, distraction or cognitive modulation of pain.
• fMRI used to evaluate the effects of pharmacological and non-pharmacological techniques on brain function in acute and chronic pain.
![Page 62: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/62.jpg)
62
![Page 63: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/63.jpg)
63
![Page 64: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/64.jpg)
64
Darwin Award
A Darwin award is bestowed posthumously to the person (usually a young male) who removes his genes from the gene pool by some seriously stupid act.
![Page 65: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/65.jpg)
65
![Page 66: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/66.jpg)
66
![Page 67: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/67.jpg)
67
![Page 68: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/68.jpg)
68
![Page 69: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/69.jpg)
69
![Page 70: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/70.jpg)
70
![Page 71: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/71.jpg)
71
![Page 72: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/72.jpg)
72
![Page 73: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/73.jpg)
73
![Page 74: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/74.jpg)
74
![Page 75: The Evolution of Pain Management · 2018-08-18 · The Evolution of Pain Management October 20, 2012 Dr. Michael Negraeff, Dr. Gillian Lauder, ... Spinal Cord Injury Chronic Headaches](https://reader033.fdocuments.us/reader033/viewer/2022060307/5f09eb937e708231d4292384/html5/thumbnails/75.jpg)