9/8/17. Mind Body Therapies for Pain and PTSD in the Military Setting. Disclosures/Conflict of Interest. CDR Jeffrey Millegan, MD MPH

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1 Mind Body Therapies for Pain and PTSD in the Military Setting CDR Jeffrey Millegan, MD MPH Disclosures/Conflict of Interest There are no commercial conflicts of interest to disclose The opinions expressed in this ardcle are those of the author and do not necessarily reflect the official policy or posidon of the Department of the Navy, Department of Defense, nor the U.S. Government. I am a military service member. This work was prepared as part of my official dudes. Title 17, USC, 105 provides that Copyright protecdon under this Dtle is not available for any work of the U.S. Government. Title 17, USC, 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person s official dudes. There is no external funding for this work. Acknowledgements: Benson Henry InsDtute for Mind Body Medicine 1

2 What is Mind Body Medicine? Medical discipline based upon the inseparable connecdon between the mind and the body Unmanaged and overwhelming stress can turn into illness and dysfuncdon and possibly disease There are self-care modalides that can increase one s capacity to manage stress and increase resilience The Three Legged Stool of Mind Body Medicine Overall Health Medica3on Procedures Self-care Resiliency Self-Care ModaliDes A regular meditadon habit Mindfulness, yoga, mantram etc RecuperaDve sleep Sleep hygiene, posidve sleep thoughts, creadng a buffer zone Resiliency-building thought habits CogniDve restructuring, posidve psychology, finding meaning in adversity Social connecdon culdvadon Diet/Exercise 2

3 TWO BASIC STEPS OF MEDITATION 1. A mental focusing tool, such as watching your breath, or repea3ng a word, phrase, prayer or visualizing a soothing image. 2. A quiet, aware, non-judging aetude, gently direcdng your mind back to your point of focus when you nodce yourself caught up in other thoughts. Medita3on Techniques with scien3fic evidence of benefit BREATHE DiaphragmaDc Breathing Body Scan Autogenic Training Progressive Muscle RelaxaDon Focused MeditaDon Transcendental RepeDDve thought Loving Kindness ContemplaDon Mantram RepeDDon Mindfulness Imagery/VisualizaDon Qigong/Tai Chi Yoga Stretching RepeDDve Movement The Benefits of MeditaDon Reduced heart rate, breathing rate, oxygen consumpdon Changes in genedc expression Reduces pain-related brain acdvadon Reduced pain catastrophizing Improved akendon and focus Increased posidve emodon and reduce depression/anxiety Improved emodonal reguladon Increased compassion Improved social connecdon 3

4 Increasing ScienDfic Evidence for MulDple CondiDons Strong to moderate evidence Cardiovascular disease Hypertension Insomnia Pain Chronic Low back pain ArthriDs Acute pain Fibromyalgia Surgical outcomes Cancer treatment tolerance Depression Anxiety Limited evidence Allergies Dermatological disorders Diabetes HIV progression Irritable bowel syndrome Post-stroke rehabilitadon PepDc ulcer Pregnancy outcomes Chronic obstrucdve pulmonary disease Tinnitus It also saves money Total healthcare udlizadon reducdon of 43% more than controls Reduces clinical encounters by 41% Imaging and lab by 50% Procedures by 21% ER visits from 3.6/yr to 1.7/yr Stahl et al, 2015 Mind Body Medicine Program ExperienDal Groups InformaDon Technology Train-The-Trainer/CME 4

5 9/8/17 Mind Body Medicine Program ExperienDal Groups InformaDon Technology Tiny.cc/mindbodymedicine Military MeditaDon Coach Coming Soon 5

6 Mind Body Medicine at NMCSD ExperienDal Groups InformaDon Technology Train-The-Trainer/CME Seven Week Program Session I: Stress Physiology, RelaxaDon Techniques Session II: Building a PracDce and RecuperaDve Sleep Session III: Mindfulness, PosiDve Psychology and CogniDve Restructuring Session IV: Qigong and Developing CogniDve Resiliency Session V: Yoga, the Power of Journaling and the Inner CriDc Session VI: Enhancing Social ConnecDon and CommunicaDon Session VII: Pueng It All Together Results PaDent Experience Pa3ent n=208 Avg (Range) Average akendance 6.9 (2-7) Overall RaDng of Program (1=very poor, 2=poor, 3=fair, 4=good 5=excellent) Refer friend to Program? (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree) Plan to condnue using cognidve restructuring? (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree) Plan to condnue meditadng? (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree) Good to Excellent 4.6 (3-5) Strongly Agree 4.8 (3-5) Agree 4.4 (2-5) Strongly Agree 4.8 (3-5) 6

7 Results FuncDonal Outcomes StaDsDcally significant improvement in: Perceived disability from pain (12%) Perceived stress (11%) Sleep quality (8%) Healthier coping with stress (11%) Depression (10%) Physical/psychological quality of life Results Did you engage with the content and learn anything? How osen did you meditate over the last week? Pre Post p value 0-1 day per week 3-4 days per week <0.001 Comfort with meditadon Neutral Comfortable Understanding of meditadon Fair Good <0.001 Understanding of cognidve restructuring Poor Good <0.001 Understanding sleep hygiene Fair Good to Very Good <0.001 Understanding value of social support Fair to Good Very Good <0.001 Mind Body Medicine at NMCSD ExperienDal Groups InformaDon Technology Train-The-Trainer/CME 7

8 5 Navy MTFs USMC Wounded Warrior Bakalion 8 Navy ships Submarine Air Force Navy Seals VA Since trained 8