An Evidence- Based Approach to Treating Pain For Medical Professionals. Allison Suran, PT, GCFP, TPS Healing Bridge Physical Therapy

Transcription

1 An Evidence- Based Approach to Treating Pain For Medical Professionals Allison Suran, PT, GCFP, TPS Healing Bridge Physical Therapy Disclosure Statement: I am the owner of Healing Bridge Physical Therapy and have no other disclosures.

2 PHYSICAL THERAPY American Physical Therapy Association Vision Statement Adopted in 2013: Transforming society by optimizing movement to improve the human experience.

3 What is Physical Therapy? What s Similar to other ancillary professionals? Modalities such as E- stim, laser, Ultrasound, etc. Manual Therapy A variety of hands- on, skilled techniques Mixed results in research: No single manual therapy technique has been proven over another. Important to be open minded and help the patient find what works for them.

4 What is Physical Therapy? What set s PT apart from other ancillary professionals? 1. Exercise and Movement: PT s are movement specialists trained in biomechanics and neurological recovery from stroke, TBI, SCI, pediatric movement disorders. 2. Setting FUNCTIONAL Goals 3. Education and Coaching But I ve tried Exercise and it flares me up and hurts too much!

5 Current Challenges Orthopedics has focused on tissues and tissue injury and has ignored the influence of the brain and nervous system. 20, 22, 61 The biomedical model seeks to find the anatomy or biomechanics at fault: Fix the faulty biomechanics and pain/disability will be resolved. 20,22 Acute Pain can determine Chronic Pain May have increased fear in patients which may increase pain. 16

6 UNDERSTANDING THE DEFINITION OF PAIN? International Association on the Study of Pain (IASP): Pain is an unpleasant sensory and emotional experience which follows actual or potential tissue damage or is described in terms of such damage.33 Lorimer Moseley 2003: (Pain Neuroscience Education) Pain is a multiple system output activated by the brain based on a perceived threat One s pain experience is NOT determined by tissue damage!

7 How can we Improve? Pain Neuroscience Education: PNE 1. The Rein of Pain lies Mainly in the Brain 2. Educate: Patients want to know more about pain 28,8,21,60, Provide detailed education about the neurobiology and physiology of pain to decrease threat value. (Louw, Diener, Butler and Puentedura. 2011) 3. Realistic Goals: Progress with Pacing and Graded Exposure 4. Down Regulation practices: Mindfulness, Relaxation Sleep *fmri s show decreased in brain threat value with 4- hours Pain Neuroscience Education Aust J Physiother. 2005;51(1):49-52 MORE PNE INFORMATION: NeuroOrthopedic Institute, International Spine and Pain Institute, Evidence in Motion

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9 Language to Inform Pa<ents Can Contribute to Fear and Catastrophiza<on Fear- Avoidance Model by Vlaeyen and Linton (2000): 56 Describes how pain disability, affective distress and physical disuse develop as a result of persistent avoidance behaviors motivated by fear. - Understanding the Placebo/Nocebo Effect: - Nocebo: A detrimental effect on health produced by psychological or psychosomatic factors such as negative expectations of treatment or prognosis.

10 KNOW THE POWER OF YOUR WORDS Words associated with pain can increase the percepaon of pain. OmiFng these words may be a simple and essenaal method by which to avoid unnecessary pain. Bulging Disc DDD, Arthritis Annular tears RTC tears Meniscus degeneration ACL tears Instability, Collapsing Bone Spurs Nerve Impingement Sciatica Pain is normal Normal Aging Wrinkles on the inside It s safe/good to keep on moving Your body knows how to heal This is not unusual In your BRAIN not All in your head! Current research shows that 30-50% of people don t have symptoms. Yet we often rely on these studies to determine our interventions. See Research Summary Handout 1, 55, 52, 53, 24, 51, 36, 48,

11 Trauma and Chronic Pain Murray J. McAllister, PsyD ExecuAve Director, InsAtute for Chronic Pain(ICP) TRAUMA HISTORY REPORTED: 90% women with FMS 60% arthritis 76% chronic LBP 66% women- chronic HA 58% migraines 56% women- chronic pelvic pain COMPARED TO GENERAL POPULATION: (F/M) F- 22% /M- 19% history of abuse F- 32%/M- 14% childhood sexual abuse F- 22%/M- 4% adult sexual assault 21% general population report domestic violence See Research Handout: ACE Study: Adverse Childhood Experiences

12 MORE PNE: Stress responses to Pain:Adrenaline. Fight,Flight,Freeze Tissues Heal, but constant stress can cause increased sensitization and pain. Immune system and pain: Cytokines, increased sensitivity, more All likely to get colds/flu. Systems Respond

13 ConAnued: The EducaAon of PNE? 1. Faulty Alarm System 2. Ion Channels have become sensitized: 3. How Pain Spreads My Hurts Don t Harm Me

14 How to calm the sensiave nervous system? Movement & Exercise, PNE, RealisAc Goals, Sleep, Manual Therapy, Safety, RelaxaAon/Mindfulness, Counseling

15 TAKE HOME POINTS Pain is NORMAL. It s OK/You re OK. Pain is being generated by your BRAIN Educate on the importance of continuing to MOVE My Hurts Don t Harm Me Pacing and Graded Exposure Tissues have very predictable stages of healing 3-6 months and on- going pain is more likely due to an extra- sensitive nervous system. ANS regulation (relaxation, mindfulness, CBT ) 50/50 approach: Even if their pain is 50% mechanical, at this point there is at least 50% is from sensitivity in the nervous system