Take Charge of Pain. Rehabilitation Therapy Services Guide

Size: px

Start display at page:

Download "Take Charge of Pain. Rehabilitation Therapy Services Guide"

Leo Goodwin
5 years ago
Views:

1 Take Charge of Pain Rehabilitation Therapy Services Guide Johns Hopkins University 2015

2 Table of Contents I. TARGET Study and Psychologically Informed Physical Therapy PIPT a. Overview b. PIPT and Take Charge of Pain c. Accessing the program II. III. IV. Take Charge of Pain Program a. Introduction b. Pain Management c. Self-Management Take Charge of Pain Lessons a. Summary Pages of Lessons 1-7 Take Charge Development Team V. Frequently Asked Questions VI. Appendix a. Brochure

I. TARGET Study and Psychologically Informed Physical Therapy PIPT Overview Low back pain (LBP) is the most common type of pain and the second most common reason for doctor visits in the United

3 I. TARGET Study and Psychologically Informed Physical Therapy PIPT Overview Low back pain (LBP) is the most common type of pain and the second most common reason for doctor visits in the United States. While prognosis of acute LBP is generally considered good, there are a significant number of individuals who develop chronic pain. Literature indicates that psychological and behavioral variables negative thinking/catastrophizing, fear avoidance, depression and anxiety, low levels of activity are risk factors for poor outcomes and transition to chronic pain. It is possible to stratify individuals risk for poor outcomes using the STarT Back tool. This allows clinicians to tailor interventions for patients who are at high risk of chronic LBP. The STarT Back tool identifies those patients who would benefit from increased education and attention due to greater perceived pain, poor physical functioning, maladaptive coping behaviors (catastrophizing, fear avoidance), and comorbid depression and anxiety. PIPT is designed to meet the needs of persons identified as being high risk. The overall aim of the TARGET Study (Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients) is to answer the question: Should prompt referral to psychologically informed PT, be strongly recommended for high risk patients presenting with acute LBP? Figure 1: STarT Back Screening and Targeted Intervention PIPT and Take Charge of Pain PIPT principles and skills guides the care provided by the therapist to high risk LBP patients. The Take Charge of Pain program provides patients a way to implement and reinforce the concepts of PIPT that are introduced in the therapy session. TCP can be integrated into the PT program as part of PIPT from the beginning of treatment or it can be initiated in the later phases of PT as the person transitions to a home program. The program is designed to be used in conjunction with physical therapy and other care. Take Charge is not a substitute for medical or psychological care. Accessing the Take Charge of Pain program Here are steps for you or patients to access the site: 1. Go to 2. click on sign up from home page, enter access code 3. Complete registration information 4. Complete brief assessment, start lessons. Access to the program is by access code. The access codes are region specific: Baltimore: Tmd164 Boston: Tma162 Pittsburgh: Tpa161 Salt Lake City: Tut163 South Carolina: Tsc165 The brochures have a space on the back to write in the code for your region. You can print patient brochures from the PIPT website:

4 At this time, Take Charge of Pain is not compatible with phones or tablets it can only be run on a desktop computer. To arrange for ongoing access to Take Charge following completion of the study contact us at the Take Charge of Pain Center. II. Take Charge of Pain Program Introduction Take Charge is an online program to help individuals manage pain following an injury. It is designed to work with other treatments to help patients decrease pain and improve quality of life. Pain is not a simple problem. It can affect the body, mind, and activity. Pain complicates recovery and can make life difficult. Take Charge recognizes that patients play an important role in their recovery. Take Charge is not a substitute for medical care, rehabilitation therapy or individual counseling. It is designed to help patients work with their doctors, therapists, and others to prevent pain from controlling their life. Pain Management Pain impacts the body, mind, and activity. Science has shown that pain is complex and affects many part of life. Because pain is a stressor, pain impacts the body as stress hormones are released which leads to muscle tension, fatigue, and sleep problems. Pain also impacts the mind as it disrupts concentration and leads to negative thinking and worry. These negative thoughts can eventually make individuals feel overwhelmed, sad, angry or anxious. Finally, pain can change activity level. People may do less in order to avoid making the pain worse, or may not able to work or spend time with others enjoying life. Effective pain management addresses the body, mind, and activity. Because pain affects many parts of health and life, many patients, particularly those at risk for poor outcomes due to fear avoidance, negative thinking or other psychological barriers need a pain management approach that covers them all. Medications and physical or occupational therapy help the body recover. In addition learning to relaxation skills and avoid negative thinking, as well as earning to balance rest and activity helps avoid acute pain from becoming chronic pain. Early intervention can make a difference. It is easier to control pain before it becomes a chronic problem. Effective pain management requires patients to do their part. Health professionals can help treat a pain problem, but they can t do it alone. Patients play an important part in recovery. Self-Management Take Charge is designed to encourage the patient to take an active role in their recovery and engage in self-management skills to reduce the risk of acute pain becoming chronic. A combination of Take Charge supported by therapist reinforcement of the following message will help the patient in their recovery:

5 You are in charge. Self-management is about you taking an active role in your recovery and pain management. While doctors and other health care professionals can help, much of your health depends on you, and what you do. Skills based. Self-management is more than increasing what you know about pain. Research shows that effective self-management programs teach specific skills relaxation, reducing negative thinking, and balancing rest and activity. These skills help you decrease your pain and improve your quality of life. Set goals and track your progress. Self-management is also about setting goals for your recovery. Effective programs help you break these goals down into achievable steps and track your progress toward your goals. Tailored to your specific needs. Take Charge was designed specifically for people who are coping with pain. Experts in the fields of rehabilitation and psychology have contributed to the development of Take Charge. Builds Confidence. Self-management programs have been shown to be effective and appear to work by building your confidence in managing pain and related health problems. III. Take Charge of Pain Lessons Using Take Charge of Pain patients work through seven lessons on the computer. Each lesson takes about 20 minutes. The lessons are designed to be done in order with each lesson building on the previous lessons. Note: At this time the program can only be run from a computer as the video and interactive component will not run properly on a phone or tablet. Generally, the individual completes two lessons per week and review their progress with their therapist when they come for a therapy appointment. Below are the major points covered in each lesson and the lesson summary provided to the patient at the end of each lesson. It is helpful to have the patients bring their lesson summary for review with you during their appointment. Involvement of the therapist reinforces their participation in Take Charge and provides an opportunity to address questions that arise. Lessons Titles: o Lesson 1 Take Charge of Pain o Lesson 2 Stress & Relaxation o Lesson 3 Your Brain & Pain o Lesson 4 Thinking About Pain o Lesson 5 Rest & Activity o Lesson 6 Managing Emotions o Lesson 7 Putting it all Together PLEASE NOTE: The materials in Take Charge of Pain are copyrighted and presented for your educational benefit. They cannot be copied without written consent.

6 Lesson 1 - Take Charge of Pain Recognize and appreciate there is a lot to do to decrease pain and increase quality of life. Begin to better understand their pain Explore some of the myths about pain Learn ways to take charge of pain by setting goals and using pain management tools Learn about how pain impacts the body, mind, and activity. The therapist is identified as a resource to discuss what they learn in the program.

7 Lesson 2 - Stress & Relaxation Learn how stress can increase pain and delay healing Explore ways to relax the mind and body to manage stress Have the opportunity to learn and practice two of five possible relaxation approaches o Deep breathing o Progressive Muscle Relaxation o Countdown o Imagery o Touch

8 Lesson 3 - Your Brain & Pain Recognize pain changes over time o Identify what makes pain better or worse o Pain fluctuates across hours and/or days o Pain fluctuations can serve as a cue to use self-management techniques Learn about distraction Identify distractions to try out Explore how to use your brain to reduce pain

9 Lesson 4 - Thinking About Pain Explore how negative thinking leads to negative feelings Learn how to change how you think Identify negative thoughts o All or none thinking o Focusing on the negative and ignoring the positive o Overgeneralizing negative events Learn how to balance negative thoughts with positive thinking by using Stop, Look, Listen Identify positive thoughts to try

10 Lesson 5 - Rest & Activity Understand how balancing rest and activity is about doing things in manageable amounts Learn that developing balance means doing but not overdoing Identify their rest and activity pattern o Overdoing o Too much time resting o Overdoing and then not doing enough o In balance Identify an activity they want to increase or change Remember to do enjoyable things especially when you are hurting

11 Lesson 6 - Managing Emotions Explore negative emotions that are common among people who experience pain o Depression o Anxiety o Anger Participants get feedback on their depression, anxiety and anger questions and how they compare to others in the general population. Recommendation for action are provided based on their score. Discover ways to increase positive feelings and protect against distress -STAR o Support o Thoughts o Activity o Relaxation

12 Lesson 7 - Putting It All Together Learn about pain traps o Alcohol overuse o Medication misuse o Street drug use Optional alcohol screening (CAGE) Recognize when more help is needed Develop a Pain Management Plan using pain tools to address the body, mind and activity

13 IV. Development Team Johns Hopkins University Stephen T. Wegener, PhD, ABPP, Principal Investigator Professor, Chief of Rehabilitation Psychology Department of Physical Medicine and Rehabilitation Johns Hopkins University 600 N. Wolfe Street, Phipps 174 Baltimore, MD Phone: Jennifer Haythornthwaite, Ph.D., Co-investigator Associate Professor, Director of The Center for Mind-Body Research, Director of Behavioral Medicine Clinic Johns Hopkins Bayview Medical Center 5510 Nathan Shock Drive, Suite 100 Baltimore, MD Phone: Nathan Parmer, Psy.D., ABPP Department of Physical Medicine and Rehabilitation Johns Hopkins University 600 N. Wolfe Street, Phipps 174 Baltimore, MD Phone: Renan C. Castillo, Ph.D. Associate Professor Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health 624 N. Broadway Hampton House 543 Baltimore, Maryland Phone: Tricia Kirkhart, Study Coordinator Department of Physical Medicine and Rehabilitation Johns Hopkins University 600 N. Wolfe Street, Phipps 174 Baltimore, MD Phone: Vanderbilt University Medical Center Kristin Archer, PT, PhD Vanderbilt University Medical Center 1211 Medical Center Drive Medical Center East, South Tower, Suite 4200 Nashville, TN Phone:

14 V. Frequently Asked Questions a. Can any patient in my clinic use Take Charge? The program is available for use by any patient for the duration of the TARGET study. To arrange for ongoing access to the program following completion of the study contact us at the Take Charge of Pain Center. b. If a patient is having difficulty using the website, what can I do? Have the patient contact the Take Charge of Pain team at: c. How can I get more Take Charge of Pain brochures? You can freely print patient brochures from the PIPT training website: or contact us at and we will send you an electronic copy for you to print. d. Why am I having trouble viewing the lessons/videos on my phone or tablet? At this time, Take Charge of Pain is not compatible with phones or tablets it can only be run on a desktop computer.

15 VI. Appendix a. Brochure

angry, Are worried about the future, Are trying to get back to work and life, Tricia Kirkhart, Study Coordinator

edu Feel helpless or... Just want some extra help getting better Login information: www.takechargeofpain.

16 Who Benefits? If you have pain and... Take Charge Pain Center Johns Hopkins University It is controlling your life, Feel depressed, irritable or angry, Are worried about the future, Are trying to get back to work and life, Tricia Kirkhart, Study Coordinator 600 North Wolfe Street Phipps 174 Baltimore, MD Phone: Fax: Feel helpless or... Just want some extra help getting better Login information: Access code: Take Charge of Pain was supported in part by a grant from National Institute of Arthritis and Musculoskeletal and Skin Diseases NIH Johns Hopkins University 2015

The Take Charge program The Take Charge program About Pain Management Pain affects your body, your mind and your activity. It complicates recovery and can make life difficult.

Take Charge is intended to work with your other treatments to help you decrease your pain and get back to the life you want.

17 The Take Charge program The Take Charge program About Pain Management Pain affects your body, your mind and your activity. It complicates recovery and can make life difficult. Take Charge is an interactive computer program designed to help you manage pain following an injury. Take Charge is intended to work with your other treatments to help you decrease your pain and get back to the life you want. You will hear from experts and other patients about ways to manage your pain. Take Charge will help you track your pain and your progress toward recovery. The program will help you use the skills you already have, and develop new tools to manage your pain. Because pain affects many parts of your health and life, you need a pain management approach that covers them all. Because you work individually with the computer you can learn and practice these new skills at your own pace. Early intervention can make a difference. It is easier to control pain before it becomes a chronic problem and slows down your recovery. Effective pain management requires you to do your part. Health professionals can help treat a pain problem, but they can t do it alone. You play an important part in your recovery. You will work through seven lessons that take about minutes. The lessons cover a variety of topics such as: how pain impacts your body, mind and activity, learning new pain management skills, and managing your emotional reactions. Take Charge is not a substitute for medical care. It is designed to help you work with your doctors, therapists, and others to prevent pain from controlling your life. Through Take Charge you will discover there are many things you can do to help manage your pain. About musculoskeletal pain Musculoskeletal pain is common in the workplace and daily life. Completing a Take Charge lesson on the computer is just the beginning. What happens, away from the computer, will make the real difference. Poorly controlled pain can lead to negative thinking, depression or anxiety and reduced activity. Most people can get better and return to their previous level of functioning.

Healthy Coping. Learning You Have Diabetes. Stress. Type of Stress

Healthy Coping. Learning You Have Diabetes. Stress. Type of Stress Healthy Coping Learning You Have Diabetes Learning you have diabetes changes your life forever. You may feel scared, shocked, angry or overwhelmed. You may not want to believe it. These are normal reactions.