Category: Pain Rehabilitation

The Dance with Pain - Tara Brach

5/22/2018

Psychologist, Tara Brach approaches therapy using mindfulness as the foundation to healing; she does this through a blend of westernized therapy and eastern buddhist practices. Her website www.tarabrach.com, has hundreds of free recorded talks, videos, and articles where she investigates different facets of the human experience; pain being one of them. In the video The Dance with Pain that I attached below, Dr. Brach explores the relationship between emotional and physical sensations when dealing with acute and/or chronic pain and discomfort. Dr. Brach reminds us when humans feel pain - they tend to contract against the pain, they judge the pain, and blame themselves, others, and/or the pain. However, this fight and resistance tends to create more physical and emotional pain/discomfort. Dr. Brach then goes on to clearly teach us ways in which we can mindfully inhabit our bodies and learn how to listen and respond to the pain with awareness and compassion.

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Restore Fx Replicated In Colorado Through Kaiser Permanente To Help Clients Get Off Opiates

3/30/2018

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NPR did a great piece on an integrated program that treats patients with chronic pain using exercise, nutrition and education. Sound familiar? The program is sponsored by Kaiser Permanente in response to the opioid epidemic and the growing concerns around using opiates as "front line" treatment for pain complaints. Restore Fx is proud to say that we have been providing this type of integrative care for the past 12 years! Listen to the podcast and we think you will see the similarities -- not only is their program interdisciplinary (as is ours) but it has all of the practitioners/healthcare providers in the same location functioning as a team (again, like ours!). Kudos to Kaiser for making this program available to its clients in Colorado. We hope that other insurance providers take note and start to offer this kind of care to their clients.

Listen here

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Article Talks About How to Treat Pain Without Opiates

2/6/2018

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The following article is from Shreveport Times and is a great overview of the problems with treating pain in this country. The opiate epidemic has clearly shown that throwing medications at pain patients is short-sighted and ineffective. It's time to mainstream Functional Restoration programs like Restore Fx and make them the gold-standard for patients with persistent pain problems.

If opioids aren’t the answer for treating chronic pain, what is?
Sarah Crawford, sarah.crawford@shreveporttimes.com
Published 6:00 a.m. CT Jan. 26, 2018 | Updated 8:58 a.m. CT Jan. 29, 2018

Dr. Daniel Clauw hasn’t newly prescribed opioids for chronic pain treatment in almost 20 years. They don’t work, says the director of the University of Michigan’s Chronic Pain and Fatigue Research Center.

Clauw decided long ago that prescribing opioids for chronic pain conditions, notably fibromyalgia, wasn't the way to go. Many other doctors differed.
He’s far less alone today. With opioid addiction and the resulting overdose deaths now a recognized epidemic, more doctors are signing on to his approach or, at least, are prescribing opioid painkillers with more care.
At a time when the Centers for Disease Control and Prevention reports that almost half of opioid overdose deaths in the U.S. involve a prescription opioid, how often physicians should continue to prescribe opioids to treat chronic pain is a highly debated topic.
But if opioids aren’t the answer for treating chronic pain, what is?
COMPLETE COVERAGE: The science of opioids
“There are a lot of drug and non-drug therapies that are known to be effective in chronic pain conditions,” Clauw said. “There are seven or eight classes of drugs that are worth trying in different chronic pain patients.”

Clauw believes classes of drugs including tricyclic drugs, gabapentinoids and serotonin-norepinephrine reuptake inhibitors can be effective, in addition to exercise, cognitive behavioral therapy and other complementary therapies.
'Pain comes from the brain'At the Mayo Clinic’s Pain Rehabilitation Centers in Arizona, Florida and Minnesota, participants in a three-week program aimed at helping patients deal with chronic pain are required to taper off prescription opioid use.
Wesley Gilliam, director of the program and a clinical psychologist with expertise in pain management, said the program acknowledges that there’s a biological contributor to patients’ pain but says that treatment also must address how people think about and experience pain emotionally.

Participants in the program have typically been dealing with challenging chronic pain conditions and have already tried numerous treatments to deal with the problem. The program utilizes occupational therapy, physical therapy and pain psychology to help participants deal with pain and learn to function, even without opioids.
“The average duration of opioid use of our patients is between five to seven years, and despite using those medications, they’re still requiring a (specialized) level of care,” Gilliam said. “What that would tell me is the opioids are not helpful for these patients.”
At the Pain Rehabilitation Center, participants learn how to deal with the multi-dimensional aspects of pain, which Gilliam said include coping with the fear of pain and learning how to function in life, even if that still means enduring some discomfort.
“When I’m hurting, if the thoughts running through my mind are, ‘This is an overwhelming catastrophe, and I’ll never have a positive life, and I’m going to hurt like this forever,’ that in and of itself amplifies the experience of pain and actually disables people, frankly,” Gilliam said.

Instead, Gilliam said people need to change the way they interpret the impact of their pain.
“It doesn’t mean life is over; it means we have to make adjustments. And how do we challenge some of those cognitions and alter how the brain interprets pain? Because pain comes from the brain, and we can change our brain structure to experience pain differently,” he said.
Six months after the program is over, the center's staff members check in with participants to see how they’re doing. About 50 percent respond, Gilliam said, and of the patients who had previously been on opioids, roughly 80 percent reported that they continued to function without the medication.
“All of our data tells us that the patients that taper off the medications in our program do just as well as patients that were not on the opioids to start with,” Gilliam said. “That’s pretty powerful.”
Nevertheless, other doctors still see opioids as being effective in certain situations.

Issue isn't black and whiteDr. Gerald Aronoff, medical director of Carolina Pain Associates in Charlotte, North Carolina, said he sees patients who, when very closely supervised, can go to school, work and function normally while on opioid medication.
“We try to start by combining non-chemical treatments — nonpharmacological agents — with exercise programs, attention to wellness principles, nutritional issues, normalizing sleep patterns, referring when appropriate to alternative medicine treaters,” he said.
Aronoff also uses physical therapy as a significant resource. The goal "is to not only treat the pain itself but the associated emotional distress that we call suffering,” he said.

While most chronic pain patients with non-cancer related pain do not need to be on opioids, Aronoff said, he believes a subgroup of patients can be kept safely on these medications to improve their quality of life, daily functional activities and ability to fulfill social roles.

His philosophy is to be cautious about who gets opioids, screening for risk factors and requiring that patients be seen in person before they receive their prescriptions.
Aronoff also noted pharmaceutical companies have made attempts to make opioids safer.
“They will never be totally safe, meaning that no one will overtake or inappropriately take them or get adverse side effects, but there is increasing development of the abuse-deterring formulation of drugs, the morphine drugs, the oxycodone drugs, the hydrocodone drugs,” he said.
Gilliam agrees that the issue isn’t black and white, and there could be certain people who responsibly take opioids for pain and continue to function well.
“It’s just very difficult to identify those patients,” he said. “I would say they’re in the significant minority.”
That is why his program continues to require patients to get off of opioids and find an alternative way to deal with the chronic pain that limits their ability to enjoy and function in life.
“If you look at the data, what you find is the most impaired patients, the highest risk patients in terms of having depression, anxiety, substance use history, the ones that are expressing the more distress, are on the highest dose opioids,” Gilliam said. “So that causes me to really question what that medication is actually doing for folks.They’re the most functionally impaired, yet they’re on the most opioids.”

According to the CDC, while opioid prescribing rates declined nationally from 2012 to 2016, they nevertheless remained high across the country in 2016.
“In about a quarter of U.S. counties,” the CDC states, “enough opioid prescriptions were dispensed for every person to have one.”
Clauw thinks the tide will eventually turn to result in even fewer patients depending on opioids for chronic pain management.
He just thinks it’s going to take a long time.

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What is the Pocket Test for Pain Management and Why Should I Care?

10/11/2017

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America is clearly embroiled in an opioid crisis. And the roots go back to over-prescription of pain medications by doctors who were either poorly informed, sadly deliberately mis-informed by Big Pharma or lacked the ethics to consider the long-term consequences of continuing to prescribe these dangerous medications. We at Restore Fx are committed to helping patients learn to manage their pain in ways that are SUSTAINABLE.

How can you determine what is a sustainable treatment for chronic pain?

At Restore Fx we have what we call the "pocket test": is it FREE? Because if it isn't you may not be able to continue to afford it at some point; is it PORTABLE? Because chronic pain follows you throughout your day-- to your work site, to the family reunion, to the church picnic and to your kids soccer game. So if you can't bring your treatment with you wherever you go, it's not of much use to you; and is it SELF-ADMINISTERED? Because if you have to go see someone to administer the treatment (i.e. massage, chiropractic, injections, surgeries or even renewing a pain medication prescription) what are you going to do when it's 3AM and your pain is through the roof? You need to be able to SELF-TREAT pain, wherever, whenever and even if you are alone at that moment. So if it doesn't pass the "Pocket Test" you may want to reconsider having it be a mainstay in your management of chronic pain. Imagine depending on chiropractic visits and then going on a family trip to another state. You wake up in terrible pain and have no other tools for managing the pain because your "go-to" is the chiropractor. I have no problem with chiropractic care, or massage therapy, or physical therapy or other treatments administered by other professionals. They can be great additional resources once you have some good "pocket-tested" tools.

What tools would pass the "pocket test"? At Restore Fx we teach mindfulness meditation, yoga, Pilates, stretching, self-massage, appropriate use of heat and ice, self-correction techniques, cognitive-behavioral therapy, nutrition and appropriate self-administered exercises. All of those things can be done on your own, without paying any money or seeing a professional. If you are not familiar with these tools you may want to look into our services or find a local provider who can teach you.

Wishing you health and wellness in your journey living with pain,

Dr. Jordan

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Why Chronic Pain and Depression Go Hand in Hand?

9/3/2014

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For those of us who work in chronic pain it’s easy to see that patients who have persisting pain for more than 6 months almost always struggle with depression. And research has also shown that those who had depression before they developed pain are much more likely to have that pain become chronic. But the mechanisms linking these two disorders have not always been fully understood.

At Restore Fx we aim to provide the most research-based and current treatments for chronic pain. Our staff constantly reviews medical journals to inform our treatments and improve care for our patients. Just today I came across an interesting article that may help to explain the link between depression and chronic pain on a brain level. Researchers were able to stimulate increased release of serotonin (a neurotransmitter/brain chemical) in mice and found that it significantly reduced their sensitivity to pain. They did this through a clever use of light-sensitive neurons that produce serotonin. For more detailed information on their study please see:

Optogenetic Recruitment of Dorsal Raphe Serotonergic Neurons Acutely Decreases Mechanosensory Responsivity in Behaving MiceGuillaume P. Dugué, Magor L. Lörincz, Eran Lottem, Enrica Audero, Sara Matias, Patricia A. Correia, Clément Léna, Zachary F. MainenResearch Article | published 22 Aug 2014 | PLOS ONE

This may help to explain why taking an antidepressant helps in reducing pain. It’s also good to note that exercise, which is helpful in painful conditions such as arthritis, also reduces depression. So what’s good for your depression is probably also good for your chronic pain.

Stay tuned for more scientific advancements on understanding chronic pain and how to best treat it.

Wishing you well,

Krista Jordan, Ph.D., ABPP

Program Director, Restore Fx

Restoring Functional Life

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The Dance with Pain - Tara Brach

Restore Fx Replicated In Colorado Through Kaiser Permanente To Help Clients Get Off Opiates

Article Talks About How to Treat Pain Without Opiates

If opioids aren’t the answer for treating chronic pain, what is?
Sarah Crawford, sarah.crawford@shreveporttimes.com
Published 6:00 a.m. CT Jan. 26, 2018 | Updated 8:58 a.m. CT Jan. 29, 2018

What is the Pocket Test for Pain Management and Why Should I Care?

Why Chronic Pain and Depression Go Hand in Hand?

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The Dance with Pain - Tara Brach

Restore Fx Replicated In Colorado Through Kaiser Permanente To Help Clients Get Off Opiates

Article Talks About How to Treat Pain Without Opiates

If opioids aren’t the answer for treating chronic pain, what is? Sarah Crawford, sarah.crawford@shreveporttimes.com Published 6:00 a.m. CT Jan. 26, 2018 | Updated 8:58 a.m. CT Jan. 29, 2018

What is the Pocket Test for Pain Management and Why Should I Care?

Why Chronic Pain and Depression Go Hand in Hand?

Author

Archives

Categories

If opioids aren’t the answer for treating chronic pain, what is?
Sarah Crawford, sarah.crawford@shreveporttimes.com
Published 6:00 a.m. CT Jan. 26, 2018 | Updated 8:58 a.m. CT Jan. 29, 2018