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My thoughts

Not all pain management facilities are the same

9/8/2023

 
(updated 12/12/23)

Has your doctor referred you to pain management but you’re unsure where to go and what to expect?

With all the different names such as pain clinics, pain centers, pain management centers, pain treatment centers, pain institutes, pain management programs, and pain rehabilitation programs, it’s easy to get confused.
 
I’ve tried to separate the different types of treatment facilities below into broad categories based on their disciplinary approach and treatment focus with a chronic pain rehabilitation rating.
 
GOOD
Intradisciplinary interventional pain management: Pain management physicians (typically anesthesiologists) provide an individualized approach to evaluate, diagnose, and treat all different types of pain frequently focusing on the cause of pain, pain reduction or elimination, and specific pain conditions. They primarily offer passive interventional procedures such as medications, injections, spinal procedures, nerve blocks, radiofrequency ablation, Ketamine IV therapy, acupuncture, pain pumps, spinal cord stimulators, and surgery.

​Multidisciplinary pain management: Pain management specialists provide interventional treatment with access or referral to other specialties like physical therapy, psychology, neurology, surgery, orthopedics, acupuncture, nutrition, and pharmacy with treatment customized to each patient based on their condition. While these providers may work in the same facility or for the same employer, they often operate independently with their own modalities and therapeutic goals.

BETTER
Multidisciplinary pain rehabilitation: A core provider team ​from multiple disciplines (physical therapy, psychology, rehabilitation medicine, anesthesiology, nursing, and occupational therapy) with additional involvement from surgeons, neurologists, internists, physiatrists, psychiatrists, social workers, dietitians, and pharmacists use the biopsychosocial model of medicine and standardized treatment approaches to help manage pain. Featuring psychological and behavioral therapies, traditional medicine, physical reconditioning, and educational components, these multi-week programs are more comprehensive but can be combined with interventional pain therapies for specific pain conditions. Care may or may not be coordinated or integrated with shared goals.

BEST
Interdisciplinary pain rehabilitation: Features a diverse multidisciplinary team including physical and occupational therapists, psychologists, dieticians, pharmacists, nurses, and medical doctors at one location. The providers interact with each other and the person using a shared biopsychosocial approach to pain – working together toward a common and coherent goal of pain rehabilitation teaching skills to empower the person to help themselves and actively self-manage the pain with the goals of reducing fear of exercise and activity, increasing daily activity; improving physical reconditioning;  decreasing healthcare utilization, and improving quality of life with some but less focus on reducing pain. Generally lasting several weeks, these programs are often hospital-based (6-8 hours per day) and group-based offering behavioral therapy, physical therapy, occupational therapy, relaxation training, medication optimization/management, as well as some sort of family education and counseling. 

Conclusions/thoughts
  • A lack of common terms and definitions made it hard to categorize the types of pain management facilities as there are no clearly established guidelines for pain management that are uniformly followed by every provider. Offering different treatment goals and components, they don’t fit into nice little boxes when doing an internet search.
  • International standards and classifications for pain management should be established to improve care.
  • As pain transitions from acute to chronic, passive interventions are best used in a complementary role to provide short-term relief to allow the person to participate in an active self-management program.
  • Due to their focus on rehabilitation instead of interventional, and therapeutic treatments and their time commitment, interdisciplinary programs can be challenging for people, especially those expecting a diagnosis, passive treatment, and/or a cure.
  • Interdisciplinary pain rehabilitation programs patterned like the program I attended at The Mayo Clinic are the gold standard of comprehensive care. One key attribute of the Mayo program was social modeling—seeing other people with similar pain experiences develop the skills they need to succeed. Unfortunately, there’s limited availability and access to these types of programs.
 
It was my family doctor and a local surgeon who recommended I attend the 3-week outpatient Mayo Clinic Pain Rehabilitation Center instead of going through another risky surgery to try to fix the pain. The program changed my life.

Please discuss your medical situation with your healthcare team.
 
Learn more
  • Is a Pain Clinic Right for You?
  • How to Move Patients from Passive Management to Active Self-Management (my article)
  • We Have a Chronic Pain Problem, not a Prescription Opioid Problem (my article)
  • Pain rehabilitation works (my blog post)
  • Interdisciplinary Rehabilitation Programs in Chronic Pain Management
  • Interdisciplinary Pain Rehabilitation Programs: Approach and Implementation
  • Interdisciplinary treatment for chronic pain: is it worth the money?
  • A Call for Saving Interdisciplinary Pain Management
  • The Demise of Multidisciplinary Pain Management Clinics?​
  • Mayo Clinic Pain Rehabilitation Center
  • My Time at the Mayo Clinic Pain Rehabilitation Center - published in HealthCentral
  • Find pain rehabilitation programs around the globe (my website)
Picture

We can learn a lot from nik wallenda

8/2/2023

 
I was blessed to see Nik Wallenda (the famous tightrope walker who has walked across the Grand Canyon, Niagara Falls, and Times Square) perform while I was on vacation.
 
As impressive as Nik's balancing skill was the message he shared about not giving up and overcoming fear.
 
He almost gave up tightrope walking after a 25-foot fall during a 2017 rehearsal for an eight-person pyramid routine seriously injured five of his friends and family members. Luckily, Nik and two others were able to catch the rope and avoid falling.
 
Like Nik, it’s important for us to overcome any fears we may have about pain and keep moving forward.
 
You can see the accident and learn more here.
 
Related resources
  • Balance: A Story of Faith, Family, and Life on the Line (Nik Wallenda)
  • Fear of Pain as a Prognostic Factor in Chronic Pain: Conceptual Models, Assessment, and Treatment Implications
  • Hurt doesn’t always me harm (my blog)
  • Pain and Me: Tamar Pincus talks about chronic pain, acceptance, and commitment (3:06)

The importance of forgiveness and gratitude

8/4/2022

 
"Pain is physical AND emotional 100% of the time."
​- Dr. Rachel Zoffness

Pain is an experience with biopsychosocial factors, including our emotions.

Often times, people living with chronic pain can become angry and less thankful. There may even be some perceived misjustice, as was in my case.
 
It can be helpful to let go of the unpleasant emotions like anger, unappreciation, and blame as they can negatively affect the chronic pain experience, disrupt relationships, and worsen our symptoms – turning up the pain volume.
 
While being forgiving, kind, and grateful won’t magically make the pain disappear; they can help lessen the pain and suffering, foster better health, build self-efficacy, and make life more enjoyable.
 
Learn more and learn how
  • The power of forgiveness (3:28)
  • 13 Most Popular Gratitude Exercises & Activities
  • A Grateful Day with Brother David Steindl-Rast (5:22)
  • How to Forgive Someone Who Traumatized You 
  • Your 5-day gratitude challenge: 5 exercises to increase your gratefulness
  • How to Forgive in Six Steps
  • Jack Kornfield: 12 Principles of Forgiveness (13:42)
  • The power of forgiveness (3:28) - I saw this while as a patient at the Mayo Clinic Pain Rehabilitation Center
  • A Grateful Day with Brother David Steindl-Rast (5:22)
  • How to let anger out | Thich Nhat Hanh answers questions (9:18) - listen to what he tells a little girl how to deal with anger
  • Taking the Steps to Forgive Yourself
  • Forgiveness: Letting go of grudges and bitterness
  • Control anger before it controls you
  • 10-minute meditation: Loving kindness (10:07)
  • Practicing Gratitude Is More Important Now Than Ever
  • Your 5-day gratitude challenge: 5 exercises to increase your gratefulness
  • How Cognitive Control Can Boost Well-Being
  • Positive thinking: Stop negative self-talk to reduce stress
  • Doing What Matters in Times of Stress: An Illustrated Guide
  • The Pain Management Workbook - A book authored by Dr. Rachel Zoffness based upon Cognitive Behavioral Therapy ​
 
Read the research
  • Forgiveness is an emotion-focused coping strategy that can reduce health risks and promote health resilience: theory, review, and hypotheses
  • Forgiveness and chronic pain: a systematic review
  • Forgiveness and chronic low back pain: a preliminary study examining the relationship of forgiveness to pain, anger, and psychological distress
  • Associations between anger and chronic primary pain: a systematic review and meta-analysis
  • Loving-kindness meditation for chronic low back pain: results from a pilot trial

cognitive behavioral therapy for pain

6/5/2022

 
​Updated 09/23/2023
Our thoughts, emotions, and behaviors can make pain worse or more manageable.
​​
We can change the chronic pain experience and retrain our overprotective pain systems by changing how we think, feel, and behave using a form of biopsychosocial treatment called Cognitive Behavioral Therapy (CBT).

CBT reprograms our minds and bodies to help us feel safe and confident in our ability to manage pain and do the things we enjoy — improving the body’s natural pain relief mechanisms, increasing function, and breaking the chronic pain cycle.

.CBT is based on the core principles that our thoughts, emotions, and behaviors interact together with the pain; that we can become trapped in unhelpful thoughts, emotions, and behaviors; and that we can modify our thoughts, emotions, and behaviors to make our experience more manageable. 

It's what changed my pain experience and my life by giving me tools to:
  • Accept the pain and live in the present.
  • Identify, challenge, and change unhelpful negative thoughts and behaviors.
  • Actively self-manage the pain.

Best yet, CBT is a do -it-yourself therapy. You can use it anytime. You don’t need help from anyone once you learn it. And there are no negative side effects.

I learned CBT while attending the prestigious 3-week interdisciplinary Mayo Clinic Pain Rehabilitation Center.  

Find a CBT pain therapist
It can be hard to find psychologists trained in cognitive behavioral therapy for pain. Ask them about their approach to treatment. You might want to use the content from my pain truths to see if their practice beliefs matches the latest pain science. There are links to therapist search tools and pain rehabilitation programs below.

Learn more and do more
  • What is CBT?  (McGovern Medical School)
  • Cognitive Behavioral Therapy for Chronic Pain (4:29)
  • ​A Magical Cure for Pain? No – it’s just Cognitive Behavioral Therapy 
  • Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach​ 
  • Reframing unhelpful thoughts
  • How To Use CBT Thought Records To Change The Way You Feel
  • How to recognize and tame your cognitive distortions​
  • 15 Cognitive Distortions To Blame for Negative Thinking
  • Cognitive Restructuring Worksheet
  • Replacement Thought Examples
  • The Pain Management Workbook
  • American Association of Pain Psychology​ - offers a search feature to connect with a pain psychologist
  • Psychology Today - offers a search feature to connect with a psychologist (be sure to look for a provider familiar with chronic pain and CBT)
  • Find a pain rehabilitation program - links to programs around the globe. 
Picture
Image courtesy of McGovern Medical School

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