Navigating Life with Chronic Pain: Part II

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Fiona McMahon, PT, DPT

Welcome back to our discussion on chronic pain. In our last blog we discussed why one might experience chronic pain and some common missteps and pitfalls that have occurred in our understanding of chronic pain. If you haven’t yet read part one of this blog, I highly recommend checking it out first so you can get the most out of this post. Click here to read it now.

For chronic pain we have drugs, surgery, mental health therapy, physical therapy, and what is called complementary alternative medicine (CAM), which includes modalities like yoga, acupuncture, and mindfulness meditation. We discussed earlier about how some opiods may actually be harmful in treating chronic pain. Unnecessary surgery can also have risks of actually increasing pain post surgically, because it can change the brain’s sensitivity to pain. Because, for most musculoskeletal conditions, a course of conservative treatment is recommended for a period of time before turning to surgery, we will focus on non-surgical, and non medical approaches to chronic pain.

Before we dive into specific treatments, let’s talk about what puts a person at risk for chronic pain. We can divide these risks into modifiable and non modifiable risks. Non modifiable risks are situations or characteristics about ourselves that we can not change. They include socioeconomic status, where you live or have lived, cultural background and genetic factors. Unfortunately, we can’t change these things, but things like alcohol intake, nutrition, and obesity are all things we can change and have been generally understood as modifiable risk factors for chronic pain. Now that we have that in mind, let’s explore different approaches for the management of chronic pain.

 

Mindfulness Practice as Pain Management

Have you tried mindfulness practice? I ask this question a lot. When I ask it, I am careful to frame it in a way that does not give the patient the impression that I think their pain is all in their head, but rather, I try and present it as part of an adjunct to the current physical therapy treatment they are receiving from myself or any of the other PT’s at Beyond Basics Physical Therapy, and any other medical intervention they may be receiving.

Mindfulness and mindfulness meditation are somewhat based on eastern meditation practices.  Not all mindfulness programs are the same, but the basic premise is to allow  the participant to to observe their thoughts, feelings, sensations, and attitudes without judgement. Giving them the opportunity to reframe their thoughts in a positive manner.

It may sound like a small change, but research is really starting to bear out that changing your frame of mind about pain can have some very real results. In a meta-analysis done by Hilton  and colleagues, mindfulness programs were found to have statistically significant positive results on pain, depression, and quality of life.

There are a lot of ways you can incorporate mindfulness into your day to day life. Apps for your phone are really helpful. I recommend both Calm and Headspace. I personally like Calm a bit better, but both are excellent. Headspace is a good starter because it breaks up meditation into more digestible nuggets, which can be a good way to start your meditation practice. Calm, as the name implies, is more soothing.  There are also guided classes you can attend in your area if that’s more up to your speed.

Be patient with mindfulness, I definitely suggest giving it the old college try. Stick with it for a week or two. If it isn’t for you, that’s perfectly okay. It’s not a moral failing, or a psychological one it’s definitely a case of different strokes for different folks.

Psychological Intervention

In a study performed by Macrae and colleagues, it was found that patients who engaged in catastrophizing type behaviors experience post surgical pain at a significantly higher rate. Catastrophizing is envisioning a situation to be far worse than it actually is. A good example for this blog would be a patient with low back pain, jumping to the conclusion that her back pain will prevent her from being able to work and she would end up on the street, secondary to her her lack of ability to secure an income. Although this is a possibility, it really isn’t a realistic one and it fails to entertain the possibility of the back pain remaining stable or getting better.

Mindfulness meditation can help with catastrophizing behaviors, but sometimes you need a little extra help. Psychological interventions, like talk therapy and cognitive behavioral therapy, can help you get a handle on these thoughts and address your current loss of function, secondary to pain in a more productive manner. Cognitive behavioral therapy as well as other forms of therapy have shown improvement in pain symptoms and quality of life in adults, and has shown even more robust effects in children.

Acupuncture

Acupuncture is an ancient form of eastern medicine that is gaining a stronger and stronger foothold in the States. It has been shown to be effective in managing a number of conditions, and chronic pain is no different. Reviews of acupuncture in the scientific literature have found that acupuncture can improve pain and function. The same review found that electroacupuncture had even more robust results for pain and stiffness.

Yoga

Yoga is super hip right now. In fact it now has its own international day on June 21st of each year. It does for good reason. A consistent and solid yoga program has been shown to improve conditions such as low back pain, myofascial pain syndrome, fibromyalgia syndrome, osteo- and rheumatoid arthritis. It can be a great option to continue to add consistent exercise and pain management into your life.

Physical Therapy and Exercise

Exercise is good for you, even if you have chronic pain. The old way of thinking was to put someone on days of bedrest when they have chronic pain. No more. Evidence has shown gentle movement progressing into more functional training can really help with chronic pain. In fact the National Institute for Healthcare Excellence’s (NICE)  osteoarthritis  guideline is  “exercise should be a core treatment… irrespective of age, comorbidity, pain severity and disability. Exercise should include: local muscle strengthening [and] general aerobic fitness”(NICE 2014) . Geneen and colleagues found in their review and meta-analysis of the current literature that just receiving the advice to exercise alone, is not sufficient to produce improvements in pain scales. That’s where the professionals like physical therapists come in, PTs have the knowledge and expertise to prescribe exercise that is not only safe and functional, but hopefully kind of fun. PTs also can diagnose and treat issues such as tissues with reduced mobility and poor alignment to ensure you get the most out of your exercise.

Data show that a prescribed and monitored exercise program by a physical therapist can have good effects on pain symptoms and can help facilitate the production of your body’s own natural painkillers.  Additionally exercise can help individuals lose weight, which can reduce the pressure on one’s  joints and further improve pain.

Aside from exercise and hands on work, we can use modalities like kinesio tape at physical therapy. Kinesiotape has been shown to improve not only pain, but decrease trigger points, improve range of motion and improve disability rates in individuals suffering with myofascial pain syndrome.

Conclusion

Chronic pain is complex. Rarely is there a silver bullet that will cure it. Treatment requires a multidisciplinary approach, which has been shown to be more effective than traditional treatment alone. Start small, where you feel comfortable when adding something new into your treatment approach. You will find what works best for you. A good place to start is here at Beyond Basics. Our staff not only has the expertise to treat you from a physical therapy perspective, they also have the ability to guide you towards other traditional and complementary treatments/practitioners that can help you reach your goal. Your treatment for chronic pain does not have to be and should not be passive, please call and make an appointment today to start your journey.  

 

Sources:

 

Achilefu A, Joshi K, Meier M. et al. Yoga and other meditative movement therapies to reduce chronic pain. J Okla State Med Assoc. 2017;110(1):14-16

 

Andersen T, Vægter H. A 13-Weeks Mindfulness Based Pain Management Program Improves Psychological Distress in Patients with Chronic Pain Compared with Waiting List Controls. Clin Pract Epidemiol Ment Health. 2016;12: 49-58

 

Ay S, Konak H, Evick D, et al. The effectiveness of kinesio taping on pain and disability in cervical myofascial pain syndrome. Rev Bras Reumatol. 2017; 57(2) 93-9

 

Eccleston C, Crombez G. Advancing psychological therapies for chronic pain [version 1]; referees: 2 approved]. F1000 Faculty Rev. 2017

 

Geneen L, Moore R, Clarke C, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews ( Review).  Cochrane Database Syst Rev 2017; 4

 

Hilton, L, Hempe; S, Ewing B. Mindfulness Meditation for Chronic Pain: Systematic review and meta-analysis. Ann Behav Med. 2017. 51:199-213

 

Kamper S, Apeldoorn A, Chiarotto A, et Al. Multidisciplinary biopsychosocial rehabilitation for chronic pain ( review). Cochrane Database Syst Rev. 2014; 9.

 

Macrae W. Chronic post-surgical pain: 10 years on. Br J Anaesth 2008;101: 77-86

 

Mayer F, Scharhag-Rosenberger F, Carlsohn A. The intensity and effects of strength training in the elderly.  Dtsch Arztebl Int 2011; 108(21):359-64

 

Neira S, Marques A, Pérez I. Effectiveness of aquatic therapy vs land based therapy for balance and pain in women with fibromyalgia: a study protocol for a randomized trial. BMC Musculoskelet Disord. 2017; 18(22)

 

Perry R, Leach V, Davies P, et al. An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools. Sytematic Reviews. 2017. 6(97)

 

Saxena R, Gupta M, Shankar N, et al. Effect of yogic intervention on pain scores and quality of life in females with chronic pelvic pain. Int J Yoga. 2017. 10(1): 9-15

 

Singh P, Chaturvedi A. Complementary and Alternative Medicine in Cancer Pain Management: A Systematic Review. Indian J Palliat Care. 2015. 21(1): 105-15

 

     

 

Meditation with Ryanne Glasper, PT, DPT on July 27

 

Fiona McMahon PT, DPT

July 27th marks our final movement class in this summer’s round. Join Ryanne Glasper PT, DPT from Beyond Basics Physical Therapy, for a meditation class that will introduce you to the practice of mediation and help you discover its broad ranging benefits. The class will be at Beyond Basics at 7pm on July 27th, 2017.

In addition to her interest in meditation, Ryanne is a certified yoga instructor as well as a phenomenal physical therapist with extensive background in orthopedics, dance medicine, and pelvic floor rehabilitation. Don’t miss this excellent chance to meet her in person and experience the calming and clarifying effects of meditation. Mindfulness practices, including meditation, tai chi, yoga, and qi gong have been proven to calm the nervous system and help with persistent pain conditions.

Register here below and keep your eyes peeled for our next series of classes!

Summer Movement Class

Beyond Basics Physical Therapy: Free Movement Classes are Here

Summer Movement ClassFiona McMahon PT, DPT

It’s summer in the city and maybe the air isn’t the only thing that’s a little stagnant? Could your workout routine use some updating? Are you itching to try something new like yoga, pilates, meditation, or tai chi? Have you been hesitant to try something new because you are nervous because of a past injury or pain condition? It’s time to take the leap and broaden your workout horizons with classes taught by practitioners with decades of combined experience in working with patients with acute and chronic pain conditions and sports and dance injuries. Take some time to read a little bit about this summer’s offerings and see if there is a right fit for you!

On July 6th at 7pm we will be offering gentle Pilates with Denise Small PT, DPT. Denise is a physical therapist at Beyond Basics Physical Therapy, who specializes in the treatment of orthopedic conditions and pelvic pain. She also is a certified Pilates instructor and combines both physical therapy and Pilates to help patients move throughout their world with increased strength and endurance, and with less pain. Denise is also a frequent contributor to the blog. Take some time to check out her recent articles,  on the Coordination of Breath and Movement, the use of Breath in in the Pilates MethodThe Benefits of Pilates with Pain Conditions, and check out our Pilates program here.

On July 13th at 7pm, Dr. Deborah Coady MD will be leading a gentle Tai Chi class designed to reduce stress, improve balance, and improve many other health conditions. Dr. Coady is a pioneer in the treatment of chronic pelvic pain and has a keen interest in the power of movement in aiding healing.

On July 20th at 7pm join Anne Taylor for Yoga. Anne teaches all over New York City and has worked with Beyond Basics Physical Therapy for years to offer private and group restorative classes for men and women with pelvic floor dysfunction.

Our last class is on July 27th at 7pm and will be lead by Ryanne Glasper PT, DPT. Ryanne will be offering a medication class to help you learn how to focus and calm the mind. Ryanne works at Beyond Basics specializing in orthopedics, dance medicine, and pelvic floor dysfunction. Ryanne is also a certified yoga instructor and has studied the Franklin Method through the Feldenkrais Institute.

If any of these classes interest you, click here to register today!

BBPT Health Tip: Diaphragmatic Breathing

just-breathe-in-cloudsFiona McMahon DPT, PT

WE LOVE DIAPHRAGMATIC BREATHING! We do, we really do and we hope you will too. What is diaphragmatic breathing you ask? Diaphragmatic breathing is a form of deep breathing where you breath deeply into your stomach. As you breath in, you will actually see your belly extend and get bigger, and as you breath out, your belly will return to it’s old spot. It’s not like our typical breathing patterns where we breath from the chest; it is a much more deep and deliberate breath.

Why We love Diaphragmatic Breathing

Diaphragmatic breathing accomplishes a lot in the body. First of all, it supplies the body with a large dose of oxygen, which is pretty obvious, but it is a much more robust breath than a simple chest breath.

Diaphragmatic breathing also works wonders on the tissues of both the abdomen and the pelvic floor. By taking a big diaphragmatic breath in, the diaphragm lowers and provides a gentle stretch to the tissues and organs of the belly as well as the pelvic floor. As you breath in you are actually providing a nice stretch to the pelvic floor.

Deep breaths can also calm down the nervous system and allow you to better relax. When you are more relaxed your body can attend to the day to day tasks such as digestion and healing. It really is amazing what some deep breaths can do.

How to breathe diaphragmatically

Start off by putting one hand on your chest, at about the area of your breastbone. Place the other hand on your stomach. You can do diaphragmatic breathing just about anywhere, so get in a position that is comfortable for you. Start by slowly breathing in. In order to tell if you are using your diaphragm, you should feel the hand on your stomach move more than the hand on your chest. As you breath in, bring your awareness to your ribs and feel them expand out to the side and back.  Finish by slowly breathing out. The out breather should be longer than the inhale. It is really that easy.

How does one actually use diaphragmatic breathing?

Really you can use it in anyway you need too. Some people find it tremendously helpful to do 10 diaphragmatic breaths every hour, while others employ deep breathing techniques in times of stress or pain. The important thing about diaphragmatic breathing, or any exercise for that matter is consistency. Try to at least get in 20 deep breaths a day.

Ph101 : Pelvic pain, meditation workshop with Ryanne Glasper, DPT & restorative yoga, calming down your pelvic floor

Fiona McMahon, DPT,

Enlightenment in nature

Earlier this summer, we discussed the nature of pain. In Putting Pain Into Context, We discussed how pain is comprised of two distinct components: the physical stimulus and how our brain interprets that stimulus. Both meditation and yoga are helpful techniques to help retrain how your brain responds to pain.

Join us on October 13th at 7pm for an introduction to both restorative yoga and meditation. Learn more about the science and try it out yourself with Anne Taylor, yoga instructor specializing in chronic pain and Ryanne Glasper, Physical Therapist and yoga instructor.  Come find out how these techniques may be helpful for you!

 

Register at pelvichealth-101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Check out our upcoming courses:

Pelvic Health 101 Fall- (003)