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 how some opioids 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. Nonmodifiable 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 observe their thoughts, feelings, sensations, and attitudes without judgment. 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 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 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 from 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, but 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

 

     

 

Mental Health, Yoga, Acupuncture, and Pelvic Pain

By Stephanie Stamas

Pelvic floor dysfunction is complicated. If you have pelvic pain or dysfunction, you know this. You know that it takes a long time to figure out what is going on and rarely is it straight forward. It’s often a more of a journey to recovery than a quick fix. As a physical therapist specializing in pelvic floor dysfunction I’ve found that what makes that journey faster is having a multi-disciplinary team of specialized practitioners addressing every aspect of the dysfunction. At the next Pelvic Health 101 lecture, you will get the unique opportunity to hear from three healthcare providers who work closely with patients at Beyond Basic PT discuss how mental health, yoga and acupuncture can be excellent adjunct therapies to help you on your healing journey.

The mind-body relationship is starting to become a hot topic in research and never in the history of pain management has there been more exciting news. Until a little over a decade ago it was thought that the brain was solid and fixed by age 5, and from there the brain deteriorated. Now it is understood that the brain changes constantly based on environment, behavior, thoughts and feelings. This can be good or bad news. The experience of anxiety and pain is the bad news. The good news is that through “retraining” the brain you can reduce/eliminate pain! This is why mental health counseling can be so important on your healing journey.

Yoga as it is practiced in the U.S. can take on many forms and selecting a class/teacher can be overwhelming for those seeking to practice yoga as a therapeutic modality. For individuals with pelvic pain, it is recommended that they practice yoga that allows for a balance between slow, conscious movement to engage and gentle stretching along with an emphasis on the breath. Engaging in a simple customized yoga practice can be beneficial for those seeking to redefine their relationship with their body, specifically allowing them to move beyond their identity as a patient. Come and take some time to pause for breath and simple movement practices that can promote greater ease and comfort for the body and mind.

Acupuncture has always been at the center of pain management. Several problems that manifest as pelvic dysfunction are regularly treated by acupuncture, including incontinence, pelvic pain, IBS and constipation. In some patients, problems in the musculoskeletal system can be the underlying origin of their complaint. When the trigger point is “dry needled” by acupuncture, this mechanically disrupts the nervous system and results in mechanical and physiological changes. In Traditional Chinese Meridian Theory, the genitalia are traversed by a number of channels, thus pain can be accessed from reflex points along these channels. A treatment regime consisting of regular acupuncture in combination with physical therapy is the ideal approach for chronic pelvic floor problems.

Come join us at Beyond Basic Physical Therapy next Tuesday, April 28th at 6:30 for the final seminar in the Pelvic Health 101 Seminar Series. Don’t miss this last opportunity to find the missing link in your step towards recovery. Sign up here.

Stuck on Acupuncture…In Utero!

By Riva Preil

UnknownPregnancy is an exciting and wonderful time, but with the many physical and hormonal changes that occur, it can also be a time of extreme discomfort. Many pregnant women suffer from fatigue, nausea, reflux, and back pain. Acupuncture is a safe, gentle and effective way to address these complaints. Prenatal acupuncture has been used for thousands of years to help women support a healthy pregnancy and uncomplicated delivery. Regular acupuncture during pregnancy sets the foundation for a healthy mother and baby. Current research suggests that women who receive acupuncture during pregnancy often have a shorter and easier birth experience.  Several European studies have concluded that weekly acupuncture starting 6 weeks prior to the due date results in significantly shorter labor.

The Traditional Chinese Medicine (TCM) treatment for breech presentation has also been in use for thousands of years. It has a success rate of 75% and carries no risk to mother or baby. It is believed to release hormones that stimulate the uterus and increase fetal activity, which encourages the baby to turn on its own.  This is generally performed between weeks 32 – 36. When successful, the baby will turn within 24 hours of treatment. Sometimes only one treatment is sufficient, or it may take several sessions for the baby to reposition itself.

Acupuncture for labor induction is safe for both mother and baby as long as there are no serious complications with the pregnancy. It is most effective starting the week of the baby’s due date.

Adapted from material by Paula Haberman, PT, L.Ac

Stuck on Acupuncture, Part 2

By Riva Preil

Pelvic Pain Disorders consist of a wide range of problems that affect multiple facets of a person’s quality of life. Since acupuncture works on many levels simultaneously, many of these problems can be addressed in a single session.

From a symptomatic point of view, many of the problems that manifest as pelvic floor dysfunction are common ailments that are regularly treated by acupuncture. Problems such as incontinence, pelvic pain, IBS, vulvodynia, interstitial cystitis, genital pain, urinary or bowel burning, frequency or retention, constipation, and diarrhea are routine ailments treated by acupuncturists.

Pelvic Floor Dysfunction has an integral relationship with the structure of the musculoskeletal system. In some patients, problems in the musculoskeletal system can be the underlying origin of their complaint. Tight or weak muscles and/or structural misalignments create imbalances in muscle tone which then lead to further postural asymmetries. Trigger points in the abdomen, iliopsoas and external oblique muscles cause vaginal, labial and groin pain as well as constipation.  Tightness of the quadratus lumborum can cause internal pelvic pain, pain with intercourse, pain in the perineum, testicular and genital pain and well as cause constipation or diarrhea.  Hamstring tightness can create pain in the obturator internus.  Tight adductors refer pain to the groin, and piriformis and gluteal muscle tightness can compress the pudendal nerve. When the trigger point is “dry needled” by acupuncture, this mechanically disrupts the integrity of the dysfunctional endplates within the trigger area, and results in mechanical and physiological resolution of the trigger points.

Furthermore, according to the traditional Chinese meridian theory, the external and internal genitals are traversed by a number of channels: the Liver or Foot Jueyin channel, the Spleen or Foot Taiyin channel, and the Kidney or Foot Shaoyin channel. Thus both internal and external genital pain can be accessed from reflex points along these channels. Points along the shin, at the ankle and on the medial knee can be used to decrease both genital pain and pain in the perineum.

A treatment regime consisting of regular acupuncture treatments in combination with Physical Therapy is the ideal approach for chronic pelvic floor dysfunction.

Adapted from material by Paula Haberman, PT, L.Ac

Stuck on Acupuncture (Part 1)

By Riva Preil

Acupuncture is among the oldest healing practices in the world. As part of Traditional Chinese Medicine (TCM), Acupuncture is rooted in the ancient philosophy of Taoism and dates back more than 5000 years.  Underlying this practice is a unique view of the world and the human body which is based on the ancient Chinese perception of humans as microcosms of the larger, surrounding universe, interconnected with nature and subject to its forces. The body is regarded as an organic entity where the various organs and tissues have distinct but interdependent functions. Restoring health relates to balancing these interconnected functions by aligning a person with their environment, their mind and their spirit.

According to Classical Chinese Theory, channels of energy called meridians run in regular patterns both externally and internally throughout the body, creating a network akin to the circulatory, myofascial or nervous systems. Acupuncture points are gates along these meridians. The energy of these meridians, called Qi, can be influenced and changed by needling or stimulation of the acupuncture points.

The meridians have been compared to rivers that flow through the body to irrigate and nourish the tissues. Any obstruction in the movement of these energetic pathways is like a dam full of impediments. Pain and disease are considered the results of blockages or imbalances in the flow of Qi. Any disharmony of Qi may affect an individual spiritually, emotionally, mentally, and/or physically.

The practice of Acupuncture can be looked upon as a procedure that enhances the body’s healing mechanisms and promotes the body’s inherent ability to heal itself.  It allows for natural restoration of homeostasis.

In Western terminology, acupuncture points are areas of increased electrical sensitivity. When stimulated, they transmit impulses to the hypothalamus-pituitary glands which release endorphins (natural substances in the body that inhibit pain).

Acupuncture has been shown to stimulate the immune system, help promote sleep, increase energy, and decrease inflammation.  It has positive effects upon circulation, blood pressure, rhythm and stroke volume of the heart, production of red and white blood cells, and secretion of gastric acid.

Adapted from material by Paula Haberman, PT, L.Ac