Chronic Pain Management - 707-624-3328: wwww.kp.orgvacaville/painmanagement - Kaiser Permanente Thrive
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Chronic Pain Management 707-624-3328: wwww.kp.org/vacaville/painmanagement
* Come Every Week, Be On Time (>15 minutes late, please reschedule) * Be Active and Involved * Respect Others and Shared Information * Dress Comfortably, Be Comfortable, Be Kind & Courteous with Any Self Selected Odor Use *Knowledge is Treatment
*Noticing, Pacing, Helpful Tools *Session 2: *Pain Physiology, Tissue Issues & Brain Mapping *Neurotags/Brain Bundling & Central Sensitization *Thoughts, Emotions and Behavior Change *Relaxation, Meditation & Pain Experience
*Online Resources (See packet) *Noticing *Notice your symptoms *Notice things that make symptoms worse or better *Tracking safe/threatening activity *Pacing *Find your baseline and respectfully nudge it *Stay sore but safe *Movement Practice: *Diaphragmatic Breathing + Relaxation 4-7-8 Breathing
*An unpleasant sensory or emotional experience associated with actual or potential tissue damage, OR described in terms of such damage. *Pain is a NORMAL human experience designed to protect our wellbeing and elicit change *Multisystem process *Can ABSOLUTELY change
* Acute Pain (duration less than * Chronic pain (duration more
3 - 6 months) than 3 – 6 months)
* Identifiable damage or injury (i.e. * Pain ≠ further damage
broken bone, ankle sprain) * No longer serves a clear
* Serves as a temporary warning biological purpose: Warning sign
sign * Continues or gets worse over
* Heals in about 3-6 months time
* Treatment: Rest, appropriate * Treatment: Keep functional
reintroduction to function
* * X-Rays and MRIs: Do not explain the
continued pain & the impairments you
experience.* Acute vs Chronic Butler & Moseley, Explain Pain Workbook
* This is the old way of thinking
* We have to move away from this
* Pain = damage
* Chronic pain must mean persistent
damage or tissue not healing
* Pain is an input
* Simple transmission*Nociceptors = fancy word for stimulus input from the body to the brain that indicate potential danger/alarm signals *Does not guarantee a pain result! *>400 nerves in a human body= 45 miles =100 billion synapses *~25% blood flow is distributed to nerves *We have enough electricity running in our body at any given time to power a light bulb *Sensors on nerves turnover every 24-48 hours
*Please understand that your brain is 100% in control of what is happening with your pain experience *Acute or chronic *Your brain will make a logical decision on pain response with reference to: *Cumulative previous experience *Knowledge *Perceived threat
* Stimulus will be evaluated by the brain * The brain will then establish and execute a pain response if threat/perceived threat is valid * Red: Afferent/Sensory information TO the brain * Blue: Efferent/Action information FROM the brain
* Pain ≠ Tissue damage * Tissue damage ≠ Pain * Intensity of Pain ≠ Extent of damage * Tissues Heal
* ABSOLUTELY NOT!! *Your pain is 100% real and in some circumstances REAL BAD
* Acute vs Chronic Butler & Moseley, Explain Pain Workbook
*Mechanical or Movement Dysfunction *Most people have some sort of mechanical dysfunction (back to norms with imaging) *Many do not have pain *Some have progressive pain experience over time *Multiple micro trauma over time
*An unpleasant sensory or emotional experience associated with actual or potential tissue damage *Pain is a NORMAL human experience designed to protect our wellbeing and elicit change *Based on perceived threat *Multisystem process *Can ABSOLUTELY change
* Toothache
* Agonizing Foot Pain
*Pain is not a true
reflection of your
tissue state of health* Add imaging with story
*80% of people experience back pain * Up to 64% of people without pain have bulging disk(s) * Low back pain: * Majority have degenerative changes on imaging ages 20+ * Bulging discs are often 50% smaller than initial scan 2 months later and fully resolved in 9 months * Consider the supine vs other positions for scans * 40% of individual have disc protrusions with NO Pain * 80% NFL /85% NBA who under go back surgery return to play * Majority of post op patients DO NOT need to restrict movement
*Some findings are so common in healthy volunteers that
they must be interpreted within the clinical context.
* Among those aged under 40 years with no back pain, MRI
will find that:
* ~50% have disk degeneration
* ~40% have a bulging disk
* ~30% have disk height loss, signal loss or protrusion
* Among those aged over 60 years with no back pain, an x-ray will
find that:
* ~90% have disk degeneration
* ~80% have disk height loss
* ~40% have facet degeneration
* ~30% have spondylolisthesis
* On Kaiser imaging* Rotator Cuff:
* 1 in 3 people 30+ have abnormal findings on imaging
* 2 in 3 people 70+ have abnormal findings on imaging
* After successful surgical intervention >2 to 3 people have
abnormal findings on diagnostic imaging
* Knee:
* Only 50% arthritic knees have pain
* Some have NO ACL and don’t know it
* 1 in 3 collegiate basketball players have abnormal findings on
diagnostic imaging with no symptoms*Imaging results frequently do not correlate with your pain
Butler & Moseley, Explain Pain * Otherwise known as the virtual body imprint in/on the brain
* Don’t wait to feel better to do, Do to feel better
* Minding your thresholds
* Refresh your homunculus
* Anything new can be perceived
by the brain as a threat/danger* Pelvis Only
Institute of Physical Art, Specialized Educational Services* Circles, diagonals, both at the same time or individually
* Your choice, As tolerated
Institute of Physical Art, Specialized Educational Services* Belly or Abdominal Breathing
Institute of Physical Art, Specialized Educational Services
* Relaxation
* 4-7-8 Breathing
* In for 4 seconds, Hold for 7 seconds and Exhale for 8 seconds*KNOW PAIN, KNOW GAIN
*KNOW PAIN or NO GAIN
*If you have been practicing, your brain is already changing: it
takes ~8 weeks to identify a lasting change in a neural
pathway
* Know Apply Pain
Knowing is not enough, we must apply. Willing is not enough, we must do.
-Bruce Lee* Movement exercises as tolerated :
* Pelvic clocks
* Scapular clocks
* Diaphragmatic breathing
* 4/7/8 Breathing
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