austinpaintherapy.com

Yoga and Back Pain

Lawrence — Tue, 01 Nov 2011 13:36:00 +0000

A recent study in the Annals of Internal Medicine (United Kingdom) of people with chronic back found that yoga helped ease that pain. Half of the 313 participants participated in weekly yoga classes taught by yoga instructors who had special training in yoga for back pain. This type of yoga is more gentle that typical yoga. According to researcher David Torgerson, “These classes were more gentle than a typical yoga class, because the yoga teachers didn’t want to exacerbate any back pain. They put together a series of yoga poses that would increase, if patients could manage it, the ability to move.” A year later, those who participated in the yoga classes still reported less pain.

To see the entire article, click here

http://www.annals.org/content/155/9/569.abstract?aimhp

Four Criteria for an Active Self-Management Pain Program

Lawrence — Fri, 22 Jul 2011 20:03:30 +0000

Self-management of chronic pain means giving patients not just the information but also the skills necessary to manage their pain and remain active in day-to-day life. This requires more than just telling your patients how to do an exercise: it entails ongoing support and guidance to help them master those skills and establish certain corrective habits and routines in response to flare-ups.

An ideal self-management program should meet the following criteria:

Personalization – Every person is different. Their pain is in different places, has different triggers, manifests to different degrees of strength; their muscles are different, their circumstances are different, their psychosocial factors are different, they were raised to react to pain differently, their bodies react to exercises differently, they progress in different ways. Therefore, it’s imperative to treat the individual, not just the symptom, and continue to adjust to his/her needs on ongoing basis.
The right tools at the right time – Use techniques with demonstrated effectiveness, and continue to build on those techniques as you continue to work with the patient, building confidence and skill over time.
Address emotional factors – Emotions have a huge effect on chronic pain. People with chronic pain have increased anxiety and fear, they withdraw from activities they want to participate in, and they’re caught in a loop of negative thinking. Addressing and treating these emotions can expedite treatment.
Reinforcement of patient responsibility – For a self-management program to be effective, it’s critical that the patient take an active role, not only doing the prescribed exercises but also monitoring and reporting accurate information to the physician. A strong experience of partnership between patient and provider is critical in effectively treating pain in the long run.

A self-management program that meets these criteria will offer vastly improved outcomes in treating patients with chronic pain. Most primary care providers don’t have the means to employ all these elements, but a pain specialist focuses exclusively on performing these functions and can ensure they are carried out to maximum benefit.

Exercising at Least 2 Minutes a Day

Lawrence — Wed, 06 Jul 2011 14:21:46 +0000

A study recently released from the American College of Sports Medicine indicated that as little as two minutes of exercise a day can decrease chronic pain.

The study measured neck and shoulder pain, tenderness, and muscle strength in 198 office workers. Participants in the “two-minutes-per-day” group decreased pain by 1.4 points out of 10, compared to 1.9 points out of 10 for the “twelve-minutes-per-day” group. They also saw decreased tenderness (4.2 points out of 32 and 4.4 points, respectively), and muscle strength increased by 6% in both groups.

The study was released June 3^rd at the 58^th Annual Meeting of the American College of Sports Medicine. It backs up a wealth of other evidence supporting the use of exercise in pain reduction.

The Pain Renaissance

Lawrence — Tue, 26 Apr 2011 13:31:38 +0000

On March 11, 2011, an article appeared in Time Magazine called “The End of Ouch”. Dr. Mehmet Oz states that “as recently as 20 years ago, chronic pain was dismissed as purely psychological — a symptom of a greater mental problem — and it was treated with a terrible blitheness”. As someone who started Austin’s first outpatient pain management program in 1989, I remember how different treatment for chronic pain was 20 years ago. To even get someone classified as “chronic pain” was difficult. Additionally, many of the therapies we routinely use (Biofeedback, counseling, water) were not considered to be useful for treating pain. The article points out that things have changed. That’s true to a point but some things are still the same. Many clinicians do not understand pain and make patients feel like it is all psychological. Since pain is invisible, it is very difficult to treat. Unfortunately, the only option some patients are offered is medication. Dr Oz goes on to point out that “Medications such as anti-inflammatories (the ibuprofen family), opioids and antidepressants are effective in the short term, but there are worries about long-term use. Pain-relief medication is one of the most abused areas of the pharmacopoeia.” I agree with that -the only problem is that if this is the only tool you are offered than you will use it. Dr. Oz also talks about the future where scientists are exploring the ability of the mind to reduce pain. We have included relaxation techniques like biofeedback since we opened in 1989.

For more information about the article, please click this link

http://www.time.com/time/specials/packages/article/0,28804,2053382_2053599_2053598,00.html

Smoking and Chronic Pain

Lawrence — Sat, 16 Apr 2011 18:26:51 +0000

In a recent study funded by the Mayo Foundation, a link between smoking and chronic pain was discovered. The researchers (Toby N. Weingarten, M.D., Yu Shi, M.D., M.P.H., Carlos B. Mantilla, M.D., Ph.D., W. Michael Hooten, M.D., and David O. Warner, M.D) found that “smokers not only have higher rates of chronic pain but also rate their pain as more intense than nonsmokers.” They found it interesting that nicotine has analgesic properties, yet in chronic pain sufferers it has the opposite effect. Additionally, chronic pain sufferers who smoked rated their pain as more life interfering than non smokers. The example they quoted was that smokers with fibromyalgia missed more days of work; reported worse sleep, greater anxiety, and depression; and had more pain, stiffness, and fatigue than nonsmokers with fibromyalgia. The good news is that there was another study by Hooten WM, Townsend CO, Bruce BK, Warner DO that showed smokers responded as well as non smokers to cognitive behavioral therapy for the treatment of chronic pain.

For more information, please click the following link…

http://www.minnesotamedicine.com/tabid/3690/Default.aspx

I have pain -I’m not a drug addict. Why behavioral pain management works!

Lawrence — Thu, 17 Mar 2011 15:17:47 +0000

Many people with chronic pain are not given proper tools to help them reduce their pain to a level that allows them to return to an active, productive lifestyle. For some people, the only tool they are given is narcotic medications. Unfortunately, they are then labeled as drug addicts. It is important to understand that depending on the only tool given to you does not make you an addict. Pseudo addiction is the term which has been used to describe patient behaviors that may occur when pain is under treated. These patients may be looked at as drug addicts when in fact they are in pain and no one has provided them any effective treatments except medication. A behavioral pain management program addresses the physical as well as the emotional aspect of pain and teaches tools to address both sides of the pain problem. Unfortunately, many pain patients with medication dependency problems are sent to traditional drug dependency programs. They typically fail these programs because their underlying pain problem is under treated. Pain has to be treated by teaching tools the patient can easily do for themselves. Additionally, having physical pain creates emotional issues like stress and frustration. If you don’t treat both sides, the patient could well be a long term failure.

Biofeedback and Relaxation Training for Headaches

Lawrence — Thu, 24 Feb 2011 15:02:32 +0000

The following article was written by Gay L. Lipchik, PhD and was reprinted with permission from the American Headache Society® Committee for Headache Education (ACHE).

Biofeedback, progressive muscle relaxation and abdominal breathing are just several of the behavioral medicine techniques proven to reduce headaches and improve quality of functioning. When employed regularly and combined with preventative medication and optimized acute therapy, quality of life is significantly better than with medication alone.

Headache sufferers are justifiably offended when a doctor or a friend dismisses their pain with an offhand remark such as, “You’re just under too much stress. Try to relax.”

Physical and mental tension can certainly make headaches worse. But simply telling someone to relax doesn’t help deal with deadlines, demanding bosses, crying babies, honking horns, unpaid bills, and missed sleep, to name just a few of life’s daily hassles. Relaxation is a skill. Like other skills, it can be mastered with time, practice and a good instructor. There are a variety of mind-body approaches to easing tension and improving pain tolerance. Some have proven track records in preventing headaches or reducing their severity.

Biofeedback and progressive muscles relaxation are the most widely accepted non-drug techniques for headache control and prevention. Their effectiveness has been demonstrated during 25 years of research with well over 100 investigations.

Biofeedback and relaxation training typically yield a 45% to 60% reduction in headache frequency and severity. This is equivalent to the reduction in headache achieved by many headache medications, such as propranolol (Inderal®) and amitriptyline (Elavil®), but without any of the negative side effects. The most common limitation of biofeedback and relaxation training is that it requires time commitment and implementation effort on behalf of the patient. Biofeedback sessions may take one hour and training sessions may include several weekly visits over the course of several months.

For many headache sufferers, the combination of drug and non-drug treatments yields the most significant improvement in headache activity. For example, the average improvement with either biofeedback alone or propranolol alone is a 55% reduction in migraine. However, when biofeedback is combined with propranolol, the average improvement is a 70% reduction in migraine.

Bringing the Body into Awareness using Biofeedback

Biofeedback (or biological feedback) uses an instrument that monitors a bodily response, such as muscle tension or skin temperature, as the person tries to modify that response. For example, the monitor might give feedback with a tone that goes higher if the muscles in the forehead tighten and lower if the muscles relax. Another type of monitor uses a visual display such as a light that changes color as you increase or decrease temperature in your hands (or feet).

Increased muscle tension and changed body temperature are two of the body’s responses to stress and strain. By providing you with instant and continuous information on these involuntary and unconscious processes in the body, you can observe and modify your body’s reaction to stress. After you have used biofeedback to develop your ability to recognize and reduce tension in your body, you will be able to do so anywhere and any time without the help of the equipment. These skills aid in preventing, reducing, or stopping a headache. Biofeedback, like progressive muscle relaxation, works best when you learn the skills from a qualified professional, typically a psychologist or psychiatrist who is trained in this procedure.

Typically, electromyogram (EMG) biofeedback is used as a prevention approach for tension-type headaches. With EMG biofeedback, an EMG machine monitors skeletal muscle tension. Just about any muscle can be monitored, but three muscles most commonly used are:

Frontalis: the muscle in your forehead that is involved with frowning and tightens up when you are worried or under pressure.
Masseter: this muscle tightens your jaw and often stays clenched when you are tense, frustrated, or angry.
Trapezius: this muscle hunches your shoulders and tightens when you are alarmed or anxious or in response to environmental stressors, such as sitting too long at a computer.

These muscles are used in EMG biofeedback because they typically respond to stress and can be easily measured. EMG training is done by placing two sensors (electrodes) at a specified distance from each other on the skin over the identified muscle. A third sensor is placed on a neutral spot to serve as an electrical reference point. These sensors do not cause any discomfort whatsoever; they simply record your body’s responses.

Thermal or hand-warming biofeedback was first used at the famous Menninger Clinic in Kansas. Researchers there discovered that headache patients who learned to raise the temperature of their hands using biofeedback had fewer and less severe headaches when they practiced this skill regularly.

Hand-warming works in the following way: When a person is anxious or under stress, the blood vessels in the fingers narrow and the hands become cooler. That’s why we tend to get “cold and clammy hands” when we’re frightened or nervous. On the other hand, when you are relaxed, the blood vessels in your hands expand and your hands get warmer. You can get an idea of how stressed you are by taking your hand or finger temperature with a thermometer or biofeedback instrument. You can learn to reduce your level of arousal through the process of temperature biofeedback training. Then, whenever your hands are cool or you are experiencing stress, you use your hand-warming skills to produce a more relaxed state.

Although it’s often assumed that “tension-type” headache responds better to techniques to control muscle tension, it has been found that migraine patients improve as much with EMG biofeedback as they do with thermal biofeedback. Thus, the mechanism of action for biofeedback and relaxation training may be more complex than meets the eye. We know that headache sufferers who regularly practice these techniques report a decreased sense of helplessness and an increased sense of self-control. These changes in mental outlook and behavior may increase your ability to prevent headaches as well as your ability to reduce pain, especially if used as soon as you notice a headache coming on.

Relaxation Training

Relation training involves learning how to achieve a physical and mental state of calm and relaxation within a few minutes. It is a systematic set of procedures, rather than simply trying to relax on your own with activities like gardening, reading, or watching TV. Relation training is recommended for headache management because headaches are often related to the body’s reaction to everyday stresses like deadlines, demanding bosses, crying babies, honking horns, unpaid bills, and missed sleep, to name a few of life’s daily hassles. For headache-prone people, stress does not need to be excessive Unpredictability or change in life is all that is needed. Even normal everyday levels of stress can trigger a headache.

Relaxation training slows down the sympathetic nervous system, which is responsible for the stress response. The sympathetic nervous system is involved in regulating heart rate, blood vessel expansion and contraction, blood pressure, sweat production, sleep, and alertness. During stress, heart rate and blood pressure increase, sweat production increases, breathing becomes shallow, and adrenaline and other hormones are released, causing blood vessels to constrict and muscles to contract. You may have noticed that your shoulders are hunched up and your jaws are clenched during stress. You can see then how slowing the stress response might be beneficial.

Deep relaxation reverses many of the physical responses that can trigger headaches. Additionally, during deep relaxation, the relaxed person takes fewer breaths per minute, yet breathes more deeply, “bathing” the blood cells in oxygen, which means more oxygen gets to the muscles and to the brain. Increasing oxygen supply to the brain seems to help prevent headaches. With practice, deep relaxation changes your body’s response to adrenaline and other stress hormones so that it takes a greater disruption from life stresses (and the stress response) to trigger a headache. Becoming deeply relaxed not only helps reduce headache frequency, but it can give a greater sense of self-control as well as decrease irritability, anxiety, depression, insomnia, and blood pressure.

Learning to Relax

Relaxation training is typically provided “live” in a clinic office by an experience therapist (usually a psychologist). Learning to become deeply relaxed may take several sessions, so you may be scheduled for 4 to 10 visits. Visits may be scheduled a couple of weeks apart or once weekly. During your clinic visits, you will be given instructions and in-office practice sessions for a variety of relaxation techniques. Most likely you will be provided audiotapes and written materials to help you practice at home between your office visits. Then you will learn how to use these skills in your daily life. Relaxation training typically begins with two primary techniques: abdominal or deep breathing and progressive muscle relaxation.

Deep Breathing: To teach you deep breathing, your therapist will ask you to place one hand on your chest and one hand on your abdomen, just under your ribs, so that you are more aware of your breathing. Next, you will be asked to breathe in slowly through your nose, pulling your breath down towards your stomach, pushing your abdomen outwards, allowing yourself to fill your lungs completely. Your hand on your abdomen should rise slightly more than your hand on your chest when you are breathing deeply. Breathe out slowly, pulling your stomach in towards your spine, and think the word “relax.” With each slow, deep breath you likely will feel yourself becoming more relaxed. After you have learned to breathe deeply, you will be asked to focus on slowing your breathing. For the first 1 to 2 weeks, you will probably be asked to practice this breathing exercise for 5 to 10 minutes, 2 to 3 times daily as well as during progressive muscle relaxation (PMR) training. After you have mastered the technique, you should check in with yourself throughout the day to remember to breathe deeply.

Progressive Muscle Relaxation: Next you will be instructed in PMR, the most commonly used muscle relaxation technique for the management of headaches. With PMR, you physically tense and then relax your muscles. It might sound like a contradiction, but for a muscle to become relaxed it is helpful for it to be tightened first. Tightening muscles also makes you more aware of what tense muscles feel like. This will help you to identify tension in those muscles early on, so you can apply relaxation skills to prevent the muscle from becoming tenser and to reserve the stress response. Your therapist will demonstrate how to gently tense and relax each muscle. You will learn to tense and then relax muscles in your hands, forearms, upper arms, feet, calves, thighs, stomach, chest, shoulders, neck, face, and head. Next, your therapist will take you through an in-office practice of slowly tensing and relaxing these muscles, while asking you to focus on each muscle, comparing sensations of relaxation with sensations of tension. Between muscle groups, you will be asked to focus also on your breathing. After tensing and relaxing all of the muscle groups, your therapist may ask you to focus on a relaxing scene that you have discussed before beginning the PMR practice. For example, many patients describe a beach scene, waterfalls, or walking through the woods. For many patients this helps to further deepen their relaxation, and the imagery can be used alone as a quick relaxation skill. The entire practice session takes about 25 to 30 minutes.

During your in-office practice of PMR, the room may be dimly lit and you may be offered the comfort of a recliner. You also will be asked to remove your eyeglasses, and you might be asked to remove your shoes, loosen your tie, belt, or any other restrictive closing (suit jacket, for example) in order to be as comfortable as possible. Your therapist will probably ask you to rate your tension levels before and after your in-office practice. And you will probably be asked to keep track of your practice in relaxation logs so that you can discuss with your therapist any problems you might have with practicing the techniques.

The Relaxation Routine

Some people become very relaxed after their first practice session, but the vast majority of people do not notice substantial reductions in muscle tension, stress levels, or headache activity until they have practiced for some time. So, do not become discouraged if you do not get immediate results. Also, not everyone can imagine the pleasant relaxing scene as vividly as they’d like. This will likely come with practice, although some people find it difficult to learn this skill. If it doesn’t get easier with practice, don’t use it as a relaxation strategy. It is important that you use what works best for you rather than to get discouraged. You don’t have to master all of the techniques your therapist teaches you to improve.

For relaxation training to be effective at reducing your headaches, initially you need to practice daily for about 25 minutes at a time. Ideally, you will practice twice daily. You need to practice enough that deep relaxation becomes a habit, so that when you say “relax” to yourself, your body knows how to respond. The amount of time it takes to get deeply relaxed gets shorter with practice and as you learn briefer methods of relaxation in your follow-up office visits.

The goal is for relaxation training to be a portable skill that you can use any time, any place, at any moment’s notice. Initially, however, you might want to consider that your body is in training. You have to train your body to know what it is to be completely relaxed.

Summary

Deep relaxation is a skill that teaches you how to recognize signs of stress in your body and how to reduce them before they reach the level of painful muscles and headache. These techniques work best to prevent headaches. However, they can be helpful if you use them as soon as you notice a headache starting, rather than during a full-blown attack.

Biofeedback and relaxation techniques are most effective in preventing headaches, rather than treating a headache in progress. Nonetheless, many headache sufferers do report that these techniques often lessen the severity and duration of headache if used during a headache attack. Many patients find these techniques to be effective alternatives to medication, while research also shows that typically headaches are best controlled over time by combining these techniques with some use of preventive and acute medication.

Living In Pain? New Survey Shows Half of Americans Mistakenly Believe Pain is Part of Life

Lawrence — Tue, 15 Feb 2011 17:26:02 +0000

According to a new survey released by the American Osteopathic Association (AOA) nearly 70% of Americans report that they, or someone they care for, have experienced pain during the past 30 days. Chronic, or reoccurring pain still affects more Americans than cancer, diabetes and heart disease combined. In fact, more than 76 million people live in pain every day. “Chronic pain is a very serious and unaddressed public health issue, and many people are reluctant to speak to their physician for fear of feeling hopeless, or simply not knowing how to initiate the conversation,” said Robert I. Danoff, DO, an AOA board-certified family physician with Aria Health System in Philadelphia. “It is important for physicians and their patients to work together to address the issue of pain. We want to shift from the ‘decade of pain’ to the ‘decade of healing’ by creating the right plan for the right patient at the right time.”

Busting the Myths Associated with Pain

The AOA survey found that most Americans believe the myths that are associated with pain and then go on to ignore, downplay or under-treat their own chronic pain:

Nearly half (48%) of Americans don’t believe pain is something that can be eased with proper treatment.
Two in five (41%) Americans believe pain is just a standard part of the aging process, while one out of 10 people would simply ignore the pain.
Nearly two in five (36%) Americans would refuse physician-recommended or prescribed pain medication for fear of becoming addicted.
One in three (34%) Americans believe pain medications that come with side effects are worse than the pain itself.
One in three (31%) Americans would not even speak to a medical professional about their pain for fear they could not afford treatment.
Only one in five Americans (18%) would speak to a specialist if experiencing chronic pain.

Although this article focuses on the patient/physician relationship, it is equally as important that the person with pain seek out proper rehabilitation help. You need to take charge of your pain and your life. For more information and to take the AOA survey, please click on the following link.

http://www.prnewswire.com/news-releases/living-in-pain-new-survey-shows-half-of-americans-mistakenly-believe-that-pain-is-just-a-part-of-life-104403883.html

Yoga and Fibromyalgia

Lawrence — Fri, 11 Feb 2011 15:26:53 +0000

An important tool we use in our clinic to combat pain is Yoga. We have always believed that the right kind of Yoga can substantially reduce pain. Unfortunately, a lot of our patients have tried Yoga without proper instruction and then quit because they feel worse after the session. The problem is that Yoga for pain is very different than Yoga for non pain sufferers. Yoga for pain suffers is a very specific, gentle process. The November 10, 2010 issue of Pain published research from the Oregon Health and Science University which shows that Yoga can be very beneficial in combating Fibromyalgia. We feel that the proper type of Yoga can be an excellent tool in to help reduce pain and increase function. For more information, please click the link below.

http://www.sciencedaily.com/releases/2010/10/101014083119.htm

Why Your Back Hurts

Lawrence — Wed, 02 Feb 2011 21:05:21 +0000

In December, Dr Bart Bishop, wrote an article that appeared in Pain.com called “Why Your Back Hurts”. In the article, Dr. Bishop talks about how to lift objects properly. He describes a method where you actually lift the object twice –one mentally and one physically. This article makes a lot of sense as you need to understand what you are trying to lift and how you are going to lift it before you attempt to lift the object. It does not matter if the object is a piece of paper on the floor or a large box. Understanding how to lift properly is equally as important as the lift itself. For further information and to view the full article, please click below.

http://pain.com/alternative-medicine/2010/12/28-why-back-hurts/