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An Integrative Approach to Chronic Pain Dear Clients and Colleagues: When the phone rings at Integrated Treatment Solutions

it is generally a person who is making either an initial attempt to get help or has mustered the energy to go to bat again and see if something different can happen after years of enduring a particular problem. It is amazing how many people struggle with ongoing health and emotional problems, including chronic pain and discomfort in their daily lives, and yet they keep going. The strength of the human will and spirit is truly amazing! But, longstanding issues are energy drains, and they can gradually erode at our health and change our personalities. Chronic pain is a chief concern for many people. Twenty-five percent of the US population is affected by chronic pain, according to the National Center for Health statistics. The cycle of chronic pain is complex and presents difficulty in breaking Many patients are prescribed opiates for immediate pain relief or anti-anxiety medications to calm down, and/or end up taking over-the-counter or prescribed sleep aids in order to get through the night. These medications are intended for short-term use but, for a variety of reasons, have unfortunately become mainstays for many patients. As a result, this contributes to a higher risk of dependency, depression, inactivity, and immense fear as quality of life diminishes with decreased promise for improvement or resolve. This issue of Living Well News is focused on An Integrative Approach to Treating Chronic Pain, defining chronic pain, identifying contributing factors as well as potential avenues towards improvement. A skill building opportunity using mindfulness is also made available to help you gain a sense of the mind-body connection. Being able to understand this critical connection is necessary in order to unravel the complexity of your pain and to work gradually towards regaining control of your health and to live a fuller life. We hope you find this issue useful and encourage you to forward it onto a family member or a friend who might be struggling with chronic pain and accompanying conditions including: depression, anxiety, chemical dependency, or other persistent problems. For more information or to schedule an appointment, contact us today by phone at 610.692.4995 or email info@MyIntegratedTX.com Warm regards, Paula Tropiano, M.A., L.P.C., CCDP-Diplomate Director Chronic Pain: A Growing and Controversial Problem The American Academy of Pain Management considers pain as a silent epidemic in the United States, noting that an estimated 50 million Americans live with chronic pain caused by disease, disorder, or accident. It is also estimated that an additional 25 million people suffer acute pain resulting from surgery or accident, with approximately two thirds of these individuals living with this pain for more than five years. The most common types of pain noted as including arthritis, lower back, bone/joint pain, muscle pain, and fibromyalgia. The consequences of untreated or failed treatment attempts are costly, with the loss of productivity and daily activity due to pain is substantial. In a study done in 2000 it was reported

that 36 million Americans missed work in the previous year due to pain and that 83 million indicated that pain affected their participation in various activities. Although pain cannot be seen, touched or measured, it is very real. It is a signal which is produced in response to injury and is processed in the complex, central nervous system creating an array of physical and emotional responses. Hence the terms pain (relating to the physical component) and suffering (to the emotional distress) are intimately related. Chronic pain is pain that continues beyond three to six months, has lasted beyond any useful function, and may or may not have a clearly defined physical basis. But why are some people more affected by pain than others? Pain is a subjective and personal experience unique to each person. Our response to pain is based on many factors, including, gender, age, and prior experiences with pain and illness, attitudes / beliefs, social influences, environment, circumstances, biochemistry, and the various dimensions which contribute to the making of who we are. For instance, if a person has had prior experiences with pain, they may anticipate its course which will affect their expectations. If a person has had a history of being abused as a child emotionally, physically, or sexually his or her perception of pain may differ accordingly, impacted by fear, compounded stress, and diminished ability to cope. If a person has a shy personality and has a difficult time asserting and asking for his or her needs and wants, pain may present another layer of complications. Our sensitivities and level of resilience can really impact our own unique response to pain, all of which are valid. Essentially, it is reasonable to believe that the unique characteristics of each individual impact ones experience of pain. This brings us to the term psychosomatic, which refers to the connection between the mind and the body recognizing it as one interdependent system highlighting the influence of emotional factors. Unfortunately, as emotions are involved, it can also be assumed that the pain sufferer is somehow making the pain happen or that the pain is all in ones head or the possibility of drug seeking behavior is occurring. Pain is, however, very real and is considered a medical priority attached to an ethical obligation out of respect for human life within healthcare. It is important that we understand the dynamics of pain so that productive steps are taken towards resolve. Understanding and being able to leverage the mind-body connection is at the base of applying an integrative approach. Mind over Matter? Mind-body oriented health professionals contend that we have more power over our pain than we realize. We know that the brain and central nervous system are connected and constantly talk to each other, sending and receiving signals such as pain messages. Messaging typically results from injury or illness and stop once the body is healed. Mind-body interventions are based on the idea that this messaging system can break down, causing miscommunication between the mind and body. Pain treatment programs that use mindbody interventions help interrupt these pain messages and reestablish healthy communication within the central nervous system. It is important to bear in mind, however, that because pain is a complex puzzle, no single health care profession holds the one and only key piece; rather, each health care professional holds a critical piece that contributes to the completion of the puzzle. Skilled practitioners are trained to see patients as multifaceted, whole systems requiring a multidisciplinary viewpoint and a tailored clinical/ behavioral approach.

Role of Behavior: Thoughts and Emotions Emotions = energy in motion Cited via addiction and codependency expert John Bradshaw, Ph.D. But, human being can only be aware of just so much on a conscious level. There are many emotional experiences that we have at the subconscious level that we do not tune into, but it is these inner experiences that have the most power over us when they go unidentified over the longer term. Feelings of anxiety, fear, tension, anger, resentment, or depression could cause a disconnection between the mind and body creating a multitude of problems. Our brain is designed to respond to such emotions, it is constantly rewiring itself to keep up with the barrage of negative stimuli. As a result, the brain may send erroneous pain messages through the body. When working within a mind-body or integrative treatment framework, a physician or behavior therapists first step is to examine behavior and environment in order to identify factors that may be causing or exacerbating the persons pain reaction. The next step is to develop more productive ways to handle the stressors in order to develop more control over physiological responses to difficult emotions. Over time, difficult emotions are processed or regulated more fluidly and distress is better tolerated without getting held up in the body. Ultimately, this helps in building the ability to become more stress hardy and resilient against negativity and sickness. Integrative Approaches Over the past few decades, an abundance of research has confirmed that mindbody therapies, either alone or with other treatments, may help resolve various types of pain and prevent pain recurrence. Techniques that were once considered complementary or alternative (such as behavioral therapy, biofeedback, cognitive therapy, guided imagery, and hypnosis, acupuncture, acupressure, nutrition, meditation, and relaxation therapy) have now become mainstream. These therapies, along with standard medical care and needed lifestyle changes, can be integrated into a tailored treatment plan, allowing the pieces to be put together towards resolve of chronic pain and restoring a higher quality of life. Where does one Start? At Integrated Treatment Solutions, we always start with a comprehensive assessment. An assessment is all about having a quality conversation about the clients history, health, home/work environment, relationships, important life experiences, world view, and concerns. Therapists generally spend more time with clients over a span of time and are helpful in being able to speak to important factors that may be impacting the clients health. When there is a health issue at hand, we always work with the clients primary care doctor and/or refer the client to an Integrative Medicine (IM) (http://www.webmd.com/a-to-z-guides/features/alternative-medicine-integrative-medicine) or Functional Medicine (FM) (http://www.yourmedicaldetective.com/public/department50.cfm) doctor who can assess and treat conditions beyond symptoms, getting to the root of a given problem. Through identifying underlying issues to the problem, we develop an integrated treatment plan with goals and a process to reach them. Many of these goals are behavioral requiring the client to try new ways of living and making changes. Learning new skills is central to making progress. Other resources and interventions are generally included, as it is necessary that the client become an active learner in the process and be willing to collaborate in their treatment. Essentially, everyone needs to do their part in order to work towards a solution.

Skill Building: Mindfulness - What Skills The first step in working with any condition worsened by stress is to start with the mind. Our minds can be our best ally or our greatest foe. Being able to distinguish the difference between what is real and what is not is important in being able to gain true control over our comfort, establish confidence and trust in our ability to cope. It is our nature to judge, that is to interpret what we see and experience, assigning some sort of meaning to it. Judgment is about survival, so we can act out of self-protection and prevent harm. But, the problem with this is that our interpretations are not always accurate. We all bring our personalities, fears, and experiences with us through our lives and they impact the way we see and experience other people and events. In order to reduce stress, tension and to build healthy habits, we must step back and relearn how to view the world. Being mindful is at the core of this way of living in the moment and noticing changes that take place in slow motion, noting the gradual progression of one moment into anotherallowing each moment to be new and residue free from the past. We can apply moment-to-moment awareness to anything, including our bodies, minds, and emotions. When we tune in and watch and listen closely to our body, we are more apt to also notice the inner dialogue we are having in response to what we think we are experiencing. For instance, a headache; it is easy to want to grab an Advil or aspirin, as our most likely immediate reaction to the pain is This is bad! Lets make this go away. We have become conditioned to just irradiate pain. However, if we would stop, maybe sit in a chair or lie down, get quiet, and mentally scan the body, we may come to identify the tension that is asking us to be released or learn to recognize some other emotion that is lingering. But, if we just silence the pain before getting the information, then we cannot take care of our health in a real way. Try the attached exercise: Mindfulness: What Skills (plug in attachment) and read through the steps. Note the breakdown and the importance of keeping it simple and sticking to what is. We, at Integrated Treatment Solutions, would like to hear from you. Let us know what you discover in using this approach. And, remember, that it is the minds habit to rush through or pass over what requires attention. Learning about the mind is the key to all health and contentment. References and Recommended Reading: Mindfulness Meditation for Pain Relief Guided Practices for Reclaiming Your Body and Your Life Jon Kabat-Zinn Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness Jon Kabat-Zinn Healing Back Pain John Sarno, MD You Tube Video: http://www.youtube.com/watch?v=9ymsLSiA2RA&feature=related The Power of Now Eckhart Tolle

Quote: You may be disappointed if you fail, but you are doomed if you dont try. Beverly Sills We invite you to sign up for the monthly issue of Living Well News please on the Integrated Treatment solutions homepage www.myintegratedtx.com .

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