CF 239: Change Your Mind About Pain Today we’re going to talk about changing your mind when it comes to pain and how looking at it differently can help our patients get in control of it. But first, here’s that sweet sweet bumper music
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
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You have found yourself smack dab in the middle of Episode #239 Now if you missed last week’s episode , we talked about Benzopdiazapines and Mirror Therapy. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Folks, not a lot going on right now in practice. It seems like I’m just in a holding pattern of sorts at the moment. You’ve probably heard me mention that we’ve been slower lately. For whatever reason. That’s true. I’m not sure why. The economy, gas prices, who knows?
This week though, sitting here on a Monday morning, and counting, I have 162 patients set up for the week and we know more will jump in as the week progresses. That’s 17 new patients set up so far this week as well. That will usually bump up to about 23-25 if I’m guessing. Whack-a-mole people. So, now that numbers are back on the rise, another hole will appear in the bucket. Another mole will pop up and have to be whacked on the noggin with my oversize sledgehammer.
So what’s it going to be?
Patients failing to stay on their schedules because we didn’t have the time available to educate them about the schedule? Not chasing A/R with any real intention? Where’s it going to be? Who knows? It’s always a great mystery but, as one thing improves, the pipes start busting elsewhere.
You better believe I have my eyes out too. At the ChiroTexpo event in Frisco a few weeks ago, I met a vendor that does billing, chases A/R, and things of that nature. They’re spending this week auditing our EHR billing records to make sure we’re up to speed and on target. I’m paying particular attention to the report of findings. I don’t do anything elaborate but when I get in a hurry, I tend to simply gloss right over it and keep scooting.
Not this time. Being in the Florida Mastermind has helped me slow down and give it the importance it deserves. And patient care will not take a step back regardless so….. We’ll see where the next a-hole mole comes popping up but believe me, I’m waiting and ready with binoculars!! Alright, let’s dive in
Our first one this week is called, “A clinical perspective on a pain neuroscience education approach to manual therapy” by Louw et. al. (Adriaan Louw 2017)and published in the Journal of Manual and Manipulative Therapy on May 22, 2017 It’s 5 years old but I included it because it’s relevant to a lot of what I teach and talk about here on the podcast.
Before we get into these two papers today, I want you to understand that I don’t for a second discount the biomedical aspect of pain and I fully believe hands-on chiropractors are in an amazing spot and well-placed to handle the biopsychosocial pain model. But only if we understand it and know how to leverage our tools in our favor. Otherwise, we make it worse.
Why They Did It
In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. So what is PNE? PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more.
PNE’s neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy. Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person’s pain experience by increasing fear-avoidance and pain catastrophization. Trust me, from the stories I get from my patients, the traditional bio-medical model doesn’t just cause catastrophization, it causes downright fear and terror in some patients. An area of physical therapy where the biomedical model is used a lot is manual therapy. I would add chiropractic to the discussion here as well.
This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a ‘hands-off’ approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, the authors explored the notion of PNE and manual therapy co-existing.
PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization, they argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. You guys and gals….if you have chronic pain patients, you have to start listening and paying attention to central sensitization, upregulated central nervous systems, cognitive behavioral therapy, mindfulness, yellow flags, fear avoidance, catastrophization, oh my.
Seriously, if these terms are unfamiliar to you, please do yourself and your patients a favor and go get the smarts. You can start the smarts right here in our podcast episodes. I talk about this stuff non-stop and have been for years here so dive in.
It’s not one thing over the other. Either….or. It’s a broad management protocol that includes PNE, SMT, exercise, massage, yoga, tai chi, low level laser, and some other stuff all piled on top. Oh, and a good provider that communicates in a hopeful and encouraging manner. Put the puzzle together. Start by getting the smarts. And quit being confusion as the kids would say. Do research about it. Lol.
Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.
The second one is called “Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study” by Hill et. al. (Renee J. Hill 2017) and also published in The Journal of Manual and Manipulative Therapy on May 4, 2017. Again, yes, old man river here as far as research goes but relevant
Why They Did It
The primary purpose of the current study was to assess the effects of a mindfulness-based stress reduction (MBSR) program, facilitated by non-psychologist clinicians, for improving psychosocial well-being. A secondary purpose of the current study was to explore the role of self-compassion as a potential underlying factor for improvements in emotional distress.
How They Did It
- 130 participants with a variety of medical complaints completed an eight-week mindfulness-based stress reduction program at Vanderbilt.
- Before treatment and at the 8-week time point, participants completed measures for emotional distress, stress, mindfulness, and self-compassion.
- Linear model estimation using ordinary least squares was used to evaluate the association between changes in self-compassion with changes in emotional distress.
- I’m not going to lie….I’m ignorant of that last part. Made be feel stupid. Which, of course, isn’t hard to do.
What They Found
- Following mindfulness-based stress reduction, participants reported significant reductions in emotional distress.
- Additionally, participants reported improvements in mindfulness and self-compassion.
- Linear regression model revealed that changes in self-compassion were significantly associated with changes in emotional distress.
Start getting the smarts. Research at least once per day.
Alright, that’s it.
Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
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We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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About the Author & Host
Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Adriaan Louw, J. N. E. J. P. (2017). “A clinical perspective on a pain neuroscience education approach to manual therapy.” Journal of Manual & Manipulative Therapy 25(3): 160-168.
Renee J. Hill, L. C. M., Li Wang & Rogelio A. Coronado, (2017). “Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study.” Journal of Manual & Manipulative Therapy 25(3): 128-136.