Pain Management Beyond the Pills and Procedures


Published on

Dustin P. Wallace, PhD, Licensed Psychologist, Integrative Pain Management Clinic, Children’s Mercy Hospitals and Clinics, Assistant Professor of Pediatrics, School of Medicine, University of Missouri-Kansas City

Pain Management Beyond the Pills and Procedures

1 Like
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Pain Management Beyond the Pills and Procedures

  1. 1. Pain Management: Beyond the Pills and Procedures JA National Conference July 21, 2012; St. Louis, MODustin P. Wallace, PhDLicensed Psychologist, Integrative Pain Management Clinic Children’s Mercy Hospitals and ClinicsAssistant Professor of Pediatrics, School of Medicine University of Missouri-Kansas City
  2. 2. Disclosures• I am not a medical doctor!• Please check with your doctor before starting any new treatment, including the ones we discuss today
  3. 3. Today’s plan1. Many things influence pain from JA2. Pills and procedures can lead to pain relief… but do not always eliminate pain3. Certain other strategies can be more effective and have fewer side-effects – Strategies for children, teens, and parents4. Time for questions and discussion – (and feel free to ask at any time!)
  4. 4. JA is a PAIN• Broad set of autoimmune inflammatory conditions – Joints: JIA (oligo-, poly-, systemic) – Tendon/ligament: Enthesitis (ankylosing spondylitis, spondyloarthropathies, reactive) – Psoriatic arthritis, dermatomyositis, scleroderma lupus, HLAB, etc…• Inflammation -> pain -> more inflammation!
  5. 5. Pain can be Disabling• Impairment varies across individuals• Severity of symptoms does not fully account for disability • According to most studies, arthritis activity accounts for less than 10% of the pain that kids report
  6. 6. Think Bio-Psycho- Socially!• Pain comes from physiological/medical factors as well as psychological, social, behavioral, historical and environmental contributions
  7. 7. Also… • Muscles guard, become tight, and may spasm• Nerves get “practiced” at pain signals – Sending nerves – Listening nerves Pictures from: imagepages/18125.htm &
  8. 8. Pills & procedures are important• Arthritis drugs: Anti-inflammatory & disease- modifying• Other pain medications• Surgeries & other procedures (injections, soft- tissue release, joint replacement, etc)• Splints or orthotics
  9. 9. But these have limitations…• Arthritis medications: – if disease is improving, more may not help pain – side effects can limit dose• Pain medications: – Hyperalgesia, side-effects• Surgeries/procedures: invasive, side-effects• Splints/orthotics: only correct certain issues
  10. 10. What other options do you have?• Lots!! – Address those overactive nerves – Ease those painful muscles – Take advantage of the pain gate
  11. 11. Pain is not merely sensoryexcitation
  12. 12. What other options do you have?• BIG categories: – Physical activity – Adequate water and nutrition – Distraction (sensory and cognitive) – “Biobehavioral” (usually relaxation-based) – Combination approaches• Parenting strategies
  13. 13. Physical Activity• Why does it help? • What you can do – Stimulates nerves – Moderation! normally – Stretching – Stretches and – Physical therapy strengthens muscles – Supports joints
  14. 14. Adequate water; good nutrition• Why does it help? • What you can do – Promotes healing – Aim for 64oz water through normal body daily processes – Variety of fresh foods – May decrease including colorful inflammation fruits and veggies – Allows medications to – Reduce processed work their best foods and sugar
  15. 15. Anti-inflammatory diet (as example) ** Not specifically endorsing this diet, but it has a number of excellent elements. Reminder: talk to your doctor before making any large changes. Picture from: drw/u/ART02995/Dr- Weil-Anti-Inflammatory- Food-Pyramid.html
  16. 16. Distraction - sensory• Why does it help? • What you can do – Closes pain gate – Heat, cold, movement – May promote in water relaxation and healing – Petting animals – Releases feel-good – Vibration neurotransmitters – TENS – Massage, self-massage
  17. 17. Distraction – sensory (massage)• Example: – Comfort Hold • Simply laying warm, full hands on your child can be very calming. Start with forehead and neck, and work down. Hold each place for a few calm breaths. – Massage: • More than just a shoulder rub!
  18. 18. Distraction – sensory (massage) • Face: sides of face, forehead, nose, chin • Stomach: hand over hand, then clockwise • Legs: hip to foot, foot, then back up • Arms: same as legs • Back: down, side to side, circular, neck, head to toe
  19. 19. Distraction – sensory (massage)
  20. 20. Distraction – sensory (massage)
  21. 21. Distraction - cognitive• Why does it help? • What you can do – Helps close pain gate – TV, movies, video – Adds fun activities games, – Releases feel-good neurotransmitters
  22. 22. Distraction - cognitive• Why does it help? • What you can do – Helps close pain gate – TV, movies, video – Adds fun activities games, – Releases feel-good – Non-video games, neurotransmitters books – Music, art, activities – Friends
  23. 23. Biobehavioral strategies• Why does it help? • What you can do – Regulates autonomic – Relaxed breathing nervous system – Progressive muscle – Decreases overactive relaxation pain nerves – Imagery/self-hypnosis – Promotes healing – Biofeedback – Meditation
  24. 24. Biobehavioral strategies• Examples: – Diaphragmatic breathing – Quick muscle relaxation – Imagery
  25. 25. Combine some of these?• Yoga or Tai Chi – Physical activity, strengthening, stretching, relaxation, biobehavioral, distraction (sensory & cognitive)• Massage – Relaxation, nerve stimulation, distraction (sensory)
  26. 26. Combine some of these?• Acupuncture – Biobehavioral, stimulates nerves• School! – Distraction (cognitive & sensory), physical activity, social engagement feels good
  27. 27. Stay in school!• Full medical homebound contraindicated for most adolescents with chronic pain – May do more harm than good• Commitment to regular school attendance despite pain is critical to prevent enduring disability – Avoid pattern of withdrawal• Students retained in one grade are 50% more likely to drop out
  28. 28. Stay in school!• Accommodations may help facilitate regular attendance: – Rest or stretch breaks – Extra time for tests/assignments – Modified PE curriculum – Assignments/grading limited to essential learning – Gradual reentry plan
  29. 29. Mood or anxiety may get in the way • Chronic medical conditions can get kids down – Especially if painful, or limiting activities • Might also worry about their pain, JA, or what is going to happen • Completely normal, but might get in the way in addition to pain/JA – If so, therapy can help
  30. 30. Mood or anxiety may get in the way • Symptom reduction and acceptance: – Education of patient and family – Relaxation and possibly biofeedback – Develop coping and self-efficacy – Build motivation – Skills training and goal setting – Reducing avoidance, engaging with values – Treating adjunctive problems such as anxiety and depression – Training parents in behavioral strategies
  31. 31. Mood or anxiety may get in the way • Referral – Ask your doctor if other patients have had good experience with a certain psychologist or therapist – Meet a couple different therapists before deciding – Find someone experienced at working with kids who have JA or other painful medical conditions • Make sure they have a good understanding of what you are coming for, and a plan to help you reach your goals!
  32. 32. Parenting pain flexibly• Many roles: – Protector, advocate, encourager, coach, comforter, limit setter, role model!• At the same time… – You have your own worries and struggles about your child, and other aspects of your life! – Responsible for helping your child’s adherence – Social/family roles disrupted
  33. 33. Parenting pain flexibly• Some challenges – Parent distress may be modeled for kids – Hard to balance being responsive and supportive, while encouraging coping and not doing too much• The good news – Good coping modeled for kids – When disease and pain management are in context with other values, kids function better!
  34. 34. Parenting pain flexibly• Role Model: – Understand stress and burden are normal – Have social support; get more help if you need it! – Follow your own values, and encourage this in your child(ren) • Keep JA treatment and pain avoidance from becoming sole family focus – Support and celebrate your child’s development
  35. 35. Let’s talk!• Questions, Comments, and Discussion!