Chronic pain is common. If we don’t suffer from it ourselves, chances are we know someone who does. Changes in the structure and function of the brain are thought to underlie chronic pain. The good news is that these changes are not hardwired. Many things can be done to influence how the brain processes pain signals including exercise, healthy eating, and better sleep, as well as thinking more adaptive thoughts, positive emotions, and feeling love and connected. This session will highlight the neuroscience related to chronic pain and how engaging in simple self-management strategies can result in less pain and a more rewarding life.
This presentation comes from the Spring Patient Education conference presented by the Scleroderma Patient Education Conference presented by the Scleroderma Foundation of Greater Chicago.
Pain is a common yet complex biopsychosocial phenomenon that affects every aspect of a patient’s life
Optimal management often requires good assessment, formulation of the problem in the patient, and combining pharmacological and non-pharmacological (psychological and social) interventions
Pain is a common yet complex biopsychosocial phenomenon that affects every aspect of a patient’s life
Optimal management often requires good assessment, formulation of the problem in the patient, and combining pharmacological and non-pharmacological (psychological and social) interventions
The document discusses bio psychosocial aspects of chronic pain from a social work perspective. It covers early models of pain from ancient civilizations, the transition to modern biopsychosocial models, and operational definitions of chronic pain. High comorbidities between chronic pain, depression, and anxiety are examined from biological, psychological, and social perspectives. Personality factors like catastrophizing that may relate to pain are also discussed.
The document discusses bio psychosocial aspects of chronic pain from a social work perspective. It covers early models of pain from ancient civilizations, the transition to modern biopsychosocial models, and operational definitions of chronic pain. High comorbidities between chronic pain, depression, and anxiety are examined from biological, psychological, and social perspectives. Personality factors like catastrophizing that may relate to pain are also discussed.
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
Diagnosis and Management of Chronic pain associated with depression.pptxssuser40df77
Chronic pain and depression are often comorbid conditions that can mutually exacerbate one another through shared neural pathways and neuroplasticity changes in the brain. Approximately half of patients with depression report chronic pain, while 30-60% of individuals with chronic pain meet criteria for depression. Regions implicated in both chronic pain processing and mood regulation include the insular cortex, prefrontal cortex, anterior cingulate, thalamus, hippocampus and amygdala. Greater functional connectivity between the nucleus accumbens and prefrontal cortex in patients with sub-acute back pain has been found to predict transition to chronic pain. Effective treatment of depression may help alleviate chronic pain.
Diagnosis and Management of Chronic pain associated with depression.pptxssuser40df77
Chronic pain and depression are often comorbid conditions that can mutually exacerbate one another through shared neural pathways and neuroplasticity changes in the brain. Approximately half of patients with depression report chronic pain, while 30-60% of individuals with chronic pain meet criteria for depression. Regions implicated in both chronic pain processing and mood regulation include the insular cortex, prefrontal cortex, anterior cingulate, thalamus, hippocampus and amygdala. Greater functional connectivity between the nucleus accumbens and prefrontal cortex in patients with sub-acute back pain has been found to predict transition to chronic pain. Effective treatment of depression may help alleviate chronic pain.
Pain is a common yet complex biopsychosocial phenomenon that affects every aspect of a patient’s life
Optimal management often requires good assessment, formulation of the problem in the patient, and combining pharmacological and non-pharmacological (psychological and social) interventions
Pain is a common yet complex biopsychosocial phenomenon that affects every aspect of a patient’s life
Optimal management often requires good assessment, formulation of the problem in the patient, and combining pharmacological and non-pharmacological (psychological and social) interventions
The document discusses bio psychosocial aspects of chronic pain from a social work perspective. It covers early models of pain from ancient civilizations, the transition to modern biopsychosocial models, and operational definitions of chronic pain. High comorbidities between chronic pain, depression, and anxiety are examined from biological, psychological, and social perspectives. Personality factors like catastrophizing that may relate to pain are also discussed.
The document discusses bio psychosocial aspects of chronic pain from a social work perspective. It covers early models of pain from ancient civilizations, the transition to modern biopsychosocial models, and operational definitions of chronic pain. High comorbidities between chronic pain, depression, and anxiety are examined from biological, psychological, and social perspectives. Personality factors like catastrophizing that may relate to pain are also discussed.
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
Common Brain Mechanisms Between Pain & AddictionPaul Coelho, MD
This document summarizes a perspective on common brain mechanisms of chronic pain and addiction. It proposes that chronic pain involves neuroadaptations similar to those seen in addiction, including reward deficiency, impaired inhibitory control, incentive sensitization, aberrant learning, and anti-reward allostatic neuroadaptations. The document provides epidemiological context on the prevalence and costs of chronic pain. It then reviews models of reward and addiction neurobiology and discusses how chronic pain may disrupt normal hedonic homeostasis in a manner analogous to addiction through an allostatic load. The perspective aims to inform improved chronic pain treatment by drawing parallels to addiction theories and interventions.
Diagnosis and Management of Chronic pain associated with depression.pptxssuser40df77
Chronic pain and depression are often comorbid conditions that can mutually exacerbate one another through shared neural pathways and neuroplasticity changes in the brain. Approximately half of patients with depression report chronic pain, while 30-60% of individuals with chronic pain meet criteria for depression. Regions implicated in both chronic pain processing and mood regulation include the insular cortex, prefrontal cortex, anterior cingulate, thalamus, hippocampus and amygdala. Greater functional connectivity between the nucleus accumbens and prefrontal cortex in patients with sub-acute back pain has been found to predict transition to chronic pain. Effective treatment of depression may help alleviate chronic pain.
Diagnosis and Management of Chronic pain associated with depression.pptxssuser40df77
Chronic pain and depression are often comorbid conditions that can mutually exacerbate one another through shared neural pathways and neuroplasticity changes in the brain. Approximately half of patients with depression report chronic pain, while 30-60% of individuals with chronic pain meet criteria for depression. Regions implicated in both chronic pain processing and mood regulation include the insular cortex, prefrontal cortex, anterior cingulate, thalamus, hippocampus and amygdala. Greater functional connectivity between the nucleus accumbens and prefrontal cortex in patients with sub-acute back pain has been found to predict transition to chronic pain. Effective treatment of depression may help alleviate chronic pain.
1) The document discusses a study that explored the daily routines and quality of life of 10 individuals with chronic pain through interviews and assessments. 2) A grounded theory called the "Paradigm of Life" emerged from the data, which found that chronic pain disrupts individuals' occupations and impacts their quality of life. 3) The theory shows how engaging in meaningful occupations can enhance quality of life by providing distraction from pain and a sense of control.
1) The document discusses a study that explored the daily routines and quality of life of 10 individuals with chronic pain through interviews and assessments. 2) A grounded theory called the "Paradigm of Life" emerged from the data, which found that chronic pain disrupts individuals' occupations and impacts their quality of life. 3) The theory shows how engaging in meaningful occupations can enhance quality of life by providing distraction from pain and a sense of control.
The Psychology of Pain: Understanding and Management in Nursing CareShahid Hussain
At the end of this session, students will be able to:
Define pain.
Explain the types of pain.
Explain physiological perspective of pain (brief).
Discuss psychological perspective of pain (gate-control theory, bio-psychosocial model of pain, etc.).
Factors affecting pain perception including psychological, social and biological.
Discuss treatment approaches for pain management (recent researches).
Discuss the role of nurses in pain management.
The Psychology of Pain: Understanding and Management in Nursing CareShahid Hussain
At the end of this session, students will be able to:
Define pain.
Explain the types of pain.
Explain physiological perspective of pain (brief).
Discuss psychological perspective of pain (gate-control theory, bio-psychosocial model of pain, etc.).
Factors affecting pain perception including psychological, social and biological.
Discuss treatment approaches for pain management (recent researches).
Discuss the role of nurses in pain management.
Salon 1 14 kasim 09.30 10.30 eli̇zabeth papathanassogloutyfngnc
This document discusses pain pathways and the neural circuitry of pain. It notes that pain is a complex response involving both physiological and psychosocial factors. Critically ill patients commonly experience moderate to severe acute pain from their medical conditions and procedures. Inadequately treated acute pain in critical illness can increase the risk of developing chronic pain after discharge and contribute to poorer health outcomes. The document outlines evidence that social support can help reduce both physical and social pain responses in the brain.
Salon 1 14 kasim 09.30 10.30 eli̇zabeth papathanassogloutyfngnc
This document discusses pain pathways and the neural circuitry of pain. It notes that pain is a complex response involving both physiological and psychosocial factors. Critically ill patients commonly experience moderate to severe acute pain from their medical conditions and procedures. Inadequately treated acute pain in critical illness can increase the risk of developing chronic pain after discharge and contribute to poorer health outcomes. The document outlines evidence that social support can help reduce both physical and social pain responses in the brain.
Salon 1 14 kasim 09.30 10.30 eli̇zabeth papathanassogloutyfngnc
This document discusses pain pathways and the neural circuitry of pain. It notes that pain is a complex response involving both physiological and psychosocial factors. Critically ill patients commonly experience moderate to severe acute pain from their medical conditions and procedures. Inadequately treated acute pain in critical illness can increase the risk of developing chronic pain after discharge and contribute to poorer health outcomes. The document outlines evidence that social support can help reduce both physical and social pain responses in the brain.
Salon 1 14 kasim 09.30 10.30 eli̇zabeth papathanassogloutyfngnc
This document discusses pain pathways and the neural circuitry of pain. It notes that pain is a complex response involving both physiological and psychosocial factors. Critically ill patients commonly experience moderate to severe acute pain from their medical conditions and procedures. Inadequately treated acute pain in critical illness can increase the risk of developing chronic pain after discharge and contribute to poorer health outcomes. The document outlines evidence that social support can help reduce both physical and social pain responses in the brain.
This presentation summarizes a proposed study looking at the effects of communication patterns on OsteoArthritis pain. Though my proposed study is not identical with the pain study I researched during my 2008-2009 academic year, it reflects the depth of my understanding and my ability to develop an effective and innovative research proposal.
This presentation summarizes a proposed study looking at the effects of communication patterns on OsteoArthritis pain. Though my proposed study is not identical with the pain study I researched during my 2008-2009 academic year, it reflects the depth of my understanding and my ability to develop an effective and innovative research proposal.
This document provides an overview of pain assessment and management strategies. It defines pain and describes the physiology and types of pain. Components of a comprehensive pain assessment are outlined, including history, physical exam, functional assessment, and use of pain scales. Both pharmacological and non-pharmacological approaches for pain management are discussed. The WHO analgesic ladder is presented as a framework for treating pain with medications. Considerations for using opioids and other pharmacological therapies are also reviewed.
This document provides an overview of pain assessment and management strategies. It defines pain and describes the physiology and types of pain. Components of a comprehensive pain assessment are outlined, including history, physical exam, functional assessment, and use of pain scales. Both pharmacological and non-pharmacological approaches for pain management are discussed. The WHO analgesic ladder is presented as a framework for treating pain with medications. Considerations for using opioids and other pharmacological therapies are also reviewed.
assessment and physiotherapy management of pain in elderly sunil JMI
1. Pain assessment in elderly patients requires a comprehensive evaluation of sensory, emotional, functional, and social impacts of pain. It also requires consideration of age-related changes and beliefs about pain.
2. A thorough history and physical exam are needed to identify potential causes of pain and evaluate for comorbidities. The history should address location, intensity, descriptors, relieving/aggravating factors, and impact on sleep, function, mood and quality of life.
3. Physical exam includes general exam, specific pain evaluation, neurological and musculoskeletal exams to identify potential causes and contributing factors. Assessment of psychological and cognitive factors is also important.
assessment and physiotherapy management of pain in elderly sunil JMI
1. Pain assessment in elderly patients requires a comprehensive evaluation of sensory, emotional, functional, and social impacts of pain. It also requires consideration of age-related changes and beliefs about pain.
2. A thorough history and physical exam are needed to identify potential causes of pain and evaluate for comorbidities. The history should address location, intensity, descriptors, relieving/aggravating factors, and impact on sleep, function, mood and quality of life.
3. Physical exam includes general exam, specific pain evaluation, neurological and musculoskeletal exams to identify potential causes and contributing factors. Assessment of psychological and cognitive factors is also important.
This talk was presented by Michael Macklin, MD from the University of Chicago at the Scleroderma Patient Education Conference on May 4, 2024, hosted by the Scleroderma Foundation of Greater Chicago. This talk includes:
Overview of scleroderma manifestations, organ involvement, brief classifications (limited, diffuse, sine scleroderma)
Overview of current treatment options, need for additional therapies
Overview of plan for multi-disciplinary scleroderma center at the University of Chicago
Potential future therapies in the literature at large
Planned trials/future treatment options at the University of Chicago
For more info about scleroderma and the foundation, head to www.stopscleroderma.org
Interstitial lung disease (ILD) is a common complication of scleroderma that leads to inflammation and scarring of the lungs. In this session, we will review the prevalence of scleroderma-associated ILD (SSc-ILD), classic symptoms, and the approach to evaluating patients with suspected disease. In addition, we will cover various treatments available for patients with SSc-ILD.
This talk was presented at the Scleroderma Patient Education Conference on May 4, 2024, hosted by the Scleroderma Foundation of Greater Chicago.
For more info about scleroderma and the foundation, head to www.stopscleroderma.org
More Related Content
Similar to Pain Resilience and More Rewarding Self-Management
1) The document discusses a study that explored the daily routines and quality of life of 10 individuals with chronic pain through interviews and assessments. 2) A grounded theory called the "Paradigm of Life" emerged from the data, which found that chronic pain disrupts individuals' occupations and impacts their quality of life. 3) The theory shows how engaging in meaningful occupations can enhance quality of life by providing distraction from pain and a sense of control.
1) The document discusses a study that explored the daily routines and quality of life of 10 individuals with chronic pain through interviews and assessments. 2) A grounded theory called the "Paradigm of Life" emerged from the data, which found that chronic pain disrupts individuals' occupations and impacts their quality of life. 3) The theory shows how engaging in meaningful occupations can enhance quality of life by providing distraction from pain and a sense of control.
The Psychology of Pain: Understanding and Management in Nursing CareShahid Hussain
At the end of this session, students will be able to:
Define pain.
Explain the types of pain.
Explain physiological perspective of pain (brief).
Discuss psychological perspective of pain (gate-control theory, bio-psychosocial model of pain, etc.).
Factors affecting pain perception including psychological, social and biological.
Discuss treatment approaches for pain management (recent researches).
Discuss the role of nurses in pain management.
The Psychology of Pain: Understanding and Management in Nursing CareShahid Hussain
At the end of this session, students will be able to:
Define pain.
Explain the types of pain.
Explain physiological perspective of pain (brief).
Discuss psychological perspective of pain (gate-control theory, bio-psychosocial model of pain, etc.).
Factors affecting pain perception including psychological, social and biological.
Discuss treatment approaches for pain management (recent researches).
Discuss the role of nurses in pain management.
Salon 1 14 kasim 09.30 10.30 eli̇zabeth papathanassogloutyfngnc
This document discusses pain pathways and the neural circuitry of pain. It notes that pain is a complex response involving both physiological and psychosocial factors. Critically ill patients commonly experience moderate to severe acute pain from their medical conditions and procedures. Inadequately treated acute pain in critical illness can increase the risk of developing chronic pain after discharge and contribute to poorer health outcomes. The document outlines evidence that social support can help reduce both physical and social pain responses in the brain.
Salon 1 14 kasim 09.30 10.30 eli̇zabeth papathanassogloutyfngnc
This document discusses pain pathways and the neural circuitry of pain. It notes that pain is a complex response involving both physiological and psychosocial factors. Critically ill patients commonly experience moderate to severe acute pain from their medical conditions and procedures. Inadequately treated acute pain in critical illness can increase the risk of developing chronic pain after discharge and contribute to poorer health outcomes. The document outlines evidence that social support can help reduce both physical and social pain responses in the brain.
Salon 1 14 kasim 09.30 10.30 eli̇zabeth papathanassogloutyfngnc
This document discusses pain pathways and the neural circuitry of pain. It notes that pain is a complex response involving both physiological and psychosocial factors. Critically ill patients commonly experience moderate to severe acute pain from their medical conditions and procedures. Inadequately treated acute pain in critical illness can increase the risk of developing chronic pain after discharge and contribute to poorer health outcomes. The document outlines evidence that social support can help reduce both physical and social pain responses in the brain.
Salon 1 14 kasim 09.30 10.30 eli̇zabeth papathanassogloutyfngnc
This document discusses pain pathways and the neural circuitry of pain. It notes that pain is a complex response involving both physiological and psychosocial factors. Critically ill patients commonly experience moderate to severe acute pain from their medical conditions and procedures. Inadequately treated acute pain in critical illness can increase the risk of developing chronic pain after discharge and contribute to poorer health outcomes. The document outlines evidence that social support can help reduce both physical and social pain responses in the brain.
This presentation summarizes a proposed study looking at the effects of communication patterns on OsteoArthritis pain. Though my proposed study is not identical with the pain study I researched during my 2008-2009 academic year, it reflects the depth of my understanding and my ability to develop an effective and innovative research proposal.
This presentation summarizes a proposed study looking at the effects of communication patterns on OsteoArthritis pain. Though my proposed study is not identical with the pain study I researched during my 2008-2009 academic year, it reflects the depth of my understanding and my ability to develop an effective and innovative research proposal.
This document provides an overview of pain assessment and management strategies. It defines pain and describes the physiology and types of pain. Components of a comprehensive pain assessment are outlined, including history, physical exam, functional assessment, and use of pain scales. Both pharmacological and non-pharmacological approaches for pain management are discussed. The WHO analgesic ladder is presented as a framework for treating pain with medications. Considerations for using opioids and other pharmacological therapies are also reviewed.
This document provides an overview of pain assessment and management strategies. It defines pain and describes the physiology and types of pain. Components of a comprehensive pain assessment are outlined, including history, physical exam, functional assessment, and use of pain scales. Both pharmacological and non-pharmacological approaches for pain management are discussed. The WHO analgesic ladder is presented as a framework for treating pain with medications. Considerations for using opioids and other pharmacological therapies are also reviewed.
assessment and physiotherapy management of pain in elderly sunil JMI
1. Pain assessment in elderly patients requires a comprehensive evaluation of sensory, emotional, functional, and social impacts of pain. It also requires consideration of age-related changes and beliefs about pain.
2. A thorough history and physical exam are needed to identify potential causes of pain and evaluate for comorbidities. The history should address location, intensity, descriptors, relieving/aggravating factors, and impact on sleep, function, mood and quality of life.
3. Physical exam includes general exam, specific pain evaluation, neurological and musculoskeletal exams to identify potential causes and contributing factors. Assessment of psychological and cognitive factors is also important.
assessment and physiotherapy management of pain in elderly sunil JMI
1. Pain assessment in elderly patients requires a comprehensive evaluation of sensory, emotional, functional, and social impacts of pain. It also requires consideration of age-related changes and beliefs about pain.
2. A thorough history and physical exam are needed to identify potential causes of pain and evaluate for comorbidities. The history should address location, intensity, descriptors, relieving/aggravating factors, and impact on sleep, function, mood and quality of life.
3. Physical exam includes general exam, specific pain evaluation, neurological and musculoskeletal exams to identify potential causes and contributing factors. Assessment of psychological and cognitive factors is also important.
Similar to Pain Resilience and More Rewarding Self-Management (20)
This talk was presented by Michael Macklin, MD from the University of Chicago at the Scleroderma Patient Education Conference on May 4, 2024, hosted by the Scleroderma Foundation of Greater Chicago. This talk includes:
Overview of scleroderma manifestations, organ involvement, brief classifications (limited, diffuse, sine scleroderma)
Overview of current treatment options, need for additional therapies
Overview of plan for multi-disciplinary scleroderma center at the University of Chicago
Potential future therapies in the literature at large
Planned trials/future treatment options at the University of Chicago
For more info about scleroderma and the foundation, head to www.stopscleroderma.org
Interstitial lung disease (ILD) is a common complication of scleroderma that leads to inflammation and scarring of the lungs. In this session, we will review the prevalence of scleroderma-associated ILD (SSc-ILD), classic symptoms, and the approach to evaluating patients with suspected disease. In addition, we will cover various treatments available for patients with SSc-ILD.
This talk was presented at the Scleroderma Patient Education Conference on May 4, 2024, hosted by the Scleroderma Foundation of Greater Chicago.
For more info about scleroderma and the foundation, head to www.stopscleroderma.org
Overview of scleroderma manifestations, organ involvement, brief classifications (limited, diffuse, sine scleroderma). Overview of current treatment options, need for additional therapies. Overview of plan for multi-disciplinary scleroderma center at the University of Chicago. Potential future therapies in the literature at large. Planned trials/future treatment options at the University of Chicago.
For more info about scleroderma and the foundation, head to www.stopscleroderma.org
This talk was presented at the Scleroderma Patient Education Conference on May 4, 2024, hosted by the Scleroderma Foundation of Greater Chicago.
This session will discuss modalities and demonstrate exercises to improve movement and function in the hands, face and mouth. Suggestions will be also be provided on the use of assistive devices and alternate techniques to accomplish tasks of daily living to increase independence and protect the hands.
This presentation was held on May 4, 2024 by the Scleroderma Foundation of Greater Chicago.
For more information on the foundation and scleroderma, head to our website at www.stopscleroderma.org
See the slides from the Scleroderma Foundation of Greater Chicago's Workshop: Improving Mental Health with Chronic Illness. This presentation was held by the mental health professionals at Ellie Mental Health.
Learn from Bethany Doerfler, MS, RD, LDN, a registered dietitian whose clinical practice and research focuses on providing wellness-based medical nutrition therapy for digestive disorders and allergic bowel diseases. She currently practices in the Division of Gastroenterology and Hepatology at Northwestern Medicine in Chicago, IL. She is the first dietitian to be fully integrated into a gastroenterology division for both research and patient care. This presentation is optimized for Scleroderma patients to learn about their diet options to improve scleroderma symptoms and their gut health.
This presentation covers gastrointestinal issues, which are commonly experienced by those living with scleroderma. This session is set to be an invaluable resource for patients and caregivers, as it will provide crucial insights and approaches to managing GI issues effectively. Dr. Khanna's vast knowledge and experience make this talk a must-attend event for anyone seeking to enhance their understanding and management of GI symptoms in scleroderma.
This document discusses calcinosis, a complication of scleroderma where calcium deposits form in the soft tissues. It outlines that calcinosis most commonly affects the hands, joints, knees and muscles. While the calcium levels in the blood are normal, inflammation and low blood flow in tissues are thought to contribute to calcinosis formation. The deposits contain bone-like proteins and crystals. 18F-NaF PET imaging may help detect early or active calcinosis. Treatments discussed include protecting joints, surgical removal of deposits, topical or injected sodium thiosulfate, medications like tofacitinib, NSAIDs, colchicine and minimizing scleroderma complications to reduce calcinosis risk over
This talk will center around the crucial topic of interstitial lung disease (ILD). Gain invaluable insights into the latest advancements in ILD management, potential treatment options, and the importance of clinical trials in advancing care for scleroderma patients.
Dr. Cuttica and Dr. Mylvaganam will co-lead an insightful talk on pulmonary hypertension (PH). Attendees will have the opportunity to learn about pulmonary hypertension, one of the most serious conditions that impact individuals with scleroderma. The talk will give an overview of pulmonary hypertension and potential treatment options.
In this talk we will discuss the most common findings associated with scleroderma. We will discuss some of the methods your dental team can utilize to help manage your condition, and also some ways that you can help yourself and your dental team manage your condition. We will discuss some unique methods for maintaining your oral health care and will conclude with an open Q&A session.
Virtually every aspect of systemic sclerosis can be beneficially impacted by exercise: inflammation, circulation, body warmth, GI, skin, musculoskeletal and lung health.
The therapeutic underpinnings of exercise target the specific mechanisms behind the pervasive SSc-disease biological, physical and psychological manifestations.
This session is intended to empower people living with scleroderma with knowledge of systemic sclerosis and the anticipated impact exercise and physical activity can have on the many manifestations of systemic sclerosis.
At the end of this session, attendees should have a better understanding of the extent of SSc and feel confident in constructing an exercise regimen generally and for their particular needs related to scleroderma.
This talk will review the best practices for monitoring for the early detection of interstitial lung disease (ILD) and pulmonary hypertension (PH), the two most common and serious lung diseases that occur in patients with scleroderma. It will also cover the many new medications approved for the treatment of ILD and PH and when these medications are indicated. The goal is for patients with scleroderma to understand the recent advances in the diagnosis and treatment of scleroderma-associated lung diseases that are leading to improved outcomes.
In this talk, Dr. Brown will expand your knowledge of how scleroderma impacts the GI tract. This presentation is crucial as an estimated 90% of scleroderma patients suffer from gastrointestinal complications.
Dr. Brown is well-known for his exceptional ability to make complex medical information easy to understand.
Presented by Murray Baron, MD at the Scleroderma Patient Education Conference, hosted by the Scleroderma Foundation Greater Chicago Chapter on Saturday, October 12, 2019 in Chicago, IL. For more about the foundation visit scleroderma.org/chicago.
Presented by Jennifer Mundt, PhD at the Scleroderma Patient Education Conference, hosted by the Scleroderma Foundation Greater Chicago Chapter on Saturday, October 12, 2019 in Chicago, IL.
This document summarizes a presentation on recent developments in treating scleroderma interstitial lung disease. It discusses that ILD affects the lung interstitium and causes decreased oxygen transfer and stiff lungs. ILD risk is higher in patients with autoantibodies like anti-Scl-70. New data shows that long-term lung function loss predicts benefit from anti-fibrotic drugs. The Senscis trial found that nintedanib slowed lung function decline in SSc-ILD patients. Hematopoietic stem cell transplant trials like ASTIS and SCOT showed reduced mortality compared to controls, but transplant-related mortality remains a concern. A new Scleroderma Lung Study trial will test pirfen
This document provides an overview of gastrointestinal manifestations and treatment in scleroderma. It discusses how 60-90% of scleroderma patients experience GI involvement, most commonly affecting the esophagus, stomach, small intestine, and colon. For the esophagus, it covers GERD, dysphagia, and their diagnostic tests and treatments like PPIs. For the stomach, it discusses gastroparesis, GAVE, and treatments like prokinetic agents and APC. It reviews SIBO, CIPO, and treatments for the small intestine. For the colon and anus, it covers constipation, fecal incontinence, diagnostic tests, and treatments including laxatives, bio
Presented by Dr. JoAnna Harper, PharmD at the Scleroderma Patient Education Conference hosted by the Scleroderma Foundation Greater Chicago Chapter on April 27, 2019 in Oakbrook, IL.
More from Scleroderma Foundation of Greater Chicago (20)
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Pain Resilience and More Rewarding Self-Management
1. Pain Resilience and More Rewarding Self-
Management
Afton L. Hassett, Psy.D.
Associate Professor
Director of Pain and Opioid Research
Department of Anesthesiology
Chronic Pain and Fatigue Research Center
University of Michigan
2. I have the following financial relationships to disclose:
o Consultant for Happify, Inc.
o Consultant for PainTools/Community Health Focus, Inc.
o Author of the book: Chronic Pain Reset: 30 Days of Activities,
Practices, and Skills to Help You Thrive
COI Disclosure Information
Afton L. Hassett, PsyD
3. Overview
Pain Resilience – Rewarding Self-Management
TOPICS
o Chronic pain in the US and in SSc
o Neuroscience of pain – in a fun way
o Concept of resilience – targets of treatment
o Interventions to enhance resilience
o Our ongoing research
5. • Chronic pain refers to pain that lasts ≥3 months1
• 20.9% of U.S. adults experienced chronic pain (51.6 million)1
• Disrupts daily work and life activities (disability)1
• Associated with depression, Alzheimer disease/dementias, higher suicide risk,
and substance use and misuse. 1
• Close to 7% (17.1 million) experienced high-impact chronic pain. 1
• New instances of chronic pain (52.4 cases [per 1000 PY]) is high compared with
other chronic diseases: diabetes (7.1 cases), depression (15.9 cases), and
hypertension (45.3 cases).2
Chronic Pain is Common and Often Debilitating
1. Rikard et al. MMWR Morb Mortal Wkly Rep 2023;72:379–385
2. Nahin et al. JAMA Netw Open. 2023 May 1;6(5):e2313563.
6. • Chronic pain has been reported in up to 75% of
patients with SSc and is often resistant to treatment. 1
• Pain is SSc is chronic and relatively stable.2
• Still, flares lasting for three days to three months
often occur in SSc3
• Greater self-efficacy for managing pain associated
with less severe pain and pain interference.2
• Patients with SSc report worse self-efficacy than
patients with other chronic diseases (i.e., MS,
cardiovascular disease, breast cancer), particularly
related to performing self-care tasks for pain 2
Chronic Pain in Scleroderma (SSc) is Common
1. Thombs et al. Arthritis Care and Research 2008, 59, 504–509.
2. Wojeck et al. Nurs Res. 2021 Set/Oct 01;70(5):334-343.
3. Suarez-Almazor et al. J Rheum 2007, 34, 1718–1726.
7. • Chronic pain often co-occurs with
poor sleep, fatigue, cognitive
difficulties, depression and anxiety.
• Stress, poor sleep, poor mood, and
inactivity makes pain worse
• Treatment (interdisciplinary care):
• Medication(s)
• Interventional pain management
• Physical therapy/exercise
• Behavioral therapies
• Pain self-management
Chronic pain is complex, and treatment requires active self-
management
8.
9. Pain processed by many areas of the brain, these areas are
interconnected and many also process thoughts and emotions.
11. The nature of pain – sensory differences
Giesecke et al. Arthritis Rheum. 2004 Feb;50(2):613-23. Gracely et al. Arthritis Rheum. 2002;46:1333-43.
Hannan et al. J Rheumatol. 2000;27:1513-7. Creamer & Hochberg. Br J Rheumatol 1997;36:726.
Coronado et al. J Man Manip Ther 2009;17:148-53. Wiesel. J Manipulative Physiol Ther 1992;15:51-3.
12. Fisher JP, Hassan DT, O’Connor N. Minerva. BMJ. 1995 Jan 7;310(70).
The nature of pain – perception
13. Rogers & Farris. Eur J Pain. 2022 Sep;26(8):1611-1635.
Meta-analysis: Pain catastrophizing, fear of pain, pain vigilance.
The nature of pain – maladaptive thoughts
Pain catastrophizing, fear avoidance, pessimism, etc.
14. Meta-analysis: Jackson et al. Pain self-efficacy. J Pain. 2014 Aug;15(8):800-14.
Review: Basten-Günther et al. Optimism. Behav Med. 2019 Oct-Dec;45(4):323-339.
The nature of pain – adaptive thoughts
15. Frey et al. Anesth Analg 2019;128:e93-e9
Goudman et al. JMIR Serious Games. 2022 May 10;10(2):e34402.
Garcia et al. J Pain. 2022 May;23(5):822-840
The nature of pain – attention and distraction
Mindfulness, open appraisal of pain signals
and immersive distraction - VR
16. Systematic review: Malfliet et al. Brain changes associated with cognitive
and emotional factors in chronic pain. Eur J Pain. 2017 May;21(5):769-786.
Review: Goesling et al. Curr Psychiatry Rep 2013;15:421
The nature of pain – intense negative emotion
17. Dunbar et al. Proc Bio Sci 2012;279:1161-7.
Manninen et al. J Neurosci 2017;37:6125-31.
Hassett et al..
Kugler et al. J Pain Res. 2021 Oct 7;14:3121-3133.
The nature of pain – intense positive emotion
18. Review: Gonder et al. The Impact of Isolation During COVID-19 on Chronic Musculoskeletal
Pain in the Geriatric Population. Pain Physician. 2022 Mar;25(2):E185-E191.
The nature of pain – social isolation
19. Review: Sturgeon & Zautra. Social pain and physical pain:
shared paths to resilience. Pain Manag. 2016;6(1):63-74.
Tarr et al. Biol Letters 2015;11: 20150767
The nature of pain – social connection
20. These studies tell us three very important things about the nature of pain
that open the door for resilience-based interventions:
• Cognitions, emotions, and sensory experiences are all neural events
processed by many of the same areas of the brain,
• Damage/tissue injury can be optional in the experience of pain,
• Psychological, emotional, social, cognitive and attentional processes are
all intricately associated with the experience of pain.
• The changes in brain networks thought to be the cause of chronic pain are
not hard wired!
Neuroplasticity makes it possible for small actions to make a
big difference!
The nature of pain.
21. II. The Concept of Resilience
“Was mich nicht umbringt macht
mich stärker.“
“That which does not kill me will
make me stronger.”
Friedrich Nietzsche's Twilight of the Idols (1888).
22. Resilience defined
• The capacity to positively adapt in response to adversity.1
• Can be considered a trait, but also reflects a dynamic adaptive capacity that
is built by successfully responding to adverse events over time (state).2
• Resilience is a malleable factor that can be improved by using targeted
interventions.3
1) Lazarus, Ann Rev Psychol 1993;44:1-22
2) Clark et al. 2018. Resilience in Aging Concepts, Research
and Outcomes (pp. 51-66). New York: Springer.
3) Bartley et al. Frontiers Psychol 2019;10:1932
23. CAPACITY TO ADAPT AND RECOVER
Low
Resilience
Moderate
Resilience
High
Resilience
Thriving!
THRIVING: Life is even better than before – a life
that feels fuller, more meaningful, and rewarding.
24. Resilience strongly predicts chronic pain outcomes:
• Presence of chronic pain
• Widespread pain
• Analgesic use
• Disability and pain interference
• Quality of life and psychosocial functioning
• Sleep impairment
• Depression, anxiety, PTS symptoms
• Psychological adaptation (e.g., pain acceptance, pain
catastrophizing, pain self-efficacy, active coping strategies,
fear avoidance)
Chng et al. Scand J Pain. 2022 Aug 11;23(2):228-250.
25. Resilience as a Concept
Resilience is a construct made up of various
conceptual elements.
• Connection: Social integration, perceived support.
• Thoughts: Effective coping, optimism, coherence
• Competence: Self-Efficacy, life has meaning/purpose
• Emotions: Positive emotions > negative emotions.
26. Resilience Targets
• Connection: Promote Social Support.
• Thoughts: Enhance Optimism
• Competence: Self-Efficacy, Purpose in Life.
• Emotions: Increase Positive Emotions.
27.
28. 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
Clean Air
Hypertension Tx
BMI lean
Exercise
Flu vaccine
Less alcohol
Less smoking
Comparison of Odds Ratios of Decreased Mortality across
Conditions Associated with Mortality
Holt-Lundstad et al. PLOS Medicine 2010;7(7):e1000316
29. 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
Clean Air
Hypertension Tx
BMI lean
Exercise
Flu vaccine
Less alcohol
Less smoking
Social support
Comparison of Odds Ratios of Decreased Mortality across
Conditions Associated with Mortality
Holt-Lundstad et al. PLOS Medicine 2010;7(7):e1000316
30. Resilience Targets
• Connection: Promote Social Support.
• Thoughts: Enhance Optimism
• Competence: Self-Efficacy, Purpose in Life.
• Emotions: Increase Positive Emotions.
31. (1) Mental and physical health;
(2) Behavioral, psychosocial, and physiological pathways;
(3) Costs (e.g., abusive relationships) + benefits for
health (strong integration);
(4) Cumulative impact on health outcomes over time.
Social Relationships and Health
Umberson and Montez. J Health Soc Behav 2011;51(Suppl):S54-S66
Ong et al. Gerontology 2016;62:443-449.
32. • 5974 individuals ≥50 Health and Retirement Study
• 2006-2016 two timepoints loneliness and symptoms (7.5 years median)
• Loneliness increased the odds of subsequently reporting pain (aOR 1.22, 95% CI 1.08,
1.37), fatigue (aOR 1.47, 95% CI 1.32, 1.65), depression (aOR 2.33, 95% CI 2.02, 2.68), as
well as the symptom cluster of all three (aOR 2.15, 95% CI 1.74, 2.67).
Powell et al. J Am Geriatr Soc. 2022 Aug;70(8):2225-2234
33. Text to Connect
• Every day for the next week, text someone
you care about, but with whom you have
not spoken to for a while. Let them know
you care and are thinking about them.
• Bonus: Send them a photo of the two of
you.
Peak Ahead: Positive Activity Interventions
Connect with others – improve social support
35. Resilience Targets
• Connection: Promote Social Support.
• Thoughts: Enhance Optimism
• Competence: Self-Efficacy, Purpose in Life.
• Emotions: Increase Positive Emotions.
36. • Chronic pain is a major problem for
veterans, post-deployment.
• 20,734 US Army soldiers assessed (CSF2),
then followed over deployment(s).
• Post-deployment pain reported in at least 1
new area of the body by 37.3%.
• Tertile analysis compared to high optimism
soldiers, those with low optimism had 35%
greater odds of reporting new pain (odds
ratio, 1.35; 95% CI, 1.21-1.50) controlling for
demographic, military and combat factors.
Protective factor: Optimism
Hassett et al. JAMA Network Open 2019;2(2):e188076
37. Systematic review of studies
assessing optimism and pain:
• 69 studies = 70% of studies
showed a beneficial association
between optimism and pain
outcomes.
• Greater percentage shown in
experimental studies (78.6%) and
those of higher quality (92.9%).
Optimism
Basten-Gunther et al. Behav Med 2019;45:323-339.
38. Resilience Targets
• Connection: Promote Social Support.
• Thoughts: Enhance Optimism
• Competence: Self-Efficacy, Purpose in Life.
• Emotions: Increase Positive Emotions.
39. Self-efficacy refers to the belief that one
has the capacity to exert control over
one’s behavior, situation, motivation,
social environment, and health.
• Meta-analysis: SE in 86 samples with
chronic pain (N=15,616)
• Self-efficacy robust protective factor for
functional impairment, psychological
distress, and pain severity.
Self-efficacy
Believe. Succeed. Control.
Jackson et al. J Pain 2014;15:800-814.
40. Your life purpose consists of the
central motivating aims of your life:
• guides life decisions,
• influences behavior,
• shapes goals,
• offers a sense of direction,
• creates meaning.
Why you get up in the morning.
Purpose in life
Engage in meaningful activities
41. Purpose in life is associated with:
o Less anxiety and depression
o Healthier aging
o Better sleep
o Better diet and nutrition
o Increased willpower
o Decreased risk of heart attack
o Decreased risk of Alzheimer’s
o Improved immune system functioning
o Increased pain tolerance
Purpose in life and health
The scientific evidence
42. Cohen R, Bavishi C, Rozanski A. Purpose in Life and Its Relationship to All-Cause Mortality and Cardiovascular Events: A Meta-Analysis. Psychosom Med.
2016 Feb-Mar;78(2):122-33.
Neal Krause. Meaning in Life and Mortality. J Gerontol B Psychol Sci Soc Sci. 2009 Jun; 64B(4):517–527.
Hill PL, Turiano NA. Purpose in life as a predictor of mortality across adulthood. Psychol Sci. 2014 Jul;25(7):1482-6.
Boyle PA, Buchman AS, Barnes LL, and Bennett DA. Effect of a purpose in life on incident Alzheimer Disease and mild cognitive impairment in
community-dwelling older persons. Arch Gen Psychiatry. 2010 Mar;67(3):304-10.
Kim ES, Sun JK, Park N, and Peterson C. Purpose in life and reduced incidence of stroke in older adults: The health and retirement study. J Psychosom
Res. 2013 May;74(5):427-32.
Kim ES, Sun JK, Park JK, et al. Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: A two-year
follow-up. J Behav Med. 2013 Apr;36(2):124-33.
Wood AM and Joseph S. The absence of positive psychological (eudaimonic) well-being as a risk factor for depression: A ten year cohort study. J Affect
Disord. 2010 May;122(3):213-7.
Fava GA, Ruini C, Rafanelli C, et al. Six-year outcome of cognitive behavioral therapy for prevention of recurrent depression. Am J Psychiatry. 2004
Oct;161(10):1872-6.
Fredrickson BL, Grewen KM, Coffey KA, et al. A functional genomic perspective on human well-being. Proc Natl Acad Sci U S A. 2013 Aug
13;110(33):13684-9.
Ruini C, Fava GA. Well-being therapy for generalized anxiety disorder. J Clin Psychol. 2009 May;65(5):510-9.
Danhauer SC, Russell GB, Tedeschi RG, et al. A longitudinal investigation of posttraumatic growth in adult patients undergoing treatment for leukemia. J
Clin Psychol Med Settings. 2013 Mar;20(1):13-24.
Purpose in life
Citations
43. Resilience Targets
• Connection: Promote Social Support.
• Thoughts: Enhance Optimism
• Competence: Self-Efficacy, Purpose in Life.
• Emotions: Increase Positive Emotions.
46. • Higher clinical pain intensity
• Higher pain report
• Worse weekly pain
• Lower pain tolerance
• Increased experimental pain sensitivity
• Less tolerance to pain
• Hyperalgesia
• Greater use of pain medication
• Worse analgesia (pentazocine)
• Pain-related disability
• Increased fatigue
• More physical symptoms
• Greater impact of pain on cognition
• Higher levels of psychiatric comorbidity
• Poor quality of life
• Poor self-efficacy for pain management
Abeare et al. Clin J Pain 2010;26:683-9
Cogan et al. J Behav Med 1987;10:139-44
Carcoba et al. J Addict Dis 2011;30:258-70
Fillingim et al. Biol Psychol 2005;69:97-112
Finan et al. Psychosom Med 2009;71:474-82
Finan et al. Health Psychol 2010;29:429-37
Finan et al. Psychosom Med 2013; 75:463-470
Hamilton et al., Ann Behav Med 2005;29:216-24
Hanssen et al. Pain 2013;154:53-8
Hassett et al. Arthritis Rheum. 2000 Nov;43(11):2493-500
Hassett et al., Arthritis Rheum 2008; 59:1742-9
Hassett et al., Arthritis Rheum 2008; 59:833-40
Hirsch et al. Qual Life Res 2012;21:18794
Kamping et al. Pain 2013; Epub ahead of print
Kenntner-Mabiala et al. Biol Psychol 2008;78:114-22
Krok and Baker. J Health Psychol 2013; In Press
Parrish et al. Health Psychol 2008;27:694-702
Schon et al. Psychophysiology 2008;45:1064-7
Seeback et al. Pain 2012;153:518-25
Sibille et al. Clin J Pain 2012;28:410-7
Smith et al. Pain 2008;138:354-61
Staud et al. Pain 2003;105:215.22
Staud. Curr Pain Heachache 2005.9:316-21
Stran et al. J Psychosom Res;60:477-84
Tang et al. Pain 2008;138:392-401
Vwesteeg et al. Qual Life Res 2009;18:953-60
Wesler et al. J Psychosoc Oncol 2013;31:451-67
Zautra et al. Pain 2007;128;128-35
Zautra et al. J Consult Clin Psychol 2005;73:212-20
Negative emotions = poor outcomes in chronic pain.
49. • Solid prospective and experimental
studies found PA related to:
• Lower overall pain ratings
• Lower pain intensity scores
• Decreased same day pain report
• Decreased subsequent day pain report
• Decreased subsequent week pain report
• Increased induced pain tolerance
• Decreased induced pain sensitivity
• Longer tolerance to pain
• Evoked potential moderation
• Decreased use of pain medication
• Lower post-op pain ratings
• Greater walking times post-surgery
• Length of stay in colorectal cancer surgery
Adams et al. Activities, Adaptation and Aging 1986;8:157-75
Alden al. Appl Psychophysiol Biofeedback 2001;26:117-26
Avia et al. Cognit Ther Res 1980;4:73-81
Bruel et al. Pain 1993;54:29-36.
Chaves et al., J Abnorm Psychol 1974;83:356-63
Clum et al. Pain 1982;12:175-83
Cogan et al. J Behav Med 1987;10:139-44
Connelly et al., 2007;131:162-70
Finan et al. Psychosom Med 2009;71:474-82
Finan et al. Health Psychol 2010;29:429-37
Finan et al. Psychosom Med 2013; 75:463-470
Gil et al., Health Psychol 2004;23:267-74
Hamilton et al., Ann Behav Med 2005;29:216-24
Hanssen et al. Pain 2013;154:53-8
Hassett et al. JAMA Netw Open. 2019 Feb 1;2(2):e188076.
Hassett et al. Clin J Pain. 2016 Oct;32(10):907-14.
Hudak et al. Psychol Rep 1991;69:779-86
Kamping et al. Pain 2013; Epub ahead of print
Kenntner-Mabiala et al., Biol Psychol 2008;78:114-22
Meagher et al., Psychosom Med 2001;63:79-90
Meulders et al. J Pain 2014;15:632-44
Morgan et al. Percept Mot Skills 1978;47:27-39
Pickett et al. J Consult Clin Psychol 1982 ;50:439-41
Powell et al., Rehabil Psychol 2009;54:83-90
Rosenbaum et al. J Abnorm Psychol 1980;89:581-90
Sharma et al., Colorectal Dis 2008;10:151-6
Stevens et al. Psychol Rep 1989;64:284-6
Strand et al., J Psychosom Res 2006;60:477-84
Tang et al., Pain 2008;138:292-401
Weaver el al. Percept Mot Skills 1994;78:632-4
Weisenberg et al. Pain 1998;76:365-75
Worthington et al. J Couns Psychol 1981;28:1-6
Zautra et al. J Consult Clin Psychol 2005;73:212-20
Zelman et al. Pain 1991;36:105-11
Positive emotional = better outcomes in chronic pain
50. Negative affect Positive affect
(high is bad) (high is good)
Healthy individuals1 18.1 (5.9) 35.0 (6.4)
Osteoarthritis2 16.6 (4.7) 31.6 (5.5)
Systemic lupus erythematosus3 22.6 (7.3) 33.8 (6.4)
Fibromyalgia4 23.2 (8.9) 29.1 (8.9)
Chronic low back pain5 24.4 (9.9) 26.0 (8.9)
Chronic pelvic pain* 24.0 (8.0) 24.4 (8.5)
Watson et al. J Pers Soc Psych 1988;6:1063-1070. 2. Finan et al. J Consult Clin Psychol. 2005 Apr; 73(2): 212–220. 3. Hassett et al. Arthritis Care Res
2012;64:1341-8. 4. Hassett et al. Arthritis Care Res 2008;59:833-40. 5. Hassett et al. Clin J Pain 2016;32:907-14. *Unpublished UM APOLO dataset.
Positive Affect and Chronic Pain
51. Many people with chronic pain tend to give
up the very things they love and value
most in order to attend to the things they
MUST do.
Meaning in life gets lost
Valued relationships get lost.
The joy in life gets lost.
Some even lose ability to even to seek and
process joy.
Verbrugge et al. Rheum Disease Clin North Am 1990;16:741-61
Katz, Hassett et al. Arthritis Care Res 2011;25(2):299-309
Valued life activities
52. Boorsook et al. Neurosci Biobehav Rev 2016;68:282-97
Kryza-Lacombe et al. Behav Res Ther. 2021 Jul;142:103860.
Disruption in reward processing (positive events) in the brain?
• The experience of pain (in chronic conditions)
can be influenced by changes in the reward
processing system in the brain.
• Reward deficiency (less likely to detect and
experience positive events).
• Results in anhedonia (feeling meh) and less
motivation to seek out positive experiences.
• Reversable!
53. • Simple positive activity interventions (PAIs) for
depression and anxiety
• PAIs may strengthen brain connectivity in reward
processing, attention, and emotion regulation
networks in the brain.
National Institute of Health Clinical and Translational Science Awards
Program Grant UL1TR001442
55. PAIs hit all Resilience Targets
• Gratitude activities
• Acts of kindness (Pos Service)
• Savoring
• Pleasant activities (VLAs)
• Positive daily reflection
• Purpose in life
• Strengths and values
What should we consider a resilience-building intervention?
Positive Activity Interventions – Positive Psychology
56. Meta-Analysis in people with chronic pain:
o PAIs compared to controls decreased:
o pain intensity
o depressive symptoms
o pain catastrophizing
o negative affect/emotions
o increased positive affect/emotions.
At 3-month follow-up, benefit persisted for
depression and positive and negative emotions.
The evidence for Positive Activity Interventions
Braunwalder et al. Pain Med. 2021 Aug 4
57. Keep a Gratitude Diary (next 30 days or longer)
1. Every day, write down 3 things for which you are grateful. It can be
anything - feeling the sunshine on your face, happy that a friend
phoned, receiving a gift, being able to take a walk, anything. Work out
a time to do this. Set an alarm on your iPhone.
2. Make a commitment to yourself that you will write down 3 things
every day.
3. The 3 things MUST be DIFFERENT each time.
4. Smile as you write them down. This will help you to feel grateful.
.
Moskowitz et al. Journal of health psychology. 2012;17(5):676-692.
Cohn et al. Journal of Positive Psychology. In press.
Emmons et al. Journal of personality and social psychology. 2003;84(2):377-389.
Kashdan et al. Behaviour research and therapy. 2006;44(2):177-199
Positive Activity Interventions
Enhance feelings of gratitude & positive thoughts
59. Acts of Kindness
• One day this week, do five kind things for
other people and one kind thing for
yourself.
• The people can be complete strangers or
friends and family members. You can do
very small acts of kindness such as holding
a door open, sharing a genuine
compliment or giving somebody a hug. For
yourself, perhaps take a long bath, call a
close friend or enjoy a book or movie.
Positive Activity Interventions
Connect with others – improve social support
Seligman ME, Rashid T, Parks AC. Positive psychotherapy. American psychol. Nov 2006;61(8):774-788.
Seligman et al. American psychol 2005;60(5):410-42. Sin & Lyuobomirsky. J Clin Psychol 2009;65:467-87.
60. • Acts of kindness have been associated with:
• decreased levels of health-related stress,
• less depression in patients living with diabetes,
• lower levels of pain,
• lower levels of cortisol,
• lower blood pressure,
• less anxiety and depression
• and much more if you include positive service/volunteering as “act of kindness”!
• Curry et al. A systematic review and meta-analysis of the effects of performing acts of kindness on the well-being of the actor.
https://doi.org/10.31219/osf.io/ytj5s
• Moskowitz JT, Hult JR, Duncan LG, et al. A positive affect intervention for people experiencing health-related stress: development and non-
randomized pilot test. Journal of health psychology. Jul 2012;17(5):676-692.
• Cohn MA, Pietrucha ME, Saslo LR, Hult JR, Moskowitz JT. An online positive affect skills intervention reduces depression in adults with type 2
diabetes. Journal of Positive Psychology. In press.
• Hausmann LR, Parks A, Youk AO, Kwoh CK. Reduction of bodily pain in response to an online positive activities intervention. The journal of pain
: official journal of the American Pain Society. May 2014;15(5):560-567.
• Nichol et al. Exploring the Effects of Volunteering on the Social, Mental, and Physical Health and Well-being of Volunteers: An Umbrella Review.
Voluntas. 2023 May 4:1-32
Acts of Kindness
61. Positive Activity Interventions
Mindfully encoding joy
Savoring:
• Every day for the next week, be sure to savor at
least two experiences (for example, your
morning coffee, a moment with a friend, or the
sun on your face as you walk to your car).
• Be sure to engage all of your senses.
• Be present, be mindful.
• Spend at least 2-3 minutes savoring each
experience.
Seligman ME, Rashid T, Parks AC. Positive psychotherapy. American psychol. Nov 2006;61(8):774-788.
Seligman et al. American psychol 2005;60(5):410-42. Sin & Lyuobomirsky. J Clin Psychol 2009;65:467-87.
62. Pleasant Activity Scheduling
• On 3 to 5 days this week, set aside time to
do something you enjoy. Put it on your
calendar and treat it with the same respect as
you would a doctor’s appointment.
• Have coffee with a friend
•Spend time on your hobby/sport
•Buy a small gift for yourself/loved one
•Take a cooking or yoga class
•Get a massage
•Binge watch a favorite show
•Take the dog on a nature hike Cuijpers et al. Clin Psychol Rev 2007;27:318-26
LARGE effect size in depression = .87
Behavioral activation!
Positive Activity Interventions
Increase positive emotions
65. Happiness and Pigs
Notice, savor, recall
“Every evening think about the people, things or events
for which you are happy. You may make a list if you like.
Pick one of these and spend a moment savoring it.
What made it so special to you? Now, write down this
moment on a “currency” slip. Use enough detail that
you can immediately recall what happened later. Next,
add the date, fold up your happy memory “currency,”
and drop it in the piggy bank. You will make these happy
memory “deposits” in the same way every evening for
the next 30 days.”
66. Happiness and Pigs
Notice, savor, recall
“At the end of 30 days, you will “close your account.”
This means that you will withdraw all of the “currency”
from your piggy bank and read each and every one of
the deposited happy memories. As you read them, try to
recall details of the happy event and what made it so
special to you at the time. Enjoy!”
67. Positive Activity Interventions – Signature Strengths
Capitalize, grow, thrive
We all have Character Strengths and these
are our secret super-powers.
70. Signature Strengths:
• Based on your Strengths Test, write down your
top seven strengths. Every day for the next
week, use one of these strengths in a way that
you have not before. Each night, write down
how you used one of your strengths that day,
including what strength you used, how you felt
before, during, and after the activity, and
whether you plan to repeat it in the future.
Use your character strengths
Capitalize, grow, thrive
72. Are PAIs effective for people with chronic pain and for
what outcomes?
RCT
o CBT for pain with PAIs to enhance engagement and
build resilience (PRISM)
o Delivered by MA using an online platform
o Telehealth coaching weekly (15 mins)
o cLBP plus fibromyalgia symptoms
o Compared PRISM to CBT and TAU groups
o Prelim: PRISM best pain and functioning outcomes
but the effect takes time, 6 months and one year.
Promoting Resilience through Innovative Self-Management (PRISM)
Hassett & Williams R01 NRO17096 NIH-NINR
73. Effects of a Resilience-Building Energy
Management Program (RENEW) on Fatigue and
Other Symptoms in Systemic Sclerosis:
A Randomized Controlled Trial
• Online CBT for pain adapted for scleroderma
and to target fatigue.
• Addition of positive activity interventions to
enhance engagement and benefit.
• Peer health coaching.
• Results: Less fatigue and pain interference and
greater resilience!
74. How can we tailor these interventions to meet the
needs of unique pain populations and/or
individuals?
75. Positive Steps Sessions
Education + Staying Active
Steps = walking program
Music is Medicine
Doing What you Love
Life Highlights
Act of Kindness
83. Pain self-management with a focus on
building resilience:
o Learn about the neuroscience of pain - gently
translated with lots of analogies and stories.
o Explore the role that thoughts, emotions, actions and
relationships play in pain processing.
o Try 30 evidenced-based strategies over 30 days, one
each day, to find the ones you like the best.
o Favorite strategies will go into your Thriving Plan, a
personalized pain-management tool kit that you
design to help you lead a life with less pain, greater
purpose, and more joy.
84. Lived Experience
eleven reflections about life with chronic pain
Christine Veasley
Michele Andwele
Ben Ahrens
Cynthia Toussaint
John Deuble
Casandra Metzger
Kathleen Sutherland
Lynne Matallana
Monica Gay
Shanna Kattari
Kevin Boehnke
Photo by Chris Veasley – ResiliencePhotography.com
88. Funding Sources and Salary Support:
NIH-National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
NIH-National Heart Lung and Blood Institute (NHLBI)
NIH-National Center for Complementary and Integrative Health (NCCIH)
NIH-National Institute of Nursing Research (NINR)
Rheumatology Research Foundation
University of Michigan, Department of Anesthesiology
Connect at AftonHassett.com