Authored by Dr. David Alter in Dr. Alter's MindMatters

The experience of pain is something with which everyone is familiar.  The experience of chronic pain is something else entirely.  Chronic pain is constructed out of many different components or elements that reinforce each other.  With chronic pain, the whole really is greater than the sum of the parts.  The good news is that the different elements of the overall pain experience can be treated separately.  When this is done, the overall experience of chronic pain can change.  For example, clinical hypnosis, a powerful tool woven into many different pain treatment approaches, can focus on:

• physical aspects of pain (e.g., the location, intensity or other sensory qualities)

• emotional aspects of pain (e.g., the fear that no one can help reduce the pain)

• cognitive aspects of pain (e.g., the belief that limitations in functioning levels make you worthless)

• spiritual aspects of pain (e.g., the conviction that the pain persists because of some past wrong the person committed)

• or the narrative aspects of pain (e.g., the interconnected memories from our past that become the on-going “story” of our lives, that contributes to self-fulfilling patterns of functioning in our lives)

For chronic pain treatment to be effective, each of these different elements has to be examined.  Each of these elements contributes to the overall experience of pain for each person.  Our culture tends to have a hard time considering a problem as caused by many different elements.  That is, perhaps, a major reason that when it comes to pain (a universal experience that creates untold misery for so many) the search for a magical cure is so strong.

Too often, the search for a solution begins and ends with prescription medications, often painkillers of one sort or another.  While moderate and focused use of such medicine can be helpful, it cannot treat all the different elements that make up the experience of chronic pain.  Not surprisingly, when pills are used to treat something for which they are not designed or intended, huge problems with dependence or addiction to pain medications arise.  This only complicates efforts to help people learn to manage the pain. 

If you are suffering from chronic pain, or if painkillers have become the primary tool you use in your efforts to manage pain, consider having a comprehensive holistic evaluation of your pain condition.  Learn what the building blocks are for your pain experience.  Learn how to change some of those building blocks and discover the power you have to change your pain experience. 

Brought to you by Diane Tanning, LAc, MS

I hope that you will enjoy this story in the New York Times on 40 NFL players who use acupuncture to treat pain and increase flexibility.  I use acupuncture to treat pain, migraines, and fertility problems, among many others concerns.  If it's good for the NFL, it's good for all of us! 

Acupuncturist Treats 40 N.F.L. Players in 4 Cities

Jets fullback Tony Richardson recently had an acupuncture session at his apartment that included 120 needles.

  By GREG BISHOP

  Published: November 29, 2010

Brought to you by Dr. David Alter's MindMatters

When all you have is a hammer, everything looks like a nail!  For far too long, the treatment of pain has relied on strong pain killing medication and invasive back surgeries.  These two approaches represent the "hammers" that have tried to "nail down" chronic pain.  The results, as nicely pointed out in the accompanying article, entitled "Back Surgery May Backfire on Patients in Pain," have been disappointing for too many pain sufferers.  Too many patients undergoing surgery for back pain experience limited benefits or actually experience increased pain with decreased ability to function. 

 To treat chronic pain effectively demands recognition that CHRONIC pain does not simply reflect damaged tissue that can be fixed with surgery.  Chronic pain is a body and mind condition that requires a body and mind treatment approach!  Chronic pain involves changes in networks of nerves that carry signals between the body and the brain; chnages in the types and amount of messenger molecules that circulate in the blood that cause the body to be more sensitive to pain; changes in mood related to worry, sadness, fear and despair; changes in thought patterns and beliefs that can keep the body in an over-aroused state; and changes in key relationships that influence the level of support or comfort that is so needed WHEN affected by chronic pain. 

 At Partners in Healing of Minneapolis, we have developed a body and mind treatment approach called the Program for Conscious Living that addresses the uniqueness and complexity of your chronic pain condition.  Call our office at 763-546-5797 to learn more about the Program for Conscious Living, and take that next step on your path to better health and improved daily functioning. 

Back surgery may backfire on patients in pain
Patients who had spinal fusion were less likely to return to work and needed more opiates, study says
by Linda Carroll (October 14, 2010) www.msnbc.com 

Just a month after back surgery, Nancy Scatena was once again in excruciating pain. The medications her doctor prescribed barely took the edge off the unrelenting back aches and searing jolts down her left leg. “The pain just kept intensifying,” says the 52-year-old Scottsdale, Ariz., woman who suffers from spinal stenosis, a narrowing of the chanel through which spinal nerves pass. “I was suicidal.”

Finally, Scatena made an appointment with another surgeon, one whom friends had called a “miracle worker.” The new doctor assured her that this second operation would fix everything, and in the pain-free weeks following an operation to fuse two of her vertebrae it seemed that he was right. But then the pain came roaring back.

Experts estimate that nearly 600,000 Americans opt for back operations each year. But for many like Scatena, surgery is just an empty promise, say pain management experts and some surgeons.

A new study in the journal Spine shows that in many cases surgery can even backfire, leaving patients in more pain.

Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, just 26 percent of those who had surgery returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine.

Unfortunately, for most patients with bad backs, there is no easy solution, no magic bullet. Pain management experts — and some surgeons — say that patients need to scale back their expectations. With the right treatments, pain can be eased, but a complete cure is unlikely.

In the wake of her operations, Scatena has turned to less invasive therapies. She’s learned to baby her back and to find ways to avoid irritating the nerves in her spine. She’s working to strengthen muscles in her lower back and abdomen so her spine will get better support. “I’ve been getting some relief from physical therapy,” she says. “And I hope that’s going to be permanent.”

27 million adults with back problems
A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, 27 million adults reported back problems with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physical therapy, pain management, chiropractor visits, and other non invasive therapies, a big chunk pays for spine surgeries.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there was an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned.

For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. “But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”

Burton and others recommend that patients get a second opinion when back surgery is recommended for the treatment of back pain without neurological symptoms, such as sciatica, especially if other treatments haven’t been suggested first.

“We are very successful at improving leg symptoms," says Dr. William Welch, vice chairman of the department of neurosurgery at the University of Pennsylvania Medical Center and chief of neurosurgery at Pennsylvania Hospital. “We are less successful at treating back pain.”

Source of pain is often hard to pinpoint
The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain. Even when the surgery is a success, it rarely dispels 100 percent of back pain, Welch says.

And while many surgeons are careful about which patients they recommend for spine operations, some are not so discriminating, says Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine. “It’s a case of, if you have a hammer, everything looks like a nail,” she explains.

In general, the best results come about through a combination of approaches, Cope says. Each strategy may reduce pain by just 10 or 20 percent, but those percentages can add up so ultimately the patient’s pain is cut back by as much as 70 or 80 percent. Strategies can include exercise and weight loss, Cope says.

That advice resonates with Marilyn Seiger, a friend of Nancy Scatena in Scottsdale. Seiger opted to skip surgery, not wanting to follow her friend's painful path, even though her doctor recommended an operation to fuse two of her vertebrae.

She has gotten some relief from physical therapy, a back brace that reminds her to keep her back straight, and the occasional pain pill.

“I don’t know anyone who’s had surgery for back pain who had success,” says Seiger, 61. “I just figure this is part of growing older. We’re living longer than our bodies were meant to last and we’re just constantly shoring things up.”

     Authored by Diane Tanning, RN, MS, L.Ac. 

My client, Tom (54), was diagnosed with arthritis in both shoulders when he was 52.  The cause, according to his orthopedic surgeon, was Tom's years of weight lifting.  The surgeon noted that shoulder replacement surgery can be performed to relieve the constant pain. However, the life span of the procedure is about 10 years and it can only be performed once.  The surgeon's best advice was to hang in there for the next 10 years and do physical therapy.  Tom found no benefit or pain relief from physical therapy. 

Tom was not able to lay on his left side without pain. He was often awakened by pain in the night.  Tom is a young man with a lot of energy and he was not ready to give in to a pain-filled future.  After months of encouragement from his wife, Tom decided to start  acupuncture with me.  After his first treatment, Tom reported that the next day, he suddenly realized that his shoulder did not hurt for the first time in years.  When I saw him for his second treatment several weeks later, Tom reported that this was the longest period of time without pain in years and he was now able to sleep on his left side.  

Acupuncture can work for you, too.  Come see me here at Partners in Healing of Minneapolis.  Use your Health Savings Account (HSA) because you deserve the best health care possible.  Call me at 763-546-5797 to make an appointment. 

           Brought to you by Diane Tanning, RN, MS, L.Ac.

We have found acupuncture crucial in our integrated pain program, the Program for Conscious Living.   This article from Acufinder Magazine (Fall, 2007) reports on a Mayo Clinic study that found acupuncture powerful in treating people with fibromyalgia.  Looking for comprehensive pain treatment and acupuncture?  Call us at 763-546-5797.

Acupuncture Helps with Fibromyalgia Symptoms

The June 2007 edition of the Mayo Clinic Proceedings (June 2007) reports on a study that found acupuncture helpful in treating the fatigue and anxiety commonly experienced by fibromyalgia patients.  In the double blind study, Mayo Clinic doctors gave 25 fibromyalgia patients acupuncture, and 25 “sham” acupuncture treatments.  Patients received six treatments during the two- to three-week study.  Their answers to the Fibromyalgia Impact Questionnaire revealed that those who received acupuncture treatments reported less fatigue and anxiety one month after treatment than did the “sham” group.  The study used only two acupuncturists and examined only patients who reported more severe symptoms, offering better experimental control.  Still the Mayo doctors urged more study to see how acupuncture can best be used in treating fibromyalgia patients. 

         Authored by Dr. David Alter on MindMatters

My daughter recently completed a Rube Goldberg assignment for 9th grade science class. Students had to invent a machine that, once started, would run on its own, and in the process demonstrate four “energy transfers” involving mechanical, chemical, thermal and electrical energy. It occurred to me later that our bodies do the same thing all the time.

•Sound wave energy is converted into electrical and chemical energies so that we can “hear” the sounds of the world.

•Our eyes receive photons of light and convert these packets of light energy into electrical and chemical signals that enable us to perceive the stunning visual world around us.

•Our thoughts are themselves made up electrical and chemical energies. Our thoughts convert these energies into production of protein molecules in our cells that power the activities of our daily lives.

Perceiving pain also requires energy transfers.

Pain is the name for particular types of chemical and electrical energy signals that are translated at different points in the body (e.g., spinal cord nerve roots & structures in the brain itself) into the experience we call pain. We are now rediscovering that imagination has the power to influence these various energy transfers in ways that alter the signal of pain.

How can you learn to do this for yourself?

•Explore imagery training (e.g., guided imagery training, develop hypnosis skills, use cognitive-behavioral techniques for modifying pain maintaining thoughts)

•Imagery training changes the sensitivity of our tissues to pain (i.e., it takes more signals to produce pain)

•Imagery changes the form of the sensation that is perceived (i.e., it changes what was pain into more tolerable sensations)

•Imagery produces physical changes in the way that networks of nerves connect to each other. Our imagination changes the structure of the physical body.

•Using imagery approaches helps your thoughts and mental images to literally restructure the brain, rewire the pain, and enable higher levels of daily functioning to be achieved.

Now, that is a Rube Goldberg project worth repeating!

At Partners in Healing of Minneapolis, we offer a number of imagery training approaches. Find out which is right for you and your body. Contact us at 763-546-5797 or visit us at www.pih-mpls.com for more information.

         Authored by Dr. David Alter on MindMatters

Do you know how to manage your pain with your mind?

Pain is a real attention-getter. Before explaining how to use your mind to manage your pain, you should know that there are two kinds of pain. Both demand that we pay attention:

Acute pain: Acute pain sensations typically signal danger involving some kind of immediate threat to our body. Acute pain directs us to pay attention so that we can address the problem. For example, if you put your finger on a hot surface, your mind tells you stop or reduce that pain and MOVE YOUR FINGER RIGHT NOW!!! 

Chronic pain: Chronic pain sensations rarely signal that your body is actually under threat. Chronic pain describes pain sensations lasting more than six months without any clear explanation for the pain. Chronic pain usually involves some way that the automatic “off-switch” for pain has gotten stuck in the “on-position.”

That is why using your mind to deal with chronic pain is so critical. Using your mind to turn off the pain switch may be challenging …but you can learn to use your mind to reduce and even eliminate your chronic pain. Here’s how:

•You can learn to turn down the intensity of the pain, like turning down the dimmer switch on a light (intensity of attention)

•You can learn how to focus away from pain (selective attention) so that it isn’t the focus of your attention

•Combining selection & intensity: When you learn to combine these skills, management of and relief from pain can be accomplished.

Rewiring the Brain

Using attention skills over time actually rewires the pathways in the brain. This enables you to develop better pain management skills. Now that is new learning that is really worth learning!

At Partners in Healing of Minneapolis, we can teach you how using our Program for Conscious Living. You have the power of your mind to manage, relieve and even eliminate your pain! Stop suffering from your pain. Contact us today at 763-546-5797 and we will show you how. 

Authored by Dr. David Alter

It is said that fences make good neighbors.  The saying implies that boundaries are often important to the effective regulation of relationships.  Most fences have gates in them that allow for the selective exit or entry across the fence-defining boundary.

The saying about fences and neighbors fits well when it comes to successful management of pain.  Every part of the body (except, ironically, the brain tissue itself) has pain signaling cells that live right next door to the tissues the pain signaling cells are designed to protect.  Most of the time, the gates between the tissues and their pain signaling cell neighbors remains closed.  When injury, infected or compromised in some manner, the pain gate opens and the pain signal makes its way to the brain, when plans for corrective action can be developed and implemented.  Once the injury or source for other pain-inducing problem has been resolved, the pain gate closes and the presence of pain disappears.

A number of years ago, Drs. Ron Melzack and Patrick Wall discovered that in chronic pain conditions, for a wide variety of reasons we are still discovering, the pain gate remains open.  The pain signals continue to fire.  Chronic pain settles in.  Sadly, after a time, even when the original problem has been solved, pain gates in the spinal cord and brain stem can remain open.  The research by Melzack and Wall, as well as by many others since then, have taught us about the many approaches that exist to close the pain gates, reducing the experience of pain in   important and lasting ways.

Here are examples of ways to close the gate of pain.  You can learn more ways to close the pain gates by contacting Partners in Healing of Minneapolis at info@pih-mpls.com.

• Manual therapies (acupressure, shiatsu massage)
• Energy-based therapies (acupuncture)
• Cognitive therapies (cognitive-behavioral pain management)
• Self-regulating therapies (biofeedback, guided imagery, clinical hypnosis)
• Relaxation and breathing-based approaches (meditation)

An exciting benefit of developing the habit of utilizing pain gate-closing therapies is that they promote the release of the natural pain numbing chemicals that are produced by our body’s innate pharmacy: endorphins and enkephalins.  Give us a call so you can learn to erect a secure fence between you and your pain.

Authored by Dr. David Alter

In the last entry we introduced the idea of pain as a faulty memory signal; a state-dependent signal that can be activated by many triggers.  We emphasized the importance of learning memory-modifying steps you can take to put you back in charge and learn to have the remembered past – the pain signal that keeps on firing – pass right on by.  By recognizing that The Pain, its Plain, Stems Mainly from the Brain, here are six suggestions to consider that help free the brain from old pain memory patterns, and allow it to express different nerve firing patterns that modify your experience of pain.

1.    Shifting the focus of attention from what can be done for you to what you are able to do for yourself.  This shift in focus orients the brain to how and where you can exercise control, which disrupts old patterns of helplessness in the face of failed efforts to obtain relief.

2.    Develop a toolbox of safe and simple movements.  The body is designed for movement.  The body needs movement the way it needs food and sleep.  Whether the safe movement involves simple stretches, a walk to the mailbox several times per day, or involvement in a yoga class, develop a movement routine you maintain.  It disrupts the memory circuits that say movement is dangerous and painful.

3.    Restoring restful sleep. While we sleep, the brain filters our experience from the past.  Sleep revises, discards or strengths aspects of past experience.  Without adequate sleep, our ability to restore energy reserves, rebound from the past experience, and feel prepared for the future is hobbled.  Explore proven methods for re-establishing restorative sleep so you give the brain the energy it needs to construct new habits of functioning during the day.

4.    Learn focused awareness skills.  When pain is present, it can be like a magnet that draws attention to it.  Pain-focused attention almost always makes the perception of pain worse!  A number of methods for developing the capacity to direct attention away from pain, or toward perceiving sensations in the body in new ways can be very useful.  Meditation, breath awareness, guided imagery and self-hypnosis are examples of focused awareness skills you can learn.

5.    Become a “sensualist”.  We are blessed with five senses.  Pain tends to make us aware of only one of them.  If pain becomes the dominant sensation that people experience, awareness of other sensations dulls.  It is important to involve yourself with activities that bring alive other sensations – taste, sight, sound, smell, taste and touch.  In addition, there is good evidence that laughter and humor release molecules that flood the brain and body with strong pain dampening effects!

6.    Letting go of what’s past (passed).  People with persistent pain tend to have much higher rates of depression, anxiety and even high rates of histories that include past traumas of various sorts.  Of course, having persistent pain can be depressing, anxiety provoking and traumatizing!  Still, past trauma tends to keep the doors to pain in your present life wide open.  Therefore, it is important to learn methods of resolving the on-going influence of past trauma on your daily life.  Doing so powerfully rewires the brain and frees up the mind to experience life anew.

Authored by Dr. David Alter

In the movie musical My Fair Lady made famous by Audrey Hepburn, she sings a song whose words begin, “The Rain in Spain Falls Mainly in the Plain.”  Her song signals her growing ability to achieve her full but untapped potential.  Every day, millions of people struggle to overcome the limitations imposed by their personal histories.  These are individuals who face the misery and despair that all too often arises with chronic pain.

Chronic pain has bedeviled healers for thousands of years.  Invisible, untouchable, and yet so many are touched by it – more than 70 million Americans per year!  A key aspect of chronic pain that makes its successful management so challenging is its disconnection from obvious tissue injury.  Typically, as the physical body heals, the process of healing turns off the nerve signals that generated the pain sensations in response to the original injury. 

What is difficult to understand is that over time pain signals become disconnected from actual tissue damage.  This involves a modification to the body’s pain signaling process.  Pain is an experience that is encoded in the brain in through state dependent learning experiences.  In other words, the experience we call pain is a type of memory that is encoded into the neural circuits of the brain, ready to be reactivated when any of the other elements that were present at the time of the original injury are once again present.  For example, when my young adult son was injured playing his favorite sport he needed stitches that were sown into his mouth without sufficient anesthetic.  When he began to anticipate going to have the stitches removed, he began to hurt again.  The hurt he felt involved reactivation of the state dependent learning that linked together the memory of stitches with the memory of pain.  The anticipation of going to have stitches removed reactivated pain!  The original emotional state (scared), the physical context (doctor’s office), the sensory cues (white coat, hospital smell, overhead paging, etc.) also served to reactive the pain because they were encoded as part of the original state dependent pain experience.

While this example involves an acute pain experience, you can appreciate the relevance to chronic pain conditions, where the encoded emotional, contextual, sensory, and cognitive cues linked to pain are more common and have been reactivated so much more powerfully over a longer period of time.  Still, the implication is clear: As hard as it is to accept, the fact of the matter is that chronic pain really is “in your head!”  It is wired into the brain’s network of nerves, ready to “fire” in response to so many different triggers. 

That the pain is in the head makes it no less real!  In fact, it allows a whole new approach to managing it: learning ways to re-program pain program wired into the brain.  To return to our theme, the key to management of chronic pain involves learning to change the “remembered pain,” the memory pattern that gets established in the brain and which is responsible for the activation, maintenance and exacerbations of chronic pain conditions.  If Audrey Hepburn were to star in a pain management movie, perhaps she would sing, “The Pain, its Plain, Stems Mainly from the Brain!”

There are a number of ways to modify chronic pain memories: the pain-maintaining signaling patterns that are at the core of chronic pain conditions.  In the next entry to this blog, six suggestions for modifying pain maintaining memory circuits will be introduced to you.  Each of the pattern-modifying techniques is useful precisely because of its proven capacity to alter the ways in which remembered pain signals are generated.