| One-Minute Clinician

Going Beyond Pharmacology for Better Outcomes

Pain is really a mind-body experience. So it's unrealistic to think that the mind and the body are somehow separate, or that we can deal with a mind process with only pharmacology. So with that underpinning, we need to figure out how to impact a person's experience with pain. That's really what this is about. It's the experience of pain and the response of the person's pain experience which is known as suffering. Our patients have narratives about their pain. 'My head is going to explode.' 'My back is killing me.' 'My feet are on fire.' None of that is true. So helping people separate from that attachment is something that every clinician can do. It's talking about what their perceptions are, how their focus is drilled into a belief system and then starting to loosen the ties to that belief. There's cognitive behavioral therapeutic interventions and there's dialectical behavioral therapy and there's acceptance commitment therapy. These are all manualized therapies that have great evidence behind them of efficacy for pain reduction; evidence that they effect changes in different parts of the brain, the somatosensory cortex and the cingulate gyrus and the insula and thalamus. So we can impact the neurophysiology of the pain experience in the brain by a variety of interventions.

Now, besides the thought-related interventions, there are physical interventions. People tend not to move and we all know that lack of movement causes pain to be worse. So how do we introduce movement into the life of the patient? Many patients are frightened of movement, and I stress the difference between hurt and harm. It will not harm you to move but it won't feel very good. So graduated exercise is something that has to be introduced into any pain patient's experience, and that could include yoga or tai chi or qigong - things that are really known to stimulate circulation and immune system function while decreasing stress and anxiety. It's also important to pay attention to nutrition. There are inflammatory foods that probably make pain worse and foods that probably decrease pain. When we're talking about toxins, the first toxin to deal with is smoking. Every clinician should instruct their patient to quit smoking if they smoke. On the positive side, hydration makes sense; flushing the system out and enhancing kidney function and helping the liver with its detoxification process. So there are a variety of pretty easy interventions, and clearly you can't talk about them all in one session. But to have them on the agenda, clinicians can help people to a better quality of life.

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