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Know Pain, Know Gain - Clinical Impact Symposium 2016

By Margaret Schmidt

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The University of Kentucky's College of Health Sciences presented this morning to kick off day two of Kindred's Clinical Impact Symposium. "How do we keep patients progressing at the expected rate, and what gets in the way of that?" asked Art Nitz, PhD, PT, ECS, OCS. How do we keep pain from getting in the way of that?

Pain, and sometimes our very best efforts, have unintended consequences. We have a shared responsibility to develop approaches that are more efficient, more accessible, more effective and do no harm. He began by discussing how the understanding and articulation of pain also has changed over time.

In 200 A.D., Galen recognized the brain as the site of feeling and described inflammation as associated with pain. Rene Descartes wrote a pain theory in 1644's History of Man  that compared the body to a machine in which signals traveled along fibers until they reached the brain. The Specificity Theory that emerged in the 1800s called pain a specific sensation. The Intensity Theory disputed nerve endings as causing pain and instead associated pain with signal transmissions. In 1965, the Gate Control Theory of Pain suggested that pain travels along fibers.

 Dr. Benedict  

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To help the audience understand our modern day understanding of pain, Dr. Timothy Benedict, an Army physical therapist, told a personal war story: In 2003 he was a combat platoon leader deployed to Iraq. One night in Iraq the area around the safe house erupted in gunfire. As he ran to coordinate defense, he was told to stand down - the Army had just captured one of Saddam Hussein's top lieutenants. People were shooting the air in celebration. The troops were given an "all clear."

So what does that have to do with chronic pain? Well, research shows us that when we help patients understand that pain does not equal bodily tissue damage-rather that it is largely controlled in the brain- they get the "all clear" to understand their nervous system and know that, because of the brain component, pain can be turned up or down.

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Our modern understanding of pain is that the brain plays a central role in producing chronic pain:

"Pain is a multiple system output activated by an individual's specific pain neural signature. The neural signature is activated whenever the brain concludes that body tissues are in danger and action is required." (Mosley 2003).

This does not mean that pain exists only in a patient's mind. However, when we understand that pain isn't tissue damage, we're less afraid to participate in the activities that can make us feel better.

Garret Naze  

new def of pain
Garret Naze, from the University of Kentucky Dentistry Orofacial Pain Clinic, where patients often drive to for over an hour for treatment, shared several of these activities with the audience.

Garret explained that slow exposure to mechanical stress can actually help people become adaptable. He pointed to the way that people grow and become able to participate in marathons after a period of time.

But there are things in our life that make us less adaptable to mechanical stress. Things like genetics, nutrition, poor sleep, lack of exercise and varied abilities to adapt to psychological trauma can hinder people's ability to deal with this "mechanical stress."

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The goal of skills training is to help patients make themselves more adaptable with psychological coping mechanisms like stress management as well as working on improving nutrition and sleep for optimal pain outcomes. These are all key aspects for recovery. Garret shared various interventions in these areas that patients can incorporate into pain management.

Garret also said clinicians must practice what they preach. Clinicians must believe in what exercise, sleep, and stress management mean for their patients to authentically motivate them to utilize multi-system pain management.

Please continue to follow the Clinical Impact Symposium 2016 on the Kindred Continuum and on Twitter @KindredHealth.

*Each year the Kindred Clinical Impact Symposium focuses on a topic to enhance clinical practice in the post-acute continuum and to maintain Kindred as a leader in clinical excellence. This eighth symposium focuses on pain management across the continuum. At this week's symposium, held in Louisville, Kentucky, national speakers discuss these topics broadly, while internal speakers bring it home to Kindred attendees from across the country.

By Margaret Schmidt