Person Approach David A Hanscom, MD Orthopedic Spine Surgeon - - PowerPoint PPT Presentation

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Person Approach David A Hanscom, MD Orthopedic Spine Surgeon - - PowerPoint PPT Presentation

Apr 28, 2023 206 likes •1.26k views

Curing Chronic Pain: A Whole Person Approach David A Hanscom, MD Orthopedic Spine Surgeon Swedish Medical Center, Seattle, WA The Junction Box Oxytocin Dopamine GABA receptors Junction Neutral Box Nervous System Adrenaline

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Curing Chronic Pain: A Whole Person Approach

David A Hanscom, MD Orthopedic Spine Surgeon Swedish Medical Center, Seattle, WA

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“The Junction Box”

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“Junction Box”

Nervous System

Neutral

Oxytocin Dopamine GABA receptors Adrenaline CortisoL Endorphins

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“There is nothing either good or bad, but thinking makes it so.”

~ William Shakespeare Hamlet, Act 2, Scene 2

The first neuroscientist?

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Suffer Mask Suppress

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Paradoxical Effects of Thought Suppression

Daniel M. Wegner, David J. Schneider, Samuel R. Carter III, and Teri L. White

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Why is Chronic Pain So Persistent?

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Pain Circuits are Reinforced

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Mystery of Phantom Limb Pain

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“Rage”

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It’s the Adrenaline

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Direct diagnosis and management of emotional factors in chronic headache patients

  • Striated muscle tension
  • Smooth muscle tension
  • Cognitive-perceptual disruption
  • Conversion
  • Abbass A, et al. Cephalalgia, 2008
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Benefits of Anger

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Coping with Anxiety

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Solving the Unsolvable

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Awareness Address all variables

Patient takes charge

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Awareness

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Address All Variables

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Variables

  • Understanding Pain
  • Sleep
  • Stress
  • Meds
  • Life Outlook
  • Physical conditioning
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Prehab

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www.backincontrol.com

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62 y/o female with neurogenic claudication

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Hunting elk

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Patient Takes Control

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Write and Rip

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Awareness

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MARK’S STORY

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Awareness Address all variables

Patient takes charge

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Thank You!

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Thank You

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116 million Americans suffer from chronic pain $635 billion is spent each year on treatments that are often ineffective and frequently do more harm than good

A Silent Epidemic

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The Many Faces of My Neurophysiologic Disorder

  • Migraines
  • Tinnitus
  • Burning feet
  • Anxiety/ panic attacks
  • Insomnia
  • Severe depression
  • PTSD
  • Chronic tendonitis
  • OCD
  • Acid Reflux
  • Back/neck pain
  • Migratory skin rashes
  • Itching scalp
  • Tension Headaches
  • Crushing chest pain
  • Palpitations
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Unresolved Pain Shifts in the Brain Over Time

Study reviewed in Brain: A Journal of Neurology

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Prospective fMRI Study LBP

  • Acute pain = 94

– < 2 months

  • Chronic pain = 59

– > 10 years

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Location of brain activity

  • Acute pain – nociceptive area
  • Chronic – emotional area
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Longitudinally followed 39 acute LBP

  • 19 recovered
  • 20 become chronic
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Scans every 3 months

for

12 months

Pain Resolved Became Chronic

  • Nociceptive area quiet
  • Activity shifted to emotional centers
  • Nociceptive quiet
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Chronic pain exists in the emotional not the nociceptive areas of the brain

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Rita

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Behavior is guided by your body’s chemical response to sensory input

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Neurological pathways are permanent Strengthen with Repetition

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Solution Principles

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Hope Forgiveness Play

Awareness

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Hope

Forgiveness Play Awareness

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I believe that one of the most basic needs that makes us human is to be in charge of our destiny with a sense of purpose. Successfully treating patients suffering from chronic pain requires re-connecting them with their original sense of vision and purpose in life.

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Hope

Forgiveness

Play Awareness

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REACTIVE

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CREATIVE

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“C” first

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Addressing anger is the “Continental Divide” of healing from chronic pain

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Hope Forgiveness

Play

Awareness

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Does Rejection Hurt? An fMRI Study

  • f Social Rejection
  • Science 302, 290 (2003)

– Naomi I. Eisenberger, et al.

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OMEGA EXPERIENCE

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Disease in man is never exactly the same as disease in an experimental animal, for in man the disease at once affects and is affected by what we call the emotional

  • life. Thus the physician who attempts to take care of

the patient while he neglects this factor is as unscientific as the investigator who neglects to control all of the conditions that affect his or her experiment.

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One of the essential qualities of the clinician is interest in humanity, for the secret of care is in caring for the patient.

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Frances Peabody

The Care of the Patient - 1927

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Hope Forgiveness Play Awareness

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Anxiety is a Neurophysiological Response to Sensory Input

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Why is Chronic Pain Hard to Treat?

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“We propose that chronic pain is the consequence of plastic changes in cortical-limbic circuitry, leading to new learning and to memory formation that are continuously reinforced and thus cannot be extinguished, as a consequence

  • f the emotional and motivational associations

with the painful stimulus …….”

Mansour 2014

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Awareness

Address all variables

Patient takes charge

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Awareness

Address all variables

Patient takes charge

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David Hanscom, MD Chronic Pain Sufferer