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AUGUST 2016

Help Move The National Pain Strategy Forward

3 September is Pain Awareness Month 4 Find the Strength to Claim Our Basic Rights 10 Helping People in Pain, One at a Time

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TABLE OF CONTENTS

Features 3 September is Pain Awareness Month 4 Find the Strength to Claim Our Basic Rights 7 The Courage to Fight for Ourselves

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The Chronicle is published three times a year by the American Chronic Pain Association.

10 Helping People in Pain, One at a Time

We welcome essays, poetry, articles, and book reviews written by people with chronic pain or their families.

12 Share Your Story

Please send inquiries to:

13 Exercise Helps Reduce Bouts of Back Pain

Departments 14 ACPA Updates 15 Book Review: Using Mindfulness 16 Book Review: Holistic Pain Relief 17 New Groups and Facilitators

The ACPA P.O. Box 850 Rocklin, CA 95677 (916) 652-8192 EXECUTIVE DIRECTOR

Penney Cowan P R E S I D E N T, BOARD OF DIRECTORS

Donald C. Manning, MD, PhD PAST P R E S I D E N T, EDITORIAL DIRECTOR

Nicole Kelly MEDICAL EDITOR

18 Tributes

Steven Feinberg, M.D. EDITOR

Alison Conte SPECIAL FEATURES

Erin Hart DESIGNER

Paulette Green 2

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F R O M T H E F O U N D E R A N D E X E C U T I V E D I R E C T O R , A C PA

September is Pain Awareness Month

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Together We Can Move the National Pain Strategy Forward by Penney Cowan

n 2001, the American Chronic Pain Association began a campaign to declare September as Pain Awareness Month. Our efforts created Partners for Understanding Pain (PUP) with 80 organizations, including health care providers, consumer groups, and community organizations such as the NAACP and the National Urban League. Everyone came together to make a positive difference for people living with pain. Over the next six years, working together toward one cause, PUP succeeded in establishing September as Pain Awareness Month. Each year, when September rolls around, we find new ways to spread this message: no one really understands the toll pain takes on a person, unless they have lived with it themselves. Today are united in a new cause. We share a common belief – that we must find a way to improve pain care for those who find their lives controlled by pain, those who must live day in and day out with pain present in every moment.

Setting Out a Plan The National Pain Strategy (NPS) is a plan to do just that, improve all areas of pain care – from understanding to education, to reimbursement, and more. The process of developing and enacting these strategies has been slow and difficult. And it leads to a larger question: what do people with pain do while they are waiting for improved care? Are they to simply grin and bear it while we figure out how to implement the NPS? We hear every day about the struggles of people who are trying desperately to get their lives back. They want to return to work so they can provide for their families, but they find the paths to help and treatment blocked.

Issues such as geography, access, capacity, insurance, money, communication, transportation, and disparities are closing doors, one after another. This cannot continue. If you ask a person with pain when they want to start feeling better, they will tell you: “yesterday.” They should not have to wait until we figure out how to move forward. Their families should not have to wait to bring “ordinary” life back into their daily routines. People who need it should have access to a balanced approach to pain care right now!

Fight for Pain Care Now In April 2016, the ACPA and 12 other groups of the Consumer Pain Advocacy Task Force, urged 70 organizations to sign a letter to the Senate Committee on Health, Education, Labor, and Pensions to urge swift implementation of the NPS. This September during Pain Awareness Month, you can make a difference. Write, call, and visit your government representatives and tell them how important it is to move forward and enact the NPS. Your voice counts; each voice counts. If you don’t know what to say, you can use the sample letters on our website. There is one for your U.S. Senator and one for your U.S. Representative to the House. We have heard the new activist motto: Lives Matter. People who live with pain matter. They and their families have so much to contribute to society. We need to help them find the treatment and aid they need to increase their function, reduce their sense of suffering, and improve their quality of life.

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Find the Strength to Claim Our Basic Rights by Erin Hart

ASK QUESTIONS

SELFATE ADVOC COM M CLEA UNICATE RLY

TAKE SIBILITY N O P S RE

When you have chronic pain, it can be hard to gain the confidence to advocate for yourself. The path to this goal is long, and riddled with potholes and detours, but eventually, it straightens and empowers the traveler, as this tenacious woman and veteran has found.

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Charla Maida Gautierre Life-Changing Experiences In her youth, Charla Maida Gautierre was outgoing and a joiner. In high school, she participated in seven clubs and played multiple sports. In her downtime as a young adult, she could be found running, cycling, and hiking. Gautierre was an honor roll student in the top five percent of her high school class, and graduated a year early with college credits. But, she said, “a wellmeaning, but misguided, counselor, told me ‘Charla, you are very bright, but I think the best thing you can do is go into the military and look for a husband. I don't think college is for you right now.’” Gautierre said she followed this suggestion, which her parents supported, and enlisted in the Marine Corps Junior ROTC unit. However, being in the military for seven years and participating in maneuvers began taking its toll physically – specifically, with Gautierre’s back. And then the unthinkable happened – something that would cause this engaging woman to completely change: she was the victim of military sexual trauma (MST). Gautierre shut down emotionally. Within two years, she was discharged, and in another year, her marriage dissolved. Physical and emotional pain enveloped her. Gautierre began drinking to combat the posttraumatic stress disorder (PTSD), as well as the chronic pain, which had expanded its hold on her body. She didn’t have health insurance through her employer, which meant she wasn’t being treated for her chronic pain or PTSD. With one young child, Gautierre found herself feeling paranoid, hypervigilant, and worn out. “I was on a steady decline,” she said. “I felt isolated, shame from the MST, as well as the physical pain,

which was amplified by the emotional pain. And when you aren’t getting those kinds of problems resolved, you find other ways of dealing with it. For me, it was self-medicating with alcohol.”

Fighting for the “Yes” In 1984, she pulled herself together and enrolled in college. Despite being a single mom with another child on the way, she posted As and Bs and graduated in only three years with a bachelor’s degree in Psychology/Sociology. She moved to Tampa, Florida, to start her master’s program in Public Health, Social, and Behavioral Sciences. She followed her then-husband, who had just received a job promotion, to Fort Myers. Wanting to finish her master’s degree, she commuted between the two Florida cities. Gautierre then moved to Tallahassee to complete her doctoral work in Social Sciences, Urban, and Regional Planning. In 1998, the effects of untreated MST emotional challenges, PTSD, and raising two kids on her own hit hard. Gautierre remembers jumping in the car one day and ending up in Tampa – not remembering why she made the choice to drive there. She refers to this as the dissociative state, a common feature of PTSD. She was now homeless and trying to figure out her next move. But something good began to arise from these experiences: she found her way to a local VA hospital, where she connected with physicians who began to address her chronic pain. However, her emotional needs remained untouched, which, she said, left her floundering. It wasn’t until she ended up in the hospital for a total hysterectomy in 2005 that she learned she might be eligible for disability benefits. continued

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“By having Kazuri in my life, I’ve found the confidence ... to push for better care; the ability to let my guard down a little, and have more open conversations with strangers – conversations I would not have if he was not by my side.”

Charla Maida Gautierre and Kazuri

continued from previous page

So she began researching the requirements, as well as the basic rights she had as a veteran. Although she was becoming more educated, Gautierre said she was not assertive and did not know how to communicate her needs. “When I attempted to go after my veteran entitlements, I hit wall after wall after wall. One thing I learned is that if you don’t have the stamina to take rejection, I think you have to be a little mentally ill because you have to be willing to hear the word no in several different forms, ignore it, and then go back again,” she said, laughing. “I’m sure in my patient records somewhere doctors wrote ‘patient does not comprehend well;’ ‘patient displays unwillingness to cooperate with the program.’ But as this is all occurring, I’m learning more about how to navigate the system, ask the right questions and speak healthcare provider language. I have a master’s in public health, and you’d have thought I would have learned how to do these things a long time ago.”

Shifting Tides Since 2012, this 54-year-old Tampa resident has also struggled with two bad foot surgeries, experiences that have forced her to assert herself. “If a doctor says that I need surgery, I will not take them on their word; I will get a second opinion. Thankfully now, veterans can go outside the VA system for another look by another provider. I know now that I can exercise those rights.

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“And ‘having rights’ are what we talk a lot about with my ACPA group members. We spend a lot of time discussing the definition of effective communication, knowing what you want to communicate, and how to be assertive. We all have these basic rights and we need to learn how to use them.”

Building Confidence There have been several noticeable shifts in confidence and assertiveness for Gautierre. She has trained for the last several years to become an itinerate pastor and preacher, and is currently pursuing her studies toward a ThD in Theology. She wants to focus on pastoral counseling and biblical studies so that she can continue to help others and pay goodness forward. For Christmas 2015, her daughter gave her a Morkie (Maltese and Yorkshire Terrier), which she named Kazuri. “When my daughter heard that you can get service dogs for help treating PTSD, she knew immediately she wanted to do this for me,” Gautierre said. “And he has changed my life. He makes me have to face people; to answer their questions about him and service dogs in general. I carry and hand out informational cards about the Americans With Disabilities Act (ADA). “By having Kazuri in my life, I’ve found the confidence to exercise my rights with a service dog; the confidence to push for better care; the ability to let my guard down a little, and have more open conversations with strangers – conversations I would not have if he was not by my side.”


The Courage to Fight for Ourselves by Erin Hart

Teresa Horn Self-advocacy is critical for those living with chronic pain, as they must be able to clearly communicate, negotiate and assert their basic rights. To do this, individuals must understand their own strengths and needs, as well as their goals, for their healthcare and life journey. This was the case for Teresa Horn, 54, of Maryville, Tennessee, who owns her Type A personality. In her small town, everyone knew that if you wanted something done, and done well, Horn was the woman for the job. And her kind, southern demeanor precluded her from saying “no� when various church, charity, and civic groups came knocking. On top of her volunteer activities, she supports her husband Doug at their financial planning and investment management firm. She initially handled administrative tasks, and then moved onto developing and nurturing client relationships.

Horn said she was always on the go and trying to be all things to all people. Unbeknownst to everyone who met her socially, Horn lived with chronic pain: endometriosis, irritable bowel, esophageal reflux, and cluster migraines, to name a few. Despite experiencing routine discomfort, Horn said she rarely let it get in the way of her outside activities. However, her lifestyle changed in May 2010. Prior to what would be her last surgery for endometriosis and adhesions, her doctor ordered a routine CAT scan for her abdominal pain. She dressed for her workday and informed her co-workers that she was stopping by the clinic and would be in the office by 10:30 a.m. She never made it. Prior to the CAT scan, she explained to her doctor that she was allergic to IVP contrast dye. When the nurse began the IV and dye drip, the last thing Horn remembers is feeling a hot rush from head to toe, and then going into full convulsions before losing consciousness. She remained unconscious for more than four hours. Doctors flushed her full of IV fluids and Benadryl before sending her home. continued CHRONICLE | AUGUST

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“I’ve learned it’s my responsibility to know my body and what will hurt me. It’s my right to ask questions – and share my expectations.”

Teresa Horn with her husband Doug

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Through later research, Horn found out that she had experienced an anaphylactic shock to her central nervous system. Following this episode, she began losing control of her body – speech, balance, digestion, and appetite, which resulted in a 45-pound weight loss. She also began using a walker. Doctors at the Cleveland Clinic determined that the anaphylactic shock was most likely the catalyst to the onslaught of new symptoms. Horn said she could only tolerate fluids and was literally starving to death in her own body. With more research, she discovered that by going gluten-free, she could increase her calorie count and food intake.

The Road to Recovery and Basic Rights With authorization from her insurance company, Horn was referred to specialists at Vanderbilt University Medical Center and then ultimately on to Cleveland Clinic. She met fantastic healthcare providers who invested a lot of time into helping her manage her health issues. At Cleveland Clinic’s Chronic Pain Rehabilitation Program, she relearned basic daily functions and walked out on her own two feet after just four weeks. It was a long road to recovery, but Horn said the experience taught her something valuable: self-identity is not related to what she does, but who she really is at heart. And she realized that standing up for herself, and even saying the word “no,” would have to be an important part of her new normal.

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When Horn started down the chronic pain path with various doctors, she said the only thing she knew about her basic rights as a patient was speaking up if something didn’t seem right. Oftentimes, she would hand prescriptions back to the nurse, explaining again about her allergies, bad side effects, or negative interactions. “I found out that a lot of the health issues I had early on were caused by scripts that did not interact well with others I was taking,” she said. “I just assumed the doctor was automatically supposed to know this and would change course. I see this all the time with my dad, my in-laws, and older friends, as they are of the mindset that what the doctor gives you, you take. But I’ve learned it’s my responsibility to know my body and what will hurt me. It’s my right to ask questions – and share my expectations.”

The Right to Challenge Horn shared one of her most recent experiences. One of her chronic issues includes an autoimmune connective tissue disease, where her elastin and collagen fight each other as a result of an unknown trigger. As part of her latest recurrence in late April, her body swelled; she could barely move without screaming. Days later, a rash broke out all over her torso. Being that the Cleveland Clinic is a nine-hour drive and she had just been there in mid-April, she was referred to a local physician – with strict orders for her care.


Establishing Boundaries and Discovering Confidence When she finally met with the doctor, she found him immediately unlikable. He hadn’t read her medical files and proceeded to accuse Horn of having a nervous breakdown. He implied Horn was a hypochondriac, and suggested she have behavioral therapy. He also contradicted every diagnosis her many physicians at the Cleveland Clinic had carefully concluded. The more Horn tried to explain her medical history, the more frustrated she became. Horn refused a prescription because she knew her own body’s hypersensitivity to medications, particularly at that dose he was proposing. She chose not to return to this healthcare provider. “The ACPA’s basic rights teach us we have the right to disagree and ask for help and proper assistance,” Horn said. “What we all need to remember is this isn’t just a physical weakness. We have the right to ask why; we have the right to take our time to respond, and to do our homework. “In my experience with that doctor, I knew I needed to respect him and his trained healthcare expertise, but he also needed to respect me as the patient and the knowledge I have about my own body.”

Horn said she has also incorporated the basic rights learnings into her personal life. She and Doug created “The 10 Commandments of Teresa,” which lovingly define her limitations and boundaries for family and friends. Some family members initially challenged the guidelines, but they now respect Horn’s need for “self-preservation.” These days, Horn has cut back on both her volunteer and office activities – bowing out with a gracious “no thank you.” She does, however, invest her experience and energy into her ACPA support group, which its members affectionately call “Chronic Wholeness.” Her group has been talking a lot lately about basic rights, and how best to build up their arsenals so they can respond properly when the need arises throughout their care. “When I started out on this journey, I couldn’t see the forest for the trees,” Horn said. “So I remind my group members it’s important to seek out others on this journey and to look for resources which can be substantiated. The Cleveland Clinic is where I gained the tools – both physically and psychologically – to address my chronic pain needs.

“When I learned I had chronic pain, I felt like the rug had been pulled out from underneath me. And, I was embarrassed for anyone to know. But I learned quickly that I first needed to accept that ‘chronic’ meant the pain wasn’t going away. That’s a hard pill to swallow when you are a Type A perfectionist like me, who thinks they can outrun it, but instead ends up falling flat. The number one fear when you have chronic pain is failure, but this doesn’t mean we’ve failed at life. It just means we need to find the tools, the providers, and the support networks to give us confidence to pursue what’s right for us.” — TERE SA HORN

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Helping

People in Pain,

1

@a time

Waiting for the U.S. government to enact change is like watching snails race. When our leaders approach an issue – such as the 116 million Americans who live with chronic pain – they tend to do so through committees, reports, and long documents, not action. by Alison Conte, Editor, The Chronicle

It was in 2011 that the Institute of Medicine (IOM) released Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research (see The Chronicle, December 2011). Five years later in March 2016, U.S. Health and Human Services followed an IOM recommendation and released a National Pain Strategy. The strategy suggested ways to: ✽ Reduce the number of people with pain ✽ Increase more effective treatment of pain ✽ Reduce the burden of chronic pain on society

What Does it Mean for You? “There are many core problems that are at the foundation of inadequate treatment of pain in this country,” said Penney Cowan, founder and executive director of the ACPA. “While this strategy supports our cause and spreads awareness, it doesn’t do much to help the individual person who has pain today.”

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Cowan described the problems and gaps in pain treatment, which are all too familiar to those who live with pain. We need: ✽ To eliminate the stigma of having an invisible disease such as chronic pain ✽ Access to informed and compassionate pain specialists ✽ Funding for comprehensive, interdisciplinary pain treatment programs ✽ Medical school instruction in a balanced approach to pain treatment ✽ Greater emphasis on self-management and other alternatives to medication ✽ To reduce the demographic and geographic disparities in pain treatment ✽ Insurance reforms to control the increasing cost of pain care ✽ More government funding of research into pain and treatments


“In addition, we have a healthcare system which doesn’t give doctors enough time to have a conversation with their patients. How can they understand what activities are important for that person? What they need to have a fulfilling life despite chronic pain?” Cowan said.

One Person at a Time ACPA focuses on the impact of chronic pain on individual lives. “We are here for people with pain,” Cowan said. She described some of the people with pain that she has met in her travels for the ACPA. These include: ✽ Older adults living in pain and isolation ✽ People with pain trying to make a living ✽ Mothers trying to care for young children ✽ People living in small towns with no access to care ✽ Physicians, nurses, caregivers, and pharmacists who are trying to help “When I give talks, I am impressed by the solutions that people find to keep going in life. Many of them say when they found the ACPA, it saved their life,” she said. “When they say that ACPA’s tools, manuals, and support groups changed the way they lived with pain, I know we are doing something right.”

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For Pain Awareness Month,

Share Your Story The impact of pain on America is the impact of chronic pain on individual people. The most important message from every ACPA member to another person with pain is this: you are not alone. We all have days when it doesn’t feel like we are moving forward. By sharing your story, you can show someone who is having a bad day that a better tomorrow is still possible. Your particular methods may not work for everyone, but your success tells other people with pain that it is possible to get your life back.

Your Voice Can Help Others This September for Pain Awareness Month, take a few minutes to tell us your story. We want to know what APCA has done to change your life. Tell us if the ACPA has helped you to… ✽ Take an active role in your healthcare ✽ Reach out to others ✽ Combat stress and negative emotions ✽ Pace yourself, so you can enjoy activities ✽ Communicate with your family and care

providers ✽ Manage pain and regain your life

How to Submit a Story We’d like to share your messages of hope and inclusion in upcoming issues of the Chronicle. YOU CAN ✽ Mail or email us your story (under 700 words) ✽ Send us your name and phone number, and we’ll have a writer interview you ✽ Send a photo of yourself doing an activity you enjoy, and a brief description ✽ You can also use the contact form at theacpa.org/Contact-Us

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CONTACT US ACPA@theacpa.org 1-800-533-3231 “How the ACPA Helped Me” Stories for the Chronicle c/o the ACPA PO Box 850 Rocklin, CA 95677


Exercise Helps Reduce Bouts of Back Pain Health researcher Chris Maher, of the University of Sydney in Australia, led a team researching ways to treat and prevent lower back pain. They reviewed 21 clinical studies involving 30,000 participants around the world. They found that simple exercise reduced the risk of repeated low-back pain in the year following a pain episode by between 25 and 40 percent. Any kinds of exercise helped, from core strengthening and aerobic exercise, to flexibility and stretching. Their review was published in January 2016 in JAMA Internal Medicine.1 The article quotes Dr. Tim Carey, an internist at the University of North Carolina in Chapel Hill, who said: “If there were a pill out there that could reduce your risk of future episodes of back pain by 30 percent, I'd probably be seeing ads on television every night.” And yet, he says, fewer than half of patients participate in an exercise program, even if they have long-term back pain. He suggests that healthcare providers should prescribe exercise more often, given its effectiveness. "That's a problem, because physical activity can be incredibly cheap to provide to patients, whereas a lot of these drugs that are being developed are incredibly expensive," Maher said. The study suggests that costs can be reduced and back pain avoided by having people with back pain undertake more exercise programs. It is estimated that the United States spends about $80 billion on spine problems, which includes lower back pain, and reflects the total amount spent on treatments, imaging, surgery, pain medicines, and the cost of missed work days. "When you start packaging it all up, the costs around the world are horrendous in terms of how much low-back pain costs, and that's why prevention is so important," Maher said. Maher suggests people with back pain avoid rest. "What we do understand about the back is that the more you use it, the more likely you are to keep it strong, fit, and healthy.” Eliminating smoking and increasing education about lower back pain also helps, the study found. 1 http://archinte.jamanetwork.com/article.aspx?articleid=2481155 http://www.npr.org/sections/health-shots/2016/01/11/462366361/forget-the-gizmosexercise-works-best-for-lower-back-pain CHRONICLE | AUGUST

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ACPA Updates ACPA Chronicle Available Online We hope you like the new design of the ACPA Chronicle, which is published three times a year, online only, during April, August and December. It is free and available to everyone on the ACPA website. ✽ You can read previous issues, going back to 2005, in our archives. ✽ We send out an email notice when a new Chronicle is posted; sign up for this email.

Pharmacist on Your Care Team A video from the ACPA and American Pharmacists Association explores why your pharmacist is an important member of your healthcare team. About 12.5 percent of all prescriptions filled in the U.S. are for pain medications, so your pharmacist is very familiar with them and able to provide answers to your medication questions. In a recent survey, 81 percent of pharmacists said they would like to speak more to people about their pain and treatment options. Your pharmacist can talk to you about the different medications, what they’re for, how they work the best, and what sort of side effects that you may experience from the medications. The Pharmacist CARE Program is an ACPA communication tool that helps people with pain follow their doctor’s orders and take prescription medicine correctly. It allows the pharmacist to clearly record what you are taking, why and how to take it and how to store it. You can download the Care Card and have your pharmacist complete it.

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Pathways Through Pain: Priorities and Goals Our new video shows how people with pain become actively involved in their recovery and improve the medical treatment they receive. Setting priorities and goals is an important part of recovery, and will help you return to doing the activities that mean the most to you.

New Communication Tools The ACPA Pain Log and Opioid Induced Constipation Conversation Guide are now available as phone apps. You can download them through Apple Store or Google Play. These apps will allow you to track your symptoms, set reminders, and view your progress, and share it all with your healthcare provider. Visit the ACPA website for details. Another new tool is the Migraine Conversation Guide. It will let you track symptoms, mood changes, and possible triggers related to migraine headaches, helping you to have more meaningful conversations with your doctor.

Federal Workers Can Give Through CFC The American Chronic Pain Association has been accepted by the U.S. Office of Personnel Management for inclusion in the fall 2016 Combined Federal Campaign (CFC) as a member of Health & Medical Research Charities of America Federation. If you work for the federal government and would like to designate the ACPA for a contribution, please use CFC number 10549. This is only valid for CFC members.


Book Review

You Are Not Your Pain: Using Mindfulness to Relieve Pain, Reduce Stress, and Restore Well-Being By Vidyamala Burch and Danny Penman Review by Tara White, RN

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his book is part of a program to decrease pain as well as stress. The basis for this program is working with your pain to acknowledge it, accept it, and thereby separate it from suffering.

These two separate processes are explained by the authors, who are both chronic pain patients. They explain that you might not be aware when aggravating factors switch on automatically, leaving you lost and alone in your pain. They offer a series of short meditation practices to “help you to build your courage to enable you to move in closer to the center of the intensity, to investigate it with friendliness and curiosity, so you can begin to see how the automatic tendencies of the mind take over.” They then teach readers how become open and compassionate with themselves, which, strange as it may seem, dissolves much of the suffering that once seemed so inevitable.

Much of this is derived from Eastern medicine, which focuses on the breath as it flows into and out of the body. In a nutshell, this allows you to see your mind and body in action, to observe painful sensations as they arise, and to let go of struggling with them. More importantly, it teaches you that pain naturally waxes and wanes. “You learn to gently observe it, rather than being caught up in it, and when you do, something remarkable happens: it begins to melt away of its own accord.” You learn that pain serves a purpose; that is to protect us from danger. However, with chronic pain, the brain has a “volume control,” which can turn up or down the intensity and duration. Mindfulness can teach us how to keep the volume turned down, rather than going into panic mode with its accompanying feelings of “I’m always going to hurt this bad.” We all know how this can spiral out of control at warp speed.

The Benefits of Mindfulness

Meditate Anywhere, Anytime

Mindfulness meditation has many benefits, including dramatically reducing pain and the emotional response to it. It can also improve: ✽ Mood and quality of life ✽ Working memory and creativity ✽ Attention span and reaction time ✽ Mental and physical stamina

Meditation takes about 20 minutes a day. You can meditate on any pleasant thought, anywhere and almost any time.

It can also help you: ✽ Fight anxiety, stress, depression ✽ Relieve exhaustion and irritability ✽ Improve your immune system ✽ Control blood sugar ✽ Improve heart health and blood pressure

Mindfulness meditation takes patience, courage, and a willingness to do the work of the program. No one else can do this work for you, but the authors guide you gently through the process.

Additionally, mindfulness enhances brain function by increasing the brain’s grey matter in areas associated with self-awareness, empathy, self-control, and attention. The authors claim that it soothes the parts of the brain that produce stress hormones and builds those areas that lift mood and promote learning. It can even reduce some of the deterioration of the brain that naturally occurs with aging.

This program is best carried out over eight weeks, although it can be done over a longer period of time. The authors’ state that many people find so many benefits that they continue with it for years. “They see it as a journey that continuously reveals their true potential.”

This is truly the wave of the future for chronic pain management. Give it a try; you have nothing to lose, and the rest of your life to be gained! You Are Not Your Pain: Using Mindfulness to Relieve Pain, Reduce Stress, and Restore Well-Being, by Vidyamala Burch and Danny Penman; published by Flatiron Books, 236 pages; $19.99 ISBN#978-1-250-05267-4; www.breathworks-mindfulness.org.uk.

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Book Review

Holistic Pain Relief: Dr. Tick’s Breakthrough Strategies to Manage and Eliminate Pain By Heather Tick, MD Review by Tara White, RN

I

have found that a focus on health is the best way to move the conversation about pain in a positive direction,” writes physician and author Heather Tick. “Most people have never been told that there are things they can do for themselves every day to affect their health and their pain. I join my patients on their journey as a guide.” With this reasoning, Dr. Tick offers breakthrough strategies for managing and eliminating pain. These include a healthy diet, resolving stress, healthy habits, dietary supplements, exercise, and awareness of options besides prescription drugs. She also discusses invasive procedures such as surgery, but leaves them until the end as she believes they should be – a last resort. During her first year of medical school, Dr. Tick volunteered to be treated for her shoulder pain as part of a course in acupuncture. As her pain was relieved with more acupuncture treatment, her eyes were opened to the healing effects of holistic medicine. Holistic medicine suggests the body cannot be separated from the mind and spirit, nor can it be treated as just a collection of parts. This would become a fundamental belief that would guide her. She says, “Chronic pain is complex. [It is] like a 50,000piece jigsaw puzzle for which we have placed about 500 pieces. We are not even sure what the big picture is. This is small comfort for those in pain. The good news is that, despite the lack of clarity in our vision, we have many useful interventions.” She says that physicians sometimes follow practice guidelines of rushed protocols, rather than taking the time to investigate the history of each individual patient. However, this is not an ideal world and there are no crystal balls. Instead, she starts to solve the mystery by helping patients change certain habits. Changes in diet, posture, and exercise can make a tremendous difference and even eliminate problems.

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Many people have a difficult time finding guidance to stay healthy and are, instead, mostly offered medication. Dr. Tick is trying to turn all this around by treating the patient first, using good listening skills and compassion. While some patients may need further intervention, many do not. Citing the incredible expense our country bears to treat chronic pain, she demonstrates how many conventionally trained doctors have begun collaborating with practitioners of complementary and alternative medicine. This led to a new field called integrative medicine, which focuses on the person and not the problem. By paying attention to factors affecting the mind, body, and spirit, the focus is shifted to healing. After all, our bodies have an innate ability to heal themselves, and it is only natural to assist them in this process. She provides many fascinating tips for a healthy, robust life of less pain. She illustrates meditation, relaxation, and other mind-body techniques that can give us a sense of control. Her views on prescription pain medications are alarming, describing unpredictable effects on various individuals. The process by which pain develops in our systems, and by which we heal ourselves, is very complicated. If any one part of these processes changes, all processes and the whole system are affected. Her best advice is “proceed with caution.” Nature and time can be powerful healers, and she recommends, whenever possible, letting them work as they were intended to. Dr. Tick’s book came at a time when I was stuck in my pain journey. She convinced me to make some immediate changes, and I have already noticed improvements. I cannot think of a better endorsement than that. Holistic Pain Relief: Dr. Tick’s Breakthrough Strategies to Manage and Eliminate Pain by Heather Tick, MD., published by New World Library, 300 pages, $15.95; ISBN# 978-1-60868-206-5.


New Gr ups TM

Welcome to our new groups and facilitators.

Mark Rhodes

Elizabeth (Betty) Godwin

Phoenix, AZ (VA Only)

Silver Spring, MD

Denise Peralta

Gerrit Bult

Yorba Linda/Brea, CA

Wilmington, NC

David Starr and Ron Berke

George Reves

Palo Alto, CA (VA Only)

Peggy Silva Delray Beach, FL

Sparks, NV

Shannon Green Pflugerville, TX

David Feinberg Bellingham, WA

For contact information for any support group facilitator, please call 800-533-3231.

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Tributes

In Memory of Aaron J. Nelson

In Memory of Roger Schmid

Given by

Given by

Ronald Doering

Ginger and Larry Hale

Ivy Powell

In Honor of Jennifer L. Murphy, PhD

Kasia Anderson

Given by

Suzanne Robinson Gregory and Sheila May

James Bull

Oxford Companies of Ann Arbor, Jeff Hauptman Sharon Filips John and Florence Dzuban Carol and Elliot Weinstock

Robert Blaine Rogers

Vicki and Robert Scott Nancy Ream Jack and Kathy Dzuban Kris and Scott Carnivale

Robert Blaine Rogers, age 21, died on March 19, 2016, at his home in Coppell, Texas, from complications of a severe traumatic brain injury after a skateboarding accident in 2011.

David and Carrie Dzuban Hedy Gaskey Chris Fortney

In Memory of Blaine Rogers Given by Theresa Strzalkowski Gina Van Bemmel Carolyn Kollmeier Robert Belew Kara Miller

Blaine Rogers defied the odds by emerging from a 10-day coma, and was determined not to let his brain injuries limit his exploration of medicine and science. He researched his own condition as if it were an intricate puzzle. Doctors told Blaine he had a gift for understanding the interactions of complex body systems. Throughout his long battle with this chronically painful condition, he shared his optimism and insights online with people all over the world.

Carol June Baskett Simon Chung Katie Palmer Jim and Kathleen Schock Marie Vrlik Mary Jones Mr. and Mrs. John Andrews Mr. and Mrs. Walter Metcalf and Family

Blaine often told his family that his traumatic brain injury made him realize that he wanted his life and his own innovative medical therapies to matter in a positive way. He wanted to have an impact on others, especially those suffering from chronic pain. With his multiple organ donations, and request for donations to the ACPA in his memory, Blaine’s mission is well underway. Source: Citizen's Advocate newspaper, Coppell, Texas, April 8, 2016.

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Thank You! CHAMPION

AMBASSADOR

EDUCATOR

BUILDER

SUPPORTER

The ACPA is a peer support organization: we help each other learn to live fully in spite of chronic pain. Your donations and purchase of materials keep the ACPA alive and reaching out to even more people with pain.

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Our Mission â?‹ To facilitate peer support and education for individuals with chronic pain and their families so that these individuals may live more fully in spite of their pain. â?‹ To raise awareness among the health care community, policy makers, and the public at large about issues of living with chronic pain.

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Chronicle August 2016