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Pain Science Education

Pain Science Education discusses the treatment of persistent pain. Learn how to use the brain, body, mind, and behavior to reduce pain and improve physical and mental well-being. This podcast offers free training for physical therapists, healthcare professionals, and people with pain. Dr. Joe Tatta is a physical therapist, educator, author, and pain researcher. He is known for his contribution to integrative pain care and for championing the safe and effective treatment of chronic pain. With over 20 years of clinical expertise, Dr. Joe is dedicated to converting cutting-edge pain science into actionable therapeutic practices. An advocate for a biopsychosocial approach, Dr. Joe developed PRISM: Pain Recovery and Integrative Systems Model, a cognitive-behavioral approach that promotes resilience, growth, and recovery. Pain Science Education invites listeners to explore a wide array of subjects including pain education, pain neuroscience, physical therapy, physiotherapy, pain psychology, wellness, and continuing education. Episodes feature interviews with leading experts, offering a deep dive into the pivotal topics shaping the field of pain management. The insights shared here aim to propel the practice of physical therapy to the forefront of primary pain management. Dr. Joe Tatta is committed to guiding therapists and healthcare providers through the complexities of pain, equipping them with the knowledge to deliver non-pharmacologic and non-invasive approaches to chronic pain. With Dr. Joe's guidance, listeners will uncover the potential of physical therapists as pivotal figures in pain management, understand the importance of health behavior change, and learn how to use integrative and lifestyle medicine in practice. Join the Pain Science Education podcast to transform your clinical approach, enrich your professional toolkit, and participate in the revolution of pain management. Each episode promises to take you one step closer to learning about pain, becoming a leader in delivering exceptional, innovative care to those suffering with pain, and ultimately improving lives across the globe.
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Now displaying: Category: general
Jun 15, 2022

In my profession of physical therapy, the lack of gay, lesbian, bisexual, transgender, and queer-specific education has given rise to deficiencies in our cultural competence and our humility. When deficiencies exist in a profession’s educational system, as well as its continued education system, it can create a climate of discrimination and disparity. This ultimately leads to decreased access to health and effective healthcare.

In the context of chronic pain, which is what we discuss on this show, LGBTQ+ people are more likely to suffer from a long-term chronic pain condition than heterosexuals. To begin this episode, I would like to share with you a couple of reasons why this community or this population of people experience more pain before we meet our expert guests.

The first reason is that a larger portion of the LGBTQ+ community lacks access to health insurance or lives in poverty, more so than their heterosexual counterparts. They’re more likely to delay medical care or, at times, just forgo it completely because they can’t afford it or they simply just don’t have access to quality healthcare.

Jun 1, 2022

We are discussing the power of peer support and group learning and chronic pain recovery. My expert guest is Dr. Amber Richard Bauer. Amber is a doctor of Physical Therapy focusing on Chronic Pain Recovery and Pain Education. She's also a certified instructor for Empowered Relief and a facilitator for mental health ten-week virtual pain care program. Amber uses elements of Acceptance and Commitment Therapy, Cognitive Behavioral Therapy, Pain Neuroscience, Education, and Mindfulness paired with her knowledge as a Physical Therapist to help clients recover from chronic pain and return to living meaningful lives.

 

Amber is a lifelong dancer and a believer in the power of the mind-body connection to heal from chronic pain, trauma, as well as illness. In this episode, you will learn about the benefits of group training for people with chronic pain, why it's important for people with pain to get support from other people, dealing with a similar condition, and the role of a licensed health professional in facilitating group care.

 

At the beginning of this episode, we talk about Amber’s journey, both her educational journey from being a dancer to a physical therapist through psychologically informed care and then back as well as her personal experience in living with and overcoming chronic pain, which we know is vitally important. Without further ado, let's begin and meet Dr. Amber Richard Bauer.

 

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May 25, 2022

It is great to be here with you again. In each episode, we generally discuss the impact of physical therapy treatments on the management of chronic pain and other chronic diseases. From there, we have explored other overlapping problems and conditions, such as things like opioids, the over-prescribing of opioids or addiction, and the movement to choose physical therapy as an alternative to opioid medication.

A clear movement also exists for a physical therapist to play a more pivotal role in treating and managing non-communicable diseases such as diabetes, metabolic syndrome, hypertension, and cardiovascular disease. This should not be too much of a leap because, as physical therapists, we have had a specialty in cardiopulmonary physical therapy for many decades. Something happened during the COVID-19 pandemic which changed our profession as well as changed our personal lives.

America’s mental health declined, with anywhere between 28% to 40% of adults struggling with depression during the height of the pandemic. Many of those numbers have stayed consistent. More people have been prescribed antidepressant medications and the mental health care shortage intensified with many providers in clinics having waitlists of 4 months to 1 year, which left many people without essential healthcare or mental health care services. As licensed doctoral trained healthcare professionals, we, physical therapists, whether realize it or not, see people with mental health concerns daily in almost every practice setting.

Our profession, like many others, has begun to advocate for ways to improve mental health and mental well-being. We now know that the epidemic of depression requires a supporting role by physical therapists. The reason is that the influence of physical therapy extends way beyond the physical benefit. It improves mental health and promotes mental well-being. Screening and addressing behavioral and mental health concerns are within the scope of physical therapy practice guidelines.

The American Physical Therapy Association published these guidelines in 2020 in the House of Delegates’ position statement. This position is generally in line with the best evidence and the growing trend in psychological uniform physical therapy, which incorporates bio-psycho-social treatments for chronic pain and other health conditions.

A few decades before the American Physical Therapy Association published these guidelines, there was the International Association for Physical Therapy and Mental Health, which is a sub-chapter of the World Confederation of Physical Therapy, which described the need and scope of physical therapy and mental health, behavioral health, and psychiatry.

What we are seeing is the construct of psychologically informed physical therapy is the same, similar to, or compliments mental health physical therapy, which is used to facilitate body awareness, problem-solving skills, cognitive restructuring, and ways to cope, which reinforce self-efficacy and improve quality of life in the face of poor mental health.

It would then appear inherent that a physical therapist can use biomedical treatments as well as psychosocial treatments based on their key role in reducing disability and fostering positive human growth. Occasionally, as physical therapists, we sell ourselves short and fail to understand the depth and the breadth of the impact we can have on someone’s quality of life. What I am referring to is the emotional and psychological benefits that can increase the value of care that we provide as individuals and as a profession.

Now more than ever, it is important that we understand and explain the breadth of the therapeutic benefits that we provide because studies demonstrate that approximately a quarter of all Americans may have a mental health condition. 25% to 50% of patients in a general outpatient physical therapy clinic have a mental health condition and upwards of 70% of patients with low back pain that report to physical therapy have some level of depression. We are already seeing this in practice.

There is a place for us to be primary care and entry point providers into the mental health care system. However, that does not mean that we simply “refer out.” It means that. As professionals, we stay engaged in patient care, and we continue to play a role independently or in the code management of the mild, moderate, and severe depression or other mental health conditions that exist in the populations of patients that we treat.

In fact, there is some literature that mild to moderate depression improves over the course of physical therapy, regardless of whether or not a mental health provider is engaged in the plan of care. How can that be or why is that? It is because movement, body awareness, physical activity, exercise, and many other interventions that we use as professionals are a catalyst for positive mental health and improved psychological well-being. When you combine physical activity with cognitive reappraisal, there is generally a greater impact on outcomes and the quality of life of the patients that you care for.

Joining us to discuss the role of the physical therapist in treating depression is Dr. Tony Varela. He is a physical therapist who brings many years of experience in musculoskeletal health, including pain management. His professional principles were paved through residency and fellowship, grounded and rich patient experiences, and reinforced by serving those surviving chronic pain, cancer, as well as trauma, and PTSD from war.

He believes there is a better version of ourselves ready to push through and he is an Assistant Professor at Arkansas College of Health Education. Tony authored a paper in the February 2022 edition of Physiotherapy Theory and Practice called The Theatre of Depression: A Role for Physical Therapy, which we will discuss in this episode. Without further ado, let’s begin. Let’s meet Tony and discuss the role of physical therapy in the treatment of depression.

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May 11, 2022

It's great to be here with you. Thanks for joining. In this episode, we are discussing a new assessment tool to guide behavior change, which is called The Physical Therapy Healthy Lifestyle Appraisal. It was developed by Dr. MarySue Ingman, who you will meet in a couple of moments. This is the first validated assessment tool for a physical therapy practice, where we can look at nutrition, physical activity, stress, sleep, and tobacco use. What I like and appreciate about this tool is that it's quick, easy, fits well into physical therapist practice, and especially if you are using integrative or lifestyle medicine approaches to treat chronic pain or chronic disease management.

 

Let me share a little bit about our guest. Dr. MarySue Ingman is an Associate Professor in the Doctor of Physical Therapy Program at St. Catherine University in St. Paul, Minnesota. Her research interests include the role of a physical therapist, health promotion, and clinical practice. She's published studies on motivational interviewing and the role of physical therapists in health promotion and wellness.

In this episode, you will learn a lot about counseling, assessment, and the science of behavior change. In fact, this episode is a sneak peek into some work that all of us have been working on for years. Some of you may know that I co-edited a textbook. That textbook is called Integrative and Lifestyle Medicine in Physical Therapy. My co-editor was another physical therapist, who you might know, whose name is Dr. Ginger Garner.

In that textbook, we invited about 40 physical therapy professionals, researchers, and educators, to contribute to this book on Integrative and Lifestyle Medicine in Physical Therapy. Chapter 3 in this textbook, which is called Coaching, Counseling, and the Science of Behavior Change, was written by MarySue and her colleague, Dr. Janet Bezner, a Professor in the Department of Physical Therapy at Texas State University.

That textbook is on track to come out soon. We are excited because we think that this will be useful for physical therapy educators, as well as clinicians who are using integrative and lifestyle medicine in physical therapy. As I mentioned, Chapter 3 is written by MarySue, where we go into Coaching, Counseling, and the Science of Behavior Change, which we will discuss in this episode. Without further ado, let's begin and learn about the Physical Therapy Healthy Lifestyle Appraisal and meet Dr. MarySue Ingman.

 

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Apr 27, 2022

We have a new topic that we are highlighting on the show. We are discussing resilience and growth after trauma, also known as post-traumatic growth, which is a theory that explains the positive human transformation that can occur after any type of physical trauma, psychological or emotional trauma, spiritual trauma, or even after struggling with a prolonged illness.

Joining us to discuss trauma and post-traumatic growth is Dr. Melissa Zeligman. She is an Assistant Professor of Counseling Education at the University of Central Florida. Prior to her Doctorate, she served as a mental health counselor working in the agency, medical, legal, as well as high school settings.

Her research focuses on trauma work, including the experience of post-traumatic growth. Positive growth or post-traumatic growth is something that interests me, especially within the context of treating people with chronic pain or other chronic health conditions that we see in physical therapy or other physical medicine or rehabilitation settings.

You are going to learn a lot about this topic. Hopefully, you will embrace it as much as I have in both clinical practices and become very interested in the research. If you are interested in learning more about a trauma-informed approach to treating chronic pain, make sure to check out our course at the IntegrativePainScienceInstitute.com called Trauma-Informed Pain Care, where you will learn how to treat trauma from a trauma-informed perspective for people living with chronic pain. Without further ado, let’s begin and learn all about post-traumatic growth.

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Apr 20, 2022

In this episode, we are discussing the latest evidence which supports the use of a ketogenic diet and its potential impact on pain and central nervous system sensitization. My guest is Dr. Rowena Field. She is a physiotherapist with many years of experience, primarily in chronic pain management. We discussed the results of her recent PhD dissertation, where she investigated the use of a ketogenic diet for the treatment of chronic pain and now incorporates this approach in her physiotherapy practice.

We will discuss how a ketogenic diet impacts pain, blood biomarkers, and quality of life for patients with chronic pain and other chronic health conditions. This is sponsored by the Functional Nutrition for Chronic Pain Practitioner Certification. In this training, you will learn how to apply diet and nutrition for multiple chronic pain syndromes, including how to use a ketogenic diet for the treatment of chronic pain. Without further ado, let's begin. Let’s meet Dr. Rowena Field and learn about how a ketogenetic diet impacts chronic pain

 

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Apr 13, 2022

As always, I am delighted and honored to be spending this time with you. I recorded an episode on embodied cognition and the body's role in thought with Psychologist Rebecca Fincher-Kiefer. In that episode, we discuss the importance of using the body as a therapeutic tool for helping modulate difficult emotions or thoughts that people may encounter from chronic pain or other various chronic health conditions. As physical therapists, using the body as a tool for healing from pain or other conditions, whether it's physical or mental, is a big part of what we do.

In this episode, we're going to go deeper into how to use the body, including how to use exercise and physical activity to improve pain as well as mental wellbeing with Dr. Jennifer Heisz. She is an expert in brain health. She's an Associate Professor and Canada research chair in Brain Health and Aging in the Department of Kinesiology at McMaster University. She directs the NeuroFitLab, which has attracted over $1 million to support her research program on the effects of exercise and physical activity on brain health.

Her award-winning research examines the effects of physical activity on brain function to promote mental health and wellbeing in young adults, older adults and individuals with Alzheimer's disease. She has a new book coming out called Move The Body, Heal The Mind, which examines the latest research on how exercise can help you overcome anxiety, depression and dementia, improve focus and creativity, sleep better and even improve chronic pain. Without further ado, let's begin with Dr. Jennifer Heisz and learn about how we can use exercise and physical activity to improve brain health.

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Apr 6, 2022

If you have been following along with this show for some time, you know the one area that interests me. A question I often ask myself and propose to you is how can we educate the public about effective pain management and raise awareness of the physical therapy profession? I have been working with a select group of professionals one-on-one on different types of outreach projects and protocols as well as connecting with innovative physical therapists who have created practice models or businesses that center on health promotion or raise awareness of the PT profession.

In this episode, you will meet Dr. Jazmine Tooles. She is a physical therapist who created the business called Explore the Magic of Motion. Explore the Magic of Motion was created in 2012 to raise awareness of the physical therapy profession. The way Jazmine achieved this was by working with the Girl Scouts of America to develop an approved Girl Scouts patch or badge. Jazmine is also a lifetime Girl Scout herself and created these patch programs to teach 6th to 12th grade Scouts about healthy living through exercise while also having them investigate the professions that utilize exercise for healing such as physical therapy.

 

Fast forward, Explore the Magic of Motion is a full business that has reached over 500 participants since its inception. It has grown to provide an interactive health and wellness learning experience not only for the community but also for clinicians as well as students. In this episode, you will learn about how Jazmine developed Explore the Magic of Motion, its history, what it offers now, and who it serves. Without further ado, let’s begin and meet Dr. Jazmine Tooles.

 

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Mar 30, 2022

In this episode, we are discussing embodied cognition and the role of bodily processes in thought. In the field of pain care, we strongly lean on theories of how the brain works and how we can use the nervous system to modulate pain. Many of these theories are rooted in the idea that the brain is the seat of cognition and views the brain as a CEO, which controls both thinking as well as our body.

However, newer theories such as embodied cognition take a different perspective which emphasizes the significance of the physical body in our cognitive abilities. Embodied cognition is a theory that draws on the work from the fields of psychology, neuroscience, philosophy, physiology, and even artificial intelligence. This new research points towards bodily processes in forming how our cognition is generated.

We are joined by Professor Rebecca Fincher-Kiefer, PhD, who is a Professor of Psychology at Gettysburg College and discusses the potential application of embodied cognition. Her research interests include the investigation of embodied cognition and how all that we know and understand is grounded in our bodies.

She's on the cutting edge of this field of study, which includes the publication of a textbook called How the Body Shapes Knowledge: Empirical Support for Embodied Cognition. In this episode, you will learn all about embodied cognition and its potential influence on pain, health, and human behavior. Without further ado, let's learn about embodied cognition and meet Professor Rebecca Fincher-Kiefer, PhD.

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Mar 23, 2022

In this episode, we're discussing how mindful movement can shift the experience of exercise or physical activity for people. This is important because the mindful movement can help people exercise in a way that is more fluid and easier, alleviate pain and with body image something they oftentimes struggle with when they begin an exercise program. Some of you may know that as a kid and adolescent and even into college, I was a gymnast. Mindful movement is something that was comfortable for me.

However, I didn't fully dive into what mindfulness was with regard to movement until about the year 1997. At my first job at St. Vincent's Medical Center, there was a free yoga class that was offered by a yoga studio down the block called Integral Yoga in New York City's Greenwich Village. It has wonderful yoga classes and I became hooked on yoga as a form of mindful movement. Although I've never become certified in yoga, I've done thousands of hours of many different types of yoga methods and techniques. I always recommend it for people with pain. Somewhere around the year 2000, I worked for a practice here in New York City that specialized in Sports and Performing Arts Medicine.

As part of that practice, we use the Pilates method of body conditioning for rehabilitating people with pain, as well as the performing artists and dancers that would come into our clinic. Moving with the mind or mindful movement is a big part of what Joseph Pilates created. He has five principles of mindful movement that he includes in his method, which is called Contrology. They include breathing, centering concentration control as well as precision. You see people bringing in these principles of movement into various types of movement methods and practices.

You'll meet Professor Anne Cox, whose research has been focused on understanding key determinants of physical activity-related behaviors as a professor and a researcher, has completed a 200-hour yoga teacher training and uses the knowledge of mindful movement to examine the effects of yoga on things like mindfulness, body image and the promotion of the physical activity.

In this episode, you'll learn all about mindful movement and how mindfulness shifts the experience of movement or physical activity? How does yoga increase mindfulness and how does being mindful affects body image or physical activity motivation? Without further ado, let's begin and meet Professor Anne Cox and learn how and why to add mindfulness to physical activity.

 

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Mar 16, 2022

We're going to talk about psychological aspects of pain rehabilitation that physical therapists perceive as important. When we're talking about research, a new topic or providing new information, oftentimes I'm talking to a pain researcher. It may be someone with a PhD or someone who is actively engaged in investigating different aspects of pain from a lifestyle and a biopsychosocial perspective.

In this episode, I'm introducing you to Alexa Knuth, who is a student physical therapist. Alexa is a student at Robert Gordon University in Aberdeen, Scotland. She is in the last year of her program and she is excited to start a career. Even before she started her career, she had already started to delve into the evidence and contribute to the evidence base by writing a paper called Psychological Aspects of Rehabilitation as Perceived by Physical Therapists. You can all access that. It was published in 2018. I came across it and thought it was important to share with all of you so we're going to be talking about that on the show.

Alexa also has an interest in working with and applying psychological techniques to a specific patient population, which is those who are looking to self-manage inflammatory arthritis like rheumatoid arthritis. There are lots of great applications for this work here. We'll talk about that in this episode as well. Overall, we'll talk about the important psychological techniques people can use for self-management and which physical therapists perceive are the most important.

As you know, psychologically-based care or psychologically-informed physical therapy is something we often discuss on this show. We teach courses on that at the Integrative Pain Science Institute. You can go over and check out our courses as well as the newly released Psychologically-Informed Pain Practitioner Certification. That's a complete certification that discusses the different multimodal approaches that you can use with regard to cognitive and behavioral interventions as well as whole health interventions for treating people with chronic pain. Without further ado, let's begin and meet Alexa Knuth.

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Mar 2, 2022

In this episode, we are discussing perfectionism and stress in the physical therapy students. Stress and burnout in the PT profession are personal interests of mine. I have done some research and explored how to use ACT in preventing burnout and creating resiliency in physical therapists. We briefly explored this topic of perfectionism in episode 217 with physical therapist Andrea Moore. She is a PT who specializes in treating women in overcoming perfectionism, and the intersection between pain and perfectionism.

Perfectionism is often caused by having high standards or having a hypercritical evaluation of oneself. Some doctor or physical therapy students experience increased stress when they go through the rather rigorous academic coursework that we take in physical therapy schools. Yet there is limited research in understanding the intersection between stress and perfectionism in the PT students, what the successful behaviors are that these students have that help them manage this increased stress, especially those who are perfectionists coming into the program.

Here to discuss perfectionism and stress in the PT student is Professor Mike Richardson. He is a Clinical Associate Professor in the Doctor of Physical Therapy Program at Hanover College. He is a Doctor of Health Science from the University of Indianapolis. His current research interests include perfectionism and stress among physical therapy students.

You will learn all about perfectionism and its prevalence among DPT students, perfectionism’s relationship to stress, and why it is important to better understand the relationship between stress and perfectionism. Finally, what can be done? What strategies can you employ if you are a DPT student or a physical therapist yourself who is looking at the impact of stress on your physical as well as mental well-being? Let's meet professor Mike Richardson and learn all about perfectionism and stress in physical therapy students.

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Feb 23, 2022

We're discussing the intersection between PTSD, Post-Traumatic Stress Disorder and CRPS, which is Complex Regional Pain Syndrome. My guest is Dr. Deborah Brandt. She is a retired Doctor of Physical Therapy. She teaches about issues regarding chronic pain and the use of somatic therapy practices. Her personal experience with and the study of complex post-traumatic stress disorder as well as complex regional pain syndrome, which she identifies as being complex psychophysical phenomena, has enriched her comprehension of both issues and provided her with unique tools to communicate her insights and knowledge to others.

In this episode, we will discuss treatment options, but more importantly, this episode is an opportunity to hear one's lived experience, which includes her knowledge of PTSD and CRPS gained through her direct firsthand experience rather than learning through textbook-like descriptions, which can be challenging to understand the full complexity of what people go through. Without further ado, let's begin and meet Deborah Brandt and learn about the intersection between PTSD and CRPS.

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Feb 9, 2022

In this episode, we are discussing the impact of physical therapy on long-term opioid use for patients undergoing a total knee replacement. My expert guest is Professor Deepak Kumar. He is an Assistant Professor in the Department of Physical Therapy and Athletic Training at Boston University and the Section of Rheumatology at Boston University School of Medicine. He directs the Movement and Applied Imaging Lab at Boston University. The goal of Dr. Kumar's research is to improve the quality and quantity of movement during everyday life in people with knee osteoarthritis to reduce pain, improve physical function and maintain joint health.

We're going to review the findings of Professor Kumar’s study called the Association of Physical Therapy Interventions With Long-term Opioid Use After Total Knee Replacement. You can find that article in the October 2021 edition of the Journal of the American Medical Association. This show has implications for people with chronic pain. Also, there is important information here for opioid use and the positive impact that physical therapy can have on people's lives living with chronic pain. Without further ado, let's begin and let's meet Professor Deepak Kumar.

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Jan 12, 2022

In this episode, we were discussing how to build a Stepped Care Model for the treatment and intervention of chronic pain. The Stepped Care Model for chronic pain originated in the VA health system and has been used in a number of other places. This model prioritizes the role of primary care providers in optimizing pharmacological management as well as the timely and equitable access to patient-centered evidence-based non-pharmacologic approaches.

Joining us to discuss this model is Dr. Matthew Bair. His principal research focuses on chronic pain, psychological comorbidity, and developing strategies to improve pain management in the primary care setting. He has a strong background in conducting clinical trials, developing and testing interventions that combine pharmacologic and non-pharmacologic treatments, and his funded work often contrasts pharmacological and behavioral approaches for pain management.

He has served on several national Veterans Affairs committees related to improving pain management as well as the Clinical Practice Guideline Committee at the American Pain Society. He serves as an Editorial Board Member for Pain Medicine and the Journal of General Internal Medicine. In this episode, you will learn all about a Stepped Care Model for Chronic Pain, the effectiveness of a Stepped Care Model, and the impact of chronic pain amongst veteran populations. Without further ado, let’s begin and let’s meet Dr. Matthew Bair and learn about a Stepped Care Model for Chronic Pain.

 

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Jan 5, 2022

In this episode, we are discussing an important reimbursement issue related to physical therapy, as well as pain care in general. That is value-based healthcare. Value-based healthcare is a healthcare delivery model in which providers, including hospitals, as well as practitioners, are paid based on the patient's health outcome. This model differs from the traditional fee-for-service or a capitated approach in which providers are typically paid based on the amount of services they deliver. Joining me on this episode to discuss the trend of value-based healthcare, specifically in the physical therapy profession, is Dr. Alice Bell.

 

She earned her Doctorate in Physical Therapy Degree from the University of Montana. Now is on staff as a Senior Payment Specialist in the Public Affairs Unit of the American Physical Therapy Association. Her professional activities include serving as a member of the Centers for Medicare Technical Expert Panel for alternative payment systems, the CPT Editorial Panel, and is an APTA appointee to the NDHI Opioid Crisis Workgroup. She has been involved in bundled payment projects and exploring the alternative practice and payment model efforts focused on early and direct access

to physical therapy.

 

In this episode, you will learn all about value-based healthcare, where value-based care intersects with the biopsychosocial approach to pain. Also, how physical therapists can assess their readiness for participating in an alternative payment model and how physical therapists can play a more central role in addressing pain in the US healthcare system. Without further ado, let's begin and let's learn about values-based healthcare with Dr. Alice Bell.

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Dec 29, 2021

In this episode, we are discussing how to use functional nutrition to treat and alleviate chronic musculoskeletal pain. My guest is Aparna Natarajan. She is a Certified Nutrition Specialist with a Master's degree in Nutrition and Functional Medicine. She is a clinician, a researcher, and an educationist who has contributed to the Institute for Functional Medicine's Meal Planning Program as a subject matter expert. She's cultivated an understanding of the mind-body connection and combines both the science, as well as the art of nutrition, Reiki, and emotional freedom technique.

 

We will discuss the importance of nutrition and overcoming chronic pain, as well as the benefits of an elimination diet for those living with chronic pain. If you enjoy this episode, make sure to stay tuned because I have a perspective paper that is being published in PTJ, the Journal of Physical Therapy, on the topic of nutrition and chronic pain, specifically for the physical therapy professional, though it relates to other professions as well.

 

That's moving through the peer-review process. For those of you that have published before, as you know, sometimes that can be a bit of a slow process but it will be out, rest assured, hopefully, sometime in early 2022. For now, let's begin and meet Aparna and learn about the importance of nutrition for chronic pain.

 

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Dec 22, 2021

Welcome back. We're discussing how to beat cancer holistically with Chris Wark. Chris is a cancer survivor, a best-selling author, and a patient advocate. He was diagnosed with Stage 3 colon cancer at the age of 26. After surgery, Chris made the decision to go against his doctor's advice, opted out of chemotherapy, and chose to use nutrition as well as other natural therapies to heal.

Chris has become one of the most well-known cancer survivors on the planet and reaches millions of people per year as a blogger, podcaster, speaker, as well as a global health coach. In this episode, we'll discuss how to beat cancer primarily by using nutrition and other lifestyle-based interventions. Without further ado, let's begin and let's meet Chris Wark.

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Dec 15, 2021

In this episode, we're talking about pain education and specifically asking the question, "What do patients value learning about pain?" Our expert guest is physiotherapist and pain researcher Hayley Leake. After working clinically for six years, Hayley embarked on a PhD mission at the University of South Australia with Professor Lorimer Moseley's research group. Her research aims to optimize pain education for adolescents and adults living with chronic pain.

Pain education is a popular treatment approach for treating persistent pain that involves learning a variety of concepts related to pain and is thought to be an important part of recovery. In this episode, we discussed targeted concepts and themes that seem to be the most important of value to those living with chronic pain when delivering a pain education intervention. Without further ado, let's begin and meet Physiotherapist and Pain Researcher, Hayley Leake.

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Dec 8, 2021

We have an important episode. We're discussing the association between chronic pain and suicide. The information you'll learn in this episode may help you screen for the risk of suicide more effectively. It may help you effectively treat suicide, and by learning and sharing this information, you may save a life. According to the American Foundation for Suicide Prevention, suicide is the tenth leading cause of death in the United States.

In 2019, approximately 48,000 Americans died by suicide. In that same year, there were an estimated 1.4 million suicide attempts. Chronic pain is a risk factor for suicide, and research indicates that chronic pain is present in about 10% of those who die by suicide. It's important as licensed healthcare professionals and loved ones of those who live with chronic pain that we learn how to ask the right questions, assess for risk factors, and intervene to help prevent suicide rates.

In a few moments, you'll meet Clinical Psychologist, Dr. Joan Rosenberg, who has conducted research in the field of suicide, as well as treated patients in her clinical practice. Before we begin, I wanted to provide you with some information to effectively ask, assess, and intervene in those you feel may be at risk for suicide, especially those who live with chronic pain. First, I'd like to provide you with a shortlist of factors that may increase the risk of suicidal behavior among people living with chronic pain.

If you're a healthcare professional, these might surprise you because we see common risk factors almost every day when we treat people with chronic pain. The first one is insomnia. Insomnia is common among people living with pain and also associated with an increased risk of suicide. The next is an over-reliance on passive coping strategies when you recognize or observe that someone is hoping their pain will go away from these passive coping strategies, increasing their risk of suicide.

The next is pain catastrophizing, a topic we've talked about in-depth on this show. All of us are well aware of the catastrophizing pain scale, and there are also other scales and self-report measures that identify catastrophizing. It's very important that we include that in our initial paperwork. The next is prescription pain medication access when other factors are present.

We're talking mostly about opioids here. It's not just if someone is taking opioids. There have to be several other factors. The factors that you learned about now present. As we're talking about prescription medication, always be on the lookout for what they call the triple threat, which is opioid, anti-anxiety medication, and alcohol use disorders. Those three together, people oftentimes overdose as well as an increased risk factor for suicidality.

There are specific pain diagnoses that have been associated with an increased risk, specifically chronic lower back pain. The diagnosis of psychogenic pain, which is medically unexplained pain or medically explained physical symptoms as well as migraine, those three, chronic lower back pain, psychogenic pain, and migraines.

Feelings of helplessness or hopelessness, individuals who will feel that they can do nothing to change or impact their pain and believe that positive outcomes are not possible for them may be at an increased risk for suicide, and then finally isolation or perceived burdensomeness. Oftentimes these go together. If you recognize or identify distressed and interpersonal relationships where someone feels like they are a burden to others or express feelings of not belonging, these are associated with an increased risk of suicide.

Suicide can look and sound a lot like depression. It's important that we screen for depression. We all know that depression rates are high in those living with pain. There's a simple way that you can screen for depression in your clinical practice, no matter what type of health professional you are. That's with the PHQ-9, Patient Health Questionnaire-9. It's readily available online if you google Patient Health Questionnaire-9.

This is a multipurpose instrument for screening, diagnosing, monitoring, and measuring the severity of depression. It includes nine questions. What's great about this is not only does it screen for depression but question number nine is a single screening question on suicide risk. A patient who answers yes to question nine needs further assessment for suicide risk by an individual who is competent to assess this risk that may or may not be you. Hopefully, by the end of this episode, you will realize that screening for suicide is possible.

What I also like about the PHQ-9 is it gives you a couple of different cutoff points for mild, moderate, moderately severe, and severe depression. With those cutoff points, it recommends proposed treatment action for each cutoff point. It's Patient Health Questionnaire-9, super simple, nine questions to screen for depression. Question number nine is specifically for suicide risk.

With some of that background information, let's bring in our expert guest, Dr. Joan Rosenberg. Dr. Rosenberg is a cutting-edge psychologist known globally as an innovator in the field of mental health. She is a two-time TEDx speaker and serves as a blogger for Psychology Today and has been a featured expert in multiple documentaries on television and radio.

As a licensed psychologist, Dr. Rosenberg speaks on how to build emotional strength and resilience, psychotherapy, and suicide prevention. She's a Professor of Psychology at Pepperdine University in Los Angeles, California, as well as maintains an active clinical practice. This episode aims to create a roadmap or a blueprint for assessing and intervening with suicide. Without further ado, let's begin and learn about this important topic and meet Dr. Joan Rosenberg.

 

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