DR HEATHER
POUPORE-KING: I'm going
to be talking about pain
management as a team sport
today.
So we heard this
morning from Dr. Mackey
about the Institute of Medicine
report and the national pain
strategy.
And the takeaway message
from both of those reports
was that we need more
integrated, interdisciplinary,
patient-centered care.
So I wanted to spend
a little bit of time
this morning sort of
defining what that means.
So think of interdisciplinary
care as being a team approach.
So that would mean that you
would have multiple clinicians,
including your pain physician,
a pain psychologist, and also
physical therapy.
And to have an
interdisciplinary team,
you need to have them all
located under the same roof,
but also they need to be openly
communicating with each other
and with you.
So multi-disciplinary
care would be
if you had all of
these providers,
but they were
working separately.
They weren't communicating with
each other about the treatment
plan, or maybe you would just
have a uni-modal approach,
which would be, maybe you
just have a physician or just
a physical therapist.
Now, the best evidence that
we have for chronic back pain
treatment is taking this
interdisciplinary approach.
So it's important that you have
all of the clinicians talking,
sharing the treatment
plan, and then
most importantly, as you'll see
with the picture up top, that
the circle, with
you, the patient,
in the middle
that's the largest,
they need to be communicating
the plan with you.
So on this treatment
team, you're the MVP.
You are the most valuable
player on your team.
Now why is that?
It's because the doctors
can make recommendations,
the physical therapist
can give you strategies
that you can use at home,
pain psychology can help you,
but really, you're
the only one that
can actually take
these suggestions
and put them into practice.
I don't know of any doctor
that can do that for you.
I know I can't do it for you.
So that really does make
you the most valuable player
on your team.
Now, how many football fans
do we have in the audience?
All right.
Those of you who don't know me,
I am a die hard football fan.
I love football.
I wait all year for it to come
back so my team can actually
make it to the Super Bowl.
They never do, but I'm waiting.
So I wanted to use
a football analogy
to describe what an
interdisciplinary approach
might look like, or what
it might not look like.
So imagine that
your medical doctor
is your coach of your team.
Pain psychology-- we get
to be the quarterback.
Physical therapy is
going to be the lineman,
and you, the patient,
you're the wide receiver.
Now, for this football analogy
regarding your back pain
treatment, imagine
that every touchdown
scored means that you're
living a full, valued,
vital, functional life.
So you want to score as many
touchdowns as possible, right?
Not just one.
Not just a fluke where you
just accidentally score it,
but you want repeated
touchdowns scored.
What do you think would happen
if you show up, it's game day,
you're ready to play,
you're ready to score
those touchdowns, and
all of a sudden you
realize that the coach never
shared the plan with you.
You don't know what the play is.
Probably decrease
the chances of you
actually scoring a
touchdown, right?
What would happen if
you're out on the field,
and all of a sudden you look and
you don't have a quarterback?
Be harder to score, right?
You really need for this
interdisciplinary team
approach, you need
everybody there,
you need everybody showing up.
You're ready to be the MVP.
You're ready to play.
But you need one more thing.
You need everybody working
from the same playbook.
So what does that playbook look
like for chronic back pain?
It would be taking a
biopsychosocial approach
for treatment.
So what does that mean?
Well, Dr. Mackey talked a little
bit about this this morning.
It means that you
take into account
all of the influences
that affect
how your brain processes pain.
So we're taking in
factors like genetics,
individual differences,
gender, we're
looking at mood
and expectations,
your thoughts about pain.
And then we're
taking into account,
you know, structural,
your spine,
your level of conditioning.
All of these factors
either turn up or turn down
the volume of pain.
So we really do need
to look at all of them.
And that's essentially
what taking
a biopsychosocial
approach means.
So what happens when you've
got all your team members,
everybody shows up to play,
you're ready as the MVP,
you're all working
from the same playbook?
Your outcomes are better.
So what does that mean for
you, the person who has pain?
It means that you've got
decreased pain severity.
That's important.
It means that you have
less pain interference.
So you can actually
be more involved
in life, your life, the
things that matter to you.
You're more likely to be
able to do those things.
You have improved function.
But then we also see
that your mood is better.
Dr. Darnell just talked
about the importance of mood.
It's not everything,
but it is one aspect
of what can amplify your pain.
So your mood is better,
your sleep is better,
and then ultimately,
what I think
is most important, your
quality of life-- it's better.
And I think that's
what people want.
They want a high
quality of life.
You want to be able to do the
things that matter to you.
So I wanted to spend a
little bit of time talking
about the incredible team that I
work with at this Stanford Pain
Management Center.
So we have our
clinical pain faculty--
that would include
our physicians,
our nurses, nurse
practitioners, and also
our physician assistant.
You're going to be hearing more
later on today regarding some
of the medical aspects
of the treatments
that we provide in our center.
And then one of the things that
makes us unique at Stanford
is that we have a pain
medicine fellowship.
So we're actually training
new doctors, or doctors,
to specialize in the
treatment of chronic pain.
So this goes back to what
Dr. Mackey was talking about,
the importance of
educating providers
on how to deliver pain
management treatment.
And then we have our
pain psychology faculty,
and that's part of what I do.
We have numerous
psychologists on staff,
and we do both
assessment, individual,
and group treatment.
And we also have our pain
psychology fellowship.
I'm the primary supervisor
for the fellowship,
so I have an opportunity
to train new psychologists
on how to treat chronic pain.
We have pain physical therapy.
You're going to be hearing from
two of our physical therapists
later on today.
And they also do
assessment, individual,
and group treatment.
And then we have our
complex case care managers.
They help to coordinate needs.
So if you're having
a difficult time
finding a treater
in your community,
they can help with the
coordination of that.
And then we have an
M.D. acupuncturist,
and then we have a strong
connection with our research
group.
And you are going
to be hearing more
about research opportunities
at the end of today's group.
So with the Stanford
team approach,
we truly are doing
interdisciplinary care,
from proper prescriptions
regarding chronic back pain,
to different procedures
that you may benefit from,
to complementary and
alternative approaches.
So we make recommendations for
over-the-counter supplements
that can help with pain.
We also have a
nutritionist, dietitian
it is our clinic in our
clinic once a month,
providing free therapy.
And I'm going to talk a little
bit about that in a second.
And then we also have
acupuncture, as I mentioned.
So individual and
group treatment,
pain psychology and physical
therapy, and then we
have something
that's really cool.
We have physical
therapy and pain
psychology teaching a group
together, which is really fun.
I teach that with Dr. Cooley,
who's going to be up next.
And then we have
self-management.
Now, for those of you who were
here at pack pain last year,
I gave a talk on
self-management.
So I just wanted to
take just a second
to explain what self-management
is, because what I've found
is that people misperceive
what this actually means.
I've had patients
say, well, does this
mean I should just suck it
up and deal with it myself?
I'm like, no, definitely
that's not what we're saying.
Self-management is you being
the MVP of your treatment team.
It means that you're taking
all the recommendations and all
the suggestions that
are made to you,
and you're putting
them into practice.
That's all self-management is.
I mean, I would argue that
you're all self-managers.
Even people who maybe are
really suffering, and their pain
has over has taken
over their lives,
they're still self managing.
They just need more tools to
self-manage more effectively.
So that brings us to
our free programs.
My mission at Stanford has been
to implement as many programs
as they will let
me to help patients
and their loved ones better
understand and cope with pain.
So in addition to the
individual treatment and groups
that I run, and the
supervision with our fellow.
I also am in charge of our
patient education and program
development.
So our first program is the
chronic pain self-management
program.
All of these are free.
Did I mention that?
They're all free.
This is a six week group
that, if you have never
been exposed to any
pain psychology,
if you haven't been exposed
to pain psychology treatment
before, this would be
a great place to start.
Because it teaches you the
basics of pain management,
and then each week you're going
to set goals for yourself.
We call that action planning.
And then when you come
back to the group,
if you ran into any trouble
reaching your goals which,
let's be honest,
we often do, then
you do problem solving and
brainstorming with your group.
So this is a peer-led group.
We also have the American
chronic pain association
that's on site once a month.
You'll notice when you
registered this morning
that there's a booth out there
being manned by James Wile.
He is the facilitator
of the ACPA group
that we have on site,
along with Suellen Johnson.
And these are people
that have pain,
and they are
helping others learn
how to better manage their
pain, and also helping
you connect with resources.
So the website is www.vacpa.org.
Excellent information.
So many resources for people who
have pain and their loved ones.
We also have the pain science
education and family support.
Started that this year.
I think this is such an
exciting addition to our clinic,
because the pain
science education is
a 30 minute lecture by one
of our medical fellows, oK
and then it's followed by
a family support group.
So this group was
really designed
for loved ones and family
members of our patients
that have chronic back pain.
I kept hearing from patients
that, the people in my life,
they just don't understand
why I still have pain.
And they keep recommending
like, have you done yoga?
Have you done acupuncture?
When's your pain
going to go away?
And it's frustrating.
They mean well.
Well, I'm going to
assume they mean well.
But it's frustrating.
So this group, patients
are welcome to attend.
But this group really
is geared toward helping
the people in your lives
understand chronic pain
and chronic pain
treatments, and also
how to support you and deal
with some of the frustrations
that maybe they have with
some of your limitations.
And then we have our
pain psychology class.
This is a single session
cognitive behavioral class,
offered to help you better
understand influences
like catastrophizing and
how that can amplify,
or if you control
it more effectively,
turn down the volume on pain.
And then we have our
free nutritional class.
So Heather Garza is
going to be giving
a talk later on today about
nutrition and chronic pain.
But we do have a
monthly group that you
can attend at our Stanford
Center if you're interested.
And that brings us to
our clinical groups.
So these are not free.
We have our coping skills and
our coping skills and movement
group.
Essentially, one has a movement
component, one doesn't.
It's a nine week cognitive
behavioral therapy group,
focused on learning how to
more effectively use your brain
to manage your pain.
And then the 30 minute movement
component is a very gentle,
I guess yoga-like
movements where
you're moving through different
ranges of motion at each joint,
and really building confidence
on how your body moves.
And we can modify any
of the movements-- well,
I don't do it.
Our physical therapist does it.
So it really is appropriate
for almost anyone.
And then another group
that I run in the clinic
is our acceptance and
commitment therapy group.
I see some folks in
the audience who've
taken a couple of my groups.
This is a really
exciting, new group
that has started
over the last year,
and ACT is a little
different from CBT.
So CBT focuses on
how can you-- you
know, tools where you can
control how you respond
to pain, so looking at your
thoughts under a microscope,
restructuring them,
changing them.
ACT is a little different.
Act focuses on helping
you identify what you're
most passionate about in life.
What matters to you?
At the end of your life,
what do you want your life
to have stood for?
And then it teaches
you, how can you
take your pain along with you?
And in the beginning
of the group,
that seems almost
impossible, otherwise why
would you come spend
eight, nine weeks with me?
The end of the group,
I've had people tell me
that this group is
literally life changing.
I had a patient--
we just finished up
a group-- I had a patient tell
me that, I came to this group
to learn how to better sleep.
And at the end,
it had completely
transformed my
relationship with pain,
my relationship with my wife,
my wife's response to my pain.
I mean, that's just
incredibly powerful.
And then last our movement
and restoration group.
So this is a group
that's led by Corinne
Cooley, our physical
therapist, and it
helps you to be able to get back
to doing some of the activities
that you once enjoyed.
So even though it's
a group setting,
you have an individualized plan.
She might talk more
about that in a second.
So I've talked a lot
about our clinical groups,
but as you know, we have a
whole research arm that's
doing just phenomenal work.
And you're going to be hearing
more about opportunities
to participate in some of
the research studies that
are going on later today.
So I wanted to just leave
you with a question.
How is your treatment team?
Do you have all the players?
Are they communicating
with each other?
Do you know what
the game plan is,
and do you feel like you're
the MVP of your team?
Thank you.
