Visit 2: Integrative Medicine & Mind - Body Practices for the Management of Fibromylagia

Top Down Strategies

Transcript

1. Integrative Medicine & Mind - Body Practices for the Management of Fibromyalgia 2nd Group Visit Top Down Strategies 3 group medical visit series presented by Integrative Medicine Specialist Marc Fierro, PA-C, L.Ac., Frank Russell MFT, Lauren McDaniel CNC, FMHC and Kimberly Defazio LVN, FMHC, at the Sutter Institute for Health and Healing
2. Welcome back! • Today’s class is the 2nd in the series. • In today’s group visit, the participants will have the opportunity to share how much they were able to implement the therapeutic recommendations from the initial group visit and assess how it is affecting their quality of life. • Today’s topics will include teaching how to implement the approaches from the categories of: • Top Down: including • Discussion on pain management with Cognitive Behavioral Therapy presented by Frank Russell, MFT. • Experiential Mindfulness based Cognitive Behavioral Therapy exercises for pain management • Additional Tai Chi – Qi Gong exercises will be taught today. • HeartMath Biofeedback discussion and demonstration with health coaches Kim and Lauren. • Management of Brain Fog and Sleep deprivation. • Discuss the # 1 Cognitive Behavioral Sleep Therapy.
3. Quick summary review of last group visit Tri flex approach to the management of Fibromyalgia. • 4 therapeutic directions organizes the 5’ R’s and 7 Seeds into a workable action plan, especially if you do ONE SMALL item from each group. • Top Down – Sleep, stress, and emotional regulation management techniques, MBCBT, journaling, counseling, cognitive training programs, biofeedback, meditation, observing nature, socializing, engaging in joyful activities. • Bottom Up – We all have 2 hearts, 1 in the chest and the 2nd is the entire body! Move daily any way you can. PACED, short interval graduated exercise, aquatic therapy, recumbent biking or pedal device, especially if dysautonomia w/ low BP, modified Yoga, Tai Chi, Qi Gong . It is okay to take a short nap before you exercise and afterwards if needed. • Inside Out – Diet, nutritional supplements, prebiotics, probiotics, herbs, essential oils, cannabinoids, low dose Naltrexone, Psilocybin and medications Lyrica, Gabapentin, Amitriptyline, Cymbalta, Savella and Ketamine. New research on Mestinon for post exertional fatigue at Brigham Young University and Harvard. • Outside In – Neurostim, laser, red light, sauna, acupuncture, massage, somatic therapy, craniosacral, osteopathy, chiropractic, injections, surgeries. • Bundled Activities – Listen to music while dancing, walking outside, Tai Chi, Yoga, Qi Gong and more exercises that use all the directions by design. Exercise with friends and pets. Participating in support groups and volunteering.
4. Patient check in: Patient check-in time! How have you been doing since last class? Please feel free to tell us what you have tried to incorporate from the Tri-Flex Lifestyle Changes into your self-care program since we met last. Please limit your comments to 2 minutes or less so everyone has a chance to share if they would like. Please raise your hand to speak or leave comments in chat. Thank you!
5. Sharing group wisdom and progress, 2nd group visit check in topics • TRI-FLEX CHECK IN: Which activities from the 4 therapeutic Directions, 7 S. E. E. D. S. and 5 R’s did you choose since the initial group visit? • Did you start or plan on seeing the health coach? • Did you start the Happiness Trap and practice with the Mindfulness Coaching program app? • Did you start reading the TIGER protocol book? • What has been the impact on your health and well-being since doing those activities?
6. Common Pain Misconceptions 1. If you cannot find the exact cause of your pain, then it must be in your head. 2. Chronic pain isn’t that bad because you get used to it after a while. 3. If you take opiates, you must be or will be an addict. 4. Chronic pain is forever. 5. Living with chronic pain eliminates the possibility of a fulfilling life.
7. Common Pain Myths and Misconceptions 6. Chronic pain is an inevitable part of growing older. 7. The best treatment for chronic pain is bed rest. 8. Weather has no impact on “real” pain. 9. Alternative treatments are ineffective. 10. If a person has “real” physical pain, then psychological treatment is not needed.
8. Behavioral Approaches • Acceptance and Commitment Therapy (ACT) • Cognitive Behavioral Therapy • Hypnosis • Mindfulness Meditation • Mindfulness-based Pain Management
9. Chronic pain • Biochemical • Psychological • Treatment needs to address • How we think about it • How we feel about it
10. Transition from Acute to Chronic Pain • Our perception of pain • Our fear of pain • MRI does not help us figure out what hurts and what doesn’t • Study: • 5% of MRIs for backpain were appropriate • 65% resulted in potentially harmful advice
11. Reasons Why Pain Becomes Persistent • Those who fear pain or are anxious about it are twice as likely to develop chronic pain • After spinal surgery • 26% returned to work • Versus 67% who didn’t • Small study: • The strongest predictors of back pain turning chronic • Are past traumatic events: being robbed, bullied or sexually assaulted
15. Recent Clinical Trial • JAMA: Psychiatry, Asher and Wager • Three conditions: • Usual care • Pain medications • Physical therapy • Placebo • Pain reprocessing therapy (twice weekly for a month) • Results (pain-free for one year): • Pain reprocessing therapy – 52% • Placebo – 27% • Usual care – 16%
16. Coping 1. Soften yourself to pain rather than fighting it. 2. Find the gray areas rather than thinking in ‘black or white’. 3. Try using the natural breath: slowly breathe in for 5 seconds and then slowly breathe out for 5 seconds.
17. Coping 4. Try moving your attention back onto the things you need to do. 5. Ease back into doing the things pain pushed out of your life. 6. Set small goals that you can achieve now: TODAY is important.
18. Coping 7. Enjoy the small things – set goals. 8. The slower you go the faster you will get there. 9. Setting goals for today is a good start. 10.You can also start to think ahead to where you will be in a few weeks or a few months.
19. Coping 11.Pushing too hard, too soon isn’t smart. 12.Be gentle with yourself. 13.Go easy and congratulate yourself on one achievement each day.
20. Coping 14.Be your own best friend. 15.Cracking the whip over yourself when you are already struggling is punishing. 16.Be gentle with yourself. 17.Go easy and try and congratulate yourself on one achievement each day
21. Tai Chi - Qi Gong Stretch Break • Cloud Hands • Small Lohan • Knee Taps • The Body Scan
22. The Progressive Muscle Relaxation and Body Scan Exercises. 1. Start with paying attention to your left foot and calf, then contract the muscles for 3-5 seconds, then relax them, then pause and pay attention to what you feel, and what you think about the area, and then thank them for supporting you. Repeat this on the right side. 2. Repeat the process on the upper left leg then upper right leg. 3. Repeat the process on the left buttock then right buttock. 4. Repeat the process on the left lower back then right lower back. You can lean to 1 side to help with the contraction. 5. Repeat the process on the left mid back then right mid back. You can draw your elbow back to 1 side to help with the contraction. 6. Repeat the process on the left upper back and neck then right upper back and neck. You can shrug your shoulder to 1 side to help with the contraction. 7. Repeat the process on the abdominal muscles. You can lean back in a chair or try to sit up when in bed just a little bit to help. 8. Repeat the process on the left hand and forearm then right hand and forearm. You can make a fist to help. 9. Repeat the process on the upper left arm then upper right arm. 10. Repeat the process on the upper left chest then upper right chest. You can press you palm into your lateral thigh to help. 11. Repeat the process on entire face contracting your eyelids, nose, and mouth. 12. Repeat the process on entire face OPENING your eyelids, nose, and mouth wide and say Ahhh. • For more energy start at the feet. To help with sleep start at the head and reverse the process but do not use any contraction paying attention to the body part. You will soon get bored and fall asleep.
23. HeartMath Biofeedback Presentation by Health Coaches
24. HeartMath Biofeedback Effect on Heart Rate Variability
25. HeartMath Devices
26. What some things I can do to manage my brain fog? • Implement external strategies and aids to keep things organized (e.g., use of an alarm, application on your smart phone, calendar, organizer, binder of important papers and checking the schedule on a regular basis). • Develop patterns and routines (e.g., placing keys and other items in the same place). • Provide prompts or cues by using checklists. • Build in additional time to process and execute tasks. • Use an alarm to assist with recalling medication doses. • Consider the use of audio books (can slow down speaking speed). • Divide large amounts of information into smaller and more manageable components if feeling easily overwhelmed with large amounts of information. • Actively listen to conversations and restate (in a different way) what you thought you heard in the conversation. •
27. Brain Fog: Software Programs for Cognitive Support and Training BrainHQ is an online headquarters for working out your brain. Think of it as a personal gym, where you exercise your memory, attention, brain speed, people skills, intelligence and navigation instead of your abs, delts, and quads. Just as our bodies require care and exercise over the course of life, so do our brains. BrainHQ provides the exercise your brain needs to be at its sharpest. Using a special algorithm, each exercise adapts in difficulty as you work so that you always train at the optimum level for you— where you are most likely to improve your performance.
28. The # 1 Sleep Remedy: The Reverse Curfew Sleep compression therapy: Is the most effective therapy for managing sleep disruption and is much better than medicine. Here are the steps: 1. Determine your allowed time in bed (sleep efficiency). Time in bed equals the average total sleep time plus 30 minutes. Use the Free CBT – I app from the Veteran’s Administration to help you track your actual sleep vs time in bed. 2. Set a wake time: Wake up at the same time every morning no matter how much sleep you got the night before. 3. Set a bedtime: Your bedtime is determined by counting back from your wake time, which is the amount of time in bed your allowed listed in Step 1.[ Basically you're going to stay up much later than normal intially.] 4. Stick to the sleep schedule as closely as possible for at least 2 weeks. If you get tired, you can add 15 minutes to your time in bed every week until you sleep better and have more energy the following day. (Start with a minimum of at least 5.5 hours or more to avoid effects of sleep deprivation). 5. Use bright light in the morning and dim in the evenings. Get a UV therapy light if needed for morning. 6. Avoid napping to enhance sleep drive. 7. Practice “Worry Dumping” by writing down all your worries and then write down the 1st step in a possible solution to each one earlier in the evening or day so you can let go and teach brain the time for worrying is before bed not at bedtime. 8. Practice good sleep hygiene in a dark, cool, and quiet room. Get out of bed if you cannot get to sleep within half an hour. If you wake up in the middle of the night you can do a quiet activity, and when you feel tired go back to bed. The body scan/ progressive muscle exercise is also useful in this situation.
29. Second group therapeutic recommendations • TOP DOWN: • 4 Pro Social Attitudes + 5 N Technique + the Serenity Prayer. • Pro Social Attitudes - Treat yourself with Kindness, Compassion, Equanimity in the form of Acceptance, and Joy. • 5N - Notice it, Name it, Normalize it, Nurture self, Now take action and do something useful or helpful for yourself and/or others. • Recognize what you can control and act on it, and things you can’t control recognize that you still can respond in a way that is consistent with your best self. • HeartMath Biofeed Back with health coach. • Use Brain Fog management tips as discussed. • Trial of Sleep Restriction CBT-I therapy if needed. • Brain HQ Cognitive support program. • Progressive Muscle exercise and Tai Chi – Qi Gong.
30. Next Class Topics: • Bottom Up • We will discuss how to incorporate more activity into your life at your pace. • Will work on learning and managing boom and bust phenomena. • Will learn how to pace and use horizontal position activities to prevent post exertional malaise. • Will learn to prevent deconditioning and increase energy with activity • Will learn more extensive Tai Chi and Qi Gong movements
31. 2nd group class question and answers.
32. Fibromyalgia Resources • Arthritis Foundation • American College of Rheumatology • National Fibromyalgia Association • Fibromyalgia on MedicineNet • Fibromyalgia on eMedicineHealth
33. Program support literature, and software apps are highly recommended for long- term success. Aim to read 3 chapters a week of the books and 3 minutes a day on the apps.
34. End of second class. Thank you for your participation!