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Changing the Conversation about PainOregon Pain Education Tools
Nora Stern PT MSPT Clinical Program Manager Comprehensive Pain Service Providence St Joseph Health and Services
Catriona Buist PsyD Assistant Professor Department of Anesthesiology and Perioperative Medicine and Psychiatry
Oregon Conference on Opioids and Other Drugs Pain and Addiction Treatment
Bend Oregon
May 29 2019
bull Presenters have no disclosures
Learning Objectives
Learn communication strategies to better navigate difficult conversations about pain and to redirect a treatment plan that addresses the 5 key domains of best-practice pain care
Learn about state-wide resources for pain education and treatment and apply tools to more effectively screen educate and provide care for patients with persistent pain
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication Methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx Multiple issues amp cognitive decline
Socialwork Supportive family and church retired shopkeeper
Nutrition Gained 40 lbs in last year
Substances Personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
6
Key Points
bull Pain is a multi-dimensional experience
bull All pain is real pain
bull Nociception is neither necessary nor sufficient for pain
bullPAIN ne HARM
Adapted from material from G Lorimer Moseley Understand and Explain Pain course material 2010
Redirect conversations
Away from eliminating pain
Towards
Understanding Pain
Function
Quality of life
Living a meaningful life
Self-management
Goal of Treatment is to Help the Patient Increase Life
PainPain
Life
LifeTreatment and increased self-efficacy
Pain
Life
PEG Tool (Krebs 2009)
httpswwworegonpainguidanceorgresourcesdifficult-conversations
10
11
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
bull Presenters have no disclosures
Learning Objectives
Learn communication strategies to better navigate difficult conversations about pain and to redirect a treatment plan that addresses the 5 key domains of best-practice pain care
Learn about state-wide resources for pain education and treatment and apply tools to more effectively screen educate and provide care for patients with persistent pain
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication Methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx Multiple issues amp cognitive decline
Socialwork Supportive family and church retired shopkeeper
Nutrition Gained 40 lbs in last year
Substances Personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
6
Key Points
bull Pain is a multi-dimensional experience
bull All pain is real pain
bull Nociception is neither necessary nor sufficient for pain
bullPAIN ne HARM
Adapted from material from G Lorimer Moseley Understand and Explain Pain course material 2010
Redirect conversations
Away from eliminating pain
Towards
Understanding Pain
Function
Quality of life
Living a meaningful life
Self-management
Goal of Treatment is to Help the Patient Increase Life
PainPain
Life
LifeTreatment and increased self-efficacy
Pain
Life
PEG Tool (Krebs 2009)
httpswwworegonpainguidanceorgresourcesdifficult-conversations
10
11
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Learning Objectives
Learn communication strategies to better navigate difficult conversations about pain and to redirect a treatment plan that addresses the 5 key domains of best-practice pain care
Learn about state-wide resources for pain education and treatment and apply tools to more effectively screen educate and provide care for patients with persistent pain
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication Methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx Multiple issues amp cognitive decline
Socialwork Supportive family and church retired shopkeeper
Nutrition Gained 40 lbs in last year
Substances Personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
6
Key Points
bull Pain is a multi-dimensional experience
bull All pain is real pain
bull Nociception is neither necessary nor sufficient for pain
bullPAIN ne HARM
Adapted from material from G Lorimer Moseley Understand and Explain Pain course material 2010
Redirect conversations
Away from eliminating pain
Towards
Understanding Pain
Function
Quality of life
Living a meaningful life
Self-management
Goal of Treatment is to Help the Patient Increase Life
PainPain
Life
LifeTreatment and increased self-efficacy
Pain
Life
PEG Tool (Krebs 2009)
httpswwworegonpainguidanceorgresourcesdifficult-conversations
10
11
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication Methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx Multiple issues amp cognitive decline
Socialwork Supportive family and church retired shopkeeper
Nutrition Gained 40 lbs in last year
Substances Personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
6
Key Points
bull Pain is a multi-dimensional experience
bull All pain is real pain
bull Nociception is neither necessary nor sufficient for pain
bullPAIN ne HARM
Adapted from material from G Lorimer Moseley Understand and Explain Pain course material 2010
Redirect conversations
Away from eliminating pain
Towards
Understanding Pain
Function
Quality of life
Living a meaningful life
Self-management
Goal of Treatment is to Help the Patient Increase Life
PainPain
Life
LifeTreatment and increased self-efficacy
Pain
Life
PEG Tool (Krebs 2009)
httpswwworegonpainguidanceorgresourcesdifficult-conversations
10
11
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
6
Key Points
bull Pain is a multi-dimensional experience
bull All pain is real pain
bull Nociception is neither necessary nor sufficient for pain
bullPAIN ne HARM
Adapted from material from G Lorimer Moseley Understand and Explain Pain course material 2010
Redirect conversations
Away from eliminating pain
Towards
Understanding Pain
Function
Quality of life
Living a meaningful life
Self-management
Goal of Treatment is to Help the Patient Increase Life
PainPain
Life
LifeTreatment and increased self-efficacy
Pain
Life
PEG Tool (Krebs 2009)
httpswwworegonpainguidanceorgresourcesdifficult-conversations
10
11
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Redirect conversations
Away from eliminating pain
Towards
Understanding Pain
Function
Quality of life
Living a meaningful life
Self-management
Goal of Treatment is to Help the Patient Increase Life
PainPain
Life
LifeTreatment and increased self-efficacy
Pain
Life
PEG Tool (Krebs 2009)
httpswwworegonpainguidanceorgresourcesdifficult-conversations
10
11
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Goal of Treatment is to Help the Patient Increase Life
PainPain
Life
LifeTreatment and increased self-efficacy
Pain
Life
PEG Tool (Krebs 2009)
httpswwworegonpainguidanceorgresourcesdifficult-conversations
10
11
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
PEG Tool (Krebs 2009)
httpswwworegonpainguidanceorgresourcesdifficult-conversations
10
11
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
10
11
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
11
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Prioritizing Care Key Domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
bull Key Conceptsbull Strategiesbull Resourcesbull Connecting with
your patient
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Videos written material and trackers
English Spanish Simplified Chinese Vietnamese Russian
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Clinician Guide
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Shared Decision Making Tool starts the conversation
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
httpswwworegonpainguidanceorgresourcespatient-education-toolkit
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Key domains Knowledge of pain
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Understanding Pain
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Videos
Written materialshared decision makingTools for explaining pain
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Key Domains Activity and Pacing
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Key domain Activity
bull Gradual return to activity to improve conditioning
bull Pacing ndash WORKING SMARTER NOT HARDER
bull Activity improves sleep
bull REMEMBER YOU ARE SORE BUT SAFE
bull Doing more is more important than exercising
bull Expect flare ups and learn to manage them with pacing
bull Gentle movement tai chi therapeutic yoga aquatic exercise PT OT
bull Remember MOTION IS LOTION
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Oregon Pain Guidance May 17 2018 23
httpswwwyoutubecomwatchv=hjenuiXDUZg
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Activity tools
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Key Domains Sleep
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Key Domain- Sleep
Sleep ndash wake cycle often disruptedFatigue makes pain worseRest is essential to rejuvenate and repair tissuesLearning to calm the nervous system can promote restTeach sleep hygieneAddress sleep apneaSleep log could be helpful to see patternsRefer for Cognitive Behavioral Therapy for Insomnia CBT-I (CBT-i coach)
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Sleep Tools
Video
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Focus treatment on these key domains
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Common Co-morbid Psychological Conditions w Chronic Pain
Thought Emotion Behavior
Anxiety amp PTSD ldquoI feel overwhelmedrdquoldquoI feel out of controlrdquoldquoNobody understands merdquoldquoNobody believes merdquo
Fear Withdraw from activity
Depression ldquoLast time I went to the park I had a flare up I canrsquot do anything I enjoyrdquoldquoI feel guilty I canrsquot contribute to my familyrdquoldquoI feel worthlessrdquo
Grief Guilt
Withdraw from activity
Grief amp Loss of Identity
ldquoIrsquove always hard to be the best ___rdquoldquoWho am I nowrdquoldquoMy daughter has to help me wash my hair and shave my legsrdquoldquoI use to be the provider for the familyrdquoldquoIrsquove lost my sense of independencerdquo
ShameGrief
Withdraw from activity
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Our goal is to help people get their life backhellip
Their Shrinking Worldhellip
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Mood ndash Key Domain
bull Depression anxiety PTSD history of trauma
complex grief isolation and stress can impact pain
bull The brain interprets chronic pain as a chronic stressor and actives the bodyrsquos stress response
bull The release of cortisol and pro-inflammatory cytokines can affect tissue regeneration immune function and metabolic controls which can increase pain
bull Decreasing pleasurable activities increases the focus on pain
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
YOUR WORDS MATTER Negative thoughts about pain can lead to maladaptive coping and increased suffering and disability
Thought ldquoI have DDDrdquo ldquoMy back is crumblingrdquo
Emotion fear
Behavior seek additional medical treatment
Idea change wording from ldquoDDDrdquo to ldquonormal age related changesrdquo
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
NeuroplasticityThe ability of the brain to form and reorganize synaptic connections especially in response to learning or experience or following injury
Remember
THE NERVES THAT FIRE TOGETHER WIRE TOGETHER
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Calming the Nervous System
bullDiaphragmatic breathingbullMindfulness trainingbullProgressive muscle relaxationbullVisualizationbull Self-hypnosisbullBiofeedbackbull Sleep bullMovement (tai chi yoga)bullApps Calmcom Headspacecom Insighttimercom
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Mood Tools
Video
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Key domains Nutrition
Knowledge of pain
Nutrition
Activity
Sleep
Mood
KEYDOMAINS
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Nutrition ndash Key Domain
bull What we eat can throw fuel on the pain affect energy level amp make us feel worse
bull Explore knowledge of healthy eating and cooking
bull Understand barriers to eating healthier
bull Dietary log can be helpful
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Nutrition Tools
Video
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Medication Tools
Video
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
63 yo female with fibromyalgia 20 years
Medical Hx Complex history
Pain Presentation Pain in multiple sites including knees and low back pain all over moves around worse with stress and cold weather
Medication methadone and benzodiazepine
Sleep Poor sleep untreated sleep apnea
Physicalfunction Generally deconditioned afraid to move because of pain
Mental health hx multiple issues amp cognitive decline
Socialwork supportive family and church retired shopkeeper
Nutrition gained 40 lbs in last year
Substances personal and family hx of alcohol and substance abuseFictional patient stock photo 2019
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Shared Decision Making Tool starts the conversation
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Questions
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
References Oregon State Pain Commission
Butler David The Sensitive Nervous System Noigroup Publications Australia (2000) p 75 78 88 35
Butler David Moseley Lorimer Explain Pain Noigroup Publications Australia (2003)
Chou R et al rdquoPrevention and treatment of low back pain evidence challenges and promising directionsrdquo Lancet Low Back Pain Series Working Group (2018) The Lancet 391(10137) 2368-2383
Chou R et al rdquoNoninvasive Nonpharmacological Treatment for Chronic Pain A Systematic Reviewrdquo AHRQ Skelly AC June 2018
Institute of Medicine National Academies ldquoRelieving Pain in Americardquo National Academies Press Washington DC 2011
Louw Adrian et al Preoperative pain neuroscience education for lumbar radiciplpathyrdquo Spine Vol 39 2014
Louw A Diener I Butler DS Puentedura EJ ldquoThe effect of neuroscience education on pain disability anxiety and stress in chronic musculoskeletal painrdquo Arch Phys Med Rehabil 2011 Dec92(12)2041-56
Meeus Mira PhD et al ldquoPain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education A Double-Blind Randomized Controlled Trialrdquo Arch Phys Med Rehabil Vol 91 August 2010
Moseley GL ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology education MRI evaluation of a single patient with chronic low back pain ldquo Australian Journal of Physiotherapy 51 49-52]
Moseley GL ldquoA Pain Neuromatrix Approach to Patients with Chronic Painrdquo Manual Therapy 20038(3) 130-140
Moseley G Lorimer PhD Nicholas Michael K Ph D and Hodges Paul W PhD ldquoA randomized controlled trial of intensive neurophysiology education in chronic low back painrdquo Clinical Journal on Pain Vol 20 p 324-330 2004
Moseley G Lorimer PhD ldquoWidespread brain activity during an abdominal task markedly reduced after pain physiology educationfMRI evaluation of a single patient with chronic low back painrdquo Australian Journal of Physiotherapy 2005 Vol 51 49
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
bull Physicians
bull Physician Assistants
bull Nursing
bull Acupuncture
bull Psychologists
bull Physical therapists
bull Occupational therapists
bull Chiropractic physicians
bull Naturopathic physicians
bull Pharmacists
bull Dentists
Required Pain Management Education
wwworegonpainmoduleorg
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
The Oregon Pain Website httpswwworegonpainguidanceorg
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
RELIEF+Improving pain management and opioid safety for older adults (55+)
bull Target primary care providers clinic staff pain specialists and behavioral health specialists
bull Program web-based printable resources and online training
50httpshealthinsightorgrelief-plus
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Pain and Opioids amp Addiction ECHO httpswwworegonechonetworkorg
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Lorimer MoseleymdashTame The BeastmdashIts time to rethink persistent pain
httpsyoutubeikUzvSph7Z4
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Motivational Interviewing for Healthcare Professionals -Online EducationCollege of Nursing at the
University of Coloradohttpwwwucdenvereduacademicscollegesnursingprograms-admissionsCE-PDPagesMotivational-Interviewing-for-Healthcare-Professionalsaspx
The Efficacy of Motivational Interviewing in Adults with Chronic Pain A Meta-Analysis and Systematic ReviewDion Alperstein amp Louise Sharpe The Journal of Pain Vol 17 No 4 (April) 2016 pp 393-403ldquoMI significantly increased adherence to chronic pain treatment in the short termhelliprdquo
Motivational Interviewing resources (Miller and Rollnick 2009)
Motivational Interviewing Network
httpsmotivationalinterviewingorg
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
Understanding Pain and Whatto Do About Itin Less than5 Minutes
Joint Pain Education Project video from the Department of Defense and Veterans Health Administration to learn more about chronic pain management
httpswwwyoutubecomwatchv=cLWntMDgFcs
