Hi, this is James Fricton, and I'm back for part C, of the course on prevention of chronic pain, a human systems approach. And I'm presenting again, from the University of Minnesota. And the part A, we discussed, the dilemma of chronic pain, and some of the problems we've see with this. With regard to our healthcare system, and the impact it has personally on us. In addition I discuss some of the paradigm shifts, that are really needed to address the full scope of chronic pain problems. In part B then, we discuss some of the mechanisms associated with chronic pain. Particularly the disorders that are common with chronic pain. we, we also went in to some of the detail mechanisms with regard to the central and peripheral sensitization some of the genetic characteristics of these of patients with chronic pain. And so I know it was complex but we did want to show you that there's a significant amount of research going on that I think is going to, to really improve the situation and understanding of chronic pain to the future. So this series of modules has really about preventing pain in the sub around our daily life. And as I discussed in part a in the third module there are three basic principles of human systems. Number one is holistic complexity. The whole is greater than the sum of the parts. And then there's chaos theory which we discussed how small change occurring on a daily basis can have a big impact down the line. And the third one that we'll discuss today is really about cybernetics and what comes around goes around and this is about positive and negative feedback cycles or recursive cycles that cause pain conditions as well as many other chronic illnesses to continue over time. So cybernetics really means that each element of a system generates a change which causes feedback to the system, as shown in this cartoon. So, as you can see, this Gahan Wilson cartoon, the risk and protective factors of this gentleman here. He's, he is frustrated. He says, dear [UNKNOWN] I am unhappy with your, and his typewriter is not working exactly. It's burning up. Its light is not working. The wallpaper, the clock, everything in his life is, is not working the way he would expect it to, and as a result of that that reaction is really his tilting of his shoulders, clenching of his teeth, clenching of his fist. And this in general if you did this over time is going to develop into a chronic pain syndrome. So it's like this cartoon. cybernetics, is once you start a cycle it just continues on like the domino effect, and eventually will come back to, hit you. So some people say it's karma, to me it's a cybernetic cycle that's occurring. So we need to understand the fact that much of our science is based on, this linear causality. Where there's a cause, like a bacteria, that causes an infection, and it results in an effect. Whereas most of chronic pain and much of chronic illness, is really much more of a circular causality. In this case there is a cause say muscle tension or muscle strain or injury this results in effect, pain, while the effect of pain causes more muscle tension. And that continues in, so to a circular causality. And it's really about which comes first, the chicken or the egg. And in this case they are both simultaneously occurring at the same time. There is no chicken or no egg. And with regard to the factors that contribute to the development of chronic pain, as I mentioned, I've showed this slide several times before. It's really all about balance. We need to make sure within these cycles that are set up in our lives. How to enhance those protected factors that, that decrease the cycle, that, that do not provide kind of, a positive reinforcement of a chronic pain cycle, at the same time as we need to work on reducing those risk factors, to decelerate the cycle that's going on. And we'll discuss, within this introduction, a few of those cycles. But first let's talk and just review again the seven realms of our lives, because what the next series of modules is going to be about discussing each one of these seven realms. The body and the physical and physiologic aspects of the body. The lifestyle realm, which is about the behaviors and action we do regularly, like diet and sleep and pacing and daily activities. The emotions that we have like anxiety depression or happiness and contentment the personal expression or the feelings we experience. And then the people around us the society we have both family colleagues personal friends as well as the communities that we live in. And the next three rounds is the spirit which is about really these higher level concepts that are about our purpose in life why do we get out of bed everyday. The beliefs that we have and hopes and faith that we hold dear. And then the mind is important also those, those are the daily thoughts and attitudes that we have about our life, about people around us, about understanding, and expectations, and resilience has a lot to do with that. And then the environment also plays a significant ef, effect. And we'll talk about what are the risk and protective factors in the environment, as well as each of the other seven realms. And then we'll talk about some of the strategies that can be used both to enhance the protective factors and reduce the risk factors. And ultimately it will decelerate any positive feedback cycles that are causing the chronic pain to continue over time. In these seven realms its important to understand that there is a functional relationship within each of the realms, and this figure kind of identifies and illustrates the fact that most of us have, you know our body in mind and, and spirit. I mean that's kind of the essence of ourselves. And we live in a social environment of people around us. As well as a physical, or natural environment around us. And the communication between these is often done through either lifestyle factors like, we're bringing diet or we sleep, or we communicate and talk with others, or emotionals. Emotion is a form of communication. It tells us what happening in the environment around us and how it impacts us personally, emotionally. And so each of these realms are very important, and because of this inter relationship you cannot take out one realm of our lives, and just analysis it by itself you have to analysis all the realms in a interconnected way. So chronic pain then cycles our recursive there are there are either positive or negative feedback cycles. And they involve each of the components within a circular pattern, the physical diagnosis and pain symptoms we have the cognitive behavioral and spiritual emotional patterns that we have to react to it or contribute to it. This impacts our social and physical environment. There are also genetic contributions that Doctor Maxner talked about and some predispositions that we have to illnesses. But each of these are part of this cycle that continues on and on. So let's examine, just to give you an idea of some of the individual cycles that I see within my practice. As well as have been studied in the literature. Like for instance poor sleep is a good example. These occur often in cycles for instance a disrupted sleep pattern, when you wake up you're fatigued you're tense you, you don't feel the same energy that normally would have if you had a good night sleep. Well this increased day tension and decreases coping ability. Often we compensate for this by drinking caffeine or doing things that would give us more alertness, but that will cause or contribute to more pain and stress of course results from your fatigue and this disrupts sleep even more. Which increases fatigue, and this cycle just continues on, and on. And there's a lot of other factors, like I mentioned caffeine, that can play a role in this also. So, what about emotional factors? Like for instance, depression, and pain are very tied in to these cybernetic cycles. Depression and anxiety contributes to poor sleep. You wake up, it's hard to, you wake up multiple times or it's hard to get to sleep, you wake up early you think about things in your life. It decreases your ability to cope, contributes then to inactivity during the day and more tensing. Some people compensate by using chemicals, alcohol is one but this increase these, these characteristics increase the central and profosensitization increases pain, people often catastrophize or think the you know the world is against them that things are just not going well. What else is going to happen and this will result in more depression anxiety which will continue this cycle over time. What about fear? Fear is something that also plays a significant role in pain. When you have pain, you have a fear of, of further injury, particularly with movement. It will hurt more if I do things. If I exercise it'll hurt more, it's better to just rest it, this is a common thought rest it, and not do activity, don't do anything that aggravates it. Well this less movement and inactivity associated with it will cause conditioning and disuse of the muscles well the muscles don't respond very well. And they are actually have more pain then particularly at rest as well as in movement, so with more pain then there's more fear reinforces the fact that oh what I did was wrong I shouldn't be exercising. I shouldn't be doing the things that are aggravating it. So we, we need to look at how fear plays a role in this cycle of continued chronic pain. Now there's other factors too such as being overweight. Overweight excessive, frequent or poor quality diet will lead to gradual increase of in overweight, or obesity. Which increased weight on the muscles and joints and also contributes to more inactivity. This does result in more pain and, and many situations poor body image sometimes depression in some situations, and, and this will lead to often of a poor diet or more increase in in the quality or in the poor quality of the diet. So this cycle continues often it's hard to really break out of that particular cycle. Now there's also cycles associated with social re, realms of our lives like secondary gain. Secondary gain is when you're gaining something from having pain other, other than the relief, and so here a person is injured and a victim has significant pain associated with that injury say for instance at work. Well, if you're injured at work typically you shouldn't go back to your usual job that you've had right away. You may be able to avoid dealing with conflicts, you may miss work, you obtain medications that will help give you relief, help you feel better. You avoid unpleasant tasks. Well all of these provide some secondary gain, and disability is a very common one. Particularly if you don't like your job. Well then others do the work, they avoi, you avoid conflict, get on disability, it's a definitely an easier life. Even though you're having pain, but the pain becomes really important to the life in order to maintain this new life of being on disability or, or having a slightly easier life. And so this continues on and reinforces the fact that you need to have the pain, in order to continue this change that you've had in your lifestyle. So these are just some of the examples of pain cycles that occur and they it's important to realize that these do occur on a short term basis as well as long term basis so short term cycles. Include worry, anxiety, muscle tension, protective posturing, musculoskeletal strain, the pain, poor sleep, diet, exercise, stress. And this cycle just continues on for days, sometimes weeks early on. Well if the pain continues, and particularly if there is not some resolution or improvement of the pain with treatment or self management this will contribute to poor understanding, unrealistic expectations. Doctor shopping, sometimes unsuccessful treatments, secondary gain, catastrophizing, feeling a helpless, hopeless, in your ability to reduce the pain. And often, a depression can result, which causes this long term cycle to continue over time. So, but the cycles are not always negative cycles. I think it's important to realize that there, when you put effort into reversing the negative cycles, you can create some positive feedback cycles which allow recovery. For instance, social support improves recovery significantly. So a person is injured, and has pain, and they have a change in activity, school, and work. Well, what social support does is help that person support recovery activities. Whether it's encourage exercise, changing and improving lifestyles, trying to identify those factors that are feeding the negative cycle. And creating new routines that are healthier that do not necessarily include reinforcing your aggravated the chronic pain. Same thing is true about helping others. So for instance, a helper assists others directly to overcome a problem, say, a chronic pain problem. Well the recipient directly benefits from that help they they appreciate the help that they receive from the the helper. And the helper generally feels good there's kind of the concept called the helper's high that I'll discuss under the social realm. The recipient shows appreciation and offers often to help others, so it's a reciprocal relationship. And feeds a positive feedback cycle of helping each other, and I think that the participants in this course on, on preventing chronic pain is a good example of people helping each other in order to identify problems and overcome, chronic pain conditions. So this cycle can be short-term as well as long term. The positive cycle. So, you can find purpose and focus on specific tasks. And you can relax the muscles, work on balance posture. Less muscle strain, less pain, good sleep, exercise, dealing with the stress and these cycles are short term can result in a lot better positive cycles. Good understanding and realistic expectations, successful treatment, feeling optimistic and improved coping skills and resilience, self efficacies, feeling hopeful, and happy and confident. And this cycle continues on over time. And the real kicker with, you need to take home with regard to the messages. Is the fact that all of what we do has an impact on the people around us in the environment. And these cycles can, we need to set them up in a positive first for ourselves. So our energy, our positive energy impacts the world. And the people around us. So, when we have health, wellness, positive energy in each of the realms, this really makes a pos, has a positive influence on the people around us directly. The more positive you are, the more people around us are going to be positive. The more family, positive influence on family, friends, and colleagues. And this will also then help us make positive decisions about our environment, our work, our world around, and have a positive impact on the environment. So this and that of course that's going to support more wellness and health and positive energy. So, this positive cycle is something we have to realize that whether we want to or not we impact. The people and the environment around us. So, in conclusion I just think that we need to recognize these cycles and support making positive impacts on the world. So, thank you very much, and I hope you enjoy the next seven modules. [BLANK_AUDIO]
