In this episode 49 protocols
▶ 16:06 Biofeedback Behaviors “And what we're finding is that there does seem to be this conserved region, set of distributed regions that do represent the experience of pain. So when somebody takes a so-called painkiller, let's take a typical over-the-counter painkiller, like ibuprofen or acetaminophen to lessen pain of some kind.” ▷ 19:14 NSAIDs for Pain That Impairs Normal Functioning Supplements “I think the threshold is when it's impacting your quality of life and your ability to take care of the activities of daily living, engage with family, friends, go to work.” ▷ 22:43 Get Medical Attention for Acute Injury Behaviors “Get medical attention if you've got an acute injury.” ▷ 26:45 Rotate NSAID Types to Find What Works Best Behaviors “So there's value in rotating them and finding out which works best for your particular situation.” ▷ 26:54 Ibuprofen Supplements “So ibuprofen is typically given no more than three times a day. It's got a short half-life... make sure that you have food in your stomach. Make sure you're not taking it on an empty stomach. Make sure you're drinking plenty of fluids.” ▷ 27:01 Naproxen Supplements “Naproxen, twice a day. What's critical, I need to give this message, is in both situations, make sure that you have food in your stomach. Make sure you're not taking it on an empty stomach. Make sure you're drinking plenty of fluids.” ▷ 27:03 Take NSAIDs With Food Behaviors “What's critical, I need to give this message, is in both situations, make sure that you have food in your stomach. Make sure you're not taking it on an empty stomach.” ▷ 27:12 Drink Plenty of Fluids With NSAIDs Behaviors “Make sure you're drinking plenty of fluids.” ▷ 27:14 Consult a Clinician Before NSAID Use if You Have GI, Bleeding, Kidney, or Heart Issues Behaviors “And if you've got any GI issues, if you've got any bleeding issues, if you've got kidney issues, if you've got heart issues, talk to your doc. Talk to your clinician before you embark on this because these medications do have side effects and adverse consequences in vulnerable people.” ▷ 28:04 Baby Aspirin Supplements “So baby aspirin, 81 milligrams a day, acts as an antiplatelet agent... I still take a baby aspirin. Every day? Yeah. I take a baby aspirin.” ▷ 28:35 Higher-Dose Aspirin Supplements “You get to the higher doses, say four times as much, up around 325 milligrams or so, it's now an anti-inflammatory. It's now acting more like the ibuprofen and the naproxen.” ▷ 31:14 Acetaminophen Supplements “Tylenol is safe on the stomach. Where you need to be careful about Tylenol is not to exceed 4,000 milligrams or four grams per day in divided doses. So two extra strength Tylenol done four times a day for many people is safe.” ▷ 31:34 Avoid Excess Acetaminophen if You Have Liver Issues or Abuse Alcohol Behaviors “The key here is around your liver. So you've got good liver function. if you're not abusing alcohol. That's a general rule of thumb that you can use for Tylenol.” ▷ 31:49 Celecoxib Supplements “There are versions of the NSAIDs that we refer to as COX-2 inhibitors. They're very selective, like celecoxib, that is less irritating on the stomach. That's by prescription only, though.” ▷ 32:17 Use Other GI-Protective Medications if NSAIDs Work but Upset Your Stomach Behaviors “If you have problems in your stomach with the NSAIDs and they're really effective for you, you can be given other types of medications that help block or reduce the GI issues associated with the NSAIDs.” ▷ 35:05 Swearing After Acute Pain Behaviors “Some people swear, and it turns out there are studies that show that swearing works. Really? Swearing reduces pain.” ▷ 35:37 Use Sensory Input to Reduce Acute Pain Behaviors “So rubbing, shaking is another one, which basically is activating those touch fibers.” ▷ 37:35 TENS Device Tools “There was the introduction of a device to take advantage of this called the TENS device. And TENS is an acronym, transcutaneous electrical neural stimulation.” ▷ 53:55 Use Heat or Cold for Acute Injury Based on Timing and Personal Response Behaviors “Traditionally, historically, we tend to think of applying cold for the first 48 hours or so after an acute injury and then heat thereafter.” ▷ 55:32 Use Cold Packs Safely Behaviors “Don't go putting an ice pack on an extremity for two hours. You'll get a frostbite.” ▷ 59:37 Movement and Exercise Behaviors “Another area is movement, exercise. Clearly changes those thresholds over time. You are probably building up some increased inhibitory tone through that process.” ▷ 1:02:39 Attentional Distraction Behaviors “So one is attentional distraction where you are distracting yourself from the thing that is causing pain. It clearly works in a lot of people.” ▷ 1:05:22 Mindfulness-Based Stress Reduction Behaviors “Mindfulness-based stress reduction has been shown effective for anxiety, for depression, for pain, just about everything. I think they should put it into all the schools. It's a great skill to learn.” ▷ 1:05:52 Cognitive Reframing of Pain Behaviors “There's a third aspect of meeting the pain, and that is more of a direct cognitive reframing about the meaning of the pain... Is that pain damaging, threatening, harmful? Or do you view it as, yeah, it hurts, but it's not harming me?” ▷ 1:11:06 Seek Medical Attention if Pain May Represent Harm Behaviors “I think that's what we first have to learn is does that pain that we're experiencing represent something that is harming us, that something that we either need to seek a medical attention now or sometime soon, and whether does continued activity worsen the tissue injury or not?” ▷ 1:20:52 Anti-Inflammatory Diet Diet “Critical. And I think we're learning more and more and more about the role of good nutrition, of healthy eating, anti-inflammatory diets, avoidance of foods that are triggers, and an incredibly underappreciated area.” ▷ 1:20:52 Avoid Trigger Foods Diet “Critical. And I think we're learning more and more and more about the role of good nutrition, of healthy eating, anti-inflammatory diets, avoidance of foods that are triggers, and an incredibly underappreciated area.” ▷ 1:25:13 Elimination Diet to Identify Food Triggers Behaviors “Well, this may be a case for elimination diets, which are provided they're done safely, where people restrict the number of foods they eat to a very limited number of foods, make sure they still get enough calories and macronutrients that they need... then you can build things in and then explore what triggers the pain or what removes the pain.” ▷ 1:39:13 Address Stressors Contributing to Pain Behaviors “It means that probably we need to identify the stressors that are contributing to that and address those. And we'll often find that in the scenarios you outlined that the pain gets better.” ▷ 1:39:58 Take a Movement and Nature Break When Stress Manifests as Pain Behaviors “For me, as a pain doc, it's a signal to me that's like, go work out, go for a walk in the forest, and take some time away from the computer.” ▷ 2:27:46 Acupuncture Behaviors “Just closing out on the acupuncture again, just to summarize, yes, in some patients, in some circumstances, I found acupuncture to be useful and it's worth a try.” ▷ 2:28:13 Chiropractic Behaviors “Chiropractic, mixed data, well-controlled studies, some have shown that it can be helpful for low back pain. Some have shown it isn't. It's truly not clear.” ▷ 2:28:34 Avoid High-Velocity Neck Manipulation Behaviors “The type of chiropractic that involves, that doesn't involve kind of, you know, the fast, high-velocity manipulation as a physician, I have some concerns about that, particularly around the neck.” ▷ 2:29:38 Assess Whether a Therapy Provides Durable Benefit Behaviors “If you go to them, ask yourself, am I getting durable benefit? ... ask yourself, is it really providing you durable benefit that is worth the effort? Or is it just rapid, it feels good in the moment?” ▷ 2:31:15 Continue Moving With Back Pain if It's Hurt Not Harm Behaviors “Anytime I've had back pain, even when it was very severe, provided I wasn't harmed and I was just hurt, continuing to move and not becoming sedentary was absolutely the fastest route to recovery.” ▷ 2:31:35 Physical Therapy Behaviors “What, if any, is the role for physical therapists in the treatment of chronic pain? Absolutely crucial. Absolutely crucial.” ▷ 2:32:16 Occupational Therapy Behaviors “And they're tying in with good physical therapists, occupational therapists, people who can do goal setting, absolutely critical.” ▷ 2:33:00 Pacing Behaviors “Pacing is so critical for people with chronic pain... The key is you set small goals, baby steps.” ▷ 2:37:02 Acetyl L-Carnitine Supplements “So for neuropathic pain, acetyl L-carnitine is one of them... Now you have to take this at higher doses. It's typically 2,000, 3,000 grams. It's a pretty large dose.” ▷ 2:38:06 Alpha-Lipoic Acid Supplements “Alpha-lipoic acid is another one. Alpha-lipoic acid, at least two mechanisms. One is it's a free radical scavenger... and it can have some benefit for neuropathic pain.” ▷ 2:39:13 Vitamin C Supplements “Vitamin C. So if you're going in for surgery and it's maybe a nerve-related surgery that you're going to have. They found vitamin C prophylactically can reduce the likelihood of having certain nerve pain conditions after surgery.” ▷ 2:39:31 Fish Oil (Omega-3 Fatty Acids) Supplements “Fish oil, the omega-3s, have been found to be beneficial around chronic pain.” ▷ 2:39:35 Creatine Supplements “More recently, the data here is on smaller numbers, creatine, which I imagine you've probably talked about it at some length, but creatine has shown in small pilot studies some benefit in fibromyalgia and some other types of conditions.” ▷ 2:40:12 Learn Supplement Side Effects and Drug Interactions Behaviors “Just be mindful that just because it's natural, just because it's over-the-counter, doesn't equate with 100% safety... get educated about the side effects and the adverse events, get educated about the drug interactions.” ▷ 2:40:33 Avoid Certain Supplements Before Surgery if They Increase Bleeding Risk Behaviors “get educated about the drug interactions the agent interactions For instance there are these over agents some of which you want to be careful of and not taking when you going into surgery because they can be platelet inhibitors and they can cause you to bleed more” ▷ 2:43:43 Deep Breathing Behaviors “They can help teach skills... They can help teach people relaxation techniques through deep breathing, things like biofeedback.” ▷ 2:44:31 Cognitive Behavioral Therapy Behaviors “The pain psychologists use classically techniques like cognitive behavioral therapy, which involves often recognizing these unhelpful thoughts and patterns that we all get into around pain and even life, to interrupting those thoughts.” ▷ 2:45:40 Acceptance and Commitment Therapy Behaviors “Cognitive behavioral therapy, mindfulness-based stress reduction, acceptance and commitment therapy are some of the tools that they use.” ▷ 2:45:46 Empowered Relief Behaviors “My partner, Beth, has developed a brief intervention called Empowered Relief... it a way of getting eight weeks of cognitive behavioral therapy in two hours. Wow. Not meant to replace CBT but as an additional tool.”