Abuse of Power in Pain Treatment

Abuse of Power in Pain Treatment

It’s been a 6 month hiatus since my last post.  Many micro projects are in the works at the moment.  It was time to re-focus on streamlining procedures to make time for writing and creating again.  I’ve recruited some behind-the-scenes administrative support which has granted me some much needed breathing room with a little bonus moral support!

In the meantime I’ve been keeping only a casual presence on social media with Facebook (FB) groups in the areas of chiropractic and pain.  These relaxed venues are a wonderful resource for me and I spend a great deal of time reading research this way and following professional debates about pain science within these groups.

The following post was originally geared towards practitioners because it was actually something I was preparing to post to a particular FB group.  Half way through writing, I realized it’s much too long and in-depth for a post like that.  It’s something that deserves wider readership and better scope (and may in fact need to be re-visited in the future.)

I have had concerns with the multidisciplinary discussions online about pain science

…and this week a patient helped me realize why.

My concern is specifically about how the rise in casual awareness of the bio-psycho-social (BPS) role in pain is affecting the way that non psychologically trained professionals handle the care of patients. An increasing number of practitioners are growing aware of the role of psychology and brain chemistry in pain…yet they are not trained appropriately about how to safely and effectively broach this topic with patients. They think that they can and should do so – based on the research.  This is a mistake – a potentially harmful one.

Don’t get me wrong – the rising awareness about the connection between pain and the brain is wonderful progress.   Increasingly the new supporting research is emerging online and at weekend seminars.  It provides strong support for collaboration between healthcare disciplines.  We are seeing that the answer to treating pain effectively is never solely via a mechanical fix (like with chiropractic, orthopedics or physical therapy.)  It’s not exclusively a dietary issue and it’s not something you can counsel your way out of by talk-therapy alone either.

The problem occurs when practitioners without mental health care credentials, try to incorporate their casual knowledge into treatment.  Without a deeper understanding of a patient’s emotional health history nor the training to safely handle someone’s full psychological burden, this ends up just being reckless and delusional behavior on the part of the practitioner.

A subtle boundary breach is serious

This week, my patient confided in me the reason she had to change physical therapy (PT) practitioners. She is someone who has a complex variety of PTSD and maybe some other combination of DSM-V diagnoses, but that is something I am not qualified to confirm.  The point is she, like many patients, is more than meets the clinical-eye.

For her to trust a new practitioner involved numerous emotional hurdles.  Under the care of this PT practitioner, as part of each visit, she found herself apparently continually pushed into the topic of deeper underlying psychological reasons for her current condition.  This probing was coming at her from someone unqualified to appropriately recognize the precarious nature of what was being forced to the surface. Then, once having re-triggered trauma for this patient, this practitioner was ill-equipped to handle the fall-out.

My patient believes that after declining numerous times to engage in discussions of her private psycho-social history, this therapist continued to press her on it and belabor the point.  While rightfully believing that this may play a role in the patient’s overall well-being – pain or no pain – it is EXTREMELY important to read your patients’ cues and realize that most people who seek the help of PTs OTs DCs LMPs LAcs are not giving consent- explicit nor implied – to discuss personal emotional matters.

What any of us healthcare providers need to do:

When we don’t get the response we’re looking for from patients – we all need to take the hint, just drop it and move on.  Meet your patients where they are at.  No one will benefit from being force-fed “insight” they are not ready for.

This patient who had to change PTs, did so – not because of a petty personality clash and not because of ineffective physical therapy, but because her emotional trauma was re-triggered and the PT’s probing was uninvited. Unfortunately this PT did not have the training, life experience nor the instinct to realize the gravity of what she was inflicting visit after visit. Any physical progress the patient could have made in regards to her pain was sabotaged.

It was no small feat to get this patient to reach out for treatment in the first place and this misstep could have been detrimental.  Luckily she has a psychiatrist and is getting the right kind of support through this glitch.

This should serve as a word of caution to all of us. It’s tempting to want to put into practice the full breadth of what we know, but it’s not always appropriate nor welcomed.

Perhaps for the BPS / pain-science educators at large it’s also a reminder to teach with this in mind.  Pain education when taught to professionals who are not adequately trained in mental health, absolutely must emphasize the importance of recognizing the need for referral to a qualified practitioner.

Practitioners: when thinking of putting your newfound knowledge to practice without extensive training, make sure that when sharing information about the psycho-social links to pain, that it’s done with kindness and not judgement.  When coming from someone who is not trained in mental health, it must be done from one human to another, in conversation and without the pretense of power differential between therapist and patient.

Working with an integrative approach and developing a robust referral network is key.  Please leave the formal psycho-social piece to the mental health professionals.

For the patients reading this: trust yourself.

Only you know what works for you and you know best what you’re ready for.  Don’t let anyone guilt you or pressure you into overriding your instinct and comfort levels.  If you feel emotionally violated or disrespected, there’s a reason for that.  You deserve to be treated with respect.  If you do your best to communicate your boundaries, then you deserve to have those respected.  Sometimes when others trigger us, whether that’s in a therapeutic relationship or not, it’s an important signal that we have some work to do within and remember, no one intends to be unkind or disrespectful.

We are all imperfect and trying to figure things out and doing the best we can, but that doesn’t mean you should tolerate anything that makes you uncomfortable.  Your boundaries and limits don’t have to be the same as someone else’s.

If you are working with a PT, OT, DC, MD, LAc, LMP or anyone else in a therapeutic capacity, and he or she is pushing you to either talk about something that you don’t want to talk about, or making you do something that feels uncomfortable – let them know that you are not okay with it.  It doesn’t matter if this seems like something you “should” be okay with or others would normally be okay with.  That’s irrelevant when it comes to your well-being.

Too often patients/ clients abdicate their power and autonomy with the idea that the therapist/doctor/professional “knows best”.  That may work for some people but it only works because there is awareness and consent.  If you feel emotionally or physically uneasy and you’re not explicitly consenting to have your boundaries pushed, either speak up or move on.  Communicate your needs or find someone who will work with you on your goals in a way that feels respectful of your comfort zones.

Anyone worth their salt will happily hear your concerns and adjust their approach accordingly.


Image Credit: Wikimedia Commons By Pieter Brueghel the Elder

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The Integrative Wisdom Project

The Integrative Wisdom Project

I strenuously applaud the naturopathic profession’s masterminds behind this movement to expose elements of collaborative natural health care.  It’s an extremely forward-thinking and inclusive group of minds putting social media to use in the name of holistic health for all and by all.  I wish for my own profession to get on this bandwagon.  Just today I had an exchange about recent shifts happening in one of the chiropractic associations as they scramble to keep step with the times and join these progressive voices.

I am very grateful for the opportunity to speak with this movement.

“Persistent limited beliefs along with complacency are part of the biggest barriers to making integrative medicine standard in healthcare. Every discipline of provider in health care, both conventional and alternative medicine practitioners, are guilty of this.”

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For more voices on this progressive movement follow the source of the original post here: The limited beliefs of integrative medicine limit progress | Integrative Wisdom

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Your Pain is Not Because You’re “Fat”

Your Pain is Not Because You’re “Fat”

What do I know about the struggle to lose weight? Not much and I don’t pretend to. That is a genetic “crap shoot” that I came out on the lucky side of.

What I DO know is that pain does not happen to overweight people alone.

The other thing I know and hear about more often than I should, is how doctors of all specialties commonly and unabashedly display extreme prejudice against people who are overweight.  Numerous patients of mine tell me similar stories about reaching out for help with their pain and being met with a host of physician encounters that leave them feeling judged and ashamed.  So many doctors are quick to blame the weight and slow to investigate past the fat.

Anyone in this day and age knows about the correlation between obesity and disease and mortality.  I’ll go out on a limb here and suggest that the majority of overweight patients know that it’s not ideal to be on the heavy side.  The last thing they need to hear is that everything wrong with them is because of their weight. First of all, that’s just not always true and more importantly, blaming their weight is certainly not something they need a doctor’s help doing.

When has fat-shaming ever helped anyone make positive lasting change? Being judged by careless strangers is one thing but by your own healthcare provider is quite another and shouldn’t be allowed.

If someone has been steadily on the heavy side for the majority of their lifetime and there hasn’t been a sudden recent change in weight, then the skeleton – while perhaps stressed in ways that lighter people aren’t – has had years to adapt.  Our bodies are pretty amazing that way and given years to slowly get used to something, we just do.  The likelihood that suddenly the weight is the main problem is unlikely for this sort of scenario.
I see plenty of lean and “fit” looking people who just wake up one day in pain and have no idea why.  We don’t say to those people: “Well it’s obviously because you’re too skinny.  Come back and see me when you’ve gained some weight.”

Here’s another problematic drawing of parallels that seems to happen quite a bit…

Any sized woman who experiences a 9 month gain of pregnancy weight should never be compared with someone who is chronically overweight.  It is completely different. Not only do most overweight people not gain that quickly but they also aren’t experiencing the unique destabilizing and mechanically disorienting effects of massive hormonal and blood volume changes.

If weight is legitimately suspected as the cause for pain, then the last thing you should do as a doc is dismiss the patient with a sweeping prescription for exercise and calorie restriction when the more likely chronic weight-related risk is cardiovascular.  If anything, this person needs to have a heart health check first.

When a patient feels alienated from their physician due to the shame over their weight, it creates a dangerous  barrier to receiving true healthcare solutions.

I hear first-hand from patients that they will simply not return for care when they feel unfairly judged and dismissed and this can be more dangerous than the weight itself.

We do need to be clear with our patients about the facts:

But facts can be shared without judgment and blame. Higher body fat percentage is a real health risk. Abdominal fat is the worst. It predisposes us to higher levels of chronic inflammation which can manifest in many ways – not just through pain.  Evidence shows that it’s inflammation that is the huge risk factor and linked with a host of diseases.

Doctors and patients alike need to be aware of the cold hard fact that body fat percentage can be dangerously high in underweight, average weight and overweight people.  This is why everyone of absolutely any size, needs to avoid being sedentary, eliminate inflammatory foods and care for their stress levels and stress coping – all of which have been shown to play a role with inflammation which is the ultimate killer.

It’s never just the weight alone.

When there is pain, the pain chemistry needs to be addressed first and foremost.  Yes, fat cells contribute to inflammation which can stack the deck against us and cause pain, but every person’s situation is unique.  Look at the mechanics.  Consider individual body chemistry.  Inquire about psycho-social factors.  These are the inroads to better, more compassionate self-care which is where weight loss can begin if indeed that is appropriate for that patient.

We are emotional creatures first.  The physical body is a reflection of who we are.  All bodies need to be greeted with kindness and respect first before change can be made.


image credit: By Peter Paul Rubens – The Prado in Google Earth: Home – 7th level of zoom, JPEG compression quality: Photoshop 10., Public Domain, https://commons.wikimedia.org/w/index.php?curid=22620913

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No, You Do NOT Need to Improve Yourself For the New Year

No, You Do NOT Need to Improve Yourself For the New Year

rogi__gorski_kotar__croatia_-_panoramioThere is nothing wrong with you.

When you start believing that you are not inherently bad or defective, that is when resolutions for change actually can have lasting effect.  All we ever need to do both in life and in health is to get out of our own way.  Eliminate the obstacles.  Like a log jam in the river – moving the logs is much easier than trying to push the river uphill.

It’s true that you might be more comfortable in your body if you exercise regularly or eat fewer inflammatory foods, but you are still a valuable human being regardless of what you choose to do about this.  If you see your intrinsic value, you would probably choose less punishing behavior, and less time would be wasted spinning in unproductive guilt when things don’t go exactly as you planned.

Letting go of the idea that there is anything “wrong” with who we are opens the door to making good choices.  Connecting with our value lets us put aside harsh judgement and shame over the choices we make when they are not ideal.

The self-improvement frenzy of the new year’s resolution tradition is dangerously destructive because it feeds all sorts of unhealthy thought patterns.  We all know that most of these “resolutions” don’t stick and it’s because they tend to be rooted in unrealistic expectations and stem from faulty assumptions that we are “broken” in some way.

There is nothing wrong with resolving to remember to do good and be good whatever “good” means to you, but please remember that goodness is a natural inclination.  So, really, you’d be resolving to be more of who you naturally are.  If anything, we should all take a moment to reflect on what is keeping us from letting our optimal potential and natural happiness surface.

When the attitudes shift from a place of self hatred to self love and acceptance the natural flow of wellness is allowed to resume.

Let’s embrace what is and who we are just as we are.  You don’t need improvement this year or any year. You are perfect just the way you are.

Now go do something healthy just for the love of it!


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Meeting Dr. Joseph Pizzorno

Meeting Dr. Joseph Pizzorno

Last month I was in San Diego attending a week long conference of the Academy of Integrative Health and Medicine (AIHM). What a refreshing gathering of so many different health specialists and generalists, truly representative of my ideal in holistic and integrative care of patients.

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Dr. Joseph Pizzorno at the AIHM conference 2016 – Looking dapper as ever despite three consecutive lectures without break!

One of the highlights for me was to attend a set of lectures given by Dr. Joseph Pizzorno and then to meet him for the first time. He is one of the founders of Bastyr University. I’ve been in touch with him for the past couple of years now because of his kind willingness to pen the foreword of my first book in the Every Body’s Guide to Everyday Pain series, Volume One – Put Out the Fire. Until now we had only corresponded remotely and so this was the first chance I’d had to meet in person this man I’m so grateful to.

I was in disbelief for quite some time that this natural health care giant was willing to associate his name with a project like mine – very much still in its infancy.

What I’ve learned about him during the process is how generous, gracious and humble he is and all of this was just confirmed by our in-person meeting in San Diego. He was practically mobbed by eager attendees after his lectures and despite being worn out from travel and an unusually long consecutive series of lecture hours without a break, he responded with patient kindness to everyone’s questions.

The topic of Dr. Pizzorno’s most recent research and writing work is environmental health.

The area of study referred to as “environmental health” concerns itself with the effect that inorganic compounds in our environment  exert on our overall well-being, whether those be naturally occurring or human-made.

It is an essential piece to the puzzle when considering the three possible triggers of everyday pain.  Exposure to these compounds can be one of the significant influences responsible for triggering an imbalance in our biochemistry – the precise factor that can add to our inflammatory toxin load and set us up for pain.  When chemistry is out of balance it can profoundly change our emotional coping and in turn our mechanical stressors as we translate emotion into posture.

Environmental toxin exposure is an awesome topic demanding supreme command of the research which Dr. Pizzorno clearly has with unique affinity.  He is in the process of preparing for the release of a new book on the topic:

The Toxin Solution: How Hidden Poisons in the Air, Water, Food, and Products We Use Are Destroying Our Health, and What We Can Do to Fix It

And there is another book in the works for a few years down the road of a more didactic nature.  I’m very excited to see both and will be heavily referencing this work for Volume Two – Fix the Fire Damage of my pain book series.

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Gratitude Heals …Holiday Stress?

Gratitude Heals …Holiday Stress?

thank-you-chinese-characters

“Thank You”

Studies show that remembering things in life to be thankful for, has a positive effect on our health. This year these health benefits will apparently have to be belated for me since I did not make it in time for Thanksgiving this year.  Often by then I’ve got my newsletter together to send out to my patients with news of the year to come but also reminding folks how much I value the kindness and trust they bring my way. It looks like it will be more of a New Year newsletter in a few more weeks….

 Joking aside about it being “belated”, gratitude is something I feel and reflect on all year long but especially around the winter season when I find myself warm and dry in stormy weather, under a roof I can call my own and one that sustains my life’s mission at the same time. I often feel mind-blowingly lucky considering the haphazard way I’ve found myself on a path to this point.  Anyone with business acumen would have vigorously shaken their heads at many points in my journey (and still today most likely).  I am truly lucky and thankful for that, all times of the year.

American Thanksgiving was early on, easily my favorite part of living in the US. My first year as a student at the chiropractic college in NY, we were given a whole day off on Wednesday to drive home for the holiday – in my case to friends’ houses. That travel day followed by a  four day weekend struck me as the greatest surprise gift ever at the time. What is this holiday magic that gives us FIVE days of time off??  Canadian Thanksgiving usually coincides with Columbus Day weekend in October. It’s generally just a Monday holiday – three day weekend and that’s it.   Canadians barely skip a beat that weekend and quickly get busy thinking about Hallowe’en costumes and parties next.

Here, the mania seems so much more urgent between Thanksgiving and the New Year because that time span is quite a bit shorter.  I see people suffering from the added strain and expectations.  There seems to be more pressured travel and disruption to our routines.  There’s also less daylight.  None of that bodes well for our health but just maybe, pausing those 4-5 days to “give thanks” in whatever way we do, is how we’re meant to balance  the stress of the season’s frenzy.

Just in case that’s not enough, I’m purposefully easing up expectations of myself in all areas this year but especially making sure not to push exercise and instead prioritizing sleep.  It’s hard not to feel guilty and torn by the things on our ever growing to-do lists or to fall into  emotionally beating ourselves up for “slacking off”.  But this is the time you need most of all to include on your list of tasks, things that give you joy and peace.  Don’t let that just be some seasonal slogan that loses meaning for the repetition of it.

Be kind and be loving with yourself.  In Chinese Medicine traditions it’s not actually until early / mid February that our energy “sap” is ready to flow again with slightly more vigor.  For some of us it begins with the Winter Solstice.  You’ll start to feel your energy return slowly with the daylight.

December 21st!By Peter Trimming, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=14383009

Let’s welcome back the light.  With the light comes hope.

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What IS “Integrative” Healthcare?

What IS “Integrative” Healthcare?

By The U.S. Army (2012 Warrior Games) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

“Integrative medicine” is a term that has become very trendy in the health and wellness industry.  It’s an approach inspired by some of the leaders in the Functional Medicine movement.  As soon as it became evident that patients demand it which means there are big dollars at stake, even mainstream medicine is coming on board.  Cleveland Clinic has opened a dedicated wing for Integrative and Lifestyle Medicine  as has Johns Hopkins with their Integrative Medicine and Digestive Center.

So, what is it exactly?

It’s healthcare designed to treat the whole person (shocker). Many of us in the natural healthcare industry who have been practicing with this mindset for decades can’t help but roll our eyes a little bit at this “new” movement, but it is one to celebrate.

It feels to me like the general public is just catching up with how I’ve been living for most of my life personally, and now professionally for close to 25 years.  What we see in the integrative circles of healthcare is a coming-together of East and West, an acceptance of the interdependence of both sides.

“Integration” refers to the coordination of care between mainstream Western medicine and traditional or “alternative” methods including but not limited to acupuncture, chiropractic, massage therapy, yoga, meditation and other lifestyle modifications. You can find “Functional Medicine” on Wikipedia defined as: medical practice or treatments that focus on optimal functioning of the body and its organs, usually involving systems of holistic or alternative medicine.  

The functional medicine movement was started by a chiropractor with a PhD in biochemistry – Jeffrey Bland.  He bravely championed the long held old-world wisdom of viewing health and disease not as a linear process between one cause and one effect, but rather a complex symphony with multiple orchestral sections that all depend on each other for harmony.   Now people like Mark Hyman MD and a slew of others, straddling mainstream and traditional methods, have embraced this much needed common-sense approach.

Integration? Or Collaboration?

What we are seeing and hearing increasingly from numerous medical centers and hospitals, as many of them move to offer these kinds of approaches under one roof, is validation of this kind of wisdom-medicine for use in the Western model.

This week’s national news headlines on ABC’s GMA morning programming included a story highlighting the benefits of integrative medicine for cancer patients at all stages of care.  The use of acupuncture, movement therapy like yoga, massage and meditation were given as examples of treatment methods used to address the emotional, spiritual and physical needs together.

Some of you who follow this blog know that, just a few weeks ago, I attended a conference held by the Academy of Integrative Health and Medicine (AIHM) where I met medical doctors, physician assistants, nurses, naturopaths, acupuncturists and other chiropractors.  All of us together acknowledging the role of each other’s specialties in the full care of a patient while remembering to also live the path that we advocate for by indulging in some reflective self care.

In conversation with someone over breakfast at this AIHM conference I shared that I am a chiropractor in solo practice. I was met with “So you don’t actually practice integrative medicine…”

This took me aback a bit because I believe I actually do the ultimate integrative practice.   This exchange made me consider that perhaps the confusion is with the concept of “collaborative” vs. “integrative”.  Solo practice means I run a one-woman-show but does not preclude my patients from receiving collaborative (or “integrative”) care.  In my opinion collaboration is essential to integrative approaches.

This meeting of two worlds, in my opinion, can happen just as effectively in a more expansive community setting and not just under one roof. Successful collaborative care for the whole person is much more about the attitudes of providers than a physical facility with a name. I see my job as more of a healthcare traffic cop of sorts.

With the training that every chiropractor receives – to serve as a primary / portal of entry provider  – we are charged with the responsibility of knowing when chiropractic will serve our patients and when other modalities are more appropriate or needed in conjunction with our work.  Who better then, to assess and help patients prioritize treatment methods and direct them to the right practitioners?

I am extremely comfortable with my limitations as a practitioner and for true whole-person healthcare I think it’s essential to beware the delusion that any one of us can be everything to everyone.

For patients who don’t yet have a healthcare team, I regularly bring their attention to physiatry, physical therapy, massage, acupuncture, psychotherapy, and whenever needed, direct them back to their mainstream medical provider or any  number of medical specialists.

Do you have a healthcare team of alternative and mainstream providers?  Are you enjoying the integrative medicine movement?  You deserve to.  Status quo is changing.  Expect more.