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.”

integrativewisdom_blog_header_yalingliou

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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Everyday Toxins, Everyday Diseases, Everyday Pain

Everyday Toxins, Everyday Diseases, Everyday Pain

toxin-solutionIt’s a shame that we have come to accept a world where there is such a thing as “everyday” pain, “everyday” disease and “everyday” toxic exposure and that is simply our current reality. But with the help of The Toxin Solution, I believe we can find a new reality.

Follow this link for the Article Source

Meet Dr. Joseph Pizzorno, ND.

“Dr. Joe” has been on the forefront of natural medicine since founding Bastyr University.

And, in his groundbreaking new book, ‘The Toxin Solution, Dr. Joe lays out:

  • the single primary driver to unexplained symptoms and fatigue
  • the cause of the rise of chronic disease effecting over 51% of adults
  • why once rare, now diabetes is reaching epidemic proportions and 37% are prediabetic (and 9 out of 10 don’t even know it).
  • why masking symptoms with medications is exacerbating the issue
  • where toxins are hiding in your everyday foods, and in products we use

    In his words, “Through deep research, I found the one link causing (1) unexplained symptoms, (2) chronic disease and pain, and a way to reverse them. The impact toxins are having on our health are devastating, but the reversal is astounding.”

Dr. Pizzorno’s research and clinical direct findings, mapped the solution to address your unique toxin-load (you must follow 4 steps to be successful), to lower your risks, and restore your inner vitality, helping you to shine from the inside-out…turning your body into a toxin-releasing machine, just like when you were a young, vibrant, child.

Click here to get your copy:  www.thetoxinsolution.com

I’ll be following this protocol along with you!

 

What’s the Big Deal if I Crack My Own Spine? – Stop Everyday Pain

What’s the Big Deal if I Crack My Own Spine? – Stop Everyday Pain

Is this you when your back feels stiff?  Looking for relief from stiffness or pain by twisting it out?  Hoping for that crack that feels like what you get from your chiropractor?  It’s not the same.  It’s more dangerous to do this yourself and you should learn about why this is.

 

Read more from the original post and early book excerpt by following the link below: “When the jammed-up joints are properly released, then the hyper-mobile joints – the ones that are cracking all the time – should not feel the need to do so much of the work anymore”

It might be that you’re noticing cracks and pops with regular daily movement or you are making your joints do this repeatedly throughout the day in the hopes for relief from pressure.  In both cases you should learn more about what’s really going on, so you make informed choices…

Source: What’s the Big Deal if I Crack My Own Spine? – Stop Everyday Pain

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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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How Does Self Image Affect Your Pain?

How Does Self Image Affect Your Pain?

An excerpt from my book as seen over at InnerSelf Publications website.

Timely for the season of self reflection and internal work.

 “by Ya-Ling Liou, D.C. If you’ve only ever seen yourself as unsure and perhaps your self-esteem is not strong, you may be more vulnerable to becoming overwhelmed by fear—stressed by the worry that your pain might devolve into a worst case scenario of unknown proportions.”

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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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