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BC ECHO FOR CHRONIC PAIN:

Chronic Pain and Trauma

Session 10: June 16, 2020

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LAND ACKNOWLEDGEMENT

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Pain BC's offices are located on the ancestral, traditional and unceded territory of the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), and Tsleil-waututh Nations.

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  • Faculty: M. Wesley Buch, Ph.D., D.Min.(c)
  • Relationships with financial sponsors: None

FACULTY/PRESENTER DISCLOSURE

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TODAY:

  1. Chronic pain & trauma co-occurrence

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  • The emotional wreck of pain/trauma co-occurrence

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  • Treating pain/trauma co-occurrence in primary care

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  • Secondary trauma, burnout & self-care

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Chronic Pain & Trauma

Co-occurrence

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CO-OCCURRENCE RESEARCH

  • Research interest is relatively new
  • Sporadic reports starting in 1980s
  • Two review articles at turn of millennium sparked renewed interest

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CO-OCCURRENCE – CHRONIC PAIN

  • Chronic pain = typically pain that persists 6 months or longer
  • IASP new definition:

an aversive sensory and emotional experience typically caused by, or resembling that caused by, actual or potential tissue injury.

  • DSM-5: Pain Disorder replaced by Somatic Symptom Disorder with Predominant Pain
  • Prevalence rates: 1 in 5 in BC; 1 in 6 across Canada

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CO-OCCURRENCE – PTSD

  • PTSD (DSM-5):

- exposure to traumatic event (more or less)

- the big 4 constellations of symptoms - intrusive reexperiencing, avoidance,

negative thoughts & mood, hyperarousal

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  • Quick questionnaires – PCL-5 (33), Trauma Informed Distress Scale (Tids, 10)
  • Prevalence: approximately 1 in 25

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CO-OCCURRENCE PREVALENCE RATES

  • Many patients with trauma history (think ACES) report traumatic events that also caused physical injuries and chronic pain
  • In trauma samples, chronic pain reported 20 – 80%
  • In chronic pain samples:

- Trauma history reported 79+%

    • PTSD 7+%

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CO-OCCURRENCE INFLUENTIAL MODELS

  • Shared vulnerability model

- Predisposing factors contribute to both, such as, anxiety sensitivity, adverse childhood experiences (ACEs)

  • Mutual maintenance model

- Pain & trauma interact through various mechanisms (e.g., fear/avoidance conditioning) to increase the severity & duration of both

    • Example: pain symptoms trigger traumatic intrusions; anxious arousal & hypervigilance (PTSD) heighten perception of pain & promote avoidance of pain-related movements.
  • Both models are highly compatible

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The Emotional Wreck

of Co-Occurrence

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CO-OCCURRENCE EMOTIONAL IMPACT

  • Co-occurrence brings more symptoms, severity, disorders & disability

- Greater emotional distress, pain intensity & disability than chronic pain without PTSD using questionnaire data

    • Greater self-reported physical health problems, helplessness (on ramp to depression) and Kinesiophobia.
  • Co-occurrence especially attracts depression & substance abuse co-morbidities.

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Treatment Tips for

Busy Clinicians

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THIS JUST IN: GET DIRTY FOR ANXIETY

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NEUROSCIENCE TREATMENT IMPLICATIONS

If chronic pain & trauma are both outputs from a brain/mind perceiving danger, then high importance to safe environment, safe relational container.

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TREATMENT FLOW CHART

Preparation

Greeting

Reception Environment

You

Assessment

Safety Behaviour

Patient Safety

Office Environment

Medicating

Naming & Educating

Resourcing

Teaching 1 Skill

Referring?

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TREATMENT PHASE SUGGESTIONS

  • In acute distress: medication (but not overmedicating), low word count – lots of listening, naming & assurance, teach a skill (mindful sx awareness skill, breathwork, distraction to task, gentle movement, meet a friend), visits closer together, referral?. (Psych: EMDR)
  • After some settling: medication change?, more talking & educating, more resourcing, more simple skills, assign homework (reading, socializing, simple skills, referral?

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PAIN-RELATED SLEEP DISTURBANCE

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MOVEMENT HEALS

  • The whole treatment village agrees
  • Medication is ultimately meant to help learning and movement
  • But paced movement

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GENTLE MOVEMENT @ HOME

 

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  • Free guided movement and relaxation for pain during COVID-19

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  • Developed from Pain BC’s Gentle Movement and Relaxation program, a training course for providers developed by Neil Pearson, a leading expert on movement and chronic pain

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  • Delivered via Zoom and Facebook Live

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  • Recorded and accessible via Pain BC YouTube channel and on Facebook

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Clinician Secondary Trauma and Burnout

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CLINICIAN BURNOUT

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Thank you!

Dr. Wesley Buch

Registered Psychologist (1186)

Clinical & Rehabilitation Psychology

Behavioural Health Care

Pain BC

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