TAKING CHARGEBlue Ridge Medical Center Chronic Pain Management Program Newsletter

VOL.2 | SEPTEMBER 2019

OVERVIEW:

Phases of Self-Management

The Fear of Pain

Gokhale Method Class

What is 4.7.8  Breathing?

Resources

Keep it Moving

Snack Time

Diabetes Self-Management

What's Next?Congratulations, you’ve taken the first step in taking charge of your health. Youjoined the Chronic Pain Management (CPM) Program! We are thrilled to seethat many of the program participants have had significant decreases in pain,some have even been able to reduce their medication. But what happens afteryou’ve completed the first course of treatment? What happens next? The CPM program is about helping you to decrease your pain and keep it atmanageable levels. When your alternative therapies end, your real work begins.As excellent as our partners at Cox Chiropractic and Silver Linings Spa are, theirability to decrease your pain depends greatly on your willingness to commit toyour health.   Phase two of the CPM program is focused on helping you learn to sustain thedecreases in pain that you have achieved with your alternative therapy. You willonce again meet with Mary or Stephanie to develop a plan to help you meet yourgoals. Are there exercises you can do at home that will help to keep your muscleslimber? Have you taken one of the self-management classes that we offer?Would you be interested in participating in a strength training class or a walkingclub? The choice is yours. If you do not put a plan in place to help strengthen your body, your pain willreturn. It’s that simple. As Issac Newton once said, “An object at rest stays at restand an object in motion stays in motion.” Let us help you to keep your body inmotion, and help you succeed in achieving your goals.

434-263-4000www.BRMedical.org

The Fear of Pain

Does my back still hurt? Yes, it does and probably always will,but now I can tell the difference between the pain of a newflare and the soreness from overworking a muscle. I’ve decided that it’s okay to be sore, because that means mymuscles are getting stronger. New pain is not okay. If I dosomething with my trainer that causes pain (or feels like itmight cause pain) I tell her I can’t do that, and we try somethingelse. After a year of seriously working to managing my pain, I amhappy that my pain level has decreased but I’m more proud ofthe fact that I didn’t give up. I am not perfect; I ate things that I was trying not to and somedays (or weeks) I skipped going to the gym, but I never stopped.I feel like I've finally taken control of my pain. I want everyone who has chronic pain or other on-goingchronic illness to have that same feeling. There are things outthere that will help you feel better, maybe it’s medication,maybe it’s diet and exercise, maybe it’s something else. But nomatter what it is, I hope you don’t give up until you’ve found it. Sincerely Yours, Stephanie MartinProgram Director

By Stephanie Martin, Program Director

Anyone who lives with chronic pain knows that pain levels arealways changing. In the summer when the weather is warmerand I can spend more time doing things I enjoy like walking inthe evenings, my pain decreases. During the winter when Ican’t seem to get warm. I hunch my shoulders and sit in oddpositions trying to stay warm, which of course increases mypain. This is my normal pain cycle. But then there are those times when I end up sleeping on aheating pad for a week wondering how I did this to myself.Those are the times I want to talk about today, when everymoment of your life is dictated by the fear of increasing yourpain.  A year ago I was having a lot of those moments. Everything Idid (even when I did nothing) made me hurt more. Sitting atwork all day was hurting my back. Working in the garden ortaking the dogs for a walk hurt my back. Even standing at thesink to wash dishes hurt. It seemed like no matter what I did, Iwas always in pain.  Something had to change. It took a few months, but I finally had a serious talk with myself.Reluctantly, I admitted that I wasn’t going to solve this problemby myself, so I talked with my health care provider and came upwith a plan.  First, I focused on adding foods to my diet to help to decreaseinflammation (more berries and fish, less bread and chocolate).Then I researched ways to strengthen my back that weren'tlikely to cause a flare up.  I found a personal trainer I couldafford who could work within my limitations. (I never imaginedexercising would be the easy part. All I had to do was show upand do what she told me to. ) Much later I learned the steps I was going through to create agoal for myself, followed the same process used in the Self-Management classes to create an “Action Plan”. When I took the Chronic Disease class, I learned how settingsmall achievable goals that were very specific meant I wasmore likely to succeed. After  the class I began creating a newaction plan each week. Eat more vegetables. Drink more water.Move more, etc. Some days I achieved my goals, others I didn’t.But no matter what, I didn’t give up. Fast forward a year and I’m still working toward my goals. Imeet with my trainer once a week and have even gotten myfamily to go with me. I’ve struggled with the diet, but overall Ihave done well. I’m always trying to do better, because now Ican tell the difference. I see changes, not only on the bathroomscale, but also in my energy level and cravings for sweets(which had gone away).

What is 4.7.8 Breathing? Medically reviewed by Timothy J. Legg, PhD, CRNP on April 20, 2018 —

Written by Ana Gotter. www.healthline.com

The 4-7-8 breathing technique is a breathing patterndeveloped by Dr. Andrew Weil. It’s based on an ancient yogictechnique called pranayama, which helps you gain controlover your breathing. When practiced regularly, it’s possiblethat this technique could help some people fall asleep in ashorter period of time. How does the 4-7-8 breathing technique work? Breathing techniques are designed to bring the body into astate of deep relaxation. Specific patterns that involve holdingthe breath for a period of time allow your body to replenish itsoxygen. From the lungs outward, techniques like 4-7-8 cangive your organs and tissues a much-needed oxygen boost. Relaxation practices also help bring the body back intobalance and regulate the fight-or-flight response we feel whenwe’re stressed. This is particularly helpful if you’reexperiencing sleeplessness due to anxiety or worriesabout what happened today — or what might happentomorrow. Swirling thoughts and concerns can keep us frombeing able to rest well. The 4-7-8 technique forces the mind and body to focus onregulating the breath, rather than replaying your worries whenyou lie down at night. Proponents claim it can soothe a racingheart or calm frazzled nerves. Dr. Weil has even described itas a “natural tranquilizer for the nervous system.” Over time and with repeated practice, proponents of 4-7-8breathing say it becomes more and more powerful. It’s saidthat at first, its effects aren’t as apparent. You might feel alittle lightheaded the first time you try it. How to do it To practice 4-7-8 breathing, find a place to sit or lie down comfortably. Be sure you practice good posture, especially when starting out. If you’re using the technique to fall asleep, lying down is best. Prepare for the practice by restingthe tip of your tongue against the roof of your mouth, right behind your top front teeth. You’ll need to keep your tongue in place throughout the practice. It takes practice to keep from moving your tongue when you exhale. Exhaling during 4-7-8 breathing can be easier for some people when they purse their lips.

The following steps should all be carried out in the cycleof one breath:

First, let your lips part. Make a whooshing sound, exhalingcompletely through your mouth.Next, close your lips, inhaling silently through your nose asyou count to four in your head.Then, for seven seconds, hold your breath.Make another whooshing exhale from your mouth for eightseconds.When you inhale again, you initiate a new cycle of breath.Practice this pattern for four full breaths.

The held breath (for seven seconds) is the most critical part ofthis practice. It’s also recommended that you only practice4-7-8 breathing for four breaths when you’re first startingout. You can gradually work your way up to eight full breaths. Thisbreathing technique shouldn’t be practiced in a setting whereyou’re not prepared to fully relax. While it doesn’t necessarilyhave to be used for falling asleep, it can still put thepractitioner into a state of deep relaxation. Make sure youdon’t need to be fully alert immediately after practicing yourbreathing cycles. If you’re experiencing mild sleeplessness due to anxietyor stress, 4-7-8 breathing could help you get the restyou’ve been missing. However, if the technique isn’t enough on its own, it might becombined effectively with other interventions, such as:

a sleeping maska white noise machineearplugsrelaxation musicdiffusing essential oils like lavenderreducing caffeine intakebedtime yoga

If 4-7-8 breathing isn’t effective for you, anothertechnique like mindfulness meditation or guidedimagery may be a better fit.

Citations: BCorliss J. (2015). Mindfulness meditation helps fight insomnia, improves sleep. health.harvard.edu/blog/mindfulness-meditation-helps-fight-insomnia-improves-sleep-201502187726Crane R. (2016). Simple sleep breathing exercises help you relax.  alaskasleep.com/blog/yoga-breathing-exercies-calm-relaxed-state-dr.-andrew-weil-4-7-8-methodRelaxation exercises for falling asleep. (n.d.).  sleepfoundation.org/relaxation-exercises-falling-asleep-0Weil A. (2010). 4-7-8 Breath.  cordem.org/files/DOCUMENTLIBRARY/2017%20AA/Handouts/Day%20Three/Biofeedback%20Exercises%20for%20Stress%202%20-%20Fernances%2C%20J.pdf

1.2.3.4.

ResourcesThe Meaning of PainBy: Nick PotterWe all fear pain and we will do almost anything to avoid it. We take to our beds, swallowpills, even submit to surgery and think we are solving the problem. But what if everythingyou thought you knew about pain turned out to be wrong or only half the truth? In TheMeaning of Pain, renowned osteopath Nick Potter draws on insights from biology,evolution and social behavior to present a radical new understanding of pain and why wefeel it. 

Good Books

Podcasts

Pain is Really StrangeBy: Steve HainesAnswering questions such as 'how can I change my pain experience?', 'what is pain?', and'how do nerves work?', this short research-based graphic book reveals just how strangepain is and explains how understanding it is often the key to relieving its effects.Studies show that understanding how pain is created and maintained by the nervoussystem can significantly lessen the pain you experience. The narrator in this original,gently humorous book explains pain in an easy-to-understand, engaging graphic formatand reveals how to change the mind's habits to transform pain

The Science of Happiness is hosted by award-winning professor Dacher Keltner, and co-produced with Public Radio International. It aims to provide listeners with research, tips,and inspiring stories. Guests are featured on the show to test practices like gratitude,mindfulness, meditation, self-compassion, and forgiveness in their daily lives, and thenrecap their experiences with well-being researchers. The hosts also teach their listenersabout scientifically researched strategies to live a happier, more meaningful life. The showupdates every Thursday, and has produced episodes such as "How to Find Your BestPossible Self" and "Quieting Your Inner Critic."

Painiac, the first podcast about mindfully living with chronic pain, is a free resource forpeople living with chronic pain or illness. Painiac is for people living with chronic pain andthe awesome people who love them. We also explore what it means to live with varioustypes of pain whether it be emotional, mental, or physical, and we share inspiring stories ofother painiacs who are learning to live well even when life hurts. With host Shelly JacksonBuffington, listeners learn about topics such as managing expectations, asking for help,working with limitations, talking with your doctor, confidence, and self-care. Painiacfeatures conversations with inspiring people across the globe who live with pain and thrivein spite of it. In each episode, Shelly shares simple and practical tools to help peoplereframe their relationship with pain and other challenging life experiences.

Keep it moving

Kneeling Arm and Leg Reach

Kneel on all fours, ensuring the handsare under the shoulders, the knees areunder the hips, and the spine is inneutral.Without moving the torso at all, reachone arm forward and the opposite legback keeping the finger tips and toeson the ground.Lift the extended arm and leg off theground, keeping the navel pulled in tohelp stabilize the torso. Hold for a fewsecond before bringing the hand andleg back down and to the start position.

Pelvic Tilt The pelvic tilt exercise helps to strengthen your abdominalmuscles.

Lie on your back on the floor with your knees bent. Flatten your back against the floor by tightening yourabdominal muscles and bending your pelvis up slightly.Lift your pelvis off the floor, keeping your shoulders and hipsin alignment. Hold for up to 10 seconds. Repeat.

Be aware of how forcefully you do this movement. Try one ortwo pelvic tilts to get the hang of it. Then perform one to checkyour tension level. If you're using a lot of muscle tension, try toease up on that. Don't worry about completing the movement. You'll likely be able to do it even after you've relaxed.

If you’ve had to readjust, you will know if you have moved the torso during the exercise. Try tocorrect this with each repetition. Repeat 3-5 times each side. If you find it too difficult to controlthe torso and spine when lifting the arm and leg, you can omit the lift until you have the strengthin the core, or do the entire exercise but with arms and legs separately.

This exercise works the entire stabilizingmuscle system for the torso.

Snack TimeBlueberry Yogurt Popsicles

Imagine the year is 1905 and the glass of “fruit-flavored drink” you left on the porch last night isnow frozen. What would you do? "I’d grab it by the “stirring stick” I’d left in it and enjoy!" That’sexactly what 11-year-old Frank Epperson did. He called his invention the "Epsicle.” It was a hitwith the kids at school, and later with his own kids who called it “Pop’s ‘sicle.” The name wascatchy and the treat was delicious, so Frank patented it in 1923 to share his Popsicle® ice popswith the world! We love popsicles, especially when they are made with blueberries. And whynot? Blueberries are good for you, providing fiber, vitamin C, vitamin K and manganese, allessential to healthy living. Here’s an easy blueberry popsicle recipe from Alex Caspero at Have aPlant that I hope you’ll try and like.

Blueberry Yogurt PopsicleMakes 8 Popsicle, depending on mold size Ingredients1 cup plain or vanilla yogurt1 cup fresh blueberries (can sub 1 cup thawed, frozen blueberries)2 tablespoons honeyPopsicle molds DirectionsPlace the yogurt, fruit and honey in a blender.Blend to desired consistency and pour into prepared Popsicle molds. Place in the freezer until frozen solid, about 4-5 hours. To unfreeze, place the molds in hot water for 10 seconds, then pull out. Nutrition Info Per Popsicle: 48 calories, 0.4g fat, 2mg cholesterol, 22mg sodium, 88mg potassium, 9.1g carbohydrates, 8.3g sugar, 1.9g protein

Gokhale Method Foundation CourseRegister today, space limited!What is the Gokhale Method?

The Gokhale Method uses healthy posture andmovement to help you restore your structural integrityand regain a pain-free life. It addresses the root cause ofmost muscle and joint pain, because you have a right toa pain-free back, neck, hips, knees, feet...

Most pain can be attributed to how we hold ourselvesand how we move. Since we aren't born with a user’smanual, we rely on our culture to guide us. About acentury ago, our culture took a wrong turn.

As a result, in the United States:90% of adults experience back pain at some point intheir lives.This year, 50% of working Americans will experienceback pain.Back pain is now the leading cause of disability inpeople under 45 years old.By age 15, more than 60% of all adolescents haveexperienced back and/or neck pain.

Over the course of this 3-week course, you will learn tosit, sleep, stand, walk, and bend in ways that protect andstrengthen you instead of wear and tear you.

Sitting will be comfortable, either with a backrest whenyou place your back in therapeutic traction(stretchsitting) or without a backrest, when you stackyour spine on a well-positioned, anteverted pelvis(stacksitting). 

Sleeping will be comfortable and provide hours ofrestorative traction, whether lying on your back or side(stretchlying). Standing will be a resting position for most of themuscles of the body with the weight-bearing bonesvertically stacked over the heels (tallstanding).

Bending will involve hinging at the hip rather than thewaist, exercising the long back muscles and sparing thespinal discs and ligaments (hip-hinging). Actions thatchallenge spinal structures, such as carrying or twisting,will involve deep layers of muscles in the abdomen andback (inner corset) to protect the spine.

Walking will be a series of smooth forward propulsions,challenging the muscles of the lower body and sparingthe weight-bearing joints throughout the body(glidewalking).

In relearning these everyday actions, you will repositionand reshape your shoulders, arms, neck, torso, pelvis,hips, legs, and feet the way they were designed to be.You will develop a high level of confidence in and senseof control over your well-being.

Once you have learned the basic principles, youintegrate them into all positions and movements. Youreveryday activities will once again become therapeutic.

Gokhale Method Foundations Course

3-week session: Saturdays from 9:30-1:00 pm. September 28, October 5, and October 12th

Registration Information

Cost: $450.00 per person. Chronic Pain Participants: $20.00*Class size is limited to 8 participants.

To Register or find out more call Stephanie at 434.263.4000 ext 1526

* To qualify for the discounted registration fee, you must be a participant in the BRMC Chronic Pain Program and beable to attend all three sessions. If you register for the course and do not attend or miss a class you will be expected topay the full registration costs. Transportation assistance is available on a limited basis.

4038 Thomas Nelson HighwayArrington, Va 22922

Diabetes Self -Management WorkshopSeptember 5th-October 10th2:00-4:30 pm @ Blue Ridge Medical Center

This unique program is designed specifically for adults who are pre-diabetic orliving with diabetes, as well as their family members and caregivers. It is FREEand open to the public. Transportation assistance is available on a limited basisfor BRMC patients. Call today to reserve your spot!

Call today to register!434.263.4000