I am excited and
delighted to introduce to you, our next speaker,
Dr. Heather King. Dr. King earned her PhD
in clinical psychology from the California School
of Professional Psychology at San Francisco. She then went on to complete
her post-doctoral fellowship training in chronic pain
management at Kaiser in San Francisco, where
she received specialized training in various
self-management approaches, and you’re going to hear a
lot about that this morning. She’s also, board certified
in biofeedback at Stanford. She’s been the primary
supervisor for our pain psychology Fellows. We’re one of the few
training programs in the country that’s training
new pain psychologists– I think, the only one
really, out in the Western US that I’m aware of in
an academic center. She is providing both,
individual and group therapy. She’s developed and
implemented a number of self-management
programs that have focused on patient
education and doing groups biofeedback services. And she’s trained our
medical assistants also, to serve as health coaches. One of the things that,
I think, stands out with what Heather is doing now
in this area of self-management is that we’ve historically,
looked at self-management as something that sits apart
from the medical care model. And where we need to
be moving is really, to integrate all of this so
it’s a continuum across what you do at home and across
what we work with you on, in the health care standpoint. And so, what Heather is doing
is a really novel approach to integrate all that
into one big package, and she’s going to talk with
you more about that now. Please, give a warm
welcome to Dr. King. [APPLAUSE] Thank you, Dr. Mackey. Because this is a
self-management talk, I just wanted to remind everyone
that, feel free to self-manage. We’ve been sitting here
for quite a few hours now so if you need to
get up and move, use the restroom– feel free. Absolutely, is that better? Everybody in the
back, can you hear me? So today’s overview, we’re going
to go through the why, what, and how of effective
self-management for back pain. And I’m also going to provide
you with some resources that you can look
into after you’re done with today’s program. So Dr. Mackey gave us a really
nice, 30,000 foot overview of chronic pain in America. He mentioned that,
the IOM report notes that there’s a hundred
million Americans living with chronic pain– that’s more than diabetes,
cancer, and heart disease combined. When I share those numbers with
the patients that I work with, they’re often, shocked
because how many times do you feel like you’re the only
person that has pain? Well, no, you can
look around this room and know from these
statistics, that there are many people in
the United States and across the world, that
are dealing with chronic pain. And it is the number one
cause of adult disability. But we’re not here to talk
about the 30,000 foot overview. I want to zoom in on the
impact that it has on you, as an individual, and the
impact that it has on your life. So I want you to take a trip
down memory lane with me. I want you to think all the
way back to what life was like before you had back pain. Now, with the patients that I
work with, they’ll often say, life before pain was good. I was active with
my relationships, with my friends, and my family. I was raising my kids. Going to work, maybe
going to school. I was involved in recreational
activities and hobbies. And I was independent. I could pretty much
do whatever I wanted. I didn’t have any limitations. Doing things like
running errands, cooking, cleaning, vacuuming– they were easy. Almost took it for
granted, it was so easy. And then, the back pain set in. And in the beginning, of
course, it was a disruption. It was probably, a
nuisance, but you can see from looking
at this slide, that it was just a
part of your life. It wasn’t filtering into
all aspects of your life. You figured, you’d go to the
doctor, you’d get treatment, and then, you’d get better. Life would go on. You’d get back to normal. And for those of
you in the room that have chronic back pain
and those of you watching, that didn’t happen. It didn’t go away. It persisted. As chronic pain
continues in our life, it doesn’t just remain in
that small little circle. It starts to bleed into
all aspects of one’s life. So it starts to affect our mood. Dr. Darnall mentioned,
irritability. I don’t know how
many people tell me, I just feel like things that I
could tolerate before, I just can’t tolerate anymore. My fuse went from here to here. It can also, affect
depression, anxiety, anger. It can interfere with
your ability to sleep and we know how hard it
is to function when you can’t get a good night’s sleep. It can also affect
your relationships. Family stress– it
doesn’t just affect the person that has
pain, it affects all of those relationships. Also, our physical conditioning. Dr. Cooley is going
to be talking next, about the importance
of movement when you have chronic back pain. Sometimes, it can lead to
weight gain or weight loss so it can cause other problems. Isolation. And then, how we feel about
ourselves, our identity. It can rob us of
that and make us start to question like, who
am I, if I can’t do the things that I used to be able to do? I had one patient that I worked
with that I thought, summarized this beautifully so I
always use his example. He said, “chronic pain
hijacked my life,” So what I just described
is this transition from acute to chronic pain. So acute pain is
considered pain that lasts less than three months. Usually has a rapid onset. The hurt– meaning the
pain that you feel– is usually associated with
some sort of tissue damage. So with that type of
pain– with acute pain– the treatments that you receive
include, rest and medications. And they’re very cure focused. You’re going to
go to the doctor. They’re going to
give you something. And you’re going to get better. The most important components
of these slides are in yellow. I know that it’s close to
lunchtime and I know myself, I start to lose focus so
I wanted make it easy. Everything that really–
the take home message, they’re highlighted in yellow. So the most important part
to know about acute pain is that your role as
the patient is passive. So what does that mean? What does it mean to be passive? It means, just like I mentioned. You go to the doctor. They’re very directive. They tell you what
to do, you do it. But then, we go
into chronic pain. That’s pain that lasts
longer than six months. Hurt– meaning pain– does not necessarily mean
imminent danger to the tissues. Dr. Cooley’s going
to get into this in a little bit more detail. She’s a physical
therapist in our clinic. But it’s important
to recognize this. Now, that does not
mean the pain that you feel is not real
because it absolutely is or that it’s not intense. It just means it doesn’t serve
the same purpose as acute pain. The treatment
course also changes. It’s less cure focused and
it’s more management focused. Activity is essential
to recovery. And medications are usually,
prescribed with caution because of the long-term side effects. Dr. Kao is going to be
talking about medications and chronic back
pain later today. And here’s the take home
message from this slide. So your role changes. Your role as a patient goes
from passive to active. So what does that mean? It means that instead
of just relying on the doctors or the
physical therapist to fix you or cure you, you have to
collaborate with them. So it’s really, more
about what you’re doing to manage your
pain that will make a difference in your function,
more so than what the doctor is doing for you. But you still need their help. Dr. Mackey mentioned how back
pain is treated as a team. Well, think of that, you
are the leader of that team. So we know the impact
of pain is significant. It affects all
aspects of one’s life. I put this in here because
increased utilization of the health care system– I think– is important. How many of you ever imagined
you’d be spending so much time having to go to the doctor? It’s just not something
that most people want to do or ever thought they
would have to do So the gold standard for
treatment for chronic back pain has three different tiers. You’ve got your
medical treatment. You’ve got your
physical reconditioning. And then, there’s also, the
behavioral and lifestyle modification. Now, research tells us,
when you get all three of these treatments
together, that’s when the results are the best. So if you have chronic
back pain and you’re only doing one of these and you feel
like your pain is interfering with your life, please, talk
to your health care provider and ask them about receiving
some of these other services. So we know that all
pain is influenced by psychological, physical,
and behavioral factors. Now, why on Earth
is that good news? It’s good news because these
are all factors that you can learn how to control. There’s a certain
loss of control that people feel
when they have pain. Loss of control over their life. Loss of control over being
able to do certain functions. So learning to control these
psychological, physical, and behavioral factors
can help you get back in the driver’s
seat of your life. You can decide
where you’re going, instead of letting the pain
decide where you’re going. So how do we do that? That brings us to the
meat of today’s talk, which is self-management. So Dr. Mackey already touched
on the national pain strategy and how this is
being used to help move things like
self-management programs, into the health care
system, which I think, is really needed and
really important, but I just wanted
to highlight this, that self-management
has been recognized to be so important that
on a national level, there’s being plans developed
on how to incorporate that into your care. And we’re doing that at
Stanford and many other places are doing this, as well. So I like this quote
because, I think, it highlights that shift
from passive to active. “Research now supports
the conclusion that how well patient’s
manage chronic pain, depends more on what
they do themselves, rather than what
is done to them.” That’s an incredibly
powerful statement. It has more to do
with what you are doing than what we, as
health care providers, are doing for you or to you. And that’s because
most of the change that happens with managing
chronic pain, it’s not done by the
health care providers. It’s done by you. So I wanted to just summarize
the research on self-management and pain. So we know that it improves
knowledge about pain, but it also, reduces disability. It improves your mood. And it enhances the
other treatments that you’re receiving. So this is something
that’s used in conjunction with all the other treatments
that you’re already receiving. So when I was asked to give
this talk on self-management, I was actually, having a
conversation with Dr. Cooley– who’s our physical therapist– and we were debating about,
what is self-management? And so I wanted to define
what self-management is so that we’re all
on the same page. So each of you are
already self-managers. You’re managing your
pain from the moment you wake up in the morning to
the moment you go to sleep. You’re not just
managing your pain when you’re at the
doctor’s office. Your physician didn’t
wake you up this morning, and get you dressed,
and feed your breakfast, and drive you here. No, you’re already
managing your pain. So this talk really isn’t
about self-management, it’s more about effective
self-management. So how do we figure out if we’re
effectively managing our pain? If you feel like you still
have limitations in your life, that you’re not able to
do things that are really important to you, then learning
additional self-management strategies might be beneficial. Some of you might be
managing effectively. Some of you might be
managing effectively in some areas and then,
maybe struggling in others. And then, there’s
probably, some of you that are just really
struggling and need some self-management resources. So I hope you’ll be
able to walk away today, with a number of those
resources so that you can help yourself
move forward and live the life that you want to live. So whenever I give my
self-management talk I like to think about,
what has to change in your perspective
of managing your pain? And I think the first step
is really, acceptance. So accepting where
you are today– your level of function– and figuring out, where am I? And then, where do I want to go? So identify what it
is that you would like to work toward so
identifying the values and goals that you have in life. And then, mobilize your support. Get the people in your
support network on board. Become active in your
care and collaborate with your providers. We know that having information
is really important, but that’s not enough. It’s not important enough
to know that catastrophizing is bad for pain. We have to do
something different so action leads to change. And you’re going to
have an opportunity at the end of today’s talk, to
develop your own action plan. So when you’re
learning new skills, it’s important to
think about, well, how do I learn a new skill? Think about a few learn
a foreign language or if you are learning
how to play the guitar– how would you do that? Well, you would read
books and watch videos. Maybe, take some classes. Talk to professionals. And you’d talk to other people
who are using those skills. Same thing with self-management. Same type of strategy applies. And you would want to remain
flexible and compassionate toward yourself because
this is not easy. It’s hard to change. And know that there’s
no endpoint to learning. It’s not like, I’ve learned to
play the guitar the best that I can and now, I’m done learning. That’s just not
the way it works. And remember, that
practice is important because the more we
practice something, then it becomes a habit. So I wanted to provide you
with some resources of how you can find these
self-management classes and tools in your community. So the first resource is the
Chronic Pain Self-Management Program. This was developed here, at
Stanford, by Dr. Kate Lorig. It’s a peer-led program. And if you live in California,
you can go to this website and it will give
you an opportunity to put in your community. It will pull up all the programs
that are offered in your area. Now, if you don’t
live in California and you’re live streaming,
you can go to this website and this will give you
information on other countries. I believe, there’s
over 20 countries that this program is offered. And this is the
book that it uses, it’s, Living a Healthy
Life with Chronic Pain. Even if you don’t
take the program, I recommend that you
purchase the book. It’s an incredible resource. And lucky for you, it’s
one of the giveaways today. So in the Chronic Pain
Self-Management Program, you learn a variety
of techniques. And I don’t have time to go
through all of them today, but I just want to highlight
three of them that, I think, are the most important. And that’s problem
solving, action planning, and decision making. Now, why are these important? Think about if you’re trying
to do something that’s hard for you to do
with your back pain, like maybe, cooking dinner
for your loved ones. Say, it’s your anniversary and
chopping vegetables is really difficult. You’re
not going to call your doctor, your physical
therapist, or your pain psychologist when you’re
halfway through the meal and be like, my back
pain has acted up. Do you think you could
walk me through this? No. But these classes actually teach
you very structured ways on how to problem solve on your own
and this is not common sense. It isn’t. So it’s really helpful to learn
these different strategies. The other thing I
wanted to mention was the American Chronic
Pain Association. This is their website. They have support
groups that are offered throughout the country. They also have valuable
resources on their web page, that you can go to. They have a wonderful series of
videos called, Health Matters, and it’s a great resource to
sit down with your loved ones and watch. They just had their
35 year anniversary. It was developed
by Penney Cowan, who is a person who has pain. She’s dedicated her life
to teaching people who have pain and their family
members, to understand pain and to move forward. So it’s just an
excellent resource. We host one of
their support groups on site, at Sanford in
Redwood City so you’ll find that on her website, as well. This is a tool
kit a difference– this is not
exhaustive– but it’s a tool kit of different
self-management skills. I just wanted to
put this up here to give you a sense of how
many different types of tools there are. And know, that it’s not
like you just use one tool, you use many tools. And it’s important to have
different tools to choose from because maybe, one day,
you run through five of them and they don’t work. What do you do? Then, you switch
to the other ones. I know I’m getting
to the end of my time so in your packet
today, you were given a piece of blue paper– well, you’re given two
pieces of blue paper, but the one that
I’m referring to is the one that has pain
management center on the top. This is what I call today’s
opportunity for change. So with all of the patients
that I work with at Stanford, I give this out. And I used to call
this homework, until I was told that
not everybody likes the word, homework so now,
it’s an opportunity for change. So what this is, is
it’s just an action plan so it allows you
to choose something that you would like to
work on or something that you’d like to change. Maybe, it’s something
that you’ve learned today. And you want to make
sure it’s reasonable, meaning it’s something you
can do between now and maybe, next week. And it’s behavior specific. So what does that mean? If I said, well, I want
to be in better shape– that is not a behavior. That’s an outcome of a behavior. So a behavior would
be, I’m going to walk. So I made up an action
plan for myself here so I’m going to walk 15 minutes
at noon, Monday and Wednesday. And then, I am identifying any
barriers that might come up. Those of you who
are in California, know it has been so hot here. So weather could be a barrier,
I could walk in the mall. And then, you’d write
your confidence level. So how confident are you
that you can complete your entire action plan? Zero to 10. If your confidence is
lower than a seven, you need to modify your
plan because you want to set yourself up for success. And then, you want to
track your progress and you want to share it
with the people in your life because you want their support. So when you checked
in today, you also got a list of resources. I provided you with some books
on managing pain, YouTube videos, and different
organizations that you can go to. I just want to thank you for
coming today to today’s talk. I just wanted to
really encourage you to use your action
plan and remember, that things don’t change,
unless we change our behavior. Thank you.

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