Striving to Thriving

Book Project

Striving to Thriving is also the title of our flagship book with a target publication late in 2021 (if the publisher cooperates). This is a practical guide and workbook for you and your providers to use in crafting an individualized treatment plan for YOU. At the end of each chapter there are various tasks, challenges, assignments to keep the reader engaged, not in the book, but in life, moving toward a thriving lifestyle.

Question: There is no shortage of books on the subject on chronic pain. So why write another one?

Yes, there are literally dozens of books readily available for chronic pain. Amazon sells most of them and a lot of them have good ratings. However, finding one written by a chronic pain patient who lives the chronic pain experience yet thrives, well I couldn’t find one. In my journey I could have used a reference containing specific practical tools to use and guide me but I couldn’t find one. Instead, I found a plethora of books written by physicians, nurses, psychologists, etc. Most are well written but from one specific perspective depending on the education and training of the particular professional. I wanted tools, or a toolbox, from which I could navigate my way to the best health possible.

Two Needs in the Chronic Pain Community

Thankfully, my pain specialist, Dr. Lisa Jo Stearns, provided some excellent materials passed out during her group sessions and her lectures were like drinking from a firehose. These were very helpful, but I also needed to hear the information she provides in her lectures more than once, as they contained a great amount of practical information for chronic pain sufferers. My problem is I can’t write as fast as she could speak. Ultimately, it was Dr. Stearns who inspired, encouraged and even challenged me to share the story of my journey. I have interviewed many chronic pain patients with various causes of chronic pain. I noticed that there were two common themes. One common theme was the need for “tools” from which one could pick and develop specific strategies that worked for them. The second challenge was how to work with multiple providers, most of which operate independently, with one perspective of the patient, rarely communicating with other providers. This work attempts to address those two needs.

Another major underlying theme in this work addresses brain health. Chronic pain destroys neural connections or pathways in the brain and establishes new ones not helpful in managing your pain or improving your quality of life. I discuss ways chronic pain harms your brain. Also important, if not more important, is knowing how chronic pain patients can protect and nurture their brains. While many other materials available touch on this subject, they don’t necessarily provide specific tools and concepts to protect and maintain brain function and improve mental health. If they cover these areas, they omit practical aspects of case management and communication between practitioners.

Again, as a chronic pain patient, I experience the entire biopsychosocial spectrum of challenges. This work provides a platform enabling the patient and every provider to build and share one common view of the patient and their struggles across all domains in the spectrum. This common view is the foundation from which patients and providers construct the treatment plan based on measurable outcomes. The measurable outcomes provide a means for determining efficacy and if any adjustments or changes are prudent, based on actual data provided by the patient.

Ultimately, this work underscores the importance of brain hygiene, and the importance of taking action to protect your brain from the ravages of chronic pain. Much of the work the patient will do to strengthen and reestablish new and healthy neuropathways is through the use of wellness writing. There are literally hundreds of research articles clearly documenting the benefits of wellness writing, not only for emotional and psychological benefits such as depression and PTSD, but for chronic pain as well. This makes sense, as many of the challenges chronic pain patients encounter are psychological in nature. Every chapter of the book includes opportunities for discovery and healing through your own writing. The results you will achieve will be both surprising and amazing.

For decades, I worked in the biomedical device industry. “Measurable outcomes” drive that entire industry and behaviors within the industry. Whether process validation or equipment qualification, nothing happens unless supporting documented measurable outcomes exist and are approved. The research required for both process and equipment characterizations is detailed, structured, and thoroughly documented. That documentation trail serves as evidence to the FDA of all the activities undertaken to produce excellent quality and reliable implantable electronic devices. Ultimately, it is the data analysis that defines all the critical inputs needed to produce such devices. Similarly, the “tools” used in the book provide both the patient and providers with various assessments, questionnaires, logs and templates to gather data (or documented evidence) from which you and your providers can measure and determine the efficacy of treatment plans.

So what role does the patient play in achieving measurable outcomes? How do patients and providers get the data? How are the data gathered, analyzed and communicated? This text addresses those questions too.

The Four Objectives

Included are practical templates, questionnaires and guides. These help both patient and provider better understand and evaluate the effectiveness of treatment plans. Why are these important?

First, because practitioners should stop treatments not providing measurable benefit, sparing the patient unnecessary pain, financial expense and stress. Instead, focus on those therapies providing relief and improved quality of life. Chronic pain patients suffer enough without enduring the frustration and disappointment in treatments having no positive effect.

Second, patient safety depends on accurate and timely communication between practitioners involved in every aspect of the patient. Everyone engaged in patient care prescribing medications must know what others are prescribing. Management of communication amongst specialists in patient care is a considerable challenge for anybody, especially if those professionals don’t practice “under one roof.” I designed the materials in this book to facilitate the communication process between the various practitioners.

Third, design, the elements in this book encourage patient engagement in their own care. The tools provided give the patient what they need to be their own Patient Advocate and do so proactively. This helps healthcare providers because the patient assumes greater responsibility in their own care. The tools are “friendly” to both patient and physician. As a result, physicians can enjoy greater confidence that the patient has the information needed to follow instructions before they leave the office. Also, the patient has the means to communicate new information to multiple providers as needed. Ownership by the patient and their specialists minimizes risks associated with accidental or improper use of medication or other therapies, assuming the patient follows professional medical advice and instructions.

Fourth, chronic pain patients struggle overcoming memory, cognition and emotional challenges. The templates, form, and exercises are designed to help the chronic pain patient overcome or work through these challenges. At the end of each chapter are activities specifically designed, so the patient experiences success, wellness, or accomplishment in all biopsychosocial aspects of life. Again, the goal is to achieve measurable outcomes leading the reader/patient to improved quality of life. The information and data contained in the tools will help your providers better understand not only what works for you, but will also help them better understand you as person, not just a patient.

Pain Management Best Practices

The Comprehensive Addiction and Recovery Act (CARA) of 2016 created the Pain Management Best Practices Inter-Agency Task Force. Their mission was to determine whether gaps in or inconsistencies between best practices for acute and chronic pain management exist and to propose updates and recommendations to those best practices. The Task Force comprised29 experts who have significant experience across the disciplines of pain management, patient advocacy substance use disorders, mental health, and minority health. The draft report describes preliminary recommendations of the Task Force submitted to Congress in 2019, following a 90-day public comment period. The final report[1] published in May 2019 aligns with and supports the underlying principles on which I started this book in January that same year. Some of the major recommendations include:

  • The establishment of individualized patient-centered care in the diagnosis and treatment of acute and chronic pain. This is important as each patient’s pain experience is unique to them as their challenges and complications are also unique to them.
  • Developing an effective pain treatment plan after proper evaluation to establish a diagnosis with measurable outcomes, focusing on improvements, including quality of life (QOL), improved functionality, and Activities of Daily Living (ADLs). “Measurable outcomes” becomes important for two reasons. First, improvement in one’s health is always critical. Second, if one form of therapy (drug or otherwise) is ineffective, it should be discontinued.
  • Taking a multidisciplinary approach for chronic pain across various disciplines, using one or more treatment modalities, when shown to improve outcomes. These include the following five broad treatment categories:
    • Medications, including non-opioid and opioids
    • Restorative Therapies
    • Interventional Approaches, Image-guided and minimally invasive procedures are available as diagnostic and therapeutic treatments, including trigger point injections, RFA (radiofrequency ablation, cryoneuroablation, neuro-modulation, etc.
    • Behavioral health approaches, cognitive, emotional, and social aspects of pain
    • Complementary and Integrative Health, including acupuncture, massage, movement therapies, spirituality, etc.

We should base effective multidisciplinary management of the complex aspects of acute and chronic pain on a biopsychosocial model of care. This is easier said than done. The challenge? Coordination of communication between providers. This is the underpinning of this work and discussed throughout the chapters.

Pain is part of the human experience. We all experience some manifestation of pain in our lives. Whether acute or chronic, we all experience pain and suffer its consequences. While pain can serve as a warning to protect us from harm, it also can cause extreme and even merciless suffering, surpassing any original cause to develop into a disease in multiple domains with far-reaching consequences. We all may share common experiences and expressions of pain, but in in reality, our experiences with pain are personal. We filter them through the lens of our unique biology, the society and community in which we were born and live, the personalities and styles of coping we have developed, and the way our life journey experienced health challenges and disease.

Finally, if you determine you need a tool that does not exist, or a modification to a specific tool, please contact me via email a david@strivingtothriving.com


[1] U.S. Department of Health and Human Services (2019, May). Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. Retrieved from U. S. Department of Health and Human Services website: https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html

 

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