Download Part 3 - Health Recovery Group

Message to the Reader
Since David Corey first published his best-selling self-help book, Pain: Learning to Live Without It,
many of the approaches, which were then perceived as “alternative”, have been accepted as “best
practice” after being shown to be effective in evidence-based scientific reviews. Although his
message has stood the test of time, the day to day practice of health care practitioners and the
needed resources to facilitate treatment too often remain woefully inadequate. The unfortunate
result; patients suffer needlessly.
David Corey completed his doctorate at York University in 1978 in psychology and post-doctoral
training in behavioral medicine at McMaster University. In 1980, he founded Health Recovery
Clinic, the first private multidisciplinary pain management facility in Ontario. Since then, his
clinics have provided interdisciplinary treatment for pain including cognitive behavioral therapy,
biofeedback, manual therapy, active physical therapy and work conditioning for thousands of
injured persons.
He has carried out clinical research in pain management and participated in numerous task forces
and panels to try and educate policy makers and the public about the appropriate management of
chronic non-malignant pain. In an effort get this message out to sufferers of chronic pain as well
as to practitioners who would like to learn more about what is taught in his multidisciplinary
clinic, David Corey has generously made his book available on this website.
This book is divided into two main parts. The first entitled Why We Hurt discusses some of the
reasons why people have chronic pain, a subject widely misunderstood, by laypeople and health
care practitioners alike. Part Two, Towards Solutions: Strategies for Overcoming Pain, outlines
the main approaches used in the Health Recovery Clinic to help people cope better with chronic
pain. The emphasis is on giving patients active, self-management tools and strategies. I believe
that adopting this approach from the very beginning would prevent much disability and needless
suffering. Part Three contains the glossary, suggested reading and the introduction by Dr.
Hamilton Hall to the first edition of the book.
I would remind all readers that this book is not intended to replace the services of a physician.
While most chronic pain is benign, any pain can be result of disease and should be diagnosed and
treated only by a physician. Readers should discuss any recommendations, as set forth in this
book, with their physician before acting. Feel free to share this material with others, with
attribution.
DAVID ETLIN MD FRCPC
Internal & Behavioural Medicine
Medical Consultant, Department of Medicine
University Health Network
Medical Director, Pain Management Program
Health Recovery Clinic, 36 York Mills Rd, Suite 110, Box 400,
Toronto, Ont. M2P 2E9
November, 2004
Foreword
For most chronic pain patients, learning to live without pain seems like an impossible task.
Because they don’t know where to start or how to proceed, most pain sufferers can't solve the
problem alone. David Corey is an expert in helping those victims of chronic pain return to a
painfree lifestyle and his program in Toronto has an enviable record of success. During the
many years I have known and worked with David, he has taught me a great deal about the
causes, effects and management of disabling pain. Now David Corey has drawn together many of
his ideas and techniques and presents them in this book.
His approach emphasizes the difference between hurt and harm, and provides practical ways to
keep pain from taking control of your life. New concepts about the nature of pain have led him
to new methods of treatment. Two keys are a positive attitude and active patient participation.
Pain reduces function. Recovery, therefore, requires physical reconditioning as well as an ability
to relax and change your perception of pain. Although every patient needs an individual
program, David Corey has provided here the basic elements and essential strategies to give many
pain patients their first insight into their own problems and the ability to initiate a pattern of
healthier behavior.
This is a book based on practical and successful experience. It addresses difficult issues ranging
from malingering, lying about the presence of illness or pain for secondary gain, to medication
abuse. It destroys the myth of the pain personality, making it clear that any of us in certain
circumstances can become victims of the chronic-pain syndrome.
Resolving chronic pain is not easy. Acute pain, the natural and even beneficial response to
injury, is a part of life. Chronic pain, in contrast, is a damaging behavioral response, a response
which is learned over time and bears little or no relationship to the original trauma. It is a
behavior which can only be reversed through knowledge, understanding, and positive action,
through recreating patterns of normal activity in a carefully structured fashion. Accepting David
Corey's message and putting his ideas to work may make the difference between living in pain or
learning to live without it.
Hamilton Hall, M.D.
Glossary
Active Therapies: Therapies in which the patient is an active
collaborator and participant in the therapeutic process (cf.
Passive Therapies).
Acupuncture: An ancient Chinese technique for the stimulation of peripheral nerves either with needles or, more
recently, with a low-power laser.
Acute Pain: Short-term severe pain which rarely lasts more
than a few days or weeks.
Adequate Therapeutic Trial: The principle that each therapy should have an optimal time frame to determine its effectiveness.
Analgesics: Medications which have the primary effect of
reducing pain.
Anti-Inflammatory Medication: Medication which has
the major effect of reducing inflammation (e.g., Feldene,
Orudis). Most anti-inflammatories also have an analgesic effect.
Anxiolytic: An activity or medication which reduces anxiety
Assertiveness: A direct way of stating one's needs, wants,
and desires to produce changes in one's environment. Not
to be confused wirh aggressiveness.
Audio-Focusing: Concentrating on verbal or other auditory
stimulation as a relaxation technique.
Autogenic Relaxation: A relaxation technique that focuses
on the various sensations that are experienced during the
process of relaxation, e.g. warmth, lightness.
Axon: The part of a nerve ce11 dong which the electrical
impulse travels.
.
Baseline: As used in this book, a measure of the amount
of an activity that produces a noticeable increase in pain.
202
Glossary
Biofeedback: A technique of measuring physiological responses that are not usually consciously available to a person.
The information is then fed back to the individual in a form
that allows him or her to leam how to modify the physiological response.
Central Nervous System: The surn total of nerve tissue
within the spinal cotd and the brain.
Chronic Pain: Pain persisting past the usual time for healing. With soft-tissue injuries this is usually defined as starting
tluee months after the date of the injury.
Cluonic-Pain Syndrome: A constellation of behavioral,
emotional, physical, and cognitive changes that accompany
chronic pain and serve to worsen the pain and the disability.
Cognition: The process of thinking and knowing, including
perception, memory, judgement, and so on. This includes
thoughts, ideas, beliefs, and attitudes.
Cognitive-Behavioral Therapy: A systernatic learning a p
proach to a range of human problems focushg here on pain
therapy. Cognitive-behavioral therapy is derived from leaming principles in psychology.
Cognitive Dissonance: A state of inner m o i 1 resulting
from contradictions in a person's beliefs, or contradictions
between beliefs and behavior.
Cognitive RestrucniRng: A systernatic process of unwv~
ering and modifying cognitions. Used in cognitive-behavioral
therapy.
Comprehensive Pain Management: Treatment that encompasses both cognitive-behavioral therapy and functional
restoration to help people manage chronic-pain problems.
Conditioned Responses: Behaviors produced because of
past leaming, either through operant or classical conditioning.
Dependence: The unhealthy need for a medication or a
treatment.
Glossary
203
Disease Model: An approach utilized by the medical profession in which complaints or ttsymptoms" are seen as
rooted in disease or injury.
Distraction: An irnagery technique in which one's attention
is facused away from the undesirable stimulus.
Dorsal Horn: A part of the spinal cord where there are numerous nerve connections that are proposed to make up
the 'gate mechanism."
Endorphins: Morphine-like substances which exist in Our
brains and bodies.
Focusing: An imagery technique in which one's attention
is concentrated on modifying the undesirable sensation.
Functional Restoration: An interdisciplinary approach to
treatment and rehabilitation focusing on the measurement
and recovery of physical capabilities as a way of overcoming
pain and disability.
Imagery: Models of the real world created in your rnind
using any of the senses. These can occur spontaneously or
can be consciously produced.
Leamed Helplessness: A state akin to depression, in which
inactive, lethargic behavior interferes with normal learning.
Learned Pain: Pain produced by the central nervous system
because of past reinforcements and conditioning. Also
known as "memorized pain."
Locaf. Anesthetic A pain-killing chemical which is usually
injected to deaden pain in a particular area, e.g. the use of
Novocain by dentists.
Malingering: The conscious "faking" of a pain state or other
symptoms.
Motor Signals: Messages sent from the central nervous system to peripheral muscles that produce muscular activity.
204
Glossary
Multi-Dimensional Treatment: A therapeutic approach
which encompasses al1 of the contributing elements of a
problem.
Neurochemicals: Specialized chemicals which exist in and
around the synapse and convey messages from one nerve
cell to the other.
Operant Pain: Pain produced through reinforcemenr of
pain behaviors.
Pacing: The process of controlling activities based upon
predetermined schedules, as opposed to having those activities controlled by pain levels.
Pain-Control Strategy: Any technique or approach used by
a person to manage pain.
Pain-Prone Personality: A theoretical construct that holds
that some people are prone to developing pain conditions.
Pain Scale: A way of reporting the amount of pain experienced, such as the O to 10 scale used in this book.
Pain System: The nervous-system pathways that serve to
signal damage and create the perception of pain.
Pain Threshold: This indicates the level at which pain begins to intrude into conscious awareness. Pain may be in
existence below the threshold level, but the individual rnay
not be constantly aware of it.
Pain Tolerance: The point at which pain becomes so severe
that it significantly interferes with activiries.
Pain-Triggers: Factors such as emotions, stress, physical activity, etc. that serve to modify the functioning of the pain
system and thereby the experience of pain.
Passive Therapies: Treatment techniques in which the patient is a passive recipient of a r e , e.g., massage, TENS, etc.
Phantom-Limb Pain: Pain in a limb or extremity that has
been amputated.
Phobia: An unreasonable fear of a thing, situation, or other
stimulus.
Glossary
205
Placebo: A "fake" treatrnent such as a sugar pill which is
given to a patient who believes that the treatment is in fact
real.
Post-Traumatic Stress Disorder: A diagnosis for a person
experiencing the emotional sequelae of a traumatic event
such as an accident or a wartime experience. It is characterized by frequent rumination on the traumatic event, nightmares, and anxiety attacks. Pain may also be a symptom.
Prepain Cue: A feeling of tightness or mild discomfort
which predictably signals the onset of a pain increase and
which can be used as a cue for pacing.
Psoriatic Artluitis: One of more than a hundred arthritic
conditions. It is associated with psoriasis.
Re-Labelling: An imagery technique in which one focuses
on directly modifying the perception and experience of a
negative stimulus.
Self-Hypnosis: Hypnosis which is conducted and controlled
by the individual.
The inner voice that helps us to monitor our actions and direct our activities.
Shaping: The process of taking small, predetermined, and
graduated steps to increase the arnount of an activity.
Sleep-Onset InSomnia: A persistent inability to fall asleep
at the desired bedtime.
Soft-Tissue Injuqc An injury to muscles, tendons, or hgaments, as distinct from an injury to bones or nerves.
Spontaneous Remission: An automatic recovery process
that occurs with any injury or disease.
Synapse: The point at which two nerve cells cornmunicate
with each other through the release and uptake of neurochernicals.
Systematic Desensitization: Consists of pairing a relaxed
state with the imagined or real presentation of the phobic
stimulus with the result that the stimulus gradually fails to
elicit the fear response.
Self-Ti&
206
Glossary
Thought-Stopping: Using a sharp, predetermined command to yourself to stop undesirable thoughts or activities.
The command can either be under your breath or spoken
out loud.
Transcutaneous Electrical Nerve Stimulation (TENS):
An electrical stimulator placed upon various points on the
skin which has the effect of temporarily reducing pain.
TypeA Personality: A theoretical conçtruct of a personality
type who is aggressive, highly stressed, success- and
achievement-oriented, uptight, anxious, and obsessive about
details. There are indications that Type-A persons rnay be
more susceptible to cardiovascular disease and stress-related
illnesses.
Working to Schedulq Pacing an activity according to a
predetermined limit, independent of pain.
Working to Tolerance: Engaging in an activity and pushing
to your level of conditionkg, i.e., your physical starnina or
pain level.
Suggested Reading
-
Benson, Herbert and Miriarn 2. Klipper. The Relaxation Resgonse. New York: Avon, 1976.
Bergland, Richard. The Fabric of M i d . New York: Viking
Penguin, 1985.
Cousins, Norman. Anatomy of an Illness as Perceived by the Patient. New York: Bantam Books, 1981.
Hall, Hamilton. More Advice From the Back Doctor. Toronto:
McClelland & Stewart, 1987.
Hanson, Peter G. TheJoy of Stress. Islington, Ont.: Hanson Stress
Management Organization, 1986.
Hanson, Richard W. and Kenneth E. Gerber. Coping With
,
Chronic Pain: A Guide to P b t SelfiManagement. New York:
Guilford Press, 1989.
Hauri, Peter and Shirley Linde. No More SkepZess Nights. New
York: John Wiley & Sons, 1990.
Hebert, Lawen Andrew. Sex B Back Pain: Advice on Restoring
Cornfortable Sex Lost to Bmk Pain. Bangor, ME: IMPACC,
Inc., 1992.
Mayer, Thomas G. and Robert J. Gatchel. Fumtional Remration
for Spinal Dismders: The Sports Medicine Approach. Malvern,
PA: Lea & Febiger, 1988.
Melzack, Ronald and Patrick Wall. The Chdlhge of Pain.
Toronto: Penguin, 1989.
Turk, Dennis C., D. Meichenbaum and Miles Genest. Pain and
Behauioral Medicine: A Cognitive-Behavioral Approach. New
York: Guilford Press, 1983.