Hello.

My name is Dr. Patrick Davis.

I’m a psychologist and I work in the chronic pain program at the Montana Spine and Pain Center at Saint Patrick Hospital and Health Sciences Center in Missoula, Montana.

For the next little bit I would like to share some information with you about our Pain School here at the Center.

First, though, I want to provide you with a bit of background information so you can see how Pain School fits into an overall approach to management of chronic pain.

At the Montana Spine and Pain Center we are committed to treating chronic pain in a comprehensive manner that involves treating the "whole person."

What this means, is that the best and most effective treatment of chronic pain involves not only identifying and trying to treat whatever underlying physical problem may have caused the pain in first place, but also identifying and managing other things which may contribute to the pain continuing longer than expected, and/or which may cause the experience of pain to be more intense and to involve more suffering than is necessary.

Many different things may contribute to pain lasting longer and being more intense than is necessary.

Surprisingly, most of these things have little to do with the original injury or illness that caused the pain in the first place.

Instead, what often happens is that the way you react to your injury, illness, or pain, although seeming to make sense on the surface, actually contributes to the pain lasting longer and becoming more severe.

Because most people don’t know that this is the case, they continue to seek treatment for their pain as if they still had an active injury or illness. These efforts, however, are doomed to failure since the original injury or illness has usually healed or resolved.

As long as you continue to live your life as if you continue to suffer from the original injury or illness, you are likely to only experience the condition worsening with time.

As time passes, the pain tends to worsen, your ability to live your life in the way you wish continues to deteriorate, and your quality of life suffers more and more with each passing month and year.

Any number of complicating factors then begin to develop, including problems with depressed mood, anxiety, irritability and anger, getting out of shape, relationship problems, social isolation, and so on.

These complicating factors contribute: to ongoing pain, more intense pain, and continued deterioration in your quality of life.

Doctors try to help, but with time it becomes obvious that medications and surgery have only limited benefit. Eventually, your doctors tell you that they have nothing more to offer, and that you will have to: "learn to live with it."

This is where Pain School usually comes into the picture.

Once your doctors have determined that additional medical treatments are not likely to be of further benefit, your doctor may refer you to a program like our Pain School.

The purpose of Pain School at the Montana Spine and Pain Center is to teach you how to live well with your pain.

The purpose of Pain School is not to cure pain, although if you make a serious effort to learn the information, and to incorporate the pain coping and management skills into your daily life, it’s quite likely that you will experience some improvement in your level of pain. You may also see a significant reduction in the frequency and intensity of the periodic flares of intense pain which make it so difficult to be fully engaged in life on a consistent basis.

Pain School is based upon some important basic concepts.

One of these fundamental concepts is the idea that pain is affected not just by physical injury and/or illness, but also by behavior, thinking, emotions, and a person's social situation. We refer to this as: the Biopsychosocial perspective.

Another fundamental concept is that of self-management. Our emphasis on self-management reflects our belief that chronic pain should be viewed like any other chronic illness. Most, if not all, chronic illness require the inclusion of a significant self-management component in addition to any traditional medical treatments.

Just as a person with Diabetes needs to learn to monitor his or her blood sugar level and manage his or her diet appropriately, you need to learn the skills to manage the things in your life that contribute to increased pain.

Self-management can be contrasted with medical management.

In medical management, patients tend to be very passive recipients of things that doctors do to them but don’t do much to help themselves.

In self-management, you move out of the patient role and into a more active role. You take the primary responsibility for management of your pain out of the hands of the doctor in much the same way as a person with diabetes takes personal responsibility for management of their illness.

If you’re willing to adopt a biopsychosocial perspective of pain, and would like to take personal responsibility for self-management of your pain, Pain School can teach you skills that will help you to more effectively manage your pain.

Pain School consists of 13 classes - one per week. Each class lasts one and a half hours. Each class brings together a group of people with chronic pain and a couple of health providers. We teach you skills that can help you better cope with your pain and improve your self management of pain. And, we practice these skills at each session.

Pain coping skills involve those things that person does to get through a difficult period of increased pain.

Pain management skills involve those things that person incorporates into his or her daily life in the interest of keeping his or her pain at as low of a level as possible, and for the purpose of preventing, or minimizing the intensity of, periodic pain flareups.

Pain school begins with an orientation session. During orientation, you will get to know our staff and we will all get to know a little bit about each other.

We also provide an overview about things like the biopsychosocial model, the self-management approach, and the gate control theory of pain.

At the second meeting we focus on values and setting goals.

We believe that chronic pain is, in a sense, a "values illness."

By this, I mean that chronic pain often gets in between you and your values. Your quality of life suffers because you are no longer living a life that you truly value.

For this reason, it is important that you clearly understand exactly what your most important values are.

When it becomes clear that pain has sidetracked you from your most important values, it makes good sense to set specific goals for improved pain management and improved coping with pain so that you can once again begin to live a life you value.

Not surprisingly then, we also place a strong emphasis on setting goals in Pain School.

Another very important aspect of Pain School is a focus on relaxation and meditation training. We believe that this particular skill is so important that we spend some time during each of the 13 meetings practicing relaxation and meditation.

Relaxation and meditation can be used very effectively to cope with periods of increased pain and can prevent such periods of increased pain from occurring in the first place.

Relaxation and meditation skills help with getting to sleep or in getting back to sleep when you are awakened by pain or anxiety. These skills help in reducing chronic muscle tension and managing feelings of anger and irritability.

During Pain School we cover several additional topics; each meeting focuses on one specific topic.

Some of these specific topics include:

• activity pacing;
• management of emotional difficulties, such as depressed mood and anxiety;
• fear of pain and avoidance of activity because of such fear;
• misconceptions, beliefs, and thoughts about pain that may result in well-meaning but self-defeating behaviors;
• nutrition;
• sleep management.

Effective self-management of pain is also improved by increased physical activity and increased physical fitness. You’ll be expected to participate in some form of structured physical activity, such as physical therapy or yoga, in addition to the weekly Pain School meetings.

Your involvement in physical therapy, yoga, or some other form of structured physical activity helps you increase your ability to do the things that you value but may have been missing out on because of pain.

By the end of Pain School, you will have been exposed to all of the information which we are aware of that can help you most effectively self-manage your pain.

You should be on the road to reducing your pain, reducing the frequency and intensity of periodic pain flare-ups, and increasing your ability to engage in valued life activities.

You should be well on the road to enjoying a significantly improved quality of life.

The road, however, goes on, and in a sense, Pain School only provides you with the necessary vehicle and roadmap for negotiating the journey through chronic pain. Once you’ve completed Pain School, you’ll need to continue to develop and further refine the skills you’ve learned in Pain School and apply them to your unique life situation. For the participant who truly embraces the biopsychosocial and self-management perspectives, this will not be a problem.

Having an effective set of skills at your disposal, you’ll be able to look down the road and see not threats, but challenges, not crises but opportunities.

I cannot emphasize enough that what determines whether or not you experience significant benefit from Pain School will be your willingness to believe that the skills taught can make a significant difference in your life. You will need to learn, experiment with, and fine tune the information presented during Pain School.

So that is a little bit about Pain School.

Are you open to learning a new and different approach to managing your pain, one which relies primarily on personal responsibility for self-management?

Are you willing to make a significant investment of time and energy to learn and practice the skills taught in Pain School?

If you are such a person, and if you are ready to explore the approach to management of your pain that I have described for you today, you may wish to ask your physician for a referral to Pain School.

While we will not claim to be able to cure your pain, we will teach you everything we know about how you can more effectively manage your pain and reclaim your life.

I hope to see you in Pain School.