Friday, July 15, 2011

Weather report

View from hotel room, Whistler BC, July 15/11
Chair lift in the background. 
Horrible cloud; cold, windy, November weather in mid July

So, here I am at CPA Congress. So far Congress has been brilliant, with great food and fabulous presentations. Can't say the same about Whistler weather. It's like going back into the cave, coming here. Hard to get here, very long trip. Next year I hear Congress will be in Saskatoon. That will be much better. 

So, what am I learning? 

Day I
All day Thursday, Pain Science Division presented "Clinical Chronic Pain Management: Practical Strategies for Everyday Physiotherapy" which was fabulous; Neil Pearson talked about neuroplasticity, how it required 90 minutes a day for a month to change anything in the brain, but that change was indeed possible. He showed a list of pain mechanisms; nociceptive, peripheral neurogenic, central neurogenic, autonomic/motor, and affective; he said that the MDs learn that list, and then they learn from pharmaceutical companies that there is a drug or class of drugs for each (and that that's ... about it). He discussed chronic pain in general, what it meant, etc. There was much more from Neil, but my notes are sketchy and handouts will be emailed out later, so, don't have those to refer to.

Deb Patterson talked about how everything that hinged on change in pain hinged first on developing a good therapeutic relationship and projective goal setting. She explained the SMART (specific, measurable, attainable, relevant, and time-bound) goal-setting model. She had a few videos of patients she had treated, including with DermoNeuroModulation (my thing), and how the therapeutic relationship had turned out. One was a woman whose ends of fingers had been amputated, traumatically, and the woman had developed horrible phantom finger pain. Previous (failed) treatment had been "desensitization" but it had backfired - tapping and stimulating the ends of the finger stumps had revved up pain instead of reducing it.  After Deb had treated her face the phantom finger pain had disappeared, briefly, giving the woman an opportunity to realize she was capable of "no pain." Deb used mirror therapy with her too.  In the video we could see how Deb had moved the woman carefully through just looking at an intact right hand in the mirror box (stimulating visual cortex), to stroking it lightly and VERY gently with a cosmetic brush (stimulating affective somatosensory cortex), to asking the patient to thoughtfully and sensitively move her fingers, watching them move in the mirror (somatosensory and premotor and motor cortex). The swelling and pain went away. Now she could now tolerate wearing her finger prostheses, and as a result was going out, was being a lot more social. Absolutely brilliant clinical intervention.

Lesley Singer talked about having chronic facial pain herself, stemming from surgery to remove a brainstem tumor; what having chronic (centrally generated) pain was like, from a patient's perspective as well as from a clinician perspective, treating other people with chronic pain. 

Dave Walton discussed measuring pain with pain scales, and scales for all things related, such as depression, catastrophizing, anxiety, locus of control, readiness to change, fear, kinesiophobia, coping behaviours and strategies. 

This day long workshop is going to form the backbone of an entire Level II of the Virtual Pain Symposium we put together a few years ago.

Day II
The plenary session this morning was by Lara Boyd of Brain Behaviour Lab at UBC. No time to discuss it right now, must run off to the next event. More to follow.

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