Supported in part by Arkansas Blue Cross and Blue Shield and the Office of the Arkansas Drug Director and in partnership with the Arkansas Academy of Family Physicians (AAFP), the Arkansas Medical Society (AMS), the Arkansas State Medical Board (ASMB), the Arkansas Department of Health (ADH) and its Division of Substance Misuse and Injury Prevention (Prescription Drug Monitoring Program—PDMP) Continuing Education Credit: TEXT: 501-406-0076 Event ID: 30864-24581

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Faculty Disclosure of Financial Relationships: The planners of this RSS, Corey Hayes, Michael Cucciare, Johnathan Goree, Leah Tobey, Teresa Hudson, Marti Morrison and Cathy Buzbee have no financial relationships with commercial interests to disclose. A planner of this RSS, Shona Ray-Griffith, MD, has a financial relationship with a commercial interest to disclose: Neuronetics, Inc. – Contracted Research. The speaker of this RSS has no financial relationships with commercial interests to disclose. The accreditation compliance reviewers of this RSS, Karen Fleming and Courtney Bryant, have no financial relationships with commercial interests to disclose.

Continuing Education Accreditation: In support of improving patient care, University of Arkansas for Medical Sciences is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Credit Designation: The University of Arkansas for Medical Sciences designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The University of Arkansas for Medical Sciences designates this live activity for a maximum of 1 ANCC contact hour. Nurses must attend the entire session in order to receive credit. This knowledge-based activity will provide pharmacists up to 1.0 contact hours or 0.1 CEU. ACPE# JA0000298-0000-18-040-L01-P AAFP Credit: Submit your AMA credit Pharmacists: Please email us your NABP number and month and day of birth

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Self-care management for patients with chronic pain Leah Tobey, PT, DPT, cert DN

Objectives 1. Discuss the importance of educating patients on self-care management for chronic pain 2. Highlight the importance of non-pharmacologic strategies and self-care ideas 3. Discuss low health literacy and how it is correlated with poor health outcomes AR-IMPACT@uams.edu

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What does self management look like? “A healthy way to live with chronic pain is to work at managing the physical, mental, and emotional concerns rooted in your particular condition.” (Lefort, et al.) Knee replacement Hip pain Back Surgery Social factors Individual thought & behavior

Alternative Pain relief: Physical management Epsom soaks Physical Therapy Exercise Dry Needling: PT Monthly massage therapy Personal Training Self-help Alternative Pain relief: Physical management Strengthening & Stretching Acupuncture Chiropractor Self-pacing for energy Deep Breathing

Alternative Pain relief: psychosocial management Take Action Make plans & carry them out Socialize Prioritize Move your Mood Self-help Alternative Pain relief: psychosocial management Positive thinking Mindfulness Avoid personal put downs Counseling Psychiatry

Self management definitions “In health care, self-care is any necessary human regulatory function which is under individual control, deliberate and self-initiated.”(Wikipedia) “The ability of an individual, in conjunction with family, community, and health care professionals, to manage symptoms, treatments, and lifestyle changes.” (dictionary) The practice of taking action to preserve or improve one's own health. Self care is creating awareness, reframing your thoughts, changing your environment. (An American Addition Centers Resource: mentalhelp.net) “Providing adequate attention to one's own physical and psychological wellness (Beauchamp & Childress, 2001). Beyond being an aspirational goal, engaging in self-care has been described as an "ethical imperative" (Norcross & Barnett, 2008) and is part of the APA's Ethics Code (2002).

Alternative pain relief….Physical Therapy?

UAMS Physical Therapy Clinics: Spine Center 501.661.7955 Institute on Aging 501.526.5770 Autumn Road 501.320.7777 Colonel Glenn 501.406.9234

Alternative pain Relief Physical Therapy Recognize the trigger of your pain PT’s differential diagnosis to find the driver of the pain Patient’s self-awareness & self-management

Patient Education Example- patient with back pain: Pt needs to understand: Her/his common causes of back pain Action planning & problem solving techniques Topics frequently discussed in PT: Anatomy of the spine Pain mechanisms Exercises for managing back pain Pt with LBP

Educational topics The importance of maintaining physical activities Importance of resuming daily activities Use of medicines for controlling back pain Rx or OTC Physical methods of pain control Ice, TENS, heat Mind-body techniques for pain control Imagery Meditation Use of proper posture and body mechanics goal example: Pt to demonstrate correct hip hinge with squat while lifting 10# without increased pain. 1990 Augustus White’s Your Aching Back

Educational topics continued Stretching exercises Strengthening exercises The importance of aerobic exercise Managing sleep difficulties Managing sexual difficulties due to back pain Managing flare-ups of back pain Handling emotional & interpersonal effects of back pain Managing work problems associated with back pain

The Why is important… Unable to recall conditions or limitations, course of action, etc. Understanding diagnosis Poor health literacy ~37% adult Arkansas heave low health literacy (AR Dept of Health) Inactivity Higher mortality risk Lower QOL scores Higher pain ratings Sedentary lifestyle Poor eating habits Knowledge is power Moderate level of activity Lower mortality risk High QOL scores Lower pain ratings Active lifestyle Mindful nutrition Self-pacing

Health literacy Educational pamphlets on pain management IOA grant booklet Available for purchase as a starter Educational handouts on common ways to manage pain Diagnosis specific This helps you as a clinician document educational efforts toward health literacy Patients can keep a journal Sleep journal Pain journal Improves self-awareness & management General exercise suggestions 30’/day (10’ min increments) 150 minutes of moderate exercise/wk

Self Care Forum: whole systems approach; NHS Mandate for integration of selfcare throughout the NHS (www.selfcareforum.org)

Conclusion Encourage patients to take an active role in protecting their well-being & happiness, in particular during periods of stress or pain. (Oxford living dictionary) “autonomy in self-care and insulin administration"

Questions about the Topic Continuing Education Credit: TEXT: 501-406-0076 Event ID: 30864-24581