2014 IPPS Conference Must-Read Nuggets: Part I

Last week our staff attended the 2014 Annual Meeting of the International Pelvic Pain Society (IPPS) in Chicago. During its nearly 20-year existence the IPPS has been a major driver of the progress made in the treatment of chronic pelvic pain. And what makes the Annual Meeting of the organization so exciting is that it provides an opportunity for our community of providers to take stock, to determine where we are and where we still need to go in our quest to provide the best treatment for our patients.

Take a look a few of these must-read nuggets from the conference!

Malinda heard Dr. Afton Hassett give a wonderful presentation titled The Role of Resilience in Chronic Pain. In her presentation, Dr. Hassett discussed the nature of pain and that pain is processed by many areas of the brain and not solely the somatosensory cortices. Pain can be sensory, emotional and cognitive. Sensory pain is what most of us are aware of. An example is when you place your hand over a hot flame. An example of emotional pain is going through a breakup.

In one study referenced by Dr. Hassett, researchers found that when a person goes through a breakup the sensory and emotional parts of the brain are both activated. The conclusion: thoughts and emotions are processed by similar parts of the brain.

Dr. Hassett discussed her research on the affects of negative and positive emotions with regard to pain. She has found that negative emotions can contribute to the following: higher pain intensity, lower pain tolerance, worse weekly pain, greater use of pain medication, increased fatigue, more physical symptoms, and poor quality of life.

Dr. Hassett stated that patients who have positive emotions have a higher tolerance to pain, decreased pain intensity, decreased same day pain report, decreased use of pain medication, and a longer life span.

Dr. Hassett acknowledged the difficulty of staying positive while experiencing pain. She recommends one or more of following interventions to help stay positive:

• Keeping a gratitude diary: Write down three things daily that you are grateful for. The three things must be different each day. Smile as you write these things down, which will help you feel grateful.
• Gratitude visit: Think of people in your life who have been kind to you, but have never heard you express your gratitude. Write a gratitude letter to one these individuals, describing why you are grateful. Name specific events or things they did for you and how it has affected your life. Make an appointment with the individual and read the letter out loud to them. Discuss how both of you feel about each other, the letter, and the future.
• Three good things: Before bed write down 3 good things that went particularly well that day. Next to each positive event, answer the following questions, “Why did this good thing happen?”
• Intentional Kindness: Everyday do one intentionally kind thing for a loved one, a complete stranger, and yourself. Look the person in the eye and be gracious. Expect nothing in return, however acknowledge the gratitude if offered by the other person. When you intentionally offer one kind thing to yourself, acknowledge the importance of self-care and kindness. Log these acts in a diary and take note what the kind act was and how it made you feel.
• Savoring a beautiful day: Block time off on your schedule for at least one hour, up to eight hours for your own pleasure. Plan one or a sequence of activities that brings you real pleasure. Savor each activity using all your senses and with feeling of gratitude.

Casie also commented on Dr. Hassett’s lecture. As PHRC’s resident Yogi, she had some interesting insights!

As a physical therapist and a yoga teacher I often find myself wearing two different thinking caps as I try to find balance between western medicine and more yogic principles in my treatment of patients with chronic pelvic pain. Often times these two worlds don’t overlap so I was pleasantly surprised when Dr. Hassett asked participants at this year’s IPPS conference to take part in an exercise I have practiced many times in yoga workshops.

Dr. Hassett asked this very serious group of health care professionals to stop and take a moment to make eye contact with the person sitting next to them, smile at them, and then say something kind to them. As you can imagine there was an uncomfortable unfamiliarity and awkwardness at first, however there was a palpable shift in the mood in the conference hall after just 3 minutes of kind exchanges and deliberate personal connection.

Dr. Hassett’s point was this; that positive affect is a positive predictor in patient’s reported pain levels, health outcomes, and sense of well-being.

As clinicians working with patients with chronic pelvic pain we are well equipped with the pharmaceuticals, nerve blocks, surgeries, etc. that our patients often unfortunately require at times. It was nice to hear that Dr. Hassett was reminding us as clinicians that we have more tools to serve these patients are using a biopyschosocial approach, something that was a common thread throughout many lectures at IPPS. The exercise mentioned above was an example of an intervention that could increase resilience, a quality that has been found in the research to play a role on positively impacting positive affect. We want this in our patients!

Dr. Hassett cited a long list of studies throughout her talk linking positive affect in patients with lower overall pain ratings, decreased induced pain sensitivity, decreased use of pain medication, and longer tolerance to pain. She cited data that linked decreased positive emotions in patients with chronic pelvic pain (Hassett et al. Reg Anes Pain Med 2012;37:398-402) and emphasized the need to boost resilience as a way to combat pain.

Another study performed on a group of patients recovering from Lyme disease showed that positive affect was the “only significant predictor of persistent symptoms” (Hassett, results not yet published). With such a direct correlation and positive predictive power it makes sense that we as clinicians promote these qualities that have the potential to help our patients in a way that surgery and injections might not.

Dr. Hassett has inspired me to wear new kind of thinking cap as I go back into the clinic this week; one that blends both evidence-based practice and classic yogic philosophies promoting psychological well being. I’m excited to get back to the clinic and start sharing these findings with my patients.

Great job Malinda and Casie! It was so interesting to read what you each took away from the presentation, which was a true highlight of the conference!

For her part, Melinda heard Carolyn Vandyken, PT speak about integrating central sensitization into clinical practice. She began by differentiating acute and persistent pain and how persistent pain involves the central nervous system and is often multifactorial. She highlighted the fact that pain cannot be removed without leaving a change in the person.  She concluded by discussing treatments aimed at the central nervous system and shared with us a powerful short animation from Dr. Brené Brown of the RSA called The Power of Empathy, http://www.thersa.org/events/rsashorts/the-power-of-empathy

And Stacey heard Jennifer Gunter, MD speak about interventional procedures for chronic pelvic pain. Dr. Gunter believes that the key principles to pain management for chronic pain are first and foremost patient self-care and then as well medical management, physical therapy, interventional procedures, and mental health care. She focused primarily on the procedure component during her lecture. She described that the benefits from procedures are often not a cure but can bring about temporary improvements that can help with improved mobility, reduce central sensitization, and improve ability to perform physical therapy. Examples of procedures are trigger point injections, nerve blocks, radiofrequency, and Botox injections.

Stay tuned next week for the second half of our conference coverage when, among others, Allison discusses Dr. Andrew Goldstein’s controversial lecture and Stephanie give us the low down on Dr. Jeannette Potts’ talk aptly titled “The Problem is NOT the Prostate!”

Did you attend the conference this year, what did you think? Are there any topics above that you’d like to read about more in depth on our blog? Let us know!

All our best,

The PHRC Team