100 Million Suffering from
Chronic Pain
Chronic pain plagues the well being and financial stability of our society. WebMD reports that “more than 100 million Americans suffer from chronic pain at a cost of around $600 billion a year in medical treatments and lost productivity, according to a report from the Institute of Medicine (IOM)”. Even with all the money being spent the IOM committee commissioned by Congress concluded that “pain is not optimally managed in the U.S. and that effective treatment of chronic pain will require a coordinated national effort to transform how the public, policy makers, and health care providers view the condition.” That report also stated that “there needed to be a Cultural Transformation in how Americans understand and approach pain management and prevention.” If you are currently working in an outpatient physical therapy department it is likely most if not all of your clients suffer with pain and of those clients over 1/3 will have chronic pain. As the chart below from the American Academy Pain Medicine illustrates a staggering 100 million Americans suffer with chronic pain not including children.
INCIDENCE OF PAIN, AS COMPARED TO MAJOR CONDITIONS
| Condition | Number of Sufferers | Source |
|---|---|---|
| Chronic Pain | 100 million Americans | Institute of Medicine of The National Academies (2) |
| Diabetes | 25.8 million Americans (diagnosed and estimated undiagnosed) |
American Diabetes Association (3) |
| Coronary Heart Disease (heart attack and chest pain) Stroke |
16.3 million Americans 7.0 million Americans |
American Heart Association (4) |
| Cancer | 11.9 million Americans | American Cancer Society (5) |
Traditional Treatment
for Chronic Pain
In my experience at the first evaluation, most clients readily describe their diagnosis and rationale as to “why” they are having pain. Since most clients have access to the internet or they have already been seen by another healthcare practitioner they start to believe what they read or what they have been told about their chronic pain as the actual cause of their pain. The treatment for this rationale is either medication, surgery, and /or some type of rehabilitative options such as manual therapy, stabilization, stretches, manipulation, dry needling, etc. Unfortunately, in most cases with chronic pain the results are not immediate and not very beneficial considering the 100 million people who suffer with chronic pain.
Our society undergoes an enormous amount of unnecessary surgeries and/or over prescribed pain medications. According to a new study in the journal Spine “suggests that in many cases surgery can even backfire, leaving patients in more pain and/or addicted to medications”. According to U.S. Department of Health and Human Services, “the U.S. is the world’s largest consumer of painkillers, using 71% of the worlds oxycodone and 99% of the worlds hydrocodene or Vicodin.” Clients suffering with chronic pain often say “what type of treatment will you administer different from the countless other physical therapists that I have seen for my chronic pain”. Clients often state they feel hopeless and doubt that physical therapy will could ever be the answer to their chronic pain.
Merging Eastern and
Western Medicine
Pain can be divided into three categories: acute, sub-acute and chronic. Chronic pain is defined as pain usually several months or years past the initial injury or initial injury when the pain to a region first began. The current paradigm to treat chronic pain clients is to identify the area of pain as dysfunction and then treat those dysfunctional pattern(s) of movement. Most medical practitioners will ask clients for a pain rating but then state that we “do not treat pain but instead treat dysfunction.” Clients are seeking therapies predominately because they are in pain not because they are stuck in a “dysfunctional pattern”.
Over the past 20 years I have earned 3 different yet overlapping medical field degrees – Certified Athletic Training (A.T.C.), Master of Science in Physical Therapy (M.S.P.T.), Licensed Acupuncturist (L.Ap.,). For the greater part of my professional career, I was in a relentless pursuit to develop a method to help clients with chronic pain experience immediate pain relief. Having a degree in both traditional western medicine and a degree in alternative eastern medicine has enabled me to merge philosophies and create my own technique – Reflexive Pattern Therapy™ (RPT™). RPT™ is the “Cultural Transformation” called upon by the IOM committee. Knowing that a client with chronic low back pain has some or all of the following findings; lumbar disc pathology, leg length discrepancy, core weakness and/or tight lower extremities will make absolutely no difference in making “immediate” changes to that client’s pain or disorder. Unfortunately this is exactly what is being performed in most if not all medical, physical therapy, chiropractic, and massage practices. This is the reason for such poor outcomes for chronic pain clients. We need to start to identify and evaluate clients with chronic pain in a completely different paradigm. This paradigm shift moves the medical practitioner from evaluating & treating clients from a structural, somatic, voluntary nerve system; thinking that intervention will make immediate changes to a client’s pain; to a new paradigm of non-structure, autonomic, involuntary nervous system thinking, that will create an instant connection and a solution for clients with chronic pain.
80/20 Principle
I have developed what I term an “80/20 principle” for medicine which is unlike the economical 80/20 rule by author Richard Koch. The medical 80/20 principle states at the beginning of treatment, I, the treating medical practitioner will do 80% of the work and the client will do 20% of the work. The job of the medical practitioner is to get the client to “feel better”. I achieve this by making immediate changes to chronic pain utilizing the techniques of RPT™, which usually takes between 1-4 client visits. At this point, the client will do 80% of the work and the treating medical practitioner will do 20%. The job of the client is to recognize they need to work to “get well”. This is where all of those initial structural, somatic, voluntary nerve system findings of; lumbar disc pathology, leg length discrepancy, core weakness and/or tight lower extremities become pertinent to helping your clients “get well”. You cannot get your clients “well” to feel “better” you must get them feeling “better” so they can get themselves “well”. The paradigm shift for the physical therapist is to learn a strategy that actually treats pain.
The Paradigm Shift – Reflexive Pattern Therapy™
RPT™ gives a medical practitioner the knowledge and expertise to be “THE” professional to treat clients with pain instead of prescribing potentially harmful drugs and suggesting unnecessary surgery. (RPT™ was founded and developed by Andrew Bloch). The RPT™ method has unidentified specific involuntary reflexive patterns of pain, tenderness or ticklishness on the body. Once a trained RPT™ therapist identifies these areas and subsequently treats these reflexive patterns, the client will have an “immediate” result. A foundation of RPT™ is that to treat chronic pain you must first treat the involuntary autonomic nervous system before you treat the voluntary somatic nervous system.
For example, if a child was crying and needed your help, would you immediately start stretching, poking, manipulating the child or would you calm the child so that you can work on the child? With RPT™ once you address the involuntary nervous system the body will have a sense of calmness and you can then begin to work on underlying dysfunctions. The paradigm shift occurs with RPT™ for two reasons. First the painful area is never directly treated, i.e. no manual therapy, soft tissue techniques, dry needling, stretches, or manipulation and second the relief to the pain area is immediate. After immediate pain reduction a physical therapist can provide a clear platform to work on mobility, stability, posture and any other underlying dysfunctions. RPT™ was not developed to take the place of traditional therapy conversely it was developed so traditional physical therapy techniques can truly work to treat dysfunction.
The RPT™ Difference
Some advantages of RPT™:
- No age restriction (proven more efficient with geriatrics than middle age clients),
- Works with pain in multiple locations,
- No fancy/expensive equipment,
- Easy to teach/learn and immediate application.
While RPT™ is not a cure it is curative. RPT™ simply allows you to get the client participating much faster in their own recovery. RPT™ is a unique and phenomenal system to address chronic pain. Using this system will enable physical therapists to lead the “Cultural Transformation” of managing, treating and preventing chronic pain.