Day 6 Pain Management

Francis was back and was the first presenter, beginning promptly at 10:00 a.m. with a half-hour of meditation. He played an audio file which he said was accessible in the members' area of the Kaiser website. I could understand about 50% of what the female speaker said.

After that, he took a few minutes to talk about his "medical mission" trip to the Philippines. He said it was special for him because it was his first visit there, even though both his parents had been born in the Philippines. He asked if anyone else had ever been to the Philippines, and M. (the one male in our group of 10 patients) said he had and that his wife was from the Philippines. So I found out those two things today.

Francis then focused on 7 core exercises and assigned 4 for "homework":

1. Spine twist (on the floor or bed)
1. Knees from side to side
2. Knees to one side, turn head (at neck) to the other side
3. Knees, head, look at hand, rotate hands
2. Squat
1. In and out of chair
2. Slide against wall
3. Standing balance (hold on to back of chair at first)
4. Lunge (both sides)

After the break, Dr. Whitehead came in for topics of the day, which included:

• Pacing and Prioritizing
• Sleep/insomnia
• Homework: develop a sleep routine

Photo below shows the view that Linda and Emily have while waiting for me at Kaiser.

At home, a Facebook friend posted this video to my Timeline with the tagline, "We need to address the opioid crisis — but not at the expense of chronic pain patients."

https://www.facebook.com/ChronicIllnessOnThemighty/videos/1641691609185914/

After viewing it, I realized that the Pain Management program at Kaiser--and probably anywhere, for that matter--is a "Pain Acceptance" program! It's definitely NOT about pain relief.

Day 5 Pain Management

Dr. Whitehead was, again, the main presenter. We started with a half hour of meditation and breathing, this time imagining we are on a beach. She seemed to be talking a little louder and I got 90% of what she said (instead of missing 90%!). The "gentle movement" was another group walk across the campus and back.
Discussion topics of the day:

1. The two RNs presented "The Feldenkrais Method" (stress-free exercise for people with arthritis) and guided us through some of the basic low-impact movements. [https://www.feldenkrais.com/about-the-feldenkrais-method/]
2. Dr. Whitehead did a quick review of the dietitian's presentation last Friday, only to point out some herbal supplements that were helpful in preventing migraines. This, my friends, IS the "anti-inflammatory foods" list that had been touted.
3. Dr. Whitehead then talked briefly about the option of keeping a pain diary (and she passed out forms) in order to determine what life events might be associated with times of pain.
4. We talked about high-impact activities and low-impact activities. At this point, we separated into small groups to discuss specific high-impact activities. All four in our group agreed that the most difficult thing to do without pain is getting out of bed!
5. Finally, our "homework" assignment is to track high-impact activities following by a low-impact activity in order to prioritize and pace our day.

Office Visit with Dr. Whitehead

9:00a seemed way too early to be up and doing anything! But it was a good session, casual and comfortable. It was mostly giving an overview of my current neck pain history and what else was going on in my life during the past year. I was relieved that she didn't think I was "bad enough" to need medication, though she said to let her know if I got into a place where I felt I needed it. She seemed optimistic that going through the Pain Management program would be beneficial to me.

She told me that Francis was the only physical therapist that dealt specifically with pain. I asked about learning acupressure and she said that Francis teaches that.

Day 4 Pain Management

End of the first full week. Dr. Whitehead started the session with a half hour of meditation. Again, she was so soft-spoken that I could barely hear here and couldn't understand most of it, but she seemed to be wanting us to imagine we are in a forest. The music that was playing conjured up images of a tropical rain forest, so there I was, with a raincoat and rain boots.

Then Ruby, the dietitian, came in, supposedly to talk about anti-inflammatory foods. She introduced herself as also the diabetes dietitian. But the presentation was specifically about migraines, not pain in general, and did NOT have anything to do with "anti-inflammatory foods"! The main message was to avoid/eliminate highly processed foods with chemical additives. No mention of nightshades, pro or con. It did recommend supplements like magnesium, riboflavin, and feverfew. It was disappointing, to say the least.

The "homework" for the weekend is to choose two pleasurable activities from a long list spanning two pages, and then journal about them. I chose "playing with the grandson" and "writing in a diary." Hence, these blog posts!

Phone appointment with Dr. Kalra

I set my alarm for 6:00a to make sure I could wake up to be coherent by 8:15a for my phone appointment with Dr. Kalra, Medical Director of the Pain Clinic. I was actually out at my desk, waiting by the phone from 7:30a until 9:30a, when he finally called! After a quick review of my pain status and current medications, he recommended gabapentin (300mg) for pain and said he would send a prescription that I could pick up at the San Leandro Kaiser. He quickly dismissed the idea that manual manipulation of the c-spine would have any lasting effects for pain relief.

Day 3 Pain Management

Today's session started out with Lisa, a Licensed Clinical Social Worker. She continued with the concept of the "Biopsychosocial Model of Pain" to show the relationship of physical pain to emotional responses. She also facilitated the meditation exercise and relaxation breathing. She wasn't nearly as soft-spoken as Dr. Whitehead, so I had no problem following her instructions during the "quiet" meditation.

The second part of this session was conducted, on behalf of Francis, for the "gentle movement" activity, which was to walk, as a group, outside around the buildings C, B, and A, and then back. Then they gave us a link to Francis' videos of exercises, which we can access at home at http://thechronicpaintoolkit.blogspot.com. I went to this blog at home, skimmed through the videos, and then clicked on a link "About Francis," and found this as part of it:

Introduction	This is a blog written by a physical therapist who specializes in chronic pain. My goal is to help improve the lives of the patients I serve.
Interests	Ketogenic diet, LCHF diet, cycling, meditation, yoga, tai chi

https://www.blogger.com/profile/08556776429137219637

Who knew?!?

Day 2 Pain Management

First "real" session (no more paperwork to fill out!). Francis is gone for 10 days on some kind of "mission trip" so Dr. Whitehead was the primary presenter. She showed a video of a TED talk by a woman who had had massive body injuries and accompanying pain and told her story of persistence in "getting her life back." I pointed out that this woman had the financial resources to do what she did, and Dr. Whitehead had to admit that was true.

She encouraged us to interact with each other by dividing us into small groups to discuss the video. Then she focused on "belly breathing" and had us practice for a long time. After that, we did relaxation/meditation and "gentle movement." Our "homework" was to practice "mindful breathing" at home. I knew I could best do that (and the meditation) while in bed.

She ended with a group exercise on the impact of chronic pain, what factors "open the gate" for pain and what factors close it. The whole point was to NOT focus on the pain! Yeah, right, a lot easier said than done!

Day 1 Pain Management Orientation

Francis and Dr. Whitehead facilitated this orientation session. There was a little more paperwork to fill out, but the "samples" of relaxation strategies with the breathing and mediation were longer. There was a lot of emphasis on the importance of attending every session (unless you are ill and contagious!), and required the patients to not only be able to attend every session, on time, and stay for the full 2 1/2 hours, but to be willing to go on temporary disability for 5 weeks. Not a problem for me!

I had already sent email to my web clients:

"This is to notify you that we are going to be in a 5-week outpatient program for Pain Management (January 19 to February 23). This does NOT mean that we can’t or won’t serve your online needs during that time. It just means that our work time will be reduced by 60%, so it might take a little longer to get to your job request. So if/when you have deadlines, please let us know as soon as possible. As always, thank you for this opportunity to be of service to you. Thank you for your patience and understanding!"

Phone appointment with Dr. Whitehead

I was on my way to the third of my three group acupuncture sessions that Dr. Sumetanon had ordered when my cell phone rang just as Linda pulled up to the front door of Building C. It was Dr. Whitehead, calling right on time as Parisa had said she would.

Dr. Whitehead verified that I could, indeed, join the Level 3 Chronic Pain Group that's starting on Friday, January 19. Yay! She also made an appointment for me, right then and there, for an office visit with her in a couple of weeks. Right after this phone appointment (which I had on my cell phone in the car), I went in for the last of my required three group acupuncture sessions.

Group Acupuncture #3

Another two weeks have passed, and this is my third group acupuncture session. Today I reported a pain level of 6.

I took this picture inside the group room, showing what I had to look at during this acupuncture session. All the other patients were behind me.

This week, the acupuncturist was a man named Paul Simon. There were two newcomers to this group, and he took time to talk to them before it was time to start the group session. He had charts showing the acupuncture points on the ears and a large model of an ear. He explained that this group used the points on the ear because those were the ones most directly related to nerve pain.

Again, I tried very hard to stay perfectly still and resist any movements of my eyes or mouth or neck--as much as it was painful--so the needles wouldn't fall out. When Paul Simon put in the needles, he was more assertive than the female acupuncturist had been, so I hoped that meant the needles wouldn't fall out!

Pain Management Overview Group

This was a three-hour--just what it was called--overview of what the Kaiser Pain Management program was like. They made it abundantly clear that, in most cases, this would not make the pain go away but would give the patient "skills" to cope with chronic pain. The main presenters were Francis, a physical therapist, and Dr. Whitehead, Pain Psychologist. They gave us just short "samples" of relaxation strategies: meditation, "calm breathing" techniques, and "gentle" movement.

There was a lot of paperwork to fill out and more detailed description of the programs offered. There were two once-a-week classes. Level 1 was called "Calm Body, Calm Mind" and was a drop-in group on Tuesdays at 3-5p. Level 2 was also once a week on Wednesdays at 3-5p with group acupuncture optional but encouraged. I knew I had to go straight for Level 3 called "Advanced Skills for Getting Your Life Back." Francis said the next Level 3 group would start on Friday, January 19, and that someone would evaluate our extensive paperwork and let us know within the next week if we would be a good candidate for that class.

I asked Francis how that could work since the next group would be starting in three days! He said to make a note at the top of my application that I wanted/needed to get into this class. So I did and kept my fingers crossed.

Pain Management Program at Union City

At my last physical therapy session (December 7) in Oakland, my therapist recommended the Kaiser Pain Management program. She sent her recommendation to Dr. Chan and I requested Dr. Chan, as well, for a referral to Pain Management. Instead, she referred me to Physical Medicine and Rehabilitation.

So I saw Dr. Sumetanon in Union City on December 14. He prescribed Flexeril, ordered an MRI, and required three visits to group acupuncture before anything else. He recommended that I attend some of Kaiser's "lifestyle" classes. I told him I was most interested in Pain Management, and he told me that my PCP (Dr. Chan) would have to give the referral to the Kaiser Pain Management program. It was only then that Dr. Chan agreed to give me a referral to Pain Management.

Three days later, I got a call from Pain Management. It felt like winning the lottery! As I had just been hearing from someone in one of my Facebook pain groups who had had to wait over three years to get into a pain management program. Someone else said that a two-year wait was very typical for those who get "free" health care in Canada.

Group Acupuncture #2

This is my second group acupuncture session, miraculously scheduled for two weeks after the first one. Again, the girl behind the screen asked me for my current pain level. This time, I said 7.

She gave me the two alcohol swabs and I knew what to do with them this time. I was not a newcomer this time, but still was one of the last patients in the room to get the five needles in each of my ears. I was a little more on edge this time and apparently twitched my nose too much because 2 or 3 of the needles fell out!