EMS World

JUL 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 44 of 51

44 JULY 2018 | EMSWORLD.com THE OPIOID CRISIS larly relevant to emergency providers and victims of accident and disaster. The Substance Abuse and Mental Health Ser vices Administration (SAMHSA) acknowledges natural disasters can have damaging mental health effects, and with the popularity of social media, notes The Pain Project's chief psychology officer, Michael Munion, MA, LPC, information can spread worldwide in near-real time, which can make tragic events seem more frequent than they really are. 4 Recognizing this (not to mention their high rates of suicide, addiction, and injur y), The Pain Project will be developing sections and content specifically for first responders. Traumas are a matter of individual perception—more about a person's reaction than the event that prompted it. Seeing a serious accident or crime can be as traumatizing to some as a mass shooting or militar y combat experience may be to others. Stress reactions can range from mild to full post-traumatic stress disorder. The good news is that some of the approaches used for chronic pain are also beneficial against traumatic stress. CBT and MBSR Our best current nonopioid approaches seem to combine physi- cal, mental, and social therapies. Recent trials suggest such inte- grative, complimentar y practices can reduce chronic pain and its disability. 3 Two with promise are cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR). CBT is a form of psychotherapy intended to repair maladaptive emotions, thoughts, and behaviors by changing patients' distorted perceptions and destructive actions. 5 It's based on the idea that individuals themselves, not outside circumstances or events, create their own experiences, including pain, and by "changing their negative thoughts and behaviors, people can change their awareness of pain and develop better coping skills, even if the actual level of pain stays the same." 6 MBSR combines aspects like mindfulness meditation, body awareness, and yoga to help people become more mindful. Its concept is that the experience of pain varies among individu- als because the body's relationship with pain is cultivated and maintained in the mind and thus manifests differently in people with var ying experiences and influences. 7 Such approaches, Bobrow notes, are safer, cheaper, and less invasive than opioids and thus more congruent with medicine's primar y edict to "first do no harm." "There are a lot of dif ferent ways cognitive therapies help," says Bobrow. "One is by instilling a sense of control. None of us likes to feel out of control. And when we don't feel well, and noth- ing's helping and nobody can figure out what's wrong, it's ver y frustrating. When you start to regain a sense of control and see you can actually manage your condition—such as pain, depres- sion, anxiety, high blood pressure, addiction, etc.—you become engaged and active and start to heal." Nutritional changes can also help interrupt pain path- ways. Among these, Carol Johnston, associate director of the nutrition program at Arizona State University, told KJZZ, are avoiding meat (which is high in arachidonic acid) and consuming fish oil (which has fatty acids that counteract it). A vegetarian diet can eliminate most sources of arachidonic acid, and antioxidant-rich foods—especially those high in vitamin C—can reduce pain associated with free radicals damaging cells. Lack of vitamin C has been linked to surgi- cal pain, infectious diseases, and cancer. 2 Essential to the success of any of these, though, is a change in patient mind-set. We can become conditioned to be passive recipients of care—but managing chronic pain requires a proactive taking-charge and increased steward- ship of one's own health affairs. Chronic pain therapies that show the greatest long-term benefit are those that actively engage the sufferer in their treatment. 8 "People have to own whatever it is they're dealing with," says Bobrow. "They can't just say, 'This person isn't helping me!' or 'This treatment isn't working!' With cognitive therapy, you become the master of your destiny and understand it's up to you." The Pain Project Live for roughly a year now, The Pain Project (w w w.thepain- project.com) gathers the latest science, success stories, and strategies for managing chronic pain beyond opioids into a single portal. It added the teleconsults late in 2017. "People like the telehealth because they can do it from the privacy of their homes," says Bobrow. "It's confidential, For More Information Circle 26 on Reader Service Card www.trueclot.com Wearable tourniquet task trainer for scenarios and classrooms Hemorrhage control task trainers

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