Darien Behravan, DO, AQPM - New Approaches in Pain Management

Darien Behravan, DO, AQPM, with the Bay Area Pain and Spine Institute was the first speaker at the conference last week and did an excellent job: I thought his information would fall into place better for you after having given the overview by Drs. Teitelbaum and Rand. 

Chronic Pain affects 20% of the US population, or 60 million people, and has an estimated cost of $150-200 billion/year in lost work and other financial effects.  Additionally and more importantly, people are having a 'bad life' in many cases.  80% of people will say they have back pain of some sort, so this is really quite an issue for health care today.  50% of people with chronic pain are not treated appropriately, per Dr. Behravan.  Typically, opiods are prescribed, which people develop a tolerance for (see previous blog about Dr. Rand and Bay Recovery).  The plasticity of the brain, which we also reported on in previous blogs comes into play, with it's increasing in the perception of pain.  People with chronic pain can lose up to 5% of their brain's grey matter every year, and he recommends a 'functional MRI' in many cases.   Many of the drugs for fibromyalgia work on the central nervous system -- the central nervous system perceives pain through three steps: transduction, transmission, modulation.   Looking at the two types of pain, noceoceptic or neuropathic is important.  In noceoceptic pain the transducers are activated. 

It is beneficial to look at pain with a 'biopsychosocial model' - meaning body, brain, society -- the whole person within the context as being a family member, employee, contributor in society.  A person has activities and functions which are affected by pain.  Pain affects C reactive proteins, compromises the immune system, dispupts sleep cycle, and affects mobility and functional status.  "There is a real tragedy of pain" in that half of patients are not treated appropriately and end up with dysfunction and sometimes addiction.  The World Health Organization has suggested a 'ladder for pain' and the American Pain Society www.ampainsoc.org/ [1] also has guidelines which he recommends people refer to.   

Suggestions for physicians (and if you're a patient, please remember YOU might be the one to print something out and take it to your provider to help them learn what is important to you): Ask "where does it hurt" instead of "what is the matter" or "what can I do for you?".  He also referred to The Stanford 5:

1. What causes the pain?
2. What does it mean to you?
3. What is it's impact on you?
4. What is your peception of appropriate treatment?
5. What is your expectation?

And then there is "The 4 As of Pain Treatment"

1. Analgesia (medications, implants*, acupuncture)
2. Activity Level
3. Adverse Reaction (such as constipation being a side effect of opiods)
4. Abherent Behavior (abuse, misuse, addiction, pseudoaddiction)

*Implants have come out of heart pacemaker technology -- the impulse interrupts the pain signal of a nerve and can be therapeutic in some conditions such as sciatica. 

I hope this has been a helpful overview of another presentation at the conference last weekend, and I want to thank Dr. Behravan for his interest -- he obviously is quite knowledgeable and I was impressed with his incorporation of acupuncture as well as looking at things through a biopsychocial model, which truly is what OT is all about (function, function, function!).  It was a very progressive group last weekend, and we're bringing you the summary here.  I'll do one more tomorrow of the rest of the presenters before moving ahead to other things.