Taking back control
Rachel Sevigny has lived most of her life with back pain.
It was controllable in her younger years, but lately it has progressed into a wrenching, immobilizing disorder marked by painful spasms.
And make no mistake: This 32-year-old Grand Rapids woman is no stranger to pain. She was an athlete in high school, playing softball but also defying convention by competing in wrestling and football.
She remembers experiencing back pain from a young age, although it always seemed she could shrug if off. That’s been less the case in recent years, however, as simple tasks cause her some difficulty.
Walking her two dogs compels her to take a two- to four-hour nap afterward. Even her greatest joy, cooking for her five children ages 9 to 15, can present challenges.
She sought relief through traditional physical therapy, but it didn’t work as she’d hoped.
Not long ago, she thought about giving up the battle.
Then she heard from Tim Phillips, a Spectrum Health physical therapist and the clinical lead of a pilot program at Spectrum Health’s Gaslight Family Medicine clinic. Phillips was familiar with Sevigny because of her involvement in physical therapy. He wanted her to give his program a try.
He brings a new treatment method to patients just like her—those who can’t overcome their chronic back pain.
The approach: Train the brain to reinterpret its perception and understanding of pain and the feelings that accompany it.
Cognitive behavioral therapy
Sevigny has about half a dozen sessions of this new therapy under her belt.
In her most recent session at an exercise studio, Phillips started off by simply talking to her—exploring the stresses in her life, discussing her goals for fitness and health.
Subtly, he engaged the mental side of her pain, encouraging her to focus on how her brain can actually play a role in helping her.
Later in the session, he tossed her exercise balls that she caught while standing on a balancing device. It was classic core fitness, accompanied by an additional component of “brain therapy.”
It’s cognitive behavioral therapy, in fact, more commonly used by psychotherapists.
It’s flat-out joy for the people. They feel invigorated. It’s like the cloud has lifted.
Here’s what experts say: All pain derives from the brain. Experiences form perceptions and reactions. The connections between a person’s thoughts and emotions and the experience of pain are all linked.
Sometimes these thoughts can be distorted, which leads to thought processes that affect the experience of pain.
Anxiety and avoidance are normal human emotions and experiences, Phillips said, but when they’re amplified they become problematic, because they are then barriers to recovery.
Motivational communication can help physical therapists identify the thoughts, emotions and other factors that affect a person’s pain—isolation, depression, stressors and such.
All these elements are bound into one complex ball: You.
But the pain is real. So too are the emotions, sensations and feelings.
And it all deserves attention.
“By no means will I tell you it’s all in your head,” said Phillips, who has 13 years of physical therapy experience. “It’s absolutely real and (patients) are living with it.”
Taking back control
Last year, six Spectrum Health physical therapists trained at Keele University, the premier research center in the United Kingdom.
They learned how to blend principles of cognitive behavioral therapy with modern neuroscience, physical therapy and a “patient-centered interview format,” or motivational communication.
“They took 30-plus years of work and cooked it down to nine questions,” Phillips said.
Patients rate themselves on various matters, such as: Do you feel safe being physically active with back pain? Do you have worrying thoughts? Do you fear your pain is never going to get better? Do you not enjoy the things you used to? How troublesome is your back pain?
From that, Phillips can start to create a treatment plan that helps a patient address the troubling thoughts that accompany back pain.
Combined with traditional physical therapy, the course of the program ranges from a few weeks to about three months.
Phillips has 55 patients who have undergone the new treatment. His first-year findings will be completed in a few months, but here’s one example:
A 45-year-old woman quit her factory job and spent more than 80 percent of each day resting to avoid back pain. She was diagnosed with degenerative disc disease, so her physician recommended physical therapy.
Warning flags soon emerged: Her boyfriend caused her stress. She feared movement that would cause pain. She thought about applying for disability.
Phillips talked to the woman about some general concepts of back pain: Hurt does not equate to harm, and most people get better with movement.
Within a week, the woman committed to daily walks. Her days soon involved only about 20 percent resting time, and she began to consider seeking employment.
“No one ever told me it was safe to start moving,” she wrote. “They just said my back was degenerating, and I worried I was hurting myself.”
Two weeks later she cancelled her final visit with Phillips—she was feeling much better.
“It’s flat-out joy for the people,” Phillips said. “They feel invigorated. It’s like the cloud has lifted. …They feel like they are empowered.”
Count Sevigny in.
“I have never failed at anything before,” she said, smiling during a recent session where she wore a pink sweatshirt that matched a tint of color in her hair. “I’m going to be with him a while. I feel like I’m getting control back.”