The “Whole Sum”
Approach To Managing
Back And Neck Pain
Elizabeth A LoFaso RN, BSN, MSEd.,ONC
Clinical Orthopedic Advisor
Knee and Hip Center
Kenmore Mercy Hospital
(716) 447-6747
Objectives
List three alternative therapies for managing
back and neck pain.
List three lifestyle changes to manage back
and neck pain.
Alternative Therapies:
Mind-Body
Therapies
Acupuncture
Chiropractic
Treatment
Massage Therapy
Therapeutic Touch
Reiki
Dietary Approaches
Nutritional
Supplements
Herbal Remedies
Lifestyle changes
Learn deep breathing or mediation to help you
relax.
Reduce stress in your life, stress intensifies pain.
Boost pain relief with the natural endorphins from
exercise.
Cut back on alcohol, this can worsen sleep
problems.
Join a support group; meet others living with back
pain.
Lifestyle changes
Don’t smoke, it can worsen pain
Track your pain level and activities every day.
Get a massage.
Eat a healthy diet.
Find ways to distract yourself from pain so you
enjoy life more
References
 Kawi, J., (2014) Chronic Low Back Pain Patients’ Perceptions on SelfManagement Support, and Functional Ability. Pain Management
Nursing 15 (1), 258-264.
 Tobias, K., Lama, S., Parker, s., (2014) Meeting the Public Health
Challenge of Pain in Later Life: What Role Can Senior Centers Play?
Pain Management Nursing 15 (4), 760-767.
 Web MD Pain Management Health Center
 Web MD Pain Coach
The Pharmacological Aspect
Of A “Whole Sum” Approach
Brenda V. Queeno, Pharm.D
Kenmore Mercy Hospital
Objectives
Attendees will be able to outline and
understand various medication options for
pain.
Attendees will be able to recognize different
medication classes used in treatment of
pain.
WHO
Analgesic
Pain
Ladder Step 2: Moderate Pain
Step 3: Severe Pain
Morphine, Hydromorphone, Methadone,
Levorphanol,
Fentanyl, oxycodone
+/- nonopioid analgesics
+/- adjuvant
APAP of ASA+
Codeine, Hydrocodone, Oxycodone,
Dihydrocodone, Tramadol
+/- adjuvant
Step 1: Mild Pain
Aspirin (ASA), Acetaminophen (APAP), Nonsteroidal
anti-inflammatory drugs (NSAID’s)
+/- adjuvant
Opioids
Bind to mu-receptors altering pain
perception
Common Opioid MOA:
*mu- receptors are a class of opioid receptors with a high affinity for enkephalins and betaendorphin, but a low affinity for dymorphins. Mainly located in periaqueductal gray region,
superficial dorsal horn of the spinal cord (some in intestines = constipation)
RI = reuptake inhibitors, LBA = low binding affinity
Opioid Chemical Classes
Phenylpiperidines
 meperidine, fentanyl, sufentanil, remifentanil
Diphenylheptanes
 methadone, propoxyphene
Morphines
 morphine, codeine, hydrocodone, oxycodone,
 oxymorphone, hydromorphone, nalbuphine,
 butorphanol, levorphanol, pentazocine
Opioid Potency
(increasing order)
meperidine<codeine<morphine<hydrocodone
<oxycodone<
hydromorphone<levorphanol<fentanyl
Neuropathic Pain Management
References
The American Journal of Managed Care. 2006; 12(9)
Sup: S256-S262.
WHO Analgesic Pain Ladder.
http://www.who.int/cancer/palliative/painladder/e
n
Ann. of Pharmacotherapy. 2007; 2(41): 255-267.
J Pain. 2009;10(2): 113-130.
J Pain. 2005 April; 6(4): 261–274.
Uptodate accessed 9/22/2015
Myofascial ReleaseTreating the
“Whole Sum” Body
Nancy McGrath Ogorek PT
Partners in Rehab West Seneca, NY 14224
(Buffalo) 716-558-5160
Objectives
 Identify importance of balancing the
pelvis for cervical & lumbar pain
 Identify importance of treating the “front
of the back” - abdominal scars for back
pain
Myofascial Release
 Gentle sustained pressure into fascial
restrictions.
Standardized testing (x-ray/CAT/MRI) do
not show fascial restrictions
Restricted fascia can exert up to 2,000
lbs per square inch of pressure on pain
structures.
What Happens In The Body
With MFR?
Mechanotransduction- mechanism by
which cells convert mechanical stimulus
into electrochemical activity
Sustained mechanical pressure produces
a piezoelectrical affect - electricity or
electric polarity due to pressure
Find The Pain
Look Elsewhere For The
Cause
Assess abdominal scarring for
low back pain
Abdominal adhesions
can pull the body
forward, making it
difficult or impossible to
stand straight.
Dural Tube twist/rotation
The Dural tube functions just like
a slinky. A distortion or adhesion
at one end will be reflected at the
other end of the body.
Examples
A baby that was delivered by forceps could
have cranial distortion resulting in lower back
pain at the level of sacro-iliac joint (SI joint) later
in life.
Fall on coccyx as a child/young adult may flex
or rotate tailbone & thus shorten dura - which
may lead to headaches/cervical pain- even
YEARS later.
Reference
Waltfritzseminars.com/blog resources/research
The Spiritual Aspect Of
A “Whole Sum”
Approach
Rev. Nancy Faery MDIV, BCC,CMI
Kenmore Mercy Hospital
Objective
 Attendees will be able to name 3
spiritual modalities for pain reduction
Complimentary Medicine
MIND
WELLNESS
BODY
SPIRIT
DEPRESSION
ANXIETY
FEAR
GRIEF/LOSS
PAIN
ANGER
FRUSTRATION
Reducing Pain- Enhances Healing
Spirituality Plays Very Important Role
 Gratitude
exercises
 Connection
with spiritual community
 Mindfulness/Breathing
 Guided
Imagery/Visualizations
 Mantra/Phrase
 Prayer/
Sacred texts
 Journaling/Writing
Other Modalities of Reducing Pain
Mandalas
Affirmations
Music
Aroma Therapy
Laughter
Pet Therapy
References
The Relaxation Response, Herbert Benson
MD
Creating Mandalas: for Insight, healing and
self expression, Susanne Fincher
The Nutritional Aspect Of A
“Whole Sum” Approach
Theresa Jackson RD CDN
Kenmore Mercy Hospital
Objectives
 Attendees will be able to describe proven
weight loss strategies and habits associated
with weight loss success
 Attendees will be able to describe key
recommendations for a healthy eating
pattern from the 2015-2020 Dietary guidelines
for America
The most effective weight loss (behavioral)
treatment is in person, high-intensity and
comprehensive weight loss interventions
provided in individual or group sessions by a
trained interventionist.
 Calorie reduction
 Increased activity
 Behavior therapy
Calorie Reduction
500-700 daily
1200-1500 calories for women
1500-1800 calories for men
Increased Activity
<150 minutes/week = minimal weight loss
150-225 minutes/week =moderate weight
loss
225-420 minutes/week =significant weight
loss
Behavior Therapy is more
important than macronutrient
metabolism for weight loss
* Key to weight loss and weight loss
maintenance was ADHERENCE
Healthy Habits of “Losers”
Reduced Calories
Increased physical Activity
Monitored their weight
Wholesome and Nourishing based
around a variety of plants, lean sources
of proteins, dairy, or other calcium and
Vitamin D rich foods, and whole grains.
 Limit saturated fats, sodium,
added sugar, and alcohol.
What can you do?
Be an example
 Support your patients
 Reach out to a Registered Dietitian
References
2015 Dietary Guidelines for Americans, which can
be found at DietaryGuidelines.gov
The AHA/ACC/TOS Guideline for the Management
of Overweight and Obesity in Adults, 2013.
QUESTIONS
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