ISSUE 6 | JUNE 2015
ispinews
In This Issue:
Editorial: Setting the Tone
and Making an Impact
6
Clinical Conference 2015
Therapeutic Pain Specialist
Announcement
Course Schedule 2015
Research:
The short term effects of preoperative neuroscience education for
lumbar radiculopathy
Hyperbaric oxygen therapy for
chronic pain
Altered cortical processing of
observed pain in fibromyalgia
syndrome patients
A multi-faceted workplace intervention for LBP in nurses’ aides
Single-point but not tonic cuff
pressure pain sensitivity is
associated with level of physical
fitness
Cost-utility of cognitive behavioral
therapy for LBP from the commercial payer perspective
Setting the Tone and
Making an Impact
Having worked with Adriaan and Colleen
for five years - not only for the International
Spine & Pain Institute but also in the Ortho
Spine & Pain Clinic - I have learned a lot.
The Ortho Spine & Pain Clinic is small;
Colleen is the primary physical therapist
and Adriaan sees patients around his travel
schedule. We see just a few patients a day.
For most of you – that probably sounds
either like heaven…or you can’t image
how it would work. I know you alone are
probably seeing 20+ patients a day. No
matter the size of the clinic the bottom line
is the same – every person that has contact
with the patient impacts the patient.
Patient load is just one of many things that
make our clinic unique. We educate all our
patients with Therapeutic Neuroscience
Education from the first phone call to their
final discharge. It doesn’t matter if that
patient comes to us with a sprained ankle or
is someone who cannot go outside because
even the slightest breeze on her face is
excruciating; education is vital to success.
I said we and I mean it. I am not a physical
therapist and am not behind the closed
door of the treatment room but my job as
the clinic manager/receptionist/anythingmy-physical-therapists-or-patients-needperson is important, too. I play a role. I
influence patients.
My tone of voice and the way I respond to
our patients makes an impact on them. If
I gasp at their situation or agree that their
circumstance is terrible I am feeding their
fear. I must be empathetic and caring, but
careful not to exacerbate their fear. Before
they walk in the door the first time we
want to reduce their stress by checking
on insurance coverage, getting them
directions, sending their intake forms, etc.
Many of our patients have commented on
the personal touch they receive before they
arrive.
I help set the tone for their
office visits. A smile and
welcome goes a long
way to someone
who is hurting.
Opening the door,
offering a beverage
or magazine while
continued on next page
Sheryl Clark
ISPI General Manager
ispinstitu te . com 1
Setting the Tone
continued from page 1
they wait, or making small talk helps
ease anxiety in our clients. Plus I get
to meet some amazing people, hear
wonderful stories and make some
really interesting friends. I maybe
have 2-5 minutes with our patients but
those minutes can make a difference.
It is amazing what eye contact and a
reassuring smile can do.
At our clinic, patients usually leave
the treatment room laughing or at
least smiling. They may be sore
or tired but they are generally in a
good mood. I guess the guy with the
funny accent is pretty humorous
and Colleen is great at connecting
and building relationships. It is
important I not bring down the mood
or if the mood isn’t so great, I have the
opportunity to be encouraging and
uplifting. If I’ve done my job right
before their first visit and when they
come in, I can figure out the right
way to support them.
Sometimes a patient will ask me
follow up questions or “What do you
think about…” after the therapist is
out of the room. I am very careful to
remind them that I am not a physical
therapist and say, “That is a great
question, let me go get Adriaan or
Colleen.” They are pleased to have a
few extra minutes to clarify something
and I didn’t give them incorrect
information. Often times they just
want to go over their experience in
the treatment room and I’m happy
to listen. Before our patients leave, I
confirm that they have our number
and remind them to please call or stop
in if they have questions or are unsure
of anything. They rarely do this but
it is a nice way to let them know we
have time for them. I’m the last face
they see on the way out and I want
it to be as reassuring as possible that
they are in good hands.
You may be saying, that is great
Sheryl, but you don’t understand my
clinic. We are running from patient
to patient, the phones are constantly
ringing, the people in the front don’t
care about what we do in the back, and
we hardly have enough staff to keep
our heads above water. I will tell you
– you’re right – I’m not in your clinic
but I truly believe if your whole team
will practice delivering a consistent
message about therapy your patients
will have better results. If you close
the door to your treatment room
with a patient who has less anxiety
and is relaxed, I believe they will
have better outcomes. If your patient
leaves your clinic with a smile on
their face, feeling like someone cares
about them, I believe they will have
better outcomes.
You have the power to influence your
whole team by including them in the
conversation, teaching the consistent
message that education is therapy
and giving value to everyone that has
patient contact. I would love to hear
what you are doing in your clinic to
improve patient outcomes as a team.
Education is Therapy
Everyone Has Back Pain
Neuroscience Education for Patients with Back Pain
Adriaan Louw, Timothy Flynn and Emilio Puentedura have released a new patient education
book entitled Everyone Has Back Pain, Neuroscience Education for Patients with Back Pain.
The book examines typical myths surrounding back pain and provides patients with easy-to-apply
strategies for calming their nerves, lessening their pain and regaining control of their lives.
Everyone Has Back Pain will officially be launched at the upcoming ISPI Conference
June 19-21. It will be available for purchase online, along with Adriaan Louw’s other patient
and clinician books, at OPTP.com.
LAUNCHING AT THE ISPI CLINICAL CONFERENCE
JUNE 19-21 IN MINNEAPOLIS!
800.367.7393 | OPTP.COM
ispinstitu te . com 2
The short term effects of preoperative neuroscience
education for lumbar radiculopathy: A case series
International J Spine Surgery May 2015; Volume 9 Article 11
Adriaan Louw, PT, PhD, Ina Diener, PT, PhD, Emilio J. Puentedura, PT, DPT, PhD
BACKGROUND: Recently a preoperative
pain neuroscience education (NE)
program was developed for lumbar
surgery (LS) for radiculopathy as a
means to decrease postoperative pain
and disability. This study attempts
to determine the short term effects, if
any, of providing NE before surgery on
patient outcomes.
METHODS: A case series of 10 patients
(female = 7) received preoperative
one-on-one educational session
by a physical therapist on the
neuroscience of pain, accompanied
by an evidence-based booklet, prior
to LS for radiculopathy.
Postintervention data was gathered
immediately after NE, as well as
1, 3 and 6 months following LS.
Primary outcome measures were
Pain Catastrophization Scale (PCS),
forward flexion, straight leg raise
(SLR) and beliefs regarding LS.
RESULTS: Immediately following NE
for LS for radiculopathy, all patients
had lower PCS scores, with 5 patients
exceeding the MDC score of 9.1 and 8
of the patients had PCS change scores
exceeding the MDC by the 1, 3 and 6
month follow ups. Physical changes
showed that fingertip-to-floor test
in 6 patients had changes in beyond
the MDC of 4.5 cm and 6 patients
had changes in SLR beyond the MDC
of 5.7°. The main finding, however,
indicated a positive and more realistic
shift in expectations regarding pain
after the impending LS by all patients.
CONCLUSIONS: The results of the
case series suggest that immediately
after NE, patients scheduled for LS
for radiculopathy had meaningful
detectable
changes
in
pain
catastrophizing,
fingertip-to-floor
test, passive SLR and positive shifts in
their beliefs about LS.
Hyperbaric Oxygen Therapy: A New Treatment for Chronic Pain?
Pain Pract. 2015 May 19
BACKGROUND AND OBJECTIVE:
Hyperbaric oxygen therapy (HBOT)
is a treatment providing 100%
oxygen at a pressure greater than
that at sea level. HBOT is becoming
increasingly recognized as a potential
treatment modality for a broad
range of ailments, including chronic
pain. In this narrative review, we
discuss the current understanding
of pathophysiology of nociceptive,
inflammatory
and
neuropathic
pain, and the body of animal studies
addressing mechanisms by which
HBOT may ameliorate these different
types of pain. Finally, we review
clinical studies suggesting that
HBOT may be useful in treating
chronic pain syndromes, including
chronic headache, fibromyalgia,
complex regional pain syndrome, and
trigeminal neuralgia.
DATABASE AND DATA TREATMENT:
A comprehensive search through
MEDLINE, EMBASE, Scopus, and Web
of Science for studies relating to HBOT
and pain was performed using the
following keywords: hyperbaric oxygen
therapy or hyperbaric oxygen treatment
(HBOT), nociceptive pain, inflammatory
pain, neuropathic pain, HBOT AND
pain, HBOT AND headache, HBOT
AND fibromyalgia, HBOT AND complex
regional pain syndrome, and HBOT AND
trigeminal neuralgia.
RESULTS:
Twenty-five
studies
examining the role of HBOT in animal
models of pain and human clinical
trials were found and reviewed for
this narrative review.
CONCLUSIONS: HBOT has been
shown to reduce pain using animal
models. Early clinical research
indicates HBOT may also be useful
in modulating human pain; however,
further studies are required to
determine whether HBOT is a safe
and efficacious treatment modality for
chronic pain conditions.
ispinstitu te . com 3
Altered cortical processing of observed pain
in fibromyalgia syndrome patients. J Pain. 2015 May 12
Fibromyalgia syndrome (FMS) is
characterized by widespread chronic
pain, fatigue, sleep disorders and
cognitive-emotional
disturbance.
FMS patients exhibit increased
sensitivity to experimental pain and
pain-related cues, as well as deficits
in emotional regulation. The present
study investigated the spatio-temporal
patterns of brain activations for
observed pain in 19 FMS patients
and 18 age-matched, healthy control
subjects using event-related potential
(ERP)
analysis.
Fibromyalgia
patients attributed greater pain and
unpleasantness to pain pictures
relative to healthy control participants.
An augmented late positive potential
(LPP) component (>500 ms) was
found in patients during both pain and
non-pain pictures, and this amplitude
difference in the LPP covaried with
perceived unpleasantness of pictures.
Mid-latency potentials (250-450
ms) demonstrated similar amplitude
increases of positive potentials in the
FMS patient group. By contrast, the
short-latency positive potential (140
ms) was reduced in FMS patients
relative to healthy control participants.
Results suggest amplitude increases to
mid-long latency cortical activations
in FMS patients, which are known
to reflect emotional control and
motivational salience of stimuli.
PERSPECTIVE:
FMS
patients
demonstrate increased activations
for pain and non-pain pictures. The
findings suggest that even innocuous,
everyday visual stimuli with somatic
connotations may challenge the
emotional state of FMS patients. Our
study points towards the importance
of cognitive-emotional therapeutic
approaches for the treatment of FMS.
A multi-faceted workplace intervention for low back pain in nurses’ aides:
a pragmatic stepped wedge cluster randomized controlled trial. Pain. 2015 May 16
The present study established the
effectiveness of a workplace multifaceted intervention consisting of
participatory ergonomics, physical
training and cognitive behavioral
training for
low back pain.
Between
November
2 0 1 2
and May
2014,
we conducted a pragmatic steppedwedge cluster-randomized controlled
trial with 594 workers from eldercare
workplaces (nursing homes and home
care) randomized to four successive
time periods, three months apart.
The intervention lasted 12 weeks
and consisted of 19 sessions in total
(physical training (12 sessions),
cognitive behavioural training
(2 sessions) and participatory
ergonomics (5 sessions)). Low
back pain was the outcome
and was measured as days,
intensity (worst pain on a
0-10 numeric rank scale)
and
bothersomeness
(days) by monthly text
messages.
Linear
mixed models were
used to estimate
the intervention
effect. Analyses were performed
according to intention to treat,
including all eligible randomized
participants and were adjusted for
baseline values of the outcome. The
linear mixed models yielded significant
effects on low back pain days of -0.8
(95% confidence interval -1.19 to
-0.38), low back pain intensity of -0.4
(95% confidence interval -0.60 to
-0.26) and bothersomeness days of -0.5
(95% confidence interval -0.85 to -0.13)
after the intervention compared to the
control group. This study shows that a
multi-faceted intervention consisting
of participatory ergonomics, physical
training and cognitive behavioral
training can reduce low back pain
among workers in eldercare. Thus,
multi-faceted interventions may be
relevant for improving low back pain
in a working population.
ispinstitu te . com 4
Single-point but not tonic cuff pressure pain sensitivity is associated
with level of physical fitness - a study of non-athletic healthy subjects.
PLoS One. 2015 May 1;10(5)
Exercise is often used for pain
rehabilitation but the link between
physical activity level and pain
sensitivity is still not fully understood.
Pressure pain sensitivity to cuff
algometry and conditioned pain
modulation (CPM) were evaluated
in highly active men (n=22), normally
active men (n=26), highly active
women (n=27) and normally active
women (n=23) based on the Godin
Leisure-Time Exercise Questionnaire.
Cuff pressure pain sensitivity was
assessed at the arm and lower leg. The
subjects scored the pain intensity on
an electronic Visual Analogue Scale
(VAS) during ten minutes with 25
kPa constant cuff pressure and two
minutes with zero pressure. The
maximal VAS score and area under the
VAS-curve were extracted. Pressure
pain thresholds (PPT) were recorded
by manual pressure algometry on the
ipsilateral tibialis anterior muscle
before, during and after the tonic arm
stimulation. Tonic cuff stimulation
of the arm and leg resulted in higher
VAS peak scores in women compared
with men (p<0.04). In all groups
the PPTs were reduced during and
after the cuff stimulation compared
with baseline (p=0.001). PPT were
higher in men compared with women
(p=0.03) and higher in highly physical
active compared with normal active
(p=0.048). Besides the well-known
gender difference in pressure pain
sensitivity this study demonstrates
that a high physical fitness degree in
non-athletic subjects is associated with
increased pressure pain thresholds
but does not affect cuff pressure pain
sensitivity in healthy people.
Cost-Utility of Cognitive Behavioral Therapy for Low Back Pain From
the Commercial Payer Perspective Spine: 15 May 2015 - Volume 40 - Issue 10 - p 725–733
OBJECTIVE: To evaluate the costutility of cognitive behavioral therapy
(CBT) for the treatment of persistent
nonspecific low back pain (LBP) from
the perspective of US commercial payers.
CBT is widely deemed clinically
effective for LBP treatment. The
evidence is suggestive of costeffectiveness.
METHODS: We constructed and
validated a Markov intention-to-treat
model to estimate the cost-utility of CBT,
with 1-year and 10-year time horizons.
We applied likelihood of
improvement and
utilities from a randomized controlled
trial assessing CBT to treat LBP. The trial
randomized subjects to treatment but
subjects freely sought health care services.
We derived the cost of equivalent rates
and types of services from US commercial
claims for LBP for a similar population.
For the 10-year estimates, we derived
recurrence rates from the literature.
The base case included medical and
pharmaceutical services and assumed
gradual loss of skill in applying CBT
techniques. Sensitivity analyses assessed
the distribution of service utilization,
utility values, and rate of LBP
recurrence. We compared
health plan designs. Results
are based on 5000 iterations of
each model and expressed
as an incremental cost per
quality-adjusted life-year.
RESULTS: The incremental costutility of CBT was $7197 per qualityadjusted life-year in the first year
and $5855 per quality-adjusted lifeyear over 10 years. The results are
robust across numerous sensitivity
analyses. No change of parameter
estimate resulted in a difference of
more than 7% from the base case
for either time horizon. Including
chiropractic and/or acupuncture care
did not substantively affect costeffectiveness. The model with medical
but no pharmaceutical costs was
more cost-effective ($5238 for 1 yr and
$3849 for 10 yr).
CONCLUSION: CBT is a costeffective approach to manage chronic
LBP among commercial health plans
members.
Cost-effectiveness
is
demonstrated for multiple plan designs.
ispinstitu te . com 5
ISPI Clinical Conference 2015:
Every Joint has a Brain
June 19, 20 & 21, 2015
Hilton Minneapolis/Bloomington, MN
Friday June 19
Keynote: The Brain, Blobs and Pain—The Pain Neuromatrix, Adriaan Louw
Saturday June 20
Keynote: Lower Extremity Biomechanics: The Brain and Motor Control, Chris Powers
• Video Analysis of Lower Extremity Biomechanics, Chris Powers
• The Frozen Shoulder Has a Brain, Paul Mintken
• Examination and Treatment of Trigger Points for the Lower Quarter, Cesar Fernández de
las Penas/Louie Puentedura
• Arms, Tunnels, Pain and Therapy, Steve Schmidt SOLD OUT
• The Foot: Use it or Lose it, Steve Forbush/Colleen Louw
Keynote: Trigger Points and a Sensitive Nervous System, C. Fernández de las Penas
Keynote: Headaches and Facial Pain, Ina Deiner
• The Foot: Use it or Lose it, Steve Forbush/Colleen Louw
• The Neck Turns the Head...or Does It?, Ina Diener SOLD OUT
• Examination and Treatment of Trigger Points for the Lower Quarter,
Cesar Fernández de las Penas/Louie Puentedura
• Arms, Tunnels, Pain and Therapy, Steve Schmidt SOLD OUT
• The Frozen Shoulder Has a Brain, Paul Mintken SOLD OUT
Keynote: Central Sensitivity 101, Steve Schmidt
Sunday June 21
• Therapeutic Neuroscience Education and the Brain, Adriaan Louw
• Treating the Low Back Via the Brain, Louie Puentedura
• Examination and Treatment of Trigger Points for the Upper Quarter, Cesar Fernández de
las Penas
• Pelvic Pain: What Every Therapist Needs to Know, Sandy Hilton
• Investigating and Treating the Triad: Shoulder, Neck and Thoracic Spine, Paul Mintken
SOLD OUT
www.ispinstitute.com
ispinstitu te . com 6
We Would Like to Thank Our Conference Sponsors:
Has Anyone Seen Louis Gifford?
In 2014 we dedicated our conference to Louis Gifford. Louis was truly a pioneer and as part of his legacy he left us with
a stunning 3-book series called Aches and Pains. This is a must read for anyone treating people in pain. As soon as the
books arrived, two eager PT’s wanted to read it at the same time and before you know…the books were scattered everywhere. Not until recent, I realized I saw Louis’ books in different places throughout my day. (I am sure he’s behind it!).
So, I thought I’d share the location of Louis’ books in and around the Louw household:
1. IN MY OFFICE ON A CHAIR (AS WE BUILD OUR PAIN CURRICULUM)
2. IN COLLEEN’S CAR ON THE DASHBOARD (FOR BALL GAMES AND
3. ON THE FLOOR IN THE BEDROOM
(SOOTHING PAIN STORIES BEFORE
BED)
ROAD TRIPS)
ispinstitu te . com 7
THERAPEUTIC PAIN SPECIALIST
THERAPEUTIC
PAINAPPROACH
SPECIALIST
AN INTERDISCIPLINARY
AN INTERDISCIPLINARY APPROACH
Neurodynamics
Neurodynamics
Too Hot
To
Handle
Too
Hot
To Handle
Therapeutic
Therapeutic
Neuroscience
Neuroscience
Education
Education
6 weeks online
3 weeks online
6 weeks online
3 weeks online
DAY 1: Lab for
Neurodynamics
DAY 1: Lab for
Neurodynamics
DAY 2: Lab for
Too
Hot2:To
Handle
DAY
Lab
for
andTo
TNE
Too Hot
Handle
and TNE
2 day intensive
3 weeks online
2 day intensive
3 weeks online
Neuroscience
America isTherapeutic
in pain. Current
data indicatesEducation:
100 million people in the US
Teaching People About
Pain
Neuroscience
Education:
suffer from Therapeutic
some form of persistent
pain - despite
injections, surgery and
DAY 1: Focus on
Function-TNE
DAY
1: Focus on
Function-TNE
DAY 2: Focus on
Function
Labs on
and
DAY 2: Focus
Practical
FunctionApplication
Labs and
Practical Application
Neurodynamics
Neurodynamics
Everything Hurts
Everything Hurts
2 day intensive
2 day intensive
In Partnership
With
In Partnership
With
Perioperative
Neuroscience
Perioperative
Education
Neuroscience
Education
Business of
Chronic
BusinessPain
of
Chronic Pain
3 weeks online
3 weeks online
In the US, over 100 million people suffer from chronic pain resulting in an increase
in the
prescription
surgery,
medical
tests andinimaging
In
US, overmedication
100 millionuse,
people
sufferinjections,
from chronic
pain resulting
an increase
in prescription medication use, surgery, injections, medical tests and imaging
THERAPEUTIC PAI
Teaching People About Pain
opioid medications
increasing at alarming rates. The evidence for therapeuA Study
of isNeurodynamics:
tic approaches in treating people
with pain
ever-increasing, resulting in
AN INTERDISCIPLINAR
The Body’s
Living Alarm System
A
Study
of
treatments such as therapeutic neuroscienceNeurodynamics:
education, graded motor imThe Body’s Living Alarm System
agery, pacing, graded exposure and more. In line with these developments,
Too Hot to Handle:
Current best-evidence shows that Therapeutic Neuroscience Education improves
the International
Spine and
Pain Institute (ISPI)
Desensitizing
Hyper-Sensitive
Patientlaunched a pain certification Current
Too
Hot totheHandle:
pain ratings,
function, physical
movement
and cost
of healthcare
utilization.
DAY 1: Lab for
best-evidence
shows that
Therapeutic
Neuroscience
Education
improves
for physicalDesensitizing
therapists inthe
January,
called Therapeutic
Pain Specialist (TPS).
Neurodynamics
Hyper-Sensitive
Patient
pain ratings, function,
physical
movement
and
cost
of
healthcare
utilization.
Neurodynamics
Therapeutic
Subsequently, ISPI partnered with EvidenceEverything
in Motion (EIM)
to take on pain
Hurts:
Neuroscience
Too Hot
DAY 2: Lab for
in America. ISPIEducation
and EIMand
have
reworked
the
TPS
certification
and
will
reExercise for Widespread
Pain andHurts:
Fatigue
Everything
To Handle
Too
Hot To Handle
Education
launch this exciting
program
September
1,
2015.
Our
July
newsletter
will
feaIn Partnership
Education and Exercise for Widespread Pain and Fatigue
Withand TNE
ture all the details
of
the
new
TPS
certification.
As
we
finalize
the
program,
AN
INTERDISCIPLINARY
APPROACH
Focus on Function:
Changing
PainFunction:
-Related
Behavior
we want to give
you on
some
preliminary
information:
Focus
THERAPEUTIC PAIN SPECIALIST
Changing Pain -Related Behavior
6 weeks online
3 weeks online
2 day intensive
Physical Therapists
PT Assistants
Neuroscience
Education:
DAY 1:PT
Focus on
Perioperative
»» TPS will bePerioperative
a true interdisciplinary
pain
certification,
Physical
Therapists
Therapists Function-TNE
OT Assistants
Assistants Neuroscience
Preemptive
Pain
Education
for Surgery DAY 1: Lab for Occupational
Neurodynamics
Neurodynamics
Perioperative
Neuroscience
Education:
open to Therapeutic
various healthcare providers including but
NeurodynamicsOccupational
Therapeutic
Neuroscience
Education:
Therapists
OT
Assistants
Medical
Doctors
Doctors
of Osteopathy
Preemptive Pain Education for Surgery
Education
Teaching People About Pain
not limited
to,
physical
therapists,
physical
therapist
Neuroscience
Too
Hot
Everything
Hurts
Medical
Doctors
Doctors
DAY 2:Nurses
Focus onof Osteopathy
DAY 2: Lab for Nurse Practicioners
Business of Chronic Pain:
assistants,
occupational
therapists,
occupationalToo
theraBusiness of
Strategies
for of
Success
Function Labs and
Hot To Handle
Education
Business
Chronic
Pain: To Handle
Nurse
Practicioners
Physician
Assistants APractical
Psychologists
and
more...
StudyNurses
of
Neurodynamics:
Chronic Pain
Application
and TNE
pist assistants,
Strategies formedical
Success doctors, doctors of osteopathy,
Physician Assistants
more...
ThePsychologists
Body’s Living Alarmand
System
nurses, nurse practitioners, physician assistants and
6 weeks online
3 weeks online
2 day intensive
3 weeks online
2 day intensive
3 weeks online
psychologists.
Too Hot to Handle:
»» TPS will feature a blended format of classes with online In the US, over
Desensitizing
thepeople
Hyper-Sensitive
100 million
suffer fromPatient
chronic pain resulting in an increase
in prescription medication use, surgery, injections, medical tests and imaging
material
as
well
as
two
weekend
intensive
hands-on
Therapeutic Neuroscience Education:
Everything Hurts:
classesTeaching People About Pain
Education and Exercise for Widespread Pain and Fatigue
»» TPS will provide oversight and mentoring by faculty speA Study of Neurodynamics:
cializing in pain neuroscience
Focus on Function:
The Body’s Living Alarm System
»» TPS Courses include*
Changing Pain -Related Behavior
• Therapeutic Neuroscience Education: Teaching PeoToo Hot to Handle:
Current best-evidence shows that Therapeutic Neuroscience Education improves
pleDesensitizing
About Pain
Perioperative Neuroscience Education:
the Hyper-Sensitive Patient
pain ratings, function, physical movement and cost of healthcare utilization.
Preemptive Pain Education for Surgery
• A Study of Neurodynamics: The Body’s Living Alarm
System
Everything Hurts:
Business of Chronic Pain:
Education
and Exercise
for Widespread the
Pain and
Fatigue
• Too Hot
to Handle:
Desensitizing
Hyper-SensiStrategies for Success
tive Patient
Focus onHurts:
Function:
• Everything
Education and Exercise for WideChanging Pain -Related Behavior
spread Pain and Fatigue
Physical Therapists
PT Assistants
• Focus on
Function: Changing
Pain-Related
Behaviors
Perioperative
Neuroscience
Education:
Occupational Therapists
OT Assistants
Preemptive Pain
Education forPreemptive
Surgery
• Perioperative Neuroscience
Education:
Medical
Doctors
Doctors
of Osteopathy
Pain Education for Surgery
Business
of
Chronic
Pain:
Nurse Practicioners
Nurses
• Business of Chronic Pain: Strategies for Success
Strategies for Success
Physician Assistants
Psychologists and more...
In the US,
in prescrip
Current be
pain rating
*Credit may be granted for past ISPI pain classes that are included in the TPS curriculum
ispinstitu te . com 8
Physi
Occup
Medic
Nurse
Physi
2015 Course Schedule
Friday
June 19
Too Hot to Handle: Desensitizing the Hypersensitive Patient
Bloomington, MN
Fri/Sat/Sun Jun 19-22
The Clinical Conference: Every Joint Has a Brain
Bloomington, MN
Sat/Sun
Jun 27 & 28
Spinal Manipulation I: A Physical Therapy Approach
Flower Mound, TX
Sat/Sun
Aug 15 & 16
The Thoracic Spine: A Manual Therapy and Pain Science Approach
Tulsa, OK
Fri/Sat/Sun Aug 21-23
Therapeutic Neuroscience Education: Educating Patients About Pain
Santiago, Chile
Sat/Sun
Sep 26 & 27
The Lumbar Spine: A Manual Therapy and Pain Science Approach
Des Moines, IA
Sat/Sun
Sep 26 & 27
Therapeutic Neuroscience Education I: Educating Patients About Pain
Spartanburg, SC
Saturday
October 3
Too Hot to Handle: Desensitizing a Hypersensitive Patient
Kansas City, MO
Sunday
October 4
Preoperative Therapeutic Neuroscience Education
Kansas City, MO
Sat/Sun
Oct 10 & 11
A Study of Neurodynamics: The Body’s Living Alarm
Philadelphia, PA
Sat/Sun
Oct 10 & 11
The Upper Quadrant: A Differential Diagnosis Approach to Manual Therapy
Liberty, MO
Sat/Sun
Oct 17 & 18
The Lumbar Spine: A Manual Therapy and Pain Science Approach
Woodbury, MN
Sat/Sun
Oct 24 & 25
Elbow, Wrist and Hand, Differential Diagnosis & Management
Flower Mound, TX
Sat/Sun
Oct 31 & Nov 1
Therapeutic Neuroscience Education: Teaching People About Pain
Fountain Valley, CA
Sat/Sun
Nov 7 & 8
Spinal Manipulation I: A Physical Therapy Approach
Ashburn, VA
Sat/Sun
Nov 14 & 15
The Lower Quadrant: A Differential Diagnosis Approach to Manual Therapy
Carroll, IA
Sat/Sun
Dec 5 & 6
Spinal Manipulation I: A Phsical Therapy Approach
Story City, IA
Sat/Sun
Dec 5 & 6
Focus on Function: Changing Pain-Related Behavior
Bloomington, MN
Sat/Sun
Dec 12 & 13
The Cervical Spine: A Manual Therapy & Pain Science Approach
Story City, IA
Courses are still being scheduled, keep checking back if you don’t see what you are looking for!
If you are interested in hosting a one or two-day class at your facility, contact us.
Education is Therapy…