Mindful Pain Solutions

July 2013

If you want others to be happy, practice compassion. If you want to be happy, practice compassion.

~ Dalai Lama..

In This Issue

In Upcoming Issues

  • Meditative positioning
  • Shingles and pain
  • Mindfulness slowing the passage of time
  • Did you know that?
  • Book Reviews

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Picture courtesy of ank.murphy

2012 Canadian Guidelines for the Diagnosis of Fibromyalgia (FM) syndrome

By Dr. Jackie Gardner-Nix

It is frustrating for those of you suffering from fibromyalgia (FM) as there is no blood test or biopsy or other investigation that definitively proves you have the condition, and there are still health care professionals who feel it is a vague entity at best. This makes it hard to claim disability from your insurers, who inevitably seem to want a rheumatologist to diagnose it.

A group of health care professionals has developed the Canadian Guidelines to assist in the diagnosis and management of FM, recently published in “Pain Research and Management” which is the pain journal of the Canadian Pain Society. These guidelines have also been endorsed by the Canadian Rheumatology Association.

Reassuringly the first paragraph states:

“Although fibromyalgia (FM) has been recognized as a clinical syndrome for the past two decades, recent neurophysiological evidence of pain dysregulation has provided scientific validation. The controversy surrounding FM stems from the subjective nature of complaints and lack of any defining abnormal biological findings”.

Prevalence rates in Canada are in the order of 2 to 3%, so it is not rare, and it affects women more than men, mostly in middle age, though it can affect all age groups.

Forty two recommendations were made, and the whole document is available on the Canadian Pain Society website (http://fmguidelines.ca). The first recommendation is:

“FM, a condition that can wax and wane over time, should be diagnosed in an individual with diffuse body pain that has been present for at least three months, and who may have symptoms of fatigue, sleep disturbance, cognitive changes, mood disorder, and other somatic symptoms to variable degrees, and when symptoms cannot be explained by any other illness”.

Most importantly the guidelines recommend the diagnosis can be made by the family physician, so that management can be instituted early, to avoid deterioration which might occur during the long wait to see a rheumatologist, which often results only in the same recommendations already made by the family doctor.

There is no magic formula to treat FM. Each person’s management is tailored to the individual. Early mobilization and activity are mandatory, and improved self-care is also an important part of treatment. Sometimes stopping working, to reduce the stress of having to go into work, is the start of the slippery slope to worsening symptoms and deconditioning, as lack of routine and despondency contribute to the slide. As in management of any condition, the sufferer can create a “basket” of strategies and interventions with the help of their health care professionals. Having a well-defined daily routine is part of the basket, particularly with regard to sleep hygiene measures, as the loss of restorative sleep is certainly a major player in the condition of FM.

Upcoming MBCPM Courses and Retreats for Health Care Professionals, Alumni and Patients


Please help us to find interested Health Care Professionals, as we want to keep our MBCPM courses running and extend them to everyone who needs them in Ontario and beyond!

Facilitator Training Course

The next MBCPM Facilitator training is planned for August 6th to 15th this year, and will incorporate a “practicum”. This is a 4 day MBCPM course for patients in Toronto, affording the chance for new facilitators-in-training to sit in, audit, and participate — particularly important for those from outside Ontario who cannot audit our existing courses. A silent weekend retreat for the facilitators-in-training, including alumni, will follow. Then there will be 4 days of facilitator training. Returning facilitators-in training will be welcomed back to any of the future training sessions, at a reduced cost. For more details and course requirements, please visit www.neuronovacentre.com/mbcpm-facilitator.

Workshop

The Centre for Mindfulness Studies (CFMS) in Toronto is hosting a 1 day workshop for Health Care Professionals as an introduction to MBCPM on Friday, November 8, 2013. For more information please follow the event web page.

Health Care Professional Courses

There are two ten week courses in MBCPM planned for Fall 2013 for Health Care professionals at various sites in Ontario to experience the benefits of the MBCPM course, helpful for stress as well as pain, and to learn more about chronic pain. The courses will be available starting later in the Fall this year: on October 1st and 2nd in after work time slots: 4 to 6 pm. Sites and scheduling can be found on our website at http://www.neuronovacentre.com/mindfulness-programs-for-health-care-professionals.

For Patients and Health Care Professionals 

Weekend Silent Retreat

A silent retreat, or “meditation intensive”, is scheduled for Saturday and Sunday, August 10th and 11th  2013, at Hart House, University of Toronto. It is non residential, and runs from 9:30 to 4:30 pm each day. Meditations alternate and include sitting, walking, body scan, and other meditations and there will be 1 hour of yoga each day. It is recommended for those alumni or others with a consistent meditation practice. Space is limited. Please call our office if interested at 416 264 2424, or email us at sara@neuronovacentre.com.

Half day silent retreat at St Michael's

Rachael Frankford, who runs MBCT courses for the dept of psychiatry at St Michael's, will run a half day silent retreat, Thursday, Aug. 1st 2013.  It will be in the Li Ka Shing Building, room 136 from 9:30 to 12:30. Our alumni are welcome: please contact our office: sara@neuronovacentre.com, to link to Rachael.

Four Day All Day Patient Course in MBCPM

We are running our first ever four day all day (9:30 am to 4:30 pm) MBCPM course for pain sufferers in Toronto from Tuesday August 6th to Friday August 9th, at St Michael’s hospital. This might appeal to those who have limited time to do the once a week version of our course, or who live in a part of Canada or Ontario which does not receive our service. Space is limited. Please contact Sara in our office at 416 264 2424, or sara@neuronovacentre.com.

MBCPM Courses for the Fall of 2013

Courses are now scheduled at various sites in Ontario for the fall and locations and times for the entry level classes can be found on our website.

Alumni courses

UPDATED The Level 2 MBCPM course will be lead in the fall by Dr. Bobby Esbin MD at St. Michael’s Hospital.  Class will start on Monday September 9th from 5:00 to 7:45pm in Room 6002 Cardinal Carter Wing.  Classes will run for six weeks, up until Monday October 14th and will be continued after a short break.  Class start up again Monday December 2nd to Monday December 23rd.  If you wish to enroll for this session please email Dr. Bobby Esbin: besbin@hotmail.com.  Please note a Physician’s Referral is required to attend this session.

In Haliburton, Barb Fraser will be running a level 2 class this Fall also ( see below for contact details).

Alumni courses (Level 2 and Emotional skills) are still not scheduled yet with Dr. Jackie until more facilitators are trained.

Maintenance class from 4 to 5 pm on Thursdays for selected sites (see website) including St Michael's (room 16101) will finish July 25th and resume September 19th 2013, and are led by Dr Jackie.

Where can I find MBCPM courses elsewhere?MBCPM entry-level courses, using our curriculum and materials, are being offered in:

Oshawa
Oshawa Community Health Centre 
Lisa Laflamme (M.S.W., R.S.W.) (Facilitator) 
with Nancy Shosenburg (M.H.P.)
Phone: 905-723-0036 x232 
Fax: 905-723-3391


Kingston
Southeastern Ontario Kingston Community Health Centres 
Programme is full for Fall 2014 and there is a wait list for January 2014. 

Danielle Deptuck (Facilitators Ruth Dubin M.D., Ph.D. and Evelyn Bowering M.S.W.) 
Phone: 613-542-2949 x1179
Fax: 613-542-7657

Thunder Bay
Ridgeway Clinic 
Darren Roberts (Trudylynn Mahood MD is Facilitator) 
Phone: 807-286-2450 
Fax: 807-623-8105

Haliburton
Haliburton Highlands Medical Centre 
Barb Fraser (M.S.W., R.S.W.) (Facilitator) 
Phone: 705-455-9220 x312 
Fax: 705-455-9315


Cambridge
but only to patients of Cambridge Memorial Hospital Mental Health Program
Mary MacDonald-Young (M.S.W., R.S.W.) (Co-facilitator with Cathy Martin-Hernandez M.S.W., R.S.W.) 
Phone: 519-621-2333 x3308 
Fax: 519-740-4936 



Outside of Canada
They are also offered in 

  • Las Vegas, USA - Dr Dona Costa
  • Melbourne, Australia - Dr Elliot Gerschman

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Picture courtesy of ank.murphy

Meditation for High Blood Pressure

By Rosa Raponi Newton

You may have heard that one of the added benefits of meditation is that it can lower blood pressure. This is because the body experiences a so-called “relaxation response” which involves the blood vessels literally opening up so that blood can flow more freely without the resistance or pressure that goes along with hypertension. Dr. Randy Zusman, of the Massachusetts General Hospital says: "It's basically a plumbing problem. You're pushing the same amount of blood through a bigger pipe,"¹ when your body is responding to meditation. Dr. Zusman and his colleagues explored this phenomenon over a 3-month long study² which compared two groups of people with high blood pressure – one group was taught to elicit the relaxation response through meditation while the other group was given information about the effects of stress on blood pressure. By the end of the 3-month period, the group who learned to meditate was more successful at lowering blood pressure and eliminating anti-hypertensive medication use.

¹ To Lower Blood Pressure, Open Up and Say ‘Om’, NPR, August 21, 2008 http://www.npr.org/2008/08/21/93796200/to-lower-blood-pressure-open-up-and-say-om

² Dusek, J. A., et al. 2008: Stress management versus lifestyle modification on systolic hypertension and medication elimination: A randomized trial, The Journal of Alternative and Complementary Medicine, 14, 129-138.

Did you know that:

Warmed milk and, also, bananas, really do have a substance in them that promotes sleep? Tryptophan is a naturally sedating amino acid that is contained in the building blocks of proteins. Tryptophan is available by prescription, and can be discussed with your physician and/or pharmacist if you are thinking of using it for sleep.

http://gallery.mailchimp.com/1558d6477400c05a7c906ca67/images/mindfulpath96631c.jpgBook Review: The Mindful Path to Self-Compassion

Reviewed by Brenda S. (Alumni)

The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions. 
Christopher K Germer, PhD (published by The Guilford Press, 2009).

This book is an excellent easy read that blends perfectly with our MBCPM courses. Germer explains that when things go wrong we get stuck in the shame and blame cycle, which causes more emotional pain. He encourages us to label and accept our emotions and offer ourselves the same compassion that we would offer a friend in distress.

Pain x Resistance = Suffering

In the first section of his book, Germer discusses Discovering Self-Compassion, where he encourages us to be kind to ourselves and listen to our bodies, “bear witness to our own pain and respond with kindness and understanding”. Germer teaches us the futility of resistance, the more we resist anxiety the more it is fueled. Consider when we can’t sleep and we get anxious as to how the next day is going to be ruined without rest creating a vicious cycle that ensures sleep won’t happen. Better to accept that sleep is out of the question and accept that you will survive the day regardless and why not use this time to meditate. “Your relationship to sleeplessness has to shift. Once you begin to truly, genuinely accept not sleeping, your body will finally get a chance to rest” (p 20). When dealing with difficult emotions he encourages a meditation to label the emotions and where they sit in our bodies and then to “soften, allow and love” (p 67). He teaches “three mindfulness-based skills we can use to handle difficult emotions: (1) focused awareness, (2) open-field awareness, and (3) loving-kindness.”(p 81). After we mindfully “feel the pain” we use self-compassion to“cherish yourself in the midst of the pain”.

In the second section he teaches how to practice loving-kindness and introduces the meta meditation “May I be safe, May I be happy, May I be healthy, May I live with ease.”(p 134) and then encourages us to think of beloved family members and friends in this way and then distant associates and then those whom we have enmity with and then the population of the world as a whole. Once we care for ourselves we are free to care for others.

In the third section, Germer encourages us to find balance and looks into various personality types that we may identify with and how to use compassion to free ourselves from self-imposed hindrance,

http://gallery.mailchimp.com/1558d6477400c05a7c906ca67/images/Radio_Microphone_medium97dc02.jpgOn the Air: The Light Within

Credit: The Light Within Broadcast Series with host Joan Jacobs www.jjacobshealth.com 

Hear Dr. Gardner-Nix discuss chronic pain management with Joan Jacobs on the The Light Within radio show at  http://joanjacobs.srbroadcasting.com.  Scroll down until you see Radio Show and click on the play button.

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Picture courtesy of ank.murphy

All previous issues of our Newsletter are available at www.neuronovacentre.com/blog

Mindful Pain Solutions News is published by The NeuroNova Centre for Mindfulness-Based Chronic Pain Management
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Newsletter Staff
Dr. Jackie Gardner-Nix MB.BS., Ph.D., MRCP(UK), Editor-In-Chief
Sara Pukal, Contributing Editor
Rosa Raponi Newton, M.Sc.OT, Contributing Editor
Marija Stankovic, M.Sc., Andrew Murphy Publisher
Marjorie Van der Veer, Copy Editor