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Chronic Pain and sexuality: How Eva Margot Kant, LCSW-R helps people navigate these issues

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(Image courtesy of Eva Margo Kant, LCSW-R)

The National Institute of Health (NIH) defines chronic pain as pain lasting more than 3 months and it affects more than 100 million Americans today.  As a pelvic floor physical therapist, I help patients with both acute and chronic pain, more specifically pelvic pain, on a daily basis. Due to the private nature of pelvic floor issues, sexual dysfunction, or bowel and bladder complaints it can be difficult for patients to feel comfortable talking about their symptoms.

The famous quote, “no man is an island,” rings true for healthcare providers who treat chronic pain as multiple specialists working together is more effective than one. I recently met with Eva Margot Kant, LCSW-R  with 12+ years of experience helping people deepen their self-esteem, navigate life’s transitions, and address fears and questions about chronic illness/pain which includes topics of sexuality and sensuality. Eva taught me some great perspectives on how she helps people heal their emotional/sexual wounds and how they can be a source of chronic pain.

Eva runs workshops about sex and disability, sex and aging and trains medical students how to talk about sex with their patients. Her goal is to help people “unpack their feelings” that are attached to physical pain and anxiety. Anxiety increases the output of the limbic system, the emotional flight or fight, and memory areas of our brain which results in pain.

Eva believes that “understanding how the body works is the key to understanding you”.  Her job is to help people understand what their sexuality is to them and to own how they view and understand it.  Eva believes that “the body always remembers.” She likened the reflexive blink of an eye that’s about to be poked to the feeling a woman with sexual pain feels if her partner demonstrates affection. The woman may fear that any show of affection may lead to sex which is painful for her, so she avoids this.

Eva’s goal is to help patients learn if some physical reflexive tightening may be due to thoughts involving shame, guilt, or embarrassment.  She helps clients decide when to disclose to a new partner about their chronic condition. She stressed the importance of self-care with their partner and to feel emotionally safe. People who have chronic pain/illness may go thru life as if they are “holding their breath.” Often times Eva finds that partners want to help, they just don’t know how. Demystifying chronic pain/illness allows partners to be supportive and an active participant in healing.

Eva’s upcoming book and course work, called “The Holy Trilogy of Sex (c),” guides patients and their partners in sensuality, sexuality, and intimacy; none of which are possible without communication, sensation, and connection. She encourages partners to engage in body mapping: offering each other a “menu” of intimate ideas that can promote togetherness without causing more pain.

As a Pelvic Physical Therapist, I invite my patient’s partner to a session to observe, learn, and understand what my patient is experiencing and teach the partner ways they can help. I work on the physical aspect of pain with my manual, movement and exercise therapies while Eva addresses on the mental and emotional aspects of chronic pain which leads to a more efficient outcome.

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EMH Team; Jennifer Jurewicz, Tova Laufer & Charissa Morrisroe with Eva Margot Kant, LCSW-R

If you have chronic pelvic pain consider receiving both physical and talk therapy to get your life back on track.  Consider visiting us at EMH Physical Therapy and Eva Margot Kant, LCSW-R if you are in the NYC area. Your pelvic floor with thank you!

Resources:
http://evamkantlcsw.com/
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm

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SOLUTIONS FOR CHRONIC PAIN

PAIN IS IN THE BRAIN
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A staggering 100 million people in the USA suffer with chronic pain, a higher number than those diagnosed with cancer, diabetes and heart disease.  Chronic pain patients suffer because they  feel like they are not believed by medical professionals especially when many test results are negative, the medications don’t make a significant difference and their doctors don’t know what else to do.

Medications or even surgical procedures alone may fail in treating chronic pain as retraining pain requires a multifaceted approach to achieve results.

Recent research reveals that Pain is in the Brain. The faulty processing of danger signals by the brain and it’s decreased ability to modulate or manage the signals received from nerves is the reason for persistent pain.  Having a variety of solutions that the patient implements concurrently may reap the best results.

( Visual infographic explaining chronic pain from behance.com)

PAIN PERCEPTION

Pain perception in a healthy body is good. It prevents us from fully burning our fingers on the stove, stepping on a nail, etc.  The way pain perception works is that the receptors in our skin/body send danger signals through nerves to the spinal cord which then sends information to the brain where the pain is “perceived.” The brain instantaneously interprets the signals as either safe or dangerous depending on your past experiences.

BRAIN CONTROLS PAIN

The brain has areas that are dedicated to our awareness of pain and areas that determine our “experience” of pain.  The healthy brain has flexible pathways and neurotransmitters that can “down modulate” or stop the danger signals. The neurotransmitters  are the “happy chemicals” that our bodies naturally produce, (e.g. serotonin, endorphin & enkephalin). They actually BLOCK pain/danger signals to the brain. “We have a drug cabinet in the brain that’s 18 to 33 times stronger than morphine” says David Butler, PT, GDAMT, M.SPP.SC (1).  There are a number of ways to  increase production of neurotransmitters.

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CIRCUITS BUILT IN YOUTH BECOME THE SUPERHIGHWAYS OF YOUR BRAIN

A recent study of chronic pain patients found 90% reported early childhood rejection by a primary caretaker, an unmet need for closeness and psychological interpersonal trauma (2). Feelings of rejection impairs the body’s ability to lower or  “down modulate” and leads to hypersensitivity to pain.

These patients also reported difficulty in expressing emotion as they did not trust the people who took care of them. Science shows that interpersonal psychological distress and pain share the same neurotransmitters, genetic and immune markers. As babies, we are initially consumed by bodily distress then, as we grow, we feel safe and trusting and we develop a higher order of emotional expression and regulation. Over time, these pathways in the brain become like superhighways so when chronic pain patients experience negative interpersonal trauma, sensitivity to pain is heightened too.

BRAIN RETRAIN PROGRAM

Find your team of health professionals who can partner with you on your pain retraining program:

  • EDUCATE yourself on the recent science of pain (www.retrainpain.org
  • EXERCISE to boost the happy chemicals in the brain, improve your body’s ability to produce anti-inflammatory cells, increase nerve growth factor, stimulate the cerebellum and cortex of the brain which prevents pain signals from being received, move the muscle and fascial tissue.  Exercises can include any cardiovascular activity like 30 minutes of brisk walking along with a stretching, yoga, Pilates program – find what makes you feel good and “Just Do It”.
  • BREATHE  and MEDITATE –  do 5 minutes of deep slow breaths 1x a day to physiologically quiet and calm the nervous system, Follow this by saying some positive Affirmations that help you feel good.
  • MANUAL THERAPY  by either a physical therapist or any body worker who helps you feel relaxed or energized.  Myofascial release, massage, and joint mobilization therapies restore motion and allow normal function. It releases trapped nerves that travel through tight muscles and fascia and helps your body to move freely
  • NUTRITION – consult a nutritionist to find the best low glycemic (lowers body inflammation), high Omega 3 diet, adequate protein intake to synthesize neurotransmitters and repair muscle.   Drink half your body weight in ounces of water for efficient metabolism and to turn off histamine which reduces inflammation and pain
  • TALK – whether individual, group therapy or via forums, research shows that talking about your situation helps you feel less isolated and can create more positive superhighways in your brain while you journey to healing

References

  1.  Treating Pain Using the Brain – David Butler, PT, GDAMT, M.SPP.SC – YouTube
  2. Psychiatric Diagnosis and Treatment of Somatizing Neuropsychiatric Disorders By and )
  3. Body in Mind – the role of the brain in chronic pain by Prof. Lorimer Mosley –  You Tube

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What is Fibromyalgia and How Can PT Help?

treatment room EMH Physical TherapyFibromyalgia is a chronic syndrome that is composed of a group of symptoms.

The symptoms associated with fibromyalgia are varied and may include:

  • Musculoskeletal pain that is widespread
  • Fatigue
  • Sleep deprivation and sleep disorders
  • Loss of memory and cognitive difficulties
  • Mood disorders such as anxiety and depression
  • Tingling in hands or feet
  • Tension headaches
  • IBS
  • Joint pain and morning stiffness
  • Dysmenorrhea and urinary problems
  • Restless leg syndrome
  • Jaw pain
  • Nausea

The cause of fibromyalgia is still largely unknown; however it has been linked to injuries, illnesses, repetitive injuries, infection, surgery, trauma or stressful events, and possibly genetic factors.

If you suffer from fibromyalgia, there are some things you can do to help control fibromyalgia symptoms, which include:

  • Gradual and regular exercise performed in moderation
  • Relaxation techniques to reduce stress levels
  • Get adequate amounts of sleep
  • Limit caffeine intake
  • Eat healthfully

Chronic pain found in fibromyalgia may be initiated by trigger points, and after this pain is generated, the central nervous system amplifies the pain and results in hypersensitivity. This means that pain symptoms from specific causes are increased exponentially and even some sensations that should not be painful are interpreted as painful. So in order to decrease symptoms of pain, it is important to treat the causes to allow the nervous system to unwind from tension. Trigger points, tender areas in the body, and musculoskeletal imbalances are treated by physical therapists to help manage fibromyalgia pain and improve quality of life.

For further information on fibromyalgia:

National Fibromyalgia Association: http://www.fmaware.org/

American Chronic Pain Association: https://theacpa.org/

P-A-I-N is a 4 letter word, but so is T-E-A-M

IMG_4839Why a team approach of seeing MD and Physical Therapy under one roof is ideal for treating chronic pain.

If you have chronic pelvic, urologic,  sexual pain/dysfunction and can answer “Yes” to this statement:

“I’ve been to a number of medical practitioners about my pelvic condition and still don’t have a definitive treatment plan”, you’re not alone!

Just like the saying  “No man is an island”, no single practitioner can provide the breadth of treatment to help patients heal from chronic pelvic pain/dysfunction without working together in a TEAM of health care providers.

” Pelvic Help for Pelvic Pain”  is a 2 week intensive, non surgical program in NYC designed and provided by EMH Physical Therapy and Dr. Robert Echenberg MD.

The program is based on a Bio-psycho-social model of care which is evidence-based on neuroscience and pain processing disorders that are triggered by both functional and structural pain generators.

During the 2 weeks, you’ll receive a thorough education about pain and how pain can be retrained, receive a variety of treatments that includes medicines, trigger point injections, manual therapies, biofeedback and instruction in a tailored home exercise/management program.

It makes sense to address pain from all angles at the same time and this team approach with such open communication between MD, PT’s and other disciplines such as acupuncture and talk therapy is unprecedented and unmatched today. If you think you’ve tried everything else, try one more thing because it works!

Patients who attended our 2 week “Pelvic Help for Pelvic Pain”  program report a sense of well being, get pain relief, learn many self help tools and feel empowered that they can continue to heal.

The following is an interview of an international 32 year old female patient with 20 years of pelvic pain who traveled to NYC to attend our program:

Q: What was the best part of the intensive 2 week “Pelvic Help for Pelvic Pain” program?

A: The best part was the global approach to my health condition by MD and DPT. Working together,  which is rare in my country, gave me a broader view of my pain and of my power to overcome it.

The compassionate way Dr. Echenberg and the EMH PTs treated me was very supportive. As chronic pain is very stressful, the caring treatments and the kindness of these health professionals were very important and one of the best parts.

Q: How did you feel at the end of the 2 weeks?

A: I felt very well educated about my pain and about my role in my treatment. I was trained by PT to be able to continue my exercise program in South America and I felt I wasn´t alone with my pain, because they told me that they´ll continue support me even with the distance. The symptoms didn´t disappear, of course, because it´s a chronic pain but I felt better and well prepared to deal with it.

We have openings in our program!

Call (212) 288-2242 to schedule your appointment.

For more information about Dr. Echenberg go to his website, http://www.instituteforwomeninpain.com/For more information about EMH physical therapy, go to their website, http://www.emhphysicaltherapy.com.

Endometriosis: ladies, let’s talk about it!

I fight like a girl graphicIt’s rare these days that a high profile celeb talks about anything that isn’t skin deep or filtered on Instagram. That’s why I give props to Lena Dunham (of HBO Girl’s fame) for writing an open and honest letter to her fans citing her endometriosis as the reason she will be missing from the press tour for the new season of her hit HBO show. That got me thinking, what other celebs have endometriosis? Are they just like us? Whoopi Goldberg, Hillary Clinton, Dolly Parton, Emma Bunton of the spice girls, Julianne Hough, and possibly Marilyn Monroe have all been linked to the diagnosis. That’s not surprising as 1 in 10 women have endometriosis, with more than 170 million women worldwide having already been diagnosed often after several years of debilitating pain.

1 in 10 women have endometriosis

So what exactly is endometriosis? Simply put, the tissue that lines the uterus (called endometrial tissue) somehow spreads to areas that it shouldn’t be causing pain and possible infertility. Endometrial tissue has been found in the adjacent areas of the body: vagina, cervix, rectum, abdomen, ovaries, bladder, and even the lungs or brain. Symptoms can include pelvic pain, painful intercourse, severe abdominal cramping, heavy periods that leave the woman incapable of leaving her bed, constipation or diarrhea, infertility or difficulty conceiving, and chronic low back pain.

What causes this terrible, invisible disease? Nobody really knows. Theories include: genetics, stress, hormone imbalance, toxins or environmental factors, a defect during embryonic development, or immune system defect. Think the symptoms sound familiar? How do we diagnose a case of endometriosis? The only way to confirm diagnosis is to “take a look” with a laparoscopic surgery which in itself introduces new injury and potential scar tissue to an already vulnerable area. At least the theory that a hysterectomy would “cure” endometriosis has been thrown out in recent years as that pesky endometrial tissue has estrogen of its own, and can re-grow in absence of a uterus. So basically our bodies can attack us from the inside at any moment without anything to be done about it?!

But wait, there’s hope! Although more research needs to be done about potential treatments and cures, there are a lot of options out there. The gold standard of diagnosis and treatment is a laparoscopy, but the tissue may grow back. Birth control or hormone therapy may help with menstrual pain and avoid a monthly relapse.

Pelvic floor PT can also help in reducing abdominal restrictions and decrease abdominal pain and cramping in addition to strengthening the core and pelvic floor muscles. Decreasing the restrictions caused by the endometrial tissue can free up the nerve endings in the abdomen decreasing pain signals sent by the entrapped nerves. Chronic pain additionally causes increased muscle tension due to our body’s protective contraction of muscles in the area that hurts. Manual techniques by a physical therapist can also help reduce this muscle tension, leading to father relief of chronic pain and faulty postures. Other forms of exercise can also be helpful including biking and walking.

Many women anecdotally report their endometriosis was “cured” after giving birth, but this is not always the case. Some have had success with acupuncture, massage, or working with a dietician to hit the disease from every angle.

The moral of the story is: DON’T GIVE UP! You’re not alone, there is help out there. The more people talk about endometriosis the less “imaginary” and “invisible” it will be. Here are some additional resources to check out for more information about endometriosis and treatment options:

The Endometriosis Foundation of America:    http://www.endofound.org/endometriosis

U.S. endo March (kind of like the Susan G Komen breast cancer walk) Happening March 19, 2016 in San Francisco!  http://www.endomarch.org/

The endometriosis association: http://www.endometriosisassn.org/endo.html