The Stress-Pain Continuum
The expression of stress (fight/flight/freeze response) can be simultaneously emotional, spiritual, psychological, biochemical, hormonal, systemic and personal, among others. The physical response to stress includes conscious and unconscious (i.e. reflex) contraction of muscles. Once the stressor has passed, muscles and other systems should return to the resting/relaxed state. The brain is designed to keep unnecessary tension out of our system. Unfortunately, in today's society, we have overrun this software. Most of us live with many of our 650 plus voluntary muscles in some form of habituated reflex contraction. Just about everyone over 40 feels stiff and tight somewhere in the body. Recent science has validated the argument that a high "stiffness score" is more detrimental to our well-being than high cholesterol. Tight muscles indicate that our autonomic system is always on. If only we could flip a switch and turn our muscles off.
Within each muscle, recent scientific studies have shown, there are spindle cells that house pressure-sensitive pain receptors. Daily stress gets muscles in a baseline state of constant contraction. Millions live with low back stiffness. Most aren't even aware of it until PAIN ensues. Once the threshold is reached, PAIN is triggered. This explains why a person can just lean over to pick up a piece of paper and "throw his back out". Hence 30% of population has a "bad" back on any given day.
We have excellent brain awareness, and therefore control, of our hand muscles. We would never walk around all day with our hand in a fist. Why should our hundreds of other "voluntary" muscles be any different?
Current State of Affairs
Today's primary care providers (PCPs) are not armed to deal with the stress-pain continuum. Over 50% of patients have some form of pain complaint, and chronic pain affects more people than cancer, diabetes and heart disease combined. These numbers are going up, not down. This is why PAIN, according to the Institute of Medicine, is a $635 billion per year problem in the US and growing. PCPs are in a conundrum. The tools they currently have are often ineffective and sometimes cause more harm than good. For example, prescription medications, at their best, only help manage the pain, not resolve it. At their worst, medications such as opioids kill. Referrals to physical therapy or to specialists for surgery do not resolve the problem. Research shows that physical therapy is only minimally effective for chronic pain and many back surgeries are unnecessary, ineffective in the long run, and often lead to further problems and repeated surgeries. The power of the pen (used to write prescriptions or referrals) is not enough. If physicians on the frontline (e.g., Emergency Medicine/Urgent Care/Primary Care) had a simple and effective option, would they use it?
What if a primary care provider could be trained in an educational-therapeutic system that re-programs the brain to immediately start sending impulses that regulate our "voluntary" muscles back to the relaxed-resting state? What if a PCP could offer this to all his/her patients either individually, in large groups or through a mobile app?
What if patients could learn, quickly and easily, to reset their own brain software, thereby breaking the reflex cycles that are causing much of this pain. What if this could be done by the patient in less than 10 minutes per day?
Ten years and multi-million dollars of clinical research with thousands of participants has turned "What if?" into reality. Dr. Ramon Nunez brought his work, Somatic Functional Therapy (SFT) to the Henry Ford Health System's Center for Integrative Medicine in 2001. The clinical researcher, Alba Rodriguez, PhD, validated its effectiveness over both conventional care such as physical therapy, as well as complementary therapies such as chiropractic, massage and acupuncture. SFT is a solution that enables the brain to "remember" how to release the stressed muscles. Does anyone recall having muscle tension as a 6 year old?
So what you ask? The results speak for themselves. In one study, over 50% of Chrysler employee participants that had chronic back pain experienced resolution of their pain by the end of a multi-week group program (over 80% of participants experienced improvement.) At 16 months, they remained pain free with no further intervention! These results have been replicated with employees at Dow Chemical, Henry Ford Health System, as well as patients insured by Blue Cross Blue Shield of Michigan, among many others.
Somatic Pain Resolution works!! It is now ready to be utilized by all clinical practitioners.
What is it?
A voluntary muscle contracts for one reason and one reason only: it receives an impulse. This impulse is either conscious, i.e. your brain sending an impulse for a specific purpose such as wanting to close your hand. Or it is unconscious, i.e. a reflex contraction such as your shoulders tensing when you are stressed. Once the stressful event passes, the body should go back to a relaxed state. A muscle relaxes for only one reason: it stops receiving an impulse. In today's society, because of a constant barrage of stressors, we have overridden this inherent capability of getting back to a resting state. Through SFT the brain becomes aware of muscles in reflex contraction and the reset button is pushed.
This is why the clinical research has shown that over 20% of patients in chronic pain experience their pain level dropping to 0 in the first treatment session. The pain switch gets turned off as soon as the contraction falls below threshold. After the reset button has been pushed an adequate number of times, the computer program can be left alone. This is why Somatic Functional Therapy works, achieving proven long-term results.
Dr. Ramon Nunez has been developing and perfecting Somatic Functional Therapy over the past 40 years of clinical practice and more than 10 years of clinical research. His trademarked protocols include specific movements that serve to debug our corrupt software program, i.e. make the brain aware of the sustained reflex contractions of voluntary muscles so that the individual can regain control of the muscles (the hardware).
Somatic Functional Therapy has its origins in both Eastern and Western medicine. Ramon Nunez has a doctorate in Traditional Chinese Medicine and Acupuncture. He is a recognized master of martial arts and 10th degree black belt. He has presented and taught in US medical schools. He has been mentored by many of the pioneers in movement therapy in the US and China.
The Research and Results
Obtained from 10 years of clinical research of Somatic Functional Therapy programs for chronic pain at:
• Henry Ford Health System
• A Specialty Pain Clinic
• Dow Chemical
• Faith-based Community
• Blue Cross Blue Shield of Michigan
The trials were conducted as Institutional Review Board-approved clinical trials to allow for definitive conclusions regarding their effectiveness. There were16-24 contact hours over 10-32 weeks. Group sizes: ~50-200 per group. Over 2,400 participants in clinical trials with more than 13,400 chronic pain conditions (>5 per person). Nearly all participants had at least 1 stress-related condition. The results were measured scientifically using validated outcome measures.
Hands-on, 1-on-1 Treatment for Chronic Back Pain
In a randomized controlled trial (RCT), patients with chronic back pain (duration 3 months to 20+ years), including sciatica, sacral pain, and “failed back surgery syndrome” were treated with:
1) conventional physical therapy (PT)
2) a combination of complementary/alternative medicine (CAM) therapies (chiropractic, acupuncture, neuromuscular therapy, hypnotherapy, and Feldenkrais movement re-education) delivered by a group of licensed practitioners.
3) an intervention that included SFT (delivered by massage therapists trained over 2 weekends in SFT Pain Resolution protocols).
Results: ELIMINATION of chronic back pain: PT=5% vs. CAM=16% vs SFT=25%.
Group Program for Chronic Back Pain
An RCT evaluated an SFT-based group educational program delivered on-site at Chrysler. There were 96 participants in 12, 2-hour sessions over 24 weeks and 59 untreated waiting list controls.
Results: RESOLUTION of chronic back pain: Participants=55% vs. Controls=0%. Significant reductions in pain, disability, medication usage, sleep disturbance and depressive symptoms.
The results of the studies encompassing more than 2400 participants were just as remarkable. The 16-month follow-up analyses showed that results are maintained long term. The demonstrated outcomes of these programs include resolution of chronic pain (nearly 40% of conditions resolved), significant decreases in stress, and improvement in numerous chronic illnesses and stress-related conditions such as depression, high blood pressure, diabetes, anxiety, and sleep disorders, among others.
These programs have been recognized both regionally and nationally. The American Hospital Association (AHA) recognized Henry Ford Health System as one 1 of 7 hospitals nationwide designated as “wellness leaders”, specifically for these outcomes-based, research-proven SFT-based programs for the hospital employees and dependents and for partnering with the community in corporate programs for Chrysler and Dow Chemical, and community benefit programs for churches (AHA 2011 “Creating a Culture of Health” report).
A Solution to the Stress & Pain Problem
Stress (i.e. stressors) cannot be eliminated. However, changing how stress is expressed through the neuromuscular system is essential to impact pain and optimize wellbeing.
The challenge with any healthcare solution is that it must be simple, safe, and scalable to be successful. It needs to be rooted in science. Comparative effectiveness to other options is required. It should be able to be delivered at the point of care. Prevention and early intervention should be its target. Compliance needs to be assured. Healthy behavioral change needs to be easy. Integration with other successful solutions is ideal. Lastly, it must have the capacity to bring costs of healthcare down in a way that is win-win-win for all concerned. Somatic Functional Therapy Pain Resolution meets these criteria.
Somatic Functional Therapy fits within the history/exam/assessment/plan format with which every physician is familiar. The training basically revolves around understanding the software system on how the brain and muscles connect. It empowers the PCP and patient to resolve what is often the core pain problem-the dysfunctional "stress response". A physician, nurse practitioner or physician assistant can be taught within a three-month basic training program.
Once the PCP makes a somatic diagnosis, the rest is algorithmic. (Somatic in this context means the brain's ability to be consciously aware, therefore in control, of the body's voluntary muscles.) The PCP can now add the "functional" component to the evaluation in conjunction with the structural and metabolic aspects that were taught in medical school. Interestingly in the ICD-9 coding book, Somatic Dysfunction is a billable code.
The patient commits five minutes before bed and five minutes upon awaking to the Somatic Pain Resolution routines. It is not a passive treatment done to the patient. Rather, the patient is responsible for his/her own pain relief. Going from pain to pleasure is a primal behavior change driver. Compliance is easily maintained. After repeated performance of these movements, muscle memory is achieved. This is why in a stressful board meeting a CEO can merely think about the routine and muscle relaxation can occur. How simple is that!
A somatic diagnosis involves listening, looking, and touching for degrees of muscular tension. It is only when a muscle reaches the threshold of its spindle cell pressure-sensitive pain fibers that pain will start. PCPs will have the ability to diagnose reflex muscular contractions before pain has presented itself. SFT pushes the re-set button so muscles can idle in neutral when not in use. The odds of chronic pain can be dramatically reduced.
The early clinical research done at Henry Ford Health System showed that SFT was five times more effective at resolving chronic back pain than physical therapy, and significantly better than a combination of multiple complementary/alternative therapies including chiropractic, acupuncture, mind-body therapy, movement re-education and neuromuscular therapy. Furthermore, it required fewer visits and was considerably more cost effective.
Currently, the only point of care treatment that frontline physicians (primary care, urgent care, emergency room) have is a pen (i.e. for writing prescriptions or referrals). A plethora of clinical studies show that drugs have limited effectiveness in chronic pain. In fact, they frequently make matters worse. This is one reason why medical spend for back pain over the past 10 years has gone from $40 to $80 billion while the level of disability has doubled. (By the way, this is called system failure in any other industry!) Given the crack-down on opioid prescribing, soon these physicians will have nothing to offer. If SFT is put in the hands of these frontline providers, they will be able to deliver a safe and clearly more effective treatment.
Very few patients want harmful and addictive medication to treat their pain. My work delivering Somatic Functional Therapy within a busy urgent care center over the past four years has born this out. Patients who come in with pain often leave in either no, or markedly reduced pain within a 15-minute urgent care visit that incorporates SFT. The prescriptions for Vicodin or Percocet are minimal, plus the patients leave happy. Ask any urgent care doctor, this rarely, if ever happens.
Somatic Functional Therapy is an educational-therapeutic system. The PCP can deliver hands-on SFT within the course of a few routine office visits. The education can be delivered individually, in large groups and via mobile apps. The 20% of the US population who suffer with major pain conditions generates $5000 per person per year in additional healthcare costs. For an employer, across the board, the cost of pain is $1000 per employee per year. If implemented correctly, based on the previous clinical studies of 25-50% pain resolution, the reduction in healthcare costs can be substantial.
Alba Rodriguez, PhD in Experimental Psychology, has been conducting clinical trials on SFT for more than 10 years. She is now in charge of developing the "big data" analytics for SFT's value-based care dashboards. (Healthcare value = Cost/Outcome). Three of the key outcomes are level of pain, function, and stress. These will be measured via a private, secure mobile app, through a HIPPA-compliant portal. It will not be a consumer-based app. This allows value to be measured, and quality control can be monitored. Incentives, if needed, can also be delivered. SFT can tap directly into the rapidly developing valued-based payment systems. "Hard" medical savings can be calculated along with the "soft" savings of decreased disability and increased productivity.
A system that integrates Somatic Functional Therapy will produce a "pareto" optimal scenario: cost savings for the Payor, increased revenue for the frontline providers and what every patient desires - FIXING the ROOT CAUSE of THEIR PROBLEM. No other pain solution offers this possibility.
The plan now is to first integrate the Somatic Functional Therapy Pain Resolution system with the frontline providers at retail clinics, urgent care centers, emergency rooms, and primary care offices. This is the entry point where the majority of patients in pain seek help. Other areas of the health care system where Somatic Functional Therapy can be of value are under consideration.
Within this system:
• Clinical training delivered
• On-line patient "educational-therapeutic" support
• Registry of patient outcomes collected
• Cost-savings calculated