Dr. Peter Abaci Presents At RSDSA Conference Supporting The CRPS Community

Dr. Peter Abaci Presenting at RSDSA Conference
Dr. Peter Abaci Presenting at RSDSA Conference for Complex Regional Pain Syndrome

Peter Abaci, MD is the co-founder and medical director of The Bay Area Pain and Wellness Center, author of, "Take Control of Your Pain", and a frequent contributor to WebMD, Pain Pathways, and Huffington Post. His objective is to teach you how to have a great life with CRPS.

This presentation is part of the broader discussion on integrated Solutions to CRPS, treating the whole person, and optimizing wellness.

Transcript

00:04
first all-star today Peter bocce is our
00:10
medical director and co-founder of the
00:12
Bay Area pain and wellness center he's a
00:14
contributing expert for WebMD and pain
00:17
pathways and I think Peter also writes
00:20
for Huffington Post I think I've seen
00:22
him do that and so real excited to have
00:24
him talk today and thank you I hope you
00:31
will be inspired to learn and I hope you
00:37
will with what you learn will inspire
00:39
you I have only one objective today and
00:42
it's a very simple one and when I in my
00:46
own clinic when I talk to my FRP
00:48
patients and our program I asked them
00:50
why do we have this program and
00:52
everybody gives good answers like you
00:54
know we're gonna learn tools to manage
00:56
our pain we're gonna be able to function
00:58
better and those are those are real
01:00
really good answers but there's really
01:02
underneath that there's really only one
01:04
thing and that's to have a great life
01:08
with with CRPS and that you know if we
01:11
can contribute just a little bit today
01:13
to help you get on a path to having that
01:16
and this will be so worth it for all of
01:20
us professor is this all real
01:32
or is it just happening inside my head
01:34
of course it's happening inside your
01:36
head Harry why should that mean that
01:40
it's not real professor what should I do
01:51
so you gonna guess I love Harry Potter
01:54
I'm a huge fan
01:56
but my talk is about conquering the
01:58
brain and you know the Harry Potter
02:01
story is really about you know
02:03
conquering the the evil demon and you
02:06
know in his case Baltimore but he didn't
02:07
do it with physical power really he
02:09
really did it with his heart his mind
02:11
and his connections with us with his
02:13
friends so when we sort of proach this
02:19
brain thing and I know some of you guys
02:20
have been to some of the other RSD essay
02:22
lectures and I you guys know a lot about
02:25
what's going on in the brain but just to
02:27
kind of bring it back a little bit we're
02:29
really talking about the structure and
02:31
function of what's going on in our
02:34
nervous system so our hardware is our
02:37
kind of a gray matter or a volume or
02:39
body of our of our nerve cells and then
02:42
a white matter
02:43
that's our cables and cords that helps
02:45
everything run well and the better our
02:47
cables and cords work the better our our
02:49
hardware works and the more effective
02:51
and efficient we are and then with CRPS
02:57
all of a sudden we start to see
02:58
significant changes to the structure and
03:01
the function of our our hardware and
03:04
software and what happens is that leads
03:07
to significant changes that we start to
03:09
experience in our bodies and then
03:11
everything starts to change so learning
03:16
how to play this game the brain game how
03:19
to use the how to win the brain game how
03:21
to use the tools it helps to understand
03:23
a few you know basic points the first
03:25
being neuroplasticity the brain is a
03:28
very dynamic always evolving always
03:30
changing thing it's never static it's
03:32
always growing and evolving depending on
03:34
what's going on and what we feed it and
03:36
how we nurture it and how we take care
03:38
of it so understanding that as a tool is
03:41
one of the ways we win the game the
03:44
second one is this concept
03:45
of neurogenesis the fact that we can
03:47
create and build new nerve cells to help
03:50
us you know in our journey that we have
03:52
the power to do that and interestingly
03:55
not only can we do that when we're when
03:57
we're not well we can also do that when
03:59
we're really old you know the power to
04:01
do that we're seeing exists until the
04:03
very end of life epigenetics so where
04:08
we've also learned that we have the
04:11
ability to turn genes on and off in our
04:13
nervous system and the with with chronic
04:18
pain with CRPS we see different genes
04:20
being expressed in different ways and so
04:23
turning on and off what's going on
04:25
genetically is a way of modifying the
04:28
experience of pain that we have whether
04:30
turning it on or turning it off and then
04:35
you know when I was little and I was
04:37
naughty my grandma would always say
04:39
Peter you're a rascal and the glial
04:41
cells are these cells in our nervous
04:43
system they can be Rascals if we let
04:46
them and they can sort of fan the flames
04:48
of pain and inflammation and chronic
04:51
nerve pain and so understanding you know
04:53
how to keep those guys at bay is another
04:56
way of winning the the brain game so at
05:00
the end of the day when you put all this
05:01
together you've got the power if the
05:04
power is inside of you to manipulate
05:06
this so that you can start to take
05:08
control take charge of the disease that
05:11
you have and start to create the change
05:13
that you want that will lead to long
05:15
lasting recovery long lasting healing
05:17
and well-being so when we're talking
05:21
about this sort of CRPS brain and some
05:24
of the the structural changes that lead
05:26
to some of the functional things that
05:29
happen we know that are the way our body
05:32
moves starts to change and starts to get
05:35
affected and we have this strong
05:37
connection between the brain and our
05:38
body is that's creating that we know
05:41
about the sort of distorted body image
05:43
the way we see ourselves moving you know
05:45
we look at ourselves in the mirror we
05:46
start to see things differently it has
05:48
to do with the way we see things at a
05:51
brain level and we start to ignore and
05:54
neglect certain parts of our body
05:56
sometimes
05:57
the sensitivities to touch I'm sure a
06:00
lot of you have know that firsthand and
06:04
the temperature changes all these things
06:07
that we start to experience or see
06:09
happening in our bodies is connected to
06:11
these structural changes taking place in
06:14
our brain and then I think the mood
06:17
changes the the you know the stress the
06:19
intense anxiety that we feel when our
06:21
body is on fire you know understanding
06:23
how this all happens this is this is
06:26
sort of the the wicked strategy that
06:28
CRPS tries to do and creates these sort
06:31
of structural changes that we have to
06:33
undo so that we so that we heal so
06:37
conquering the pain brain to win this
06:42
game we want to create the structural
06:44
changes that we want for ourselves to be
06:46
the the healthier recovered version of
06:49
ourselves and I say use the R's you know
06:53
whatever you know a lot of ours you can
06:54
think of remodel rework revise
06:58
reconfigure we go on and on and on of
07:00
how we want to redo ourselves but really
07:02
I think one of the most important ones
07:03
that keep in mind is the last one is
07:05
repetition when we're talking about
07:07
creating lasting neuroplastic changes
07:10
changing our nervous system we have to
07:13
do it over and over again we can't give
07:14
up we have to sync we have to hang in
07:16
there we have to stick in there and
07:17
we've learned this from even with stroke
07:19
patients and Stroke recovering
07:21
rehabilitation it takes time we have to
07:23
sort of practice and do over and over
07:26
again but if we do that if we hang in
07:27
there if we do that we start to create
07:29
the change that we want to see so I like
07:33
to talk about five sort of key elements
07:36
of success so when you're working with
07:37
your providers your health care teams
07:39
when you go back home if you can sort of
07:41
keep these things in wine and use this
07:43
as part of building your strategy I
07:45
think this will help you you know
07:47
conquer the brain and win the pain game
07:49
the first one is mobility so what can
07:54
take us away more from being mobile than
07:57
our pain and what can you know the less
08:01
mobile we are the less are the more
08:03
quality of life goes down and so the
08:05
more we can get around the more active
08:07
we are the better usually our quality of
08:09
life is so
08:10
when you're talking with your doctor's
08:12
working with your team think about what
08:14
things can we do that's going to help us
08:16
be more mobile and more active second
08:20
one is interaction so we've learned a
08:22
lot from research that the the quality
08:26
of our social connections and the the
08:29
how well socially connected we are has a
08:31
lot to do with how happy we are how sick
08:33
you know how how long we live how well
08:36
we live how good our health is our sense
08:37
of well-being a lot of it has to do with
08:39
social connectivity and you know I think
08:42
when we're in pain you know what suffers
08:45
more than our social connections you
08:46
know we have we maybe become
08:48
disconnected from our friends our
08:50
co-workers maybe we would draw from
08:52
family members so what sort of
08:54
treatments what sort of things can be
08:56
done to help rebuild social bonds and
08:58
connections so obviously things like
09:01
being here today and then third one is
09:04
is independence what sort of treatments
09:07
or things can be done to help to help me
09:10
be more more independent nobody really
09:13
wants to be dependent on other people
09:15
for four basic life activities ADL's
09:18
things like that
09:19
how can I work my medical treatments to
09:23
make me a more independent person make
09:25
that part of your strategy the fourth
09:29
one's really important validation we all
09:31
need to be validated I think a lot of us
09:33
can relate to what is it like when
09:36
people don't understand what we're going
09:37
through maybe we don't feel like our
09:39
doctors believe that we're really
09:41
suffering the way we feel we are or our
09:43
family members how many people here are
09:45
our friends or family of somebody with
09:48
with CRPS yeah way to go all right
09:51
validation starts with education and the
09:54
more that we can educate other people
09:55
about what's really going on with this
09:58
disease the better that we can all work
10:00
together last one is love at the at the
10:05
the core bottom of everything you know
10:07
at the end of the day with whatever you
10:09
do with your health the the basic human
10:13
necessity in life is love and it's a
10:16
two-way thing one of course is we we
10:19
need to be loved and the other I think
10:21
to have a truly satisfied happy
10:24
as we have to be able to love other
10:25
people and so nothing can strip love
10:29
away from you faster than a challenging
10:32
pain problem and so when we're
10:34
navigating our strategies and how we're
10:36
approaching you know our health and what
10:39
we're gonna do to treat it we kind of
10:41
figure out how can we bring more love
10:42
back both receiving love and giving love
10:45
it is it is our core necessity and where
10:49
the real value comes in with what we do
10:52
so the storm so I think this is a big a
10:57
big issue with with chronic pain in
10:59
general and certainly with challenging
11:02
CRPS problems I think the more that we
11:04
we understand pain the more we
11:06
understand that that trauma as often
11:10
runs hand in hand many times with with
11:13
an experience of of intense ongoing pain
11:16
and when we're experiencing trauma signs
11:19
of that might be mood swings flashbacks
11:22
panic attacks nightmares feeling
11:25
socially withdrawn or isolated those are
11:27
signs of trauma and when we talk about
11:31
the the stress response we talk about
11:34
the fight-or-flight you know when you're
11:36
when you're faced with a stressful event
11:37
are you gonna fight it take it on you're
11:39
gonna try to run away we often you know
11:41
I'm sure you've heard about that but
11:43
some people who study trauma also talk
11:45
about a third response which is freeze
11:46
which is we get stuck and we can't move
11:49
and we can't do anything because we are
11:51
so overwhelmed by our feelings of trauma
11:54
and when we have that going on we can't
11:57
heal we can't get better we can't move
11:58
forward we can't create the great
12:00
neuroplastic changes that we want to see
12:02
for our success so we have to get
12:04
unstuck and to do that we have to
12:06
effectively work on the trauma if it's
12:09
an issue and I kind of like to describe
12:13
the the three phases of trauma one is
12:16
for some of us it might be the the
12:19
accident or the injury that happened
12:21
that maybe created the CRPS so maybe it
12:25
was a you know
12:26
accident a work injury whatever was that
12:30
event can be traumatic and that trauma
12:31
experience can can live with us
12:33
hand-in-hand as we're struggling with
12:35
the rest of our injury and our health
12:37
and our pain the second second one is if
12:42
some of us had a traumatic experience
12:44
earlier in life of some sort and we sort
12:49
of store that away in our in our brains
12:51
in our memory what that was like and we
12:53
move on but then later we start to feel
12:56
you know an injury or a lot of pain the
12:59
the unraveling of that starts to come
13:01
out again and we start to feel these
13:03
trauma experiences because it's been the
13:05
seeds were planted maybe in our nervous
13:08
system many many years ago that's
13:10
potentially the second face of trauma
13:12
and then the third one is believe it or
13:15
not I think being just the experience of
13:17
being in pain for a long time it's
13:19
traumatic I think it can be traumatic
13:21
and you know all of a sudden you know I
13:23
see people going from you know being a
13:26
you know a dad and work in and taking
13:29
care of his family to getting injured to
13:31
six months later not better and
13:33
nightmares and mood swings and crying
13:36
and doesn't know what's going on I think
13:38
the experience of train the experience
13:40
of pain for an extended period of time
13:41
can be a traumatic experience and start
13:44
to create trauma symptoms so whatever
13:46
the sources are it's important that we
13:49
get a handle on that and then just sort
13:51
of looking at the different parts of the
13:53
neurologic system of the brain all that
13:56
are raveled into the trauma experience
13:59
and also you know very heavily connected
14:01
to that to the pain experience so of an
14:07
important part of this is calming the
14:09
storm there's different ways of doing
14:12
that one is through meditation either
14:16
still meditation or what I call active
14:19
meditation that we can do walking like
14:21
in a beautiful setting like we're in
14:23
today and as we do that we start to
14:26
build in boost our gray matter our white
14:29
matter starts to work better for us we
14:31
start to see positive brain changes we
14:33
start to win the brain game breathing
14:36
exercises helping calm our neurologic
14:39
system down
14:40
we call the parasympathetic nervous
14:41
system which helps relax us brings our
14:44
heart rate down brings our stress levels
14:46
down learning breathing exercises that
14:48
help us do that helps calm the storm
14:51
alright therapy what you got excited
14:53
you're gonna learn more about today
14:55
research has shown that art therapy can
14:58
activate this part of a brain call the
15:01
periaqueductal gray so that that's a
15:03
part of a brain kind of a descending
15:05
area that sends sort of pain relief
15:07
messages down to our body so that's
15:09
pretty cool
15:10
who doesn't want a good periaqueductal
15:11
grey I know I do so we're gonna learn
15:15
more about that which is exciting
15:17
yoga we see you know research is
15:20
starting to show some really interesting
15:21
positive neuroplastic changes with yoga
15:24
and trauma I like to think of yoga's
15:26
therapy not exercise and if we approach
15:28
it that way I think we can get a lot out
15:31
of it EMDR eye movement desensitization
15:37
and reprocessing this is an another cool
15:41
interesting way of treating trauma
15:43
symptoms there might be some
15:45
practitioners here today you might even
15:47
get to talk to who have expertise in
15:49
that another another bad egg is is these
15:54
harmful thoughts that we start to get
15:56
and we talked about the genetic changes
15:59
and the environment that we're in and
16:01
how that leads to more pain and they you
16:03
know how we feed our brain leads to how
16:05
we how we end up feeling and sometimes
16:08
the the thoughts that we have can create
16:11
this sort of toxic environment and then
16:13
that can lead us down a place where we
16:14
don't want to be which is which is in in
16:16
more pain and suffering more so I like
16:21
to say big three harmful thoughts that
16:23
we have to kind of be on the lookout for
16:25
and work on the first is catastrophizing
16:29
catastrophizing is when we feel like
16:31
something is a lot worse than it really
16:33
is you know somebody a doctor or a
16:35
friend or somebody says something about
16:36
our medical condition and we think it
16:38
sounds really really bad and research
16:41
shows that the more we catastrophize the
16:44
more likely we are to have chronic pain
16:45
the more likely we are to need strong
16:48
medications so we have to source
16:50
safeguard how we process our own metal
16:53
information the second is fear and pain
16:59
plays this fear game with us and I like
17:01
to say that our fear is our sort of
17:04
wicked wicked evil stepmother in our
17:07
pain stories and it's what keeps us in a
17:10
box holds us back and an understanding
17:12
the unhealthy fears versus the the the
17:15
healthy fears in our lives is really a
17:18
key process it in overcoming in
17:20
conquering conquering pain there's a
17:22
concept in pain management we use called
17:25
fear avoidance you're gonna hear more
17:26
about that today
17:27
and then the third one is is our anger
17:31
and you know angry okay if you ain't if
17:35
you're really angry can you be happy at
17:36
the same time no can you can you love
17:40
other people and experience love if
17:41
you're really angry
17:42
you really can't and anger seems to have
17:45
a way of just overwhelming us when we
17:47
when we let it and when that happens we
17:49
are back to that sort of place of fries
17:52
where we can't go forward we can't get
17:54
better so then we fight this with our
17:58
healing thoughts first ones the
18:01
acceptance and acceptance is not giving
18:04
up acceptance is is actually overcoming
18:08
and winning this that winning this
18:09
battle but it's it's recognizing that we
18:11
have a problem that we're gonna keep it
18:14
in a box and that we're gonna live our
18:15
lives in a successful way with whatever
18:18
our challenges our gratitude so I like
18:22
this quote gratitude heals it energizes
18:25
and it transforms lives and that's from
18:28
you know famous gratitude researcher and
18:31
actually research shows a lot of health
18:33
benefits from gratitude exercises then
18:37
the other one is compassion responding
18:40
responding to the needs of others and
18:42
also some positive health research done
18:45
on compassion exercises improves our
18:48
heart health makes a relationships
18:50
better we live longer it's all good and
18:54
there's different ways you know
18:56
gratitude compassion don't just
18:59
necessarily happen sometimes we have to
19:01
be proactive to bring that into our
19:02
lives there's different ways of doing
19:04
that you can do gratitude journaling you
19:06
can keep
19:07
write down a few things everyday that
19:08
you feel grateful for we see positive
19:10
effects of that and then with compassion
19:13
you can count kindness you can write
19:14
down acts of kindness that maybe happen
19:16
in your day and if you start to think
19:17
about these things you start to be more
19:19
proactive about bringing more and more
19:21
in that into your life and research
19:24
seems to show it works another really
19:27
good one - winning this sort of pain
19:30
brain game is exercise and you're gonna
19:34
hear a lot more about that later as well
19:35
but we we've learned that exercise has a
19:39
very powerful effect on on how we
19:42
function neurologically and in our
19:44
brains and it it helps at when we
19:47
workout or when we are when we're moving
19:48
our bodies when we're doing things
19:50
physically we start to see these
19:52
neurotropic factors get produced that
19:54
helps a boost and expand our brains and
19:56
we start to be able to use that as a
19:58
tool to create the changes that we want
20:00
to see so we get more more gray matter
20:03
and our hippocampus our learning centers
20:06
and he has mentioned earlier even in the
20:09
you know old age stages of life exercise
20:12
can produce increased gray matter in our
20:15
learning centers can help us learn
20:17
better slow down dementia things like
20:19
that and we see better function in a
20:24
number of different key parts of our
20:26
brains and really these these brain
20:29
areas that exercise helps are really the
20:31
very many of the same areas of our
20:33
brains that are struggling when we're
20:35
when we're in pain in the the sort of
20:38
gut brain connection is another area
20:40
that we're learning things about and
20:41
this is interesting because there's this
20:44
sort of two-way communication between
20:46
our our neurologic system and our brains
20:48
and our guts and we know that we have in
20:51
our in our in our gut we have this
20:54
microbiome we have all hundreds of
20:56
different types of bacteria inside our
20:58
our intestines and the the makeup of
21:00
those bacteria change or can change
21:03
depending on what's going on and what
21:05
we're seeing is when changes happen to
21:07
our microbiome that creates changes in
21:10
our brain and vice versa when things
21:12
happen in our brain changes happen there
21:15
it changes the way the makeup of the
21:17
bacteria and our microbiome vary
21:20
interesting so the sum of the direct
21:23
things that we can do that change the
21:25
the microbiome in our in our gut the
21:28
food that we eat some of the medications
21:30
that we take environmental toxins all
21:34
have an effect and I like to use the
21:37
rule of seven if you're thinking about
21:39
this topic and the rule of seven for me
21:41
is every day try to have seven different
21:44
types of produce throughout the day you
21:47
know fruits and vegetables basically
21:49
pick seven things try to hit that number
21:52
every day sleep how many people in here
21:55
have a hard time with sleep right it's
21:58
like the biggest complaint next to pain
21:59
I think that we hear so good laughing a
22:02
long sleep are the two best cures for
22:04
for anything it's a great Irish proverb
22:07
and you know if you who needs doctors
22:10
really if you can laugh a little and
22:12
sleep a little you don't need me on from
22:15
a scientific level we learned that sleep
22:17
is very valuable tool when we're trying
22:19
to win the the sort of pain game and
22:22
creating positive neuroplastic changes
22:23
we need some good sleep to do that brain
22:27
is very active during sleep so lot so
22:30
let's say we're learning Spanish and
22:32
we're learning French and we're studying
22:33
during the day at night time we start to
22:36
mold these brain connections that help
22:38
us remember what we're learning while
22:40
we're sleeping and so the neuro plastic
22:42
process is very active at night even
22:44
though we're sleeping and we've also
22:47
there's been a number of good studies
22:48
you know they've come out the last few
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years that show a definite connection
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correlation between how much pain we
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feel and how good or bad were sleeping
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so sleep hygiene important learning
23:01
tools and strategies that improve our
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sleep at night you know if we have a
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double cappuccino after dinner is that
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good sleep hygiene no if we're looking
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at Facebook on our phones 11 o'clock at
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night is that good at sleep hygiene no
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and then you may or may not know about
23:17
this but cognitive behavioral therapy
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for sleep has been shown to be the most
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effective way to improve our sleep
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better than pills so if you can connect
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with psychologists or therapists and
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your communities you know if you want to
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work on sleep start finding someone that
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you can work with tomorrow some some
23:33
good
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strategies that will help you with that
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so once we once we do all this and we
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got our strategy going we start to soar
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and fly and take off with with our
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journey and pretty much everything that
23:47
I talked about today is in my my second
23:50
book if you're interested in reading
23:51
more all right thanks
24:00
[Music]
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you