Mark's Musings - November 4

Below is an aggregation of the stories I posted on LinkedIn since my last edition. I curate them through the prism of an "intersection of chronic pain and appropriate treatment" and so they come attached with my opinion.

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Grieving the Life I Had Before Chronic Illness (556 views)

I have mentioned in the past how a serious injury at work and/or the advent of #ChronicPain can initiate the grief process. This author does a much better job of explaining it ... because she lived it:

"I lost my health, my ability to stand up, to think clearly, to see straight, to run, to hike, to work out, to go out, to feel normal. I lost my ability to do the things that constituted my every day: going to school, going to work, living alone, going out with friends, my ability to drive. I lost my sense of self; I previously felt strong, confident and indestructible in my daily life. I was fit, I was active, I was healthy. I lost my sense of autonomy – the belief that I could do anything I set my mind out to. I lost my sense of purpose and accomplishment; I lost my academic scholarship for school, my ability to read and learn, my drive. I literally lost everything that made me, me."

Not that it's easy (and after reading this you'll know it's not), but the goal is Acceptance. If you're in that situation but not yet reached that step, find somebody to talk to. For people "stuck" in the early stages of grief (denial, anger, bargaining, depression), sometimes a little push is needed to help them make progress. That's when Acceptance and Commitment Therapy (ACT) can be very helpful. If you're not familiar with it, Psychology Today defines it as follows: "Clients learn to stop avoiding, denying, and struggling with their inner emotions and, instead, accept that these deeper feelings are appropriate responses to certain situations that should not prevent them from moving forward in their lives. With this understanding, clients begin to accept their issues and hardships and commit to making necessary changes in their behavior, regardless of what is going on in their lives, and how they feel about it."

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Marketing Magic (2,328 views)

Why do I have to do the math?

2 servings * 410 calories/serving = 820 total calories

Here's my theory. Nobody reads the fine print ("about 2 servings" ... "Per serving"). They do notice the big/bold print ("410"). The manufacturer knows and leverages that fact. It's not that they're being dishonest - all of the information needed to make a decision is there. It's just that they know human nature and so they make the more appealing number bigger. 410 vs. 820 could make a difference on your choice to consume. So as you're trying to do the right thing for your own health & wellness, always read the fine print.

I responded to a couple of comments, just in case my original verbiage was too subtle:

• We live in the age of "googling" as a verb that inundates every conversation (there is no "I don't know the answer to that" any more). And yet, with all of that info at our fingertips, we still struggle with the wise application (or required effort) of it. Doing the research, whether it's the math on a label or studying ingredients/alternatives, is the key to better choices. And, typically, better choices yield better outcomes.
• It's not about the math - it's about marketing methods to potentially mislead people that don't read the fine print. Why not put "820 calories" (which actually could be more since they use the term "about" 2 servings) rather than 410? Why not put "56%" of your total daily recommended fat (rather than 28%)? Is it because it's too complicated to calculate for the label? Or is it because the manufacturer / marketer wants to lessen the shock value and make it seems less than it really is?

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Common joint pain treatment may be more harmful than thought (1,566 views)

Wow. The long-term unintended (and apparently unknown, until now) consequences may be more risky than the short-term benefits. If you get these shots to help with osteoarthritic pain, you may want to reconsider. Thanks to Anne Asher for sharing this important PSA. Sometimes the "science is settled" (at least in people's opinion). Other times, the science needs to be continually evaluated as longer-term consequences are better understood which means conclusions can change based on the evolving science. Conclusions from science are not always applicable to every unique individual - in this case, the review of existing literature showed that "8 percent of patients developed complications, including cartilage loss, stress fractures, bone deterioration and joint destruction, in the two to 15 months following the injections." Eight percent is a relatively low number unless you're in that eight percent. So this study is not the sole reason to stop corticosteroid injections as a treatment for osteoarthritis. However, it does highlight that these injections do potentially bring risk that patients need to understand when choosing their treatments. Interestingly, a spokesperson for the American Academy of Orthopedic Surgeons "recommends that patients with osteoarthritis first talk with a physician about noninvasive approaches, such as exercise, physical therapy and weight loss." The Arthritis Foundation agreed, saying "a healthy lifestyle remains the key to managing osteoarthritis ... Exercise is really one of the best things that can be done." It is the patient's responsibility to understand the risks vs. benefits and make an informed choice. Another article, provided by Dr. Stephen Grinstead, entitled "Joint Injections: Are They Worth the Risk?" gives even more interesting context.

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Psychosocial Care: The Secret Sauce to Successful Patient Outcomes (482 views)

#BioPsychoSocialSpiritual is not just a hashtag - it's a best practice in how to help people recover from an injury or learn how to manage their "new normal." This blogpost explains how it works when it comes to "catastrophic spinal cord and brain injuries" but these are best practices regardless of the type of injury or the chances of full recovery. I especially appreciated the delineation between "multi-disciplinary" and "inter-disciplinary." Spoiler alert - "inter" is more effective (which I learned in-person from the best practitioners around the country, including Craig Hospital, starting in 2011). "For a center to provide truly excellent psychosocial care, the team must be interdisciplinary with each member working in concert, using each other’s strengths, always with the patient’s goals in mind." The good news is that many in Work Comp now understand the value of psychosocial care. The not-so-good-news is that intellectual acknowledgment doesn't often enough convert into actual prescriptions and payments. Changing behavior - payers, providers, patients - is never easy and never overnight. But if it's the right thing to do, eventually that behavior does change because continuing to do the same thing and expecting different results is insanity. If we keep talking about psychosocial, eventually it will become the norm. And everyone should benefit from that.

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You Are What You Think (546 views)

You've heard the slogan "you are what you eat"? Just as applicable ... You Become what you Think! Hat tip to Jim Anderson for reminding me. Athletes have been using visualization techniques for several years because they understand this fact. The first step in being successful is seeing yourself being successful. Or, another way of saying it, "creating a mental image or intention of what you want to happen or feel in reality." You can't do it if you can't see it. That even extends to those in chronic pain. The brain is your best ally (and sometimes your worst enemy) in making life better (or worse).

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Reduce MSDs to Reduce Opioid Deaths, Report Suggests (203 views)

Your Friday takeaway ... “In all of these categories (construction, agriculture, material moving occupations, maintenance/repair, transportation, production, food preparation, waste management, and healthcare), work requires forceful exertions. There is a clear correlation between jobs with the highest injury and illness rates and opioid-related overdose death rates ... When ergonomics is not practiced at all, or not done correctly, there are social and economic consequences; the most recognizable social consequence is workplace MSDs (musculoskeletal disorders) ... It is critical that workplace interventions be implemented to address the workplace hazards that lead to injuries for which opioids are prescribed. This includes deploying a comprehensive and systematic process for identifying, analyzing and controlling workplace risk factors that lead to workplace MSDs.” Proactive > Reactive, so addressing musculoskeletal injuries ASAP with the least pharmaceutical / most patient-engaged approach (e.g. Simple Therapy, where I'm an Advisory Board member) is key to reversing these numbers.

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In addition, I published three blogposts:

• "Mark's Musings - October 21" on October 28
• "Mark's Musings - October 28" on October 31
• "Beware of Survivorship Bias" on November 1 by WorkCompWire

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#PreventTheMess + #CleanUpTheMess = The Answer.