PLUSAsk theExpert➲ p.6

Anti-inflammatory Cooking

➲ p.8

Pain Q & A ➲ p.14

Comfortwith

CreativityFinding relief from

pain with artPAGE 11

ComPLeXreGioNaL

PaiNSyndrome/Reflex

SympatheticDystrophy Therapy

PAGE 9

Publ ished monthly by

Boost Medica l

9977 N 90th Street , Sui te 320

Scottsdale , AZ 85258

Volume #17

Publ ished August , 2011

CliNiCAl EDiToR:

Tory McJunkin, M.D.

PuBliShER: Clayton Peck

EDiToR/WRiTER: Kelli Donley,

Jennifer Gitt

lAyouT: Addie Mirabella

CoNTACT uS

Boost Medical

9977 N 90th street, suite 320

scottsdale, aZ 85258

Phone: 888-627-6121

Email: info@boostmedical.com

PRiNT SuBSCRiPTioN iNFoRMATioN

888-627-6121

4WElCoME lETTER We welcome you to the August issue!

6ASK ThE ExPERTDepression and Pain: Recognizing the symptoms, finding help By: Kara Gasperone

8AuGuST CooKiNGin the heat of the summer, we must rely on our creativity to provide relief. These colorful recipes are healthy, anti-inflammatory and aesthetically pleasing.

9CoMPlEx REGioNAl PAiNSyndrome/Reflex Sympathetic Dystrophy Therapy By: Dr. Tiffany Moat, DC

11CoMFoRT WiTh CREATiViTyFinding relief from pain with art By: Kelli M. Donley

14PAiN Q&AWhat technically is “back pain?”

CoNteNtS

A u g u s t 2 0 1 14

in our pract ice , pat ients hear

us use the words “conser-

vat ive care ,” qui te of ten.

Conservat ive care means

we’ve t r ied many other

opt ions to so lve a pat ient ’s

pa in before moving forward

wi th a s t ronger dose of med-

icat ion, or a surg ica l pro-

cedure . Th is month’s issue

of Ar izona Pa in Monthly

focuses on an ent i re ly non-

t rad i t iona l , yet conserva-

t ive , area of pa in manage-

ment – ar t therapy. have you

ever fe l t a rush of happiness

af ter tak ing a great photo-

graph? Fe l t ca lmed by putt ing

a beaut i fu l , aesthet ic meal

on the tab le for your fami ly?

Known your shoulders would

re lax when you sat down to

the pot ter ’s wheel , p icked up

kni t t ing needles or a pa int

brush?

We recognize there are many

benef i ts to express ing onesel f

through art – inc luding pain

reduct ion. our feature art ic le

Shout for joy to the Lord, all the earth, burst into jubilant song with music; make music to the Lord with the harp,

with the harp and the sound of singing. Psalm 98: 4-5

weLCome

A u g u s t 2 0 1 1 5

interv iews severa l ar t thera-

pists who have seen astound-

ing changes in thei r pat ients .

our ask the expert co lumn

interv iews local therapist

Kara Gasparone about the l ink

between depress ion and pain.

And our late summer rec ipes

are geared to provide a tasty,

fun and artsy plan to feed

those you love.

We hope you are enjoy-

ing these last few days of

summer heat and are as ready

for cool autumn temperatures

as we are! We look forward to

seeing you in our off ice and

hear ing about your recovery

f rom pain.

From our fami l ies to yours,

Paul lynch, MD and Tory

McJunkin, MD

P.S. if you have an interest-

ing pain related story or idea

you’d like to share with our

editor, please email Kell i

Donley: kell id@arizonapain.com

Paul Lynch, MD and Tory McJunkin, MD

have you ever found yoursel f

cur led up on the couch with

your softest b lanket and sal t -

iest junk food, watching the

umpteenth commercia l for

Pajamajeans because i t ’s 3

am and you can’t s leep again?

or perhaps you’re a wor ld-

c lass scrapbooker who hasn’t

had the mot ivat ion to g lue a

s ingle rh inestone to a photo

page in weeks. Maybe you’re

suffer ing f rom a migra ine for

the s ixth  day in a row that

won’t go away no matter how

much water and caffe ine you

stubbornly consume in a dark,

noise less room.

i f any of th is sounds fami l -

iar, you could be one of the

est imated 7-10 percent of

Amer icans who suffer f rom

chronic depress ion.

Depress ion can be a sneaky

bedfe l low that does not d is-

cr iminate against sufferers .

People f rom every race, creed

and socioeconomic status

a l l over the wor ld have been

found to exper ience depres-

s ion. Consider the fo l lowing

s igns and symptoms:

• lack of energy

• unusual s leep pat-

terns  – e i ther insomnia or

hypersomnia

• Bizarre appet i te , at t imes

character ized by unusual

weight loss or gain

• loss of enjoyment in

th ings you used to love

• iso lat ion

• Poor concentrat ion or

rest lessness

• Feel ing hopeless, worth-

less or just “empty”

• Physica l pain that doesn’t

go away with medica l

t reatment (headaches,

body aches, jo int pain,

pers istent i l lness, etc) .

i f you have recent ly expe-

r ienced a loss or t rauma –

such as a fami ly member’s

pass ing, or a bad car acc ident

–  some or a l l of   the symp-

toms l is ted above are to be

expected as you process a

catastrophic event .  however,

i f these are symptoms that

have been present for more

than 2 months, or i f you are

exper iencing these symptoms

without prerequis i te t rauma,

consul t a pr imary care physi -

c ian or a mental heal th pro-

fess ional ; th is type of depres-

s ion could be chronic .

Many events can cause a

depress ive response, most

notably any di ff icu l t t ransi -

t ion exper ienced in l i fe . There

is no one s ingle cause of

depress ion. Sc ient ists th ink

i t ’s l ike ly a combinat ion of

b iochemical , cogni t ive and

environmental factors that

A u g u s t 2 0 1 16

Depression and Pain: Recognizing the Symptoms, Finding Help

aSk the eXPert

Kara Gasperone

contr ibute to a person’s ten-

dency to exper ience depres-

s ion.   i f you think you or

a fami ly member might be

deal ing with depress ion, take

a look at the indiv idual ’s

behavior against the l is t of

symptoms noted above. A lso,

somet imes a s imple “Are you

doing okay?” can reveal so

much.

The l ink between depres-

s ion and physica l pain is one

that should not be minimized.

in focus groups conducted

by the Nat ional inst i tute of

Mental heal th, many people

suffer ing f rom depress ion

didn’t know that the chronic

physica l pain they had been

exper iencing had anything to

do with depress ion. Chronic

headaches, jo int pain and

digest ive pain are common

in people who suffer f rom

depress ion, and often these

symptoms are t reated unsuc-

cessful ly with pain medica-

t ions. Psychiatr ic medicat ions

can be useful a ids in the

t reatment of depress ion, yet

many physic ians seek to t reat

the symptoms with pain medi-

cat ions, miss ing the under ly-

ing source of the pain.

The good news is   that there

are  p lenty  of ways to combat

depress ion  that do not

require the use of psychiat -

r ic medicat ions. Exerc ise is

hugely important . The endor-

phins your bra in rust les up

af ter a great h ike or b ike r ide

can send symptoms running

for the hi l ls .   i f you have

chronic pain, swimming is an

excel lent low- impact act iv-

i ty.  Because everyone exper i -

ences depress ion di fferent ly,

i t ’s important to know your

own coping ski l ls . Whether

i t ’s reading a l l seven harry

Potter novels in succes-

s ion, forc ing yoursel f to go

out with f r iends for coffee,

or tackl ing home projects - -

managing your symptoms by

ut i l iz ing coping ski l ls  can be

doable. however, i f you’ve

t r ied  th is  and nothing seems

to be working, schedule a

consul tat ion with a mental

heal th provider.

Many modern therapists worry

the st igma of seeking mental

heal th t reatment can be a

barr ier to people in need of

help. Mainta in ing emot ional

and mental heal th is as nec-

essary  as mainta in ing physi -

ca l heal th.

The take-home message is

s imply: depress ion is a very

human exper ience. i t is

something that everyone wi l l

exper ience at a t ime in his or

her l i fe . But when i t becomes

di ff icu l t to funct ion on a day-

to-day basis ,  when you have

pers istent physica l pain  or

when you feel l ike you’ve lost

contro l , i t ’s okay to ask for

help. in fact , i t ’s necessary –

untreated and out of contro l ,

depress ion can become cr ip-

pl ing both emot ional ly and

physica l ly, and can damage

important re lat ionships.

Seek help f rom a psycholo-

g ist or therapist that you feel

has a t rue understanding of

what you’re going through.

i promise that you wi l l fee l

heard and accepted when you

meet the r ight profess ional .

Kara Gasperone is a marr iage

and fami ly therapist working

toward independent l icen-

sure Ar izona. She works with

k ids, fami l ies and couples.

Her pass ion for therapy and

mental health was born from

a des ire to show the world

seeking profess ional help

doesn’t have to be a cold,

formal exper ience – i t is

human. She enjoys spr inkl ing

a pinch of personal i ty and a

heavy dose of exper ience on

her approach to therapy. She

can be reached at  kara.gas-

perone@gmai l .com.

A u g u s t 2 0 1 1 7

ingredients:

• 1 pound plum tomatoes, diced,

drained

• 1 1/2 cups diced seeded water-

melon

• 1 large yellow bell pepper, diced

• 1/2 large cucumber, diced

• 1/2 cup thinly sliced radishes

• 3 tablespoons olive oil, divided

• 10 ounces feta cheese, broken

into small cubes (about 2 1/2

cups), divided

• 2 green onions, chopped, divided

• 1/4 cup thinly sliced fresh mint

leaves, divided

• 1/2 cup plain Greek-

style yogurt

Directions:

Combine first five ingredi-

ents with 2 tablespoons of

olive oil in bowl. To this,

add half of the cheese,

onions and mint. in a food

processor, mix the remain-

ing cheese, onions and mint

with yogurt. Simply blend.

Add a dash of salt, pep-

per and cayenne if you like

spice. Mix with salad.

SuMMER TAbbouLEH

in the heat of the summer, we must rely on our creativity to provide relief. These colorful recipes are healthy, anti-inflammatory and aesthetically pleasing.

aUGUSt CookiNG

WATERMELon FETA SALAD

ingredients:

• 1/2 cup bulgur or quinoa

• 3 tablespoons olive oil

• 1 cup boiling-hot water

• 2 cups finely chopped fresh

flat-leaf parsley

• 1/2 cup finely chopped fresh

mint

• 2 medium tomatoes, cut into

1/4-inch pieces

• 1/2 cucumber, peeled, cored,

and diced

• 4 tablespoons fresh lemon

juice

• 3/4 teaspoon kosher salt

• 1/4 teaspoon black pepper

Directions:

Mix bulgur or quinoa and 1 table-

spoon oil in a heatproof bowl.

Add boiling water, cover bowl

with plastic wrap and let sit 15

minutes. Drain, pressing with a

paper towel to remove any excess

liquid. Place bulgur in bowl; add

remaining ingredients. Drizzle 2

tablespoons oil on top. Mix well.

A u g u s t 2 0 1 18

A u g u s t 2 0 1 1 9

Syndrome/Reflex Sympathetic Dystrophy Therapy

By: Dr. Tiffany Moat, DCCRPS is a chronic neurologi -

ca l pain syndrome. A pat ient ’s

symptoms may inc lude:

severe burning pain, patho-

log ica l changes in bone and

skin, changes in b lood f low,

excess ive sweat ing, t issue

swel l ing and extreme sensi -

t iv i ty to touch. This is typ-

ica l ly reported in the arms

or legs, but CRPS may affect

any part of the body. in some

pat ients , mult ip le areas may

be affected at the same t ime.

CRPS is an error on the part

of the nervous system. Nerves

misf i re , sending cont inu-

ous pain s ignals to the bra in.

CRPS usual ly develops af ter

severe or mi ld t rauma.

There are many treatments

that can help with the symp-

toms of CRPS; however, there

is no s ingle t reatment to

cure. The fo l lowing t reatments

can help ease symptoms:

Pharmacologica l Therapy: pain

management physic ians may

prescr ibe an appropr iate med-

icat ion regimen.

intervent ional Therapy:

procedures – of ten using

f luoroscopic/x-ray guidance

– performed by anesthesio l -

ogy-t ra ined pain physic ians

can help reduce painful nerve

pathways. These may inc lude:

sympathet ic nerve blocks and

per iphera l nerve blocks; or

spinal cord st imulat ion – a

wel l -establ ished treatment

opt ion that involves a tempo-

rary t r ia l of the therapy and

opt ion of permanent implan-

tat ion of the device.

Conservat ive Therapy: desen-

s i t izat ion therapy regimen,

t ranscutaneous e lectr ica l

nerve st imulat ion (TENS)

therapy or e lectr ica l acupunc-

ture – a l l per formed by chi ro-

pract ic staff .

When prescr ibed one of the

aforement ioned treatment

plans, fo l lowing i t is cr i t ica l

to success to maximize re l ie f

of symptoms. The conserva-

t ive therapies are as cr i t ica l ly

important as the pharmaco-

log ica l and intervent ional

therapies.

More speci f ica l ly, desensi -

t izat ion therapy is used to

modi fy how sensi t ive an area

is to a speci f ic st imulus. i t is

ComPLeX reGioNaL

PaiN

CRPS may affect any

part of the body.

A u g u s t 2 0 1 110

designed to apply a st imulus

to the affected area for short

per iods of t ime, which can

be done f requent ly through-

out the day. Desensi t izat ion

therapy of ten inc ludes appl i -

cat ion of unpleasant st imul i

to the hypersensi t ive area

for a short per iod of t ime.

These unpleasant st imul i are

th ings that the body is of ten

exposed to dai ly ; thus, they

are not harmful or damaging.

The i tems used for desensi t i -

zat ion therapy vary depending

on what st imul i the affected

body part t ransmits as pain.

Such desens i t izat ion pro-

grams beg in wi th s t imul i that

produce the least pa infu l

response. once the pa infu l

area star ts to acc l imate to

the appl ied st imulus , the

next s t imulus is incorpo-

rated. For example , a therapy

program may star t wi th sof t

mater ia l such as s i lk , and

progress to rougher mater ia ls

l ike wool or textured fabr ics

( i .e . Ve lc ro) . Desens i t izat ion

exerc ises , s t retch ing, hot

and co ld s t imul i , TENS uni t

therapy as wel l as e lect ro-

acupuncture may be incor-

porated in the t reatment to

decrease pa in and normal ize

nerve responses.

Depending on the sever i ty

of the condit ion i t may be

at t imes more to lerable to

the pat ient , especia l ly ear ly

in the therapy, i f he or she

seeks a l ternate modal i t ies

to help ease the discomfort .

These modal i t ies may inc lude

sympathet ic nerve blocks,

per iphera l nerve blocks, and/

or analges ic medicat ions pro-

v ided by our pain physic ians.

Desensi t izat ion therapy is

used to minimize the body’s

painful response to a certa in

st imul i . The goal of th is

therapy is to hinder or inter-

rupt the body’s interpretat ion

of rout ine st imul i as painful

st imul i . To begin, i t is advised

pat ients speak with a phy-

s ic ian, chi ropractor or ther-

apist to determine i f any of

the previously discussed ther-

apies are appropr iate and

recommended.

Desensit izat ion exercises, stretching, hot and cold st imuli ,

TEnS unit therapy as wel l as electro-acupuncture may be

incorporated in the treatment to decrease pain and

normalize nerve responses.

A u g u s t 2 0 1 1 11

Pablo Picasso once said, “Art

washes from the soul the dust

of everyday life.” Art – broadly

defined by Webster and cer-

tainly more specific to the indi-

vidual – can serve as another

outlet for pain relief. May it

be paining an abstract woman,

as Picasso, writing a Bach-

inspired concerto or simply

putting together a bouquet of

flowers grown in the garden,

art therapy is helping many in

pain find comfort.

Finding Rel ief from Pain with Art

By: Kell i M. Donley

Comfort with Creativity

Recognizing the l ink between

mental health and physical

pain, such therapies may help

identi fy issues ofemotional

turmoil that can then be

addressed and resolved.

A u g u s t 2 0 1 112

“The American Music Therapy

Associat ion descr ibes music

therapy as a ‘c l in ica l and evi -

dence-based use of music

intervent ions to accompl ish

indiv idual ized goals within a

therapeut ic re lat ionship by a

credent ia led profess ional who

has completed an approved

music therapy program,’”

says luciana da Fonseca,

MT-BC, the former mental

heal th coordinator and music

therapist for the internat ional

Rescue Committee in Phoenix .

“ i l ike to descr ibe i t as us ing

music , as a tool to achieve

the c l ient ’s goals .”

Da Fonseca, who has worked

with internal ly d isplaced

people, asy lees and refugees

in the desert southwest , says

music therapy is one form of

ar t that is unique in helping

those in pain – both physica l

and mental – f ind re l ie f .

“Di fferent then ta lk therapy,

music therapy creates a

f r iendly environment f rom the

f i rst moment that you meet

the c l ient ,” she says. “The

c l ient does not need to know

how to play any instrument.

The music therapist does. We

meet the c l ient , do an assess-

ment – inc luding a back-

ground history of emot ional

and physica l concerns, and

create the goals and objec-

t ives for thei r t reatment.”

Depending on the sever i ty of

the symptoms, t reatment may

last 1-3 years , she says.

Art therapy is a lso unique

in i ts compat ib i l i ty with

pat ients , or c l ients , of

a l l ages. A study of such

modal i t ies – publ ished in

Psychologica l intervent ions: A

Guide to Strategies – showed

creat ion of ar twork can help

express emot ion – espe-

c ia l ly subconscious feel ing.

Recogniz ing the l ink between

mental heal th and physica l

pain, such therapies may help

ident i fy issues of emot ional

Art therapy is also unique in i ts compatibi l i ty with patients ,

or cl ients , of al l ages.

A u g u s t 2 0 1 1 13

turmoi l that can then be

addressed and resolved.

“ i f the c l ient ’s goal is to

reduce physica l pain, we

wi l l inc lude music re laxat ion

and breathing techniques,”

says Da Fonseca. “Afterward,

the c l ient can use these

learned ski l ls at home when

in pain. i f the c l ient ’s goal

is to reduce emot ional pain,

we would create an environ-

ment where he or she would

feel comfortable to express

these feel ings. Just l ike ta lk

therapy, we do not offer one

speci f ic so lut ion, but instead

a way for the c l ient to f ind

within him or hersel f to con-

f ront fears , and achieve a

better state of mind. one of

the invent ions that works

real ly wel l , i f working with

teenagers and adults , is to

create song lyr ics about a

painful s i tuat ion.”

Da Fonseca, who is working

on a graduate degree in coun-

sel ing to complement her

studies in music therapy, says

she has seen the benef i ts of

music therapy for many.

“We work with a l l types of

the populat ion: psychiat -

r ic , chi ldren with disabi l i t ies

– inc luding: cerebra l palsy,

aut ist ic , Downs Syndrome;

e lder ly (st roke, demen-

t ia) ;  chi ldren and teenag-

ers at r isk (behaviors issues) ;

inmates; medica l hospi ta ls

(cancer, pediatr ic uni ts , etc) ;

and hospice,” she says.

Whi le some may not bel ieve

physica l d iscomfort could be

re l ieved by learning to play

the gui tar, or banging on

drums, Da Fonseca says the

research is on the s ide of her

profess ion.

“Music therapis ts have a c l in -

ica l background,” she says .

“We have to do cont inuing

educat ion to keep our cer t i f i -

cat ion, etc . P lus , i t i s sc ien-

t i f i ca l ly shown to improve a

c l ient ’s emot ional or phys ica l

need.”

The American Art Therapy

Associat ion agrees. off ic ia ls

wr i te , “Art therapy is based

on the bel ief that the creat ive

process involved in art is t ic

se l f -express ion helps people

to resolve conf l ic ts and prob-

lems, develop interpersonal

sk i l ls , manage behavior,

reduce stress, increase sel f -

esteem and sel f -awareness,

and achieve ins ight .”

Perhaps the answer to your

nagg ing headaches i s some-

th ing you never cons idered

before : lessons on a ce l lo , a

pot te ry c lass or learn ing to

kn i t .

For addit ional resources,

inc luding state chapters of

ar t therapy associat ions, l is ts

of therapist and c lass ideas,

v is i t : www.americanart thera-

pyassociat ion.org.

For more informat ion f rom

luciana Da Fonseca, emai l :

fonseca_luc iana@hotmai l .com

A u g u s t 2 0 1 114

Near ly every Amer ican wi l l

have back pain at some

point in his or her l i fe . Pain

symptoms usual ly lead to

a speci f ic area of the back,

which can inc lude verte-

brae, the spinal cord or back

muscles. Disorders within the

abdomen can a lso cause back

discomfort .

What Part of My Back am I

Most L ike ly to In jure?

The lower back is the most

common area for back pain.

Af ter the common cold, lower

back pain is the leading cause

of lost workdays.

What are the Most Common

Causes of Lower Back Pain?

one common cause of pain

within the lumbar vertebrae is

lumbar spinal stenosis . Spines

harden with age and can

become overgrown. lumbar

spinal stenosis puts pressure

on spinal chords because of

vertebrae growth. The pres-

sure of stenosis can affect

sensi t ive nerves in the spinal

cord, which somet imes causes

numbness, as wel l as cause

pain amongst vertebrae.

A herniated disc is another

common lower back problem.

As the discs in between ver-

tebrae degenerate, they

become more l ike ly to rupture

and expand. Protruding discs

of ten inter fere with the sur-

rounding nerves, causing pain

and weakness. Symptoms

of herniated discs inc lude

muscle spasms, t ing l ing and

numbness, and shoot ing pain

in the back and down the

legs.

How Can I Prevent Back Pain?

Prevent ive measures and

habi ts are s imple. Good

posture keeps the back

strong and in proper a l ign-

ment. When l i f t ing an object ,

bend at the knees and keep

the back stra ight and protect

lumbar vertebrae. Core exer-

c ises strengthen the back

muscles around the spine,

which protects the spine and

mainta ins mobi l i ty. Avoid

chronic pain by taking proper

rest and treatment when back

pain occurs . S imple problems

l ike muscle st ra ins cause

back pain, and ice can be

appl ied to l imit inf lammation.

What Technical ly is “back Pain?”

PaiN Q&a