New Chronic Pain Approaches With Joe Tatta, PT, DPT

Welcome back to the Healing Pain Podcast with Joe Tatta, PT, DPT

In this special episode, Dr. Joe Tatta shares updates on what he is up to and delves into new chronic pain approaches that revolutionize the medical field today. He talks about PRISM, or Pain Recovery and Integrative Model, a cognitive behavioral approach to physical therapy for the management of chronic pain that he has been working on for over two years. He also talks about how the biopsychosocial model is helpful in approaching pain’s multidimensional nature. Furthermore, Dr. Joe elaborates the six critical domains involved in pain recovery and the two types of pain mindsets in literature.

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New Chronic Pain Approaches With Joe Tatta, PT, DPT

On this episode, I’ll provide you with some updates and discuss what’s new at the Integrative Pain Science Institute. I wanted to take some time this week to connect with you in a more one-on-one way. I know that you tune in each week to listen to the amazing guests and the topics that we have related to chronic pain. We broadcast those weekly. I know you’re probably wondering, “What’s Dr. Joe up to? I know Dr. Joe writes some books and he does some research and he creates courses. What else is he working on in the year 2023 and beyond?”

I wanted to share with you some of the things that I’ve been working on and developing both individually as well as in a collaborative manner with other physical therapists and other pain researchers. Much of this is new, so I’m excited to share this with you. I think it’s going to impact not only the world of chronic pain, but specifically the world of physical therapy.

If you remember back in March 2023, if you’re following along with my newsletter, I presented a two-hour session at the Michigan Annual Physical Therapy Association Conference and Pain Summit. I want to extend a big thank you to the physical therapists and the physical therapist assistants at the Michigan Physical Therapy Association for hosting me. They have an incredible group there. They’re really up-to-date on some of the latest approaches to treating chronic pain.

When I was there, I presented a two-hour session on something that I had that’s new, which is called PRISM. PRISM stands for Pain Recovery and Integrative Systems Model. PRISM is a model that I’ve been working on probably for over two years. I want to take you back a little bit and let you know how we arrived here, and why this is important at this juncture.

If you’ve been following along with the Healing Pain Podcast, you know that there are approximately 100 million Americans who live with chronic pain. Out of that 100 million Americans, probably about 20% of them are receiving care that is poor, inadequate, and really outdated. With that, it’s resulting in an extreme amount of financial loss. About $600 billion a year is spent on medical treatments and loss of productivity related to chronic pain syndromes.

There are approximately 100 million Americans who live with chronic pain. About 20% of them receive poor, inadequate, and outdated care. Click To Tweet

If you’re like me and you are a healthcare practitioner working in our sick care system, you realize that people with pain are completely frustrated. They’re totally fed up with how their pain is being managed and treated. They’re looking for a skilled practitioner who can help them recover from chronic pain in a more humanistic and comprehensive way.

We do have this model called the biopsychosocial model. I’m sure all of you have heard the biopsychosocial model for pain at this point. That is used commonly to approach the more multidimensional nature of pain. Although, the biopsychosocial model has faced a lot of criticism, both from clinicians as well as researchers. The biggest criticism around the biopsychosocial model is that one, people really aren’t using the entire model, they’re using pieces of it. When they use pieces of the model, they’re emphasizing or underemphasizing either one of the biomedical, psychological, or social factors that are involved in this model.

Basically, no one is really using the entire model. In addition, the biopsychosocial model originated outside the profession of physical therapy. It may not provide either specific clinical guidance or help physical therapists with the clinical decision-making that’s needed to treat that complex multidimensional nature of pain.

The other thing is that in the profession of physical therapy, and this is happening in other professions as well, there is a more of a primary care approach, or we’re working in a primary care capacity to treat chronic pain. We’re looking for models that can support the advancing scope of contemporary primary care physical therapy practice. What that really means if we’re looking for models that are comprehensive, that address the multidimensional nature of pain, that consider biomedical, psychosocial, contextual, as well as lifestyle factors.

With that in mind, over the course of the last two years, and many meetings and lots of research, I got together with some colleagues and we developed PRISM, Pain Recovery and Integrative Systems Model. It is a cognitive behavioral approach for physical therapy for the management of chronic pain. I want to make sure that I thank and extend my gratitude to my co-authors on this model and make sure to name them by name.

They are Dr. Rose Pignataro. She is a physical therapy professor at Emory & Henry College in Virginia. Janet Bezner, who runs the physical therapy program at Texas State University in Round Rock, Texas. Dr. Steven George, who is a physical therapist and our leading pain researcher. You can find him at the Duke Clinical Research Institute in Durham, North Carolina. Carey Rothschild, who is a professor of Physical Therapy at the University of Central Florida in Orlando, Florida.

You may be asking why did we take on this project of creating a new model to manage pain? Two reasons. One is we don’t have a model that’s specific for the physical therapy profession that’s comprehensive in nature. Two, the National Institutes of Health Federal Pain Research Strategy has called on new models for pain management. Our aim with PRISM was to develop a comprehensive model that addresses the multidimensional nature of pain while building resilience, nurturing human growth, and facilitating pain recovery.

Let me share a little bit about the model with you and talk about three of the key benefits of this model. PRISM is a salutogenic, integrative, cognitive behavioral model to guide physical therapists and other healthcare professionals in managing the multidimensional nature of pain. Let’s unpack those three parts. We have salutogenic, integrative, and cognitive behavioral. Let’s begin with this term, salutogenic. Salutogenic basically means to promote health and wellness. In the foundation of PRISM, it really is a health and wellness approach to treating pain.

The origin of salutogenesis comes from the Latin salus, meaning health, and the Greek genesis, which means origin. Salutogenesis refers to the origins of health. This is a new strength-based approach to pain rehabilitation. It promotes health and wellness. With that, it’s life-affirming, it’s positive, so it gives people a positive sense, and it’s very optimistic. People see that there is hope in maintaining or improving their health and wellness, sometimes even in the face of pain.

The second aspect, integrative, basically means that we conducted a systematic review to find the most important processes responsible for pain recovery, and the processes that were responsible for the behavior change necessary for that pain recovery. The last part, which is the cognitive behavioral piece, we recognize the influence of the brain, the body, the mind, and behavior and pain management. Bringing a cognitive behavioral approach to PRISM lends to its comprehensive nature.

The PRISM model aligns with things that are happening both on a national level here in the United States of America, as well as other international initiatives to better understand and manage chronic pain. It does have some overlapping or some potential application of course to address the opioid crisis because there are overlaps between opioid use and chronic pain. The idea of building resilience, nurturing growth, and facilitating recovery is something that the NIH, the National Institutes of Health, is actually currently investing a lot of money into because they really feel that this is the way forward in helping people with chronic pain.

In applying PRISM, you guide people through an evidence-based approach that allows you to treat the whole person. One of the best features of PRISM is that you don’t have to chase after the driver of pain or the driver of nociception. Early pain scientists thought that pain relief could only be achieved if we knew the source of nociception and we’d have to basically identify nociception and then disrupt it or disrupt the communication of nociception with the brain. We now know that that thinking is flawed. The reason why is because nociception and pain are actually two different phenomena. That’s really key here.

Nociception is the neural process of encoding a noxious stimulus or encoding pain, if you will, where pain is actually a personal lived experience. What that tells you is that the personal lived experience of pain involves more than just pathways in the brain. What we have here with PRISM is an evolution in our understanding of pain, that pain is a personal experience that of course is involved or influenced by biopsychosocial factors, but it also recognizes that pain and nociception are different constructs. It acknowledges that pain is influenced by our prior life experiences. Life experiences actually construct or shape how we perceive pain. Finally, pain impacts our health and our well-being.

We did write this up in a paper that went through rigorous peer review. It will be published in PTGA or the Journal of Physical Therapy very shortly. Make sure you stay connected. You want to hop on over to my email list by going to IntegrativePainScienceInstitute.com, and signing up for the newsletter. I’ll be releasing updates on the paper once it’s published, which should be very shortly within the next couple of weeks.

Since you’re there and I’m here now, and we’re talking about this model, let me give you a little sneak peek into what we found. We found these six critical domains that are involved in pain recovery. Those six domains are person context, purpose, pain literacy, pain mindset, physical capacity, and physiology. Actually, these six domains are interconnected. In some way, these have to be addressed. When you address them, you’re more likely to facilitate a successful pain recovery.

If you notice one of those critical domains or the central domains in the PRISM model is what we call pain mindset. We found there are actually two types of pain mindsets in the literature. There is a fixed pain mindset and there is a flexible pain mindset. This flexible pain mindset allows people to flexibly respond to the lived experience of pain. It allows them to stay motivated. It allows them to engage in behaviors that improve their mood and their disability, and allows them to respond flexibly to the behaviors that they have to adopt in pain recovery.

HPP 312 | New Chronic Pain Approaches
A flexible pain mindset allows people to flexibly respond to the lived experience of pain. It helps them stay motivated and engage in behaviors that improve their mood.

 

As healthcare professionals, we treat people with pain. We need skills and tools to help nurture and cultivate this flexible mindset. One of the ways that you can do that is by using mindfulness and psychological flexibility. Mindfulness and psychological flexibility are actually central processes in the PRISM model. If you’re already using mindfulness and psychological flexibility exercises, you probably notice a marked difference in your patients even after one session. Things like fear, anxiety, they’re less avoidant, all of those things happen as a result of training mindfulness and psychological flexibility,

which enhances this one central domain of a flexible pain mindset.

If you notice, we’re currently in May 2023. May is National Meditation and Mindfulness Month. If you’re not using these tools and exercises, it’s a great time to implement this into your clinical practice and your personal life. Grab a paper and a pen or grab your cell phone to make a note. I want to give you a promotion code that will take 25% off our two most popular mindfulness-based programs. The first one is the Mindfulness-Based Pain Relief Practitioner Certification Program. The second is our ACT for Chronic Pain or Acceptance and Commitment Therapy for Chronic Pain Program. That promotion code is MAY2023.

When you register for the Mindfulness-Based Pain Relief Practitioner Certification Program or the Acceptance and Commitment Therapy for Chronic Pain Program, simply enter the promo code, MAY2023, to receive 25% off both of those programs. The Mindfulness-Based Pain Relief Practitioner Certification Program is a seven-week virtual online training for all practitioners who treat pain. As you know, my courses are open to all health and wellness professionals.

The great thing about this program or this certification is that it teaches patients to use their most greatest tool, and that’s their mind, to help alleviate their pain. Research shows that just a couple of minutes of daily practice can help alleviate pain, and the other body and mind symptoms that are associated with living with chronic pain.

The second course, ACT for Chronic Pain, is based on a cognitive behavioral approach for treating chronic pain. We actually published a study based on the results of this course in the Journal of Contextual Behavioral Science last year 2022. You can read that study. It’s called the ACT-Trained Physical Therapist, Psychologically Flexible, Resilient, and Armed with Evidence-Based Tools. In that study, we demonstrated how a similar training to this improves psychological flexibility. The physical therapist who took the course reported ACT to be an essential psychologically informed approach to managing chronic pain.

I teach both the Mindfulness-Based Pain Relief and the ACT for Chronic Pain courses. Don’t miss out, make sure you enter that promo code, MAY2023, to receive 25% off any course. You may want to purchase them both because these are complementary approaches that align and reinforce one another. Plus, you’ll be able to take advantage of that one-time limited discount, which is only running for the month of May.

Earlier in this episode, I spoke about PRISM and how I provided a session to the attendees at the Michigan Physical Therapy Conference, their annual conference. I’m actually going to be doing a national tour to each state’s Physical Therapy Association National Conference to speak about PRISM. If you have a connection to one of your state conferences or your PT state conference, make sure to reach out to me. I’ll be happy to meet with you in your state, or to deliver that virtually and present a session on PRISM. We will also be presenting a session on PRISM at the 2024 CSM, that’s Combined Sections Meeting, which is the annual American Physical Therapy Association Conference, which will be in Boston this year 2023.

That’s about all I have to share with you, the things that I’m working on, projects both that I’m developing independently and other projects that I’m working on in collaboration with other clinicians and researchers. Stay tuned, of course, I’ll release more updates as I have them. Most importantly, I want to thank you for being a part of our community here and for tuning in to the show each and every week. This is episode number 312. Stay tuned for more. We’ll have more great guests, great topics, trainings, and offerings coming up shortly. I’m Dr. Joe Tatta. It’s been a pleasure spending this one on one time with you on this episode. Make sure to share this episode with your friends and family on your favorite social media handle. I wish you continued success and health. I’ll see you next time.

 

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About Joe Tatta

Born in New York City, Dr. Joe Tatta is a licensed physical therapist and founder of the Integrative Pain Science Institute. After decades of running a private practice, he found himself frustrated by the limitations of the biomedical model and traditional physical therapy. He experienced how quick-fix and magic-bullet solutions for pain disempowered people and restricted their quality of life. Applying research and clinical experience, he began a journey to improve pain care. The culmination of his work is the PRISM: Pain Recovery and Integrative Systems Model. Rather than focusing on pathology or impairments, PRISM promotes health, resilience, and personal growth to facilitate pain recovery, providing a framework for clinical decision-making.

Dr. Tatta is a speaker, trainer, 3x author, adjunct physical therapy professor, and podcast host. His current focus is on supporting physical therapists to serve as primary care providers at the top of their scope of practice. This work centers on educating and mentoring physical therapists in biopsychosocial interventions for integrative, whole-person health care.

He is passionate about implementation science and strategies that facilitate the uptake of evidence-based practice and research into regular use by practitioners and stakeholders.

His most important role is amplifying voices marginalized by pain.

Learn more at: integrativepainscienceinstitute.com.

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