Your career path began as a dentist. What led you to the field of chronic pain?
Fricton: I had always wanted to be a dentist since fifth grade. I went to college with the goal of pursuing a career in Dentistry. My interest in chronic pain came on during the 1970s, when there were many major societal changes including the Vietnam war, opening U.S. relations with Asia, introduction of acupuncture, and growing interest in natural foods, holistic health and well-being. These changes piqued my interest in acupuncture while in Dental School. During my third year in Dental School, I spent two months visiting the only academic-based acupuncture program in the country at UCLA. It happened to be part of a new program at UCLA called the Pain Control Unit; it was in the School of Psychology and was run by a faculty physician, the late Dr. Richard Kroening. He encouraged me to come back to UCLA and become a medical resident in Anesthesiology with a focus in Pain Management.
Thus, after Dental School, instead of going into any traditional dental specialty program such as orthodontics or oral surgery, I then decided to move to Los Angeles and take this residency position at UCLA. I started the first residency programs in head, neck, and orofacial pain management and completed the program in 1980. It was exciting to explore and learn about pain and the many medical, dental, alternative and complementary treatments for pain The use of integrative care of blending traditional medical care with complementary care strategies such as acupuncture and yoga has been the focus on my career. I completed my training and was appointed as a tenure track faculty position at the University of Minnesota. For past 30 years, I have been a Professor at the University of Minnesota, a researcher and educator at HealthPartners Institute for Education and Research, and a head and neck pain specialist at the Minnesota Head and Neck Pain Clinic. I have published several academic books on pain and over 100 clinical and scientific articles focused on prevention and treatment of chronic pain. There is much clinical and scientific knowledge that people need to know about their own daily lives to help them live a life without chronic pain– a good life. I try to use this knowledge and principles when I care for my patients and the work I do.
How did you first learn about chronic pain? Would you share your college roommate/yoga story?
Fricton: We all have serious pain at some time in our lives. My first major pain was in college as a young student. I injured my back while volunteering at a day care center and playing with children. The pain was severe and disabling. I could not get out of bed for a couple of days. It raised many questions about my physical health and my future. I went to student health and they indicated surgery was not possible, I was too young, and that I needed to learn to live with it. Then, synchronicity popped up. My college roommate at the time was taking a yoga program. This was 1972 and yoga was not common. Ram Dass, the former Harvard professor, left on a pilgrimage to India in the late ’60s as Dr. Richard Alpert and returned as a yoga teacher and a new identity. His 1970 tour of college campuses and his book Be Here Now established yoga as a lifestyle for a new generation including those at University of Iowa. I became one of those practitioners. When I did yoga, my back pain disappeared in about a week. I was blown away by the effectiveness of this supposed spiritual practice. However, I later learned that it was not only the calming of the mind and spirit that was so effective but also the stretching and strengthening of my muscles. I have been practicing yoga most days since then. This also piqued by interest in pain management before I even attended dental and medical school.
Currently as the President of the International Myopain Society (IMS), what is your mission? How does the Society help the chronic pain community?
Fricton: Chronic pain such as head, neck, and back pain is at epidemic levels around the world causing significant suffering, functional limitations, addiction, and missed work. As a result, chronic pain has become the highest-cost condition in all of health care with the use of high cost passive treatments such as medications, rehabilitation, injections, surgery, and implanted devices in an attempt to alleviate the pain. Yet, research has found that the majority of chronic pain is from the muscles and can be readily improved by activating the patient through training on self-management skills that improve muscle and joint function such as yoga, exercise, ergonomics, meditation, improving diet, sleep, and other lifestyle factors. The results in systematic reviews of self-management strategies suggested that they had better and longer term outcomes than passive treatments such as medication, therapies, and surgery. Thus, I felt there was a need to help all patients understand these concepts and how to change them to improve their pain. Therefore, my mission as President of the IMS is to broaden our understanding of preventing chronic pain. Thus, the IMS created the Campaign for Preventing Chronic Pain and Addiction to begin this process of helping each and every person learn how about their pain and how to relieve and prevent chronic pain.
What is the campaign for preventing chronic pain?
Fricton: To solve the chronic pain problem, we need a revolution in health care. We spend billions of dollars on advances in pharmaceuticals, devices, surgeries, and other innovative treatments for chronic pain, yet fail to deliver long-term successful relief due to the lack of engaging, empowering, and educating patients in these self-management strategies. We need to replace our current passive model of doctor-centered care with patient-centered transformative care. Thus, the IMS created the Campaign for Preventing Chronic Pain and Addiction to help each and every health professional and patient learn how to relieve and prevent chronic pain with transformative care, e.g. integrating training with treatment.
The Campaign has three goals:
- Expand education on preventing chronic pain.
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- Risk and Protective Factor Assessment
- Personalized Self-Management Training Program
- The Seven Realms Guide to Preventing Chronic Pain
- Tools and other resources for chronic pain
- Marketing and Seminars on Preventing Chronic Pain
- Access to health coaching for chronic pain
- Expand research on chronic pain.
- Efficacy of patient and provider training tools
- Risk and protective factors for chronic pain
- Better and safer pharmaceuticals and treatments
- Innovative patient-centered treatment strategies
- Expand advocacy for preventing chronic pain.
What led you to creating the online course, Preventing Chronic Pain, a University of Minnesota MOOC education offering through Coursera?
Fricton: The on-line MOOC course at www.coursera.org/learn/chronic-pain was developed to help begin transformative changes to health care by focusing on a broader model of health care. When we use a broader human systems approach, we can better understand how individual risk factors in the cognitive, behavioral, physical, emotional, spiritual, social, and environmental realms of our lives can interact to perpetuate chronic pain and, if improved, can prevent it. The course was first offered in 2014 and now has had over 40,000 participants. The course evaluations showed that 91% of participants believed the overall experience was satisfying, 92% believed it met the objectives, 93% believed that it made a difference in their life, and 85% believed that it made a difference in the care of patients.
Selected comments from participants included; “This course is one of the most generous offerings that I have ever encountered. There is so much life-changing, life-affirming information available at no charge, to anyone who wants it; it is rare and amazing. I am VERY grateful for it.” “The learning experience has been tremendous!! Everyone should have this knowledge, especially those in the health profession.” “I loved this class and want to take it again!” “Absolutely fascinating and enlightening…This information should be part of every health care educational program!” “This course has really helped me to understand myself better and why I think, act and see the world as I do.” “I am eternally grateful for taking the time and energy to provide this beacon of knowledge to the world.” “I think this course is a wonderful gift, because pain is an avoidable part of our life. I have learned so many things.”
You have spoken and written that it is possible to prevent chronic pain. What do you think are the components to a patient’s success?
Fricton: Yes, I believe it is possible to prevent chronic pain. We need to understand that pain is our protector that tells us when something is wrong. Whether it is acute brief pain or persistent chronic pain, there are identifiable causes that if changed will result in relief. These causes are individual risk factors that occur in the cognitive, behavioral, physical, emotional, spiritual, social, and environmental realms of our lives and can interact to perpetuate chronic pain and, if improved, can prevent it. The mechanism for this modulation of pain lies in the concept of sensitization either at the tissue level or the brain level. As health care providers, we need to leverage this new research to accomplish both primary (before it comes on) and secondary (after it is present) prevention of chronic pain. This can best be accomplished through a transformative care model. This model of care integrates training with treatments. As doctors, we treat patients with evidence-based treatments such as medications, therapies, injections, and surgery. These treatments improve pain in many cases, but in nearly half of cases, patients do not improve. This lack of improvement is typically due to risk factors which are more under the patient’s control such as repetitive strain, ergonomic issues, stress, and emotional issues. When we train patients to improve these risk factors and strengthen their protective factors using modalities such as exercise, eating and sleeping well, and maintaining positive emotions, they get better faster. Thus, a transformative care model can transform both the patient and the health care system to improve their outcomes. In our clinic, we have health psychologists, physical therapists, and health coaches who work with patients to achieve their goals of pain relief. We are also incorporating online training to help patients identify and control risk factors that are causing their pain condition. Transformative care will eventually replace biomedical care for all chronic illnesses.
Melissa Swanson is a chronic pain patient, advocate, and author of Ravyn’s Doll: How to Explain Fibromyalgia to Your Child. Through her Facebook page, she offers positive encouragement, medical information, resources, and support to 16,000+ fibromyalgia and chronic pain patients. In addition to her own blog, Melissa has been published in “Living Well with Fibromyalgia” and the NFMCPA “Advocate Voice.” She’s a graduate of the 2014 Class of Leaders Against Pain Scholarship Training sponsored by the National Fibromyalgia & Chronic Pain Association and a member of the Leaders Against Pain Action Network.