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Pain Assessment and Intervention

From a Psychophysiological Perspective

45 Hours of CE Credit / Course Fee $550

Instructor: Richard A. Sherman, PhD

Course Concept and Objectives: Students learn by watching audiovisual lectures provided on CDs, reading assignments both from materials provided on the CD and standard texts, and interacting with their instructor via e-mail. They answer short essay questions after each lecture rather than taking exams. Previous students have found that this course takes between 45 and 95 hours of work to perform.

Pain is among the most common reasons patients approach the health care community and is, tragically, among the least successfully managed problems. The assessment and management of acute and chronic pain are fraught with ignorance, poor training, difficulties, complexities, and controversies all of which combine to produce pervasive misdiagnoses and ludicrously improper, ineffective care. Thus, patients with both acute and chronic pain frequently receive poor care from the medical community and are left to fend for themselves as best they can in the world of rumor, self-medication, and charlatans.

It is the objective of this course to provide you with the information you need to understand the underlying problems, be able to perform a reasonable assessment of patients with chronic and acute pain both on and off the ward, recognize when pain is not being appropriately or adequately ameliorated, and to be able to make or recommend interventions consistent with your clinical skills. Specifically, this course intends to:

1. Provide you with a basic understanding of the physiology, biochemistry, and psychology underlying pain mechanisms.
2. Provide you with sufficient knowledge about how pain mechanisms work to apply the knowledge to their evaluative and therapeutic interventions.
3. Give detailed information about several pain syndromes (including headache, RSD, low back pain, and phantom limb pain) so you will be abreast of current knowledge and be aware that similar depths of knowledge exist for most pain syndromes and must be searched out before attempting to evaluate or treat people with the problem.
4. Summarize the strengths and weaknesses of evidence supporting the efficacy of self-regulatory interventions for prevention and reduction of various pain problems.
5. Provide extensive examples of how to perform evaluations and non-pharmacological interventions.

How we are going to proceed through the course:
This home study course is divided into 25 units. Each unit consists of a recorded audiovisual lecture, one of more chapters of reading in the texts, review questions to be answered, and a real time recitation with me. The lecture portion of the course is presented through a series of audiovisual lectures profusely illustrated by power-point slides. There isn't enough lecture time to cover all of the practices - especially those related to pharmacology - so your reading will be very important. When you sign up for the course, I will mail you two CDs containing the audiovisual lectures, background materials, and a copy of the slide set upon which the lectures are based so you can make notes on your copy of the slides as you attend the lecture. After each lecture, you will answer a brief series of essay questions about each topic covered during the lecture, e-mail your answers to me, and then speak with me by phone about each topic. This will give you an opportunity to ask questions and for me to fill in gray areas and provide additional information on topics of special interest to you.

Cost / Administration / Policies:

Cost and payment: The course costs $550 payable either by credit card on the Foundation's web site www.behavmedfoundation.org or by check in US dollars to the Foundation at the letterhead address in advance.

Other Policies: For information about the Foundation and its policies, please see our web site www.behavmedfoundation.org.

CEUs: course and is approved for 45 hours of continuing education units (CEUs) by the APA, California's Boards of Psychology and Behavioral Sciences (Approval # PCE1895), and NBCC.

Faculty: Richard A. Sherman, PhD is certified by BCIA, approved by BCIA to teach the general biofeedback certification and other courses. He is a professional psychophysiologist with extensive training (his PhD is in biology / physiology) and has over 30 years of experience in pain research and treatment. He has over 130 publications in the area. Dr. Sherman's CV is available upon request and is on the CD accompanying the course materials.

Contacting me: The best way to contact me is via e-mail at rsherman@nwinet.com. I check my e-mail several times per day, seven days per week unless I am away at a meeting, etc. If I am going to be unavailable for a few days while you are taking this course, I will let you know. Our post-unit phone chats (360 452 - 5020) need to be scheduled in advance by e-mail but can be virtually any day of the week within limited hours.

Figure developed by the Biofeedback Foundation of Europe’s chronic pain team in Jan 2010
based on a drawing provided by Dr. Sherman.

Lecture Topics:

1. Introduction
2. Basic physiology related to pain
3. Basic Psychophysiology (stress - pain relationships, etc.)
4. Mechanisms of typical pain disorders
5. Assessment techniques
6. Interventions (Physical, surgical, behavioral, alternative, and pharmacological)

Required Text: (Cost of the text is not included in the course fee)

Sherman, R: Pain Assessment and Intervention from a Psychophysiological Perspective. Published by the Association for Applied Psychophysiology and Biofeedback (AAPB) in 2004. Can be purchased from either AAPB (800-477-8892 or aapb@resourcenter.com) or the Foundation.

Very Close to Required but you can get away without them:

1. Pain: A textbook for Therapists. Edited by Jenny Strong, Anita Unruh, Anthony Wright, G. Baxter. Published by Churchill Livingstone of NY. 2002. ISBN 0-443-05978-0.
2. Turk, D, Melzack R: Handbook of Pain Assessment; Second Edition. Guilford Press of NY. 2001. ISBN 1-57230-488X.

Optional Reading:

1. Wolf's Headache and other head pain - 7th edition. Edited by Stephen Silberstein, Richard Lipton and Donald Dalessio. Oxford University Press of NY 2001. ISBN 0-19-513518-0.
2. Mark Schwartz et al: Biofeedback: A Practitioner's guide. Guilford Press of New York, 2003.

Lectures and their associated reading:

You should do the assigned reading either before or "attending" the lectures.

1. Background and basic concepts (Sherman 1, Strong 1)
2. Determining credibility of techniques (Turk 31 - 34, Sherman Section H)
3. Stress - pain relationships, psychological factors (Sherman 1, 4, Strong 4 - 6, 22, Turk 1 - 10)
4. Physiological bases of pain 1 - muscles (Sherman 1 - 6, 7 - 12, Strong 17))
5 & 6. Physiological bases of pain 2 and 3 - nerves (Strong 2 & 3)
7. Physiological bases of pain 4 - blood flow (Sherman 13 - 15)
8.Assessment 1 - basic concepts and psychophysiological Techniques (Sherman 16 - 18, Strong 7, Turk 15 - 22, 29, 30)
9. Assessment 2 - trigger points (Sherman 19)
10. Assessment 3 - headaches (Turk 11, 24 - 26, Sherman 20)
11. Assessment 4 - low back pain (Turk 23, Sherman 21)
12. Assessment 5 - phantom limb pain (Sherman 22, Turk 27, 28, Strong 18)
13. Assessment 6 - abdominal pain, chest pain, & complex patients (Turk 30, Sherman 23 - 25)
14. Intervention 1 - basic concepts, surgical and physical interventions (Turk 12, Strong 8, 10, 11, 13, 14, 20, 21, Sherman 26, 48, 49)
15 & 16. Interventions 2 & 3 - alternative medicine interventions (Strong 12, Sherman 51, 52)
17 - 19. Interventions 4 - 6: behavioral medicine interventions (Strong 9, 14, 15, Sherman 36 - 41)
20 - 23. Interventions 7 - 10: Biofeedback 1 - 4 (Sherman 26 - 33, 42 - 47)
24. Interventions 11 - pharmacological intervention (Sherman 50, Strong 16, 50)
25. Success rates and conclusion
26. Optional material on pelvic floor pain (slide sets 9.1, 9.3, and 9.6)

End of course description

 

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