Consulting On Clinical Issues

Psychophysiologically Based Pain Consultation Service

INTENT – ASSIST CLINICIANS IN HANDLING THEIR PAIN PATIENTS:This service is designed to assist clinicians having patients in chronically severe pain for who underlying physical problems can not be identified and who are not responsive to traditional interventions.

This service does not work directly with nor advise individual patients.

TYPES OF PATIENTS: People in chronically severe pain having underlying disorders which can not be diagnosed with traditional medical assessment techniques and who are unresponsive to traditional medical treatments frequently have psychophysiologically based disorders amenable to both objective assessment and treatment with psychophysiological techniques.

PAINFUL AREAS / PROBLEMS: Painful areas / problems most frequently amenable to psychophysiological assessment and intervention include headache, upper back pain, low back pain, jaw area pain / TMD, pelvic floor pain, subluxation of the patella, non-cardiac chest pain, irritable bowel syndrome, Transud’s syndrome, phantom limb pain, and many others.

TECHNIQUES: Psychophysiological assessment techniques include performing non-invasive, painless recordings of many physiological parameters (e.g. muscle tension, peripheral blood flow, etc.) as they change in response to pain. Objective assessments frequently show exactly what dysfunction in the person’s physiology underlies the pain.

Psychophysiologically based interventions usually include teaching people to recognize when the physiological system causing the pain is performing incorrectly and to correct the system’s pattern of function.

EFFICACY: Many hundreds of studies have demonstrated the efficacy of the techniques. Studies are frequently placebo controlled, double blind with long term follow-ups but are most often small to medium size clinical studies. For further information, go to www.aapb.org

HOW CONSULTATIONS ARE PERFORMED: The consultation service helps the clinician(a) understand the psychophysiological aspects of the case, (b) perform a logical assessment, (c) plan the behaviorally based intervention. It then guides the clinician through the treatment. The first step is an initial phone contact with Dr. Richard Sherman, our coordinating consultant, to discuss and review the case. Dr. Sherman either handles the case directly, refers it to another consultant on the team with more expertise in the area, or organizes a team to provide the optimal combination of expertise as needed (very rare). Records can be sent via e-mail if necessary (rare). Recommendations are made for an assessment approach. If the clinician is performing a psychophysiological evaluation, Dr. Sherman can be on the phone to talk the clinical through the process and to interpret the results. Further assessment and / or treatment approaches are developed and Dr. Sherman or the most appropriate team member works with the clinician at every step to assure that optimal therapy is provided.

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COORDINATING CONSULTANT: Dr. Richard A. Sherman, Ph.D. has over 30 years of experience in assessing and treating pain patients in the clinical research setting. He has directed orthopedic pain clinics, performed grant supported research on various pain problems, and taught residents and others about pain, research techniques, psychophysiological assessment & intervention, etc. in medical centers, university’s, and clinics. He is currently dean of the Psychophysiology Doctoral Program at the U of Natural Medicine and directs the Behavioral Medicine Research and Training Foundation. Please see the summary of his resume below.

SUB-SPECIALTY CONSULTANTS:

Adult Headache: Mary Scholz, MS, RN, Ph.D. and Marvin Hoffert, MD

Pediatric Headache: Nanny Christie, MS, LPC, BCIA-C., PhD

Pain: Richard Sherman, Ph.D.(psychophysiology);Susan Middaugh, PT, Ph.D.; Timothy Sobie, MS, PT, GCFP, PhDc (candidate); Mary Scholz, MS, RN, Ph.D.,

EEG/Psychophysiological – Neurological Disorders: Gerald Kozlowski, Ph.D.

BRIEF SUMMARY of Dr. Richard A. Sherman’s RESUME

Degree: Ph.D. in Psychobiology, New York University, Bronx, N.Y., 1973
Experience Total of 30 years experience doing research, clinical work, and teaching

Present Positions:
President, Association for Applied Psychophysiology and Biofeedback

Dean, Psychophysiology Doctoral Program, University of Natural Medicine, Santa Fe, New Mexico, January, 2003 – present.

Director, Behavioral Medicine Research and Training Foundation, Suquamish, Washington, January, 2000 – present.

Psychophysiology Consultant for Psychology at Madigan Army Medical Center, Tacoma Wa.

Master Instructor, Chapman University, Bangor Campus, Wa

Research is / has been supported by GRANTS from the National Institutes of Health (NIH), the Department of Veterans Affairs (VA), the U.S. Army (open competition with universities), Private Industry, and non profit groups. History of continuous funding.

2. Previous positions include (a) Director of Research and Professor; Behavioral Physiology Institutes, Bainbridge Washington. July, 1998 – December, 1999, (b) Chief of Surgical Research, Madigan Army Medical Center, 1994 – 1998, (c) Director of Orthopedic Research at Fitzsimons Army Medical Center, 1987 1994, (d) Chief of Investigative Psychology at DD Eisenhower Army Medical Center, 1980 1987, (e) Director, Behavioral Assessment Laboratory, US Army Environmental Hygiene Agency, 1978 1980, and (f), six others.

Research / Discoveries best known for:

  1. Identification of physiological mechanisms causing phantom limb pain, surveys on occurrence of phantom limb and stump pain, and development of treatments for these disorders.
  2. Development of ambulatory recording techniques leading to determination of relationships between headache, low back pain, and muscle tension in subject’s normal environments.
  3. Treatment of migraine headaches with pulsing electromagnetic fields.

Publications: 131 publications and 2 accepted for publication. Includes 46 articles in peer reviewed journals, 8 chapters, 4 booklets, and 4 books. Most of the publications relate to clinical studies of pain evaluation and treatment.

Most Relevant Publications in the past 15 years:

Books:
Sherman R, Devor M, Jones C, Katz J, Marbach J: Phantom Pain, New York, Plenum Press; 1996. (Book)

Sherman R, and Jones C: The Amputee’s Guide, Published by the British Limbless Ex serviceperson’s Assoc. 1997. (Book)

Sherman R: Pain Assessment and Intervention from a Psychophysiological Perspective. Association for Applied Psychophysiology, Wheat Ridge Colorado, 2004. (Book)

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Articles and Chapters:
Karstetter K, Sherman R: Use of Thermography for initial detection of early Reflex Sympathetic Dystrophy. Journal of the American Podiatric Medical Association, 81: 198 205, 1991.

Sherman R, Sherman C: Physiological parameters that change when pain changes: Approaches to unraveling the “cause or reaction” quandary. Bulletin of the American Pain Society, 1(4): 11 15, 1991.

Sherman R, Griffin V, Evans C, Grana A: Temporal relationships between changes in phantom limb pain intensity and changes in surface electromyogram of the residual limb. Int. J. of Psychophysiology 13: 71 77, 1992.

Sherman R, Arena J: Phantom Limb Pain: Mechanisms, incidence, and treatment. Critical Reviews in Physical and Rehabilitation Medicine 4: 1 26, 1992.

Sherman R, Arena J: Biofeedback in the assessment and treatment of low back pain. Chapter 8 in: (J.V. Basmajian and R. Nyberg, eds) Rational Manual Therapies. Williams & Wilkins, 1992, pages 177 197.

Sherman R: Phantom limb pain: Mechanism based Management. Clinics in Podiatric Medicine and Surgery: Pain Management 11: 85 106, 1994. Saunders, Philadelphia, 1994.

Sherman R, Karstetter K, Damiano M, Evans C: Stability of temperature asymmetries in RSD over time, with treatment, and changes in pain. Clinical Journal of Pain, 10(1), 71 77, 1994

Sherman R: What do we really know about phantom limb pain? Pain Reviews 1(3): 261-274, 1994.

Sherman R, Camfield M, Arena J: The effect of presence or absence of pain on low back pain patients’ answers to questions on the MMPI’s Hy, Hs, and D scales. Journal of Military Psychology, 7(1): 28-38, 1995.

Sherman R, Karstetter K, Woerman A, and May H: Prediction and portrayal of lower limb pain disorders among soldiers in basic training using videothermography. Clinical Journal of Pain, 11(3): 236-241, 1995.

Sherman R, May H, Karstetter K, and Woerman A: Prevention of lower limb pain among soldiers in basic training using shock absorbing boot and sneaker inserts. Journal of the American Podiatric Association, 86(3): 117 – 122, 1996

Sherman R, Karstetter K, and Woerman A: Comparative effectiveness of videothermography, contact thermography, and infrared beam thermography for scanning skin temperature. J of Rehabilitation Research, 33: 377-386, 1996.

Sherman R, Davis G, Wong M: Behavioral treatment of urinary incontinence among female soldiers. Military Medicine, 162: 690 – 694, 1997.

Sherman R, Acosta N, Robson L: Treatment of migraine headaches with pulsing electromagnetic fields: A double blind, placebo controlled study. Headache 39: 567 – 575, 1999.

Flor H, Birbaumer N, Sherman R: Phantom limb pain. Pain: Clinical Updates 8: 1-4, 2000.

Sherman R: Behavioral protocols for burning and cramping phantom limb pain. Chapter 68 (pages 845-849) in Pain Management: A practical Guide for Clinicians, 6th ed. Edited by Richard S. Weiner. CRC Press, NY, 2002.

Sherman R: Biofeedback. Chapter 10 (ages 125-137) in E. Leskowitz (Ed.) Complementary and Alternative Medicine in Rehabilitation. New York, Harcourt (W.B. Saunders), 2002.

Sherman R: Postamputation pain. Chapter 32 in Textbook of Clinical Pain Management, Volume on Chronic Pain Ed by Troels Jensen Peter Wilson, David Haddox, and Andrew Rice. Arnold Publishers, London. Pages 427-436; 2003.

Sherman R: Clinical Research; Second Edition. Published by the Behavioral Medicine R&T Foundation, Suquamish, WA, 2003. (Book)

Tan G, Sherman R, Shanti B.F.: Biofeedback pain interventions. Practical Pain Management 3(3): 12-18, 2003.

Sherman R: Instrumentation Methodology for Recording and Feeding-back Surface Electromyographic (sEMG) Signals. Journal of Applied Psychophysiology 28: 107 – 120, 2003.

Sherman R: Psychophysiological recording and biofeedback: Tools for enabling people to control their physiologies. Chapter 6 ( 99 – 113) in: Enabling Technologies edited by M. MacLachlan and P. Gallagher. Elsevier / Churchill Livingstone, Edinburgh, NY, London, 2003.