Pain Management Tactics for Patients Who Have Comorbid Post Traumatic Stress Disorder, With J.P. (Jack) Ginsberg, PhD

Pain Management Clinic Doctor Talking to Patient, Spine

Pain management continues to win attention from all areas of the clinical industry, especially in light of the opioid epidemic in the United States.

Symptoms of pain can be hard to validate and quantify. For this reason, the risk of provider malpractice is heightened because of over-prescribed pain medication.

However, thanks to thought leaders who specialize in pain management, healthcare has realized some of the most reliable, innovative, opioid-free pain therapy practices.

Confirm BioSciences spoke with Dr. J.P. (Jack) Ginsberg, PhD, to learn how to simplify diagnoses, adopt proven treatment methods, and discover effective technology used in pain management.

Dr. Ginsberg is a licensed Clinical Psychologist and Neuropsychologist at Wm. Jennings Bryan Dorn VA Medical Center in South Carolina. In tandem with his research, Dr. Ginsberg provides expert care for patients with symptomatic pain and comorbid Post Traumatic Stress Disorder (PTSD).

What is “Standardization” in Healthcare?

A shared challenge among providers of all specialties is the standardization of care. Pain is usually described subjectively from patient to patient, but there are ways to objectify findings. According to Dr. Ginsberg, “the same questionnaire given to many individuals with chronic pain in the same manner will standardize the results. But this does not assure that, for example, a ‘2’ on a rating scale from one individual will be comparable to a ‘2’ from another individual on the same rating scale.”

It’s no surprise, as Dr. Ginsberg states, that “there are physiological links between chronic pain, stress disorders, and depression.” Studies conducted by The National Center for Biotechnology Information (NCBI) report that patients who have psychiatric disorders such as depression, anxiety and PTSD seek clinical care more frequently than people who do not suffer from a psychiatric disorder.1

What is Post Traumatic Stress Disorder?

Post Traumatic Stress Disorder is a prevalent illness, especially among war veterans. Taken from The United States Department of Veterans Affairs:

  •  7-8% of the country’s population will have to cope with PTSD at some point in their lives.2

  • Women are more likely to develop PTSD symptoms than men.

  • War veterans are very susceptible to developing PTSD.

To yield success in treatment and minimize pain sensation, Dr. Ginsberg practices three domains of care for PTSD sufferers:

Medication

  • Careful assessment of a patient’s health history is critical. Patients who are already prescribed medication are susceptible to deadly cross-reactivity if providers suggest contraindicative medicine.

  • If a medication treatment plan is required based on the analysis of a certified professional, medication must only be prescribed as necessary. Opiates can dull senses, thereby impacting quality of life and overall sense of satisfaction.

  • Providers must be mindful when weaning their patients from opiates, as being held liable for negligence is possible if withdrawal symptoms cause further health complications.

Narcotic Pain Relievers

Side Effects of Opiate Use

Symptoms and side effects of prolonged opiate use include:

  • Depression
  • Digestive problems
  • Brain damage
  • Liver damage
  • Lung damage

Counseling

The way people respond to life events may influence their interpretation of pain symptoms. Therapist-assisted counseling can recalibrate a patient’s emotional, mental and physical state, with the goal of achieving a baseline for pain symptoms.

Self-Help

This is a new practice for handling PTSD. “Mind-body self-help is becoming increasingly common in the healthcare setting,” according to Dr. Ginsberg. “Self-help guides for mind-body treatments are easy to find online and in bookstores and libraries, as well as being promoted through TV and other publications. I encourage patients to find out about several possible techniques that interest them, try them out to see which one they like the best, then stick with it.”

How to Self-Meditate

While some mind-body practices require the assistance of a certified provider, others can be practiced independently without clinical intervention or medication:

  • Acupuncture
  • Massage
  • Meditation
  • Music therapy
  • Reiki
  • Qi Gong
  • Yoga

Dr. Ginsberg claims he is “committed to using Heart Rate Variability (HRV) as a biomarker of emotional well-being and HRV Biofeedback as a treatment.”

How to Measure Heart Rate Variability

HRV analysis software not only measures the distance in space and time between heartbeats; they also depict patterns in respiration. Breathing typically becomes more controlled under HRV Biofeedback treatment, and patients who are mindful of their breathing throughout the day are less likely to experience stress, a well-known agitator of physiological and psychiatric issues.

Using HRV analysis software can significantly improve a patient’s nervous system by helping to regulate their emotional reactions to seemingly normal “trigger” events. HRV strengthens a patient’s cognitive appraisal skills, which are responsible for the recognition and subsequent response to non-physical stimuli.

According to Dr. Ginsberg, “the technology for monitoring heart rate and then analyzing pulses has become extremely simple to use.  Very few patients express any reluctance to find out more about HRVB.” Generally, low heart rate variability seems to correlate to the onset or exacerbation of PTSD symptoms.3

But the implications of HRV treatment extends beyond PTSD management. A study funded by The Heart and Stroke Foundation of Canada and the Biofeedback Federation of Europe found “HRV independently predicts mortality within the initial two years following a heart attack.”4 HRV measurements are thus applicable in many healthcare settings.

Importance of Patient-Provider Relationship

No matter their specialty, physicians must be prepared for the rare circumstances where patient-provider relationships break down because of ineffective treatment, lack of empathy, and other reasons. In these situations, Dr. Ginsberg suggests “to retreat from whatever the activity is that has brought me into interaction with that patient and wait for a later time when hopefully the patient will be more receptive.”

Pain management therapy, particularly in the field of psychoanalysis, has forged a path of success with evidence-based outcomes as proof. Dr. Ginsberg leaves us with a hopeful statement:

“It has been a truism in the past that patients with mental illness do not seek treatment because of denial and lack of insight on the one hand and stigma on the other. This is less true now-a-days, however, as destigmatization of mental illness in the military and in civilian communities has lowered barriers.”

J.P. (Jack) Ginsberg, PhD, continues to thrive in his role, authoring and co-authoring several studies and publications concerning the association between pain symptoms and PTSD in war veterans.

Are you attending Pain Week 2018 in Las Vegas? Visit Confirm BioSciences at Booth #419 and learn about the drug testing strategies that are most fitting for your pain management or rehabilitation center.


1Institute of Medicine (US) Committee on Pain, et al. “Psychiatric Aspects of Chronic Pain.”Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives., U.S. National Library of Medicine, 1 Jan. 1987, www.ncbi.nlm.nih.gov/books/NBK219250/.

2PTSD: National Center for PTSD.” How Common Is PTSD? – PTSD: National Center for PTSD, 5 July 2007, www.ptsd.va.gov/public/ptsd-overview/basics/how-common-is-ptsd.asp

3Gillie, B. L., & Thayer, J. F. (2014). Individual differences in resting heart rate variability and cognitive control in posttraumatic stress disorder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4097943/

4The Expert Series (2017). Heart Rate Variability (HRV). 4th ed. Montréal, Quebec: Thought Technology Ltd., p.2. Available at: http://www.thoughttechnology.com/pdf/CardioProFinal.pdf.