Proven Methods. Lasting Results.

Sometimes the Smallest Things Make the Biggest Difference

Wellness is the complete integration of body, mind, and spirit - the realization that everything we do, think, feel, and believe has an effect on our state of well-being.

- Greg Anderson

Greg Anderson is the author of six books, including the international bestseller The Cancer Conqueror, and founder of the American Wellness Project. Through lectures and workshops and as a consultant to businesses and health-care organizations, he is recognized as one of America's foremost wellness authorities.

Kairos Chronic Pain Coaching Basics.

We developed Kairos Chronic Pain Coaching to help chronic pain sufferers and their families navigate through the confusing and often, challenging labyrinth of secondary effects of chronic pain by educating, supporting, guiding and arming our clients with holistic, integrative, non-pharmacologic coping techniques. Furthermore, KCPC was carefully designed around proven methods, research, and protocols.

Regardless of where you are in your plight with chronic pain, The Kairos Chronic Pain Wellness Coaching Programs were designed with your unique story in mind. The goals we set, the topics we address, and the work we embark on will be all be your own personalized program.

To see a list of just a few of the subject matters we can focus our energy on, please click here.

With each client, we strive to achieve 3 basic goals:

Assist you and your family let go of what was
Help you and your family accept what is
Instilling hope for an empowered future by teaching a variety of skills that better balance the mental, emotional, physical and spiritual body systems

With that said, there are also 5 foundational themes that will not change from person to person or program to program. Why? Because every person I've met in chronic pain has shared these difficulties in varying degrees.

1. Increase Activities of Daily Living (ADL's) + Redefining Realistic Roles and Goals

2. Patient + Family Education on Chronic Pain, Communication, Holistic Physical and Emotional Coping Skills

3. Paradigm Shifts to Change Relationship + Behavior Responses to Pain

4. Accountability + Self-Management

5. Finding Balance in the Mental, Emotional, Physical and Spiritual Body Systems to Increase Overall Functionality

3 + 5

It was important to Founder, Integrative Wellness Life Coach and Fellow Chronic Pain Sufferer, Christina H Chororos that the following theories and approaches were embedded into each of the (4) Kairos Chronic Pain Coaching's Chronic Pain Wellness Programs.

The Foundational Approaches We Use:

Integrative Wellness Coaching
- Coaching Towards Balance
- Inside-Out-Outside-In Model
Mind-Body Medicine/ CAM
The Bowen Theory

Pain Models We Follow:

Interdisciplinary Model
Biopsychosocial Model of Pain
Patient-Centered Approach
Self-Management

Integrative Wellness

Integrative Wellness Coaching

A traditional (or general) life coach is someone who typically is known for helping their clients reach a goal or make a change in their life and is customarily defined as a person who counsels and encourages clients on matters having to do with personal challenges.

The word integrative as defined by the dictionary is: Combining allopathic and complementary therapies and/or serving or intending to unify separate things.

An Integrative Wellness Life Coach is certified to help their clients reach a goal or make a change in their life and counsel and encourage their clients on matters having to do with personal challenges - BUT unlike traditional life coaches, an Integrative Wellness Life Coach is trained to help their clients gain freedom from the past, by healing core issues and overcoming negative habits and patterns - while

empowering their clients to change their life with effective tools, techniques, and specific action steps

It was for these reasons, founder, Christina H Chororos carefully chose to obtain her certification from Integrative Wellness Academy

Coaching Towards Balance

As it's related to Integrative Wellness Life Coaching, balance means wellness, harmony, and wholeness.

An Integrative Wellness Life Coach does this through a holistic and integrative approach. By coaching towards balance in all four body systems (the mental, emotional, physical and spiritual systems) we move life coaching from simply counseling and encouraging to fully equipping and empowering clients to make effective, lasting change.

I strive to teach about the interconnection and effects between all four body systems. What this means is as we move towards balance in the physical body system, we must take the other three (mental, emotional and spiritual) systems into consideration.

Coaching towards balance isn't about having you dramatically change everything you do. In fact, there is growing research that shows that changing behaviors in order to move towards healthier lifestyles is a science. During our coaching sessions, we will discuss the latest research and work to apply it to your life in small, digestible steps.

Learn about MEPS (Mental, Emotional, Physical and Spiritual) Body Systems

Inside-Out-Outside-In Coaching Model

The reason so many of us have experienced the ineffectiveness of trying to will a change (like losing weight or quitting smoking) is likely due to the core issues that are at play. A simple exertion of one's will to try to force change from only the outside-in is about as ineffective for permanent change as telling yourself affirmations but not being in agreement with the new ideas in any capacity.

To give you an example of this model in practice would be the following scenario:

Let's imagine a little boy learning to ride his bicycle. He falls and skins his knee. As the caring adult in his life, we would put a band-aid on his knee. But stopping there wouldn't be healing him completely. In order for that to happen, we would need to teach him how to correct the mistake so he doesn't fall again, help him get past his sadness and fear now associated with riding his bike and encourage him to connect with his full abilities.

Inside-Out-Outside-In Model

Mind-Body Medicine

Mind-body medicine uses the power of thoughts and emotions to influence physical health. Western medical views have largely been shaped by the system of thought that mind and body were separate from each other.

In the United States, interests in correlating a relationship between body, mind, and emotions date as far back as 200 years ago!

People like Jon Kabat-Zinn, PhD, Dean Ornish, MD, David Spiegel, MD, Bernie Spiegel, MD, and Bruce Lipton, PhD, have played significant roles in furthering the credibility and significance of mind-body connection in modern medicine.

However, mounting evidence for the role of the mind in disease and healing is leading to greater acceptance. Suddenly our grandmother nagging us that "too much stress will make us sick"...has some validity after all.

The National Insitute of Health (NIH) wrote the following fact-sheet on mind-body medicine:

"The concept that the mind is important in health and illness dates back to ancient times. In the West, the notion that mind and body were separate began during the Renaissance and Enlightenment eras. Increasing numbers of scientific and technological discoveries furthered this split and led to an emphasis on disease-based models, pathological changes, and external cures. The role of mind and belief in health and illness began to re-enter Western health care in the 20th century, led by discoveries about pain control via the placebo effect and effects of stress on health."

Mind-body medicine focuses on:

The interactions among the brain, the rest of the body, the mind, and behavior

The National Center for Complementary and Alternative Medicine (NCCAM) is the component of the NIH that studies complementary and alternative medicine (CAM). Within CAM, some examples of mind-body

medicine practices are meditation, hypnosis, tai chi, and yoga."

"The ways in which emotional, mental, social, spiritual, experiential, and behavioral factors can directly affect health." (1)

Cited Articles:

“NIH Fact Sheets - Mind-Body Medicine Practices in Complementary and Alternative Medicine.” National Institutes of Health, U.S. Department of Health and Human Services, report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=102.

Cited Articles _ Mind-Body

The Bowen Theory

As suggested by the National Institute of Health, and arguably, the most overlooked, yet most critical component in the treatment of any health problem is providing care for both the family unit and the identified patient. Herein lies the pivotal substratum.

Originated by psychiatrist, Dr. Murray Bowen and founder of the Georgetown University Family Center, the Kairos Chronic Pain Wellness Program uses the "family systems theory" as our program's fundamental guiding principle.

Bowen family systems theory is a theory of human behavior that views the family as an emotional unit and uses systems thinking to describe the complex interactions in the unit. It is the nature of a family that its members are intensely connected emotionally. Often people feel distant or disconnected from their families, but this is more feeling than fact. Families so profoundly affect their members’ thoughts, feelings, and actions that it often seems as if people are living under the same “emotional skin.” People solicit each other’s attention, approval, and support and react to each other’s needs, expectations, and upsets. The connectedness and reactivity make the functioning of family members interdependent. A change in one person’s functioning is predictably followed by reciprocal changes in the functioning of others. Families differ somewhat in the degree of interdependence, but it is always present to some degree. (1)

However, we didn't stop at just incorporating "family systems theory" into our wellness programs - I decided to partner with the Founder and Clinical Director, of Hellenic Therapy Center, Maria Sikoutris-DiIorio, MA, Ed.S., LPC, who studied alongside The Bowen Center's best and brightest and uses the Bowen Theory in her private practice.

So Why Do We Treat Both You and Your Family?

By treating you, your caregiver and/or spouse and family, we will begin to heal the wide-ranging toll chronic pain takes. This was an extremely hard concept for me to understand - I was the one in daily pain so I was the only one in pain...right? Not really. Change of any kind requires an adjustment period. For chronic pain sufferers, suddenly our lives seem to revolve around our limitations, not our contributions. We miss who we once were, and all the things we used to be able to do so easily. We're grieving the people and the lives we once had...however, so are our loved ones.

Family theory dictates that which affects one family member affects the others.

Cited Articles:

Kerr, Michael E. “One Family’s Story: A Primer on Bowen Theory.” The Bowen Center for the Study of the Family. 2000. http://www.thebowencenter.org.

The Bowen Theory

Cited Articles _Bowen Theory

Interdisciplinary Model

Though I have discussed interdisciplinary care in my own words and have taken the time to break it down for you, the following quoted articles couldn't have been said better.

"An interdisciplinary approach is hardly unique to pain care. It also is used, to beneficial effect, in palliative care, rehabilitation, critical care, mental health, and geriatrics (Paice, 2005). Interdisciplinary approaches for chronic pain have been supported by numerous studies from many different countries and study populations, including 10 major studies/reviews."

"Ideally, most patients with severe persistent pain would obtain pain care from an interdisciplinary team, as opposed to a specialist who might focus on a narrow range of treatments and have a restricted view of how pain is affecting the patient. The interdisciplinary model incorporates assessment and diagnosis, not just therapy. It is an integrated, coordinated, and multimodal approach to care targeting multiple dimensions of the chronic pain experience—including disease management, reduction in pain severity, improved functioning, and emotional well-being and health-related quality of life—that is developed through a comprehensive evaluation by multiple specialists (usually physicians, nurses, psychologists or other mental health professionals, rehabilitation specialists, and/or complementary and alternative medicine [CAM] therapists). In the primary care setting, the team most often includes a primary care practitioner, nurse, and mental health clinician. In specialty and tertiary care settings, this team approach most often emphasizes psychological, pharmacological, and rehabilitation approaches." (1)

"...the presence of pain affects all aspects of an individual’s functioning. As a consequence, an interdisciplinary approach that incorporates the knowledge and skills of a number of health care providers is essential for successful treatment and patient management."

"The composition of the team will vary since practice settings differ in size, complexity, resources, and patient populations. Measurement goals will differ depending on type of pain and state of the patient’s disease. However, regardless of the population served, interdisciplinary care is patient-centered, family-centered, and stakeholder centered (ie, case manager, adjuster, employer). Treatment should be holistic, never directed toward an isolated body part or symptom. Efforts are made to achieve empowerment of the patient and his or her caregivers or significant others." (2)

Interdisciplinary Model

Multidisciplinary Approach OR Interdisciplinary Approach

Here's another way of looking at it. You've probably realized, quite quickly that as chronic pain sufferers, we are Olympic gold medalists at being human guinea pigs.

Suddenly, we are caught in a tiring cycle of doctor appointments, tests, medications, and treatment therapies - what I call, The Cycle of Diagnosis + Treatment.

Where an interdisciplinary approach attempts to prevent this cycle by creating a collaborative team, a multidisciplinary model perpetuates this cycle by tolerating teamwork.

It goes a little something like this...Stop me if you've heard this one.

(I couldn't help myself...)

The Chronic Pain Cycle of Diagnosis + Treatment

10.

Your physician refers you to a mental health professional.

You're put on more medication.

Wait. Why is the ONE person who isn't a doctor, the ONLY one communicating with everyone? What if I miss something?

You spend

hours researching

each proposed

approach,

Coin toss, perhaps?

With...

psychologists

psychatrists

urologists

endocrinologists

gynecologists

oncologists

cardiologists

gastrointentists

neurologists

pulomolonigsts

rheumatologists

dermatologists

hematologists

chiropractors

orthopedists

O/T's

P/T's

nutritionists

osteopaths

massage therapists

naturopathic doctors

acupuncturists

...Well, you get the idea...

You must complete a series of tests/exams - blood work, MRI's,

Cat Scans, ultrasounds, etc.

Begin here.

You're initially diagnosed with an illness or injury by your physician. You're in excruciating pain that you can no longer tolerate.

Results are back. You're referred to a surgeon or specialist for a second (or third, or fourth opinion). Each time, you have to retell your medical history + records.

Who needs a full-time job?

Each physician has contending opinions and/or vastly different treatment plans. Each one seems confident that their approach is best.

Great.

You schedule a surgery or procedure. The surgeon/specialist then refers you to a physical therapist or a pain management physician for extended care.

You're given exercises to do at home and medication to manage the pain.

That was easy.

(sarcasm anyone?)

An acceptable amount of time passes and you're still in pain. Only now, you're becoming depressed and anxious.

Oh, good.

Twelve short weeks of being in daily pain, your injury or illness quickly catapults

you into incurable CP.

Awesome.

11.

Still, in pain you and your loved ones continue searching for solutions....again.

Each time, with new specialists...and so the cycle continues...

Suddenly, you're in a never-ending cycle of doctor appointments, tests, medications, and treatment therapies.

Here's the Problem.

With each physician you see, each test you have, each diagnosis you receive, each medication you're prescribed...a medical chart is created by the physician's office that is treating you. With each new specialist you see, your medical chart is requested.

HIPAA releases must be signed. Fax numbers need to be obtained. Following up with the office staff is imperative.

And, if you'd like a hard copy for your files? That is a new set of hoops to jump through.

It becomes a full-time job.

There isn't a team leader or true "team."

It's likely you're not a doctor. You don't know what questions to ask. You don't know what therapies or medications interact with other medications physicians have prescribed.

Additionally, you're exhausted and in pain.

Your caregiver or loved ones are stressed, overwhelmed and exhausted as well.

The Solution.

KCPC will help.

We will help you by focusing your care.
We will speak with your physicians and centralize your care.
We will provide you with written outlines for requesting your medical charts.
We will support you in organizing + streamlining your medical records.
We will discuss your treatment options and weigh the pros and cons of each.

Cited Articles:

(1) “Read ‘Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research’ at NAP.edu.” National Academies Press: OpenBook, www.nap.edu/read/13172/chapter/5?term=patient%2Beducation.

(2) “Interdisciplinary Care.” Advanced Pain Management, apmhealth.com/news-updates/apm-blog/content/interdisciplinary-care.

Cited Articles _ Interdisciplinary

Biopsychosocial Model of Pain

Chronic Pain

Social

Work

Social

Family

Sleep

Fear

Depression

Anxiety

Coping skills

Psychological

Biological

Injury

Illness

Trauma

Infection

Cancer

Nerve damage

Nociceptive

Quality of Life

Activities of daily living

Social + family functioning

Mental health

The biopsychosocial model of pain takes into account a patients’ unique biologic and genetic constitution, psychological factors, and societal and environmental conditions. It postulates that pain impacts the biological, physical + social systems which, in turn, affects the experience of pain. In other words, physical pain is only one contributing factor to chronic pain - pain is a mind-body experience.

KCPC approaches the work we do together through a biopsychosocial approach by taking your unique biologic and genetic make-up, psychological, emotional, social and environmental circumstances.

In fact, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research stated,

"The biopsychosocial approach, combining physical and emotional factors in assessing and treating chronic pain, offers a uniquely valuable clinical perspective."

Cited Articles:

Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. 3, Care of People with Pain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92517/

Self-Management

Self-management is an important tool KCPC teaches every client. Many chronic pain sufferers, including myself, predominately look "outward" for pain management solutions. As we discussed here, there isn't a handbook we can reference or a "troubleshooting" manual we're given when diagnosed with an illness, disease and/or CP. So, it's natural to assume that physicians are the authority on your illness - it's natural to look to loved ones to support you emotionally and physically - it's natural to believe medications are the only way to manage your illness, disease and/or CP, after all, that's why they exist, no?

However, looking to and solely relying on "outside" pain management methods perpetuates dependency and indirectly feeds a subconscious "victim mentality."

Please understand we are NOT saying that these sources aren't necessary for your CP case - we also aren't suggesting that you change your treatment plan - we are simply stating that making the paradigm shift from expecting others must and should carry the responsibility of your pain management, quality of life, emotional distress and completion of activities of daily living (ADL's) to understanding that you, in fact, are capable, able, and accountable for managing these areas of your life will greatly improve your perceived pain.

Just keep reading...even if you think I am speaking nonsense.

You may be thinking, "you obviously don't understand how much pain I endure on a daily basis," or "I physically CAN'T (insert an ADL here: get up, take a shower/bath, go food shopping, etc.) without the help of someone" or, "I couldn't make it through a day without the help of my medications."

I so get it. I have been there. I have had the same beliefs, expectations, and demeanor so don't write me off just yet- keep reading.

Before I was stricken with pain, I was a confident, driven, independent woman.

I didn't need the people in my life, I wanted the people in my life.

However, after becoming stricken with pain, I found myself physically and emotionally dependent on two of the most important people in my life - my Dad and partner. Big deal, right? That's what families are for.

Except, my Dad unexpectedly passed away. And then, I got divorced.

WTF?! Seriously?! Now what?

After an epic...and I mean epic pity-party, I quickly realized it was one hell of a way to learn an extremely important lesson - Self-management. I was the first line of defense...or, first responder if you will. I was responsible for my health.

"Chronic pain, like all chronic conditions, requires day-to-day management by the affected individual. Lorig and Holman, leaders in the field for the past three decades, have delineated the key tasks involved in the self-management of a chronic condition to enhance quality of life. These tasks include managing medical interventions such as using medication appropriately and building partnerships with their healthcare providers (HCPs); using cognitive and behavioral strategies to manage symptoms; modifying family, social and work roles, and responsibilities to maintain some normalcy in life; and dealing with the emotional consequences of a chronic condition. Daily challenges will be different for each individual and may change over time, thus transferable skills such as problem-solving, decision-making, resource identification and communication skills for partnering with HCPs are invaluable."

"Self-management also requires the ability to appraise one’s situation and resources, and decide on a course of action. This ability is called self-efficacy in social cognitive theory and can be enhanced by: practicing and mastering a task or skill; observing peers modeling the skill; receiving reinforcement feedback and support; and working on improving one’s emotional state."

Furthermore, "self-management succeeds partly because it helps patients believe in their own capacity to control their pain (Keefe et al., 2008). Pain beliefs correlate with outcomes, and patients function better when they have some control, are not severely disabled, and avoid “catastrophizing” pain—that is, exaggerating its threat and believing they cannot control it."(2)

An article published in Future Medicine: Journal Pain Management stated the following:

"Acceptance of the chronic nature of their pain is a necessary step before individuals are ready to self-manage."

"Clinicians can play a critical role in supporting self-management through answering questions, providing advice, addressing barriers and facilitators, and encouraging self-management efforts." (1)

Listed below are suggested steps imperative for effective implementation.

The KCPC Wellness Programs

have these interventions embedded within the curriculum to

ensure successful KCPC client outcomes.

Cited Articles _ Self Management

Self-management interventions (SMIs) teach the skills required for day-to-day management of chronic pain conditions and may be based on the Stanford model, acceptance and commitment therapy, or cognitive–behavioral therapy.

SMIs target self-efficacy and include peer role modeling, practicing skills, feedback and, support, and/or addressing emotion

SMIs delivered in group sessions include the benefit(s) of the group dynamic while being cost-effective, and online interventions can be used to reach immobile or rural groups

SMIs are effective in reducing pain and improving mental health and health-related quality of life in chronic pain groups.

SMIs combined with antidepressant pharmacotherapy are more effective in reducing depression than either modality alone.

Individuals must accept the chronic nature of their pain before they are ready to listen to self-management teaching.

Self-management teaching needs to be tailored to individual functional abilities, include regular support and encouragement, and be consistent between clinicians.

Individuals encounter both barriers to, and facilitators of, self-management that need to be first assessed and then addressed by either healthcare providers or SMIs to help individuals success.

The Pain Stages of Change Questionnaire can be a useful tool to help identify who is ready to self-manage their pain.

Cited Articles:

(1) Self-management interventions for chronic pain

Elizabeth G Mann, Sandra LeFort, and Elizabeth G VanDenKerkhof

Pain Management 2013 3:3, 211-222

Patient-Centered

Research by the Picker Institute has delineated 8 dimensions of patient-centered care, including:

respect for the patient's values, preferences, and expressed needs
information and education
access to care
emotional support to relieve fear and anxiety
involvement of family and friends
continuity and secure transition between health care settings
physical comfort
coordination of care (1)

Makes sense, no?

Patient-centered care is particularly important for chronic pain sufferers. in the chronic pain community. geography, economics, mobility, insurance, and employment and/or personal commitments are just a few of the identifiable factors that prevent chronic pain patients from receiving balanced pain management care.These barriers to health care can greatly affect a chronic pain patient's adherence to any kind of pain management program.

Kairos Chronic Pain Coaching understands these barriers to care, which is why your coaching program is designed around you and your needs.

Cited Articles:

(1)

Gerteis M, Edgman-Levitan S, Daley J, Delbanco TL. Through the Patient's Eyes: Understanding and Promoting Patient-Centered Care. San Francisco, Calif: Jossey-Bass; 1993. [Ref list]

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