Hi this is James Fricton again, and this is part two of the third module, The Balance Between Health and Illness. And the title of this is Holistic Complexity, the whole is greater than the sum of its parts, and as this cartoon illustrates, but didn't you once tell us that the whole is greater than the sum of its parts? What we want to do within this particular part, is examine both the individual parts of an automobile in this case, and how they contribute to the function of the whole. If you do not know both, you don't have a complete picture of the, of the person or the car. So, where the, where's the action with regard to contributing factors in risk and protective factors? It's really in the balance between risk and protective factors, and obviously we want more protective factors than risk factors. And each of these fall into one of the seven realms. The body or our physiology, or pathophysiology, and physical aspects of us. Our lifestyles, which is our behavior patterns, like such as diet, sleep patterns, our occupation, what do we do everyday, our exercise level. Are the emotions that we have, the anxiety, depression, or happiness and contentment. Our social relationships that we have, our society surrounding us. Our family members, our friends, and of course our spiritual side also, which is the feelings of faith and hope and purpose within the world. Our mind, which is our cognitions, our thoughts, our attitudes, and finally our environment, which is the setting, the natural setting that we're in. Now interestingly enough, to help you remember these seven realms, they are listed in order that shows the acronym BLESSME. [BLANK_AUDIO]. So, what are the functional relationships in each realm? I think it's important to understand how these interact with each other. Of course, our, ourselves, the person is the spiritual, our mind, our thoughts, our attitudes and our, our body. But then we interact with this environment around us, which includes the social environment, the people, family, friends around us, or our physical environment, the nature, or the artificial, the room around us, artificial environment. And we interact with these two environments through either emotional means, or behavioral or lifestyle means. We eat food, we sleep, we have emotions, anger, happiness, anxiety, depression, as a result of that interaction with the environment around us. And each of these, then, can become a risk factor or a protective factor. Well how do we determine what is a risk factor or a protective factor? Really it's about the evidence, we do studies to determine whether or not a factor plays a role in the development of an illness, like chronic pain. Or whether it protects us, and helps prevent chronic pain. Well there's two different general types of evidence, one is unfiltered information that goes, one from expert opinion all the way up to randomized control trials, to determine the relationship between factors within our health and, and illness. And then those studies and information, then can be put together within filtered information. That everything from article, synopses to evidence based guidelines, that are expert based and integrate scientific literature, up to scientific reviews, we're going to discuss a few of these studies. The lowest level of quality of a clinical trial, clinical study, is a correlational study. And in this example what you're looking at is a relationship between two factors, if one changes, does the other change also? Now, here's three illustrations that show what we mean by correlation. As auto mileage goes up, the value of the auto goes down and it's a negative correlation, and if it's perfect, it's a minus one. Now with auto quality is correlated autybody, auto body color, no correlation there. And you can see it's spread all over the map and it's a zero correlation, whereas with auto accidents that you have, the cost of auto insurance goes up and it's a positive correlation between those two. So this is true of risk factors, as well as protective factors. Now let's look at predictive studies. Now these are prospective, longitudinal studies where we go forward and we see what happens. We look at an entire population that includes somebody who does not have chronic pain, is disease free. And they're exposed to a risk factor right here, and there's another group that does not have the risk factor. And then you see what happens to them, did they become cases or controls? Do they have chronic pain or don't? Or in both the unexposed as well as exposed cases and controls. Now, in this regard we can determine the odds ratio. The odds ratio is what does the likelihood of a person getting chronic pain if they have that risk factor, and you can determine risk by looking at those four groups again. Did they have group A exposed or not exposed? Did they develop pain or continue to have pain? And you divide those people who have, were exposed with pain, times those people with no pain and not exposed, with this, the other two groups, and you divide them together and you get the odds ratio to determine what, how, what, how common it is that a person who is exposed will develop chronic pain. Well, if you can take those correlational studies and the prospective predictive studies and put them together in systematic reviews, you, you'll have a good basis for making recommendations. There's a confusing array of available literature out there, and hundreds of studies on clinical risk factors, with the diversity in many different things. What we want to do with a systematic review then, is identify all the risk and protective factor studies that are out there. Include every one of them and synthesize, we do a review process looking at both quality, as well as what is the data show and we combine the data from the different studies and conduct a meta-analysis to determine. What our conclusions are, with regard to a risk factor or protective factor. So, let's review some of the factors in each of the seven realms. And, again, lifestyle, spiritual, the cognition, our mind, the emotion, society, environmental, and our physical realm. Now in the physical realm, the protective factors that have found to be most important, are posture and exercise, all different types of exercise, from relaxation, to stretching, to strengthening and conditioning. And then our genetic makeup can play a role in protecting us from chronic pain. Whereas on that physical side, there's a number of physical risk factors putting poor posture, tight, tense muscles, hypo or hyper mobile joints, weak muscles, poor conditioning, injury of course is significant, and comorbid conditions. Then in the lifestyle realm, we have protective factors include such factors as good diet, healthy diets. Low caffeine for instance, activity level, whether we sleep well or not. Pacing, how fast we rush through our lives, and whether we have variation in our lifestyles. And low risk behaviors, and whether medications and take supplements can be protective. And then there was risk factors include poor diet, inactivity, sitting a lot during the day. Poor sleep, feeling hurried or rushed, straining the muscles, repetitive strain, high risk behaviors. And lots of adverse events from either medications, chemicals, and other factors. And then we also look at emotional factors, which includes of course the positive emotions are very protective, and negative emotions are risk factors and particularly depression, anger, anxiety are some of the most common risk factors for chronic pain. The social realm is also very important, we find that protective factors include helping others, having a purpose to help others around you. Harmony and peace in our relationships, social support is really important also. And being treated as as normal, even if you have an injury,is important, otherwise there's secondary gain. And then be intolerant, inflexible is also important, whereas risk factors including people who are self-centered and focused only on themselves, poor me, conflict and abuse, lack of support, secondary gain and social approval and being intolerant and demanding. In the spiritual realm, a number of factors seem to be very important, including, love, self-esteem, purpose and direction, having specific, well defined beliefs and faith and which leads to hope and optimism. And the risk factors include things such as hate and low self esteem, feeling lost and meaningless in life being unbelieving and cynis, cynical about the world, and about the pain and about what. How they can be helped, having doubt, being hopeless and pessimistic. In the mind realm, protective factors that are really about understanding the whole problem and all the factors that play a role in the condition. Being resilient in the ability to rebound, self-efficacy and, and having self control is very important, accepting responsibility and thus being compliant and realistic in expectations are all very helpful. Whereas, negative risk factors include ignorance of the whole problem or low resilience and self-efficacy, denying responsibility, poor compliance, and unrealistic expectations. Finally in the environmental realm, protective factors include having an environment that is clean and organized and safe. It protects you from getting an illness, or injury and that you act cautious and careful within that environment. Whereas risk factors that are lead to injury or illness are infective environments that are unclean or filthy, chaotic, dangerous and threatening, accident prone and negligent environments are all, play a role in increasing injuries. So, each of these risk and protective factors in each realm are going to be discussed in more detail within each of the modules, then we have a number of guest lecturers, who I think you'll be very fascinated to hear. It's important that not all these risk and protective factors are created equal, some are much more important than others, protective factors are more important than risk factors, and we will discuss these details. But it's important to see all, see each person, yourselves and the people around you, as a whole person. We are all complex, and we need to identify all the disorders, the diagnosis, risk factors and protective factors in any particular situation. So, thank you.
