Meet Lonnie Zeltzer M.D., the founder of Creative Healing for Youth in Pain (CHYP)
Interviewed by Marlena Trafas
Editor’s Note
Dr. Lonnie Zeltzer is a Professor of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA, Director of the Pediatric Pain Program at UCLA Mattel Children's Hospital, and Past-Medical Director of Trinity Kids Care pediatric hospice. Her research covers the development of chronic pain, mind-body-pain connections, and the impact of complementary therapies on chronic pain. She has written numerous books and articles about the subject while also appearing on TV and radio as expert in the field. As an extension of her focus on chronic pain in teens and children, Dr. Zeltzer founded the Creative Healing for Youth in Pain (CHYP) nonprofit.
CHYP aims to empower youth living with chronic pain by introducing them to creative activities and experiences that will strengthen their connection between body and mind, reduce pain, and increase daily functioning. Below Dr. Zeltzer discusses how physicians traditionally treat those with chronic pain, the importance of social networking in healing, and the differences between “psychological” and “biopsychosocial” approaches to healing.
What exactly is the thinking behind creative healing and the benefits it offers those suffering from chronic pain? How does it interact with a patient’s overactive nervous system differently than other methods for alleviating chronic pain?
Chronic pain is now recognized as its own disease rather than a symptom. It is the experience of an over-active nervous system. The teens that tend to have chronic pain are very bright, creative, sensitive, and observant. These are all great qualities that make them unique, but this is also what makes them susceptible to chronic pain. Their brains learn so quickly and so deeply, that it sometimes becomes so “aware” it can actually get stuck in the brain’s “pain loops” and fire pain signals too often or too much. This is why I call it the “Smart Brain Pain Syndrome” – their brains process information (including pain) in a very special way. Since it is a neurological condition that occurs primarily in the brain, but affects different parts of the body, the traditional medical model that most physicians use does not typically work for the child with chronic pain. Research has shown that the most effective ways of changing these central pain circuits and reducing pain are not with medications, but with creative activities for the mind and body. With this creative healing approach teens can learn how to “unstick” their smart brains and teach them how to turn down their overactive pain receptors when they don’t need to be working so hard. Like I said, they have this issue because of their high-functioning mind and intelligence. So, through the process of strengthening the mind/body connection with creative healing activities, their brains can teach themselves new ways to experience information.
How do teens experience chronic pain differently than adults?
We know that adolescence is a period of development, which includes the body, brain, and nervous system. We talk about neuroplasticity, meaning the ability of the brain to form new neural connections or pathways. If pain is not well addressed during the teen years, when there is more ability for the brain to change, then it is more likely that pain can continue into adulthood. Adolescence is an important period for developing different strategies that change the neural/electrical signaling for the brain to develop stronger connections in the pain control centers of the brain. And this can happen in many different ways.
Adolescence is a time of identity formation – “who am I?” The main “job” of a teen is to explore life outside of the family. The teen starts moving away from the nest and into the outer world with more exposure to people and experiences. Pain can inhibit all of that, delaying important developmental tasks and really hindering the adolescent’s growth.
Why is social networking important for those in chronic pain and in the healthcare system as a whole?
I have been working with this population for forty years, and one of the main issues that I have noticed is loneliness. Many of these teens with pain have to drop out of school and stop playing sports or participating in activities because of the pain. Unfortunately, that is where most of their friends are – it is their connection to peers.
There is a pattern of loneliness for teens across the healthcare system, but there doesn’t have to be. This group of intelligent and creative young people are still yearning for the same acceptance, understanding, and compassion that we all are – but for them it is often more difficult to find that kind of empathy, especially with peers. So, I have been noticing the trends in the tech world, and social networking seemed like the perfect tool to fill the gap that my patients tend to have. They often feel alone in their experience of chronic pain because not everyone “gets it. . Introducing them to other teens who know the struggles of chronic pain can build a special kind of relationship that cannot always be achieved because of barriers like location and transportation. Let’s put the resources online, create a community, and give them a voice.
While CHYP is adamant that chronic pain is real and not simply a “psychological” problem, creative healing seems to utilize a “biopsychosocial” model. Wouldn’t that suggest that chronic pain has psychological causes? What exactly are the different contextual meanings of “psychological” and “biopsychosocial”?
Chronic pain is complex and involves many different things that can keep the pain going. This can include stress, thoughts, mood, emotion, focus of attention, past memories, and much more. These all have neurobiologic mechanisms, so we no longer think of pain as medical or psychological because the brain and body are connected.
“Psychological” indicates a source is mental, but the “biopsychosocial” approach recognizes that there is not simply one source. We still do have to address the psychological components, because that is important, but there are also biological and social experiences that are constantly shaping everyone. All pain relates to the brain/body biology, so we can’t point the finger at just one “cause.”
Why are most physicians not taught how to treat chronic pain in more holistic ways?
Traditionally, physicians are taught the biomedical model of having a cluster of symptoms by history and a cluster of physical signs from the exam. Then, they put that together to develop what is called a “differential diagnosis”, meaning all the possible medical problems that this cluster of signs and symptoms fit into. From that, they use further medical testing to narrow down to the diagnosis – so it’s a process from the many to the one or ones. Diagnosing and treating chronic pain involves a very different approach.
Medical residents are not usually taught or exposed to things like acupuncture, meditation, or other mind/body therapies. Some may refer patients out to these resources, but they don’t always know how to judge the quality of the people they are referring to. A lot of physicians tend to focus on what they know, which is medication, physical therapy, and interventional or surgical procedures as the primary treatment. In the end, the medical education system does not expose many physicians to alternative or complementary healing options.
One potential reason is that biomedical procedures tend to be more lucrative, and therefore supports the business-side of healthcare. Another is that, even though the research is out there to support many holistic methods, there still tends to be stigma surrounding it in the scientific field. The issue is that most chronic pain does not easily fit into the biomedical model of evaluation and treatment. Lastly, I see time as a relevant barrier for physicians. Diagnosing and treating chronic pain is like peeling an onion. Every time you peel one layer you find there may be another layer to address, so it’s not easy or quick. It takes time. Even if they have the knowledge and understanding of chronic pain, most doctors don’t have the time to unpeel and address all the issues.
Is CHYP working to expand its thinking and programs outside of California?
Yes! I have found that one of the main barriers to treatment, especially when it comes to pediatric chronic pain, is location. There are not many pediatric chronic pain programs out there, so you have to either be lucky enough to live near one or be able to travel to one. Then, there is the issue of insurance, finances, continuation of care, access to treatment options, and other logistics. Even if everything falls into place, there are extensive waitlists that can put off your appointment for months or years – because there are not enough resources out there to meet the needs of this population. Some hospitals and clinics may “treat” pediatric pain, but they use adult based programs focused on interventional procedures without specialists who are trained in pediatric chronic pain management.
CHYP is actually spread out across North America because we want as much diversity and representation as possible. We have team members in Los Angeles, Palo Alto, Atlanta, Boston, Toronto, and we are just continuing to grow! The website is not meant to replace any type of individual clinical services, but rather provide education and specific techniques with practical web-based group experiences. In other words, the website will supplement individual clinical services and provide opportunities for youth to learn more before seeking a specific local practitioner or to supplement local therapies.
