We refer to pain as not just one physical symptom or experience, but pain is actually pain plus suffering. Pain is the physical part, the tissue damage or pain with an organic cause like a tumor or a wound, or in nerve damage or overbearing of the nerves, whatever it may be. The suffering component comes in, in those categories we've talked about, like the cognitive stress. That can sometimes lead to compounding factors like depression and anxiety as other elements like purpose and meaning may suffer because of the pain. We've already talked about the importance of social relationships and if those become impaired because of pain and that certainly can impact the pain experience. It can become a bit of a vicious cycle. One way to really partner with patients and work together with people to help impact their pain experience, is to check-in with them about what their goals are. Many people who are living with chronic pain don't even have the expectation anymore they'll ever be completely pain-free. But that doesn't mean there aren't ways we can find to help them increase their energy or their joy, improve their relationships, or enhance performance of their daily activities in some way. It's important to check in with people to find out what's important to them and to identify micro goals and to begin working towards those mini-goals because if you can make someone's life 10 percent better, 10 percent better, 10 percent better, all of a sudden the chronic pain may still be there, but their quality of life and your experience around the chronic pain may change dramatically and that's where we can chip away and make big impacts with integrative therapies. Do you want to just make a mention of the equation that can sometimes lead to chronic pain? This is certainly not always the cause of chronic pain, but when someone has experienced a trauma, whether it's physical, mental, emotional, there's certainly an immense amount of stress that usually results from experiencing a trauma. If there's an intervention at that point and the stress is dealt with, it can impact the way that that trauma is stored in the body and expresses itself later. If trauma leads to stress and more stress and stress builds and the stress isn't addressed, that can impact the chronic pain experience and exacerbate it. Because we know that it literally changes the nerve pathways and stress increases levels of cortisol over time. Especially in children, we know that increased levels of cortisol over time, lead to sensitization during those very important developmental stages and then they're at higher risk for increased chronic pain later in life. This can be another way that acupressure can be used to maybe interrupt that cycle and improve outcomes. This week we're really focusing on the sequences and the protocols for physical pain elements. But later in the course we have a module on well-being and those will offer some sequences on things like anxiety and insomnia. You may see ways that even those sequences can be used to interrupt this cycle and impact pain or the pain experience. I think it's just useful to mention that acupressure is one item in a long list of integrative modalities that we have that we can use to impact the pain experience. Mindfulness, MBSR, MBCR, and SMART, those are all four different ways of describing mindfulness training. MBSR is the mindfulness-based stress reduction, MBCR is a mindfulness course specific to cancer, and then the SMART program is a resilience management training program. Yoga or Yoga Calm can be used for improving the pain experience. I would also add Pilates to this list, Tai Chi and acupressure or acupuncture, massage the EM technique is another type of massage and then of course, physical therapy. We could also add occupational therapy, music therapy, art therapy, chiropractic, craniosacral. There are many, many therapies that can be in a similar category. To summarize, what we want you to take away from this lecture is that acupressure can be an important part of a multimodal or multi-pronged approach to pain management. There is utility both at the self-care level, all the way up to the level of national policy to following the guidelines that the NIH put out, the joint commission put out, to really queuing into things like the opioid crisis that we're in. The goal of acupressure can sometimes be it suddenly to alleviate a physical symptom like a headache, a tension headache [inaudible] a very simple example, but other times it can be to impact the entire pain experience and not just the physical symptom. Keep an open mind in a broad lens when thinking about how acupressure can be used to impact the pain experience.