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Last year, giving to nonprofits was up by an average of 4.5% nationwide. But here in Santa Cruz, donations to the nonprofits participating in our holiday giving campaign Santa Cruz Gives grew by 19% in 2018 over the previous year.

The message has come through loud and clear: people in Santa Cruz County care about improving and uplifting their community, and they have chosen Santa Cruz Gives as a vehicle for being a part of that positive change.

So we are thrilled to announce that for 2019, we have expanded the number of local nonprofits accepted into the campaign. In previous years, we were wary of growing too fast, and overreaching beyond what this fledgling charitable project was capable of sustaining.

But you have sustained this effort, and driven it far more quickly than we imagined when we first conceived it. If we reach our goal of raising $300,000 between now and the end of the campaign at midnight on Dec. 31, then Santa Cruz Gives will have raised more than $1 million for local nonprofits in its first five years. That is an incredible testament to the spirit of giving in Santa Cruz County.

The bold growth of this program would not have been possible without our partners at the Volunteer Center of Santa Cruz County and Community Foundation Santa Cruz County, and our business sponsors Santa Cruz County Bank, Wynn Capital Management and Oswald.

Most of all, it would not be possible without you. So please give generously to our participating nonprofits. Read about all of them hereboth their mission statements and the projects they will fund with the money raised through Santa Cruz Givesthen go to santacruzgives.org, our easy-to-use website that lets you give conveniently and securely to all of your favorite causes.

Organization Mission: We create and support one-on-one mentoring relationships that ignite the power and promise of youth. We have served more than 7,000 local at-risk children, providing a crucial foundation at a critical time in their lives. Mentors make Santa Cruz County a safer and healthier place by helping children make better decisions, which increases their chances of staying in school and decreases their challenges with substance abuse, teen pregnancy and the criminal justice system.

Transgender Matching Program and LGBTQ+ Service Expansion

Our local agency, Big Brothers Big Sisters of Santa Cruz County, is the first and only agency in the entire nation to have a Trans Matching Program. We began matching transgender youth with volunteer transgender adult mentors in 2015. The program now serves as a national model.

Using our proven mentoring model, volunteers receive in-depth training on how to support these youth, who routinely face pervasive injustice, bias and mental illness in their daily lives. Research shows a quality mentoring relationship reduces the risk of suicide in the trans population by 50%.

We want to expand our efforts in the LGBTQ+ arena through training, roundtables and enhanced match support for all of our mentors, our matches and for other youth-serving organizations in the community. Discrimination and bias often begin in childhood, as LGBTQ+ youth explore their gender identites. They are at high risk of harassment, physical and sexual violence, and suicide. We work with this underserved population in close partnership with other agencies.

We grasp that gender identity can be fluid, and providing deeper support for all LGBTQ+ program participants will improve outcomes for youth we serve. Our volunteers are trained when first matched, and many matches last for well over five years. We must update our training so that long-term volunteers are prepared.

Organization Mission: The Bird School Project aims to inspire and equip both students and teachers to love, study and steward their local environment.

Creating Leaders for the Environment

In 2020, Bird School Project aims to unify youth leadership around a vision for lives that are relaxed, mentally resilient and less distracted.

The Bird School Project provides educational experiences to students directly on their schoolyards, making nature and a bit of wilderness easily revisited, leading to appreciation, inquiry and stewardship. Students grow an appreciation for the unexpected and a love for nature.

The main goal is to deliver a four-week, eight-lesson life science unit on birdingincluding guided, on-campus bird walks; use of binoculars; close examination of museum specimens; and the use of a field journal in which students learn to record their observations creatively.

Students build skills in focus, direct observation, meaning-making, arguing from evidence, and collaborating with peersand benefit further from the research-based, proven healing effects of time spent outdoors. Observations of real-time happenings in nature generate a sense of connection with other living organisms and lower stress about school, peer groups or family life among diverse youth.

We provide programming countywide, but focus in the Pajaro Valley on middle school students. Their school schedules allow for few opportunities for field trips, and programs like ours are needed to connect students with their environment.

Organization Mission: CASA of Santa Cruz County advocates for children, providing court-appointed volunteers so each child in the Dependency Court system feels cared for and connected with the people, families and resources they need to heal and flourish into adulthood. CASA empowers volunteers to directly influence life-changing decisions affecting children in dependency (foster) care.

Be the Voice for a Child in Foster Care

CASA of Santa Cruz is seeing more children under the age of 3 entering the foster-care system. This is where CASA comes in: We recruit, screen, train, and supervise volunteer advocates to work one-on-one with children and their families to support reunification or permanent placement into a safe and healthy home. Advocates get to know their childs situation and needs, help caregivers access resources to meet those needs, and advocate for the childs best interests in court, community and school settings.

They build strong relationships with the family and work with a CASA advocate supervisor to create an advocacy plan for their child. They provide regular reports to the court, which the judge relies upon to inform life-changing decisions for children in foster care.

Our advocates understand that children experience great trauma as a result of entering the foster care system, provide them with a warm layer of support, and connect them to resources to benefit their development and well-being. CASA is the only organization with volunteers officially sworn in by the court, acting as advocates for our areas youth.

When a case opens in Dependency Court, the focus is on the parents/caregivers gaining resources to help meet their case plan, but a CASA volunteer focuses on the child. While they may support the entire family, their priority is the child. Advocates are assigned to the childs case until the child is placed in a safe, permanent home and the case is dismissed.

CASA children have a higher rate of adoption than those without an advocate, are less likely to return to the system, are substantially less likely to spend time in long-term foster care, and are more likely to become healthy adults who break the cycle of abuse.

Organization Mission: The Coastal Watershed Council was formed to address the declining health of watersheds connected to the Monterey Bay National Marine Sanctuary, with a mission to preserve and protect coastal watersheds through community stewardship, education and monitoring. Since 1995, CWC has educated thousands of volunteers and thousands of students to monitor water quality, enhance habitat and protect the natural resources along our Central Coast.

San Lorenzo River Health Days

Santa Cruz formed because of the San Lorenzo River. The river remains our primary drinking water source, and is designated as a critical habitat for threatened and endangered species of fish.

Most locals agree that our community deserves a healthy river ecosystem surrounded by safe and inviting parks. With your help, we can make further progress toward a vibrant riverfront.

CWC is asking for support for River Health Days. We will engage volunteers, including youth groups and corporate teams, to remove invasive species and replace them with native plants.

In addition to improving ecosystem health, these community work days reintroduce families and youth to the river through meaningful, positive experiences in nature. Last year, 674 CWC volunteers contributed 1,782 hours of work and planted 2,120 native plants, replacing 6,450 square feet of ice plant.

Organization Mission: Community Bridges envisions a thriving community where every person has the opportunity to unleash their full potential. We believe that when we work together, anything is possible. Our family of 10 vital programs across 20 sites meets the needs of nearly 20,000 local children, families and seniors each year with essential services, equitable access to resources and as advocates for health and dignity across every stage of life.

Food Stability for Homeless Seniors

In 2017, 39% of homeless people in Santa Cruz County were over the age of 50, and 70% of homeless deaths were people over the age of 50. For the past five years, Meals on Wheels (MOW) for Santa Cruz County, a program of Community Bridges, has seen an increase in homeless senior participants at Louden Nelson Community Center.

While MOW has been providing meals five days per week to eligible older adults (more than 650 warm, nutritious meals per week), to address food insecurity among the vulnerable homeless population, we have begun to assemble weekend meal packs that provide at least two nutritious meals.

We are asking Santa Cruz Gives donors to join MOW efforts to ensure that no senior goes hungry, and support our goal to ensure that homeless seniors attending Louden Nelson will have nutritious meals on the weekends in 2020.

Funding will provide participants two shelf-stable mealsmeals they will not be able to receive otherwise because most dining facilities are closed on weekends.

Organization Mission: To create lasting oral health for underserved children and adults.

Give Kids a Smile Day

There is nothing quite like a toothacheit is all-consuming. Toothaches are the most common reason low-income children miss school, and theyre largely preventable. You can help make prevention more common than treatment, so that children are able to focus on school instead of a toothache.

Give Kids a Smile Day provides free dental care for uninsured kids who would otherwise fall through the cracksfamilies who dont qualify for public insurance and cant afford expensive or even discounted dental care. The need in Santa Cruz County is huge. Two out of three people with public insurance (and many more low-income, uninsured residents) are not receiving dental care.

Dientes aims to create healthy habits and positive experiences with the dentist. With your generosity, we can prevent expensive treatment in the future and help kids continue good oral health throughout life.

Your support is needed to get rid of toothaches, so local kids can get back to being kids.

Organization Mission: Farm Discovery empowers youth and families to regenerate healthy food, farming, nature, and community in the Pajaro Valley. We improve personal and community health and our impact on the Earth by building collaborative agricultural, ecological and social systems.

Farming and Environmental Education Internship for Local Young Adults

Many local farms cannot find skilled labor locally and must hire workers from outside the area, even while the Pajaro Valley is home to the largest family-owned organic farm in the U.S. In addition, our most food-insecure members often work in agriculture or are the children of agricultural workers.

We address both issues by offering Santa Cruz County youth an opportunity to learn to grow healthy food through a 10-month paid internship that inspires them to pursue careers in agriculture or environmental education. The students gain a unique set of skills aligned with Next Generation Science Standards.

Interns will spread their knowledge in the community by teaching thousands of local youth through our field trips and summer camp programs, passing on the skills to grow their own produce, along with cooking and preserving, tackling two major skill sets to benefit younger students and their families.

The interns finish the program with various levels of mastery of skills, such as propagation, cultivation, soil fertility, pest management, and post-production that Farm Discovery is uniquely suited to provide with access to Live Earth Farms 150 acres of organic productionan inspiring learning space.

Organization Mission: Food, What?! is a youth empowerment and food justice organization. At FoodWhat, youth cultivate their well-being, liberation and power by engaging in relationships with land, food and each other. Youth from Watsonville to Santa Cruz join the FoodWhat Crew through our spring internship, summer job training and fall project management programs. Within the supportive space of FoodWhat, youth grow, cook, eat, and distribute farm-fresh, organic food while addressing local food justice issues.

Youth-Powered Farm Stand For Community Health

In our project, FoodWhat youth gain real-life work experience by running a prescriptive farm stand in partnership with Salud para la Gente and Lakeside Organic Gardens. Salud health care providers prescribe patients with diabetes a voucher to the youth-run farm stand stationed right outside the clinic.

Some of the produce at the stand is grown and harvested by FoodWhat youth, and some is donated by our partner farm. At the farm stand, clients choose from an abundant selection that includes rainbow carrots, broccoli, chard, cucumbers, cauliflower, peppers, and tomatoes.

We cannot overstate the importance of this aspect: Local youth combine training with their lived experience to address needs in their own neighborhoods.

The new project increases FoodWhats distribution by over 2,000 pounds to those with the highest need, and is an opportunity for youth to support patients as they build strong habits around accessing healthy food, integrate this food into their familys diets, and create a community space at the intersection of youth power and community health.

Organization Mission: To inspire all girls to be strong, smart and bold, and to respect themselves and the world around them. Girls Inc. serves 1,700 girls in 41 schools with trained professionals (often older teens), who mentor them in a safe environment. Girls are inspired to pursue secondary education, develop leadership and decision-making skills, serve their communities, and acquire the ability and wisdom to lead healthy lifestyles.

Growing Together

The relationship between a girl and her mother is so powerful, it affects everything from her health and self-esteem to setting the stage for all relationships throughout her life. Communication can be a common challenge for young girls and their mothers. As girls go through puberty and related physical, mental and emotional changes, the challenges can escalate.

We hope to assist by supporting girls and their mothers or another significant adult with our new program: Growing Together. Its designed to increase positive communication between girls ages 9-12 and their mothers, or possibly a sister, aunt, grandmother, or father.

Your gift will support girls in Santa Cruz County for a weekly get-together for four weeks to share activities aimed at learning about values, body changes, health and hygiene, nutrition and exercise, goals, problem-solving strategies, conflict resolution and positive communication.

Girls Inc. teaches girls to set and achieve goals, boldly confront challenges, resist peer pressure, see college as attainable, and explore nontraditional fields.

Organization Mission: Local and vital, Grey Bears promotes nutrition, activity and social connection as a recipe for healthy aging. Our vision is that all seniors live healthy, meaningful lives. Grey Bears has evolved into one of the most efficient and resourceful food distribution, reuse and recycling nonprofits in the U.S.

Engage at Every Age

Grey Bears is a nutritional lifeline for 3,800 low-income seniors, families and veterans, delivering weekly brown bags full of fresh produce and healthy staples to Santa Cruz County aging adults. Additional daily food distributions and 40,000 hot meals served annually nourish thousands more. It all adds up to more than 2 million pounds of food distributed each year.

Hundreds of volunteers enjoy more than 20 volunteer opportunities. Their service makes our programs possible while cultivating social support systems and health benefits for both volunteers and participants. Weekly classes include tech help, Spanish, cooking, chair yoga, fix-it clinics, and luncheon events designed to keep seniors active and socially engaged, and help them age with joy, grace and dignity.

Organization Mission: Groundswell restores coastal ecosystems using nature-based solutions. We are a constructive group of ecologists, naturalists, educators, and community dedicated to designing and building habitat that makes our coast better for nature and people. We prioritize restoration that increases biodiversity, coastal resiliency, and expands community outreach. We harvest local seeds, grow native plants, then plant at degraded habitats in need of stewardship. We are small but mighty, making this work happen by pulling together an amazing group of committed volunteers, teachers and K-12 students from all over Santa Cruz County to participate in the full cycle restoration process. Groundswell has rebuilt habitat resources and restored over 11% of the Santa Cruz coastline, including well-loved beaches like Seabright, Natural Bridges and Davenport Landing.

Saving Santa Cruz Monarchs

Monarchs are on the verge of collapse, and have declined 99% on the West Coast since the 1980s. Santa Cruz is a monarch hotspot where Lighthouse Field State Beach Park is home to the second-largest overwintering population of monarch butterflies in California.

To save Santa Cruz monarchs, we want to continue to lead the community in enhancing this critical habitat. We can do this together by building nectar resources, optimizing overwintering grove conditions and curbing predation. We steward the grove ecosystem and have led students and community volunteers in this effort.

We need your help to continue this critical work, as well as to expand to other overwintering sites in Santa Cruz. Monarchs are at the heart of our community and an important part of our tourist industry.

Organization Mission: Our Mission: In the soil of our urban farm and garden, people find the tools they need to build a home in the world. Our Vision: We envision a thriving and inclusive community, workforce, and local food system. We Value: The capacity of every individual for growth and renewal, the joy that comes from growing and sharing healthy food, the well-being created by vibrant social and natural ecosystems.

Two Steps Closer to Home

The Homeless Garden Project (HGP) is building a new, permanent home, Pogonip Farm. Located within the City of Santa Cruzs Pogonip greenbelt, our new 9-acre farm will triple our capacity to transform lives and build community connections. Serving as a national model, Pogonip Farm will be the heart of HGPs dynamic agriculture program for people who are experiencing homelessness. We help to transform lives by finding homes, providing job training, teaching skills, providing volunteer opportunities, and stewarding land through organic farming.Last year, 100% of our trainee graduates obtained stable employment and stable housing, and more than 7,000 pounds of fresh, organic produce were distributed to nonprofits throughout Santa Cruz County, feeding 2,500-plus people. Strong bonds are formed by our community of volunteers, interns, customers, and trainees that break down the profound sense of isolation felt by many people experiencing homelessness.

Please consider making a gift toward one-time costs to build the Farm Center at Pogonip: an administrative and kitchen building, a barn, and greenhouses.

Organization Mission: Homeless Services Center partners with individuals and families to create pathways out of their homelessness into permanent housing.

Youth Rapid Re-Housing

The number of young adults experiencing homelessness in Santa Cruz County has grown more than 30% in the past two years. Many homeless young adults were emancipated from our foster care system, and have little or no familial support.

Imagine prepping for your first day of school or a job interview without a place to call home. With your support, we can help 100 homeless young people ages 18-24 get off the streets and into permanent housing.

All of our programs operate with a housing-first methodology: to quickly move people experiencing homelessness into permanent housing, while providing support and services to help them stay housed as they work on achieving goals. Our programs save the county millions of dollars in emergency services every year, while also saving lives.

We believe our community is innovative enough, committed enough and compassionate enough to build a future in which every young person has a home. Your gift can help us guide more youth to develop good lifetime habits.

Organization Mission: The all-volunteer Live Like Coco Foundation helps local kids grow up healthy and with opportunities to pursue their dreams. Our foundation is named for and inspired by Coco Lazenby, a self-described book lover, cat petter and environmentalist, who was killed in a car accident in 2015 at age 12. To honor Cocos bright spirit and big heart, our foundation works in four areas that made a difference in her life: literacy, nature, health and wellness, and funding for extracurricular activities.

See the article here:
Santa Cruz Gives 2019: A Guide to Holiday Giving - Good Times Weekly

In a world of hurt. Its a figure of speech not meant to be taken literally. But its a real place to those who inhabit the world of persistent pain, one whose moment-by-moment ramifications can upend and redefine life.

Theres a continuum in this world of hurt: Pain is variable and many manage it themselves without going to the doctor. They can hold jobs and function, albeit through varying levels of pain. For others, severe chronic pain can mean an inability to sit comfortably, or far worse, to fall off to sleep at night, day in and day out. For some, pain brings an inability to work, to get out and see friends, to travel or to take in a movie. And, with those compounding, cascading inabilities, an ever-shrinking solitary world because of hurt.

The threat of even more hurt must be defended against. When you have chronic pain, says 27-year-old Erika Delgado of South San Francisco, who has suffered with it her whole life, its like constantly being in flight mode. You constantly feel that youre in danger.

Often patients are reluctant to talk about pain that may send them to one doctor or therapist after another. Or pain that doesnt have a clear diagnosis, or pain that doesnt look obvious. They go stoic. You adapt, says David, a 68-year-old former executive who has been dealing with the after-effects of a sports injury and two back surgeries for two decades. At some point, youve got to say that what youve got is what youve got.

Despite the constant burning sensation in his back, the healthy appearing Redwood City resident tries to cope with his chronic pain quietly and, as much as possible, anonymously. Nobody wants to acknowledge their disability, says David, who nonetheless manages two contradictory things: an active schedule as a community volunteer and usually only two hours of sleep a night.

Except for those born with a rare congenital insensitivity which makes them literally feel no pain, everyone experiences it. A 2018 report for the U.S. Centers for Disease Control and Prevention estimated that 50 million Americans suffer from some form of chronic pain, and of that number, 19.6 million have pain severe enough that it frequently limits life or work activities. The economic toll is an estimated $560 billion in medical care, lost productivity and disability programs. The prevalence of pain, not surprisingly, goes up with age.

Pain, however, is actually beneficial, warning of danger so people can respond, for example, by pulling a hand away from a hot surface. Episodes of acute pain go with the territory for stubbed toes and broken bones, but the symptoms usually resolve as the tissue heals or bones mend. Persistent, or chronic pain, on the other hand, can become a disease in its own right, as the nervous system over time becomes rewired, even spreading pain beyond the original area. Thats one of the reasons why it can be so challenging to treat and so frustrating to those who live with it.

If theres good news in all of this for Peninsula residents, its that advances are being made in better understanding the causes and effective treatments for pain, and with that the ability to offer more personalized approaches for targeting individual patients. Whether high-technology brain imaging, or no-tech therapies like breathing exercises and yoga, there are more alternatives available than just going home with a prescription for pain pills something the nations opioid crisis has elevated as an urgent concern.

Dr. Sean Mackey is chief of the division of pain medicine and director of neuroscience and the pain lab at Stanford University. He leads a multidisciplinary team which brings academic research findings into a clinical setting to help patients alleviate longstanding pain and even to prevent pain, notably following surgery, from transitioning from acute to chronic. Our message, Mackey says, is that you dont have to suffer in silence, that there are approaches that can help.

Stanford Health Cares Pain Management Center at 500 Broadway in Redwood City is one of the largest, most comprehensive pain centers in the United States, if not the world, according to Mackey, and has twice been designated a Center of Excellence by the American Pain Society. Physicians from multiple disciplines including psychiatrists, physical therapists, nutritionists and others get involved treating patients.

One of the things that I think is unique to the Stanford program is that we integrate our research and clinical missions very tightly, he adds. Clinical knowledge can feed researchers with questions to go after, and research discoveries are translated into safe, effective therapies. One example of something that is being tested is transcranial magnetic stimulation brain zapping using something like a coil placed on top of the patients head. It doesnt hurt, Mackey says. Theres no pain and you can induce a current through it that generates a magnetic field that can activate different brain centers, and we can turn on and off the brain systems that are associated with pain. And weve had some really good results with it.

Stanford has been recruiting volunteers for further study of the efficacy of TMS for two kinds of pain, one of several studies that are planned. Another one is seeking evidence of the benefits of acupuncture for low back pain.

The Stanford scientists also study novel applications for medications, according to Mackey, as an example, repurposing naltrexone, which was originally used to treat drug and alcohol addiction. But at much lower doses, like one tenth of the usual dose, it has a completely different action, he says. It blocks nerve inflammation so its been very useful with fibromyalgia, which predominately affects women in their 30s, 40s and 50s, as well as some other chronic painful conditions.

Among the other new alternatives, Stanford is also using implanted devices that can override pain signals to a specific nerve and provide relief.

If the body had only a single pain center, obviously treating pain would be much simpler, but many parts of the brain and neural pathways are involved in the pain experience. One of the problems when pain becomes chronic is that it can alter both the peripheral nervous systems and the brain and spinal cord so that it amplifies the experience of pain and that magnifies it, according to Mackey. When that occurs, someone who has come through an injury or surgery may no longer need the original signals to keep on feeling pain.

What is experienced as pain relies on many sensory cues, among them emotions, beliefs, thoughts and expectations, and one of the factors that can feed into chronic pain is known as catastrophizing. The big word can apply to anything. Bills. The job. The country. But with pain, rumination, hopelessness and a feeling that the condition will never get better can trap the brain in an endless loop that is very difficult to break out of.

But the pain is still real. Unfortunately, in part because its invisible, patients commonly report feeling they are being blamed for their pain, according to Stanford associate professor Dr. BethDarnall, who has a doctorate in clinical psychology and is a pain scientist. (Its) a misperception that somehow people are saying pain is all in your head. Youre making it up. Its not real. Theres not a medical basis for your pain, therefore there must be something wrong with you (But) all pain is real. I always say that at the outset. All pain is real.

One of her primary interests is in developing low-cost, accessible treatments that empower patients so they can begin participating in managing their symptoms rather than feeling at the mercy of them among them cycles of poor sleep, persistent worry and feeling helpless.Darnall, who teaches a class on this at Stanfords Redwood City clinic four times a year, says studies demonstrate that in two months or so of cognitive behavioral therapy, improvement can be shown. They have evidenced substantial volumetric increases in the regions of the brain associated with brain control so literally increasing the brain matter in those regions that associate better regulation of pain.

Its long been established that cognitive and behavioral therapies are important in addressing chronic pain. Whats different is that were now focusing more and getting people better access to what works, she says. Rapid access to relief is kind of where the rubber hits the road.

Pain physician and professor Dr. Ming-Chih Kao is chief of Stanfords network of pain clinics (including the one in Redwood City), which is expanding geographically: Patients who are already in pain benefit because they dont have to drive so far for treatments and can come in more often.

Kao started his career in internal medicine, intending to focus on cancer as his specialty, but decided to switch to pain management in part because of how common pain complaints are, headaches and back pain topping the list. In the primary clinic that I saw about 20 to 30 percent of my patients could benefit from a pain specialist, he says. But the diagnosis and treatment of pain, he also saw, is very complicated and requires a team approach.

When he started at Stanford as a fellow, patients routinely were coming in who had been prescribed very high dosages of opiates. Primary care doctors, he says, were trying to do the right thing to reduce pain but the nature of opiate medications is that patients get used to it very quickly. They develop tolerance. They had to escalate the dose again and again and again. And pretty soon, some patients are finding themselves taking astronomical doses. And still not getting pain relief.

The issue has taken on new urgency as a result of the nations opioid crisis, which is commanding more public and regulatory attention. From a period when the drugs were overpromoted and the risks minimized, the pendulum has swung the other way, and in 2016 the Centers for Disease Control and Prevention recommended against opioids as a first-line treatment for chronic pain. There has been pushback from patients and physicians alike that things have gone too far the other way. (Both Mackey andDarnallhave spoken out against forced tapering of opioids.)

Fortunately, Kao notes, there are new medications available that can be used safely to treat chronic pain, and many patients on large-dose opiates have been switching over successfully. There are 200-plus medications for pain management; 20 are opioids.

With most patients who develop chronic pain, Kao observes, usually theres not just one cause. It may start out with a herniated disk, nerve impingement, joint inflammation or a muscle or tendon issue. If pain persists and reaches a high level, secondary injuries from disuse or being bedbound can set in too.

Sofor us, a patient coming in with back pain or a headache, weve got to figure out what parts of the pain cycle are important contributors to the chronic pain and then we try to tackle them one by one, Kao says, not just with the doctors but with the rest of our team.

Lifestyle changes can make a big difference. Oftentimes patients find themselves essentially in a feedback loop where they become less and less active to avoid pain, Kao says, but unfortunately inactivity over long periods of time weakens muscles and that can cause secondarily more pain. So thats actually the cycle were trying to break for a lot of patients. The therapeutic prescription might include swimming, yoga, Nordic walking using poles, biofeedback and meditation and psychological counseling to improve coping skills and the ability to commit to a treatment program.

San Mateo Medical Center the countys safety net hospital offers a multidisciplinary pain clinic that includes similar therapies including meditation, physical therapy, yoga and art, as well as classes to help patients understand the physiology of pain. The program draws heavily on the work of Australian neuroscientist Dr. Lorimer Moseley, whose poplar and entertaining talks on You Tube help as the title of one of his books puts it Explain Pain.

Clinic patient Douglas has the autoimmune disease fibromyalgia, which makes people hypersensitive to pain. Since she enrolled in the hospitals program early this year, she feels better and has gained a new perspective about how the mind and the body are linked. This class reminds us were not crazy, she says. Our pain is real.

It would be hard to find a more enthusiastic graduate than San Bruno resident JohnAcayan, aback painsufferer who says the pain clinic has helped him get past being depressed about things he can no longer do and instead look forward to what he can do. One of the things the pain management clinic has done for me is help me to realize that (if) youre injured, perhaps youre not going to be 100 percent the same, youre not going to be able to do everything that you used to. But you can be happy. You can do other things.

He even tried acupuncture, and despite a fear of needles, It was fantastic. I couldnt believe it. It made everything go away. Ill say literally the rest of that day was so tranquil. Absolutely no pain. Zero. That night, I slept fantastic. The next morning was great, but after a few days the pain came back. He tries not to think about pain so much. At one time, in fact, he thought his medication needed to be stronger. He was taking 600 milligrams of tramadol a day and is now down to 50. The clinic team guided him to the realization that he didnt need that much. I could take a pill and be happy and lightheaded, he says, but that isnt the way I want to feel. I want to feel normal. I dont want to feel loopy.

This summer,Acayangot to try out something fairly new in the hospitals treatment toolbox virtual reality. Patients put on goggles and operate controls to throw things at friendly sea otters on a video screen and become completely engrossed. Another version has a biofeedback component that gives viewers some control as their heart rate changes.

Chief Medical Information Officer Dr. MichaelAratowsays virtual reality can calm people down in high-anxiety areas like emergency rooms. He brought the idea to Dr. MelissaFledderjohann, a licensed clinical psychologist who directs the pain management clinic, and she readily agreed to offer it in her program. Most patients get a reduced pain sensation while theyre using VR, according toFledderjohann. We know that during and right after it, they definitely feel a decrease,Aratowsays. The question is does that decrease persist until next time? The jurys still out on that one.

SaysFledderjohann: It helps reinforce the concepts in our classes, saying There are tools you can do to manage your pain, reduce your pain. Its not just an external thing thats coming at you. You yourself can do your own pain management. And this would be a good example. By going though VR, you saw your pain reduced.

SimonKoytiger, a physical therapist who manages Vibrant Care Rehabilitation in San Carlos, is also a proponent of a comprehensive and holistic approach to treating pain, which he views a symptom, not the root of the problem. Especially in the fast-paced Bay Area, lifestyle issues including lack of exercise, working long hours, stress, poor diet and anxiety can show up as back or knee problems, andKoytigertries to help patients develop healthier habits. We have this chronic pain issue, he says. Lifestyle is never going to show up on an MRI.

Exercise, he points out, helps reduce pain many ways, first by making people stronger and less fragile and improving the capacity of all tissues in the body. Exercise also has endocrine effects, releasing the happy hormones serotonin and dopamine and reducing the production of the stress hormone cortisol.

I talk to patients about these three pillars very frequently: Its physical exercise, its diet and nutrition and its mental health,Koytigeradds. AndactuallyIm a bit of a believer, even though Im a physical therapist, that the primary pillar is mental health. Because who is the one whos choosing to eat well? Who is the one whos deciding to exercise that day or not? We make those decisions and if we are at ease and we have more peace and calmness in our minds, we are going to naturally do those things that are right for our body. If we are suffering with depression and anxiety and stress, its going to be much more challenging to balance those two domains.

Coming back from chronic pain can be a long haul.

Woodside resident Brad Dary, 65, counts himself fortunate that he came out the other side of years of chronic pain, which began in 1995 with a laminectomy followed by fusion surgery for a vertebra five years later.

For the first year after the surgery, I felt like I was cut in half, he says. I moved home with my parents. I was literally in bed for a year after that operation. It would take me about a half an hour to get from the bed to the bathroom. You cant do anything without your back being involved. I used a walker. He had to take morphine for the pain but hated having a foggy brain and couldnt wait to get off of it.

He tried acupuncture once but thought it was silly. But Dary, who is a videographer, says through a slow progression of pushing himself to do exercise and the healing process, he finally recovered. You just fight it out, he says. My biggest thing was doing exercise and trying to build my muscles as best I could Everyones situation is different. I had a lot of time to heal. It was 10 years. Today he jogs three times a weekand works out with weights. He thinks having to work so hard to get where he is challenges him to be more alive.

Rose who did not want to be identified by her real name for this story has made a remarkable comeback too from barely being able to get out of a hospital bed using a walker. The southern San Mateo County resident disciplines herself to walk two miles, three times a week and has worked up to doing 15 minutes on an exercise bike at the gym. Shes arrived at this point 15 years after a series of back surgeries over four years, the first to address stenosis and then two more that turned out to be needed because of damaged disks.

When it all began, she had a job, but she had to give up working long ago.

Patients tend not to do their physical therapy if its too painful, and she was prescribed fentanyl and vicodin to help her be better able to do the therapy she would need, which it did. They put me on heavy opioids because they knew to get through years of it would be so painful because all of these core muscles were, waist to pelvis front and back, cut three times through three surgeries, Rose explains. So that is a huge amount of healing.

Fifteen years ago, her first pain management doctor assured her that it would easy to get off the opioids when the time came. Its no problem, Rose clearly recalls him saying. Literally, he told me No problem. You just gradually step off the opioids.

But when she had been on them for six years and was ready to start declining, she learned otherwise. It took three years of tapering to get off opioids, drugs so powerful that she had to cut back milligram by milligram, for a month perhaps and then wait two months to cut back again. Each time, she had to deal anew with increased pain, plus the jittery withdrawal symptoms. Her skin felt like it was crawling and she had no idea what it was until someone she knows who works with people in addiction explained it to her.

Id never done drugs, she says. I didnt know. Im such an innocent Girl Scout.

She methodically tracked her dosage on an Excel spreadsheet. With such a plodding pace, it helped to be able to look back and confirm that she really was taking less. Rose says her current pain specialist is a Kaiser Permanente doctor who has been with her every step of the way and is her cheerleader. He emphasizes the importance to her of pacing activities, not overdoing and causing more pain that will trigger a desire for more opioids. Though she was already slender, when one of Roses physicians told her that losing five pounds would reduce the pain, she lost ten. In my case, she says, it makes a huge difference.

More than anything, what has really gotten her through it all, says Rose, is her support system of her husband and friends and her Christian faith. A Bible study group from church met in her house when she could not get out, and it helped to know that they were praying for her. Prayer is meditation, she observes, and the Bible study group was group therapy.

Roses advice to others with chronic pain? From my experience, really slow is what does it, she responds with a laugh, like the old Aesops fable, the tortoise always wins.

This story was originally published in the November print edition of Climate Magazine.

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Stanford's new, innovative tools to address chronic pain - Climate Online