All posts by richmondstace

20Jul/15
vintage typewriter by philhearing | https://flic.kr/p/9pRzps

Gillian’s story | back pain and mindfulness

vintage typewriter by philhearing | https://flic.kr/p/9pRzps

vintage typewriter by philhearing | https://flic.kr/p/9pRzps

Many thanks for Gillian’s story | back pain and mindfulness

MY PAIN STORY – GILLIAN WESTON

I am always a busy person; I play short mat bowls several times a week and have represented my County and England, I run a Junior session for bowls, I love to swim and I am a member of Horsham Rock Choir. I use a computer as the main part of my job of Practice Manager for a charity.

My problems began in 2010 when I slipped on some ice and inadvertently tried to break my fall with my left arm. I had restricted movement and upper arm nerve pain but after some physio my situation improved.

In Dec 2012 I developed pain in both arms after lifting a heavy object at work. I was referred for physio in Jan 2013 when I was diagnosed with tennis elbow in my right arm and shoulder impingement/tennis elbow in the left. After some exercises my right arm improved but I had further physio in the following months for my left arm. During this time the worst aspect was the nerve pain from my elbow to my hand – no painkillers relieved it, and I was in constant pain with or without movement, even scratching my face or lifting a kettle were agony!

In September 2013 when I was still in a lot of pain and had a further condition added – ulnar nerve entrapment – I was given 2 steroid injections. There was an improvement but of course the underlying problems were still there and in January 2014 there was a return of my intense pain. A further course of steroids followed, but the actual injection was excruciatingly painful and I was left with numbness in my ring finger. I was pain free until Nov 2014 when I moved a pot in the garden and experienced a twinge in my elbow, the problem was exacerbated when I used a simple screwdriver in Dec at work and I ended up in the worst pain I had had for some time.

By Jan 2015 I was at the end of my tether and rather than go the NHS route saw a physio who I knew privately. She felt that my neck was also the cause of my problem plus bad posture. Her approach was more holistic and she gave me some acupressure to try and calm me down from my very distressed state. She even suggested counselling as she was concerned about my mental health as a direct result. I was at various times loaned a TENS machine, given ultrasound and massaged. She helped me address by posture and gave discussed calming techniques. She discussed with me how my mental state was affecting my pain but I was sceptical about this at the time and more or less dismissed it. There was a degree of improvement in my condition over the following month thanks to the new physiotherapist but I was still struggling day to day.

During all these periods in and out of pain I have had to stop playing bowls and going swimming, use my right hand more – particularly with the mouse at work, been unable to sleep on my left side, been restricted doing the dance moves at choir, and not been able to do many day to day things that I used to take for granted.

In March 2015 I attended Heathrow Airport with Horsham Rock Choir where Georgie Standage my choir leader and Richmond Stace were hosting an event for UP. I took one of the flyers and did my research via the UP website. I found the videos very interesting – in particular the one explaining how “all pain comes from the brain” (Lorimer Moseley). I took particular interest too in the mindfulness videos. But I also found the written information really useful too. Over the following weeks I used mindfulness apps and also ‘talked’ myself out of pain. When I felt pain I closed my eyes and tried to focus on other parts of my body; if I hit my weakened elbow (as I do frequently!) I told myself that it was fine, it would hurt for a while and then I’d be OK. I used Mindfulness to keep me calm and I found that my nerve pain lessened in the weeks that followed.

By May I was able to resume my bowls for short periods to use my mouse at work left handed, do my Rock Choir moves without pain and return to swimming. Significantly I can sleep for periods on my left side without pain – which I haven’t done for a long time!

It is now July 2015 and I have been pain free for just over 3 months–other than the odd elbow bash! I do get the occasional twinge, and very interestingly if I am stressed about anything I get a bit of nerve pain in my arm! Looking back some of the worst pain ties in with significant stressful times in my life. I am still wary and careful about exacerbating things, but importantly I feel that “yes I do have pain sometimes, but pain doesn’t have me”. I am indebted to UP for giving me my life back, and I continue to use the techniques I have learnt – in particular the Mindfulness Breathing – to keep me calm and in control.

20Jul/15
Kitty Terwolbeck
| https://flic.kr/p/nJ3oH4

Zen and the art of human maintenance

Kitty Terwolbeck | https://flic.kr/p/nJ3oH4

Kitty Terwolbeck
| https://flic.kr/p/nJ3oH4

Zen and the art of human maintenance is not a spiritual blog but rather a practical one that considers a way of approaching hands on treatment–this is whether you are a massage therapist, a physiotherapist, an osteopath or any other clinician who uses their hands for examination and treatment. Equally it could apply to a person comforting a loved one.

How you bring yourself to the act has a huge impact upon the act itself. Setting the scene both in terms of the environment and the focus of your intention will play out through the treatment in subtle ways that effect the overall experience. A moment’s preparation in that vain allows the therapist to focus and be present meaning that the full experience is had, allowing for a sensitivity (via the therapist’s hands yet experienced through their whole person) that enables gentle responsiveness to adapt the treatment to the recipient’s needs. A classic example is being aware of how the muscles react to different levels of touch. Being aware means that you can detect even gentle guarding that indicates protection and need for both nourishment (improved blood flow and oxygen delivery to over-working muscles that are being told to tighten in an attempt to protect–yet this comes at a cost, both of energy and a build up of acids) and a sense of safety so that the systems that are protecting the body can ease up.

Take a moment: before you begin the treatment, 3 easy breaths to become aware of what is happening now, how you are feeling, what you are thinking; continue to maintain awareness of the present moment, letting go of distracting thoughts that interfere with your focus.

Zen is a sense of oneness with the present experience, what is happening right now, free from distractions and letting life flow. There are many situations when this state of simply being is very useful–before exams, interviews, when negotiating, discussions with your employer, before performing etc. However, cultivating this skill on a moment to moment basis is hugely beneficial as it allows you to see and think clearly, even when thinking about the past or future, which can cloud what is really happening now. These are all just thoughts, but when we become embroiled, the body reacts and responds because we are our body as much as we are our mind, and all that this means. So, just thinking about being in an argument or giving a speech creates similar responses in the body as if you are there; but you are not.

In giving treatment to another person, being fully present means that you fully experience the moment. You will be completely engaged in all that is happening ‘now’, creating a potency that cannot be otherwise reached with a wandering mind that has no connection with the treatment. This is undoubtedly a practical skill that can be developed, some calling it ‘focused attention training’ and others ‘mindfulness’. Everyone has the ability to focus, even for short periods, and to enhance the skill with practice. There would be some benefit of simply taking a few breaths as described above, yet there is even greater advantages to be had from further practice with 5-10 minutes of mindful breathing each day; more if you are so inclined.

Not only does being present whilst treating enhance the treatment through a more responsive selection of pressures and movements, the clinician also benefits from the calm created, and the clarity of thoguht offered by being present and aware. In effect, the whole experiecne means that while you are treating, you are being treated. A good way to measure this is by noting how you feel at the end of the day. A mindful day will end with energy, and non-mindful day with fatigue. I know which I prefer.

* These are skills to be learned and developed in the Pain Coach Mentoring Programme for clinicians | call 07518 445493 for details

20Jul/15
Photomarathon - Alphabet by Eva Van Ostade | https://flic.kr/p/i84n6g

My A to Z of pain

Photomarathon - Alphabet by Eva Van Ostade | https://flic.kr/p/i84n6g

Photomarathon – Alphabet by Eva Van Ostade | https://flic.kr/p/i84n6g

My A to Z of pain –

This is by no means exhaustive, but rather a brainstorm of some of the most salient features of the Pain Coach Programme to overcome chronic pain and injury.

I am sure that I will mould this and re-shape it in time, as you are also free to from this basic framework. At the heart of the thinking lies the person suffering persisting pain, whereby their sense of self and who they feel that they are has been compromised and affected by the pain. Pain often becomes all-encompassing, pervading into all corners of one’s existence. Except that this need not be the case as we understand our pain, develop our thinking to take the right action and focus, utterly focus upon the vision of how we want to be living. All too often the messages given and auto-suggested are negative and inaccurate and hence as soon as the thinking is right and based on what we really know about pain, the person will see the opportunity to move forward towards a meaningful life once more.

A to Z of pain:

Attitude to pain affects what you think and the action you take.

Behaviours are chosen based on your beliefs; work on your beliefs about pain by really understanding it.

Change happens in the wake of developing your thinking about pain.

Decide to focus on what you can do rather than what you can’t.

Energise yourself with movement, breathing, diet and engagement with people who nourish you and make you feel good.

Focus on your vision of who you want to be and what you want to be doing. Re-visit this focus often each day.

Galvanise your strengths and focus on them to develop and grow.

Habits of health created by you.

Intelligent emotionally to be aware of how you and others are feeling so that you can make positive changes by focusing on your strengths.

Jump for joy as often as you can; if not literally, then in your mind — imagine jumping!

Kick unhealthy habits by developing your strengths.

Laughter has great effects on health and you.

Meaning is key for engagement at work and in relationships, so create a meaning for all these situations.

Notice what is happening right now; be mindful and see how anxiety drops and you feel better. When you feel better, your pain feels better.

Observe your thoughts rather than being embroiled in them.

Persevere to achieve your vision.

Quiet time to re-charge.

Refresh often during the day with movement, breathing and creating calmness in your mind.

Success comes with perseverance, choosing to think positively, learning from mistakes and focusing upon your vision.

Tell yourself positive messages over and over and notive how you feel — also using your own body language: sit up, stand tall, be proud becasue you are worthy.

Understand your pain is undoubtedkly the fisrt step in overcoming pain.

Virtues and morals drive what we do because that’s what we believe. They should be in synch with those of our relationships and work.

Worthy of overcoming pain and living a meaningful life – you are!

X factor is something we all have. Use it to motivate yourself and change emotional gears.

Yes I can.

Zzzz’s are an absolute must for health. 8 hours.

* These thoughts derive from the Pain Coach Programme for overcoming chronic pain.

There is a programme for individuals suffering chronic pain and a mentoring programme for clinicians who work with people with chronic pain problems who want to develop their skills and strengths. Call us now: 07518 445493

13Jul/15
By Tess Watson | https://flic.kr/p/8W6Gkm

Pain and society

By Tess Watson | https://flic.kr/p/8W6Gkm

By Tess Watson | https://flic.kr/p/8W6Gkm

Pain and society — Pain is an issue in society, and for society. Why pain has become the number one global health burden is a question that we must consider and answer using on-going study of what pain really is, how it influences us, how we influence pain, how pain emerges from individuals who form society and how society views pain. No mean task, however we must envision where we want to be as a society and focus on getting there.

One of the biggest problems with pain is that it is misunderstood. The predominent thinking remains in the pathological and body structure camp as an explanation for pain. This thinking needs to develop across the whole of society, in fact begining in schools where I believe children should be taught about pain.

Fear is a huge factor in pain — what does this mean? Will it get better? Will this pain ever go away? Etc etc. Of course those who understand pain will know that these very thoughts are ample to fuel further protection and hence pain. We need people to understand that pain emerges in them as an individual, very much flavoured the situation in which the pain is noted, influenced by past experiences, beliefs about pain and immediate thoughts and emotions. There are reams of papers examining these factors. The early messages are vital when someone has injured themeselves or suffre an acute episode of pain. The right thinking from the outset creates a way forward with effective behaviours and actions to allow the body systems to co-ordinate healing and recovery. Unnecessary fear and worry simply divert resources away from these processes and hence affect the outcomes. We do not need to fear pain but rather, take action and deal with pain.

When someone has more persisting pain, and this is likely due to certain vulnerabilities that we are understanding more and more, again the mesages must be clear and accurate. The notions of management and coping are just not good enough. We can deliver much better care, advice, coaching and treatment than ‘management’ implies. This is beneficial for the individual, the funder and hence society as a whole. Society needs to be purporting the right messages about pain and therefore we need to develop thinking on a large scale.

When I studies the Pain MSc at Kings College London under Dr Mick Thacker, I used to wonder why it was called ‘Pain: science and society’. Whilst I do not know the exact reasons for KCL’s entitling of the course, now it is obvious to me that we have a huge societal problem that needs urgent attention. There is a responsibility for all of us to come together and develop so that change occurs in the wake of new thinking based on the huge amount of research into pain. We need the support of the policy makers, businesses and individuals. Why policy makers and business? Because we can change what is happening now including the vast cost of chronic pain — this huge pot of money could become available for many other areas of life. So let’s move forward together.

If you are a policy maker or a business recognising the effects of chronic pain on society or upon your business, contact me for information on shifting and devloping thinking to take big action. t 07518 445493

Pain and society by Richmond Stace

11Jul/15
By LordEfan | https://flic.kr/p/kUfKKZ

Pain and the perfectionist

By LordEfan | https://flic.kr/p/kUfKKZ

By LordEfan | https://flic.kr/p/kUfKKZ

Pain and the perfectionist could be a title of a book in which the character suffers on-going pain, seeking to conquer himself using his perfectionist traits. I know of no such book, but I do know that a significant number of people who I see with chronic pain are perfectionists.

Like most things though, it is how you look at it that makes the difference. Most traits that we exhibit have a benefit and a purpose in our lives in one quarter but can be problematic in other arenas. Perfectionism is no different.

Whilst being a perfectionist would be highly adaptable when studying the detail of a document, arranging a bouquet or organising an event, when this spills over into being hard upon oneself, it can push the individual too far. Compassion must start with the self — being kind to yourself. It is all too common that people are self-critical, either overtly or more frequently via the inner dialogue. Continually telling yourself that you are not good enough or that you will never achieve is the exact opposite of believing in yourself. If there is one characteristic that is vital in overcoming pain, it is the belief that you can do it.

The sense of never being quite good enough is a safety mechanism of sorts. On the flip side it may drive the individual to practice or work harder, and this is acceptable if it does not cause angst and on-going stress that is incongruent with health and a feeling of wellness. Chronic stress is a significant issue in the modern world, having a huge role in many of the common problems that we see today — e.g. functional pain syndromes such as IBS, headache, migraine, functional abdominal complaints. Chronic stress causes the body to set itself in an inflammatory state, and there is a constant preparedness for action to fight or run away from a wild animal. Except there is no wild animal, just our thoughts and interpretations. These we can learn to observe rather than become embroiled within with techniques such as mindfulness.

Perfectionism is a strength that we can foster as part of the programme of overcoming pain. I base my treatment and training programmes upon your strengths as these are what we use in life to succeed, and succeed you will by nurturing these within an action plan that takes you back to a meaningful life. It is easy to say don’t be too hard on yourself, yet difficult to master. But it is possible to harness the strength of perfectionism and use it to overcome your pain.

For information about the Pain Coach Programme to overcome chronic pain, call 07518 445493. The Pain Coach Programme is also a learning programme for clinicians who want to develop their skills, either 1:1 mentoring or in small groups. Call us for details or email [email protected]

 

10Jul/15
You are beautiful by La Melodie https://flic.kr/p/99ACEa

Pain and guilt

You are beautiful by La Melodie https://flic.kr/p/99ACEa

You are beautiful by La Melodie https://flic.kr/p/99ACEa

Many people who I meet will describe their pain and guilt. Naturally they come to tell me about their lived experience of pain and how this impact upon their lives. They narrate a story in which they are the person who has lost their sense of self, who they think that they should be and how they think their life should be. In answer, I will seek to make sense of their story with explanations and a route forward (the coaching and treatment programme). Then we encounter the challenge to surmount feelings of guilt at the thought of dedicating time to ‘me’ in order to overcome the pain. How will I do these things when I have to…….? You can fill the gap with work, be a wife, be a husband, be a mother etc etc. Familiar feeling?

So here is the deal. You actually deserve to get better because you are worth it. One of the common themes in chronic pain is that the sense of self-worth diminishes, if it was not already ground down by life’s experiences over the years. This is certainly something that needs to be worked upon as part of the coaching programme, along with self-belief, self-efficacy, confidence, focus, resilience and motivation to name a few.

How can we do the things that we need to do in both thought and action, if we do not prioritise? It is your job to get better.

A clever programme will easily interlace into your life rather than be seen to be something separate. We have a lived experience and the development of self to change health and pain is moment to moment. It is as simple and as hard as developing new habits using the skills and strengths that you already possess. A clever programme will use your strengths to overcome your pain. And by overcome, I mean resume a meaningful life, and what this means to you — not the clinician or anyone else, you. When you feel like you, according to you, then all those around you will benefit as well. So as much as you may begin by viewing the prioritisation of the programme as being selfish (and I hope you do not now, or did not, but soon you won’t), to be you again requires that you do make this one of your top 3 priorities. You are not separate from your environment or the people in that environment, and hence you need to focus on you and those around you need to develop their thinking about this as well.

For this reason, I encourage partners and family to come to some sessions, or even come on their own to develop their thinking and to see their role in your recovery. You could even start by asking them to read this blog.

To be you is not to be selfish but a vision to be achieved.

For further information about the Pain Coach Programme to overcome pain, call now 07518 445493 — you deserve it!

09Jul/15

The habits of pain

When we have suffered pain for some time, the habits we create can become part of the problem, and part of the reason why we are not moving forward. Whilst certain actions that become habitual are useful in the early stages, they only have a role for a finite period of time. Subsequently, other strategies need to be used to develop, learn and move on to overcome pain. 

A simple example would be a limp that is useful after an ankle sprain, that is not helpful one year later. In different parts of the body we do different things according to the typical actions that body part would be actually used for as well as intended use. This latter point is relevant because we are continually predicting and planning actions mostly at a subconscious level. We are responding to ten environment we are in, the context of that environment and the tools within that environment that we may use, such as a cup or a pen that the brain plans to pick up on sight if relevant. We don’t always know about this, and interestingly, just the mere plan or intent of doing something can cause pain on the basis that we are in protect mode. The same is true for watching others actions that would be of a high threat value to us. Someone with pain in their back may experience a twinge on observing someone else bending. For clinicians, this offers clues as to the level of protection — bend in front of the patient to see how they feel. 

As well as movement based habits that are actually based upon our beliefs about pain, injury, ourselves and the world, we have habits of thought. We automatically think about a situation, someone’s comments and about something we may need to do. These thoughts, if identified with, will impact upon what we choose to do. If I believe that when I move it hurts because I am further injuring myself, I will either not move or will move in a guarded way. In part I will do this on purpose, in part my protective systems (nervous, immune, autonomic) will inlfuence my movement upstream by contacting the sensorimotor areas of my brain. Of course we are not just brain but whole person, so I say this for convenience of the description. We learn quickly at the outset that a particular movement hurts and we may then anticipate this and decide not to move to to tense up and move abnormally. Whilst this is again useful in the early stages when the tissues really need protecting (whilst healing), as time goes on we need to move to get fitter and back to normal life. 

These are just a few examples of what happens. In some cases there are cycles of inflammation that trigger an acute flare-up within a persisting problem. Initially it maybe useful to use some of these protective habits, but only in the short-term. Not allowing them to take hold and only using them wisely is key. I like the metaphor that describes a man who is walking through a forest and comes upon a fast moving river. To cross he builds a raft and successfully reaches the other side. Does he still have a need for the raft? Should he hoist the raft onto his shoulders and carry the cumbersome vessel thought the trees? I think not. At each moment we need to think clearly about what is the wisest action. 

As I said earlier, and often say, we must address the whole person including their habits of thought and action and how the two entwine. We must explore why protective habits are being used and then develop this thinking into a range of skills that take the person onwards to where it is they envision being. This vision is vital and I work hard with people to create a strong image of what it is they want and how it is they want to be. This becomes their steer and all their thinking, focus and actions are upon attaining this vision. We become what we focus upon and hence we must use our strengths. 

For further information about my Pain Coach Programme for overcoming persisting pain, please call 07518 445493

08Jul/15
Lateral view of neck by Double-M https://flic.kr/p/9swvo6

Dystonia coaching programme

Lateral view of neck by Double-M https://flic.kr/p/9swvo6

Lateral view of neck by Double-M https://flic.kr/p/9swvo6

The dystonia coaching programme that I have developed over the past few years is based on similar thinking to that of persisting and complex pain. In fact, the reason why I started working with people experiencing dystonia is because of a conversation with Dr Marie-Helene Marion (the movement disorder specialist).

We were discussing biology, people and influences, thinking that we were talking about the same thing, but in fact I was talking about persisting pain and Dr Marion was talking about dystonia! From thereon it was clear that there are significant parallels in what we see and who we see, leading to an innovative approach based on the latest neurosciences. I was fortunate enough to talk about this at The Dystonia Society meeting and The British Neurotoxin Network conference.

Most cases of dystonia that I see are cervical. This is a troubling condition in many ways, including the social aspect that is commonly forgotten. By this I mean how dystonia impacts upon the person’s social interactions due to the way it can make them feel about themselves. This is such an important part of the problem, as the way we think and feel affects our sense of self and how we move. With a movement disorder, this is highly pertinent. Our thoughts and feelings can frequently be impacted upon by the way we think others see us, potentially driving behaviours such as avoidance and protective posturing, both of which affect quality of life.

There are several other notable consistent findings. An altered sense of body position that underpins the imprecision of knowing where your body is in space and the movement imprecision that is the classic sign. In fact, it is the sensorimotor function that is a problem as a whole, influenced by a range of factors such as thoughts, emotions, the environment. As with pain, dystonia is a whole person problem and as such requires whole person thinking behind the treatment and training programme.

Botox treatment often has good effects when used at the right dosages. Commonly people become engrained in thinking that they must have injections every 3 months, with this expectation influencing behaviours and outcomes. In my dystonia programme we immediately aim to develop this thinking into how we can gap out the need with specific training but also challenging unwarranted expectations. It is exciting to think that drugs are affected by the way we think as it opens the door to great possibilities.

Much like the Pain Coach Programme for persisting pain, the dystonia programme targets the person: their thinking, emotions, movements, sensations as a whole. There are specific training exercises that take advantage of our ability to develop (commonly called neuroplasticity) and learn, and a range of strategies that target the influences upon the way we move and face the world including stress, anxiety, thoughts, other people and the environment. Our understanding of ‘how we work’ is ever-growing and this is cause for great optimism as we see people overcome chronic pain and dystonia in theor own individual way.

For more details or to book an appointment, call now 07518 445493

29Jun/15
'neck' by JB | https://flic.kr/p/4VYHd1

Overcoming neck pain

'neck' by JB | https://flic.kr/p/4VYHd1

‘neck’ by JB | https://flic.kr/p/4VYHd1

Overcoming neck pain is the aim of the many sufferers of this common persisting problem–it’s in the top 10 of global health burdens! What causes neck pain? Regular readers will be familiar with the notion that pain emerges in the person, located where protection is deemed necessary. The feeling of pain, (‘I am in pain’) exists as a motivator through its unpleasantness, demanding attention and action sufficient to reduce the threat and hence leading to pain relief.

The question to ponder upon is why is this person in pain? What has created such a threat value that there is benefit from a painful experience to drive some form of change in thought and action and vice versa, such that the threat diminishes. What can potentially pose a threat? We have to say potentially because these factors will not bring about a pain response in all people as we know. The existence of pain and intensity of pain do not rely upon these factors. Instead it is the meaning and the significance given to these factors that determines what happens next. Consciously I may not believe that sitting for an hour is ‘dangerous’, yet from my body, which of course is not separate from who I think ‘I’ am, emerges the feeling of pain. This is where the sense of self becomes confusing because how can my body be separate from ‘me’. We often use language, especially to do with pain, that distances ourselves from the feeling, except this is erroneous thinking as the pain is emerging in us, much like a thought emerges and becomes conscious. Consciousness is the background upon which a small amount of what is going on appears to us, including pain and other sensory experiences that can frequently evoke emotions.

Examples of factors that can be rated as dangerous:

  • Inflammation (tissue damage, neurogenic)
  • Infection
  • Contexts: e.g. sitting at a desk, driving, carrying a bag
  • Thoughts: the meaning that we give to the pain
  • Stress: this is a response to perceiving a situation as being threatening rather than the actual situation itself
  • Tiredness

In other words we must look beyond, well beyond the area that hurts and think about the person and their life, which includes environments in which they inhabit (home, work, play), people they spend time with, things that they do, past experiences, pain vulnerabilities. This is the same for pain in the neck as it is with any other persisting pain problem. Only with a comprehensive view can we think broadly enough to devise a programme of treatment, training and coaching to sustainably overcome the problem.

***

Pain Coach Programme to sustainably overcome persisting and complex pain. Call now: 07518 445493

21Jun/15
Social Innovation Camp (2009)

Caring for our elderly

Social Innovation Camp (2009)

Social Innovation Camp (2009)

Caring for our elderly is a society wide responsibility. On a micro level, individuals care for family members or friends. On a macro level, the government must create a framework that permits this to happen effectively as well as ensuring that supporting services for carers are accessible and fair. This blog is about the former, suggesting a way of thinking to help carers optimise their effectiveness. However, if a policy maker is reading, you should be considering how to best facilitate and support these straight forward strategies.

There are a multitude of problems associated with being older, but we must not forget that it is a person and not just a range of conditions. An individual is living the experience that we observe, and if this lived experience is painful, limiting, confusing or isolating, we can only imagine what this must be like. There is no better example than dementia, when that person’s reality is shifted brutally into a seeming groundhog day. We have no idea what this can be like, but we must empathise and realise that many of the behaviours are due to fear and anxiety re-lived over and over.

A simple example: an individual spending more time in bed than being up and about, also suffering dementia. The stiffness in the body ensues and often needs easing with gentle therapy. The passive movements when another person takes hold of your body to move the joints or massage the muscles can be painful as a norm. However, this can provoke a protective response as the person withdraws their limb for fear of pain or it actually hurts. The pain eases with the treatment and relief can be obvious. The next day, the same fear is evoked as there has been no memory laid down from the previous day, so the whole experience is repeated as if new, fears and all.

Remembering that the person is that, a person, is a guiding light in our thinking. Cultivating compassion through the practice of working with the vulnerable is a valuable skill to benefit both the recipient of the care and the giver. Seeing the experience for what it really is, rather than clouding it with thoughts, allows the carer to focus on the individual and their needs. These are simple practices that just need to become habits, and when they do, amazing things can happen. It is not for me to tell you what they are, but if you do practice, you will soon know.

Here are a handful of tips that I routinely give to carers:

  • Create calm in your own mind before every interaction, even if it is just a few moments of breathing and re-focusing.
  • Be present throughout the session, noticing all that is happening right now.
  • Use a calm voice and smooth movements — before changing someone’s position or encouraging them to move, explain calmly what you will be doing and why; even if you are not sure they will understand. It will put you in the right frame of mind and perhaps they will pick up on your tone and compassioned intention.
  • Use touch skillfully. Stroking has amazing effects on the body sense, sculpting the feel of the body for that person as you send signals into the brain maps as well as creating a soothing atmosphere and calming the person.
  • Position the individual so that they can be alert to all the stimuli around them. You know what it feels like to be slumped in bed or in a chair — stiff, lethargic etc. Change their position so that they can be part of what is happening whilst you talk to them and engage as much as possible in a positive tone. Remember that the position our body takes affects how we feel. Make someone feel good by giving them height and posture.

There are many more easy things that we can do to make a massive difference. Carers have a key role and if they know and understand all the influence that they can have, it changes everything for the better.

I encourage carers to come to sessions or to come alone to learn about what they can do. Feeling empowered as a carer is really important, and the Pain Coach programme incorporates the needs of the carer so that the relationship with the patient is bi-directionally healthy.

Call me for further details on the Pain Coach programme: 07518 445493