All posts by richmondstace

Pain and Communication

The problem of pain

Pain and communicationCommunication has a large role in pain from the perspective of telling someone that you are suffering but also in the treatment of pain. At the BASRaT Symposium last week I outlined some of the key features that I will summarise here.

Before discussing communication I highlighted what is the one of the most significant and costly problems on the planet: pain. There are vast costs to society and individuals as the numbers of people suffering chronic pain are enormous. The British Pain Society recently called it the ‘silent epidemic’.

It is thought that 20% of the population suffer on-going pain, including 1 in 5 children. Whilst we can say that the former is a significant number necessitating action, the latter absolutely needs to change. We must understand why this is the case. What is it about modern living and culture that is creating a generation of pain and anxiety? There are some obvious candidates: pressure to achieve at all costs, a lack of self-esteem, narcissism encouraged by popular culture, and obsession with social media at the expense of developing connections and communication skills (including addiction to devices).

One of the main reasons for the scale of the pain problem is the misunderstanding of pain through society. The biomedical model still predominates when there is the search for a structure or pathology to explain the pain and extent of the pain. The preferable biopsychosocial model takes into consideration the important psychological and social dimensions, but often the ‘bio’ receives most attention. Modern understanding of pain would suggest that actually, a better framing would be a sociopsychobiological model because whilst understanding the pathophysiology and molecular aspects of pain is important for scientists and clinicians, the person in pain just needs to know what to do when they are in pain. They need a process to follow with an understanding as to why this is important. Neuroscience education has a place in the treatment of pain, but not a primary one.

Pain is a subjective experience emerging in the person, influenced by a range of social, cultural, contextual and environmental factors, past experiences and beliefs, in the face of a perceived threat. Pain is about protection and survival.

Pain & communication

With the size of the problem in mind alongside the understanding that pain is poorly related to injury and tissue health or pathology, we looked at some important aspects of communication.

One of the communication streams that is often forgotten is the inner dialogue. This is the story that you tell yourself about you and life; that little voice that is so familiar and if not trained can be so disruptive. This is the inner dialogue that can cause such suffering when we berate ourselves for not being good enough. This is relevant for the person with chronic pain as self-criticism is a common feature when in fact kindness and self-compassion is a key driver in getting better. Equally, the clinician’s inner dialogue will affect his or her approach and decision making. Think of a scenario when you are tired, you were late for work, you stubbed your toe on the bed and then you are faced with your first patient who has not improved. You need clarity of thought to approach this situation, not a mind cluttered with annoyance and frustration.

What are you telling yourself? What are you convincing yourself? How are you choosing to think?

How we communicate pain to the person has an impact on their understanding, which is paramount in validating their story to date, and in helping them engage with the programme. Firstly we must listen deeply so that we can know the person as much as the condition ~ the two are not separate. Listening deeply is a skill allied with active listening when you are fully present, in contact via body position, your eyes and expressions (verbal and non-verbal), and allowing them the space and time to tell their story. This narrative holds many clues so our full attention is required, jotting down key points and phrases. In sum, there are different communication dynamics co-existing: the inner dialogue of the person, that os the clinician and the (outer) communication between the two.

Compassion and empathy

Cultivating compassion and empathy as a clinician is an extremely worthwhile exercise. Those who have chosen the caring professions have already demonstrated these characteristics by the very nature of the choice ~ we care and want to help others to live their lives. It is interesting and reflective to consider the question: why do I care?

Not only is this important for the clinician, but also for the patient to learn such skills, especially if they are hard on themselves. It is very easy to pick up on this when they speak to you. The problem with being a self-critic without control is that it is very threatening and hence is provoking the self-protect systems that exist to make sure we survive. These systems have a significant role in pain and hence we are aiming to do the very opposite: active the care-giving systems and effect parasympathetic actions. In a sense our job is to help the person realise that they are safe, how they can safely build up their meaningful activities and adapt in a way that means they are living meaningfully.

What are compassion and empathy?

  • Empathy ~ the capacity to share the feelings of others
  • Compassion ~ feelings of warmth, concern and care for the other…with a strong motivation to improve the other’s wellbeing (Singer & Klimecki)

These will be familiar to clinicians and therapists, but what may not be so familiar is the fact that we can train and practice simple skills to improve our capacity.

It will not be a surprise to many that our brains change when we practice and learn, and this is no different for compassion. Neuroscientists have been looking at these mechanisms for some years now, gathering data on these brain changes and how they manifest in the person. Aside from the science, developing a compassionate society has obvious benefits for all:

Love and compassion are necessities, not luxuries. Without them, humanity cannot survive ~ Dalai Lama

These are skills that should be practiced from an early age with purpose, in homes, schools and workplaces. And just to be clear, compassion is not characterised by weakness or femininity as can be said; not at all. Compassion takes courage and is for all.

Simple practices

There are a range of practices that clinicians and therapists can use for both themselves and their patients. Remember that there is an interaction between the care-giver and receiver, both benefitting from a kind action on a chemical level. Fostering and nurturing every opportunity means that we set the scene: the welcome, the greeting, the opening question or comment, the engagement, the demonstration of care, the calm environment, and much more. Being aware of the present moment and crafting each unique session is a skill to be fostered.

It is beyond the scope to describe the following in detail, but as an indicator, these practices are easily started, often a challenge to continue, but immensely worthwhile for the individual and society:

  • mindfulness
  • lovingkindness meditation
  • the practice of gratitude
  • cultivating an ability to control the wandering mind
  • purposefully generating positive emotions

It is worth remembering that as a clinician, you are the treatment as much as any approach you apply. There is no separation. Developing your capacities hence will have a significant impact on your clients and patients as you increasingly set the scene and communicate in such a way that the person feels trust towards you, a sense of being cared for and a belief that they can get better.

Here is a great video from one of the foremost researchers in the field of compassion, Richard Davidson

For further information on the Pain & Wellbeing Coach Programme or clinician/therapist 1:1 Pain Coach Mentoring contact us below or call 07518 445493

06Nov/16
Richmond Stace | Specialist Pain Physio

@painphysio podcasts

Recently I have given a couple of interviews about pain ~ @painphysio podcasts. One is in preparation for the BASRaT conference on November 19th in London when I spoke to Steve Aspinall about communication and pain (accompanying blog coming soon) and the other was a conversation with Harriett Seager from the Wellbeing Examiner.

On the BJSM podcast page:

Talk with Harriett Seager:

* Pain Coach Programme 1:1 mentoring for clinicians to develop skills and knowledge when working with chronic and complex pain | t. 07518 445493

* Pain Coach Programme to overcome pain | t. 07518 445493

or contact us via the form below ~

02Nov/16
Hands

Trusting hands

HandsTrusting hands — Our hands have many roles, from manipulating tools to communication to soothing another person. We hold a pen and write, we gesticulate, we put our hand on someone’s shoulder. It is the last action that I am interested in here, as we employ touch to make someone feel better by both letting them know we care and changing the sensory activity of the body. There is one aspect of this that is important, and that is meaning. The meaning or intention behind my action and the meaning construed by the recipient. They can be at odds, so setting the scene and making a judgement is important. Certainly in the therapeutic setting, clinicians must judge the right time and the right approach for hands on therapy, especially in chronic pain. Trusting hands is one way to describe them.

In some cases, even light touch can be very painful. Sometimes the pain of hands on treatment can be deemed to be good — ‘that’s a good pain, keep going’ they may say! If the body systems and the person are in protect state, they may well guard the area by tensing up or gesturing to keep people away. They are in fact predicting and expecting that the touch will hurt and therefore put up a defence. There are also people who do not like being touched for a range of reasons beyond whether they think it will hurt or not. This is of course a consideration for the therapist who wants to use their hands.

The notion of trusting hands emerges from a compassionate approach to treating pain. Always beginning with deep and active listening to gain insight into the causes of suffering, the trusting hands become part of the way we communicate our concern and caring before using them to ‘listen’ to the body through touch. This is not an alternative view but instead a way of gaining further understanding of how that person’s body is responding to movement and touch (mechanical forces). We can feel and see the existence of guarding, which demonstrates that protect state is ‘on’ and monitor how this changes as the individual begins to feel safer and more confident. This is in the knowledge that there is no harm or damage associated with the pain, the pain being an indicator of a perception of threat, not a gauge on injury.

The way in which the hands touch the body from the initial contact to the strokes or pressures applied will all imply a certain message. This is why the clinician needs to be aware of their intent and be present when laying on hands. The trusting aspect comes via experience. In other words, the trust results from the recipient knowing that the purpose of touch is to make him or her feel better by changing their experience. They will most likely have some preconceived ideas as to how hands on therapy works and the therapist may have to tweak this thinking in line with what we actually know. In a nutshell, we are seeking to change the way in which the brain predicts the causes of the sensory information coming from the area we are treating. Through this new prediction, or update, as a consequence of an explanation that sets the scene and primes in the right way (think of ploughing a field before sewing the seeds) and then the applied treatment, the person has a new experience, one that is feeling better. I usually explain to people that the feeling better aspect gives them a new reference point so that they know their body can feel different and good. They then use their programme strategies (Pain Coach Programme) to re-enact this feeling over and over as a new habit, which is getting better.

The trust element comes from the whole approach to the person, viewing and treating them as a whole and not a ‘body part’. Respecting their views, beliefs, values and validating their story is vital in creating a trusting partnership. Within this context, the hands play the trusting role of communicating compassion as well as effecting the benefits that have been well studied. Hands on therapies are part of a complete programme of care, and used wisely can facilitate many of the other aspects of the training and treatment.

Each session should result in the person having had a positive experience, feeling inspired and encouraged to practice their training and strategies in their world, their reality. What happens in the clinic is a bubble, often of safety, and then the person needs to take that across the bridge into their world and live. In this way, to resume living a meaningful life requires us to do just that. You get back to living by actually living and knowing how you can do this each day, gradually building up the things you can do and starting to re-engage with things you have stopped doing. With working knowledge of your pain you realise that you can do this with increasing confidence, the fear dissolves and the focus is upon getting better using the strengths that you already have and know. The trusting hands have a role in this science and compassionate based approach to chronic pain.

  • Pain Coach Programme to overcome chronic pain | t. 07518 445493
  • Pain Coach 1:1 mentoring and day seminars for clinicians and therapists | t. 07518 445493 or complete the contact form below

 

24Oct/16
Women in pain

Women in pain

Women in painRecently I gave a talk to a group of female health professionals at the Inspiring Women in Medicine meeting entitled ‘Women in pain’. I spoke about the significant societal problem of women suffering persistent pain, which is one of the issues that comes under the banner of women’s health. Society needs women to be healthy and hence the problem of women in pain must be addressed. Fundamentally at present, society does not understand pain sufficiently to address this enormous public health matter effectively, which is where I believe we must begin: understanding pain.

If society understood pain….

  • individuals would know what to do and think in order to orientate themselves towards getting better
  • it would not be feared; instead the focus would be on overcoming pain
  • healthcare would deliver the right messages early on so that the right actions are informed by correct beliefs about pain
  • the right treatment appraoches would be employed from the outset
  • there would not be the same level of suffering — the figures say: 100 milliion Americans suffer persistent pain; 20% of the population; 1:5 children

Chronic pain is a huge global health burden that costs both individuals and society enormously in terms of finances and suffering. Of course, this pervades out into family and social networks and hence those around the individual can also be suffering through their on-going provision of care. Pain is a strain on society, literally. If it were understood, this can change.

Women in painWomen are reported to suffer more pain and visit their doctor more often about pain than men. Females are more likely to suffer functional pain syndromes. There are still many people, including healthcare professionals, who do not know what functional pain syndromes are or have insight into the basic biology that emerges as a range of painful problems that are very common. They include irritable bowel syndrome (IBS), migraine and headache, back pain, fibromyalgia, pelvic pain (e.g. vulvodynia, painful bladder syndrome, dysmennorhoea) and temporomadibular dysfunction. Other regular features include anxiety, depression, a history of early life events (and later in life when a challenging situation brings about pain and suffering), perfectionism, a person who is very hard on themselves and hypermobility.

This being the case, one would expect that research into how females experience pain and why they feel more pain would be stacking up. Unfortunately this is not the case with most research done in males and male rats. Clearly that has to change alongside the overall attitudes to women in pain.

Women in painRecently the press ran with stories about how women in pain receive different care and approaches to men. Women waited longer for treatment, were less likely to receive opiates for pain (opiates are effective for acute pain — there are big issues with the use of opiates for chronic pain) and were deemed to be more emotional and hence somehow their pain was different in the sense of how it should be treated. Of course this is wrong on every level. Each person has a unique pain experience that is flavoured by a perception of threat within a certain context and enviornment, based on prior experience and beliefs of that person. Therefore, each person needs to be addressed as such and treated according to this principle, man or woman.

There arWomen in paine some ideas as to why men and women should experience pain differently. The most obvious is that of gender biology based primarily around hormones and the menstrual cycle. In particular there maybe an important time at the onset of menarche when sensitisation could emerge in some individuals, thereby priming them for future events such as injuries, viruses and illnesses when the systems that protect us (immune, nervous, sensorimotor, autonomic, endocrine — they work together as opposed to being in isolation) are active in the face of a perceived threat and increasingly vigorously. What the person lives are the symptoms of thee systems working including fever, pain, altered perceptions of the world, altered thinking and emotions. It can sound like these are all separate ‘reactions’ when in fact they are part of an on-going cyclical process: we think, perceive and act as a unified lived experience.

Another observation relates to empathy and how women maybe more empathetic for the purposes of caring for their children. A truly empathetic person is a caring person yet they must be careful and skilled so as not to embody their own versions of observed others’ suffering. As an example, it is not uncommon for me to feel a pain in the same place that a patient is describing their pain to me. Understanding the mechanism, I can rationalise the feeling and it will pass as I actvely change my perception — this is likely the same mechanism that underpins the change from being in pain to not being in pain in all people. I know that others I have spoken to also have this experience, which one could argue is deeply helpful as a healthcare practitioner as we seek to understand the causes of the other person’s suffering.

A described emotion that often appears within conversations about pain, particularly women in pain, is that of guilt. The reasons for expressing guilt are based around the conflict between work, home, partner and children — trying to please all but rarely pleasing or looking after oneself. Being kind to self is important in the sense that being hard on oneself can be the cause of great suffering. This is common and will almost certainly be taking the woman closer to her biological protect line, the point at which threat is perceived and enacted as a pain experience. Learning how to foster the existing compassion towards oneself then, is a typical part of a comprehensive programme for getting better. With many whom I see displaying and admitting perfectionist traits, it is not a surprise that harsh inner dialogue results in repeated negative emotions. Strung together frequently, this forms the basis for chronic stress, which in turn is the means for a pro-inflammatory state, which emerges as aches and pains, troubled tummies, headaches, mood changes, sleep issues, fertility problems and more. The reason is simply that in the pro-inflammatory state, the body is in survive mode that is great when there is a real threat. However, most of the time there is no threat, it is just something we are thinking about that triggers the same response via a prediction taht one exists.

Now, there is nothing wrong in experiencing negative emotions. We need them as much as the others. It is really about the apporpiateness of the emotions: when we feel them, how long we feel them for, how often etc etc. If we consistently think that something bad will happen or ruminate on things that have happened rather than seeing things for what they really are in this moment, then this basic survival biology will keep going. This is where mindful practice is so beneficial, cultivating awareness of existing habits that allows for a reappraisal, a space to see things for what they are and gain insight into the causes of your own suffering and others, from which you can choose a new and healthy way onward. Clearly there is much more to say about mindfulness and its benefits, in particular in the face of mcuh exciting data from studies across the world.

Whilst this blog scratches the surface, it hopefully provides some food for thought. This is a significant public health issue that we can tackle by understanding pain and applying simple and sensible compassion-driven care, which will make a huge difference. Coaching the individual woman to coach herself in a direction that is toward her desired outcome is out role as we empower individuals and allow them to realise their sense of agency in getting better. There are simple measures such as movement, exercise and mindfulness that work in synergy to create a meaningful life to be engaging and enjoyed so that when challenges arrive, they are overcome and used as learning experiences. Science, compassion and sense are at the heart of the Pain Coach approach, one that we can all adopt to change for the better. Ourselves and our patients.

RS

The Pain Coach 1:1 Mentoring programme is for busy clinicians who wish to develop their working knowledge and to be effective in coaching people suffering chronic pain to lead meaningful and fulfilled lives. Contact us on the form below or call Jo for further information t. 07518 445493

 

 

 

23Oct/16

Is mindfulness for everyone?

MindfulnessWalk into a bookshop and you cannot help but notice the ever-increasing number of books about mindfulness filling the shelves, which begs the question, is mindfulness for everyone?

In my opinion, mindfulness is a practice that everyone could choose to incorporate into their lives, however, not everyone will wish to make that choice. It is also the case that the route to mindful practice can be different for different people. For example, sitting or lying and being mindful or meditating can be result in greater suffering in some circumstances and hence that person needs something else at that time. An individual suffering PTSD for instance, could discover that mindful practice leads to a greater state of stress and anxiety. There are several possible reasons for this, including whether they have been instructed in the right way about what mindfulness really is and how we go about the practice. With so many people offering mindfulness at the moment, it can be difficult to know who best to listen to or follow.

Starting any new practice is a challenge and requires dedication and perseverance. In so doing, one learns and realises that each moment there is an opportunity to get better at what you are doing. As Ajahn Brahm says, ‘there’s no such thing as a bad meditation’ — we can always take something from the practice, and the fact that you have practiced has created a learning opportunity. Sometimes the practice results in a great feeling of serenity as the inner dialogue quietens, and sometimes the voice chunters away. Good? Bad? It is what you think it is!

Mindfulness is simply about being aware of your thoughts, feelings and sensations as they pass by, which they always do. The realisation of impermanence is an important one as moments continuously flow. Noticing what you are thinking and feeling without judgement means that you begin to see things for what they are and the causes of your, and other’s suffering. This insight is invaluable for our health. One is tempted to say emotional health but this would suggest some kind of separation between body and mind. There can be no separation between body and mind as we are a whole person living experiences that are unified of cognition, perception and action. The practices of mindfulness provide a way of ‘doing’ this, although really when being mindful, we are not actually doing anything other than being aware, using our attention. To add compassion to this means that you have the intention to be kind to others and yourself with all the accompanying health benefits from positive social interactions and kindness to self.

Mindfulness is a practice with several straightforward methods (below), which is why it is accessible to all. However, actual practicing is the challenge as we have so many existing habits of thought. Our minds do wander and are filled with chaotic thoughts that inform feelings, emotions, actions and perceptions, yet all of these dimensions inform each other. This complexity defines the challenge and how one day we can quieten down the inner chat and another day it seems to make no difference. Remembering that it is not the thought or series of thoughts that is the issue, instead it is recognising that this is the content of the mind, which is not me per se. I am not the contents of my mind, and being able to realise that is hugely empowering.

Two common practices are mindful breathing and mindful walking, both if which are accessible at any moment to most. Paying attention to what arises in this moment is at the essence of the practice that develops one’s ability to focus, choose what to attend to, to reappraise a thought pattern, see things for what they are, realise that anger or another emotion is present yet you can remain focused on your intention. Keeping a focus on your intention is a great skill demonstrated at a time when an argument ensues. Instead of emotional reactions with hurtful words, maintaining a course for the intention that is usually a kind action towards another, you listen deeply and understand the other party, allowing for effective communication towards a resolution. Be able to see the reasons for the other person’s actions provides great opportunity for transforming the situation. This would be a good example of using mindfulness and compassion, the two differing.

Returning to the primary question, I believe that mindful practices can be integrated practically into people’s day to day living if the person makes the choice to do so. Potentially, this is the case for anyone. However, each person needs good instruction and guidance, in essence to become their own coach to transform their inner dialogue to one of kindness and compassion toward self and others. Mindfulness creates the awareness within which this can happen through attention training (mindfulness is about attention whereas compassion is my motivation or intention ~ there’s a difference). Some will need other ways into the regular practice by using breathing and movement, some will need different explanations to be guided and supported, but the the aim is always to develop ways to reduce suffering.

RS

Mindfulness practice is a part of the Pain Coach Programme for overcoming pain | contact us by email: [email protected] or call us 07518 445493

09Oct/16

We have done the run

upandrunThe Royal Parks 1/2 marathon today (9th October 2016) ~ we have done the run!

Team UP completed the run around the Parks and London today to raise awareness for UP and money to launch our campaign. It was a great success!

The Team: Richmond Stace, Jonathan Vickers, Peter Brown, Chris Mutch & Ann Dunmall

On a beautiful morning, we completed the course in good time. Ann even sang in the Rock Choir performance on the main stage!! Awesome!

We were very well supported by Jo, Lucy, Lucy H, Georgie, Mark and of course the volunteers and staff. A big thanks to Sally!

#upandrun

#upandrun

This success means that we will do it again. And again. The #upandrun will now be one of the ways in which we continue to raise awareness through exposure and conversations with people and other charities. UP will support runners in the UK and beyond by funding their place and supplying a running shirt while the runner raises money for UP. So if you want to run for us, get in touch ~ [email protected]

You can still support us here: upandrun

And now for the feet to go up!

08Oct/16

The day before the run

The day before the run ~

upandrunI am excited about the run now. I have never run a 1/2 marathon before and so it is a step into the unknown. Having said that, each day is a step into the unknown as we can only ever try and predict the future based upon what we know. In that sense, why worry?

It is tempting to have a little run today to keep the legs moving. I have been told that having run for over an hour and now used to plodding along for this time, the last 45 minutes to an hour will be fuelled by the event atoms sphere created by the people and the place. I’ll let you know.

The UP team have had incredible support in many ways including the very generous donations that continue to be made. You can give here to contribute to our mission of changing the number one global health burden that is chronic pain ~ click here

The aim was £5000 and we have already achieved over £7000 demonstrating how people feel about the scale of this problem. It is around 1:5 people, 20% of children, that experience and live with persistent pain. This is an enormous number of people and of course the reasons for the pain are far and wide as are the contributing factors. Many people do not realise that tiredness, stress and emotional state play a significant role in an individual’s pain.

~ Pain is not well related to injury. Consider phantom limb pain for a moment. There is no limb yet there is pain in that limb; in that space. We don’t need a physical presence to suffer pain and this is because most of the biology of pain does not exists where we actually feel it. You don’t need to hear a joke laugh, you may just think of something funny. When you are at the cinema and the film appears on the screen, where are all the components that make this possible? Most are not on or involving the screen. There is a the projector, the software, the power source etc etc. In understanding pain, we think more widely and hence develop therapies and ways forwards ~ this is the essence of UP and the research we are supporting.

The money that has been raised so far will allow us to set up a strong foundation. We will apply to become a charity, which will enable us to grow and develop. We hope to link with other charities who are in aid of conditions where pain is a problem. The website can now be transformed into a great resource for all to access and learn about pain ~ understand pain to change pain has always been our motto. Like any problem, when we understand it, we know what to do.

The understanding of pain has moved on enormously over the past 10 years and this will continue. In particular my optimism comes from the incredible research that is being undertaken, which we will be reporting upon and supporting. Interestingly, the main thrust comes now from a blend of disciplines drawing upon their knowledge to create a fresh and testable model that is by far the most exciting model that exists. It would not surprise me if this model were to explain many of life’s conundrums.

So now it’s back to the run. The people have supported us and our job at the UP team is to put one foot in front of the other and have fun tomorrow at the Royal Parks 1/2 marathon. Look out for the logo and come and say hello!

What else can you do to help UP?

Follow us on twitter here @upandsing and use #upandrun for the hashtag of the day and on Facebook; retweet our tweets, tweet your own, tweet a picture of the UP logo, grab a picture with one of the UP team!

RS

08Oct/16

UP supports research into pain

UP | understand painUP supports research into pain ~ one of our main objectives is to raise money to support vital research that will make a significant difference to the way in which pain is understood and treated. Such research is underway here in the UK. This is both exciting and necessary in moving forward our thinking so that we can have a significant impact on the global problem of pain.

Mick Thacker has been an enormous influence upon my work and beyond, and in fact I blame him entirely for my obsession with understanding pain! I still recall the lecture he gave when I had my ‘aha’ moment, realising that there was a way forward. Not looking back since, there have been incredible steps forward to where we are now. Mick has had a huge impact upon so many people over the years and this continues. We have a lot to be thankful for and I am grateful for the opportunity to support the work he describes below. I believe that this research is by far our best opportunity to truly understand pain.

‘We propose an interdisciplinary programme of research that focuses on a new approach to pain based on the Predictive Processing Framework (PP) set out by Profs Andy Clark, Jakob Hohwy, Anil Seth and Karl Friston. The main feature of this proposition is that pain arises from circular influences that link the body (including a brain) with the world. This approach sees pain as an action-orientated perception that attempts to both identify and alleviate/limit the potential causes of actual, potential or ‘imagined’ danger to the self. We believe that this approach will extend well beyond the current bio-psychosocial model.

Working closely with philosophers and neuroscientists we will reframe our current understanding of pain using models of PP and will marry empirical based experiments into nociception with current philosophical perspectives. We plan to use these newly acquired perspectives to propose and plan a series of empirical studies that examine pain from the perspective of PP. The direction of these studies are likely to employ many different approaches across the (cognitive) neurosciences including human psychophysics and neuroimaging as well as the development of modelling paradigms involving artificial neural networks and related techniques allowing us to fully understand and evaluate pain and it’s impact on the person.’

Mick Thacker PhD. MSc. Grad Dip Phys. Grad Dip MNMSD. HPC. FCSP.
Senior Consultant AHP (Pain) Guy’s & St Thomas’ NHS Foundation Trust &
Centre for Human and Aerospace Physiological Sciences. King’s College London.
Pain Section, Neuroimaging. Institute of Psychiatry. Kings College London.
Adjunct Senior Research Fellow, School of Health Sciences. University of South Australia.

06Oct/16

Some strong words about pain

#upandrun

#upandrun

Here are some strong words about pain because this is what drives the UP | understand pain campaign (www.understandpain.com). Chronic pain is the number one global health burden — it costs us the most and then consider the personal cost and suffering endured by each individual. We are not just talking about musculoskeletal pain (e.g., back pain, neck pain, osteoarthritis etc.) but all pain: headaches, migraines, pelvic pain, irritable bowel syndrome, cancer related pain, pain related to conditions such as diabetes, heart disease, lung disease and all the other situations in which we hurt and can continue to suffer.

Traditionally the search for the reasons for pain consisted of looking for a pathology, an injury or other structural explanation in the body. The biomedical model needs something to find, something to see with the naked eye or on a scan. Pain can never be seen.

Pain is the ultimate example of a conscious experience, and conscious experiences are built by the individual based on a number of factors that are biological, psychological and sociological. Typically it is the biology that is focused upon with some psychology, which means that the biopsychosocial model purported for some years now, is not really used except in name.

The reality is that you cannot separate these dimensions. How is psychology not biological or sociological? How is biology not psychological? It makes no sense to divide what is a lived experience, a first person experience that embraces the unification of thoughts, perceptions and actions. Fortunately for society, there is a model that is most likely to be able to reflect this unification and the research needed to test the model is going to be supported by the UP campaign (charity-to-be).

As society has evolved so has our pain. Chronic pain is a societal phenomenon — on certain parts of the world, back pain did not exist until the concept was introduced by modern healthcare. That is a societal issue, not a medical issue. And by this regard, society needs a shift to support a new understanding of pain to relieve that very society of this on-going pain problem. This is not a medical problem. As time moves away from the initiation of the pain experience, it shifts rapidly towards the need for a sociopsychological model — what does the person in pain need to understand? What do they need to do? How do they engage with their family? How do they engage with their work? How do they communicate their pain? What actions do they need to take day to day to get better?

This is a public health problem that needs addressing as such. It is not dramatic to say that world leaders and policy makers need to be having conversations about the health problem that costs the globe the most and taking action now. It is absurd that the main reason for seeking help, the vehicle taking people to healthcare is frequently pain. How much formal training do healthcare professionals receive?

The passion behind UP | understand pain emerges from the absolute need for an enforced change from the bottom up. Society needs to be instrumental in the change for its own good and so this is where UP is taking the campaign. To the people. The voice of the people to enforce the necessary change.

This weekend UP has a team at The Royal Parks 1/2 Marathon, raising funds that will be the foundation for all that is described above. So join us and spread the word as we raise the profile of this problem into the consciousness of society for action to be taken now.

Join us on Twitter @upandsing using #upandrun 

12Sep/16
Mindful commuting

Mindful commuting

Mindful commutingMany people commute to work creating a great opportunity to create calm, focus and prepare for a top performance, simply with mindful commuting. In London, a huge number of commuters use the tube, which is rammed with people (in a rush), often smelly and particularly hot in the summer. How can one create calm and focus in those circumstances you may wonder?

As a commuter you join thousands of others, some of which push you, breathe on you, lean on you, rest their paper on you (I once saw a woman rest her newpaper on a man’s back, which she quickly moved when he turned, only to put it back when he looked away — it was quite amusing), stare at you and nudge you. Today there was a small space next to me and a man forced his way into it creating discomfort for everyone, including himself. So there are just a few incidences that could challenge one’s patience and yet what a great opportunity to develop the skills of patience and compassion towards others. In doing so, you feel better versus feeling anger, frustration or annoyance. We can choose.

Over and above developing a compassionate outlook for the day ahead by looking deeply at a situation (we can consider that the other person may be suffering for a range of reasons and hence behaving in a certain way), we can use the following practices to orientate ourselves towards positive emotions. Being aware of and acknowledging positive emotions broadens our thinking and receptiveness as well as enhances our resilience in the face of a challenge, all of which impact upon our performance at work based on how we communicate with ourselves and others.

  • each time you find yourself becoming irritated on your commute, take 3 breaths and in particular notice your out-breath
  • walk mindfully, paying attention to each step and just be curious as to what is going on around you. Notice how it makes you feel and return your attention to your walking
  • if you cannot get through the crowd because it is busy, return your attention to your breathing to create calm and then walk mindfully
  • be aware of those around you and wish them well in your thinking, noticing how this makes you feel and how the world then appears
  • as you pay attention to your breathing, think kindly about your colleagues and boss so that when you encounter them, you communicate with skill and not on a background of feeling stressed and anxious
  • if you feel stressed and anxious it is because your thinking (embodied) has drifted into the past or future, thereby flavouring the present. Take 3 breaths and see things for what they are; be aware of this moment
  • listen to a mindful app on the journey
  • practice mindful breathing when you simply pay attention to your breath that holds you in the present moment

There are many more ways of practicing but in essence just using one or two will help you create calm and focus. Try it and see!

Mindfulness is a very practical way of being that creates calm, peace and allows you to to see things for what they are as you are consistently aware of the present moment, you listen deeply and speak with skill to communicate understanding and compassion. This is transformative in all situations and achievable for all.

Mindfulness practice forms part of the Pain Coach Programme for pain and chronic pain | t. 07518 445493