08Feb/16
Pain Coach Programme

Hip replacement

Having seen Eamonn Homes on Twitter up and about on crutches after a hip replacement (good work), I thought I would share a few tips that I give to people undergoing orthopaedic surgery. Hip replacements and knee replacements are common nowadays but there is always a person going through the procedure with his or her hopes, dreams, fears and past experiences. As one of my greatest influence’s, Oliver Sacks, would always say, it is as much the person as the condition. Each person’s experience is unique to them and necessitates validation and respect.

  • Pre-operatively, understand your pain so that you have a working knowledge to enable you to deal with it effectively. The pain is normal, not to be feared, instead to be overcome with the right actions post-operatively. In many, many cases the operation results in pain relief and a much improved quality of life.
  • Post-operatively the pain needs to be well controlled. Conversely, a predictor of on-going pain is poorly controlled pain at the outset, so keep talking to your doctors and nurses and inform them if you are suffering. On another level, the pain can dissuade you from that early movement and mobilisation that is important for recovery.
  • Relaxing and calming techniques help your body to focus on healing. If you are unnecessarily stressed, anxious or fearful, important resources are diverted to protection and survival rather than healing. Common methods that I teach people are to use their working knowledge of their pain to reduce the threat and choose the right healthy action, mindfulness, visualisation, sensory exercises and breathing.
  • Using motor imagery activates and exercises the areas of the brain that plan and execute movement. When movement is limited, these are great exercises to keep the higher centres working for you. The quality and precision of the way we move depends upon these representations and they need to be accurate. Some of this accuracy is lost when we are in pain or not moving normally. Imagine moving your hip, knee, foot and walking; all these are simple and you can do them as often as you like. Visualisations are also a great way of creating calm and motivating you to take the right action. Remember, when you think about something, your brain and mind are very active but with your body — our minds are embodied, in other words an extension of, and part of our thinking (embodied cognition).
  • If you are anticipating that a movement will hurt, visualise the end position (e.g. standing up) and then imagine the act of standing up over and over (10-15 reps) and then do it.

Pain Coach ProgrammeThere are many other sensorimotor execises and techniques that a person can use over and above the standard movements and post-operative exercises (and pre-operatively), to get the best outcome. In essence, it is about creating the right conditions for healing and recovery, holding a vision of how you want to be and then work towards that vision (dealing with distractions on the way — e.g. fears, worries, negative messages) of health and a meaningful life.

This is the way of the Pain Coach Programme | t. 07518 445493

08Feb/16
CRPS

CRPS Research

CRPSKeep up to date with some of the recent CRPS research papers. You can click on the title link for the full text version. My comments are posted ‘RS’ in italics.

Pain exposure physical therapy (PEPT) compared to conventional treatment in complex regional pain syndrome type 1: a randomised controlled trial

abstract

To compare the effectiveness of pain exposure physical therapy (PEPT) with conventional treatment in patients with complex regional pain syndrome type 1 (CRPS-1) in a randomised controlled trial with a blinded assessor.

The study was conducted at a level 1 trauma centre in the Netherlands.

56 adult patients with CRPS-1 participated. Three patients were lost to follow-up

Patients received either PEPT in a maximum of five treatment sessions, or conventional treatment following the Dutch multidisciplinary guideline.

Outcomes were assessed at baseline and at 3, 6 and 9 months after randomisation. The primary outcome measure was the Impairment level Sum Score—Restricted Version (ISS-RV), consisting of visual analogue scale for pain (VAS-pain), McGill Pain Questionnaire, active range of motion (AROM) and skin temperature. Secondary outcome measures included Pain Disability Index (PDI); muscle strength; Short Form 36 (SF-36); disability of arm, shoulder and hand; Lower Limb Tasks Questionnaire (LLTQ); 10 m walk test; timed up-and-go test (TUG) and EuroQol-5D.

The intention-to-treat analysis showed a clinically relevant decrease in ISS-RV (6.7 points for PEPT and 6.2 points for conventional treatment), but the between-group difference was not significant (0.96, 95% CI −1.56 to 3.48). Participants allocated to PEPT experienced a greater improvement in AROM (between-group difference 0.51, 95% CI 0.07 to 0.94; p=0.02). The per protocol analysis showed larger and significant between-group effects on ISS-RV, VAS-pain, AROM, PDI, SF-36, LLTQ and TUG.

We cannot conclude that PEPT is superior to conventional treatment for patients with CRPS-1. Further high-quality research on the effects of PEPT is warranted given the potential effects as indicated by the per protocol analysis.

***

High-frequency repetitive sensory stimulation as intervention to improve sensory loss in patients with CRPS type 1

abstract

Achieving perceptual gains in healthy individuals or facilitating rehabilitation in patients is generally considered to require intense training to engage neuronal plasticity mechanisms. Recent work, however, suggested that beneficial outcome similar to training can be effectively acquired by a complementary approach in which the learning occurs in response to mere exposure to repetitive sensory stimulation (rSS). For example, high-frequency repetitive sensory stimulation (HF-rSS) enhances tactile performance and induces cortical reorganization in healthy subjects and patients after stroke. Patients with complex regional pain syndrome (CRPS) show impaired tactile performance associated with shrinkage of cortical maps. We here investigated the feasibility and efficacy of HF-rSS, and low-frequency rSS (LF-rSS) to enhance tactile performance and reduce pain intensity in 20 patients with CRPS type I. Intermittent high- or low-frequency electrical stimuli were applied for 45 min/day to all fingertips of the affected hand for 5 days. Main outcome measures were spatial two-point-discrimination thresholds and mechanical detection thresholds measured on the tip of the index finger bilaterally. Secondary endpoint was current pain intensity. All measures were assessed before and on day 5 after the last stimulation session. HF-rSS applied in 16 patients improved tactile discrimination on the affected hand significantly without changes contralaterally. Current pain intensity remained unchanged on average, but decreased in four patients by ≥30%. This limited pain relief might be due to the short stimulation period of 5 days only. In contrast, after LF-rSS, tactile discrimination was impaired in all four patients, while detection thresholds and pain were not affected. Our data suggest that HF-rSS could be used as a novel approach in CRPS treatment to improve sensory loss. Longer treatment periods might be required to induce consistent pain relief.

RS: This is an interesting finding. Stimulation that brings about changes in the cortical maps is not a new notion, and indeed is part of normal learning. We stimulate with movement and/or touch under day to day circumstances, and in fact that is what we need to employ moment to moment at home to overcome CRPS and other painful conditions. Most people will not have access to equipment but are able to use simple touch, two point discrimination and movement, all of which form a vital part of the training and self-coaching programme. Pain is a lived experience and the programme must become part of life and hence be as simple as possible, which it can.

***

Motor imagery and its effect on complex regional pain syndrome: an integrative review

abstract

The motor imagery (MI) has been proposed as a treatment in the complex regional pain syndrome type 1 (CRPS-1), since it seems to promote a brain reorganization effect on sensory-motor areas of pain perception. The aim of this paper is to investigate, through an integrative critical review, the influence of MI on the CRPS-1, correlating their evidence to clinical practice. Research in PEDro, Medline, Bireme and Google Scholar databases was conducted. Nine randomized controlled trials (level 2), 1 non-controlled clinical study (level 3), 1 case study (level 4), 1 systematic review (level 1), 2 review articles and 1 comment (level 5) were found. We can conclude that MI has shown effect in reducing pain and functionality that remains after 6 months of treatment. However, the difference between the MI strategies for CRPS-1 is unknown as well as the intensity of mental stress influences the painful response or effect of MI or other peripheral neuropathies.

RS: motor imagery does have an impact on our ability to move, and often rapidly so after a few repetitions. Using imagery and visualisation to assess mental representations, body sense and integrity alongside other simple tests gives an insight into the different hierarchical levels of contribution to the brain’s best guess about this moment for the individual. What we are experiencing now is our brain’s prediction (or best guess) when it has chosen from a number of hypotheses. Using imagery and visualisation, we can impact on the predictions as well as our own expecations that feed such predictions and our own conscious sense of what is to come. Pain is worse when we expect something to hurt, so what if we do not expect this and indeed anticipate something different, new and healthy?

***

Fear and reward circuit alterations in padeiatric CRPS

abstract

In chronic pain, a number of brain regions involved in emotion (e.g., amygdala, hippocampus, nucleus accumbens, insula, anterior cingulate, and prefrontal cortex) show significant functional and morphometric changes. One phenotypic manifestation of these changes is pain-related fear (PRF). PRF is associated with profoundly altered behavioral adaptations to chronic pain. For example, patients with a neuropathic pain condition known as complex regional pain syndrome (CRPS) often avoid use of and may even neglect the affected body area(s), thus maintaining and likely enhancing PRF. These changes form part of an overall maladaptation to chronic pain. To examine fear-related brain circuit alterations in humans, 20 pediatric patients with CRPS and 20 sex- and age-matched healthy controls underwent functional magnetic resonance imaging (fMRI) in response to a well-established fearful faces paradigm. Despite no significant differences on self-reported emotional valence and arousal between the two groups, CRPS patients displayed a diminished response to fearful faces in regions associated with emotional processing compared to healthy controls. Additionally, increased PRF levels were associated with decreased activity in a number of brain regions including the right amygdala, insula, putamen, and caudate. Blunted activation in patients suggests that (a) individuals with chronic pain may have deficits in cognitive-affective brain circuits that may represent an underlying vulnerability or consequence to the chronic pain state; and (b) fear of pain may contribute and/or maintain these brain alterations. Our results shed new light on altered affective circuits in patients with chronic pain and identify PRF as a potentially important treatment target.

Pain Coach ProgrammeRS: we know that fear provokes on-going and more protection as we are perceiving a threat. Pain is also about perceived threat that is being predicted by our brain’s best guess about a particular situation or context base on what has happened before. This is one of the reasons why pain can be so specifically associated with a particular movement, a place or a thought. Many are puzzled by the changeable nature of pain and how it can exists one minute and not the next. Understanding pain allows people to realise that this is exactly the lived experience, especially in youngsters who can appear to be moving normally and then be in agony. Their brains have predicted a need for protection and hence they are in pain. The perceived threat passes and the new prediction is ‘no threat’ and hence no pain. This is how it works and unfortunately many people are not believed as a consequence and a really important reason why society needs to understand pain. Fear of pain being eradicated results in positive change and is a key step towards overcoming pain, starting with a working knowledge. I use UBER-M as a self-coaching tool that I give to individuals: U (understand pain; working knowledge), B (breathing & mindfulness), E (exercises – specific and general), R (re-charge energy to engage); M (movement for health and expression); the question to ask is this: ‘Are these thoughts and actions taking me towards my vision of a healthy me?’

Pain Coach Programme to overcome CRPS and chronic pain | t. 07518 445493

UP | understand painUP | Understand Pain — join us on Twitter @upandsing

 

08Feb/16
Cold shower by Thomas8047 | https://flic.kr/p/oi7RaM

Lingering colds

Cold shower by Thomas8047 | https://flic.kr/p/oi7RaM

Cold shower by Thomas8047 | https://flic.kr/p/oi7RaM

A number of people have described their lingering colds, which have been persisting for a few weeks. This is longer than anticipated, and of course rather annoying and inconvenient. Daytime sniffling and night time disturbance whilst low on the list of ailments in terms of seriousness, they do impact upon life: tiredness, aches and pain, disrupted appetite, reduced concentration for example.

Beyond the normal symptoms, someone who has a degree of sensitivity at play, in other words a pre-existing painful problem, will frequently endure an amplification of their pain. It is common for the body to ache when we have a cold, and when we have an existing painful body area, it will typically hurt more during this period as the immune system pumps out pro-inflammatory cytokines (messengers) that increase sensitivity. A further noteworthy observation is that of prolonged symptoms when the person tries to exercise, discovering that their usual post-gym or post-run soreness is worse and continues for a few days. The overall symptoms of the cold can persist for longer as well unless the conditions for recovery are met, and this means meeting basic needs: what we eat, what we drink, enough rest and recuperation, enough sleep and dealing with situations that cause stress and anxiety.

Some people believe that we catch a cold by being cold. As far as I know this has never been the case. The feelings and sensations of having a cold are the body’s responses to a virus (no need for antibiotics then) or bacteria (may need antibiotics but not always — judiscious reasoning needed by your doctor). You cannot feel a cold, only the emergent experiences of the body that are mortivators for action to rest, recuperate, hibernate, protect etc etc. If you ignore these clear motivators, you are probably going to prolong the cold and your suffering as well as all those around you at home, at work and on the tube (ever had someone with a cold next to you on the tube? And when I say next to you, I mean squeezed right up to you).

So, loPain Coach Programmeok after your basic needs. In fact, this is vital anyway and will reduce the risk of catching a cold in the first place! And from suffering the effects of survive rather than thrive. Wouldn’t you rather flourish, engage and perform? Be wise. Be health wise.

Pain Coach Programme to overcome chronic pain and live a healthy & meaningful life

t. 07518 445493

 

08Feb/16
mindfulness by swampland | https://flic.kr/p/k3t1k

Practical mindfulness

mindfulness by swampland | https://flic.kr/p/k3t1k

mindfulness by swampland | https://flic.kr/p/k3t1k

Practical mindfulness is for everyone. It is for everyone who wants to develop insight into their own mind, and in so doing will relieve an amount of suffering that is significantly impacting upon their life in a number of ways: pain, anxiety, ill health.

It is important to point out at this juncture that the mind does not exist purely in our heads but rather we are our mind, and our bodies are an extension of our minds as they reach out to both sample and create the world that we perceive. We think with our whole self. And if you are befuddled by this, just for a moment consider where you feel hungry or thirsty? Is it in your head? Does your mouth go off for a drink? Or do you feel thirsty and you go and get a drink to quench your thirst?

Practical mindfulness, for me, is about creating the conditions for health. We have everything we need to be healthy, yet life seems to get in the way. Consider: too busy to exercise or move? I want that cake because I am hungry and fancy a snack. I feel stressed because of what that person has said to me. I am anxious about _______ (fill in the gap).

Mindfulness is about being aware of what is happening in this moment, noticing the temporary nature of things and letting go (are you still thinking about what that person said? Who is left holding the burning coal?) in a non-judgmental way. This flies in the face of how we have been brought up in our society: judge! Blame! Dwell on the past and re-play that tape of that event you think that you remember — except you don’t well at all you just think you do! Crave! Want! No awareness runs through these common choices of thought or action. How are you choosing to think right now? Is there a better choice that would make you feel better? If you are aware of your habits of thought, then you can make a better choice to shift your perception and hence your conscious experience of what is happening right now.

Being present does not mean that you do not recall memories but rather that you do it with skill, noticing how it makes you feel and living the full richness without suffering, whilst letting go of unhelful thoughts. Being present does not mean that you do not plan, but instead means that you plan the future (that never comes because there is only this moment) in the present moment and therefore do not suffer the anxiety of an undesirable future. How often do you tell yourself that it will not work out? Or that you will fail or that you are not good enough? Is it true or are you just telling yourself that story. It is just a story, or a train of thoughts that you embody, live and enact and so it goes on. But it does not have to keep going on like this as we are all changing, all of the time. It is the direction we must choose: shall I keep on listening to that inner voice or let it go and be mindful? That is your choice.

Mindfulness does not require one to become spiritual or religious. It does not require any equipment. The principles are straight forward. It is only when someone keeps telling themselves that it is hard, is it hard. Why not choose to say to yourself that you will, or that you can rather than you can’t or you won’t?

There are two main practical practices: the moment to moment taking a breath to become aware, developing a sense of what is happening now and the sitting or lying practice for a period of time (usually 5-10 minutes initially) several times a day. In the regular practice you are putting down the heavy bags of past and future, and the suffering from living out the thoughts that keep passing through, especially those that you hold onto and resist. Resistence causes tension and other protective predictions that zap our energy and bring on aches and pains that are so common — migraine, headache, irritable bowel syndrome, back pain, neck pain — as our bodies try to keep up with the wandering mind. Taming the mind by gathering insight and cultivating curiosity makes way for calm times to plug-in, refresh and renew as you create the conditions for a healthy, performing, engaging you amidst the multitude of continuous stimuli in the world around. By the way, it is our embodied minds that are creating that reality, so there’s another reason to look after it, just like you do your body. You get fit in the gym, clean your body, groom your body, clothe your body. What do you do for your mind that gives you the sense of everything including that body?

Practical mindfulness is part of the Pain Coach programme for persisting and chronic pain, stress and anxiety. t. 07518 445493

 

07Feb/16
Lego Family by the great 8 | https://flic.kr/p/9z3rus

Family and friends

Lego Family by the great 8 | https://flic.kr/p/9z3rus

Lego Family by the great 8 | https://flic.kr/p/9z3rus

Family and friends are vitally important in a person’s overcoming of their pain. For this reason, I have outlined some of the key reasons before moving onto the common advice that I give to individuals and their loved ones.

We are each enormously influenced by the people we grow up with and spend time with, as they have a role in shaping our beliefs about ourselves and the world in which we live. This includes of course, our thinking about health and pain that drive our choices of behaviour and on-going thinking. And therein lies an important notion, that of the choice we have to develop our thinking and take on a different perspective, thereby creating new perceptions and realities.

The influence referred to above can, if used wisely, be of immense value in overcoming pain. Wise use relies upon all parties both truly understanding pain and how it emerges in the individual, in other words a working knowledge that can be used practically to inform best action that is congruent with health.

The individual bears their pain, suffering the lived experience moment to moment, yet those around the person also suffer in different ways and for different reasons. In this sense, the fact that we are not existing in isolation, when the person gets better, so do those around them. It is a potent realisation that when we choose to take healthy action, the people around us appear to change, as do the world and our overall reality. This is exemplified by the character played by Bill Murray in the film Groundhog Day.

In short, an individual’s pain experience is flavoured somewhat by the attitudes, behaviours and actions of those around, and indeed those around are influenced by the way that the pain of an individual emerges. For this reason, a treatment programme should embrace these dynamics, which could be studied and described in far more detail than I have here, and lever effect for the benefit of all.

How? There are some simple steps and practices that can be taken, which I have outlined below:

  • Both the individual in pain and his/her family and friends have a working knowledge of the pain emerging in that person, noting the individualistic nature of their pain. A working knowledge permits clear and wise thinking in any given moment, continuing to choose a direction congruent with overcoming pain. Family and friends realise the changeable nature of pain, recognising the influences upon pain and how the intensity and suffering fluctuate moment to moment.
  • With a plan in place, encouragement, support and motivation can be provided by family and friends, using the right language, gestures and actions. The plan points toward the vision, giving direction and a steer to recognise whether the person is being distracted or heading towards health. The plan is devised with the clinician who advises upon day to day, moment to moment strategies and exercises.
  • Family and friends can play an active role in a selection of the treatments, including sensory work, touch based therapies, mindfulness and simply providing company whilst the exercises are performed little and often through the day.
  • Learning when to help and when to promote independence is an evolving skill that blends the practical with an understanding of the person.

People often ask whether family and friends should be involved in their recovery. I would suggest that it is not a case of whether, but rather how they can be involved.

 

31Jan/16
CRPS

Ellen’s CRPS story

CRPSHere is Ellen’s CRPS story in her own words, kindly sharing her experience for you to read:

My name is Ellen Williams and I have had CRPS for 5 years. My CRPS story began 6 months after I had an arthroscopy on my left knee after a sporting injury. Being told I was suffering from an incurable disorder, which is also invisible to everyone apart from me, was a rather daunting prospect at the age of 15. For the first 2 years I was told that I had a good chance of it disappearing, as I was young and fit enough to “fight” it like it was some sort of infection. 18 months of intensive physiotherapy, on a weekly basis helped to a certain extent but not enough to click my brain back. When the physical physiotherapy stopped working, I began asking questions. My doctor was the one to give me the news I did not want, telling me that now it was unlikely to go for a long time, if ever. As a 17 year old, hoping to go to university, beginning to think of what the future it felt like nothing mattered anymore because I was never going to be able to live the “normal” future I had been planning since I was 10. Needless to say this was the first time I had got very depressed during my battle with CRPS. However this is when I began to see Richmond. He gave me and my family the answers we needed but had never been given before, that yes I may have to live with this disorder for the rest of my life but that does not mean that life cannot be as good as it was always going to be. Learning to manage my disorder has had its difficulties along the way however every bad moment was worth it when I look back at how much I have managed to achieve since the first time I saw Richmond. My family has been there the whole time, through the tears, pain and happier times however I have always wondered about how hard it is for them. I struggle to see my mum unwell so I cannot imagine how she feels having to see me in agony and knowing there is nothing she can do to stop it. The one piece of information I would give to anyone with CRPS is that it is not just the person who suffers, so if you cannot try for yourself, maybe try for the ones who love you. Needless to say I am now 6 months away from finishing my degree and am doing what I love on a daily basis. I am happy. I never thought I would be able to say that 3 years ago and that does not mean I do not have bad days, some worse than others however my daily life is happy and is “normal” for me.

06Jan/16
UP | understand pain

Onwards in 2016

UP | understand painOnwards in 2016 is my thinking. This is not a New Year’s resolution, but instead a commitment to developing the work thus far, upon raising awareness of the vast problem of pain across the globe. Whilst many organisations, governments and charities are focusing on particular conditions, and fine work many are doing, there is an overarching problem that needs addressing — the problem of pain: what it is? What it means to the individual? What is the impact? What can we do to overcome pain? This leads on to simple questions that we must answer swiftly: why am I in pain? What can I do? What are others going to do? How long will it take?

Pain appears in injury, in stress, in anxiety, in cancer, in heart disease, in diabetes, inUP | understand pain schools, in homes, in workplaces, on the playing field, in men, in women, in children, in the existence of disease, in the absence of disease, it comes in a moment and passes in a moment. Pain is everywhere, and whilst it plays a necessary role in our learning and survival, in many cases the pain is prolonged, amplified and causing on-going suffering when it need not. We have an obligation to change this situation because we can. We have the knowledge, we have the skills and we have know-how and it needs to be used across the board. This is a societal problem that we can tackle together, starting with understanding pain.

The UP campaign that we started last year has gathered great momentum, capturing our imagination and those who were touched by the events at T5 Heathrow, and creating a platform for our plans in 2016 and beyond. This year we will gain charity status and be taking our message as far and as wide as we can — each new person who knows about UP and that pain can change will be a messenger, and this way we can reach out across society. The facts that I give people each day, the knowledge and skills that we work upon together to create the conditions for change in a direction that the person desires, steers them towards sustained health and a life well lived. We are changing all the time, every moment is new and an opportunity, so we can learn to embrace this and keep moving onward!

Onward for me is continuing to develop the blend of pain sciences, philosophy and coaching to get the best out of each and every individual. We all have great potential that is to be realised, and this includes people overcoming their pain. There are too many negative messages given, wrong messages given and subsequent self-talk that predicts poor outcomes. This is not necessary at all and needs to be reversed. Let us talk of health and feeling good as much as we can! There are always challenging times, yet we can view these as difficult or as an opportunity to learn. We will not always be happy, but we can learn how to recognise thought viruses and old beliefs that we can update and change perspective upon in order to view things differently and hence feel differently as our embodied mind evolves.

So, with great gusto, onwards and UP!

07Dec/15
Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

Central sensitisation and higher centres

Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

There is a difference between central sensitisation and higher centres. In recent months I have seen people confuse the two, so I thought it best to differentiate in brief.

Central sensitisation is actually a laboratory based phenomenon that describes changes in the nervous system that result in modulation of the signals from the periphery. In addition, the inhibitory processes are dulled with consequential increases in sensitivity. This can mean that things that hurt will hurt more, and things that would not normally hurt now do. This can be transient but in some people with these mechanisms at play, they experience on-going pain as there is a predicted on-going perception of threat.

The role of the higher centres in pain include interpresting the meaning of the signals from the body (all body tissues and systems) and the brain makes a best guess. This best guess is our perception of reality at any given moment. What translates biological activity within hierarhical systems (networks, processes etc) into what we perceive, we do not understand–this is consciousness. We need the higher centres to convert biology to a lived experience, and the two are different, much like a scan does not tell us about pain. The scan is obective, pain is subjective. It is the person who brign spain to life and flavours it with their experience that is made of bodily sensations, thoughts and feelings culminating in what is.

So, whilst there may not be central sensitisation at play in all cases of chronic tendon pain, if you are feeling pain in that location, the higher centres are doing a protective job that is your lived experience; it hurts in the area where the tendon occupies — we have established that pain occupies a space and not a tisse; e.g. phantom limb pain. And because any pain experience requires higher centre activity, we must address this as much as the health of the body, the tissues, the person.

Pain Coach Programme for persisting and chronic pain. t. 07518 445493

Science | Compassion | Sense

07Dec/15
Vulvodynia

Pain Coach for vulvodynia

VulvodyniaPain Coach for vulvodynia and other persisting pains is an approach based on a blend of the latest thinking in pain science and strengths-based coaching. What does this mean?

Modern thinking about pain considers that the lived experience of pain is ‘whole person’, in other words, it is ‘me’ who is in pain and not the body part/area. By addressing the person, in effect steering thoughts, feelings and behaviours towards health, pain is overcome and a meaningful life is resumed, as defined by the individual themselves. Bearing this in mind, we can seek to achieve this with strategies that parallel the lived experience, becoming new habits that nurture change in a way that is healthy. Pain is embedded with the person, their life, their reality and how this is created by their whole self — body systems (including the brain, immune system), their body and the environment.

With pain being part of who we are at that moment, we need to be able to think clearly and logically about that moment, seeing it for what it is, and then respond in the best and wisest way. We are continually updating, with a fundamental design that means we change with every passing moment. The brain predicts what will happen next and the sum of the best guessed meaning to all sensory information is what we perceive in that moment. Each moment is of course in passing, with a new one on the way. Nothing is permanent, and this is also true for pain. Having a baseline understanding creates a new layer of thinking, which creates a new layer of lived experience each moment, and this is how we can overcome pain. You may ask why, if we are always changing, has my pain persisted; and this is a great question.

Why does pain persist? On one level, it is because there is on-going prediction of the need for protection against a perceived threat. The range of cues and triggers widens over time, as does vigilance and habits of thinking that underpin and flavour the lived experience. The sensory and sampling systems adapt and suggest threat, and the prediction goes on and on, until you take decisive action and create new thinking and behaviours to take the continual change in a new direction. To do this, as I said earlier, the new awareness and habits need to match the lived experience, and be employed moment to moment–in any given moment you need to be able to be witness to your thinking, emotional state and bodily sensations, then using this awareness to decide upon the best action (UBER-M is one of my self-coaching strategies that I have previously written about).

Putting this into practice for vulvodynia, we begin with the development of a working knowledge of the individual’s pain and what influences their pain (e.g. stress, anxiety, context, environment, anticipation, expectation, attentional bias, catastrophising, hypervigilance — to name but a few). Using this working knowledge, the person creates a sense of safety that is the foundation of the precise actions taken: specific exercises, training, general exercise, breathing/mindful techniques, re-charging (energy), movements that all form the healthy actions. This is becoming your own coach, so that at any given moment you can think and act to cultivate healthy habits, and in so doing, replace those that have been predictive of the need to protect.

The most frequently described pain experience is during intercourse with the clear impact upon the person and potentially affecting relationships and an ability to conceive. All are greatly emotive. There is often, rightly or wrongly, a sense of wanting to be healthy once again for their partner’s sake. Within this thinking, there can be a sense of guilt with the individual being hard upon themselves, the latter being a common characteristic, and one that needs to be addressed by developing kindness towards self.

UP | understand painAnticipation that a movement or activity will hurt sets up a cycle of protection — priming, expectant thoughts that drive tension and changes in perception, predictions of the need for protect then predominate and sure enough, the experience is painful and the cycle maintained through habit of thought and action. There are many points when new habits can be created from the moment of initiation of intercourse to during intercourse at different points (an anticipatory thought, a sensation of pain) and developing new thinking and reactions by practicing at other times — in essence reconfiguring the whole experience to resume the intimacy rather than fear of pain.

Pain Coach ProgrammeWe are designed to change, and we are changing continuously — it may not always seem like it, bit if you stop for a moment and note how your thoughts, feelings and body sensations shift and move like Constable’s skies, even within a minute or two, you will be aware of this in action. This awareness opens an opportunity to consciously decide to make changes in a direction of health, and in so doing, change your pain with new realisation and action. This all begins with the understanding of pain so that you can take wise action at every moment. The skills that you develop for overcoming vulvodynia you have probably noticed will be transferable to many areas of life because this is about your lived experience, moment to moment. Many women report feeling calmer, noticing more, responding and thinking with greater clarity and generally feeling well and healthy.

Pain Coach Programme to overcome persisting pain problems — t. 07518 445493

05Dec/15
40+60 Feet | Bark |https://flic.kr/p/7rvmbB

Henderson’s heel

40+60 Feet | Bark |https://flic.kr/p/7rvmbB

40+60 Feet | Bark |https://flic.kr/p/7rvmbB

Henderson’s heel has captured the front page of the Guardian sports supplement today. The article claims that he has been told to play through pain as there is no cure for plantar fasciitis–the plantar fascia is a strip of tissue spanning from the heel to the forefoot.

In the general population this problem exists and is typified by first steps soreness on getting out of bed. The pain is often noted on walking, standing and running, in some cases being sore and stiff to begin with before easing and then building again.

The usual explanation is overload, but there is more to it than that. As with any persisting problem, it is not just about the blamed tissue, but much, much more. Similar to tendon problems, when the focus is merely on the structure, the outcomes are limited as are expectations:

“…with my heel there isn’t a timescale, there isn’t really a cure….”, said Jordan Henderson, continuing to describe how he feels, “There have been times when I’ve been pretty down because we couldn’t find the answers”.

Pain problems need to be addressed in line with our modern understanding of what pain really is, a protective device in the face of a perceived threat. The point in time when something hurts is not in isolation to what has been learned or believed beforehand, the meaning, the context and prediction of what may happen. Consider the footballer who attaches great importance to the state and health of their body and their legs and feet in particular. Also think about how these problems are discussed and viewed within the culture of football; all the views and opinions and what they are based upon. An injury deemed to be chronic or long-term has great consequences for the career of a footballer and hence the meaning of this pain is different to an amateur player or someone who does not play football. Much like the violinist who cuts their finger, this is more pertinent when they are about to play a concert — we know that pain threshold is lower in violinist due to the meaning and context. There is no reason to think this is different in footballers and their legs. What is the relevance?

Our pain experience is determined by the extent of threat and not the extent of tissue damage. How threatening to the footballer is the notion of a chronic foot problem? Very. Does this impact on the experience of pain, definitely. Pain tells us little about the tissue state, but much about how the brain is predicting what the sensory input (about the body and the environment) is meaning based on what is thought and believed. Already you should be seeing how the ‘treatment’ of such a problem needs more than local interventions to change the way in which the body-brain-environment interactions are manifesting as pain, in this case in Henderson’s heel.

We are designed to change and hence pain can and does change when you understand it and take the wisest and healthiest action. This action goes upstream of where the pain is felt.

Where do we feel pain? In our body, because this is where we perceive our actions, largely created by brain networks and body systems, yet none in isolation and none predominating. All are vital to have a sense of what is happening right now. And what is happening right now? Our reality in any given moment is created by the sum of all the activity in our body and brain within a certain context. This incorporates habits and associations that create the backdrop for prediction; e.g./ Henderson arrives at the training ground, and even at the thought of running around, the systems that protect us are engaging and priming in preparation so that when he begins to run, threat is assumed based on what is known, what has been and what could be. Result, pain in the heel.

Now, of course there can be an inflammatory response as well, and this may well have been detected on various scans. However, there are different inflammatory mechanisms, the one we know well from injury: think of a sprained ankle; and then neurogenic inflammation that is a feature of on-going sensitivity, when the peripheral nerves are stimulated from on high to release inflammatory chemicals into the tissues they supply, thereby maintaining the cycle. Again, predicting that healing is required, the higher centres trigger this response, and it needs addressing, but not just locally. This is the big problem with tendon treatments currently, the focus on the periphery. There must be an interpretation of what is happening in the tissues and concurrent thinking and feeling to make the experience of pain a conscious one. There is not always central sensitisation at play, but there are always higher centres involved with a conscious sensation.

There is much more to discuss and note in relation to the points raised, but for now we can look at the principles that are important for overcoming an on-going pain problem in relation to Henderson’s heel. Considering that pain is about threat value, the over-arching aim is to reduce the perception of threat and hence the prediction of required protection. This begins with understanding pain so that the individual’s thinking is based on the working knowledge that they are safe. Safe that is, to perform specific and general exercises to nourish the body and move for health. The specific desensitising techniques are tailored to the person who feels the pain, considering the existing associations and triggers. A sensorimotor training programme works to normalise movement from the planning level to the actual execution, thereby creating a new layer of experience that forms the basis for the next prediction; the prediction of safety. Building the tolerance gradually, allowing for adaptation is key. There are a number of ways to go about this, but in essence, the programme is to be lived through the day, moment-to-moment to match the lived experience that is pain.

It is the person who feels pain, not their foot or their tendon. Their tendon or fascia is not a separate entity seeking help. They are merely the place or space in the body where the pain is felt. The biology of the whole experience sits within that that creates who we feel we are, and the richness of that experience in that moment. Hence, we must always work with the person: their body tissues, their environment, their neuroimmune system and how the sum of all of this creates their lived experience. Within each dimension, there are a number of actions that influence the whole. This is how people overcome pain — not their foot; the person. And who are these people that overcome their pain? What do they look like?

They look like you and me. They have a working knowledge of their pain that allows them to exercise and re-train on a basis of the true meaning of their pain, a feeling of safety, diminished threat, the creation of safety in situations once deemed threatening, and they match their lived experience of pain with a programme that is likewise lived, health based, strengths-based and they have a clear vision of where they are going based on their values.

Pain can and does change, beginning with understanding it.

Pain Coach Programme for persisting pain — t. 07518 445493