26Oct/14
Mindfulness

Pelvic pain in men

Many men experience chronic pelvic pain that significantly affects their lives. When we talk of pelvic pain, we often think about women and their suffering, however, this problem is one that besets both sexes and hence we must encourage all who endure such pain to seek help. As with any persisting pain state, pelvic pain impacts upon the way we think, the way we act and the decisions we make, thereby intruding on quality of life.

There are many reasons why men can suffer pelvic pain. To identify all the causes is not the purpose of this blog, but rather to highlight the problem and provide an insight into how the body becomes stuck in a protective mode. This is the experiential dimension, the story that is told and the narrative that provides all the clues. For the pelvic pain itself is downstream, and with chronic pain we must also go upstream to look at the context within which the pain is happening.

Most people who come to see me do not have pathology or ‘damage’ that justifies the pain response that they suffer. Some have nothing of note at all as shown by scans and other tests. Understanding that you can be in pain without an injury is an important step towards changing pain — for those new to this notion, consider phantom limb pain for a moment. Often there is a start point that involves inflammation, which shifts the body into protect mode. Protect mode involves many body systems, conscious and unconscious behaviours (the latter being habits and conditioned responses). When the body is protecting itself, the area needing attention and defending will hurt, but we also move differently and think differently — if you have a painful ankle, you may think twice about ‘popping’ out to the shop for a paper.

In many cases, these protective responses die down as healing progresses. However, this does not always happen, and with statistics suggesting that 20% of the population suffer chronic pain, many continue to experience protection despite the tissues healing — pain, tension, a different sense of the body (there are many other feelings and sensations described to me, and I encourage this narrative so that I can fully appreciate the story). My thinking about this on-going protection is that the body senses all is not as well as it should be. In other words, the individual is not fully fit, the tissues (muscles, joints etc) are not entirely healthy, behaviours are not orientated towards health, and lifestyle factors in which pain is embedded have not been addressed satisfactorily. This is a huge topic to address at another time, but suffice to say, as much as pain is multi-factoral, so is recovery, which is why a programme to change pain must address the biology of pain and all the influences upon this biology (they are also biology!).

Back to the pelvis, an area full of muscles, nerves, blood vessels, ligaments and other soft tissues. From the pelvis ‘hang’ the legs, and on top sits the trunk. And let’s not forget the genitals, and both their importance and necessary sensitivity. The deep tension and pain that one feels in this region is truly visceral, radiating out into the groin and abdomen, accompanied by an awful tension and pulling in the muscles and testicles. Once the pelvis is grabbing your attention, it can be hard to distract yourself without learning how to change body tension.

In this very personal tale of pelvic pain, Tim Parks describes his own journey via the book he wrote, “Teach us to sit still”. It’s a wonderful read for so many reasons, and I frequently encourage patients to tuck in. For me though, the bottom line is that Tim has validated a problem that needs addressing in a comprehensive manner, because so often there is no serious pathology despite the significance of the suffering. Getting to grips with this is part of moving forward and should be embraced. We do not need pathology to hurt. There are other reasons, one of which includes, as Tim says, sitting on your pelvis for 20 years and being stressed — this is by far enough to cause nasty pelvic pain!

What do you do when you are stressed? Tense muscles. This has an energy cost and impacts on the way oxygen is delivered to those very muscles. Consider exercising a muscle over and over. It hurts. It is exactly the same in the pelvis that you may be parked (no pun intended Tim!) on for extended periods of time. “I don’t get stressed” you may say. First of all, I don’t believe you (sorry!), because we all stress out at times and secondly, most of the time we are unaware of what our body is doing in response to our thoughts, environment and what we are doing; that is until it is too late — ooh, my ____ hurts because I haven’t moved for ____ hours (fill in the gaps).

So, what can we do. What do we need to do. Here are a few things that I believe are fundamental to changing what your body is doing:

  • Understand your pain and condition — that’s your clinician’s job, to help you.
  • Create awareness of how your body is responding rather than being on autopilot and then fire-fighting when it gets too much.
  • Think about what the body needs — oxygen to the tissues, especially nerves that become very grumpy when the supply drops (numb bum from being sat too long) — and make sure you do enough to nourish the muscles: move and breathe!
  • Go upstream of the pelvic pain, and look long and hard at your lifestyle and environments — e.g. How are you doing things? Where are you doing things? What habits can you release and change?

Chronic pain is a huge and costly global problem. The main reason why this is true is because of misunderstandings and the low expectations of successfully overcoming the condition (patients and clinicians) because the focus is upon treating ‘structures’ deemed to cause pain. Pain is not a structure, hence why this approach fails. The science of pain has moved forward hugely over the past 10 years and continues to deliver a new understanding. This new understanding challenges existing thinking, and it needs to. Pioneers of pain are hard at work and are finding ways to reduce suffering, and we can. It starts with a change of thinking based on new knowledge. Your knowledge that is translated into effective action.

If you are suffering pelvic pain, get in touch and start your programme to overcome your pain — call us now 07518 445493 — Specialist clinic in London and Surrey for chronic pain & persisting pain

 

22Oct/14
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Girls, stress and pain

I have seen a number of teenage girls over the past year who are affected by chronic pain. They are often referred because of recurring headaches or migraines but we discover that there is widespread sensitive at play. How does this happen? Why does it happen?

Headaches and migraines can be functional pains. When these pains are part of a picture of sensitivity, often accompanied by anxiety, there are often other problems such as irritable bowel syndrome, pelvic pain and jaw pain. Whilst these problems all appear to be different, they have a common biology. Typically I work with women aged between 30 and 55 who suffer these aches and pains, but increasingly this is an issue of the younger female. Having said that, when I explore the story of an adult, we often find reasons for sensitivity that begin in childhood. This priming sets the scene for later events.

As adults we face many challenges. We have body systems that are trigged by these challenges, especially if we think they are threatening to us. In particular the autonomic nervous system (ANS) is quite brilliant at preparing us to fight or run away, which is very useful…..if you are facing a wild animal. On a day to day basis, it is in fact useful for the ANS to kick in and create some feelings in the body that alert us to danger — the caveat being, nothing is dangerous until it is interpreted as so, and hence we need a construct of ‘danger’ and of the thing that is perceived to be dangerous. For example, a baby may not have the construct of a lion and hence sees this big, cuddly, moving….thingy…like my teddy (may not have a construct for any of these either!), and essentially detects no threat. As the baby detects no threat, he or she behaves in a way that may not threaten the lion and hence the lion may feel safe. Both feeling safe, they become friends. Perhaps — these things have happened apparently. Please do not try this at home, but hopefully you get the idea. Back to day to day….

In the modern world we often feel anxious. This is the body warning us that something is threatening. In many cases that I see, there is a strong reaction to banal events and non-threatening cues. Or if the cue is worthy of attention, the response is well out of proportion — e.g. utter panic and defensive thinking-behaviours. To what do we respond most frequently? Definitely not lions. Muggers? Gunmen? Earthquakes? Tidal waves? These are all inherently dangerous situations, that we simply do not often face. Sadly some people do have such encounters but the majority of us do not. The answer is our own thinking. The thoughts that are evoked — seemingly appearing form nowhere at times — are not the actual problem but instead the interpretation of the thought (metacognotion; our thinking about our thinking). The meaning that we give to a thought, often automatically, will determine the body response as our thoughts are embodied. And just to complicate things further in relation to thinking, there’s a world of difference between the experiencing-self and the memory-self. The former refers to what is happening right now, the latter to what we remember, or think we remember. In terms of pain, if our memory of a painful event concludes with a high level of pain, this will flavour the memory-self and we will report as such. The story, which is a snapshot within our lives, and how it turns out has a huge impact upon the subsequent memory of what happened.

The adult within an environment that becomes threatening, the workplace for example, can become very responsive to different cues that once were innocuous. Now they pose a potential danger and each time that happens and we respond with protective thinking and behaviours, the relationship becomes stronger — conditioning. There is no reason any this cannot be the same for younger people who are consistently within an environment and context that begins to pose a threat; a demanding school environment with high expectations plus the child’s own expectations and perfectionist traits. Place this context within a changing period of life and minimal time for rest and there is the risk of burn out or development of problems that involve many body systems. We cannot, no matter what age we are, continue to work at a level that is all about survival.

I focus on girls and women because females outnumber the males coming to the clinic. Many are perfectionist, many are hypermobile, many are anxious, many are in pain and many are suffering. This is a situation that needs addressing worldwide, and starts with understanding what is happening, why it is happens and how it happens. Over the past 10 years this understanding has evolved enormously, providing tangible ways forward. This does not mean that we need to change perfectionism, but rather recognise it and use it wisely; this does not mean that anxiety is abnormal, but rather recognise it as a normal emotion that motivates learning and action; this does not mean that feeling pain is a problem to fear, but rather know it can change when we take the right action; and it does not mean that we will not suffer, but rather accept that part of living involves suffering that we can overcome and move on.

We have created an incredible, fast moving world. The body does not work at such a pace. It needs time to refresh and renew so that we can think with clarity and perform to a high level, achieve and be successful. We are humans. We are a whole-person with no division between body and mind; instead one thinking, feeling, sensing, creating, moving and living entity responding to the experience of the now and to memory of what we think happened. Gaining control over this with understanding and awareness provides a route forward to wellbeing, no matter where the start point.

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If you are suffering with persisting pains — body pain, joint pain, irritable bowel syndrome (IBS), headache, migraine, pelvic pain, jaw pain + feeling anxious, unwell, tired — call now and start moving forward 07518 445493 | Clinics in Harley Street, Chelsea and New Malden

20Oct/14

Chelsea FC – ‘long, long’ injury list

Part of the role of being a manager is to juggle the team according to injuries. The list of injured players in The Premiership at the moment is significant. Jose Mourhino described his list as ‘long, long’, hence the Chelsea manager is being forced to consider his options for the forthcoming games. With the ever-growing costs involved in football, questions about players’ availability are now a routine focus for interviews.

Diego Costa is struggling with a persisting hamstring injury. Leg injuries and pain are the scourge of footballer’s careers, but with a change in thinking, many of the on-going problems can be eradicated.

Certainly players work hard on their conditioning to make sure that their bodies are prepared for the rigour and vigour of the modern game. Time away from running and kicking allows for the body to adapt — muscles and the systems that control the muscles. Active rest is vital and should include a techniques that create calm in the body via the mind. We know only too well the potent influence of the mind upon the body and vice versa. Allowing a negative thought about pain or injury to take hold will affect movement and performance. But, there are effective ways of dealing with this and should be routine for both players and managers.

There is a difference between hamstring pain and a hamstring injury. The latter involves damaged tissue whereas the former does not. Everyone needs to understand this and know how to discriminate — by everyone, I mean players, medical staff and managers. With everyone knowing the facts about pain and injury, communication is open and free, meaning that any stress created by worry and concern is eliminated. One thing that is not good for pain is stress. Why? Because the body will be in protect mode, and this is not compatible with recovery.

Understanding pain and injury is the start point. From here, recovery can be planned and implemented, working with all the body systems involved with injury and pain — and that includes body awareness, sensorimotor function, immune function, autonomic function; all involved with protection. Protection is vital in the initial stage of an actual injury, but as healing takes hold, the biology of protection may need a helping hand to switch off.

Struggling to get back to football? Have a player who is struggling? Get in touch and we can work together to return him or her to play — 07518 445493

 

 

18Oct/14

More Premiership injury woe

Headlines today in The Guardian sport section report that Daniel Sturridge is suffering from a further strain, this time in his calf. I do not know if this is the same leg as the thigh strain from which he has recently recovered, but if so, I would not be surprised. In addition, we learn that Raheem Stirling told Roy Hodgson that his legs were sore. Anyone who plays sports will know that feeling.

A second injury or pain on the same side — why?

When we injure a muscle or ligament, inflammatory chemicals are released locally. Danger-sensing nerves (nociceptors) are activated by these chemicals when their threshold of firing is lowered. Danger signals are sent to the spinal cord, where modulation takes place with signals being sent down from the brain — these are in response to thoughts, emotions, context, perceived danger etc. The danger signals are then sent up to the brain via a second neuron, where an analysis of what is happening takes place. On concluding that there is danger, pain emerges from the body in the place where it is thought the problem lies. The body uses cortical (brain) maps to allocate the pain in the body. Put simply, the biology of pain does not reside in the injured tissues but instead involves the protective functioning of many body systems working together.

Once protection kicks in, pain draws our attention to the area, our movement changes as does our thinking amongst other things. This does not involve only the injured body region, but widespread responses of body systems that protect us from actual and potential threat. The original injury goes through a healing process — we have incredibly potent healing abilities — yet the sensitivity and protection can persist. If, for example, the thigh is strained, it is all the ‘wiring’ that involves the leg that will be on alert. Without full resolution, and this includes confidence in the body, the systems are primed and hence during this period it is easier to ‘pick up’ another injury. Sometimes there is an actual injury and damage, but often there is nothing discernible yet it hurts in the same way. Differentiating an actual injury from the sensation of an injury is important. Players and coaches understanding these mechanisms (of pain) is vital in my view, so that these problems can be tackled efficiently. It would be straight-forward to deliver a mandatory, FA backed education package — contact me for details of an education programme.

In summary, why do pains appear on the same side? Because the initial sensitivity has not fully resolved in the case when no actual injury can be found. If there is a strain or sprain detected, there is a good chance that motor control, body sense and awareness and or confidence are not complete. Of course, there is always the possibility of just plain old bad luck, however I would suggest that it is more likely that the body remains in a degree of protection mode.

Aching legs and recovery

Briefly, the body needs time to recover from the demands of exercise. This can be all out rest for a short period but also active rest that would be a lower intensity of movement and activity; a skills based session for example. There are ways of enhancing recovery that include focused movements and body awareness exercises as well as the practice of mindfulness. We have a great ability to adapt, and in fact our body systems are continually changing and adapting to our lifestyles. This is one of the reasons for chronic health problems in a society that is ‘wired’ and ‘immediate’. Put simply, our bodies are not designed in this way.

Educating players about pain, injury, recovery and health empowers them to make good decisions. With coaches and managers also understanding these principles, it creates a positive culture with clear communication about injury and pain. A player should always feel that he can talk openly about how he is feeling, physically and mentally — although I would argue that these are one and the same because we are whole person: genes, character, personality, experience, knowledge, beliefs, mind, body etc., with no single feature standing above the others.

Contact me for information about pain seminars and training at your club — 07518 445493

 

12Oct/14

Recovering well from surgery

Recent research suggests that we are getting closer to being able to predict how well individuals will recover from surgery (Science Translational Medicine, doi.org/v2p). This will be an important step forward, especially if outcomes can be determined by a blood test that predicts recovery times by identifying the immune signature. The results will need to be repeated, but this is an exciting development.

I see many people who underwent surgery and struggled to recover due to pain or the lesser known sickness response. I believe that with careful observation, listening to the patient’s story and a detailed assessment before the operation, we can identify those who are likely to have problems with pain. It is in part the history that provides clues about sensitivity and also how the person is approaching the surgery. Whilst anxiety and concern are natural, if worry takes hold, anxiety affects the immune system and other body systems, potentially diverting their workings towards protection rather than healing. There are effective ways of preventing this from happening with a proactive programme that starts before surgery and then optimises the recovery after surgery.

Call us now to find out about pre-operative assessments & the post-operative proactive recovery programme – 07518 445493

 

 

12Oct/14

Athletes still on the bench?

Chronic pain exists in sport. It is a frustrating problem for players and coaches alike, and is accompanied by an expensive price tag in professional sport. Similar to non-sporting injuries, there is initial tissue damage (e.g. a ligament sprain) that triggers inflammation, a normal part of healing, which typically hurts. This is meant to happen as a motivator to take action: to protect the injured body and to change behaviour to allow healing to progress.

The focus of treatment is usually the injured body region. Reasonable, you may think. Indeed in the early stages, it is wise to think about creating the right environment for local healing. However, there are responses that go far beyond the muscles, ligaments and joints. It is worth pointing out here that we only ‘feel’ those structures because of how our brains create the experience, this merely touching the subject on how we really ‘feel’. This in mind, it is only logical to think further than the injured tissue in order to comprehensively rehabilitate an injury.

In persisting pain states that present as an on-going injury or an inability to return to the playing field, thinking beyond the body is essential. Why is this player not recovering? The ligament has healed, the bone has healed, there is little or no inflammation on the scan etc, etc. What is going on? Going upstream of these tissues provides the answers. In fact, going upstream will explain persisting inflammation in many cases, and help to break the cycle.

Pain is multi-system, pain is emergent, pain is whole-person. A range of body systems kick-in when we injure ourselves, and sometimes they do not switch off as you may expect. There are indicators at the time of injury that suggest the route forward will be an issue. These need to be addressed rapidly.

I read and hear about treatment and rehabilitation programmes that focus on movement, proprioception, strength, core and the like. All important, but what happens when these fail to get the sports person back to play? What is the reason? The answers lie in the adaptations of the body systems and the beliefs and expectations of the healthcare professionals and the athletes.

Different thinking is needed for persisting, complex and chronic pain.

If you are struggling to return to sport or you are working with a player who is stuck, get in touch and we can work together to identify the problems and how to solve them: call now 07518 445493 

02Oct/14

CRPS Research Update | October 2014 #CRPS

Welcome to the Complex Regional Pain Syndrome Research Update for October, a summary of the latest studies. 

If you are suffering with CRPS, I am here to show you how you can move forward — come and visit the CRPS clinic page here.

Spinal cord stimulation for complex regional pain syndrome type 1 with dystonia: a case report and discussion of the literature.
Voet C1, le Polain de Waroux B2, Forget P2, Deumens R3, Masquelier E4.

Abstract
BACKGROUND:
Complex Regional Pain Syndrome type 1 (CRPS-1) is a debilitating chronic pain disorder, the physiopathology of which can lead to dystonia associated with changes in the autonomic, central and peripheral nervous system. An interdisciplinary approach (pharmacological, interventional and psychological therapies in conjunction with a rehabilitation pathway) is central to progress towards pain reduction and restoration of function.
AIM:
This case report aims to stimulate reflection and development of mechanism-based therapeutic strategies concerning CRPS associated with dystonia.
CASE DESCRIPTION:
A 31 year old female CRPS-1 patient presented with dystonia of the right foot following ligamentoplasty for chronic ankle instability. She did not have a satisfactory response to the usual therapies. Multiple anesthetic blocks (popliteal, epidural and intrathecal) were not associated with significant anesthesia and analgesia. Mobilization of the foot by a physiotherapist was not possible. A multidisciplinary approach with psychological support, physiotherapy and spinal cord stimulation (SCS) brought pain relief, rehabilitation and improvement in the quality of life.
CONCLUSION:
The present case report demonstrates the occurrence of multilevel (peripheral and central) pathological modifications in the nervous system of a CRPS-1 patient with dystonia. This conclusion is based on the patient’s pain being resistant to anesthetic blocks at different levels and the favourable, at least initially, response to SCS. The importance of the bio-psycho-social model is also suggested, permitting behavioural change

RS: With CRPS we absolutely need to consider ‘multilevel’ modifications and adaptations within the nervous system but also how all the other systems that have a role in protecting us are functioning. This often manifests as habitual thinking and activities that maintain protection. Realising these habits, automatic by the nature of being a habit, and making changes with specific training creates new patterns of activity that head towards health.

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Longstanding Complex Regional Pain Syndrome is associated with activating autoantibodies against α-1a adrenoceptors.
Dubuis E1, Thompson V2, Leite MI3, Blaes F4, Maihöfner C5, Greensmith D6, Vincent A7, Shenker N8, Kuttikat A9, Leuwer M10, Goebel A11.

Abstract
Complex Regional Pain Syndrome (CRPS) is a limb-confined post-traumatic pain syndrome with sympathetic features. The cause is unknown, but the results of a randomized crossover trial on low-dose IVIG treatment point to a possible autoimmune mechanism. We tested purified serum immunoglobulin G (IgG) from patients with longstanding CRPS for evidence of antibodies interacting with autonomic receptors on adult primary cardiomyocytes, comparing with control IgG from healthy and disease controls, and related the results to the clinical response to treatment with low-dose intravenous immunoglobulins (IvIG). We simultaneously recorded both single cell contractions and intracellular calcium handling in an electrical field. Ten of 18 CRPS preparations and only 1/57 control preparations (p<0.0001) increased the sensitivity of the myocytes to the electric field and this effect was abrogated by pre-incubation with alpha1a receptor blockers. By contrast, effects on baseline calcium were blocked by pre-incubation with atropine. Interestingly, serum-IgG preparations from all four CRPS patients who had responded to low-dose IVIG with meaningful pain relief were effective in these assays, although 4/8 of the non-responders were also active. To see if there were antibodies to the alpha1a receptor, CRPS-IgG was applied to alpha 1a receptor transfected rat1-fibroblast cells. The CRPS serum IgG induced calcium flux, and FACS showed that there was serum IgG binding to the cells. The results suggest that patients with longstanding CRPS have serum antibodies to alpha 1a receptors, and that measurement of these antibodies may be useful in the diagnosis and management of the patients.

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A CRPS-IgG-transfer-trauma model reproducing inflammatory and positive sensory signs associated with complex regional pain syndrome.
Tékus V1, Hajna Z1, Borbély É1, Markovics A1, Bagoly T1, Szolcsányi J2, Thompson V3, Kemény Á1, Helyes Z2, Goebel A4.

Abstract
The aetiology of complex regional pain syndrome (CRPS), a highly painful, usually post-traumatic condition affecting the limbs, is unknown, but recent results have suggested an autoimmune contribution. To confirm a role for pathogenic autoantibodies, we established a passive-transfer trauma model. Prior to undergoing incision of hind limb plantar skin and muscle, mice were injected either with serum IgG obtained from chronic CRPS patients or matched healthy volunteers, or with saline. Unilateral hind limb plantar skin and muscle incision was performed to induce typical, mild tissue injury. Mechanical hyperalgesia, paw swelling, heat and cold sensitivity, weight-bearing ability, locomotor activity, motor coordination, paw temperature, and body weight were investigated for 8days. After sacrifice, proinflammatory sensory neuropeptides and cytokines were measured in paw tissues. CRPS patient IgG treatment significantly increased hind limb mechanical hyperalgesia and oedema in the incised paw compared with IgG from healthy subjects or saline. Plantar incision induced a remarkable elevation of substance P immunoreactivity on day 8, which was significantly increased by CRPS-IgG. In this IgG-transfer-trauma model for CRPS, serum IgG from chronic CRPS patients induced clinical and laboratory features resembling the human disease. These results support the hypothesis that autoantibodies may contribute to the pathophysiology of CRPS, and that autoantibody-removing therapies may be effective treatments for long-standing CRPS.

RS – as ever we must consider the role of the immune system but in the light of other systems as no system works in isolation to the others. There is vast interaction between the immune system, nervous system, endocrine system and autonomic nervous system to the point where I believe we are a single system interpreting and responding. One response maybe pain as part of protection and our systems become very good at protecting us — this is not to suggest that our systems and ‘me’ are separate entities. Whole person is the only way we can sensibly think about this.

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Local Anesthetic Sympathectomy Restores fMRI Cortical Maps in CRPS I after Upper Extremity Stellate Blockade: A Prospective Case Study.
Stude P, Enax-Krumova EK1, Lenz M, Lissek S, Nicolas V, Peters S, Westermann A, Tegenthoff M, Maier C.

Abstract
BACKGROUND:
Patients with complex regional pain syndrome type I (CRPS I) show a cortical reorganization with contralateral shrinkage of cortical maps in S1. The relevance of pain and disuse for the development and the maintenance of this shrinkage is unclear.
OBJECTIVE:
Aim of the study was to assess whether short-term pain relief induces changes in the cortical representation of the affected hand in patients with CRPS type I.
STUDY DESIGN:
Case series analysis of prospectively collected data.
METHODS:
We enrolled a case series of 5 consecutive patients with CRPS type I (disease duration 3 – 36 months) of the non-dominant upper-limb and previously diagnosed sympathetically maintained pain (SMP) by reduction of the pain intensity of more than > 30% after prior diagnostic sympathetic block. We performed fMRI for analysis of the cortical representation of the affected hand immediately before as well as one hour after isolated sympathetic block of the stellate ganglion on the affected side.
STATISTICS:
Wilcoxon-Test, paired t-test, P < 0.05.
RESULTS:
Pain decrease after isolated sympathetic block (pain intensity on the numerical rating scale (0 – 10) before block: 6.8 ± 1.9, afterwards: 3.8 ± 1.3) was accompanied by an increase in the blood oxygenation level dependent (BOLD) response of cortical representational maps only of the affected hand which had been reduced before the block, despite the fact that clinical and neurophysiological assessment revealed no changes in the sensorimotor function.
LIMITATIONS:
The interpretation of the present results is partly limited due to the small number of included patients and the missing control group with placebo injection.
CONCLUSIONS:
The association between recovery of the cortical representation and pain relief supports the hypothesis that pain could be a relevant factor for changes of somatosensory cortical maps in CRPS, and that these are rapidly reversible

RS – we are either in pain or not in pain. If our focus is elsewhere and we are not experiencing pain, then we are not in pain. Whilst this may sound obvious, many people tell me that they are in pain all of the time. When I ask about times that they feel no pain, an oft given answer is that the pain is hidden at times when they do not feel it. Pain cannot hide. It is on-off, binary. At any given moment, we are either in pain or not in pain. Every moment changes and hence pain can change in a moment — referring to the rapidly reversible change in maps in this article; and why wouldn’t we have the ability to rapidly adapt? I believe we can change and it happens in a moment — our thinking, actions and experiences. Consider how we can be happy in a moment, and sad in a moment. Happiness is a feeling, pain is a feeling. Both have a purpose, to motivate us to do something or think in a particular way. There is a desperate need to change the globe’s thinking on pain, this being my main purpose. In doing so, we can alleviate a vast amount of suffering from pain, narrowing it down the pain that we need for survival and eliminating the pain that persists for no good reason.

28Sep/14

Fibromyalgia in women | #fibromyalgia

I see many women suffering with fibromyalgia. I also see many women who have widespread aches and pains, frequently without an injury, but rather a gradual increase in pain across the body. This maybe fibromyalgia, but in essence we are talking about sensitisation that evolves if no action is taken.

The commonest profile is this: a woman with young children (may have had some problems conceiving), aches and pains across the body, disturbed sleep or too little sleep, always tired, emotions and mood vary, concentration and focus can wax and wane, irritable bowel syndrome (IBS — bloating, pain), migraines, headaches, jaw pain (perhaps grinding in her sleep), anxious, ‘stressy’, very little time to rest and recuperate, repeated bladder infections (often there is no actual infection, but the symptoms are the same) and poor recovery from illnesses. 

There is a common biological thread with these problems. On appearance it would be logical to assume that they are unrelated — many healthcare professionals also take this view. BUT, this is not the case. These functional pain syndromes are all manifest of adaptations in the nervous system, immune system, autonomic nervous system and endocrine system. The good news is that the changes are not set in stone because we are mouldable, or plastic. We learn and adapt according to our thinking, beliefs and actions.

Understanding your pain changes your thinking so this is the initial step. Thoughts are based on beliefs and evolve to ‘I can change my pain’ when you know the facts. First setting up your thinking, then creating a vision to aim for and finally making a definite plan to follow allows you to head towards sustainable change with healthy habits. It is a challenge, but one that is wholly worthwhile.

Women in Pain Clinic is based at 132 Harley Street in London — call now to start your programme and move forward 07932 689081

 

 

28Sep/14

CRPS – the narrative holds the clues |#CRPS

The story told by the patient with CRPS provides insight into their suffering, characterised and brought to life by their chosen language, body posturing, body language, and changing facial expressions. The priming for a condition frequently arises months or years before from an illness, a stressful event, a previous injury or painful event. The way in which the body systems respond to the prior challenge creates a learning experience so that when the body is faced with another similar threat, the responses swiftly kick in. In CRPS this can be with absolute gusto as the level of protection reaches the stratosphere in many cases.

One of the common problems in CRPS is an altered sense of the body, particularly where the condition manifests but this can extend to that whole side of the body. Careful testing of movement precision and sensation identifies these changes as does questioning about clumsiness and the feel of the body. The feel of the body has a substrate in at least the sensory cortex — neurons + immune cells and their neurotransmitters and cytokines.

On questioning, people will volunteer that the limb feels detached, as if it does not belong to them, the sense of size changes and that it does not do what they demand. This is vital information as this identifies a key feature of CRPS (and other pain problems) that must be addressed with understanding and specific training. It is highly unlikely that pain will improve until body sense and precision improves.

So, as a patient you should always explain this feeling, strange (and scary) as it may appear, and as a clinician you should always ask.

London CRPS clinic with Richmond Stace — call now to book your first appointment 07932 689081

28Sep/14

Premiership football injuries — all too common, time to re-think

Opening the sports pages this morning (Saturday), the news is abound with the football injuries in the Premiership. Manchester United report nine unfit players just a few weeks into the season. Nasri is ‘out for a month’ as he is due to have surgery for a ‘serious groin injury’ — if it is a serious groin injury and requires surgery, how can Nasri be back in one month whilst allowing for healing, re-training of body sense and control, fitness and an ability to perform free of any thoughts that impact upon his play? A return without fully addressing these fundamental factors will set Nasri up for a greater risk of future problems.

Just as the thinking in pain, the largest global health burden, needs to be constantly challenged, so does the way we think about injuries in football and sport.

Clubs, managers, fans and players alike want a rapid return to the field. The financial and footballing culture demands that players are back as soon as possible. The pressure is great, but pressure is created by the way one thinks and perceives a situation. Change the thinking and a different system will emerge that allows for improved preventative strategies, full recovery and gradual return. 80% recovered is not good enough, 90% recovered is not good enough; unless of course the risk of re-ignition of pain is deemed to be acceptable. We should always aim for a full and sustainable recovery.

There are simple ways of evolving thinking, beginning with players really understanding pain and injury — for example, the poor relationship between pain and the extent of tissue damage, the many influences upon how we control movement and perform, the context around an injury and how this affects the body’s response. This education and training should equally be delivered to managers, coaches and club owners. The biggest issues are the lack of understanding of pain and the communication around the injury. With understanding of pain and clear communication from the outset, there is a strong basis for optimal recovery.

Some pains come from incidents, such as a tackle (direct trauma) or a turn of pace (hamstring strain), and others from a prior injury that has not fully recovered or emerge as a result of the body gradually protecting itself more and more. This latter scenario develops from incomplete recovery from normal training and match play, i.e. there is not enough rest and recuperation time for normal tissue breakdown-rebuild. Both of these scenarios need greater consideration to keep the players playing. And sometimes, the wisest action is that they do not play.

Drawing upon the neuroscience of pain and performance, persisting injury problems in football can be addressed in such a way as to sustainably reduce the risk of re-injury and on-going niggles. We accept that sport can hurt. But when performance is compromised by factors that we can address, for the sakes of all those involved, we can think differently and take the treatment of injuries to a new level that is all about learning and moving forwards.

If you are a player struggling to return to play or a club, call us now to start your recovery: 07932 689081