14Mar/16

Physiotherapy Dystonia Network Meeting

Last week was the Physiotherapy Dystonia Network Meeting in Birmingham, attended by physiotherapists who work with people suffering dystonia who wish to engage in conversations to further our understanding and impact upon this condition. Chaired by Dr Marie-Helene Marion, it was a day of engaging conversations, led by pertinent, short talks that shared knowledge and experience. One aim is to develop the network, which would further the awareness of dystonia and create opportunities for clinicians to build their skills and knowledge together.

I was asked to talk about my approach to cervical dystonia (see my slides here: http://www.slideshare.net/RichmondStaceMCSPMSc/physiotherapy-dystonia-network-meeting-11th-march-2016). Similar to the way in which I approach persistent pain, the programme is neuroscience-based coaching and treatment for cervical dystonia.

Beginning with how Dr Marion and I met, and how we shared stories of chronic pain and dystonia before realising that there was significant overlap in the characteristics and hence approach that could be taken, I then provided some background as to why I do what I do with people suffering cervical dystonia. I emphasised the over-arching need to consider the whole-person, their story and how their narrative fits within their life as a lived experience.

Cervical dystonia is a condition that sits at the root of the sense of self. We face the world with our bodies and the way in which we move, posture and gesture communicates with others. Yet this moving and posturing is affected by the way we feel, where we are, who we are with, what we have been doing, what we may do in the future moments (and we may not be aware of what that will be in any given environment), and hence the final product of movement is the brain’s best guess as to what we should be doing in the light of the current evidence, based on past experience. And the brain does not always get it right! Of course we are not separate from our brain; we are our brain, our body, our mind and our reality as created by the sum of these within a particular environment.

Despite this seeming complexity and perhaps departure from the classic model of mind-body separation, a moment’s thought and we soon realise with some simple examples that embodied cognition is a useful way of thinking about the way we exist. Where do you feel anxious? Usually in your abdomen or chest although anxiety would be considered a ‘mental’ experience. Trying to separate body and mind does no justice to our lived experience and reduces the impact of any treatment programme.

Having briefly covered this, I described some of the training methods that include motor imagery, visualisation, sensory discrimination training, proprioception and motor training. None of these are discreet but instead are moulded together in the form of a comprehensive programme to create new learning experiences towards a more normally functioning sensorimotor system, but remembering that this ‘system’ works closely with emotional, attentional and motivational areas of the brain, that is of course part of the whole person, residing within their reality and perception of life to date. Nothing happens in isolation. We seek to restore a sense of self; who we feel we should be.

My talk was brief and hence only able to scrath the surface of some important considerations, especially the need to set the scene for training by helping the person develop their thinking and self-coaching skills. The aim now is to expand this talk into a day long learning experience that looks at each area and how they tie together into an approach. Keep an eye on the website and twitter for updates (@painphysio). There will also be a series of blogs, considering some of the key issues in cervical dystonia to follow.

If you would like any further information, please do get in touch: 07518 445493

Useful links:

The British Neurotoxin Network

The Dystonia Society

 

24Feb/16

Chronic fatigue syndrome

Chronic fatigue syndromeAn excellent article by Jo Marchant addressing chronic fatigue syndrome recently appeared in The Observer. Interestingly, the following question was posed, “Is it physical or mental – or a combination of the two?”, highlighting the on-going dichotomy that is seen to exist in both society and in healthcare.

I spend a fair amount of time helping people to understand their perceptions and experiences, usually involving pain and suffering. This is about giving a meaning to their pain, validating their lived experience before looking at the ways in which they can change direction towards a healthy and meaningful existence. Importantly, a vital part of this working knowledge is understanding that there is no body-mind separation. There is a general shift towards people’s acceptance of this fact, yet there is still some way to go before this could be seen as mainstream thinking across society. However, this is certainly not alternative thinking, as we have a significant amount of scientific and philosophical literature that is dedicated to this very question.

To answer the question quoted at the start of my blog, chronic fatigue syndrome is not physical, it is not mental and it is not a combination of both. Chronic fatigue sydrome is a whole person experience, much like pain, when the symptoms emerge in the person, in a location or in locations felt and described anatomically for convenience. Yet the biology of both CFS and pain exist well beyond where the feelings are felt. Similar to the notion of mind that does not only exist in the head, or the brain or behind the eyes as can be thought. There are no controllers pulling knobs and turning dials behind our eyes, although there can be the sense that we ‘see’ the world, the perceived world, through these eyes, creating the illusion that the thinker is in the cranium. Fascinating.

However, my mind exists in me, the whole person. I think and I am my whole body and my whole body is the thinker, hence there being no separation. As a simple example, anxiety is usually viewed as a psychological state of mind, yet where do we feel anxious? The stomach, the gut, the chest perhaps. Not in my head, that’s for sure. Same for pain — it is not in the head!!! I am sure many readers have either heard this about pain, either as a patient or a patient tells you that is what they have been told because no ’tissue’ or structure has been found to explain their pain. This is actually because structures do not explain pain as many now know.

Accepting the notion of a whole person opens a range of avenues for therapeutic purposes as we seek to give the person suffering symptoms the knowledge and skills to resume a meaningful and healthy life. The key principle and underlying thinking (with my whole person as the clinician or therapist) is that the individual in front of you is complete and the sum of parts that only exist as a whole — e.g./ as we are conversing or exploring movements (also known as tests, assessments etc.), seeing how the that person moves and experiences movement or expresses themselves with certain words and gestures that illustrate the meaning that they wish to convey.

The aim of a health-giving programme is to provide the individual with the knowledge and skills he or she need to overcome their problem and steer their change (we are designed to change; it is one of the very few definites) to a meaningful life. There maybe treatment within this programme, but in essence it is about giving the person the independence with regard to thought and action, which they understand are emergent from themselves as a whole person, enabling and empowering decisions that lead to action that is congruent with health. Understanding this means that the individual knows which levels they can use, combining movement and thought for best outcomes. This would include working knowledge of symptoms allowing for wise thought and selecting best action, specific techniques and strategies that promote the meeting of basic needs (i.e./ nutritional intake, fluid intake, security, movement, rest), movement and exercise for health and building tolerance for activity, resilience and motivation, and skills to deal with unhelpful and distracting thoughts (e.g./ practical mindfulness). These are some of the key elements of the Pain Coach Programme, when you become your own coach, conceptualised as a compass that one can use to determine current direction and motivate a shift in direction when needed, moment to moment. Essentially, with chronic fatigue and pain as lived experiences, it is the moment to moment thinking and actions that are vital in heading towards the healthy you.

********

Contact us on 07518 445493 | Pain Coach Programme for Health & Living

 

 

13Feb/16

Tendon pain

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

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

Tendon pain has been a big topic for some years. The problem is seen commonly in the clinic and frequently poses a challenge because so often tendon pain persists. Local factors and nociception are typically blamed, yet when treatment is focused at the tissue level, the limitations are exposed. As an aside, tissue based strategies are cited, yet there is really no such thing as a tissue based treatment simply because the tissues are not separate from the person. They are the person, and of course the person knows that something is being done to them and hence emotions and thoughts are at play, affecting the outcome — consider the person who observes your hands whilst you mobilise or massage whilst remaining calm and curious versus the person who is anxious, guarded with their hand poised and ready to grasp your hand as you start treatment; the latter person demonstrating why it is vital that the threat value be diminished before starting any intervention.

Pete’s excellent blog about tendon pain acknowledges the person, perhaps for the first time in tendon literature, which is music to my ears. Having been heavily influenced by Oliver Sacks, my philosophy has always been to consider the person as much, if not more than the condition as it explains how a particular issue manifests uniquely in that person. Certainly in my mind, the ‘initial assessment’ for me is about getting to know the person, which then rolls into their own experience of pain.

I first started looking with interest at tendon pain some ten years ago as an example of a persistent condition in sport. With an interest in chronic pain, it appeared that the discussions about tendon pain remained within the boundaries of where the pain emerged, yet our understanding of pain had advanced to the higher centres and many body systems involved in the experience of pain. Even nociception was discovered as being an incomplete picture as this biological process can be afoot with or without pain. Detection of threat does not mean it has to hurt, and indeed nociception itself is not something we actually feel. However, when the brain (which is of course part of the person and not separate, although our language does sometimes suggest this) predicts the need for protection, pain emerges in the person in a location deemed under threat or potential threat. This complex activity, which includes consciousness and the mind (these are both small subjects……..), is a whole person experience that is lived moment to moment and hence a focus on what happens in the tendon is only part of the picture. There is still very little acknowledgement elsewhere within the hierarchy, so here are a few thoughts I would like to share.

Previously I have expressed the view that we treat, advise and educate a person; a whole person. The approach that I favour is one that delivers the (working) knowledge and skills for the individual so that they can overcome their pain problem and resume a meaningful life as defined by themselves. Fragmenting for convenience is common, breaking down a whole into parts, yet this can never give a full picture. Medicine and healthcare typically specialise and whilst this has value, in the case of a persisting pain that often means that people fall between the cracks. For example, a female with fibromyalgia, IBS, migraines and pelvic pain may be seeing a rheumatologist, a gastroenterologist, a neurologist and a gynaecologist, and whilst elimination of anything pathological is important, there is an understood common upstream biology. Interestingly, many of these cases also have tender tendons that can be a surprise to the person when the tendons are pressed, especially considering that they are not the primary reason for seeking help.

Nothing happens in isolation (is one of my favourite phrases), and hence the biological expressions in and around a tendon are not separate from the mechanisms that underpin how pain arises in our consciousness. We cannot explain how this happens — how do chemical reactions in our body become a lived experience? Despite the lack of an answer, it clearly involves more than the tissue or structure alone.

This is not to say that the brain and the mind alone are responsible. Where is the mind? Where is the seat of the mind? Again, we do not know. Yet surely the mind is not just in the brain, an argument put forward by supporters of embodied cognition. It is me that thinks, not my brain or my mind, but me. And I think with my whole person because I am a whole person, and indeed when I feel pain, it is me that feels pain and not the body part where I feel it. Because I am more than that body part, the experience of pain must involve the whole person in that moment in that context. It is also true to say that to be in pain, we must be thinking that we are in pain as much as experiencing the sensory qualities of pain. Thinking draws our attention to the said experience, otherwise it is subconscious and hence not occurring to me.

For tendon pain, practically speaking, we must of course consider the health of the tendon itself and surrounding tissues, but also the person’s general state (who are they, how are they), prior experiences relevant to the problem (e.g./ tendon pain, pain, general health), beliefs, expectations, vulnerabilities to developing persistent pain, their story of how the pain emerged, their movement patterns (and why they are moving in such a way; both at the planning stages of movement and actual movement), body sense and sense of self at the very minimum. This information is gathered within the first conversation, setting the scene as trust and rapport develops naturally from exploration of their story that validates and empathises.

This is a mere and brief overview of my thinking about tendon pain, which poses a significant clinical problem, often persisting for longer than is expected. Whilst the focus remains on the tendon and nociception, there will be limited results in my view as this only tells a part of the story of the person in pain. This is true for any pain, and not just tendon pain. Pain emerges in the person and all that that person means and embodies, hence we must address the person as much, if not more than the condition. As Oliver Sacks wrote on his father, a GP: ‘He knew the human, the inward side of his patients no less than their bodies and felt he could not treat one without the other’. So true and this has always been my abiding principle.

Pain Coach Programme | t. 07518 445493

08Feb/16

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 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

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

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

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

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

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!