18Sep/15

Sports injuries that don’t go away

Jan-Joost Verhoef| https://flic.kr/p/6qqqCU

Jan-Joost Verhoef| https://flic.kr/p/6qqqCU

There are many cases of sports injuries that don’t go away. They linger on and on, becoming increasingly impacting as the sensitivity builds, often accompanied with varying patterns swelling and stiffness. Understanding what is happening is the key to deciding upon the right action to change course and recover. The way that your body and you respond is determined by the circumstances of the injury, prior experiences (injured the area before? previous injuries?), beliefs about pain and injury, genetics, the immediate thoughts and messages given by others and the action taken at that point, including pain relief. Here are some of the reasons:

  • The circumstances of the injury: how healthy you are, how you are feeling at the time, where you are, how the injury happened (your fault? Someone else’s fault? An accident? In fact, it is how you perceive it that is important, not the actual reality), your first automatic thoughts, the time of the game, the importance of the game — all of these factors come together, physical-emotional to create a memory of that moment, the pain intensity determined by the perceived level of threat, and not the extent of the tissue damage (consider the player who has a break but does not realise until later). The way you and your body respond to an injury will be very different if you are stressed vs relaxed for example.
  • Previous injuries leave their mark in terms of how you think about them and the associated pain. If you have injured the area before, then there is a greater likelihood that it will hurt because the body will protect more readily. If you have had a good or a bad experience before, this affects how your body systems that heal and protect will kick in.
  • Your beliefs about pain and injury that began to be sculpted in the early days of bumps and bruises and in particular how people around you reacted — too much mollycoddling by parents/teachers is perhaps not great for how we learn to deal effectively with injury; that’s both in the way we think but also how our biological systems work. What you are thinking will impact upon the pain (‘I must get up and play on in this cup final’ vs ‘it is the end of my career’ = very different biologies), and hence the early messages given by the clinicians and therapists must be accurate and calming.
  • It seems that we can have a genetic predisposition to over-responding to injury, with inflammation kicking in as it should but more vigorously. Some people are more inflammatory that others so it seems.
  • The early actions after an injury, including the messages as mentioned above, are really important to set up healing. It is normal for an injury to hurt, however in cases of severe pain, this needs to be addressed with the right analgesia. Early high levels of pain can affect the trajectory of the problem.

For these reasons and others, some injuries appear to persist or recur, which is highly frustrating for the individual, and for the therapists. Sometimes the factors mentioned above set into place a level of sensitivity and certain protective behaviours that mean protection is vigorous — this in terms of the way the person thinks, acts and their biology plays out. This needs to be identified as quickly as possible so that the right treatment can be administered alongside working with the player to developing his or her thinking. Whatever is playing out in their minds will be affecting their biological responses, in a positive or a negative way, so we must intervene or encourage depending on the predominant thought processes.

When an individual is experiencing an on-going issue there are a range of factors to consider and address, some relating to the points above. Hearing their complete story is a vital start point, including an understanding of their perception of the events to date, as well as prior experiences that will flavour what happened then and what is happening now.

Here are some examples of the common features:

  • Often the body continues to try and heal, squirting inflammatory chemicals into the area periodically or in response to movement. This is neurogenic inflammation and sensitises just like inflammation from a fresh injury and is part of the sensitised state, but co-ordinated by higher centres
  • Rarely does the person understand their pain, which creates worry and concern. Remember that chronic stress can make us more inflammatory — also consider other life stresses as these will impact; if the body/person is in survive mode (fright-flight), then resources for healing and recovery are limited.
  • Altered movement patterns, in part from fear/lack of confidence but also as part of protect mode. These must be re-trained from the right baseline (often people start too far down the line and fail)
  • A belief that there is a re-injury when in fact it is a flare up, or an increase in sensitivity, not an actual injury

In brief, we must ensure that the individual’s thinking is right — understand pain and injury, their pain and injury — and that they are taking the right actions towards recovery (a negative thought or over-training will not take you towards recovery); but they need to be able to think clearly about this themselves, because they are with themselves all the time whereas the therapist is with them periodically. They need to become their own coach, which is why I developed the Pain Coach Programme — not only are we coaching them, but also teaching them to become their own coach. When the understanding and thinking is in place, the training and exercises are all straightforward. I use no fancy tools or kit to coach and treat, except of course the most fancy piece of kit we all possess, our brains! But let’s not be all brain-centric; we are talking whole person. It is the person who is injured, not their leg or arm; it is the person who feels pain in the context of who they believe they are and in their life, not a leg or an arm. The person feels hungry, not their stomach. Remembering this when educating, coaching and treating creates the right thinking platform.

Pain Coach 1:1 Mentoring Programme for Clinicians — see here or call us 07518 445493

14Sep/15

Cervical dystonia

Keoni Cabral | https://flic.kr/p/9EVhyB

Keoni Cabral | https://flic.kr/p/9EVhyB

Cervical dystonia (CD) is a movement disorder that is characterised by unwanted and involuntary spasms of the muscles in the neck and shoulder region. It can also affect the facial muscles. There is a genetic aspect to cervical dystonia but frequently, people who come for the treatment and re-training programme will describe a period of stress when the problem really took off.

It is not uncommon to hear that the diagnosis eventually came some years after the problem began. Typically a neurologist will diagnose dystonia, although an informed GP or physiotherapist may also identify it from the twitching, pulling and sometimes writhing movements that are cleary involuntary.

Cervical dystonia can be a distressing condition for a number of reasons: the pain and discomfort from the constant tugging, the continuous battle between opposing muscles and attempted conscious corrections, the awareness of others looking, the way that the movement patterns and body sense affects how you feel and your sense of self, your self-esteem and confidence in social situations, perhaps hopelessness in the face of the persisting symptoms; all impact on the condiiton itself and your hopes and expectations.

In conversation with people with CD, we usually identify certain traits such as perfectionism, obsessiveness and a lack of compassion towards oneself (self-critical). In addition, there can be a heightened awareness towards the body, including aesthetically–how do I look? Combining the desire to look a certain way with the manifestations of CD and there is a great deal of angst created.

Modern treatment is often led medically, once diagnosed, 3 monthly injections of botulinum toxin are typical. With the right dose and careful placement of the injections, this creates a great opportunity for sensorimotor re-training. Whilst the training is the mainstay of improving movement, there are a number of other considerations, the so-called non-motor factors. These must be addressed within a treatment and training programme. Merely focusing on the senses and movements is simply not enough, and indeed when we purely attend to a problem at the expense of all else, it will increasingly dominate our thinking. So in a way, to treat a problem, we should not always treat the problem!

Sensorimotor training develops normal body sense and movement, the two being absolutely interrelated. Without good body sense, you cannot move with normal precision, and when we move abnormally, or what is deemed abnormal by the motor system, then our bodies can feel different. When our bodies feel different, the way in which we engage with the world changes and so on. Specific exercises and techniques are used on a ‘little and often’ basis, which are simple and do not require equipment except a mirror on occasion. They necessitate practice like any training that is designed to improve performance, in this case precise movements for everyday life.

Where there has been and is on-going tension from overactive muscles, these body tissues and the underlying joints that are limited in movement by the tension, require nourishment with easy and regular movements. This often works best after a period of relaxation from breathing exercises or mindfulness, both of which promote better blood flow and oxygen delivery. I call this ‘motion is lotion’, a term that I did not coin but use with everyone I see to encourage healthy movement, whether for chronic pain, dystonia or both.

The way we move and the way that our brains plan movement based on predicting what we may do in a given environment, is affected by many factors: e.g./ how you are feeling, what you are thinking, who you are with, what you have been doing, how tired you are, what you plan to do, what your brain predicts that you may do, what you have done before in that environment, to name but a few. You will not be aware of many of these, but you’ll be aware that your spasm or pulling worsens or eases depending on certain circusmstances. Identifying these circumstances and situations allows you to begin dissolving these associations and habits, creating new patterns of movement. Remember that we are designed to learn and change, with opportunities to do so existing at all times.

Spending some time doing something that is meaningful to you is a great way of focusing on something else. Many people with dystonia find that when they are in full flow, the spasm and pulling ease off. This can be when painting, speaking, reading or listening to music. Even if during a meaningful activity you notice the symptoms, you can practice and improve, acknowledging the symptoms and returning your attention to the favoured activity. The pleasure that you gain and the realisation that you can attend elsewhere is part of overcoming the problem.

Mindfulness practice and relaxation play a significant role in changing the brain state, immune state and dampen down other systems that work to protect us including the sensorimotor system. When we perceive a threat, the muscles tense up in readiness to fight or run away. This is a basic biological function that does not help the already overactive muscles of dystonia. Mindfulness is not a spiritual or religious practice but rather a practical way of looking your thinking rather than becoming embroiled in thoughts and living out the past or future in your head. The techniques are simple and can be practiced anywhere.

This is a brief insight into both the condition and some of the ways that we go about changing your experience with a training and treatment programme. As ever, it is the person who needs treatment as they are living the experience of dystonia (it is not the neck experiencing dystonia), much like it is the person who feels hunger, not their stomach that feels hunger. Thinking widely and individually is key to successfully changing the unwanted movement patterns and easing the symptoms, allowing for the resumption of a meaningful life.

For more information or to book an appointment, call 07518 445493

14Sep/15

Neuroplasticity and impermanence

Licorice Medusa| https://flic.kr/p/Hu2gG

Licorice Medusa| https://flic.kr/p/Hu2gG

I was asking myself whether neuroplasticity and impermanence are related and how this dynamic would work on a practical level. Concluding that there is some usefulness in relating the scientific neuroplastic characteristics to the Buddhist philosophical construct of impermanence, I have briefly shared my thoughts here.

Neuroplasticity refers to brain cells’ (neurons) ability to change at synaptic and non-synaptic levels. The synapses are where neurons communicate and hence the communication can change, whereas non-synaptic changes occur in the axons and dendrites (structures of the neurons). Impermanence is a fundamental part of Buddhism whereby it is agreed that nothing is permanent. In other words, change is constantly afoot as each moment passes to the next and so on.

On the basis that we are continually learning and changing with each and every new experience, moulding our reality in that given moment, it is highly probable that neuroplastic changes are underpinning our lived experience. We are of course on a continuum, begining with a blank slate to be filled as we progress through our life, genes being appropriately sculpted through exposure and meaning and creating what is a rich, textured existence. The fact that no moment is the same and each is so fleeting, fundamentally means that change is a constant and a definite and hence nothing about existence can be permanent.

Whilst we like to attach ourselves to various things such as our partner, our body, our beliefs, all of these are constantly changing too, alongside the changes that we are making. This constant dynamism is what makes life so fascinating, piquing our curiosity at each and every turn with the unfolding of events. It is worth considering for a moment (that has just passed) that the past does not exist anymore, except in our unreliable memory, and that the future does not exist, except in our minds that attempt to anticipate and guess what may happen. You can argue the usefulness of predicting the future in order to make plans or indeed the recall of a past event to learn. Whilst this may have some use in certain situations, the large problem remains that when we ‘re-live’ a moment passed or project ourselves forward, the whole person responds as if actually there with all the same emotions, physiological responses and on-going thoughts–we feel it and live it. Through these lived experiences, which are invented and illusory, we then further sculpt our biological machinery, priming ourselves for what is to come.

Think about someone who bumps into you on the train. If this annoys you, do you carry on thinking about it or do you let it go? What mood were you in when it happened? In a tired, grumpy state, you may retort with anger; whereas a compassionate mood would see you forgive or even laugh. And what happens next when you arrive at work? How has that moment framed the next? With ever passing moments, impermanence at play, the realisation of this moving film in which you are the author, director and the star who can make choices moment-to-moment is a potent one.

So, let us enjoy being plastic and discovering the full impact of neuroplasticity (much is said about this nowadays, yet there is a great deal to learn about how changes in synaptic activity translate into real-time experience, learning and behaviour) and impermanence as these are characteristics we can use to grow and develop to take on challenges. Certainly in terms of pain and chronic pain, to understand that we are constantly changing creates realistic hope that pain can also change. Pain does change when you understand it fully and take healthy actions based on sound thinking.

Much of my time is spent with people suffering chronic pain, coaching them and treating them, harnessing their own ability to grow and change with new knowledge and skills that are employed to overcome their pain. Witnessing their change is an incredible priviledge as well as a wonderful example of neuroplasticity and impermanence.

 

12Sep/15

The interoceptors

Chris Jackson | https://flic.kr/p/e9U1Ku

Chris Jackson | https://flic.kr/p/e9U1Ku

The interoceptors. It sounds like the latest box set action hero series in which the heroes, the interoceptors, save the world from a terrible threat in the shape of _________. You can use your imagination to fill in the gap. Close your eyes and think of something that causes on-going suffering to millions of people.

Alas no, for the interoceptors are the actual sufferers. You may have filled the gap with an alien-shaped villain, or you may have thought of chronic pain–no surprise for regular readers.

Interoception is the term used to describe the inner sense of your body’s physiology — some reading here and here. This ties in inextricably with your sense of ‘self’, who I am. Some debate that the sense of self is an illusion and Buddhists purport the belief in non-self; just to give you some background on the subject of self, which is indeed absolutely fascinating and relevant to pain.

Another term used in the literature and sometimes in the clinic as a result, is hypervigilance. This is often paired, or followed by catastrophising. What a couple of words! Anyhow, in essence they mean that the person is readily aware of feelings and sensations in their body, in themselves that is (the two are not distinct), and then attribute these to something bad and hence provoke on-going negative thoughts and feelings. This is one of the contributing cycles to pain, as the persistent negativity affects thoughts and behaviours that impact upon the pain itself–intensity, on-going attribution, moment-to-moment choices etc.

Interoception being the very sensing of physiology from within (exteroception is without), that is apparently amplified in many cases of on-going pain, mean that people feel sensations in their body (some pain, some non-pain) and are so aware, that this completely occupies their experience in that moment–there is only one real moment, and that has just passed, as has that one, and that one; the point being that past and future are in our minds, the only real moment is the one passing..now…now etc etc. We can really only attend to a few foci at any one time and if much of our capacity is taken up with monitoring how our body, how ‘ourself’, feels and what this means, there is not much room for anything else! It is exhausting and increases perceptions of these sensations including pain. It is a habit.

Pain is all about threat. When your body systems that protect you are activated in the face of a perceived or actual threat (the former occurs more and more and in relation to non-threatening cues in chronic pain), the ensuing protection includes pain as well as a range of other responses. When the perceived threat diminishes because it goes away, heals up or we comfort ourselves for example, the pain subsides, sometimes very quickly. When we are vigilant to body signals and then over-worry about what they mean, including normal feelings that then become misinterpreted, this increases the threat, and hence the likelihood of pain.

For all these reasons then, understanding pain and the associated aspects of the pain experience are key: e.g./ attention, focus, expectation, awareness, thoughts, feelings, emotions.

The interoceptors*, in case you haven’t twigged, are people who are very aware of the feel of their bodies, logging many of the normal sensations and worrying that these feelings are problematic or part of their pain issue as well as feeling aches and pains and considering them to be signs of danger, and hence increasing the threat. Most people with persisting pain develop this habit and need guidance and experiences to change this, re-focusing their energies on the right thinking and actions.

* Just a brief note on this apparent labelling — I am not a fan of labelling, hence this note. No-one is any ‘one’ entity; we all have different and unique blends of characteristics that change according to how we are feeling, perceiving the current moment, where we are, who we are with, what our brains are predicting we may do with that person or in that environment etc).

The Pain Coach Programme for chronic pain | 07518 445493

25Aug/15

I am in pain

We often say I am in pain but does this really describe what is happening. Knit-picking perhaps, but I think that what we say, the words we use and the way that we use them are fundamental to being human and who we are as individuals. The innumerable phrases that have been passed down the generations will have their origins in a time was very different. So how relevant are they now? And how useful?

Someone says to you, I am in pain and instinctvely you know what they mean. You cannot possibly know what they feel or how they are feeling it, but you know that they are feeling something unpleasant and want you to know about it. There is a point to telling others about your pain, perhaps to seek help or advice, to gain sympathy or to give reason for non-participation for example. These are all accepted reaons for sharing, and would typically be known as part of the social dimension of pain.

However, we cannot really be ‘in’ pain. We can feel pain, pain can emerge from our very being (this includes our body) and pain can hurt, but you cannot be in pain. You can be in a house, a car or tent. Being in something suggests that you can get out. If you say that you are in pain, it suggests that you can get out of pain. Now, pain changes and is transformed (we are not in a constant state of anything, hence pain comes and goes like any other state–pain is part of a protective state), but you cannot get out of pain because you cannot be in pain. There is no entrance or doorway to pain that once you have entered requires you to find an exit.

Should we change our terminology and what effect would that have? I don’t think it will really change anytime soon, however when clinicians are thinking about the pain being described by an individual, it is more accurate to  consider the whole person from where the pain emerges in a particular location, with the underpinning biology involving many systems upstream of the lived experience. A story book requires a reader, words on a page and the book to be bound together. The book is the body that is read yet the reader must take the words and create a meaning, a story that makes sense, lived in his or her whole person–a beautiful description is felt and lived through the whole person involving complex biology that is a blended mind-body; embodied cognition. Our body is a story book yet the story is our experience. Changing the terminology will occur with time and as the understanding of pain evolves.

The growth of pain understanding is vital as a basis for informed choices and treatment choices–one of the biggest reasons for chronic pain being the number one global health burden is the lack of understanding, whereby the medical model continues to predominate treatment choices; i.e./ target treatment at the place where pain is felt in the body. This misses the point of pain as part of the way in which a whole person protects himself/herself, and indeed much of our common language contributes to an old belief system that our generation has been brought up upon. Evolution takes time and of course a new and more complex explanation to replace one that is simple, will be threatening. Nonetheless, this is where we will go as people experience failed treatments or do not reach the expected outcomes alongside developments in pain science that become increasingly known in the public domain. This knowledge will demand that things continue to change, and as a result so will our language. As is common though, this is a two way street and if we take opportunites to change our language, then we are using the social dimensions of pain to create learning opportunities that lay the foundation for perceptual shifts. And there’s one thing that changes pain, and that’s a perceptual shift.

Richmond with Georgie Standage co-founded UP | Understand Pain, a campaign to raise awareness of the problem of pain and what we can do to overcome pain — we are no longer managing pain, we are changing pain and coaching people back to a meaningful life. The next UP event is in October when more than 1000 singers will be performing; even more than last time! 

The Pain Coach Programme is a comprehensive strengths based approach to overcoming pain. Call us on 07518 445493 to start your programme.

20Aug/15

Pain and compassion

puppy love by Porsche Brosseau https://flic.kr/p/cu9h5h

puppy love by Porsche Brosseau https://flic.kr/p/cu9h5h

Pain and compassion are being explored at a forthcoming British Pain Society Conference, so I thought that I would comment on a couple of important aspects.

Firstly, as clinicians compassion plays a role in our desire to guide and treat others in pain and most likely coloured our choice to become a health-carer in the first instance. Secondly, I find that the vast majority, if not all those I see are compassionate people to everyone (or most!) except themselves. Here are some brief thoughts.

Compassion is defined as ‘inclining one to help or be merciful’ (Oxford Dictionary). The Dalai Lama describes compassion from a Buddhist viewpoint: ‘Compassion is said to be the empathetic wish that aspires to see the object of compassion, the sentient being, free from suffering’. There must be an object of compassion that is another individual or of course the one that is often forgotten, oneself.

The feeling of compassion is often described as a warmth across the chest; the type of feeling associated with seeing a small, defenceless animal, or perhaps a newborn child. This feeling enhances our empathy, which drives actions of kindness towards that being. As a clinician there are clear benefits of cultivating a compassionate approach towards patients who suffer the consequences of pain, particularly on-going pain. Certainly compassionate listening and actions are skills to be nurtured as they envelope the therapeutic encounter with essential authenticity. Compassion also creates an environment and a context for effective and skilful communication; an openness that encourages the patient to express themselves as themselves, revealing the challenges that can be surmounted with a joint therapeutic effort. The importance of the clinician being kind to himself or herself is akin to that of the patient. Looking at ways to grow and flourish, to be a better clinician requires acknowledgement of the current standing, acceptance and a desire to improve, yet without self-criticism.

Frequently patients will illustrate their harshness towards themselves. This punishment and criticism fosters angst, frustration, anger and other negative emotions that are draining, damaging and ultimately wasteful as energies are put into everything but clear thought and action towards improvement. At any given time, one does his or her best based on their knowledge and skills — everyone makes mistakes, which the wise learn from and see the opportunity in errors, the opportunity to develop. Learning to be kind to oneself, often breaking a habit of some years (many people I see are perfectionists; but in some arenas this trait is very useful and a strength that enables high performance resulting in success; so let us learn how and when to utilise it), is a vital part of learning how to overcome pain, especially persisting pain.

Here are several videos that are useful to that end:

Learning about compassion towards oneself and others is part of the Pain Coach Programme for overcoming and transforming persisting and chronic pain. Call us to book your appointment: 07518 445493 | Clinics in London | Sessions available on Skype on request

12Aug/15

I’ve been diagnosed with CRPS

Budapest | Moyan Brenn http://bit.ly/1EnHXWp

Budapest | Moyan Brenn http://bit.ly/1EnHXWp

I’ve been diagnosed with CRPS. This is a common way that the conversation begins with people who contact me, often scared witless by what they have found out online or by what they have been told. Others are confused and do not really understand what CRPS means, except they know it hurts like hell and has turned their life upside down.

Before reading any further, have a look at this link that outlines the latest criteria named after the place where it was recently established: The Budapest Criteria 

Complex Regional Pain Syndrome, also known as RSD (the old term — reflex sympathetic dystrophy), like any ‘syndrome’ is a collection of signs and symptoms that are gathered together and given a name. However, CRPS is complex (biologically), it is regional (usually affecting a limb), it is painful (one of the worst), and as I said, a syndrome. There you have it, CRPS.

Many people like to have a diagnosis, a label and a peg on which they can hang their hat. A diagnosis is useful if everyone then understands the implications and the treatment is standardised thereafter with effect. This is not the case with CRPS as few really seem to understand the condition.

Depending on where you go, you will be in receipt of treatment that varies according to the profession you see. Medically you are often offered drugs and interventions that can work to relieve some of the symptoms. As with any pain though, despite relief that everyone hopes for, drugs do not teach you how to restore normal living. For this you need to work with someone who understands the complexity of pain and CRPS and who can guide you to think in the right way so that you focus upon the right actions to move forward.

Here are some tips:

1. Read the classification and ensure that you are indeed suffering CRPS (there is type 1 and 2, which differentiate those with the condition from a non-nerve injury and a nerve injury that trigger the complex and painful responses)

2. Work with someone who genuinely understands CRPS, can educate, guide and motivate you through a comprehensive programme — that person must also know that pain can and does change!

3. Understand that medication has a role but you have a bigger role. There in only one person who can transform pain, and that is you. You just need to know how.

4. Do not nurture fear by reading about other’s difficulties online. We all suffer fear, anger and other negative emotions, but they are not helpful if they persist. You can learn the skill of deciding how to think, perceive and act using the strengths that you already possess in overcoming your pain.

5. You are NOT complex regional pain syndrome. Do not let this or any other conditions define you. You are ________ ________ (fill your name here) who is a son, brother, wife, husband, father, mother, employee, sport lover, art critic….again, fill in yourself and remember it.

6. Focus on what you can do; focus on your strengths and focus on overcoming the pain and CRPS.

The Pain Coach Programme focuses on your strengths that you will use to overcome your pain, including resilience, motivation, empathy, compassion, concentration and many others. Developing and growing your inner drive, you will learn skills and develop your knowledge so that you in effect become your own coach moment-to-moment, choosing to take each opportunity to transform and change pain on your return to a meaningful life.

t. 07518 445493

12Aug/15

Using your strengths to overcome pain

Trust Strength Focus | DiddyOh | http://bit.ly/1ToCvPt

Trust Strength Focus | DiddyOh | http://bit.ly/1ToCvPt

Using your strengths to overcome pain is a fundamental principle of the Pain Coach Programme. Everyone has strengths such as focus, creativity, self-confidence, compassion and empathy. We have used these strengths during our lives to achieve success, at work for example. What I find however, is that people are not using their strengths to overcome their pain, and instead fall into a passive role and hope that something or someone will help — medication is a common one of these! ‘That will solve my problem’, but of course pills do not teach you how to return to a meaningful life, that only comes from the lived experience.

In the first meeting we discuss your pain, problems, story and life so that we can identify where we must begin and the strengths that you have that will enable the necessary actions. You will be using strengths in certain arenas, but probably not in that of your health and pain. The focus is absolutely on your ‘cans’ and not your ‘can’ts’, developing these with strategies and progressions so that the former facilitate the latter with time, practice and perseverance.

One very common example of practicing a strength on a day to day basis but not for oneself is compassion. This means that the person is kind, caring and giving, but not towards themselves. To give is rewarding and health giving, but you must be kind to yourself to do this with most effect. In fact, it is distinctly unhealthy to be repeatedly hard on yourself as it creates much angst, worry and anger that creates chronic stress that in turn creates a chronically inflamed state. Developing kindness and compassion towards oneself then is part of developing your strengths to overcome pain.

The Pain Coach Programme is all about developing your strengths and using them to effectively face the moment to moment aspects of pain as well as an overall approach to desensitising and relieving pain. To follow the programme of exercises and techniques, you need motivation, resilience, focus, energy and an ability to deal with distractions from your end goal. Pain Coach prepares you and guides you so that you become your own coach and move forward to a meaningful life once again. There is only one person who changes and transforms pain and suffering, and that is the person who is currently suffering. They just need to know how to do it!

To start your Pain Coach Programme for chronic and persisting pain, call us now: 07518 445493

Common reasons for starting the programme: back pain | neck pain | RSI | CRPS | sports injuries | arthritis | pelvic pain | IBS | migraine | headache | dystonia | chronic pain | sciatica

05Aug/15

Messages about pain

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

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

When someone seeks help for their pain and injury, they will be given messages about pain that are potent. They are told a, b and c, and hence often take these messages and become them via their own thinking and actions. This is the reason why the early messages about pain need to be accurately based on what we really know about pain and that they motivate people to focus on what they must do to recover. The way in which we think about and hence perceive our pain has tremendous impact on the extent of suffering and how we actually experience the pain itself. Put simply, a lack of understanding that can create concern, worry and anxiety, will raise the threat value of the whole situation, and therefore the body (you) protects further, including an increase in the intensity of the pain itself. All these experiences of thought and action are chemically based — depending on which chemicals are working with which receptors determines how the body systems are functioning and underpinning what we live out.

So what should the messages contain?

1. Facts about pain and the injury, including the poor relationship between the two, that pain is part of a protective response that includes other protective means such as altered movement (e.g. limping) and that the way we think and feel influence both the amount of suffering we endure as well as the actual intensity of the pain itself.

2. The person has an active role in overcoming pain — based on (new perhaps) understanding of pain and person, what is happening, why it is happening and what action needs to be taken.

3. Other relevant information to develop the person’s understanding, and in so doing, gain their trust, respect to follow a programme that motivates through positive thinking and experience towards their vision of how they want to be and live their life.

Undoubtedly, as with any problem we must understand it before we can deal with it. In the case of chronic pain, explanations incorporate the biological changes, behavioural changes and cognitive-emotional changes afoot and how to address these comprehensively–whole person.

The whole person approach recognises that there are many inter-related dimensions of that person, and that we must consider the individual as a whole rather than a back or a knee or any other structure or pathology. The experience of pain and other symptoms is a conscious leap from the underpinning biology, and no-one fully understands how our bodies, our ‘selves’, make that leap from biology to the lived experience. However, listening carefully and compassionately to the individual provides many clues as to why they are in protect and survive mode, emerging as pain and other symptoms, behaviours, thought processes and ultimate actions. This becomes the start point for designing a bespoke, proactive programme, beginning with the right messages.

Whilst the first meeting may identify where the actions taken by the individual are incongruent with recovery, it is worth remembering that this person is doing their very best with the knowledge and skills that they possess at that moment. Everyone has strengths with which they attained success in a range of arenas. Elucidating these strengths creates a start point and also allows that person to know and start feeling that they have the tools to overcome pain, but need guidance on how to best use them. That is our job.

This approach is part of The Pain Coach Programme for individuals to overcome their pain problem and for clinicians seeking to learn the Pain Coach approach for chronic pain. Contact us for more details if you are suffering chronic pain or a therapist wanting to advance yourself in the field of chronic pain: 07518 445493

20Jul/15

Gillian’s story | back pain and mindfulness

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

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

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

MY PAIN STORY – GILLIAN WESTON

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

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

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

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

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

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

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

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

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