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!

07Dec/15

Central sensitisation and higher centres

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

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

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

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

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

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

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

Science | Compassion | Sense

07Dec/15

Pain Coach for vulvodynia

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

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

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

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

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

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

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

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

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

05Dec/15

Henderson’s heel

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pain can and does change, beginning with understanding it.

Pain Coach Programme for persisting pain — t. 07518 445493

 

23Nov/15

Art of living

Pain Coach ProgrammeWe like to be good at things. Sport, work, parenting, music are all common examples. We practice, note what goes well and what does not, making changes, and essentially practicing to get better.

But what is common to all of these and everything else in our lives? What overarches all of these? Living. Living itself. There’s an art to living a life of content—and this does not mean that there is no pain or suffering. A life well lived is one of moment to moment skill, and this includes what we tell ourselves and what we do. The moment to moment experiences. These determine overall how content we are rather than the ‘biggies’: new car, new iPad, and the so-called life events. Now, these are all significant (if they are significant to you) yet they make up fleeting moments much like anything else. They are passing through, like other moments. It really depends on how you are framing it; what do you think about it? That’s what makes it what it is, for you in this moment.

So, there is an art to living well that depends on what you are telling yourself over and over. A situation is just a situation until you rate the situation and then feel it and live it. Until that point, it is nothing. We create our reality in any given moment and this is an art form. And art forms need good quality practice just like sports, music, how we communicate etc. The great thing about this is that we have every moment to practice and get good at it. You don’t need to go anywhere or any kit to get good at the art of living. So what do you need? Nothing.

Whilst you are seeking to be somewhere else, you are missing what is happening now. And that is all that is happening. Have plans, have aspirations but see them for what they are—plans and aspirations. Work out how to get there, but see that for what it is—a plan for how to get there. Be excited, be nervous, be anxious, but see these feelings for what they are—feelings, emotions that will pass as everything else does. Impermanence.

Here’s a simple tip of how to enact this: cultivate the habit of standing or sitting talk, taking a normal breath in and paying attention to this breath. Do this every time you feel tense, anxious, happy, excited, angry, sad…… Try it and see what happens.

19Nov/15

CRPS UK 2015

CRPS UK Conference 20154 years ago I came down to Bath to speak at the CRPS UK conference and so I was delighted to be asked to return and talk today. To take listeners beyond the theory, I asked Georgie and Jo to join me as a triple act, to illustrate and to enliven what I was saying by describing their lived experiences. Chatting to people afterwards, it appears that this gave an insight into the potential that everyone has for changing in a positive and constructive way; a way that is meaningful for them.

UP | understand painFor those who could not be there and for those who are there who would like a summary of my key points, this blog is for you.

The talk was entitled ‘Understand pain to change pain’, the message being that by understanding your pain, you think and act in such a way that you can go about overcoming your pain.

Establishing how we think about our pain is a key start point — how do you think about your pain? Why do you think it hurts? Why do you have persisting symptoms? These are some of the questions that need answering in order to move forward. Pain is a protective response to a perceived threat, and it is the person who does the ‘perceiving’ as well as embodying the experience of pain. We are the producer and the experiencer of our pain that is felt in the body, in a location that is deemed needy of protection in that moment. For reasons to be fully understood, our bodies can become very, very good at this response, and create many habits of thought and action that influence the likelihood of pain. Remember though, pain is a response to a perceived threat, so changing one’s perception begins to change the pain experience; reduce the threat, reduce the pain. Some may wonder why then, do they still feel pain despite having eradicated fear of the pain and other conscious threats? This is because there are many, many subconscious cues in the environment, in what we think and do, that can be perceived as being threatening. Whilst we cannot account for each and every variable, and how these change in combination with other variables, we can alter the perceived threat of the most obvious ones: movements, places, people, thoughts.

CRPSIt is the person who feels pain, not the body part. I may experience pain in my knee but it is not my knee that is in pain, I am. This may sound strange initially, but think about it for a minute. Who is thirsty? You or your mouth? Who is hungry? You or your stomach? Who is in pain? Your or your knee? Therefore, who needs treatment, training, coaching etc? You do, the person who feels pain and lives the pain. Any treatment programme must address the whole person and their lived life — this is them and their life in which the pain is embedded. It also has to make sense, engaging the person so that they continue to create the conditions for change.

To overcome pain we must firstly understand pain, much like a farmer would plough his field before sowing seeds–a vital start point. Having a working knowledge of your pain allows you to engage with your programme, focus on your vision of how you want your life to be and how you are going to get there whilst dealing with distractions. Distractions usually come in the form of negative thoughts, which deflate, demotivate and actually intensify pain responses by increasing the threat value. Understanding pain also helps to reduce and eradicate fear that also impacts on how you experience your pain. Fearful thoughts and avoidance both contribute to on-going pain and hence are necessarily addressed.

UP | understand painThere are many strategies, techniques and exercises that can be used, but for these to work, our thinking needs to be straight and based on a working knowledge. This is useable knowledge that can be considered at any given moment to ensure that the inner dialogue is based on truth and not on fearful opinion–think about what you tell yourself every day; what do you convince yourself? The Pain Coach Programme over-arches the specific strategies employed. The Pain Coach delivers the knowledge and skills to the person so that they become their own coach at any give moment, deciding on the best and healthiest course of action; towards the vision. A blend of the latest thinking in pain science with strengths-based coaching gives the person everything that they need to overcome their pain. What does overcoming pain mean? It means that you live your life in a meaningful way according to you, and that there are always opportunities to grow and develop.

UP | understand painI ran through some of the strategies that I use within the Pain Coach Programme including UBER-M, which is one that I give to people so that they may choose the wise and healthy option, taking them towards their goals; this as opposed to being distracted by negative (embodied) thoughts and unhealthy actions.

  • U–understand: a working knowledge of my problem; what do I know? what do I do now? This is about clarity, not fear
  • B–breathe: mindful practice and breathing to cultivate awareness of the bodily aspects of the pain experience and how thoughts manifest in the body, and then what you can do to change these habits
  • E–exercise: specific sensorimotor training and general activity
  • R–re-charge: we need enough energy to engage with life!
  • M–movement: to nourish the tissues and the body maps in the brain to have a sense of normal

Normal = no threat; no threat = no pain

Pain is all about perceived threat. Reduce the threat consciously by understanding and knowing what to do (that’s the easy bit!), and then go about reducing the perceived threat that occurs via habits and subconscious processing. This includes environmental cues, contextual cues and habits of thought; the so-called ‘autopilot’. Persisting pain is characterised by many habits, automatically learned responses and attentional biases. These must be addressed by constructing a programme that works with the person, not just their painful body part –> it is the person who is in pain, not their foot, arm, back etc. My back, to use an example, cannot feel pain. I feel pain. I experience pain, and I experience my pain in my back. There is an enormous difference in the underlying thinking and hence the approach. The whole person approach is vital for pain and any other condition having said that! If healthcare at large adopted this way of thinking, we would be far more successful with persisting conditions; this to the point where the suffering lessens and lessens. Reducing the impact results in a meaningful life, and this is achievable for all by developing understanding and then choosing wise actions.

My emphasis throughout the talk was on understanding pain to change pain. How can just understanding pain change pain, you may ask? Put simply, by understanding pain you are changing the way that you think about it, the meaning that you give to it and what you then do about it. If you do not understand your pain, like any problem, you cannot solve it, and the erroneous thoughts that one has can lead down a route of perpetuating fear, avoidance, beliefs that pain will not change. This route is one of on-going suffering. Understanding pain creates the way forward to overcoming pain; overcoming pain being the return to a meaningful life as defined by the person. When you know what you are dealing with and how to deal with it in any given moment, then you are creating the conditions for healthy change. This is the essence of Pain Coach, creating those conditions as often as possible, becoming aware of certain habits, learned behaviours and associations, compassionately correcting and moving onward with a selection of strategies. This is about getting back to life by living that life. Keeping that in the forefront of your thoughts, and letting go of distractions leads you towards your success. Let us be positive with good reason, because we are always changing, and with positive strategies.

For more information or to book an appointment, please call 07518 445493 or email [email protected]