Category Archives: Chronic pain

24Jul/17

Improve staff fitness

Improve staff fitness

Call to improve staff fitness by the Chief Executive of Public Health England, Duncan Selbie

To improve staff fitness is a great idea all round. According to The Observer yesterday, the cost of staff sickness is £29 billion a year. Denis Campbell reports upon Duncan Selbie’s call for companies to encourage healthy practices. Imagine freeing up some of that cash for education, including educating the next generation to look after themselves. We may laud ‘great results’ in A*’s and A’s but at what cost? We continue to see the figures for mental health rising in kids? I would rather my kid had a D, had tried his best and was all-round healthy. What use is an A if you are suffering depression?

“To improve staff fitness is a great idea all round”

The main target for this message seems to be small and medium sized businesses. Naturally this draws responses about the costs and limited opportunities within such firms compared to bigger companies. However, this problem can easily be solved by creating guidelines and providing support ~ see below for some ideas. It would be well worth the investment.

We can look at the trend in big businesses of building gyms on-site, having physiotherapy and doctors available, bringing sandwiches to the desk and even a neck massage while your pour over your spreadsheets. However, you could also argue that this merely keeps people at their desk or in the workplace for longer, often in the very environment that is causing most of the problems!

“The skills of wellbeing easily weave into the day”

There are a vast number of different options for healthy practices and skills of wellbeing. Teaching people such practices each day, I am very familiar working with individuals who have decided to create new patterns (habits) to supersede existing patterns that cause pain and suffering. Most people I see have chronic pain together with varying degrees of anxiety, depression and other persisting ills (e.g. migraine, headache, IBS, pelvic pain, fibromyalgia, chronic fatigue). Usually this is accompanied by perfectionism (expectations are never met resulting in ‘I am not good enough’ and consequential stress) and self-criticism to a unhealthy degree.

Many people spend their lives in protect mode. Occasionally they experience care-giving mode, but not often. Biologically these people are likely to be ‘inflamed’ much of the time, which explains many of the common complaints in the modern world for which medicine has no answer. The endless search for a medical explanation leads down a slope of decreasing expectations and hope. In essence, like chronic pain, this is not actually a medical problem. Once any sinister pathology has been excluded, the biomedical model offers nothing here as the problem is embedded in society; i.e. it is a public health issue.

To address a public health issue, we need society’s thinking to change. For thinking to change, existing beliefs must be shaken as we update our understanding. Understand Pain is a purpose led enterprise that works to change society’s thinking about pain. In the same way we can build upon the strengths in society with regards to being active. The ‘already active’ can become champions, spreading the right messages about the healthy practices that they have adopted. These people are living examples of the benefit.

“Staff fitness benefits business and society”

Staff fitness

Turning this on its head as I like to do, let’s think about living well and meaningfully. In other words, what can we do and what can we focus on? What positive action can we take as individuals and society? This is not just about small and medium sized businesses creating opportunity for healthy practices. Businesses must collaborate with staff who they themselves need to be motivated to live well. We all have this responsibility to ourselves, our families and society.

There is too much knowledge to sit back now, we all have a role to play, not just the business owners. However, if owners and executives take the right steps and lead from the front, they will inspire action. Do we have good enough leaders to do this and recognise the benefits for the business itself and society as a whole? That’s another question!

What could we do at our place?

Consider how staff will engage with the business and colleagues when the right environment and ethos exists. What are the company values? This is a great opportunity for small and medium sized businesses to engage deeply with its people. Even if this means re-writing the values in an effort to keep growing.

  • Create a space for exercise
  • Create a space for meditation
  • Link with local teachers: yoga, Pilates etc. ~ also an opportunity for staff to bond by doing something together
  • Encourage meetings that are mobile ~ where can we go? Let’s walk and talk
  • Encourage conversation over email/text ~ walk to that person’s desk
  • Compulsory lunch break away from the desk
  • Education programme for the skills of wellbeing

Using your imagination, you will be able to come up with some great ideas for your place. Your people are your greatest resource. Looking after them means looking after your business.


If you would like to know more about healthy practices and skills of wellbeing, please contact us. See what we can do for you as an individual and a business

Individual coaching and workshops ~ t. 07518 445493
16Jul/17
Andy Murray hip pain

Andy Murray’s hip

Wimbledon 2017 ~ the growing injury list

Andy Murray hip pain

The Wimbledon Championship has featured a significant number of injuries this year. On the same day we lost Djokovic and Andy Murray, the former retiring through injury, the latter struggling with hip pain. Sadly for British fans and tennis fans, the intensity of the pain prevented him from progressing. Murray was obviously struggling to move normally as his body shifted into a state of protect.

Why do players breakdown at the tournament?

There are several reasons. The game has become increasingly physical together with the pressure to perform in tournament after tournament. Everybody needs recovery time, and some players may simply have figured in too little within their schedule. It is not just the game time that requires subsequent recovery, but also the training: on court, strength and conditioning etc.

One must ask about the pressures to play, both financially and to achieve a ranking. To earn money, and this is a job that pays the bills, and to be ranked, players need to play. They are also driven to be the best that they can be, which means pushing oneself. The cultural meme in sport ‘no pain no pain’ exists and anyone involved in any kind of physical activity knows that intense play hurts. So when is it normal and when is it a problem?

It is somewhat easier to make that judgement in amateur sport when the stakes are not so high. Your career does not depend on playing that extra game. In professional sport, understanding pain is absolutely key in making this all.

This week a commentator pointed out that all players have some kind of injury and that no-one is 100% fit. What is 100% fit anyway? This will mean different things to different people. Do players feel aches and pains everyday? Yes, everybody does to a greater or lesser degree. Life hurts! But in many cases, the pains come and go, and do not impact upon life or performance. If a pain repeatedly occurs and does have an impact upon performance and life, this is something that does need to be addressed.

Acute injury vs persistent injury vs persistent pain

It is interesting that most of the injuries we have seen this year have not been acute. In other words, the players knew about the problem beforehand as it has been rumbling on for some time. Murray reported that his hip has been something he has been dealing with for years.

This is with the exception of Bethanie Mattek-Sands when her knee injury happened there and then, taking everyone by surprise. This is one of the reasons it was so shocking, because no one expected it, least of all Bethanie herself.

There is a difference between an injury moment and a pain moment. Pain and injury are not the same. Pain is part of the way we are alerted to being in a state of protect, a great motivator compelling action, and an injury is when there is a disruption to our body. An injury can often hurt but it does not have to, and the extent of the pain varies enormously depending upon a number of factors.

Andy Murray's hip

Pain and injury are not the same – read here

The terms pain and injury are often used interchangeably and this is not correct. Persistent or chronic pain and chronic injury are not the same. A chronic injury would mean that the healing process has not completed, taking longer than would be expected. Persistent or chronic pain is not well related to the tissue state, instead being a reflection of an on-going state of protect. There are a number of reasons why the state of protect persists and these are a main focus for the treatment and coaching programme to overcome the problem.

Murray’s hip pain

Whether Andy Murray has an injury or a pain problem we do not know. I hope he knows because this will determine the treatment and the training needed. Undoubtedly when a player is training and playing as often as Murray, there needs to be down time. Has he had this time? Federer took time off and appears to have benefited.

No-one can keep going at a high pace in life without recharging. We all must figure in refresh and renew points through each day, learning how to switch to ‘care-giving’ mode. In this state, our body systems are doing all the vital things for long-term health and well-being. Without this we burnout: chronic pain, poor sleep, low mood, depression, anxiety, irritable bowel syndrome, fertility issues etc etc, many of the common, modern day ills.

A person who presents with a long term hip pain needs to tell their complete story. From there the key points and ‘primers’ are identified. In essence the person does not feel themselves and the aim is for them to be able to say, ‘I feel myself’. In fact, when we feel ourselves and get what we expect, we are in flow and do not really think too much about how we are doing things. They just happen. We do not normally think about walking, but if my hip hurts I will scrutinise every step, the pavement, others walking towards me, hills, steps etc. The world looks different and I feel different. Normalising these is key.

Let’s hope that the nature of the problem can be truly established and then dealt with effectively and with long-term results in mind. Hips, like any body area, are not in isolation to the whole, and typically relate closely to the back and pelvis. Murray has had back issues before, a very common problem in both athletes and the general population, so I am sure this will be considered as part of the bigger picture.

What is your picture of success?

We all have our picture of success and should know what that looks like. This vision becomes a reference point and an orientation as we follow the necessary training programme and learn along the way. One can check in and ask: ‘Am I heading in my desired direction or am I being distracted?’. For Andy Murray, I would imagine his picture involves him consistently playing his best tennis. The key is to focus on what we want rather than what we don’t want. When I ask patients ‘what do you want?’, they often reply at first, ‘I don’t want this pain’.

Whilst this is an understandable response, the pain is actually what you do not want rather than what you do. This may sound all rather semantic, however there is an important practical difference. What we focus upon, we get more of. Think about what you actually want, crystallising the image and doing your utter best to get there.

“Don’t think of red elephants

Andy Murray, like all sports people, has a coach. His coach will work together with him to tap into his ‘greatest self’ so that Murray can achieve his best results. It is no different with overcoming pain. The person suffering chronic (on-going) pain is coached to be their greatest self. They are coached to become their own coach. In other words, because the person is with themselves consistently, they need to know independently how to orientate their thinking and what actions to take to get the best results. On the strong foundation of understanding paincoaching provides a structured way onwards, carving out a fulfilling life.


Pain Coach Programme to live a fulfilling life ~ t. 07518 445493 mailto:painphysiolondon@gmail.com
09Jul/17
Andy Murray's hip

Pain and injury at Wimbledon

Why is there so much pain and injury at Wimbledon this year?

Pain and injury at Wimbledon

Seven retirements and a very painful injury on-court yesterday at Wimbledon have given the tournament a different feel. Pain and injury are part of sport, but many people have been surprised by the turn of events. Federer has called for a review of the system and several players have complained about the state of the courts. All are factors of course. The game is simply made up of the synergy of players, court and tournament. When all are ticking, we see great tennis.

The very painful moment

Bethanie Mattek-Sands was screaming out in pain this week after her knee appeared to give way. One report suggested that she could have sustained a knee cap dislocation. This can be extremely painful until relocated. Seeing the dislocation can add to the trauma. When our body does not appear as we expect, the sight can trigger feelings of aversion.

Why so much pain?

Pain is a part of the way we protect ourselves. There are many other things going on when we are in state of protect: change in movement, change in sense, altered thinking and emotion, change in perception. In other words, the world looks different and feels different as we take action in the name of survival. This is a normal shift of state in the face of a perceived threat. Pain is a lived experience when there is a perceived threat. Pain is not well related to injury. This is the common misunderstanding. Just because it hurts a lot, it does not mean that the injury is more severe. We have known this for a long time ~ see here: pain in sport, 3 key points.

When thinking about the reasons for the pain response, the context is key. In other words the situation plays a significant part in the pain experience. As well as potential tissue injury, where that possible injury occurs and what is happening is highly relevant — it always has to happen somewhere! The full picture perceived creates a learning opportunity. If this is possibly dangerous, I need to remember what happened and where so that next time I can react differently.

All of this information is processed together with sensory information from the body, based upon what is already known about injury and the situation. In essence we make a best guess about the possible causes of the sensory information on a background of our previous experiences. In effect, we weigh up the evidence: new information vs what we know, which then suggests a scenario. If this is a potentially dangerous situation, pain can then form part of the experience. The more danger perceived, the more intense the pain.

How much danger did Bethanie perceive when her knee gave way at the biggest tennis championship in the world, in front of a big crowd, when each game is career shaping?

Whatever the outcome for Bethanie, I wish her well.

Messi’s knee

In 2012 Lionel Messi was running into the box when he brushed the keeper as he came out to meet him at speed. Messi managed to get a shot away (he missed) before he hit the ground clutching his knee. He was quoted as saying that he thought his career was over because of the pain.

How dangerous was the situation to Messi? Consider: the perceived injury (he did not know about the extent of the damage at that point), the game, the crowd silent, the body part involved, how knee injuries are thought of in the culture of football, the immediate thoughts about injury and what it means and much more.

Messi was taken off the field on a cart and whisked to hospital where he was scanned. What was the injury? A bruise.

Pain and injury are not the same. The terms are often used synonymously, but this is not correct usage. A further example is phantom limb pain. The person suffers pain in a limb that no longer exists.

Pain and injury

Why have there been so many injuries?

We have seen multiple retirements during games at Wimbledon this year. Whilst some people have been frustrated, we must also consider that these players have to make choices. These are based on the culture of the sport, the system, their career, their income and their understanding of pain.

There will be a weighing up of the pros and cons, and each individual will consider different factors before deciding. We do not know what those factors are in each case, so we cannot make any specific assumptions or criticise. In life, how many assumptions are made when someone is being critical of another without knowing the full picture?

“aches and pains are part of sport

In sport, the day to day aches and pains are a well known part of the deal. Simple measures are taken to address theses responses so that the athlete can continue to perform: e.g./ physiotherapy treatment, massage, ice baths, stretching, periodisation. However, despite the level of fitness, each body needs to adapt to the demands of the training and play. Without this time, there can be a tipping of the ‘build-breakdown’ balance towards the breakdown (inflammation). A state of chronic inflammation is likely to explain a range of common problems that can become significant.

When an acute injury occurs in sport, there is pressure to resume play as soon as possible. Do players return too soon? Are they fully ready? Being ready means that the body tissue are robust to withstand the stresses and strains, movement patterns are normalised (and not guarded), body sense is acute and thought patterns focus on the game and not on the body.

“the clues are in the story

We do not know all the factors involved with each player at Wimbledon who had to retire, but the points described above are relevant and need consideration. When clinicians are assessing an injury, this is especially so. Each injury or pain moment (the two are different) occurs in a context as we have established. Nothing happens in isolation, we are on a timeline, and hence we must consider how the person may be primed by prior learning. What are the influences upon this current moment? Some will be obvious and some more hidden. This is why allowing the person to tell their story is vital. The clues lie within their narrative, so we must listen actively and be open.

This is a brief look at some of the key issues. Pain and injury are always going to feature in sport. We need to draw upon the pinnacle of our knowledge of pain and bring this into the athletic world. In other words, we need a shift in the thinking away from the biomedical model, instead looking at the wider picture: a true biopsychosocial, or sociopsychobio model. Here is a reminder of the key points:

The key points:
  • pain and injury are poorly related
  • pain is suffered by the (whole) person not a body part (e.g. tendon pain ~ the primary focus remains on the tendon rather than the person)
  • pain does change when it is understood by the person and they actively create new patterns

22Jun/17
CRPS UK

Delighted to be a trustee for CRPS UK

delighted to be a trustee for CRPS UK

CRPS UK ~ a charity supporting people suffering Complex Regional Pain Syndrome (CRPS) and their carers

I am delighted to be a trustee for CRPS UK. In recent years I have spoken at the conferences and this year was invited to run the 2017 London Marathon for the charity.

CRPS is an example of a condition that can be excruciatingly painful. The Budapest Criteria lays out the necessary signs and symptoms, which is important in terms of a diagnosis and for research.

There are several issues that need urgent addressing and I will help CRPS with their endeavours.

As with other painful conditions, the first problem lies with the misunderstanding of pain. The predominant model remains biomedical, however this approach does not offer answers for persistent or chronic pain. The biomedical model relies on finding a pathology or structural basis to explain the pain. Pain is poorly related to tissue state because it is part of the way that the body protects itself. We have known this for many years, the famous lecture and paper being published in 1979.

“society does not understand pain despite it being the largest global health burden

Early diagnosis is important for CRPS as it guides treatment and prevents unnecessary suffering. This means that CRPS needs to be recognised by healthcare professionals. A common scenario is an incident resulting in the development of the condition, which is not recognised, thereby treated inefficiently, the symptoms worsen and so the cycle goes on. An important note is that poor treatment outcomes and low expectations affect the outcomes. However, the third point is that pain can and does change.

The predominant messages in society (and healthcare) are negative and suggest that the person has to merely cope or manage their pain. With the bar set so low and teeing up the person’s expectations at such a meagre height, no wonder there is minimal improvement. Why would you bother? This is all wrong and certainly not in line with what we really know about pain and people.

We have remarkable potential and need to know how to tap into it. What is getting in the way of recovery and getting better? What are the barriers to living? In exploring these by using our own amazing resources, we can achieve success and change. We are designed to change; you cannot not change! It is a matter of choosing a direction.

“what do you want in life? How does it look?

My Pain Coach Programme stemmed from understanding and believing in people’s ability to change, their resourcefulness (that they may not know they have because of negative messages to self and from others) and the latest pain sciences.

delighted to be a trustee for CRPS UK

Richmond Stace

Who am I?

For those who don’t know me and who are wondering why I have been asked to be a trustee for CRPS UK, here is a brief background. I am a physiotherapist with a background in pain neuroscience, rehabilitation and nursing. For many years I have worked with people suffering chronic and complex pain, giving them the understanding of pain that they can use to get better. In 2015 together with Georgie Standage, who came to see me with CRPS, we created UP | understand pain. Starting as an awareness campaign, UP was launched with a huge singing event.

delighted to be a trustee for CRPS UK

UP is now focusing on delivering the right messages about pain via the new website due to be available as a resource this year, and workshops for people who need to understand pain: sufferers, their families, clinicians, policymakers, patient representative group and other stakeholders.

I am very excited to be working with the team at CRPS UK, driving forward to change the way that the condition is recognised and treated. At the outset, people need to understand pain and know their role in getting better and their potential. Setting the scene from the beginning is vital and then using the right approaches so that the person can overcome their pain and live a meaningful life.

RS

 

 

13Jun/17

Steps forward at SIP 2017

Positive work done at SIP 2017

There were some important steps forward at SIP 2017 last week when stakeholders got together to discuss the societal issue of pain and agree ways forward. Positive work was done by the collective, consisting of patient representative groups, policy makers, clinicians, scientists and others.

It is rare that all the stakeholders meet, making this a very special conference. Here is an initial summary.

Societal Impact of Pain

Steps forwards at SIP 2017

The problems

The title of the interest group itself, ‘Societal Impact of Pain’ or SIP, drew me to the 2017 conference. I firmly believe pain to be a societal issue that has enormous consequences for individuals and the world in which we live. Whilst there are many meetings dedicated to pain, most focus on a scientific programme. This is only part of a much bigger picture that includes socioeconomic factors, culture, beliefs, gender, access to healthcare, understanding of pain and lifestyle, to name but a few. SIP, as far as addressing pain as it needs to be addressed is ‘on the money’. And speaking of money….

Chronic pain is a huge economic burden. The cost of pain to the EU each year is up to €441 bn — today that is £387 bn.

Wake up policy makers, yes that is £387 billion.

Back pain alone costs €12 bn per year in Europe although the most staggering figure is the €441 bn think about all the other conditions that hurt) and the source of immeasurable suffering for millions. It is estimated that 100 million people suffer in Europe.

“Pain causes a problem for individuals as well as a challenge for healthcare systems, economies and society (SIP 2017)

Clearly, what we are doing at the moment does not work. There are reasons for this, including the fact that pain is misunderstood in society: healthcare professionals and people (patients). This results in the wrong messages being purported, low expectations and poor outcomes. This must change and the SIP 2017 meeting was a perfect breeding ground for positive work in the right direction. There were some significant steps forward, emerging from the synergy of different groups gathered together.

What was my purpose?

Representing UP | understand pain, I was attending SIP 2017 to gain insight into the current thinking about pain from a societal perspective. In particular I was interested in the language being used, the messages being given about pain, and the plans for positive work to drive change. Listening to the talks, being at the meetings and talking to different stakeholders, I was inspired. My passion has been strengthened by what I heard. I know that UP is absolutely on track and my aim now is to contribute to the on-going work, primarily by changing the way society thinks about pain — see workshops here.

The message that I deliver, and that of UP, is that pain can and does change when it is understood thereby empowering, enabling and inspiring the individual to realise his or her potential. The individual is part of society and hence with so many people suffering, this means society is suffering. Drawing together the necessary people to create the conditions for change was the purpose of SIP 2017. From the outcomes (see below), this is what has been achieved.

See the SIP 2017 Impressions here: videos and photos

Who was there?

One of the features of the meeting was the range of people in attendance. For fruitful discussion and action it is essential that stakeholders from the different sectors get together. This is exactly what SIP 2017 created. In no particular order, there were clinicians, academics, scientists, policy makers, MEPs, patient groups and organisations, patient representatives and others who have an interest in the advancement of how society thinks about and addresses pain.

Understand pain to change pain

The right language

The focus was upon the person and their individual experiences of pain within the context of modern society. We all need to understand pain for different reasons, although we are all potential patients!

  • People suffering need to understand pain so that they can realise their potential for change and live a purposeful life
  • Clinicians need to understand pain so that they can deliver the treatments and coaching to people in need
  • Policy makers need to understand pain so that they can create platforms that enable best care

I was pleased to hear and see recommendations for coaching, although the term was not defined. Having used a coaching model for some years, I have seen this bring results, as it is always a means to getting the very best out of the individual ~ see The Pain Coach Programme.

Within the biomedical model, which does not work for persistent pain, the person is reliant upon the clinician providing treatment. We know that this approach is ineffective and in turn, ineffective treatments result in greater costs as the loop of suffering continues. Giving the person the skills, knowledge and know-how enables and inspires people to make the decision to commit to the practices that free them from this loop. People do not need to be dependent upon healthcare to get better. With a clear vision of success and a way to go about it, people can get results and live a meaningful life. This is the philosophy of UP and I was delighted to hear these messages at the meeting.

An issue raised by many was the measurement of pain. The way that pain improvements are captured and the desired outcomes differed between people (patients) and policy makers. The Numerical Rating Score (NRS) is often used, but what does this tell us about the lived experience of the person? Pain is not a score and a person is not a number. If I rate my pain 6/10 right now, that is a mere snapshot. It could be different 10 minutes later and was probably different 10 minutes before. The chosen number tells the clinician nothing about the suffering or the impact. It is when the impact lessens, when suffering eases does the person acknowledge change. No-one would naturally be telling themselves that they have a score for pain unless they have been told to keep a tally. We need to understand what is meaningful for the person, for example, going to work, playing with the kids, going to the shop.

Understand pain to change pain

Valletta panorama, Malta

Steps forward

SIP have issued this press release following the symposium:

‘MARTIN SEYCHELL, DEPUTY DIRECTOR GENERAL DG SANTE, FORMALLY ANNOUNCES LAUNCH OF PAIN EXPERT AND STAKEHOLDER GROUP ON THE EU HEALTH POLICY PLATFORM AT THE SOCIETAL IMPACT OF PAIN SYMPOSIUM’

Mr Seychell gave an excellent talk, absolutely nailing down the key issues and a way forward. This has been followed by with positive action. The SIP statement reads:

‘The European Commission is following SIP’s lead and has launched the EU Health Policy Platform to build a bridge between health systems and policy makers. Among other health policy areas, the societal impact of pain is included as well and will have a dedicated expert group.’

From the workshops the following recommendations emerged:

  1. Establish an EU platform on the societal impact of pain
  2. Develop instruments to assess the societal impact of pain
  3. Initiate policies addressing the impact of pain on employment
  4. Prioritise pain within education for health care professionals, patients and the general public
  5. Increase investment in research on the Societal Impact of Pain

A further success has been the classification of pain

Building momentum

Following this inspiring meeting where so much positive work was done, we now need to take action individually and collectively to get results. I see no reason why we cannot achieve the aims by continuing to drive the right messages about pain. This is a very exciting time from the perspective of EU policy but also in terms of our understanding of pain. The pinnacle of that knowledge must filter down through society, which is the purpose of UP.

To do this we (UP) are very open to creating partnerships with stakeholders who share our desire for change. UP provides the knowledge and the know-how that is needed for results, because without understanding pain, there can be no success. Conversely, understanding pain means that we can create a vision of a healthier society that we enable with simple practices available for all. Society can work together to ease the enormous suffering that currently exists. We all have a stake in that and a responsibility to drive change in that direction.

~ A huge thanks to the organisers and Norbert van Rooij


Please do get in touch if you would like to organise a meeting or a workshop: +447518445493 or email painphysiolondon@gmail.com

 

12Jun/17

What is pain?

What is pain?

Thoughts from the SIP 2017 Conference

Societal Impact of Pain

“Society needs to understand pain ~ what is pain?

Last week I attended the SIP 2017 Conference in Malta where a meeting of stakeholders deeply considered the issue of pain in society. Pain is a societal problem and the way forward will emerge from considering pain in this light. Significant and exciting steps were taken, which will be covered in a forthcoming article on this site and the UP | understand pain site.

Chronic pain is the number one global health burden. The approaches used for pain are not working. We are seeing the figures increasing over the years as more and more people suffer ~ 100 million people in Europe. Why? The main reason is the misunderstanding of pain that results in unnecessary investigations, treatments that don’t work and low expectations. The predominant thinking remains ‘biomedical’ both in terms of healthcare delivered and society’s expectations. Pain is not a medical problem. It is a public health, or societal issue. We are in it together, all of us. Even clinicians are patients!

Where do we start?

The UP enterprise has a purpose, and that is to change the way that society thinks about pain, hence Understand Pain. From the point of understanding comes new belief and commitment to reach one’s potential. The vision is a world where people understand pain so that the focus is upon the practices that foster a healthy, meaningful existence within the context of the person’s unique life. This emerges from co-operation between the person and the care-giver, working together to achieve results. This is the essence of Pain Coach, grounded in pain sciences, modern philosophy and strengths based coaching, delivering results based on what works.

Pain Coach not only gives individuals unique knowledge and skills according to their needs, but also the all-important know how. I may have the best drill in the world, but without the know-how I will still make big holes in the wall as I try to hang a picture. The Pain Coach coaches the person to coach themselves to overcome pain. Conversely, interventions and medicines are ways to circumnavigate the problem. This is not to say that they do not have a role, however, the person learns nothing about facing it and transforming the experience and therefore will continue the loop of suffering. Only by learning about one’s existing patterns and creating new patterns in line with a vision of success, can the person overcome their pain.

“What do you focus on?

What do you focus on? What language do you use to yourself over and over? What story do you tell yourself? You can make the decision to change your story. What can you control? Your attitudes, your thoughts, your day to day decisions are all yours. What do you do consistently? What do you think and embody consistently? That becomes the story of you. You can choose another script. That is the role of a coach, to help you realise and actualise your choices. To help you make decisions but ultimately you make them and commit to doing positive work to move in a desired direction. You decide the direction.

What is pain?

Pain is part of the whole person state of protect. Pain is poorly related to any stage of injury, tissue damage or indeed tissue state. This is the common misunderstanding, that somehow pain and injury are the same or related. This is not the case and indeed Pat Wall, the father of pain science and medicine, stated this in his 1979 paper. Why then, is this not practiced as mainstream? This is one of the key messages for all.

What are we protecting against? Initially there may be some kind of actual threat such as an injury or disease state, which is rightly interpreted by body systems as dangerous or potentially dangerous.  That’s the whole point of pain in a sense, to be so unpleasant that it compels us to take action. It is a vital survival mechanism without which we have no way to detect actual or potential danger. But, the pain itself remains part of a protect state in light of a perceived threat.

“Pain is a feature of a state of protection

When pain persists, aka chronic pain (not everyone likes this term or wishes to be labelled as such), it means that a state of protect is persistently emerging as the prediction of threat frequents each day. The range of cues or patterns interpreted as potentially dangerous seems to widen and widen so that normally innocuous situations are deemed to be dangerous. This does not mean it has always to be at a conscious level as most of our biology operates in the dark, ie/ there are hidden causes. However, expectation does play a role in as much as when we expect something to hurt it does and often more as we prime, raise the threat level, predict to ourselves that it will hurt and guess what?

Pain is not a constant state. There is no constant state, instead we are continuously ‘updating’, dynamically exploring the environment with the aim of meeting our predicted needs. When a person suffers chronic pain, they will experience a number of episodes in a given day, with a more challenging day featuring more frequent or longer episodes, and a better day featuring less or shorter episodes.

We are changing by design. No moment is the same. Like a foot placed in a river, it is never the same water that passes by. So change is not the question, rather which direction will you go? Which direction will you choose? To coach yourself towards a vision of success? To decide to commit to the practices of well-being? When people realise that they do have a choice it is empowering, inspiring and enabling.  We can decide to reach our potential.

Who suffers chronic pain?

Work is being done to discover more about who would be vulnerable to a chronic state of protect. Players include genetics, past experience (e.g. prior pain, early life events) and gender. One way to think about this is that we are on a timeline, so nothing happens in isolation. When I stub my toe, my existing health and sense of well-being will influence how I react both ‘myself’ and my biology. In other words, if I am very tired and stressed, my experience will be very different to if I were relaxed and happy. Getting the person’s story is key to understanding the context.

You can think of life’s events as priming. From day dot we are shaping ourselves and being shaped, right up until this moment. Every experience and everything learned sculpts us, our body manifest of the sum of all the things we have done and felt. The body systems that protect us evolve and become highly efficient, predicting that the causes of the sensory information mean that danger exists. Actively changing the sensory information with new practices, new habits and patterns of thought and action take us on different path. A path onward in a chosen direction. Our attitude to change and belief in our own abilities are both key factors — and both can change in themselves!

“Pain is whole person — it’s not my back in pain, I am in pain. Me

The perception or experience of pain is coloured by many factors in that person’s life, including past experience, beliefs, context, environment, actions (current and predicted), emotional state, attentional bias (what I am focusing upon), other people and more. Pain undoubtedly emerges in the person. In other words, it is the person who suffers pain, not the body region where it is felt. Much like it is the person who is thirsty, not their mouth.

In summary

  • It is the whole person who feels pain
  • Pain is part of the way we protect ourselves in the light of a perceived threat
  • Pain can and does change
  • Understand pain to change pain
04Jun/17

Headache

Headache is a leading cause of suffering

Headache and migraine are in the top 12 of the Global Health Burden of Disease Study (2011)

 

Headaches

If you watched Doctor in the House on BBC recently, you would have gained an insight into the terrible suffering caused by cluster headache. This is one of the many conditions characterised by chronic pain. In this case, there was significant improvement as the family made some important changes. More on this shortly.

Chronic pain is the number one global health burden, costing more that cancer, heart disease and diabetes put together. There are millions of people across the globe enduring chronic pain states. They have little or no understanding of why they continue to suffer and no knowledge of how to overcome their pain. This can and must change, and to do so means that society needs to understand pain ~ this is the reason for UP | understand pain. Pain is a public health problem of huge significance.

The programme hosted by Dr Rangan Chatterjee highlighted the impact not only upon the brave lady Gemma, but also upon the family. It was their shift in thinking that resulted in new habits, which create the right conditions to get better. That was a choice made based upon new understanding. Realising that we have a choice is a key first step. We can make the decision to commit to doing the things that will change our health, our relationships, our performance and our pain.

Pain always occurs in a context and involves life’s habits. On realising the range of influences upon pain, the person can instigate changes that make a huge difference. In the family setting, this involves all members, including children. There are huge numbers of children who suffer pain (1 in 5) and huge numbers who support a parent. This is a vast problem in itself.

A brief look at pain ~ what is it?

Pain is a whole person state of protect based on the existing and prior evidence that there is a threat or possible threat to the person. Much of the processing is subconscious, our biology in the dark (e.g./ you don’t know what your liver is doing right now), emerging as a lived experience or perception. Anything that poses a possible threat can result in pain. It is important to consider that something only becomes a threat when we think it so, and hence the meaning we choose to give a situation makes it what is it.

It is not only when we are thinking that something is a threat to us of course. Our biological systems interpret sensory information and predict that it indicates possible or actual danger. Working on a just in case basis means that we can get it wring. When we are sensitive,m this can happen more often than not, which is why pain can become so dominant. The range of contexts and situations widen and we notice the pain moments over and over. This does not have to continue. We can actively infer something else with new understanding, new actions, new habits and new patterns — that’s the programme.

Pain and injury are words often used synonymously, but they are simply not the same. Pain is part of a protect state, very similar to that of stress, and injury is something you can see. The former uniquely subjective and a perception constructed by the whole person

What can we do about pain?

The short answer: a lot!

The first step with any change is to make the decision to commit to practicing new habits that lead towards your desired outcome. This decision comes off the back of understanding pain because then you realise that there is plenty you can do to change and overcome your pain.

This always starts with developing a working knowledge of your pain so that you can coach yourself: the right thinking and the right actions to get the best outcome. Initially you are likely to need advice, treatment and coaching to ensure you remain on track.

When you understand pain, you do not fear it or try to avoid it, instead you face your pain, learn about your pain and overcome your pain. This is different to taking a pill or having an injection, which circumnavigate the issue. Only by facing the challenge can we transform the experience of pain. Many messages in modern society encourage us to avoid the difficult things in life but they are unavoidable. We are not typically taught skills to face the challenges that will come up, and so when we do have something to deal with, we suffer. This does not need to be the case, certainly when it comes to pain.

This is not to say that pain is not unpleasant. Of course it is, but we can learn how to minimise the impact and work to create a happy and meaningful life, by living and practicing the skills of well-being. By living I mean that you try to do the things that you want to as much as you can. More dated thinking about pain suggests that you have to get better in order to resume living, however I have turned this on its head and said that you get back to living by getting back to living. Getting back to living IS the way to get better.

In a sense there is a template of how your life and you should be, and there is no real separation between the two. When the template of what is actually happening is different to the expected one, this mismatch creates a drive to bring them together. Pain is one of those drivers. So, if we try to live as best we can, we are in fact bringing these two templates together. Of course there will be a certain tolerance, even perhaps a few moments in some cases, but this is the start point or the baseline. Working from your baseline, you can get ‘fitter’ and healthier with the practices you commit to, and thereby point yourself in a desired direction.

“what is your vision of success?

A treatment programme is therefore weaved into your life. You are in the driving seat. This is an important concept as healthcare often puts you in the passenger seat, or as one patient told me, ‘in the boot’. This is not right and will certainly not help the person to get better. The modern understanding of pain tells us a very different story, which is exciting, but must be told as far and as wide as is possible, which is the reason for UP | understand pain.

If you are suffering headaches, you should consult with your healthcare practitioner as a first port of call. You will want to know the possible reasons why you have headaches, but then you will want to know what you can do, what they will do to support you and roughly how long this will take. With an understanding and a direction, with a decision to commit to practices of well-being and determination, it can be transformative.

RS

 

 

 

 

05May/17

Exams, stress and pain tips

Exams, stress and pain tips
Exams, stress and pain tips

Exam exhaustion | Felix Neumann

Exams, stress and pain tips ~ It is that time of year again when kids are preparing for their exams. With the emphasis on high grades reflecting success, the pressure on youth has increased. There is the sense that if they do not achieve all those ‘A’ grades, then somehow they are a failure. What a terribly damaging way to go about it, and indeed one of the major influences upon kids health. Levels of pain, anxiety and depression are on the rise. Social media also has a part to play, not the channels themselves per se but the way in which it is used and relied upon as a source of temporary reward ~ ‘likes’ etc. We can and must change this as a society.

One of the most respected and successful sports coaches of all time, John Wooden, made the key point that each person should be focusing upon what they can control and to do their very best. If your attentions are on doing your very best, you will be successful, for you. If you thinking drifts towards the grade ‘you must’ achieve, then your focus is not on doing your best, it is on the grade. Re-focus on doing your very best: maximum effort. Besides, if you are focusing on and doing your best, there is no worry or anxiety because you are doing. Those feelings only appear when we are thinking about being somewhere else, whilst embodying the feelings and hence suffering. That somewhere else is the past or future, and neither exist.

We can realise that this is not necessary as we learn to make other choices. Ask yourself: How am I choosing to feel? Could you choose to think about the situation in another way and feel better or good? Yes you can. Try it and see!

Read hereJohn Wooden ~ Wooden: A Lifetime of Observations and Reflections On and Off the Court
Choice

You could choose to think about something in life you face as a problem, that it is difficult, perhaps impossible or that your efforts are doomed to failure. How are you likely to feel? Or, you could choose to view the situation as a challenge, an opportunity to learn something and seek to find and practice ways to overcome the challenge. How would this feel? Very different. We feel better when we have understanding and a plan that we action because we are actually doing, and this includes writing a new inner dialogue or script. How are you pre-empting or expecting things to go? How often do they actually turn out that way? Well if so, why not water the seeds of positivity rather than anticipate the worst outcome or a miserable outcome? Re-frame your thinking that is always embodied, i.e. we experience our thoughts with our whole self including our bodies — where do you feel the feelings that you label as anxiety? They are remarkably similar to the feelings of excitement but which label are you choosing? Choose another and see what happens.

Here are some exercises from Mike Pegg on Positive Scripting: click here
The inner dialogue

What are you telling yourself? Are you listening? The two are different. You cannot stop thoughts popping in but you can choose what you do with them. The practice of mindfulness is a way of achieving this as you are aware and open to the different thoughts, feelings and emotions as they pass through rather than become embroiled.

Self-confidence relies upon the inner dialogue. No matter what you have achieved before, what you are telling yourself and listening to now is what determines your confidence. Create a positive script about what you can do and what you can control: my own thoughts, my own actions, where I focus, doing my best.

Developing insight into your own mind creates the opportunity to choose your direction. We are always changing, but which way do you want to go?

Some great reading on how to communicate with yourself and others: Thich Nhat Hanh
Movement and posturing

Movement and exercise are healthy. During periods of revision we need to move to nourish the body but also our thinking — the two are NOT separate but parts of you. Changing position, using some exercises, walking, jogging and other activities punctuated through the day help to keep the focus. Some exercise in the morning before starting, changing posture and position every 30 minutes or so and having a good break every 45-60 minutes can help to keep a certain freshness and concentration.

This is about performance and to perform we need to focus in the present moment. Refresh and renew then, are key ingredients.

Recharging and sleep

You need good sleep patterns for healthy functioning. Make sure you have a routine that you stick to through the exam period. Many important healthy activities occur during sleep, including a kind of physiological cleaning in the brain. When this does not happen we can feel groggy and moody the next day.

If you are tired, focus on mantras such as ‘I need energy’ rather than ‘I am tired’. We notice what is on our agenda and therefore by telling yourself that you need energy, you’ll be orientated towards this as a goal: regular healthy snacks, fresh air, movement, mindful practice, periods of relaxation.

Through the day we need to plug in. Refreshing yourself allows you to focus well for bursts of time.

Pain and stress are body (whole person) states due to a perceived threat

People come to see me because thus far they have not been able to recover from their pain problem. This is inherently stressful, which adds to the biological and behavioural mix resulting in on-going states of protect.

~ pain and injury are poorly related and are definitely not the same

Pain is about protection and not a precise guide for tissue health or state. This is the common misunderstanding that leads to ineffective treatments. Pain and injury are not well related and they are definitely not the same. Pain is a unique perception emerging in the person and belonging to the person. This is one of many we experience but it is a dominant feeling, as it should be, to motivate action in line with getting better.

Persistent pain involves many adaptations that include those in the brain (emotional, reward and emotional centres in particular), the way we perceive the world and ourselves, the way we make decisions, behave and the way we act. The world appears to be far more dangerous than it really is and the rating of threat is applied in normal circumstances, just in case. For example, sitting is not dangerous yet it is often associated with back pain. The body systems in weighing up the evidence and based on prior experience, deem sitting in a chair to be actually or potentially dangerous. It is the result of the weight of this evidence that manifests as pain in the area of the body deemed to need protection and awareness.

Overcoming pain is about changing this weighting of evidence by taking new actions (habits) based upon new thinking (understand your pain), beliefs and expectations.

During exam times there is usually a change in routine. More sitting, less exercise, and potentially more stress depending upon how the individual views the situation. For optimising performance, this must be addressed whether there is pre-existing pain or not.

It is common for pain to increase during times of stress and pressure. This is not because the tissue state changes greatly but instead the perception of threat is raised and hence protection more likely. We can also tend to anticipate certain relationships. For example: ‘sitting will hurt’, which can become a predominant thought pattern unless we work to create a new way forward. We are always changing, it is a matter of which way you choose to go.

Simple practices during exam times can make a significant difference. Starting with understanding your pain, you can choose to use the strategies mentioned previously that include regular movement, appropriate exercise, practicing a positive script, refreshing & renewing, together with mindful practices (that actually enable many of the others), deep relaxation, imagery and visualisation. Making a plan of which to use and when through the revision and exam timetable can make all the difference.

Pain Coach and Wellness Coach ~ to overcome life’s challenges, live well and perform

For appointments or enquires about Pain Coach Mentoring and speaking events, call Jo on 07518 445493
05Apr/17

5 ways a partner can help you

Chronic pain can be the source of huge strain upon a relationship. Partners and other people close to the suffering individual can be at a loss as to what they can do to help. Sometimes their assistance is welcomed and other times not. It can be confusing and stressful. There are many ways that a partner can help and some will be individual to those involved. Here are 5 ways a partner can help you:

Be an extra pair of ears and eyes

During consultations with specialists or therapists, it can be useful for a partner to come along. Beforehand you can decide upon their role. The possibilities include:

  • listening and note taking
  • offering observations about what has been happening
  • watching and learning exercises so that they can provide feedback at home
  • just being there for moral support

Sometimes having someone else in the room, even a loved one, can be distracting depending upon what is being practiced. So do discuss this with your clinician for the best outcome.

Understand pain

When your partner understands pain they will be able to further empathise and act through compassion rather than fear and worry. We do respond and are influenced by the people we are close to, meaning that if they have a working knowledge of pain they will better provide support and encouragement.

Pain can and does vary as each pain experience is as unique as each unfolding moment. Knowing that pain is related to perception of threat rather than tissue damage or injury, along with some of the main influences (e.g. emotional state, context, tiredness) helps to navigate a way forward. To overcome pain the person learns to coach themselves, making best choices in line with their picture of success. Sometimes we need help or someone to listen to us whilst making these choices.



A hug

Touch is healthy, especially from a loved one. Someone recently told me about how a hug from her children relieved her pain. Why? The release of oxytocin for a starter. The feelings of compassion and love can cut through all other emotions and feelings, which is why the development of self-compassion is one of the key skills of well-being.

Sometimes a hug can be painful of course, depending on where you feel your pain. If this is the case, then simple touch somewhere else is enough. Seek to notice the good feelings that emerge in you: what do they feel like? Where do you feel them? Concentrate on them. And if you are not with that person, just imagine a hug or a loving touch. This triggers similar activity, just like when you think about that beautiful scene in nature, your body systems respond as if you are there ~ our thinking is embodied.

Practice the skills of well-being together

A good example is metta or loving kindness meditation that cultivates self-compassion. It is best to gain instruction 1:1 to start with and then use a recording as a prompt until you are familiar with the practice. Group practice is also good when the collective or community creates a soothing atmosphere in which to practice.

At home, practice metta with your partner. Doing it together, you form a bond as you spend meaningful time together. You can also practice the exercises together. These are nourishing and healthy movements with the purpose of restoring confidence as well as layering in good experiences of activity to overcome pain.

Spend time together doing something meaningful

We are designed to connect. The chemicals we release and experience as that feel-good factor, do so when we have meaningful interactions. Pain all too often appears to limit choice and our tolerance for activity. However, on thinking about what we CAN do rather than what we cannot, we begin to build and broaden the effects of choosing positive action.

Positive action is all about focusing on what we can do: e.g./ I can go for a coffee with a friend for half an hour to gain the benefits of connecting, moving, a change of scene etc. and I will concentrate on these benefits. Make some plans, working within your current tolerance level, knowing that you are safe to do so, and follow them through by keeping yourself pointed towards the picture of success*. You can then gradually build your tolerance by pushing a little with increasing confidence.

There are many other ways that a partner can be involved. The key is to communicate openly and make plans together ~ here is a great insight into communication by Thich Nhat Hanh.


* Clarifying your picture of success gives you a direction and the opportunity to check in and ask yourself: am I heading in that direction or am I being distracted?

Please note: Whilst the practices above can appear to be straightforward, you should always discuss your approaches with your healthcare professional

04Apr/17

Not long now

Not long now ~ with only a few weeks away before the London Marathon, I must admit that I am getting rather excited. It has been very worthwhile putting in all the miles with the aim of really enjoying the day.



One more long run to do this weekend and then I will be tailing off as advised by my team of trainers and co-runners. Yesterday a friend asked me about these 20+ milers and how you keep going. I never imagined that I would ever be running for 3-4 hours, and certainly never thought I would be popping out for a ‘quick 10 miles’. I have found that the time passes quickly once I get going but really focusing on what is going on around me, looking up, coaching myself to remain relaxed and feel inspired by the encouragement I receive.

Anyhow, the really important bit is raising money and awareness of two key projects tackling the number one global health burden: pain. The charity CRPS UK and the social enterprise UP | understand pain both envision a world of people understanding their own potential to live well and to overcome their pain.

THE PROBLEM OF PAIN

The costs of chronic pain to individuals and society are vast. Loss of earnings, loss of productivity, the expense of treatments that often don’t work and above all the immense suffering. This need not be the case if society really understood pain. By understanding pain, individuals would know where to put their efforts to get better from the outset of a pain problem, whatever the cause, and healthcare would deliver effective care.

The thinking on pain still largely resides in out-dated models. This means that individuals become reliant upon passive treatments, are subjected to endless unnecessary investigations and are exposed to the wrong messages about pain that keep expectations low and purport fears and worries that only increase suffering.

“Pain is poorly related to injury, tissue health, structures in the body, biomechanics or pathology

Our journey to understand pain began when two remarkable men created pain medicine. Pat Wall and Ron Melzack changed the landscape forever and have inspired a generation of scientists and clinicians to ask questions about pain and discover the answers: what is pain? What is pain for? What can we do about pain?

Our knowledge about pain has increased enormously but there is a long way to go before our current understanding is practiced day to day in society. This gap is a significant societal issue, and one that UP will bridge with the forthcoming education programmes and an online resource that is this very website. The UP site will be re-launched this year, packed with information that people can use to understand pain.

WE HAVE AMAZING POTENTIAL

Humans are incredible. We are designed to change, adapt and learn, so tapping into our natural resources is one of the most potent and enabling things we can do. Consider all the achievements of mankind, which largely boil down to a clear picture of success, an ability to focus upon a plan of action, taking action and learning along the way when facing challenges. Together with a dose of determination, courage and belief, we can achieve by always being the best that we can be: ‘I will be the best me today’ is not a bad mantra to have!

The challenge of pain is no different. The programmes that UP will run for people in pain and for clinicians are all based on how we can be successful, how we can chose the positive route, how we can achieve our best. This is by focusing on what we do well, how we do it and how we can do more of this whilst acknowledging and seeking to improve in other areas.

So this in my mind drives my desire to do my best in training and on the day on 23rd April. Having said that, I will be pleased to see some familiar faces in the crowd on the way round! Or even faces I don’t know who want to support our causes. Pain affects so many people across the globe for so many reasons. Together we can change this by changing the way society thinks about pain and our expectations. Let’s expect to do well and live well.

Please support us here by donating whatever you can and join us for a quiz night before the run on Thursday 20th April in Surbiton — see here.

Thanks!!