Category Archives: Chronic pain

15Mar/17

Values mismatch

Listening to peoples’ stories for over 20 years, one picks up on the important themes that consistently arise. These are the areas that need addressing as part of a full programme to overcome chronic pain. One such theme is the values mismatch.

Values mismatch

Put simply, a values mismatch is when our deepest held beliefs about ourselves and the world are at odds with the value system in which you find yourself. Arguably the most common context for a values mismatch is when the individual’s values do not fit with those of the workplace. A further example can be when a person’s values evolve so that a difference exists between the new values and those held by the family or close network.

As an illustration, trust is the value at odds. With trust being of inherent importance to the person, when the work environment is driven by high levels of competitiveness, the so-called dog eat dog culture, underhand methods can be rife and accepted by the company. This fear based approach causes great suffering. Continuously looking over one’s shoulder is unhealthy and unsustainable. For the person who holds the value of trust to be dear, this can drive a more consistent state of protect. Further to this is the impact upon health and the sense of well-being.

Values mismatch and suffering

The mismatch can affect us deeply as we either try to fit in or somehow rebel against the culture. Both require effort. Add this to the energy cost of being in a sustained state of survival, and one can begin to see how health can be affected. How many people who suffer burnout would tell you that they hated their work? Scratch beneath the surface and you usually discover that it started well. With time they became ground down by the demands, the attitudes and behaviours. We are not separate from the environment, nor the other people who we are surrounded by, and hence the ‘toxic’ place affects our health. Even just thinking about the place or certain people there cause a feeling of discomfort or anxiety.

When we are in survive mode for sustained periods of time it potentially affects many body systems. The systems that protect us are looking out for danger and the feel of our body and self is just that. We feel on edge, uncomfortable, tense, anxious and this tells us that threats are about. They may or may not be, yet this is what we feel. Our body is saying there is danger when in fact there is no actual threat. The systems work on a just in case basis. With protect state ‘on’ consistently, everything appears to be dangerous. Now, every little prompt or cue stokes the fire: watching the news, reading social media, the look someone gives you etc. How you consciously interpret these things and how your body systems alert you has changed.

“Our body is saying that there is danger when there is no actual threat. This is a habit that can change

The common manifestations in terms of health include chronic pain, fibromyalgia, fatigue, poor sleep, irritable bowel syndrome, headaches, migraines, struggling to recover from an illness or injury, jaw pain, anxiety, depression, poor concentration and memory, feelings of isolation and despair, and a great deal of suffering.

This does not need to continue. You can change course by understanding why this has happened, addressing the reasons and creating a new way forward. We are designed to learn and change, and with a new moments continuously unfolding, we have enormous potential to succeed with the right thinking and right actions. Writing down our values helps to clarify what is important to us. From there we can see how any mismatch maybe affecting us. Then we can seek to understand how we can best go about achieving alignment with our values. This would form part of a programme of training, coaching and treatment so that you can achieve your best by focusing on your strengths.

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Pain Coach Programme to achieve your best | t. 07518 445493

 

 

 

13Mar/17

3 ways to ease suffering

We all suffer. Suffering is part of living and so is unavoidable. There are many reasons for suffering and they are unique to that person and the way that they view life. The Oxford Dictionary defines suffering as “The state of undergoing pain, distress, or hardship”. We are all subject to these states regardless of age, gender, culture or class. In fact, we could say that humanity is connected by the universal experience of suffering. Bearing this in mind and essentially normalising suffering as part of life, it would be prudent to develop some skills that allow us to face suffering, transform, learn about, and ease it. Here are 3 ways to ease suffering.

These are simple practices for everyone that can be integrated into day to day life. Moment to moment awareness creates the opportunity to practice healthy habits resulting in living well.

Acceptance

Accepting what is happening right now dissolves any resistance. Resistance results in suffering because we are not happy with how we are or where we are or what we have. This is a common cause of discomfort and resistance can certainly drive tension and pain in the body. Accepting is NOT giving up. Instead it is actively being open to what exists now as a lived experience, allowing it to transform as it always does with each passing moment. Acceptance allows us to move forward in a chosen direction whereas resistance does not.

Mindful practice

There are simple mindful practices that give us insight into the way we think and feel, help us to be acceptant, allow us to let go of unhelpful thoughts and to be open to experiences as they unfold. By the very nature of these practices, a sense of well being emerges as we fully engage with the joys of life as well as think clearly about how to surmount the inevitable challenges we face. Here are a few examples:

  • take 4-5 slightly deeper breaths at regular intervals during the day, being fully aware of the ‘in’ and ‘out’
  • pay full attention to what you are doing, whatever that happens to be
  • formal practice of mindfulness meditation ~ this is best done with a coach or instructor to start, or in a group
Practicing gratitude

There are great benefits of practicing gratitude as a skill of well-being. Next time you are feeling glum, in pain, feeling anxious, try thinking about something you are grateful for. This does not need to be anything momentous, instead something more day to day such as the clothes on your back, the sun in the sky or a text from a friend. It needs to have some kind of meaning to you. Practicing gratitude can change the way we relate to an issue of concern. We release some important and healthy chemicals by actively generating the feeling (the feeling is underpinned by those chemicals as best we know), which creates the conditions for more clarity. Clarity of thought means we can focus on the thinking/actions that can result in face a challenge successfully.

The Pain Coach Programme to overcome pain and to live well | t. 07518 445493

08Mar/17

Find peace

In a sense I think that we are all trying to find peace. We week to find peace within ourselves and the world in which we find ourselves — the two are entwined.

We often hear the word peace nowadays. This is because peace is a state we strive for globally in the face of threats that are often purported in the media. There are fewer who seek the polar opposite; people who appear to welcome violence, war and other destructive states. This can only be because of wrong perceptions of the world resulting in wrong thinking and wrong actions.

In terms of chronic pain, perhaps we can say that we strive for a state of peace. This is an idea that came from a conversation with a learned friend some months ago. It was based upon thinking about the ‘opposite’ of pain, which cannot simply be pain free. When we are pain free, we are not thinking ‘I am pain free’, instead just acting, thinking and perceiving as a blended trio within each moment. To find peace seems to be a good place to start overcoming pain.

What is a state of peace?

By definition, peace means ‘quiet, tranquility, mental calm, serenity; a state of friendliness’ (Oxford Dictionary). Consider how we feel and think when in pain. We are suffering, fighting, surviving, emotionally turbulent, living the storm of physical sensations and the turmoil of the thoughts and feelings about these sensations. The former appears to be a good place to be in comparison. There is however, one issue, and that is the effect of resistance to what is happening right now.

Resistance itself causes great suffering. Not wanting to be here, instead wanting to be there. Not wanting to look like this, instead wanting to look like that, are two common examples. This is being non-acceptant and fighting the present moment. But it does not necessarily seem natural to do anything else other than resist. Why would you not want to feel better? Look better? etc etc.

This is an issue of desire and the grip that it can have upon us that causes suffering. The problem is that if you are strongly focusing upon how you want to be and resisting how you are or what you have, you are missing the opportunity that exists now. This is in the form of acceptance, which is simply acknowledging and being open to what is happening right now without resistance. Accepting what is happening right now relieves the suffering and allows us to take the right actions to find peace. These actions can only happen now because now is the only real moment. Thinking about what you might do or what you did only exist in your (embodied) thoughts. Concrete action can only be in this moment.

By being present we can find peace. This emerges from simple practices such as mindful breathing and mindful activities that mean you are present, aware, open, insightful and accepting in a compassionate way.

Where is peace?

There is only one place that we can find peace. That is within ourselves. I recall a pertinent moment a few years ago when a friend said to me ‘I hope you find peace’. It is something we appear to look for, yet we don’t need to look because it is right here. We simply need to create the conditions for peace to emerge and be felt. Does this mean no pain? No, not necessarily. Can you feel pain and be at peace? Yes, absolutely. And in this state, the pain transforms and our suffering eases. So, when we find peace that was already there, just overladen with our day to day fears and worries, the pain rents less and less space. Then we can concentrate our efforts on living well, which is the way to overcome pain.

How can I be present and find peace?

Everything that ‘happens’ does so now, in this moment. It is called being present and we can be fully aware, attending to this moment to gain all the rewards. To be present we can start with a few simple practices:

1. Take our attention to our breathing, even just 4-5 breaths, and do this regularly through the day ~ set a reminder

2. Fully attend to what we are doing, whatever that may be. ‘An unhappy mind is a wandering mind’ was a recent study title. We are happier when we are attending to what we are doing in this moment.

You may also choose to regularly practice mindfulness and other meditations such as metta, or loving kindness meditation. The formal practice each day develops our ability to accept, let go, be open, be tolerant, gain insight into our own and others’ thinking. In so doing, in the wake of the practice comes a sense of peace and calm that deepens in time. There are well described healthy benefits of regular mindfulness practices yet it is important that we practice for the sake of practice and not to ‘become’ something else. This is a challenge but you will recall that trying to be someone else or be somewhere else creates resistance. By far the best way to begin practice is with a teacher but there are some excellent apps and videos aplenty on you tube; for example Thich Nhat Hanh, The Dalai Lama, Matthieu Ricard, Ajahn Brahm, Jon Kabat Zinn.

Pain and peace

Pain is as complex as any other lived experience. It involves the whole person, their biology, their consciousness, their past experiences and their genetics to name but a few factors — it is complex! Equally as complex is pain relief that involves all the same factors. Where we feel pain is not where pain is ‘generated’, instead this is where there exists a perceived threat.

Regular readers of modern pain science literature will know that pain is related to being threatened or potentially threatened, acting in the name of survival. The location of the pain is really a projection of all the biology involved with protecting us, emerging in a specific place where we are compelled to attend. If there is actually an injury there it seems to make sense. Often in cases of chronic pain there is no obvious injury or pathology. This is because pain and injury are poorly related. Despite this, the pain felt is the pain felt. Pain cannot be seen so we must listen to the person as it is the individual who feels the pain.

“Pain and injury are poorly related

Existing under a state of threat results in a range of thoughts and behaviours that can be combatant in nature. Consider what we have said about peace. To find peace we must be acceptant, open and demonstrate compassion towards ourselves and others. If we ‘fight’ the pain, we are only fighting ourselves. Creating a sense of peace allows us to choose to focus on the actions (e.g./ exercises, re-framing our thinking to reduce fear, socialising, practicing mindfulness, gradually becoming more active, and many more) that create the conditions for living well.

Overcoming pain is an active task. The person needs guidance, motivation and support but the to begin with the basics to sustainably move in the desired direction. This includes a working knowledge about (your) pain with skills and practices to use day to day, moment to moment. The new knowledge about pain creates a sense of safety rather than threat, peace if you like. This clarity that emerges from understanding pain means that the person can truly focus on what they need to do to get better. This starts with thinking like the healthy person who is living well: ‘what would they think and do here?’ you can ask yourself, before doing exactly that, albeit with certain limitations at the start. These limitations can and will be worked upon: ‘can I?’ turns to ‘I can’ and ‘will I?’ turns to ‘I will.

From a place of peace and clarity come right perceptions about oneself and the world. To find peace is to find it in oneself. It is there and may need uncovering. When you do, the world looks to be a different place. One that is far less threatening and one in which to thrive and to live a meaningful life.

The Pain Coach Programme to address suffering by learning to live well | t. 07518 445493
05Mar/17

Mindfulness in brief and 5 easy practices

Mindfulness in brief and 5 easy practices ~ there are many books and articles available on the topic of mindfulness so I thought I would write a brief summary. Just to add to the existing and vast literature….

This is how Thich Nhat Hanh answers the question ‘What is mindfulness?’ in his book for children ‘Is nothing something?’:

“Mindfulness is energy. This energy helps us enjoy what is happening right now. Mindful energy can bring us a lot of joy. It helps us suffer less and learnt from our suffering. A good way to get some mindful energy is to close your eyes and breath easily. Just pay attention to your breath. If you can enjoy your in-breath and out-breath, you are creating mindful energy.”

Simple.

“Mindfulness is energy ~ Thich Nhat Hanh

To practice mindfulness you do NOT have to do any of the following:

  • Become religious or change religions ~ mindful practice is not about being religious.
  • Wear an outfit.
  • Pay money.
  • Change anything about yourself.
  • Go to a special place

In other words, anyone can practice, wherever they find themselves and gain the benefits of being mindful, although one of the key points about being mindful is that you are not actually ‘doing’ anything.

Being mindful means you are aware of what is happening right now, accepting what is happening right now, accepting who you are and how you feel and what you are thinking right now, without judgement. This observation and experience of what it is like to be you creates insight into you and the world, seeing reality and seeing things for what they are rather that being judged or clouded by unskillful thinking. Instead of striving to be somewhere else or someone else, we accept who we are and cultivate compassion towards ourselves and others. Both are very important skills for being healthy.

We can simply practice mindfulness by paying attention to our (normal) breathing, which means that we are present in this moment. Much suffering comes from either dwelling or repeating the past, or from anticipating a future that is not pleasant. Some of the thoughts can stem form being hard on ourselves, telling ourselves that we are not good enough or worthy of happiness and health. This is wrong thinking and mindfulness allows us to see this and let go.

Further suffering comes from wanting to be somewhere else whilst not accepting where one is now. Similarly with material goods: wanting something but not being grateful of satisfied with what you have now. It comes down to the same thing really, that is accepting yourself and current circumstances with compassion. Acceptance is certainly not giving in, instead seeing things for what they really are and letting go of resistance. Letting go of resistance immediately eases suffering.

Of course you can download an app or buy a book, but by far the best is to be instructed by someone who knows the practice. The group dynamic is often a good start point, gaining the benefit of practicing together. Questions inevitably arise and it is important that these be answered so that you understand what you are doing and why. Having said that, here are some simple practices to start right now.

Mindfulness in brief and 5 easy practices ~

1. Set a reminder, and every few hours stop and pay attention to 4-5 breaths. This brings you to the present moment, allowing you to realise the effects of thoughts; and they are just thoughts. How do they differ from reality and what is actually happening right now?

2. Ask yourself how you are choosing to think right now?

3. Name the emotion you are feeling.

4. Pay full attention to what you are doing, whatever that happens to be.

5. Check in to your body and see what is going on — tension? warmth? comfort? etc etc. Notice the ‘what it is like’ and the thoughts that you have about the experience — the two are different and there is great value in knowing the difference.

~ mindfulness practices are part of the Pain Coach Programme developing insight, calm and compassion to create the conditions for recovery and living well.
Pain Coach Programme to overcome chronic pain t. 07518 445493
20Feb/17

Pain is whole person

Pain is whole person

There is only one way to approach the problem of chronic pain as it emerges in the individual, and that is by addressing the whole person. This way demonstrates a true understanding of pain: the lack of any pain system, pain signals or pain centres and that the vast majority of the biology of pain is not where we actually feel it in the body or body space in the case of phantom limb pain. Much like when you watch a film in the cinema, most of what you need is not on the screen.

With pain being absolutely individual, coloured by the context, the environment in which it is being phenomenologically experienced, prior experience and beliefs (about pain, health, danger, ‘me’, the world etc.), the action we are motivated and compelled to take, existing health and level of threat perception to name but a few. In short, this includes activity in the brain and central nervous system, immune system, endocrine system, sensorimotor system, visual system, and the autonomic nervous system. Most of this is not where the pain is felt.

Pain and injury are notorious for being poorly related. There are countless stories of people suffering great trauma (tissue damage) and reporting minimal or no pain, some sustaining minor injuries and describing agonising pain and a huge variation in between. Considering the factors in the previous paragraph, one can start to understand why. In essence it is due to pain being a better indicator of the level of perception of threat; i.e./ more threat, or existence of threat = pain.

Bearing this in mind, and this is the current understanding of pain, you can see why the whole person approach is necessary. It is as much about the person as the condition, as Oliver Sacks wrote and practiced, and indeed this is a vital principle to work to. Understand the person and their circumstances and you go some way to seeing a way forward. Listening deeply in the first instance creates the opportunity to gain insight into the reasons for the person’s suffering — the reasons for pain and what is influencing that experience. From this foundation, one develops a rapport, not just as a clinician or therapist but as a trusted advisor, giving the person the knowledge and skills to overcome their pain and live a meaningful life.

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Pain Coach Programme to overcome chronic pain ~ t. 07518 445493 or email: [email protected]

 

18Feb/17

Pain and choice

Pain and choice

There is one thing that pain does and that is narrow down our choices. A sense of choice has a major role in the sense of ‘me’ and who I am. Losing choice impacts upon us significantly as we feel less and less like ourselves and who we are meant to be. This is a very common description of the impact factor that I hear when listening to people enduring states of chronic pain.

Talking to people with pain as we seek to gain insight into the causes of their suffering. This provides a way to offer support, guidance and a way forward. Of course we can only move forward, but sometimes it does not feel like that! Groundhog day.

Enabling one to see their choices then, becomes a valuable and important exercise. We have many, but sometimes we just need a little help to realise and then actualise. I believe that the greatest steps are taken when this happens as the person feels empowered to steer their ship once more.

We need to know where we are going of course, a direction created by clarifying what we want as opposed to what we do not want ~ “I don’t want pain” versus “I want to live well”. Focusing upon living well motivates actions and behaviours in line with this whereas thinking about getting rid of pain keeps our attention on pain. We will only be successful, and we can be, if we have the right approach, mindset and attitude that we may have to cultivate and practice. Most I see do need to work upon these skills of attention, resilience, self-belief and determination. That is the first choice.

We can choose our approach. We can choose to engage in healthy activities. We can choose to take every opportunity to live well. We can choose to create the conditions to feel better. We can choose to have meaningful interactions. We can choose to leave some thoughts alone if they make us feel bad. We can choose to move and gradually move more as we adapt. We can choose to learn about our pain and our responses to pain, and then change them if need be. There are many choices we can make.

Of course it sounds easy when written and the doing is different. It is an experience. However, it is perfectly do-able. We are designed to change and do so every moment that passes. We can harness our potential and opportunities with simple measures, practices and skills based on new knowledge. Achieving success is with everybody’s reach although sometimes we need some help and guidance. But we can do it. This is the ethos of UP. Let us make choices to live well, create joy and face challenges with a sense of ‘I can’.

Choose ‘I can’.

18Feb/17

Why am I running the London Marathon?

Why am I running the London Marathon?

We are 10 weeks away from the London Marathon and I am getting excited about the day. The training is going well, and I am using others experience and knowledge as a yardstick, reaching 16 miles so far. A bit more nudging in March and I’ll be set to join the thousands of other runners, coursing round the great city of London.

So why am I doing this? The answer is simple. To raise awareness and money to address the biggest global health burden, chronic pain. It costs us the most economically but of course the amount of suffering worldwide is immeasurable. This must change and we can change it by shifting our thinking to be in line with what we know about pain. With an understanding of pain, individuals realise their potential to overcome their pain and live meaningful lives. This is achievable, and in this day and age we have the means to reach across the globe to give people the knowledge and skills. This is the story of UP | understand pain, which was co-founded by myself and Georgie as a pain awareness campaign. Now we have big plans to take the project to another level to achieve our aim of changing the way society thinks about pain.

Complex Regional Pain Syndrome (CRPS) can be a terribly disabling condition, characterised by intense pain. Many people have not heard of CRPS and within healthcare diagnosis is often delayed. This is a problem because like most conditions, early identification allows for treatment to begin. The treatment must be based upon the person’s understanding of the signs and symptoms, for there is an understandable fear that drives on-going protection. Therefore, as with any injury or pain problem, the early messages must be right and make sense.A person’s belief drives their behaviours and subsequent thinking, so a good working knowledge of pain is vital ~ understand pain to change pain.

CRPS UK gained a place in this year’s London Marathon, and having spoken twice at their conferences and being in regular contact, I ‘volunteered’ to be the runner. I was very excited to be chosen and gratefully accepted, which is now why I am out in the Lycra every other day (I will not be posting a picture of that!). CRPS UK is a charity dedicated to advancing the understanding of the condition and supporting people with CRPS. The people involved are doing incredible work to raise the profile and have achieved so much through their dedication. Please visit their website here.

You may be someone suffering chronic pain or know someone who is regularly in pain. Most of us do know someone and can see the effects upon their life. This is not just pain from backs and joints but pain related to cancer, heart disease, arthritis, irritable bowel syndrome, headaches, migraines, rheumatological diseases, pelvic pain and many other conditions that hurt. The work being done by CRPS UK and UP aims to change this and provide resources and training that gives individuals and society a way forward, to overcome pain and live well.

Please show your support here and donate generously

Thankyou!!

01Feb/17

The inner dialogue

The inner dialogue ~ what do you listen to and what do you tell yourself?
You are beautiful by La Melodie https://flic.kr/p/99ACEa

You are beautiful by La Melodie https://flic.kr/p/99ACEa

One of the things that makes us human is the inner dialogue or inner voice that is fairly continuously ‘speaking’ to us. Of course the voice is part of each and everyone of us and is not an outside agent. To some people it can appear to be coming from somewhere or someone else as in the case of psychiatric disorders. That must be frightening.

The inner dialogue is part of the workings of our mind. Our minds play a significant role in our actions and perceptions but it is not a one way street. The physicality of our existence can impact upon the way in which we think. The branch of philosophy named embodied cognition has much to say on this matter, addressing the notion that our thinking is embodied. A simple example is when thinking about hunger and food, we would typically feel that in our body, interpreting the sensations as being in need of food. A further example is the way we gesture with our hands to demonstrate a point, freeing up resources for further thinking. Consider how you feel when you think of a loved one or a difficult situation in the past — where do you experience it? Certainly not ‘in the head’.

There is a skill in choosing whether to listen to and act upon our inner dialogue or our thinking. It is true that we do not choose the workings of our mind, however we can learn about how it works, our habits of thought and realise how we embody these thoughts. In so doing, we have the opportunity and responsibility to become increasingly skilful in deciding whether to pay attention or to let go of thoughts and the inner dialogue. Being mindful is just that. We are aware of the thoughts, noticing their impermanence, recurrent nature, the way they create feelings in the body, but we are not engaging or becoming embroiled. There is a monumental difference between being in the film and watching the film. You are still experiencing the full richness of the feelings and emotions but with curiosity, with compassion and with an intent to only act with kindness, towards self and others.

Learning to be observant of the inner dialogue allows you to make choices. We have choices and often need to realise them. How am I choosing to feel or think about a particular situation? Even asking yourself that question gives you space to decide what you can do. Shifting the thinking to take another perspective can give a very different feel to the experience. Knowing that you can do this is very empowering, as you know that you can face challenges with skill and insight.

The story we tell ourselves can be so impacting upon our reality, lived experiences and ultimately our health and sense of well-being. If you persistently tell yourself that you are not good enough, have not tried hard enough or blame yourself for all sorts of things that may not actually be your fault, this will create a range of unpleasant feelings in the body as well as paint a bleak picture of life. Being hard on oneself causes our protect systems to switch into action. A range of common ailments manifest if these systems are ‘on’ too much without adequate refresh and renew time. Such problems include chronic aches and pains, sleep disturbance, gut issues, mood variance and exhaustion; very common presentations in my clinic. This need not be the case by learning some simple skills of well-being and day to day practices that stoke up our healthy systems. This is the bulk of the work we do to overcome pain and health problems — see here.

The inner dialogue and pain

Pain and the inner dialogueThe inner dialogue can tell us our story; the story of me. The self that I experience moment to moment, which is continually updating. Our implicit ability to change creates great hope as we can transform our suffering by gaining knowledge and insight into our existing habits. From this awareness we can choose to create new habits that are based upon our value system (what is important to you in life) and are by design all about sustainably living a meaningful life.

Many people with chronic pain have received messages that suggest pain must be managed or that they must just cope. This lowers expectations and hence our story and the inner dialogue is based on this belief. We can and must do better. Changing our story, and this is applicable to any story we tell ourselves, creates a new way onward. This begins with understanding pain. Countless people have told me how much better they feel on starting to understand their pain when we discuss their experiences at the first meeting. There is no magic here. We feel better when we have understanding of a problem and insight into how we can address the issues — feelings of agency, choice and empowerment feed and motivate us to take action; the right action. The Pain Coach Programme is all about the right action based on the right thinking. Understand your pain, write and see a new story and then live it. This is the story of your success, whether it be overcoming pain, setting up a business, writing an essay, doing an exam or playing a game of football. Use the story wisely, make it count and use every moment in a way that encourages and motivates more and more great action.

The Pain Coach Programme is a blend of strengths based coaching and pain sciences for your to achieve your success | t. 07518 445493

 

30Jan/17

CRPS Diagnosis

CRPS Diagnosis

CRPSComplex Regional Pain Syndrome (CRPS) is a collection of signs and symptoms that define this particular condition. A syndrome according to the Oxford Dictionaries, is a ‘group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms’. Therefore, we can clump together any set of symptoms and give it a name, which is really what has happened over the years in medicine. The important point is that when we use the term, we should all know what we are talking about and know what we should look for to make a diagnosis. In other words, a set of guidelines.

The Budapest Criteria delivers guidelines for CRPS, which you can read about in this paper by Harden et al. (2013). The clinical criteria (see below) acknowledge the sensory, vasomotor, sudomotor/oedema and motor/trophic categories that really highlight the complexity of CRPS. Pain is often the primary concern, with people describing their incredible suffering in a range of graphic ways. However, it is not just the pain that causes suffering but the way in which the life of the person changes together with their sense of who they are and their sense of agency seemingly lost. One of the roles of the clinician is certainly to help restore that sense of who I am, a construct that is built from many of life’s ‘components’.

Budapest Criteria

1. Continuing pain, which is disproportionate to any inciting event

2. Must report at least one symptom in three of the four following categories

  • Sensory: Reports of hyperalgesia and/or allodynia
  • Vasomotor: Reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry
  • Sudomotor/Edema: Reports of edema and/or sweating changes and/or sweating asymmetry
  • Motor/Trophic: Reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

3. Must display at least one sign at time of evaluation in two or more of the following categories

  • Sensory: Evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement)
  • Vasomotor: Evidence of temperature asymmetry and/or skin color changes and/or asymmetry
  • Sudomotor/Edema: Evidence of edema and/or sweating changes and/or sweating asymmetry
  • Motor/Trophic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

4. There is no other diagnosis that better explains the signs and symptoms

Importance of diagnosis

A diagnosis made in the same way, based on the same criteria means that clinicians, researchers and patients alike are all discussing the same condition. This may seem pedantic but in fact it is vital for creating a way forward. Clinicians mus know what they are treating, patients must know what they are being treated for and researchers must know what they are researching. Sounds obvious but let’s not take it for granted. So the Budapest Criteria has pointed all those with an interest in the same direction. Consequently we can focus on creating better and better treatments.

As with any painful condition, the start point must be understanding the pain itself. The following questions arise that we must be try to answer:

  • why am I in pain?
  • why this much pain?
  • why is it persisting?
  • what influences my pain?
  • what do I, the bearer of the pain, need to do to get better?
  • what will you do, the clinician or therapist, to help me get better?
  • how long will it take?

New thinking, new science, new models of pain over the past 10 years has advanced our knowledge enormously. Understanding how we change, how our body systems update, how we can make choices as individuals, and the practices we can use to change our pain experience to name but a few, create great hope as we tap into our amazing strengths and resources as human beings. Detailing the treatment approaches is for another series of blogs, but here the key point is that the first step in overcoming pain is to understand it. It is the misunderstanding of pain that causes erroneous thinking and action, which we can and must address across society — pain is a public health issue. Chronic pain is one of the largest global health burdens (Vos et al. 2012). It costs us the most alongside depression, and I believe that this need not be the case if and when we change how we think about pain, based on current and emerging knowledge.

“The first step to overcoming pain is to understand it”

upandrunThis is the reason for UP | understand pain, which we started in 2015 with the aim of changing the way people think and then approach their pain, realising their potential and knowing what they can do. We are about to launch the new website that is packed with practical information for the globe to access online. Alongside this we have plans to create a social enterprise that will purport the same messages, coming from the great thinkers and clinicians who are shaping a new era in changing pain.

In April I will be running the London Marathon to raise awareness of the work of both UP and CRPS UK. You can support the work that both are doing to change pain by donating here

Thank you!

 

29Jan/17

Pills, injections & surgery don’t teach you how to live

Pills, injections & surgery don’t teach you how to live ~ pain is a public health and social issue
Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

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

In chronic pain, everything changes. The way you think, feel, move and body sense are all impacted by this on-going state of protection that keeps you in a defensive mode. Even the world looks different as perceptions of the environment are distorted (Ref). The changes that we live and experience have biological underpinnings that have and continue to be studied. Clarifying what is happening at this level aims to give rise to new clinical approaches, both pharmacological and non-pharamcological.

This short article is by no means anti-medicine or anti-surgery because these methods have their place. In that place they must remain, viewed as an option within an overall plan or programme that delivers the outcome of overcoming pain. My point is simply that understanding pain means that we realise that explanations relying upon tissue structure or pathology do not hold up. Pain is not a structure and pain cannot be seen on any scan or x-ray. Pain is a lived experience emerging in a person, which is a culmination of multilevel neuroimmune processing and consequent prediction of the existence of a possible threat. Pain exists within our perception of the current moment that is informed by context and past experience (priors): what we are thinking, what we are doing, who we are with, where we are.

Only I can experience my pain under these circumstances, with some ‘components’ being conscious and many being subconscious. For example, I know that I am anticipating pain in the form of a thought: ‘I expect my back to hurt when I put on those shoes’. Yet I do not know and cannot ‘feel’ the activity of my brain, instead living the biological processing as a conscious experience of what it is like to exist in this moment. Here if course we are contemplating consciousness and what it is like to be me, and we do not know how biology becomes this experience.

Pain emerging in the person makes it as complex as the person; and we are complex! Equally, pain relief or achieving a pain frePain Coach Programmee state is as complex. Neither are permanent states as we are continually changing as our body systems and models of the world update. Our ability to shape our body systems with experience creates such opportunity and with that hope. But it is the individual who shapes their systems by making choices based on understanding. This is why understanding pain is so important as a starter. By this I don’t mean knowing all the chemicals and receptors, instead a working knowledge of pain that can be used practically at any given moment so that the person knows what to think and do. In essence, they learn to coach themselves, which is the basis of my Pain Coach Programme.

There are many influences upon the pain experience itself as well as the likelihood that we will feel pain. Unsurprisingly these include stress, anxiety, thoughts, emotional state, environment, other people, fear, context, memory, tiredness and past experience. The person can understand these influences and develop practices that lessen and ease their impact, learning new habits that are pointed towards health and happiness. This is a significant part of the programme of getting and living well. Pills, injections and surgery do not provide such a learning opportunity. Indeed there maybe relief in the short term and there is a potential role here, yet we are interested in long term change in a desired direction.

Suffering chronic pain has many effects upon the person. Certainly their biology has adapted and changed meaning that they can be in a protect or vigilant state more often, and therefore more reactive with emotions and behaviours. Body sense often changes resulting in altered movement patterns, which in turn cause issues navigating the world as well as providing sensory information that can be continually interpreted as evidence of a threat. Recall that pain is in the face of a perceived threat: more threat = more likelihood of pain. Learning the skills of wellbeing together with specific training sculpts biology towards that underpinning lived experiences of health and wellbeing. Again, pills, injections and surgery do not provide such an opportunity.

Overcoming pain to live a meaningful life requires understanding, effort, practice, resilience, motivation and the right attitude. Everyone has the ability to use their strengths and values to motivate actions (thoughts and acts — remember that a thought is an action) that steer change in a positive direction. It is realising that we can choose. We can choose the attitude we take towards a challenge, and the challenge of chronic pain can be one of the greatest faced by an individual.

Rightly so, an argument has been put forward that pain should be considered an issue of public health. Pain is certainly a societal problem, and in looking at it in this way, we are more like to be able to address the issue that costs us an extraordinary amount of money each year. Financial cost is one thing, but the amount of suffering across the globe and in particular in poorer regions, is another. We are compelled to think differently and we can to do this with the knowledge that we have about pain emerging from science, social and philosophical fields. This is a desperate situation needing collaborations between countries and organisations. Fundamentally, the picture of the modern pain epidemic can be changed, beginning with changing society’s thinking about pain. This involves practical and engaged education projects.

Pain education has been trumpeted and righty so. However, there has been a focus on the neuroscience of pain, especially the role of the brain to the point that the brain is described as somehow being separate from the person. Very contemporary philosophical thinking together with neuroscience has nudged us towards the whole person and viewing pain as a lived experience emerging in the person. This allows us to consider a range of ways to educate the person about how they can change their pain, overcome their pain and live a meaningful life. Of course this is always work in progress and it continues with great gusto. The emphasis on chemicals and receptors has moved on. Whilst interesting to know the microbiology of pain, what the person on pain really needs are practical ways of changing their pain in that moment.

Reflecting on the points made, one can see that the biomedical approach to pain is limited by the fact that pain is a social and public health problem, not a medical problem. Some of the recent best thinking about pain has come from historians, public health experts, English scholars, philosophers, artists, and poets. People ask me how they can learn more about pain. The answer lies in listening and looking at society and people who live the experience. Pain and suffering are ubiquitous. They do not live in a book and certainly not a medical textbook!

So what next?

UP | Understanding PainAt UP | understand pain we are working on several projects that will deliver the latest information and thinking about pain to society. Very soon the new UP website will be launched, giving us an online reach across the globe, allowing people to access this information. UP is a social project, working to evolve the way societies think about pain so that suffering can be reduced. With pain being such an individual matter, when only I can feel my pain that is defined by my knowledge, beliefs and experiences to date, the projects must be culturally sensitive. This does not mean going about it carefully, indeed we need to be shouting the current understanding of pain from the rooftops, instead referring to the fact that there is a significant cultural dimension that blends with all other dimensions of the pain experience.

For example, one place that I intend to have an impact is Cambodia (I will explain my reasons in a later blog). The first steps have to include a deeper insight into the current thinking and what factors and beliefs underpin that thinking. We know that it is not simple to replace an existing model with another, even if the latter is more logical and accurate.

Delivering skills and knowledge to people suffering and to those providing the care in principle is straight forward. Much of what is delivered is straight forward, understandable and does not rely on expensive or complicated equipment. The Pain Coach Programme is easily taught and scaled for example, not only giving people what they need to point themselves towards being healthy but creating habits from which emerges healthy, meaningful living. In so doing, pain becomes less and less of a feature, simply because the person is engaged with their life, feeling that sense of being able to make a choice, having meaningful interactions with others, resulting in fulfilment.

Pain is a social issue, a public health issue. Pills, injections and surgery will not solve this problem and in fact can be the cause of increasing reliance on such measures, meaning the individuals have no understanding of what they need to do to get better. Medical interventions do not teach people how to live and whilst there maybe a place for this kind of relief, it must be within the bigger picture, a model of that person’s life that includes all dimensions: e.g./ social, psychological, cultural, gender, biological. The risks of using medication have been well publicised in terms of opioids and this remains a significant social issue.

It is the person who feels pain, the whole person, not the body part. Society’s thinking can evolve in line with what we really know about pain and make a huge impact upon the vast amount of suffering that comes at such great expense. This starts now.