Category Archives: Chronic pain

21Jan/17
Engaged physiotherapy

Engaged physiotherapy for pain

Engaged physiotherapy for pain and the modern world

Engaged physiotherapyEngaged physiotherapy is an approach embracing full awareness of oneself as a clinician, full awareness of the person you are working with, full awareness of the context and past, compassion (self and others), insight, and modern sciences (the facts ~ what we know). I have ‘borrowed’ the term from Thich Nhat Hanh who describes engaged Buddhism, which is the practical use of the philosophical principles such as mindfulness, mindful breathing and mindful walking.

Cultivating our awareness as clinicians and gaining insight into the causes of suffering affords us the opportunity to think clearly about the best action for the individual, in this case in pain. Together with an understanding an use of modern sciences, especially pain science, cognitive science and neuroscience (there is vast overlap of course), and philosophy, we can consider each person’s story and create a way onward that is grounded in understanding, compassion, belief and the right attitude to succeed.

There are simple practices that clinicians can use each day that develop and grow awareness and insight. Here are some examples:

  • The greeting
  • Being present during a consultation using the breath
  • Deep and active listening
  • Compassionate speech
  • The creation of a calm and peaceful environment
The greeting

The initial contact often sets the scene. We can think about how we present ourselves with posturing, gestures, language and the simple smile. I would suggest always going to the patient to greet them in the waiting area, and behaving very much like you are welcoming an old friend into your home.

Being present

Using the breath we remain present and aware of what is happening right now. What is passing through me (my mind)? Any bias? Preconception? Judgement? Being aware allows us to let these go so we can focus on active and deep listening. Practicing mindful breathing each day formally for 5-10 minutes helps us to develop this skill that we can use through the day, every day for professional and personal relations to benefit

Deep listening

One of the most valuable gifts we can give to another person is ourselves and our time. Being fully present to listen to the patient (or colleague or family member or friend) creates the conditions for a meaningful interaction. All involved parties benefit from meaningful interactions as we release certain healthy chemicals in these contexts. In deep listening we can hear and understand the suffering of the other, enabling the best and wisest course of action, which may simply be to continue to listen without interruption. Learning to be comfortable with silence is a valuable skill. Much can emerge from moments of silence. (Reading here)

Compassionate speech

Choosing our words carefully, considering their effects, is an important skill to develop. The words we utter have potent effects on others as they hear, process, imagine, think and react. Of course using kind, compassionate words can create the conditions for calm and insight, enabling the person to see a way forward. A focus on health and being well maintains the desired direction, hence the use of words that encourage this thinking and vision helps the person to orientate themselves towards a desired outcome.

We have the spoken word and we have the inner dialogue. Being skilful with both is important as we need to consider which thoughts we are fuelling, or which seeds we are watering by the way we think and what we say. An example would be the effects of engaging in idle gossip. In the long-term, gossip can create issues of trust and miscommunication that breeds suffering.

As a clinician, we should always be thinking about delivering the right messages based on truth, and that provide a compassionate way forward. Helping the patient develop their skills of self-compassion is frequently needed in cases of chronic pain. Understanding that self-compassion is one of the skills of well being helps individuals to practice and benefit from the nurturing of the care-giving systems in the body that play such a big part in our health and happiness.

Creating a calm environment

We are very responsive to the environment. Consider how you would feel working in an office with no windows and in the basement of a block compared to an office with a view over a park or a river.

Clinicians need to think about how the patient might think and feel coming into the clinic. We seek to create a peaceful space for people to experience feelings of calm and gain insight into how they can be, how they can transform their state of being and how they can use these practices in their day to day lives.

The simple practices are just some of the ways we can use our knowledge and skills to create the conditions for people to get better. We no longer have to think about managing or coping, instead use engaged physiotherapy and approaches to give people the belief, understanding and skills to coach themselves, fostering independence and a sense of agency, restoring choice and meaningful living.

****

These practices are part of the Pain Coach Programme, which is a focus upon getting better and achieving success in overcoming pain. The programme for patients is a comprehensive way forward addressing a pain problem by focusing on getting healthy and well, and the programme for clinicians is to develop their skills and knowledge to coach patients. If you would like further information, please email us: [email protected] or call 07518 445493.

16Jan/17
Pain after joint replacement

Pain after joint replacement

Pain after joint replacement

Pain after joint replacementA number of people experience pain after joint replacement, therefore it is important to identify those who are potentially at risk, devise ways to minimise the risk and ensure that post-operatively each individual receives what they need to resume a meaningful life. Knee and hip replacements are being increasingly performed and hence we are likely to see more people suffering persistent pain. Pain is already one of the largest global health burdens, so understanding pain and what we can do is vital for the global community.

2016 was the Global Year Against Pain in the Joints

There are several key facts to understand about pain:

  • The pain that we feel is poorly related to the extent of tissue damage, tissue changes or injury.
  • Pain is contextual and the likelihood of feeling pain is determined by the perception of threat, both consciously and by body systems that are designed to protect us. In essence, any situation that is judged to be threatening will have implications for a pain experience. This is why stress (a perceived threat) and tiredness play such a role in pain.
  • There is no actual, specific biology of pain, instead a state of protect. In the case of chronic pain, this state is ‘on’ much of the time (a habit) and the person must learn how to change this with different types of training (The Pain Coach Programme). There are no pain signals, pain receptors, pain molecules or pain centres. The biology that is involved with the experience of pain is largely found NOT where we actually feel the pain. Much like when you watch a film in the cinema, most of what you need is not on the screen.
  • And now for some good news! Pain can and does change, but you need to understand it and know what to do.
Risk factors for chronic postoperative pain ~ what to look out for
  • Preoperative pain: if uncontrolled, high intensity and impacting, there is a risk of chronic pain after joint replacement (Arendt-Nielsen et al. 2015). The pain and the person must be addressed before the procedure.
  • Widespread pain is associated with chronic pain after joint replacement (Petersen et al. 2016; Wylde et al. 2011).
  • In some cases of osteoarthritis (OA), temporal summation has been shown to be associated with pain after joint replacement, so evidence of this should be noted.
  • People with fibromyalgia tend to have a higher risk of suffering postoperative pain (D’Apuzzo et al. 2012).
  • When the person has OA that affects a number of joints (Perruccio et al. 2012).
  • Catastrophising about the pain and a lack of effective coping strategies predicted postoperative pain after knee replacement (Baert et al. 2016).
  • Genetic factors, prior experiences (previous surgeries and the quality of the experience and outcomes), beliefs and other influences should be considered.
What can we do?

On deeply listening to the person, we will hear about their experiences and understand the causes of their suffering. If indeed a joint replacement is indicated, then we must ensure the person who will live the experience has a working knowledge of what will happen, who will do what, their role and what they can do to focus on being healthy and well for the best possible recovery.

A simple preoperative education session with the relevant information, an opportunity to ask questions and to learn practices that create the best conditions for healing and recovery would benefit all, but in particular those with identified risk factors. Understanding pain is a key skill and will put the person in a good position to recover whilst they are administered the right pain medications.

The early days set the scene for the coming rehabilitation. Simple breathing and mindful exercises, movements, motor imagery and pain relief all have a role to play. Monitoring how the person is feeling and gauging their belief in their own ability to recover provides insight and opportunities to motivate, encourage and guide compassionately.

Simple, low cost interventions such as these are very likely to make a difference. We can identify the needs of the individual, address any areas of concern before and after the joint replacement and then closely observe the recovery and rehabilitation plan.

Pain Coach Programme ~ preoperative assessment and practices | t. 07518 445493 or contact us using the form below

Common terms used include total joint replacement, total hip replacement, total knee replacement and total joint arthroplasty

15Jan/17
Creating peace

Creating peace

Creating peace is vital for suffering individuals and for society

Creating peaceCreating peace should be the aim of all society but of course peace must reside in each individual for this to happen. One of the greatest proponents of peace is Thich Nhat Hanh, a Vietnemese monk who works tirelessly to bring engaged Buddhism to the world. This means simply teaching simple practices that can be used by everyone, not in a religious sense, but instead as a way of creating peace through compassion and insight. Mindfulness is the main vehicle, and to be mindful is to be fully present, to be aware, to have insight, to have clarity, to experience emotions and thoughts in this moment, to be judgmental, and to be accepting.

Mindfulness is a simple practice ~ anytime, anywhere

Mindfulness is a practice that can be used through each day in different ways to gain these healthy benefits. Some describe a practice like this as a skill of well-being, or the skill of being well. These skills form a major part of the Pain Coach Programme, which is a comprehensive approach not only to overcome pain and chronic health issues but to create the best health to live a meaningful life within our ever-changing circumstances. It is much like learning to sail a boat when the sea is sometimes calm and the sea is sometimes ferocious. The wandering mind is an unhappy mind, read the title of a well-publicised piece of research. Whilst we also know that to permit mind wandering can be useful for ideas and creativity, having control over when this starts and finishes maybe important. Certainly being able to attend to what you are doing in this moment is a valuable health skill afforded by mindfulness practice.

Those who have practiced mindfulness will know that creating peace is one of the emerging experiences. We cannot quieten our mind directly, but the mind can calm within the context of being mindful. Thoughts just come, and we cannot stop them much like King Canute could not stop the sea. Yet we learn how to become insightful and skilful as these thoughts pop in, seeing them as just thoughts and opinions that are often very different from reality and truth. Being observant and curious about our thoughts, or the story that we tell ourselves, gives us space to choose how to respond. How can you respond? You can decide to re-focus your attention on what is happening now by using your breath, you can let the thought go (they pass by anyway), you can purposely generate a positive feeling, you can engage in a meaningful interaction or you can perform an act of generosity. All of these you can do in a way that is informed with self-compassion, being kind to yourself, a key skil of well-being.

Individually we are responsible for creating peace within ourselves. It is an error to think that somehow peace or happiness comes from somewhere or someone else. Mindfulness teaches us that we can come back to ourselves at anytime in order to feel at home and secure. That sense of safety, warmth, comfort and peace we can generate ourselves with increasing effect by practicing the skills of being well and cultivating our awareness and insight. In doing this, we are regularly promoting our own health by activating the care-giving systems in our bodies. These play a vital role in day to day physiological functioning: nourishing body systems, diverting resources to healing, repair, refreshing and renewing, digesting food and building energy levels that we need to live and feel well. This is in contrast to the protect and service systems that are designed to work in short bursts. It is when the protect mode is operating consistently that we can develop a wide range of common ailments: IBS, migraine, pelvic pain, wide spread aches and pains, chronic pain, fibromyalgia, and fertility issues to name a few. Choosing to lead a hectic life full of habits that promote survival without adequate deep relaxation only results in health issues. However, we can always make the choice to make a change in a new direction.

We are changing every moment, you just need to choose your direction in line with your vision of the well-you and groove new habits

There are many issues with modern society and its impact upon the health of all, however we also have a great deal of knowledge we can use to make an impact. There are many simple practices that we can use each day to improve our world. This all begins with a shift in thinking beyond oneself towards a mindset of how we can best give and serve our world and the people in the world. We are interconnected in many ways and collectively we can be responsible for social developments that benefit all. We are seeing this increasingly with social enterprises emerging in different sectors. This work is vital for all of us.

Creating peace within ourselves with a simple practice each day is the basis for a collective peace within society. On an individual basis, the creation of peace within is the same as creating the conditions for health as the parasympathetic nervous system predominates. There is so much to be gained from practices that can be learned by all ages (children, teenagers, adults and seniors) in different environments (nurseries, schools, workplaces, homes and healthcare facilities). Low cost, easily implemented and science-based there are a number of initiatives across the world that we can build upon and develop. However, it starts with the individual.

Pain Coach Programme to overcome chronic pain by using the skills of being well to lead a meaningful life | t. 07518 445493 or contact us using the form below.

14Dec/16
What is said, what is heard

In pain ~ what is said, what is heard?

In pain ~ what is said, what is heard?

Anyone who has tried to describe their pain knows how incredibly difficult it is to find words that truly represent what they feel. The same could be said for many lived experiences, the ‘what it is like to……’ that we attempt to transmit to another person. But of course the other person cannot actually know or feel what you feel. We only know what it is like to be ‘me’.

Acknowledging this issue, when we ask people to describe their pain, they are permitted to use any words from their own vocabulary and any comparison or metaphor that emerges from their thinking because this is as close as they will get. Whilst they are telling us what they feel, as well as words that attempt to describe the raw feel of pain, others will demonstrate the degree of suffering and emotional distress that are the additional factors, or second arrow in Buddhism terms. We experience a raw feel, which would be the first arrow, and then the thoughts and emotions that have their own ‘feel’ and typically are the source of the greatest suffering, which are the second arrows.

The raw feel of pain is the raw feel of pain. The add ons are all the thoughts and feelings associated with the pain that are the cause of great suffering. 

Active or deep listening allows us to really hear what the person is saying to us. This is sitting in a state of calm and non-judgement, allowing the person to express themselves in their own unique way. Silence maybe part of this ‘exchange’ that the clinician can become increasingly comfortable residing in, with the knowledge that from silence can emerge important dialogue. Only through deep listening can we hear the words of the other that emerge within a particular context that must also be recognised ~ i.e. the difference in the way someone behaves in different situations such as the clinic when they may be anxious. We must get as close as we can to hear what the individual is saying: have I truly heard what they have said?

We can enhance the flow of communication with our posture and the way we move within the dialogue. A simple movement towards the person shows engagement whilst eye contact can be used judiciously. It is worth considering that for some people eye contact can be challenging or threatening, hence awareness and being present are important.

Our way of being, when filled with compassion and empathy, creates the opportunity for the person to speak and tell their story that is full of all the information that we need as clinicians to gain insight into their suffering and the causes of their suffering.

Pain Coach Programme for chronic pain | skills of well being to live a meaningful life | t. 07518 445493

Pain and Communication

The problem of pain

Pain and communicationCommunication has a large role in pain from the perspective of telling someone that you are suffering but also in the treatment of pain. At the BASRaT Symposium last week I outlined some of the key features that I will summarise here.

Before discussing communication I highlighted what is the one of the most significant and costly problems on the planet: pain. There are vast costs to society and individuals as the numbers of people suffering chronic pain are enormous. The British Pain Society recently called it the ‘silent epidemic’.

It is thought that 20% of the population suffer on-going pain, including 1 in 5 children. Whilst we can say that the former is a significant number necessitating action, the latter absolutely needs to change. We must understand why this is the case. What is it about modern living and culture that is creating a generation of pain and anxiety? There are some obvious candidates: pressure to achieve at all costs, a lack of self-esteem, narcissism encouraged by popular culture, and obsession with social media at the expense of developing connections and communication skills (including addiction to devices).

One of the main reasons for the scale of the pain problem is the misunderstanding of pain through society. The biomedical model still predominates when there is the search for a structure or pathology to explain the pain and extent of the pain. The preferable biopsychosocial model takes into consideration the important psychological and social dimensions, but often the ‘bio’ receives most attention. Modern understanding of pain would suggest that actually, a better framing would be a sociopsychobiological model because whilst understanding the pathophysiology and molecular aspects of pain is important for scientists and clinicians, the person in pain just needs to know what to do when they are in pain. They need a process to follow with an understanding as to why this is important. Neuroscience education has a place in the treatment of pain, but not a primary one.

Pain is a subjective experience emerging in the person, influenced by a range of social, cultural, contextual and environmental factors, past experiences and beliefs, in the face of a perceived threat. Pain is about protection and survival.

Pain & communication

With the size of the problem in mind alongside the understanding that pain is poorly related to injury and tissue health or pathology, we looked at some important aspects of communication.

One of the communication streams that is often forgotten is the inner dialogue. This is the story that you tell yourself about you and life; that little voice that is so familiar and if not trained can be so disruptive. This is the inner dialogue that can cause such suffering when we berate ourselves for not being good enough. This is relevant for the person with chronic pain as self-criticism is a common feature when in fact kindness and self-compassion is a key driver in getting better. Equally, the clinician’s inner dialogue will affect his or her approach and decision making. Think of a scenario when you are tired, you were late for work, you stubbed your toe on the bed and then you are faced with your first patient who has not improved. You need clarity of thought to approach this situation, not a mind cluttered with annoyance and frustration.

What are you telling yourself? What are you convincing yourself? How are you choosing to think?

How we communicate pain to the person has an impact on their understanding, which is paramount in validating their story to date, and in helping them engage with the programme. Firstly we must listen deeply so that we can know the person as much as the condition ~ the two are not separate. Listening deeply is a skill allied with active listening when you are fully present, in contact via body position, your eyes and expressions (verbal and non-verbal), and allowing them the space and time to tell their story. This narrative holds many clues so our full attention is required, jotting down key points and phrases. In sum, there are different communication dynamics co-existing: the inner dialogue of the person, that os the clinician and the (outer) communication between the two.

Compassion and empathy

Cultivating compassion and empathy as a clinician is an extremely worthwhile exercise. Those who have chosen the caring professions have already demonstrated these characteristics by the very nature of the choice ~ we care and want to help others to live their lives. It is interesting and reflective to consider the question: why do I care?

Not only is this important for the clinician, but also for the patient to learn such skills, especially if they are hard on themselves. It is very easy to pick up on this when they speak to you. The problem with being a self-critic without control is that it is very threatening and hence is provoking the self-protect systems that exist to make sure we survive. These systems have a significant role in pain and hence we are aiming to do the very opposite: active the care-giving systems and effect parasympathetic actions. In a sense our job is to help the person realise that they are safe, how they can safely build up their meaningful activities and adapt in a way that means they are living meaningfully.

What are compassion and empathy?

  • Empathy ~ the capacity to share the feelings of others
  • Compassion ~ feelings of warmth, concern and care for the other…with a strong motivation to improve the other’s wellbeing (Singer & Klimecki)

These will be familiar to clinicians and therapists, but what may not be so familiar is the fact that we can train and practice simple skills to improve our capacity.

It will not be a surprise to many that our brains change when we practice and learn, and this is no different for compassion. Neuroscientists have been looking at these mechanisms for some years now, gathering data on these brain changes and how they manifest in the person. Aside from the science, developing a compassionate society has obvious benefits for all:

Love and compassion are necessities, not luxuries. Without them, humanity cannot survive ~ Dalai Lama

These are skills that should be practiced from an early age with purpose, in homes, schools and workplaces. And just to be clear, compassion is not characterised by weakness or femininity as can be said; not at all. Compassion takes courage and is for all.

Simple practices

There are a range of practices that clinicians and therapists can use for both themselves and their patients. Remember that there is an interaction between the care-giver and receiver, both benefitting from a kind action on a chemical level. Fostering and nurturing every opportunity means that we set the scene: the welcome, the greeting, the opening question or comment, the engagement, the demonstration of care, the calm environment, and much more. Being aware of the present moment and crafting each unique session is a skill to be fostered.

It is beyond the scope to describe the following in detail, but as an indicator, these practices are easily started, often a challenge to continue, but immensely worthwhile for the individual and society:

  • mindfulness
  • lovingkindness meditation
  • the practice of gratitude
  • cultivating an ability to control the wandering mind
  • purposefully generating positive emotions

It is worth remembering that as a clinician, you are the treatment as much as any approach you apply. There is no separation. Developing your capacities hence will have a significant impact on your clients and patients as you increasingly set the scene and communicate in such a way that the person feels trust towards you, a sense of being cared for and a belief that they can get better.

Here is a great video from one of the foremost researchers in the field of compassion, Richard Davidson

For further information on the Pain & Wellbeing Coach Programme or clinician/therapist 1:1 Pain Coach Mentoring contact us below or call 07518 445493

24Oct/16
Women in pain

Women in pain

Women in painRecently I gave a talk to a group of female health professionals at the Inspiring Women in Medicine meeting entitled ‘Women in pain’. I spoke about the significant societal problem of women suffering persistent pain, which is one of the issues that comes under the banner of women’s health. Society needs women to be healthy and hence the problem of women in pain must be addressed. Fundamentally at present, society does not understand pain sufficiently to address this enormous public health matter effectively, which is where I believe we must begin: understanding pain.

If society understood pain….

  • individuals would know what to do and think in order to orientate themselves towards getting better
  • it would not be feared; instead the focus would be on overcoming pain
  • healthcare would deliver the right messages early on so that the right actions are informed by correct beliefs about pain
  • the right treatment appraoches would be employed from the outset
  • there would not be the same level of suffering — the figures say: 100 milliion Americans suffer persistent pain; 20% of the population; 1:5 children

Chronic pain is a huge global health burden that costs both individuals and society enormously in terms of finances and suffering. Of course, this pervades out into family and social networks and hence those around the individual can also be suffering through their on-going provision of care. Pain is a strain on society, literally. If it were understood, this can change.

Women in painWomen are reported to suffer more pain and visit their doctor more often about pain than men. Females are more likely to suffer functional pain syndromes. There are still many people, including healthcare professionals, who do not know what functional pain syndromes are or have insight into the basic biology that emerges as a range of painful problems that are very common. They include irritable bowel syndrome (IBS), migraine and headache, back pain, fibromyalgia, pelvic pain (e.g. vulvodynia, painful bladder syndrome, dysmennorhoea) and temporomadibular dysfunction. Other regular features include anxiety, depression, a history of early life events (and later in life when a challenging situation brings about pain and suffering), perfectionism, a person who is very hard on themselves and hypermobility.

This being the case, one would expect that research into how females experience pain and why they feel more pain would be stacking up. Unfortunately this is not the case with most research done in males and male rats. Clearly that has to change alongside the overall attitudes to women in pain.

Women in painRecently the press ran with stories about how women in pain receive different care and approaches to men. Women waited longer for treatment, were less likely to receive opiates for pain (opiates are effective for acute pain — there are big issues with the use of opiates for chronic pain) and were deemed to be more emotional and hence somehow their pain was different in the sense of how it should be treated. Of course this is wrong on every level. Each person has a unique pain experience that is flavoured by a perception of threat within a certain context and enviornment, based on prior experience and beliefs of that person. Therefore, each person needs to be addressed as such and treated according to this principle, man or woman.

There arWomen in paine some ideas as to why men and women should experience pain differently. The most obvious is that of gender biology based primarily around hormones and the menstrual cycle. In particular there maybe an important time at the onset of menarche when sensitisation could emerge in some individuals, thereby priming them for future events such as injuries, viruses and illnesses when the systems that protect us (immune, nervous, sensorimotor, autonomic, endocrine — they work together as opposed to being in isolation) are active in the face of a perceived threat and increasingly vigorously. What the person lives are the symptoms of thee systems working including fever, pain, altered perceptions of the world, altered thinking and emotions. It can sound like these are all separate ‘reactions’ when in fact they are part of an on-going cyclical process: we think, perceive and act as a unified lived experience.

Another observation relates to empathy and how women maybe more empathetic for the purposes of caring for their children. A truly empathetic person is a caring person yet they must be careful and skilled so as not to embody their own versions of observed others’ suffering. As an example, it is not uncommon for me to feel a pain in the same place that a patient is describing their pain to me. Understanding the mechanism, I can rationalise the feeling and it will pass as I actvely change my perception — this is likely the same mechanism that underpins the change from being in pain to not being in pain in all people. I know that others I have spoken to also have this experience, which one could argue is deeply helpful as a healthcare practitioner as we seek to understand the causes of the other person’s suffering.

A described emotion that often appears within conversations about pain, particularly women in pain, is that of guilt. The reasons for expressing guilt are based around the conflict between work, home, partner and children — trying to please all but rarely pleasing or looking after oneself. Being kind to self is important in the sense that being hard on oneself can be the cause of great suffering. This is common and will almost certainly be taking the woman closer to her biological protect line, the point at which threat is perceived and enacted as a pain experience. Learning how to foster the existing compassion towards oneself then, is a typical part of a comprehensive programme for getting better. With many whom I see displaying and admitting perfectionist traits, it is not a surprise that harsh inner dialogue results in repeated negative emotions. Strung together frequently, this forms the basis for chronic stress, which in turn is the means for a pro-inflammatory state, which emerges as aches and pains, troubled tummies, headaches, mood changes, sleep issues, fertility problems and more. The reason is simply that in the pro-inflammatory state, the body is in survive mode that is great when there is a real threat. However, most of the time there is no threat, it is just something we are thinking about that triggers the same response via a prediction taht one exists.

Now, there is nothing wrong in experiencing negative emotions. We need them as much as the others. It is really about the apporpiateness of the emotions: when we feel them, how long we feel them for, how often etc etc. If we consistently think that something bad will happen or ruminate on things that have happened rather than seeing things for what they really are in this moment, then this basic survival biology will keep going. This is where mindful practice is so beneficial, cultivating awareness of existing habits that allows for a reappraisal, a space to see things for what they are and gain insight into the causes of your own suffering and others, from which you can choose a new and healthy way onward. Clearly there is much more to say about mindfulness and its benefits, in particular in the face of mcuh exciting data from studies across the world.

Whilst this blog scratches the surface, it hopefully provides some food for thought. This is a significant public health issue that we can tackle by understanding pain and applying simple and sensible compassion-driven care, which will make a huge difference. Coaching the individual woman to coach herself in a direction that is toward her desired outcome is out role as we empower individuals and allow them to realise their sense of agency in getting better. There are simple measures such as movement, exercise and mindfulness that work in synergy to create a meaningful life to be engaging and enjoyed so that when challenges arrive, they are overcome and used as learning experiences. Science, compassion and sense are at the heart of the Pain Coach approach, one that we can all adopt to change for the better. Ourselves and our patients.

RS

The Pain Coach 1:1 Mentoring programme is for busy clinicians who wish to develop their working knowledge and to be effective in coaching people suffering chronic pain to lead meaningful and fulfilled lives. Contact us on the form below or call Jo for further information t. 07518 445493

 

 

 

23Oct/16

Is mindfulness for everyone?

MindfulnessWalk into a bookshop and you cannot help but notice the ever-increasing number of books about mindfulness filling the shelves, which begs the question, is mindfulness for everyone?

In my opinion, mindfulness is a practice that everyone could choose to incorporate into their lives, however, not everyone will wish to make that choice. It is also the case that the route to mindful practice can be different for different people. For example, sitting or lying and being mindful or meditating can be result in greater suffering in some circumstances and hence that person needs something else at that time. An individual suffering PTSD for instance, could discover that mindful practice leads to a greater state of stress and anxiety. There are several possible reasons for this, including whether they have been instructed in the right way about what mindfulness really is and how we go about the practice. With so many people offering mindfulness at the moment, it can be difficult to know who best to listen to or follow.

Starting any new practice is a challenge and requires dedication and perseverance. In so doing, one learns and realises that each moment there is an opportunity to get better at what you are doing. As Ajahn Brahm says, ‘there’s no such thing as a bad meditation’ — we can always take something from the practice, and the fact that you have practiced has created a learning opportunity. Sometimes the practice results in a great feeling of serenity as the inner dialogue quietens, and sometimes the voice chunters away. Good? Bad? It is what you think it is!

Mindfulness is simply about being aware of your thoughts, feelings and sensations as they pass by, which they always do. The realisation of impermanence is an important one as moments continuously flow. Noticing what you are thinking and feeling without judgement means that you begin to see things for what they are and the causes of your, and other’s suffering. This insight is invaluable for our health. One is tempted to say emotional health but this would suggest some kind of separation between body and mind. There can be no separation between body and mind as we are a whole person living experiences that are unified of cognition, perception and action. The practices of mindfulness provide a way of ‘doing’ this, although really when being mindful, we are not actually doing anything other than being aware, using our attention. To add compassion to this means that you have the intention to be kind to others and yourself with all the accompanying health benefits from positive social interactions and kindness to self.

Mindfulness is a practice with several straightforward methods (below), which is why it is accessible to all. However, actual practicing is the challenge as we have so many existing habits of thought. Our minds do wander and are filled with chaotic thoughts that inform feelings, emotions, actions and perceptions, yet all of these dimensions inform each other. This complexity defines the challenge and how one day we can quieten down the inner chat and another day it seems to make no difference. Remembering that it is not the thought or series of thoughts that is the issue, instead it is recognising that this is the content of the mind, which is not me per se. I am not the contents of my mind, and being able to realise that is hugely empowering.

Two common practices are mindful breathing and mindful walking, both if which are accessible at any moment to most. Paying attention to what arises in this moment is at the essence of the practice that develops one’s ability to focus, choose what to attend to, to reappraise a thought pattern, see things for what they are, realise that anger or another emotion is present yet you can remain focused on your intention. Keeping a focus on your intention is a great skill demonstrated at a time when an argument ensues. Instead of emotional reactions with hurtful words, maintaining a course for the intention that is usually a kind action towards another, you listen deeply and understand the other party, allowing for effective communication towards a resolution. Be able to see the reasons for the other person’s actions provides great opportunity for transforming the situation. This would be a good example of using mindfulness and compassion, the two differing.

Returning to the primary question, I believe that mindful practices can be integrated practically into people’s day to day living if the person makes the choice to do so. Potentially, this is the case for anyone. However, each person needs good instruction and guidance, in essence to become their own coach to transform their inner dialogue to one of kindness and compassion toward self and others. Mindfulness creates the awareness within which this can happen through attention training (mindfulness is about attention whereas compassion is my motivation or intention ~ there’s a difference). Some will need other ways into the regular practice by using breathing and movement, some will need different explanations to be guided and supported, but the the aim is always to develop ways to reduce suffering.

RS

Mindfulness practice is a part of the Pain Coach Programme for overcoming pain | contact us by email: [email protected] or call us 07518 445493

28Aug/16
Creating peace

Simple skills

simple skillsThere are a number of simple skills that can be practiced to become a better clinician. In essence, when we are fully present and engaged, we are communicating this to the patient thereby creating a nourishing environment. This environment sets the scene for new understanding and new habits, beginning the transformation of the suffering person.

We are not separate from the environment in which we reside and hence we, the clinicians, have a role in how the environment supports the person getting better. Arranging the treatment space is important then, enabling the patient to feel welcome, heard, comfortable and free to express themselves. This expression is the story to which the clinician must listen deeply as all the information is contained within the narrative. Allowing the person to speak in their own language with occasional prompts and guidance is the basis of the onward journey towards their vision of a desired outcome.

For the clinician to practice mindfulness is a simple way of maintaining presence and engagement with the patient. This simply means that you are listening deeply and using insight to see the causes of suffering that are revealed as the person speaks freely. Add to this compassionate speech and the communication facilitates the way forward. Communication is part of the treatment as the clinician helps the patient understand their pain and suffering — what has happened so far, what is happening now, what is influencing their pain, what they can do, what the clinician will do and how they will go about it.

Practicing mindfulness is a simple skill. As a starter, the clinician can take 4-5 breaths between patients, paying attention to the rise and fall of their chest. On the out-breath you can consciously let go of unhelpful and distracting thoughts. As soon as your mind drifts into the past or future, you are no longer present and your engagement dissolves. During the session, recognising this happening and bringing your attention back to your breath is a way of re-engaging once more.

Taking a break midway through the day to move, breath and nourish is an important refresh and renew point. A period of deep relaxation for 10-20 minutes gives us energy to be present once more and focus on the patient: their words, their gestures, their messages. We must develop our abilities to gain insight into the causes of the patient’s suffering so that we can guide and treat, enabling them to get better and ease their pain and suffering. In fact, by gaining insight ourselves, we can then help the patient to develop their insight into the causes of their own suffering and create new healthy habits around their thinking, choices and actions to actively infer new experiences.

Practical point: start by taking 4-5 breaths between patients, and at the start of the day express gratitude for the opportunity to help people get better.

********

Pain Coach 1:1 Mentoring Programme — develop yourself and your insights to coach people overcome their pain | t. 07518 445493

27Aug/16
If pain

If pain

If painIf pain was understood, there would be less suffering.

If pain was understood, the right messages would be given from a young age, sculpting behaviours based on what needs to be done.

If pain was understood, there would be no fear about it.

If pain was understood, we would focus on what we can do to feel better.

If pain was understood, it would be known that listening deeply is the first step to help someone transform their pain.

If pain was understood, it would be known that understanding pain changes pain.

If pain was understood, there would be an enormous amount of money available for a better society.

If pain was understood, it would sit in the realm of public health and not medicine.

If pain was understood, there would not be the reliance on medication.

If pain was understood, what would the world be like?

— this is the mission of UP | understand pain; to globally change the understanding of pain, because put simply, the world would be a better place if pain were understood.

www.understandpain.com

23Aug/16

Inequalities in pain relief

A brief article in yesterday’s Guardian highlighted one of the inequalities in pain relief. The author, Grace Rahman, focused on the question why black patients are given less pain relief in the light of recent research. With pain being the most common cause of Emergency Room visits, there is plenty of data to analyse. This is likely to be the same in the UK, pain being the primary vehicle that takes people to seek help. As a significant aside, it astounds me that pain is so low on the public health agenda in terms of funding for research as well as overall recognition.

Depression and chronic pain take the first two positions in global health burdens — they cost us the most. Yet where are the campaigns? Where is the TV coverage? They do not exists despite the fact that pain is a universal experience, except in an unlucky few with a rare genetic disorder, which is normal and necessary for survival but so deeply troubling when it persists. Therein lies a major issue contributing to the question penned by the journalist: why are black patients given less pain relief?

Previously, young babies may not have been given pain relief and older people may still not receive adequate pain relief, especially those who are cognitively impaired. The aggression seen in someone suffering dementia may well be due to pain that a simple analgesic would relieve. The misunderstanding of pain underpins all of these contexts, resulting in poor treatment that is based on the wrong thinking. The lack of pain education is incredible when you consider it in this light.

A study quoted by the author highlighted the knowledge gaps of white medical students who rated pain levels to be lower in black people when looking at case studies. Why would this be the case? It was thought to be due to ‘entrenched ideas’ about how people differ biologically and about how they behave in relation to using medication.

Each person is unique with their own personal experiences and narratives of their life to date. This makes an individual’s pain unique, and at any given moment our lived experience that could include pain, is also unique. I have never had this moment before and never will again. So even in the individual, the pain is never the same. We are always changing as we build up prior experiences with every passing moment in time. Understanding this is important and also delivers hope, because when combined with a working knowledge of pain and what we can do to actively steer a desired course within realistic parameters, we actualise change.

Therefore, as clinicians and as a society we must appreciate that each person’s experience of pain is unique and just as they person says it is — listening deeply is vital to gain an understanding with the required compassion. Just spending those moments with the person, allowing them the time and space to describe their experience allows a calming. We must certainly appreciate culture, gender and beliefs as we impart the truth behind someone’s pain, giving them knowledge and skills to overcome their pain and what fuels the sensations. This is the same for every person — whatever the colour of your skin, age or sex. Deep listening, compassionate speech and a focus on what action to take in this moment.

Much suffering comes from how we think about our pain, which is why we feel better when we understand pain and the fear dissolves. When the fear and worry decrease, so the pain eases and we can focus on what we need to do to get better. Fear, worry and depression are based on the contents of our thinking from the past or the future, neither of which exist except in our embodied minds. The only real moment is this one, now. Practicing being present and seeing what is actually in front of you by using the breath for example, allows the person to let go and concentrate on this moment. This is the foundation for moving onward in a chosen direction.

Medication is part of overcoming pain. It can be useful when used wisely within a plan that includes how and when the drugs will be reduced. Of course this is individualised to the person, their condition and their needs. Many people choose not to use pain relief, and certainly the opiate based drugs. Everyone wants relief and this should be a primary aim of any treatment programme, however, the person needs to understand how they themselves via their own thinking, perceptions and actions can change their pain. This is the main bulk of the work for that person as they need to be able to coach themselves at any given moment, each day. The strategies and exercises become healthy habits formed through practice that interweaves into the day. Continuing with normal activities in tolerable chunks maintains a sense of living a life and I often say to people that they can only get only get back to living by getting back to living — doing the things you want to and starting doing the things you have not been doing, bit by bit; thinking ‘can’ instead of ‘cannot’. It is just that you need some ways and means to do so as you build up tolerance by following a programme. A simple analogy is all the background work that an athlete would do in order to perform their sport. The programme is the background work.

Bearing this in mind, there is only one way and this is to consider and treat the unique person as much as the condition. In doing so we learn about their suffering and guide them forwards with treatment that gives the person working knowledge of their pain and skills so that they can coach or mentor themselves forward by thinking and acting in such a way as to take them forwards.

********

Pain Coach Programme for persistent and chronic pain | t. 07518 445493