Category Archives: Pain Education

24Jul/17

Improve staff fitness

chronic back pain, Chronic pain, Pain, Pain Coach, Pain Education, , , , , ,

Improve staff fitness

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

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

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

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

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

“The skills of wellbeing easily weave into the day”

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

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

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

“Staff fitness benefits business and society”

Staff fitness

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

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

What could we do at our place?

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

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

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

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

Individual coaching and workshops ~ t. 07518 445493
27Mar/17

Charity quiz night

Chronic pain, Complex regional pain syndrome, CRPS, CRPS Guidelines, CRPS treatment, Pain, Pain Coach, Pain Education, , , ,
Charity Quiz Night

On Thursday 20th April we are having a charity quiz night at Wags N Tails in Surbiton to raise money for CRPS UK and UP | understand pain — click here for the event link — please come along and support us! 

Richmond is running the London Marathon this year to support CRPS UK and UP — please donate here

Chronic pain is the number one global health burden

Chronic pain costs us the most of all the health problems that exist. One only has to think of all the conditions that are painful and consider the expenditure on investigations and treatment. This is in addition to the loss of productivity. Some 20% of the population suffers chronic pain, including 1:5 children, which begins to provide insight into the immeasurable suffering. People from all corners of society are struggling to understand why they are in pain, do not know what they can do and feel isolated as their plight continues. This does not need to be the case.

UP | understand pain

At UP, we have a vision of a world where people understand pain and know what they can do to live well. This begins with changing the way society thinks about pain, truly understanding the facts, in which case they would know that there is a way forward. We are constantly changing and learning meaning that we have the resources and the potential to get better. People need to know how.

UP is to be re-launched this year as a social enterprise that will deliver the latest knowledge about pain and how it can be applied. The know-how is vital as are the skills of well-being and self-coaching. The programmes will be delivered to people suffering pain and to healthcare professionals who work with people in pain. This includes trainees who are the new generation of clinicians and therapists. We also plan to take our message to the policy makers to create changes ‘top down’.

CRPS UK

The CRPS UK charity supports people who have been diagnosed with complex regional pain syndrome (CRPS — sometimes called RSD) and their families. The most recent diagnostic guide is the Budapest Criteria.

CRPS is poorly recognised and understood. This means that diagnosis and the right treatment can be delayed, resulting in on-going suffering. The pain of CRPS can be unimaginable with the impact upon the person’s life being enormous.

We can and must do better with CRPS and all pain conditions. The right messages early on and the right actions taken by both the individual and clinicians will make a huge difference.

The work being done by both CRPS UK and UP will be instrumental in the forthcoming changes that must happen in society. Pain is a public health issue of the utmost importance — the costs and the suffering. Pain must be addressed in this way, which is what we are doing at UP. This massive problem affects us all and we can do so much to transform the issue.

Please support our work by coming to the charity quiz on Thursday 20th April or donate here.

 

13Mar/17

3 ways to ease suffering

Chronic pain, Mindfulness, Pain, Pain Coach, Pain Education, , , , ,

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

Chronic pain, Chronic pain treatment, Mindfulness, Pain, Pain Education, ,

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
20Feb/17

Pain is whole person

Chronic pain, Pain, Pain Coach, Pain Education, , , , ,
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.

+++

Pain Coach Programme to overcome chronic pain ~ t. 07518 445493 or email: painphysiolondon@gmail.com

 

01Feb/17

The inner dialogue

Chronic pain, Pain, Pain Coach, Pain Education, , ,
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

 

18Jun/16

Biology of pelvic pain

Chronic pain, Functional Pain Syndromes, Pain Coach, Pain Education, Pelvic Pain, , , , ,

Pain nowMost of the biology of pelvic pain does not exist in the pelvis. The same is true for any pain — back pain, knee pain, neck pain etc. Much like the screen turning blank in the cinema, the problem itself is not the screen but instead the projector or the power source. In other words, to think about pain requires us to go well beyond the place where it is experienced.

Pain is of course lived and whilst it must have a location, the relationship between pain and injury is unreliable. With a huge number of factors influencing the chances of feeling pain in any given circumstance, there is a requirement for a perception of threat that is salient and exceeds other predictions in terms of a hierarchy. Once felt, pain compels action much like thirst and hunger. Again, like thirst and hunger, context and meaning we give to the sensations influence that very experience, which clarifies to a greater extent the difference between on-going (chronic) pain and that of labour.

To feel pain we need a concept of the body, which itself is constructed elsewhere as the sensory information flowing from the body systems is predicted to mean something based upon what is already known and has been experienced, we need a nervous system, an immune system, a sensorimotor system, a sense of self and consciousness to name but a few. Where in the pelvis do these reside?

This is not to ignore where we may feel pain as this is an ‘access’ to the pain experience that should be used in terms of movement and touch. However, it is the person who is in pain and not the body part. My pelvis is not in pain, I am. My pelvis does not go and seek help, I do. My pelvis does not ease its pain, I do. So when ‘treating’ a person, we must go beyond the place where the pain is felt to be successful. And it is vital that the person is considered a whole; there is no separation of mind-body. The notion of physiological, body, psychological division etc. etc., just does not fit with the lived experience; I think, and I do so with my whole person — embodied cognition.

Locally one will usually find evidence of protection and guarding, which themselves manifest as the tightness, spasm, painful responses to touch and movement. This is all manifest of an overall state of protection, co-ordinated largely unconsciously accompanied by a range of behaviours and thinking that quickly become habitual — they are certainly learned from priors, our reference point. This is simply why delving gently into the story is important, as we can identify vulnerabilities to persisting pain such as previous experiences of pain, functional pain syndromes, stressful episodes in life; all those things that put us on alert when the range of cues and triggers gradually expand so now I am vigilant and responding to all sorts of normal situations with fear.

The start point is always developing the person’s working knowledge of their pain, which also validates their story. So many people still report that they feel that they have not been believed, which I find incredible. How can someone work in healthCARE and not believe what a person says? Baffling. Once the working knowledge is being utilised and is generating a new backstory, new reference points emerge. We create opportunities for good experiences over and over, moment to moment, day after day, in line with their desired outcome, the healthy ‘me’ that is envisioned from word go. This strong foundation that opens choices once more then permits exploration of normal and desired activities supported by sensorimotor training and other nourishing movements, alongside techniques in focus, relisience and motivation. Realising and actualising change in a desired direction must be acknowledged as the person lives this change knowing that they can.

Pain can and does change when you understand it, know where you want to go and how to get there, quickly getting back to wise, healthy action when distracted (i.e./ flare ups, mood variance, loss of focus etc). The biology of the pain is one aspect, hidden in the dark within us, and the lived experience is another. The two are drawn together to give meaning and to develop an understanding of the thinking and action that sculpt a new perception of self and pain, resuming the sense of who I am, as only known and lived by that person.

14May/16

Kids know about pain distraction

Chronic pain, Pain, Pain Education, ,

Pain distractionI overheard an interesting conversation this week that demonstrated kids know about pain distraction.

Driving my kids to swimming, my eldest daughter was giving us an update on her wobbly tooth and the fact that it hurt. She was concerned that it maybe too painful to go swimming. My youngest daughter, 6 years, then piped up with an insightful suggestion: don’t worry about your tooth because when you are in the cold water you will forget about it’.

To me, as a pain-head (a term sometimes used to describe someone who is obsessively interested in pain and what it is), this was fascinating. Life in action, a natural comment based on some experience that my youngest must have had at some point, or at least heard about. I would think the former is more likely as the message surely stuck with her to the extent that her model of the world in relation to safety-threat has been updated to consider distraction as a way of changing pain and reducing the threat value — pain is a lived experience, compelling action in the face of a prediction of a perceived threat based on the hypothesised causes of the sensory information in relation to prior experience.

RS

11Apr/16

Hands-on treatment for pain

Chronic pain, Pain Coach, Pain Education, Uncategorized, , ,

Hands-on treatment for pain should form part of the therapy programme for painful conditions including chronic or persisting pain. A line of thought exists that the hands-off approach for chronic pain is best yet there are some clear ways that clinicians can use their hands with great effect. It is also expected when a person goes to see a physiotherapist that they will receive manual treatments as a way to feel better, and indeed people often do feel better when such therapies are used wisely.

There is no certainty as to why hands-on treatment works but it is safe to assume that touch has an effect that is likely to be underpinned by a change in the interpretation of sensory input from the body. Modern concepts of brain function suggest that what we experience is the brain’s best guess about what the sensory information in that moment means, based on prior experience. This based upon probability that the sensory information infers something, i.e. something pleasant and hence the touch feels good, comforting, soothing etc., or something unpleasant and therefore the touch can feel painful or uncomfortable.

Touch is deemed important for healthy development and is certainly an act that is used commonly to communicate. In the same way then, touch can be used to communicate in the therapeutic setting as well as create an opportunity to change pain and sensitivity. We are changing constantly with each moment being fresh and new — in fact, this is one of only a few definites in life, is that we change. We are designed to change and hence the feeling we are feeling now is only temporary. The sense of ourselves, ‘me’, is something that we feel is constant yet it changes as time passes and we gather new experiences, learning and developing.

It is worth pointing out that the mention of brain does not mean that we are only a brain. I am a whole person made of my body, brain, mind and environment, none of which is any more important as it is the sum that makes me and who I feel I am at any given moment. The false division of mind and body certainly does not hold up. My mind is not in my head or my brain, I ma my mind, which is why when I think I use my body and my brain together as ‘me’ within a particular context (environment) in a particular moment (that has just passed). This may seem like play with words, yet it is fundamental to successfully addressing pain because this understanding gives both hope and a practical way forward as we use this knowledge to create a programme of treatment, training and movement to overcome pain so that it does not dominate but instead has its place as a survival mechanism. Briefly, pain is a motivator to take action on the basis that I am predicting the need for protection against a perceived threat. More threat, more protection, more pain — not more pain = more damage as was traditionally thought. Hence, the reduction of threat is our aim.

Now back to touch: how we can use it and how it plays a role in reducing pain. Preparing the recipient of the hands-on treatment is important, priming them with an explanation and positive expectations. This can be done by simply describing why it is useful, saying that it is usually a pleasant experience to ease symptoms whilst dropping in calming, soothing words into the conversation. Addressing concerns, especially if they have had a painful treatment beforehand, is also part of the preamble, in essence ploughing the field before sewing the seeds. Then the contact begins.

The clinician can do a few things to prepare him or herself so that the first contact is felt to be compassionate and soothing from the outset. This is of course the aim — to be soothing and to create calm, changing the way that the recipient’s brain is predicting what the sensory information means, i.e. it means safety. And safety in turn means less, or no need for protection, and no protection = no pain.

  • Prepare clean, warm hands
  • Take a breath or two and let muscles relax on the out-breath (we are not always aware of how much tension we are holding, especially if we have been using manual therapy often through the day)
  • Let go of any distracting thoughts and be entirely focused on the touch and responses of the person; again, the out-breath is good for focusing on the present moment

On starting the hands-on part of the session, having prepared the recipient and being present oneself, the first touch allows the therapist to note how guarded and protective the person is in respect of the body. The image of pushing a cork in a barrel of water is a useful visualisation of how to ease into, and respond to the person. It is worth considering that it is the person experiencing the touch and not the body part itself. It is the person who is conscious and gives meaning to the touch, and hence it is the person to keep in mind as you lay hands on. The treatment then becomes a dance or an art form as the hands and the body form an alliance that aims to transform sensory signals into the experience of relief; soothing, calming and peaceful. This would be the same whether the technique more soft tissue (the many forms of massage) or mobilising a joint.

  • Prepare the person
  • Prepare yourself
  • Apply the treatment
  • Conclude the treatment, making it obvious with the hands before uttering a few soothing words (consider tone, volume etc) that allows the person to realise the completion
  • Give a few moments for orientation and shift of state before inviting them to sit up or change position

Of course, hands-on forms only part of the programme with the other facets addressing the different dimensions of pain in an integrated manner: addressing the whole person. However, a key point made here is that in order to be as effective as we can, recognising our role as individual clinicians with our own characteristics and style, we must pay attention to the person, ourselves and the context in equal measure.

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03Apr/16

Knowing about your condition

Pain Coach, Pain Education, ,

Knowing about your condition can be a double edged sword, as illustrated by Ian Jack in @guardian yesterday — read here. Jack describes his experience of anosmia, the loss of the sense of smell. However, he goes on to describe how reading an article about anosmia made him consider ‘that I was in fact a member of a disabled and neglected group’, which he was ‘happier not to think about’.

The piece raises a number of important issues. Firstly that losing one of our five senses has an impact on our ability to predict the world and hence our lived experience, secondly that this impact can be underestimated by the individual in some cases and by society looking in, and thirdly that knowledge about a problem does not always help per se. Everyday people are learning that they have a condition, generally more accurately from a diagnostician and more precariously via the Internet. The latter is of course quite able to ‘diagnose’ in response to a list of words (symptoms) but the danger is that the list of possibilities still require adjudication, and it is the same person choosing an answer. It is a little like your doctor giving you a list of conditions to choose from when you tell him your symptoms, and you then choose the most sinister. Oh yes, and the computer, device, phone etc. does not examine you or try to understand you as an individual.

I write and speak regularly on the fact that people need to understand their pain in order to know that they can overcome their pain, with an emphasis on both the quality of the explanation (teaching – learning scenario) and the context in which the information is delivered. Reading an article as did Ian Jack, or finding some information online, or someone else sharing their experiences must all be put into context. These are other people’s stories and not yours is the first point, so extrapolating to your unique story has its dangers unless you have someone to clarify and provide perspective — that’s my job. Spending time giving meaning to the person’s story is important, identifying the key points and explaining what can happen in order to arrive at the present moment. Nothing happens in isolation because we have had a prior experience to flavour this one. Looking back, however, can be done in an objective way, recognising the limits of the reliability of our memory, yet it is the question ‘what do I think and do now?’ that is important.

A common scenario in modern healthcare is the interpretation of the scan result for musculoskeletal pain. Back pain for example, frequently leads to an MRI scan to look for a structure to explain the pain. Yet pain cannot be seen. You can see the state of the discs and joints according to a picture taken in a moment (a snapshot), but what does this tell you about the person’s lived experience of pain? One is objective (a picture) and one is subjective (pain). But how often is the disc or joint used to explain pain as the healthcare professional shows the person (patient) the picture, pointing to the culprit on a screen? Now that the person has ‘seen’ the picture, it becomes part of the story with the solution becoming the need to do something to that disc or joint. They have new information that is now influencing their outcome, yet they will not be thinking this as it is all part of the subconscious processing that shapes our thinking and experiences. However, when a scan result is used within the context of modern pain science, we can use the information to sculpt a positive outlook but this relies upon time with the person to fully explain and answer questions as opposed to finding an article online or in the media when thoughts arise with no-one to qualify or ask. Thoughts interpreted as threatening have protective consequences from pain to feelings of stress and anxiety.

In summary, we need to be judicious about the information we expose ourselves to and use rational thinking to determine the relevance to ourselves. We are all utterly unique with our own stories and lived experiences, so when you pick up an article, bear this in mind. You would also be wise to write down any concerns or questions and ask a trusted adviser to put perspective on those thoughts so that they form part of how you overcome your problem.

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