Category Archives: Pain Education

04Mar/14
Protect the body with armour - the muscular system

Pain – the unseen force

Le Horla“Do we see the hundred-thousandth part of what exists? Look, here is the wind, which is the strongest force in nature, which knocks men down, destroys buildings, uproots trees, whips the sea up into mountains of water, destroys cliffs, and throws great ships onto the shoals; here is the wind that kills, whistles, groans, howls–have you ever seen it, and can you see it? Yet it exists.” Guy De Maupassant – the monk talking to the author at Mont Saint-Michel.

Pain, have you ever seen it, and can you see it? The unseen power of pain that is the cause of suffering is one of our greatest enigmas. We are understanding where pain comes from with greater precision but with every painful experience being unique, the pattern of activity in the brain is rightly different on each occasion. The widespread networks of neurons that are active when we are in pain are not specific to hurting, there is no pain centre. It is fascinating that we can see similar brain activity during a pain that results from nociceptive stimulation of the body and from social isolation. Neither pain can be seen from the outside, only the facial expression and verbalisation with the hundreds of words that can describe the feeling.

Is this the reason why people are disbelieved? Because pain cannot be seen. How can anyone truly measure the pain of another? Hurting is subjective. I know and only I know how much it hurts and how it affects me. All too often a patient describes returning to work and feeling a sense that colleagues do not believe or understand their suffering. This can only increase the threat and elucidate further protective responses that feed into the cycle of thoughts–physical responses–emotions–thoughts.

Thoughts cannot be seen but they are real as they play in the mind, each one creating a body response: “I am hungry,”, the stomach rumbles; “I don’t know my lines,” the stomach tightens and tingles; “I have pain, what does it mean?” the body tightens, the pain intensifies. None of these can be seen but they exist as much as the wind that can bend a tree.

Protect the body with armour - the muscular system

Protect the body with armour – the muscular system

Pain is embodied. We feel pain in a location in the body, even if the body part no longer exists such is the case in phantom limb pain. The brain networks ensure that we attend to the body region deemed in need of protection, creating the unpleasant experience that is pain so that action is taken to resolve the issue. In the early stages of an injury we actively protect the area by reducing movement, guarding with increased tension, warning others away with bandages and crutches. If you are travelling in London on the tube, this may even afford you a seat in rush hour. Persisting pain is not related to the extent of tissue damage, if it ever really is–for pain is not an accurate indicator of tissue damage. Chronic pain can feel like a fresh injury and drives the same behaviours: attention towards the painful area, guarding with the musculoskeletal system by tightening up the muscles–our natural armour, and avoidance. These behaviours feed back into the body systems that tell the brain something is up and the brain responds by continuing to protect. The cycle continues until there is a good reason for it to stop because a safe state has been achieved.

The challenge of tackling chronic pain means that we must look beyond the tissues. Exploring the brain, the immune system, the endocrine system, the motor system and how they interact to create our moment to moment experiences, the interface with life and how we respond at any given time. Nothing is permanent. Pain can come and pain can go. Cultivating the conditions for pain to change is the contemporary way of thinking and each person requires a unique approach based on sound scientific principles. So, much like we can harness the wind to create power, we can harness our biology to create a meaningful life.

RS

To book an appointment or for information about our bespoke treatment and training programmes for pain and chronic pain, contact us today: 07932 689081

 

 

08Jan/14
Turn 'no' into 'yes'

Too many cases of “I can’t” — the effects of persisting pain

Turn 'no' into 'yes'

Turn ‘no’ into ‘yes’

Frequently patients tell me at the first meeting that they cannot do x, y and z. Naturally, when something hurts we avoid that activity or action because pain is unpleasant. It hurts physically and mentally. In the acute stages of an injury or condition, it is wise to be protective as this is a key time for the tissues to heal, and although some movement is important for this process, too much can be disruptive. As time goes on, gradually re-engaging with normal and desirable activities restores day to day living. However, in some cases, in the early stages of pain and injury, the protection in terms of the thinking about the pain and subsequent behaviours becomes such that they persist beyond a useful time. The longer that this continues, the harder it becomes to break the habits.

Don’t feed the brain with “I can’t”, feed it with “I can” — cultivate the natural goal seeking and creative mechanisms of the brain

The vast majority of patients who come to the clinic have had their pain for months or years. I would like to have seen them earlier so as to break the habits of thought and action that are preventing forward movement. As a result of the longevity and severity of the pain, the impact factors, distress and suffering, a blend of experiences, expectations and thinking about the problem, it is common to slip gradually into a range of avoidances that are strongly linked with thoughts that “I can’t do …. or …..”. These thoughts may have been fuelled by messages from care providers.

As a general statement, most activities that someone avoids because they fear that it will be damaging or painful can be approached with specific strategies that address both the thinking about the activity and the actual task itself. Recalling that pain is a protective device, an emergent experience within the body in an area that is perceived to be under threat and requiring defence, by diminishing the threat we can change the pain. And there are many ways of doing this on an individual basis — as pain is an individual experience with unique features for that person.

One of the main aims of our contemporary approach is to ensure that the individual understands their pain and problem so that the fear and threat value dissolves away. This leaves a more confident person willing to engage in training that promotes normal activities and re-engagement with desired pass-times.

To learn how you can do this, call us now 07932 689081

07Jan/14
Hypermobility

Hypermobility – Ehlers Danlos Syndrome and gastrointestinal problems

Hypermobility

Hypermobility

Hypermobility is common and is certainly a feature that we often see in patients at the clinics. Some patients have been diagnosed with hypermobility but do not know what it really means and need clarification, some are suffering aches and pains that are limiting and troublesome and still others visit with chronic pain and hypermobility is seen at the assessment.

See hypermobility blogs — blog 1 — blog 2 — blog 3

I always begin with an explanation that includes pointing out that many top athletes are hypermobile and hence there can be advantages. Per se, hypermobility is not necessarily a problem and in fact many who come for advice do not have any significant issues. They may need a programme that includes spatial awareness training, balance and proprioceptive exercises, but in essence, they can continue as normal.

Those patients who suffer pain and on-going pain, often widespread, require a different approach that considers the pain source and the influences upon pain. The training will include proprioception and spatial awareness exercises, but the baseline start point will be different. Before this even, there is often a need to tackle the sensitivity in several ways, termed top-down and bottom-up. Top-down refers to how we can target the brain including education, strategies to deal with thoughts that create anxiety and adaptations to the body maps that change our body sense and experience. Bottom-up is the use of the body tissues to change sensory processing and hence pain and sensitivity. There are many ways of doing this, and altering the combinations of the top-down and bottom-up  strategies creates potent ways of tackling pain.

Frequently, those who suffer persisting musculoskeletal pain will also bare pain through other body systems, especially the gut. See this recent review:

BKW5H0_stomach-ache_342x198Functional digestive symptoms and quality of life in patients with ehlers-danlos syndromes: results of a national cohort study on 134 patients. Zeitoun JD et al.

Abstract

BACKGROUND AND OBJECTIVES:

Ehlers-Danlos syndromes (EDS) are a heterogeneous group of heritable connective tissue disorders. Gastrointestinal manifestations in EDS have been described but their frequency, nature and impact are poorly known. We aimed to assess digestive features in a national cohort of EDS patients.

METHODS:

A questionnaire has been sent to 212 EDS patients through the French patient support group, all of which had been formally diagnosed according to the Villefranche criteria. The questionnaire included questions about digestive functional symptoms, the GIQLI (Gastrointestinal Quality of Life Index), KESS scoring system and the Rome III criteria.

RESULTS:

Overall, 135 patients (64% response rate) completed the questionnaire and 134 were analyzable (123 women; 91%). Mean age and Body Mass Index were respectively 35±14.7 years and 24.3±6.1 kg/m(2). The most common EDS subtype was hypermobility form (n=108; 80.6%). GIQLI and KESS median values were respectively 63.5 (27-117) and 19 [13.5-22]. Eighty four percent of patients had functional bowel disorders (FBD) according to the Rome III criteria. An irritable bowel syndrome according to the same criteria was observed in 64 patients (48%) and 48 patients (36%) reported functional constipation. A gastro-esophageal reflux disease (GERD) was reported in 90 patients (68.7%), significantly associated with a poorer GIQLI (60.5±16.8 versus 75.9±20.3; p<0.0001). GIQLI was also negatively impacted by the presence of an irritable bowel syndrome or functional constipation (p=0.007). There was a significant correlation between FBD and GERD.

CONCLUSIONS:

Natural frequency of gastrointestinal manifestations in EDS seems higher than previously assessed. FBD and GERD are very common in our study population, the largest ever published until now. Their impact is herein shown to be important. A systematic clinical assessment of digestive features should be recommended in EDS

It is routine in our clinic to ask about other body systems as this tells us a great deal about the level and type of sensitivity, which in turn guides the comprehensive treatment and training programme.

Increasingly, patients are being referred for irritable bowel syndrome and other functional pains (e.g./ migraine, headache, chronic back pain, chronic joint pain, pelvic pain, vulvodynia). Due to the underpinning sensitivity residing within the central nervous system — this is not a disease but rather an adaptation; neuroplasticity at play — we can target these mechanisms with a range of effective strategies to re-learn or re-programme the way in which the neuroimmune system is expressing itself. These systems are fundamentally designed to change, learn and grow. They simply need the right conditions to do so, and all too often there is a belief that a situation cannot change and hence all the choices and behaviours prevent any form of forward movement. This is just not true and through our understanding of the body systems and their adaptability, we are creating increasingly effective and diverse ways of tackling pain and suffering.

If you have been diagnosed with hypermobility or are suffering with chronic pain, call us now to discover how you can change your experience and move on: 07932 689081 — Specialist Pain Physio Clinics in London: Hypermobility Clinics

01Jan/14
The patient journey

Humanising the patient journey

The patient journeyModern healthcare features innumerable methods of technical investigation such as the MRI scan, blood tests and nerve conduction tests. All provide detailed information about structures and physiology state yet none tells us about the person, the human being.

Many people will undergo tests and often this is necessary to determine whether there is a serious pathology or changes in body that require specific procedures.

No matter what the test or investigation, it must never be forgotten that it is a human being ‘tested’, not a number in a line, or a condition, but an individual with thoughts, beliefs, expectations and fears. It is by addressing these that we can make the patient journey a human one that has meaning.

The patient journey usually begins when something feels wrong: a pain, a change in the way the body works or is experienced, a sudden incident or a gradual realisation that there is an altered sense of self. This threshold and realisation prompts action. A visit to the doctor or in the alarming situation a rapid transfer to a hospital, may be the first encounter with the healthcare system.

Those first moments of the experience, the thoughts, the feelings, the interactions, the words, the fear evoked by all of these, will impact upon the trajectory of the journey and of course the immediate care for an emergency.

At each of these points, when there is an opportunity to reassure, calm, listen, just be, they should be taken. These simple yet potent interjections that can be administered with ease in amongst the hullabaloo of tests, wires, medical language, white coats, stethoscopes, needles, injections and trolleys. Let them not be lost.

As we stroll into 2014, as the science progresses, it is reassuring to see some authors drawing upon philosophical thought, in particular phenomenology, so we can keep a firm footing in the patient’s experience, for this is where the real story resides. The patient narrative is the key thread that must be given room for expression via firm description, vague terms and bodily expression. The examination that follows; who examines who? The connection, the information flow that requires sound mind, as this is the function of the mind that must interact with the examiner.

So let us in healthcare be mindful of the human being at the centre of the story. The experience that they share with us is unique and an expression of their perception build upon a set of entrenched beliefs about their life, the World and their expectations — and hopes and dreams. We are in a strong position to oil the wheels that need to turn smoothly for a patient journey to lead anywhere meaningful.

01Jan/14
Specialist Pain Physio Clinics in London for pain, complex pain and injury

Mindfulness programme

The light out of the darkMindfulness commonly forms part of a comprehensive treatment and training programme for pain, anxiety and stress. The origins of the practice stem from many years ago but in a modern sense, mindfulness is mind training that is akin to physical training used to improve fitness. A great deal of time is dedicated to physical activity for health, less so on the mental side, however the two are inextricably entwined. For one you simply need the other, and to combine the training is the most potent way of cultivating the conditions for healthy living or recovery from pain and injury.

The modern day use of mindfulness is to create health, foster clarity of thought, increase awareness of thoughts and actions for self-improvement and to reduce stress, anxiety and pain that occurs as a consequence of simple practices. Mindfulness is not steeped in religion, but is a philosophical framework to attain a more fulfilling existence.

See Vietnemese Buddhist monk Thich Nhat Hanh speaking here 

Thich Nhat HanhA programme of mindfulness activities, followed week by week over a period of 8-10 weeks is an excellent way to groove the habit. It is a learning process that increasingly develops awareness in order to make the necessary changes to promote health. Many activities and thought processes are automatic or habitual, but do not point us towards a positive, fulfilling existence. To change this situation requires practice, in essence to re-wire the way we are working via the characteristic neuroplasticity, a feature of the nervous system that underpins learning and adaptation.

Over the 8-10 weeks the practice of a variety of mindfulness activities creates a healthy habit. Several daily sessions of 12-20 minutes focused training is the goal. In addition, forming a routine of performing tasks in a mindful way is a powerful way of regularly enrich awareness; this is simply by paying attention to a normal activity such as cleaning, making a drink or walking. Attend to the sounds, the feel, the aroma and physical sensations thereby standing in the present moment rather than drifting automatically into the past or building a future.

Typically over the period of training, the practice of mindful breathing to cultivate awareness of the effects of thoughts upon the body and vice versa, the body scan to regain a sense of the physical body and how it constantly changes and responds, mindful movements that combines awareness with comfortable motions that nourish the body tissues, working with the pain and suffering and developing compassion towards oneself and others.

For further information or to book, please call us: 07932 689081

19Dec/13
A scan does not show pain

Low back pain & neck pain | a very common problem

Back pain and neck pain are very common

Most of us will experience low back pain and neck pain at some point in our lives. In fact, it is unusual not to have some aches and pains around the spine. With back and neck pain being so common in the modern world, you would assume that treatment is very effective. Sadly not.

There are different scenarios with back and neck pain, often either a nasty acute type pain or a lower level nagging pain that grinds on and on. A further common situation that I see is a persisting back pain that is part of an overall picture of widespread pain. Accompanying the pain is altered movement and muscle tension that adds to the unpleasantness. This is mainly due to the effects of overactive muscles that are being told to protect the area — acids released, reduced oxygen levels; both of which can excite local nerve endings (nociceptors) that send danger signals to the brain.

When a particular movement or action triggers the pain, we assume that this is dangerous and the cause of the pain. This is not quite the case. There is a lead up to the moment of pain when the nervous system is becoming sensitised, often slowly, over a period of time. This is called priming. Then, at a given moment, when the system is close to the threshold of becoming excited, a normally innocuous movement just tips the physiology over the line with a consequential range of protective responses that include pain, spasm and altered movement.

Sometimes there are changes in the tissues or ‘damage’. Again there is often an assumption that when the pain begins, this is the point of injury. This can be the case but equally the changes in the tissues may have been evolving over a period of time. The reality is that you will never really know, even with a scan. The scan may show a disc bulge or herniation but does this describe your pain? Or tell you when the problem began? No.

Unpleasant as the body responses are, they are normal, necessary and part of the way in which the body defends itself, largely organised by the brain. The pain draws our attention to the area that the brain wants us to protect. When the pain is severe of course our attentional bias will be towards the region most of the time — hypervigilance. How we think about the pain will determine the impact, level of suffering and influences the trajectory of the problem as our thoughts and beliefs about back pain will impact upon what action is taken. In the very acute stages, there may not be a great choice when the pain and spasm is strong, thereby limiting movement vigorously. It is good to know that this phase, as horrible as it can be, does not last too long in most cases if the right action is taken based on good knowledge.

It is always advisable to seek help and guidance: know that nature of the problem, how long it can go on, what is normal and what you need to do to ensure a good recovery. Generally, understanding that pain is not an accurate indicator of tissue damage — see video here — , controlling the pain with various measures in the early stages and trying to move as best you can starts off on the right footing. It can be scary when the pain is severe, so calming strategies really help to reduce the impact — anxiety is based on thinking catastrophically about the problem, thereby triggering more body defences in pain and tension. Mindful breathing and other relaxation skills should be practiced regularly.

In summary, back pain and neck pain are very common. The primary message here is that the acute stages are unpleasant and often distressing but they do not last long in most cases if the problem is managed well with understanding to reduce concerns and to minimise the threat value, good pain control, simple movement strategies and a little treatment to ease tension and change the sensory processing in the body so that it feels more comfortable.

If you have low back pain or neck pain, especially persisting pain or widespread pain, come and see us to find out how you can change your pain and get moving again: call 07932 689081

 

17Dec/13
Brain~Body

A quick note on brain~body — body~brain

Brain~BodyThe brain is where it’s at. Or so it seems if you read the press or look at the bookshelves. The notion that brain is everything has been challenged recently and so it should — see here. We need enquiry at every point, challenging the comfort of thinking that we know.

Despite this, it seems logical to think that the brain is involved with much of our existence. The ‘hows’ and ‘whys’ need continued clarification. In a crude sense, on the end of our brain lies a body. This body is where we feel life whether that be the experience of an external stimulus such as touch or the result of a thought that always triggers a physical and emotional response once we engage with that thought.

The term ‘body-mind’ has been used countless times by both mainstream practitioners of medicine and health and alternative or complimentary therapists. Most people understand the concept although many still try to deny the links. Can a thought really change the physiology in my body? Of course it can. It happens all the time. In fact, I would argue that our body functioning is the emergent physical manifestation of all the processing going on in the mind.

The way in which we move, posture, position ourselves is dependent upon the task at hand but also the task that we may engage with at some point in the near future. The brain is the greatest predictor and will continually analyse the environment, the situation and compare this to what it knows to create the actions necessary. In cases of chronic pain or stress, the brain becomes hypervigilant and responsive to a range of cues that would not normally evoke a protective response but now does via the the autonomic nervous system (‘fright or flight’), the nervous and immune systems.

Much of the activity in our body systems we are unaware of as the brain and reflexive activity takes care so we can attend to the necessary survival tasks. Filtering out the millions of stimuli, the brain draws our attention to what is deemed to be salient for that moment.

In a state of anxiety, this is usually felt in the body — churning stomach, tension, sweaty palms etc. We use the body as a yardstick as to how we are feeling although the thoughts evoking these bodily and physiological responses are not always immediately apparent. The thoughts will eventually pop in there, or emerge, this from an unspecified network of neurons in the brain.

In essence, we can think about the body~brain or brain~body relationship as a needy one; they need each other for full function. To separate makes no sense bit neither does to blame one or the other. Thinking about the emergent features of the synchrony appears to provide a better way of considering problems such as pain, stress and other conditions.

RS — Specialist Pain Physio Clinics, London 

10Dec/13
Brain~Body

Uncomfortably numb

Feeling numb can mean that the self has lost its physical presence, or in an emotional sense, feelings have become blunted. These are both different constructs of loss for which we are compelled to seek an answer, often causing great angst. To step out of the normal sense of self is profound, difficult to define and causes suffering, whereby one has lost his or her role.

Physical numbness, if we can say this, will usually be described in terms of a body region feeling different. Altered body sense is a common finding in persisting pain states and in post-traumatic stress disorder (PTSD). In extreme situations, an out of body experience can be described where the person views themselves from an outsider’s perspective, in the third person. Often though, one refers to numbness as an area with reduced or no sensation. This can be objective such as when a stimulus (eg/ a pin prick; a light brush) is applied to the body surface and the sensation is lacking; or subjective when an area is felt to be numb yet a stimulus can be felt normally.

Although numbness in the the body is not painful per se, it is often tarnished with an aversive element that is described as unpleasant. This seems to be a particular issue in the extremities; conditions that involve nerves such as Morton’s neuroma. The mismatch between what is physically present and can be seen yet not felt, is difficult to understand and compute until the construct is explained.

An explanation: the body is felt via its physical presence in space, interacting with the immediate environment, yet is ‘constructed’ by networks of neurons in the brain. These neurons or brain regions are integrated, working like superhighways in many cases, thereby enhancing certain experiences or responses. At any given moment, the feelings that we feel and the physical sensations that we experience are a set of responses that the brain judges to be meaningful and biologically useful. The precision with which we sense our physical self and move is determined by accurate brain (cortical) representations or maps of the body. These maps are genetically determined yet moulded with experience, for example the way the hand representation changes in a violinist. Similarly, when pain persists we know that the maps change and thereby contribute to the altered body sense that is frequently described. It is worth noting that patients can be reluctant to charge their altered body experiences for fear of disbelief when in fact they are a vital part of the picture.

Emotional numbness is consistent with physical numbness in the sense of a stunted experience, whereby the expected or normal feeling in response to a situation fails to emerge. Rather, something else happens thereby creating a mismatch between the expected feeling and that which occurs. This experience manifests as a negative and is not discriminatory, affecting a range of emotional responses. A sense of detachment from the world often accompanies the lack of feeling. One could argue that this is a form of protection against feelings of vulnerability where we can also use our physical body, our armour, to shield us from the threat. Of course the threat is down to our own perception of a situation, another example of a brain construct. A situation is a situation but we provide the meaning based upon our own belief system and respond accordingly, often automatically.

Cultivating a normal sense of self is, in my view, the primary aim of rehabilitation and this encompasses both the physical and emotional dimensions. Both are influenced by thoughts, the cognitive dimension, that emerge from our belief system that drives behaviours. Hence, a programme design must reflect the interaction as it presents in the individual, most of the clues residing in the patient’s narrative that we must attend to in great detail. Validating the story and creating meaning is the first step towards a normal sense of self, to be enhanced with specific sensorimotor training and cognitive techniques such as mindfulness based stress reduction and mindfulness per se.

Wider thinking and practice is desperately required in tackling the problem of persisting pain. One of many responses to threat, pain is part of the way in which we protect ourselves along with changes in movement and other drivers to create the conditions for recovery. Sadly, many people ignore or miss these cues in the early stages through being fed inaccurate information about pain and injury. Many common ailments that can become highly impacting and distressing such as irritable bowel syndrome, headaches, pelvic pain, widespread musculoskeletal pain, anxiety, fertility issues and low mood, gradually creep up on us as the sensitivity builds over a period of time; the slow-burners. An answer to these problems that are typically underpinned by central sensitisation and altered immune-endocrine functioning, is to create awareness and habits that do not continually provoke ‘fright or flight’ responses that essentially shut down many systems in readiness for the wild animal that is not present. Actually, the wild animal is the emotional brain that when untamed can and does create havoc through the body, affecting every system.

The ever-evolving science and consequent understanding now puts us in a great position to trigger change. Initially discussing numbness, I have purposely drifted toward a more comprehensive view looking down on the complexity of the problems that we are creating in modern existence, manifesting as common functional pains. As much as we are knowing more and more about these conditions, we are actually describing the workings of the different body systems in response to a perceived threat that may or may not exist. This is always multi-system: nervous, immune, endocrine etc. and all must be considered when we are thinking about a pain response. But let’s not just think about pain as this is one aspect of the problem, one part of the emergent experience for the individual — think movement, think language, think body language, think ‘how can we reduce the threat’ for this individual so as to change their experience of their body responses. It is at this point that we see a shift and it is possible in all of us. We are designed to change and grow and develop, so let’s create the conditions for that change physically, cognitively and emotionally.

09Oct/13
Neuroscience

Lorimer Moseley talks about pain (2013)

Treatment of pain and injuryHere is the latest video of Dr Lorimer Moseley talking about the current understanding of pain. Regular readers will know that Lorimer’s work is some of the most influential upon the approach that I take to pain and in particular persisting pain. By thinking brain we can devise individualised treatment and training programmes for your pain problem. Read on and watch the video.

“If you have a brain, you will experience pain. If you don’t, you won’t”

“We feel pain in our body and we feel it in a particular location. But it is impossible to feel pain without a brain and it is completely possible to feel pain without the body part”

Lorimer tells the story of the man with the prosthetic limb who gave him a hitch out of Adelaide. This is a great illustration of the brain creating the experience of pain but without a message of danger. The questions arises: is all pain phantom pain? The notion that the brain produces pain, it does not recognise pain coming from somewhere.

What burdens society?

CHRONIC BACK PAIN – NUMBER 1 BURDENSOME WORLD HEALTH ISSUE

NECK PAIN – NUMBER 4

MIGRAINE & HEADACHE  – NUMBER 8

OSTEOARTHRITIS – NUMBER 11

Low back pain | persisting low back painPain is about protection. Pain is a most sophisticated device and hence the brain must decide how much to protect an area of the body.

The danger message is not pain. Nociceptors send danger signals to the brain but you do not need this to feel pain.

Can you spot the disconnect between damage and pain? Can you think of an example in your life? Pain is produced by the brain and the brain is the most trainable part of the body. Pain depends on how much danger your brain THINKS you are in, not how much you are actually in. It’s an evaluation of danger.

Watch the video for more…

02Oct/13
Back pain and neck pain | Common problems that we treat

BBC Horizon ‘The Secret World of Pain’ | #pain

Back pain and neck pain | Common problems that we treatBBC’s Horizon programme in 2011 that looked at the latest research in pain. Understanding has rolled on since this time, but some interesting features nonetheless. It is worth remembering that pain is a conscious experience that emerges from the body although the actual representation is within the brain–a widespread matrix of neurons in the brain. The bottom line is ‘threat’. When the brain determines that our body is in danger, we will feel pain in the area that needs protecting. This is of course very useful biologically in an acute situation (although the intensity of the pain or even the existence of pain is hugely–consider the many tales in A & E and on the battlefield where significant trauma causes no pain) but not so if it persists. The underlying activity and certainly the focus of treatment is very different.