Category Archives: Pain

07Jun/16
Pain, loneliness, poverty and health

Depression and inflammation

Depression and inflammationFor some years there has been thinking about depression and inflammation being related in as much as when we are in the throes of inflammation, our mood changes. Think about when you feel unwell and how your mood drops, which is part of the well known sickness response. In some people, probably a large number, these sickness responses are the norm. In other words, they endure a level of this sickness response consistently that is underpinned to an extent by on-going inflammation.

Reports today about a study at Kings College London describe how inflammatory markers in the blood could identify a ‘type’ that would benefit from a certain antidepressant drug — read here. This would make the prescription specific for the person, so rather than trialing a drug, we would know which would be most likely to be effective for that person by identifying the blood markers.

Many people I see with persistent pain are low in mood and some have been diagnosed as being depressed. In my mind, it is entirely understandable why someone suffering on-going pain, who cannot see a way out, would be in such a state. In simple terms, the person with chronic pain may well be chronically inflamed. We know that people who perceive themselves to be under chronic stress will be inflamed as the body continues to protect itself via the immune system and other systems that have such a role. Typically and understandably, someone in a chronic pain state is stressed by their very circumstance and hence can be inflamed.

It is very common to suffer an enduring pain state and generally feel unwell; a sickness response. We all know what a sickness response feels like — we don’t feel ourselves, aches and pains, loss of appetite, irritability, emotional, sleepy, tiredness, poor concentration etc. This is underpinned by inflammation and how this drives a range of experiences and behaviours, all designed to create the conditions for recovery. In the short term this is adaptive but if prolonged, the symptoms are enormously impacting and potentially maintaining a cycle of stress and anxiety.

Like any problem, understanding its nature is the start point so that problem solving can be effective; i.e. think about it in the right way and take the right action, congruent with recovery and the desired outcome. Realising the links between health state, depression and inflammation helps to distance oneself from the lived experience, being less embroiled with that particular ‘film’, instead focusing on what needs to be done to overcome the problem.

A loss of the senses of self is often a part of a persisting condition such as chronic pain or dystonia. The overarching aim of a followed programme is for the individual to resume living their life with a sense of self worth which they can identify: I feel myself again. This self feels normal to that person, and only that person knows how that experience is lived. As best they can, I ask them to describe that experience, and this forms the desired outcome. The sense of self is at least a unification of body sense, interoception, exteroception, the inner dialogue and our past experiences. Improving body sense with exercises, some general and some specific, is a simple way of stepping towards that outcome. And of course there are all the other benefits of exercise to consider.

It will undoubtedly be very useful to identify who will benefit from which antidepressant drug, yet we must still consider each (whole) person. A comprehensive programme of treatment for pain for example, includes developing working knowledge of pain so that the person can independently make effective choices as well as eradicate fears, specific training, general activities, gradual progression of activity, and mindfulness to name but a few. However, it is not just the exercises that are important. The person also needs to be motivated, resilient and focused, all strengths that they have likely used before in other arenas but now need to employ here and now with their health — this is the strengths based coaching aspect of the Pain Coach Programme. In cases of depression, the chosen drug maybe more specific and hence more efficacious, yet there are other actions that are also important such as understanding the links as explained and consistent physical activity. Great work in the aforementioned study; it will be interesting to watch how this progresses.

Pain Coach Programme | t. 07518 445493

14May/16
Pain distraction

Kids know about pain distraction

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

10May/16
Pat Wall Lecture 2016 | British Pain Society ASM

Pat Wall Lecture 2016

Pat Wall Lecture 2016 | British Pain Society ASM Listening to Professor Stephen Hunt give the Pat Wall lecture 2016 this morning at The Pain Society ASM evoked a number of thoughts. The meat of the talk addressed recent molecular experiments that could provide new forms of treatment; very much a mechanism-based approach to modifying peripheral and central adaptations (sensitisation) — of course the two are not exclusive, instead being part of a spectrum of changes in respect of an initial insult (usually), and in those vulnerable, a state of persistency ensues. Whilst fascinating and relevant of course, it was the references to Pat Wall that really interested me due to the insights that still hold true.

I was struck by Professor Hunt’s point that many do not consider pain to be a need state. A need state that is a conscious means of motivating action that is the thin slice atop biology in the dark that prepares and operates the healing process, most of which is unbeknownst to us — we feel pain, note swelling and the feel of swelling as it occupies space, changes in the way we move, feel and think. The notion of pain being a need state has been a big part of my thinking over the years, and to me it would seem strange not to consider pain this way. Having been educated by Dr Mick Thacker, who spent a great deal of time with Pat Wall, it is no surprise that these messages have been handed down.

Everyone has examples of the unreliable relationship between injury and pain if they stop and think for a minute. Often quoted are phantom limb pains, paper cuts and battlefield wounds to illustrate the enormous variance. The tissues themselves simply do not explain pain. So what does explain pain? The meaning, the context and ultimately the level of perception of threat (predicted top-down): more threat = more pain, which is why it usually hurts more when you don’t understand your pain and worry about it! And why pain feels better when you, the person feels better. Again it was Pat Wall who provoked this realisation.

It is always valuable to go back to the original lectures and writings as they remain so relevant. We desperately need to address pain globally, it is the reason for so much suffering. New questions to provoke new thinking and research will add to the already gathering hope, steering society towards a modern understanding of pain: what is pain? What is it’s purpose? Knowing that it changes and taking action to enact that change. The coming together of philosophy and neuroscience is really helping us to see pain in a different light, explaining it to patients so they can understand how they have got from A to B and then how to coach themselves to overcome their suffering.

09May/16
GB: Get Better

Get better

GB: Get Better

GB: Get Better

Regular readers will know that I firmly believe in getting better when it comes to pain and persisting pain. This should be our aim with each person. This thinking also needs to underpin research, policy making and clinical decision making across the board.

Recently I was asked to speak at an event that considered the question ‘how do tendons get better’, and my area of focus was the brain and pain. More on this shortly, but it was a pertinent question because for some time I have been pondering why people do get better (from persistent pain), what does getting better actually mean and who gets better?

To answer these questions experientially, I thought through many cases that I have seen to identify the common features. Not especially scientific, but a start point. People getting better meant that they would report that they felt more like themselves. A common phrase that we use, ‘I don’t feel myself today’, tells the world that all is not well, and equally saying ‘I feel myself again’ reports that what is happening in my world is what I expect to happen; a match up in other words. And who are these people who get better from a persisting pain state in the face of messages from society that chronic pain is here to stay and needs to be managed or coped with?

In short, these are people who take on board the true messages about pain and what it really is based on our modern understanding. Not only do they listen and put in into perspective within their lives, but they use the new information as working knowledge to be applied consistently, challenging previous thinking to drive new actions that are congruent with being healthy. With this working knowldge, moment by moment they are able to make clear decisions and groove new habits, pointing themselves via their perceptions and actions towards their desired outcome, as defined by themselves at the outset.

Everyone has experienced success in one or more arenas of their life, whether at home, at school, in work or playing sport. This success is achieved by focusing upon the desired outcome and then taking every opportunity to get there, even if things go wrong along the way. Distracting (unhelpful) thoughts and unforseen events are dealt with as learning experiences, and soon enough the person is back on the path towards their vision of success. Take a moment to recall a success and note how you did it. What strengths did you use? How could you bring them into this arena? The people that use their strengths and focus on their vision consistently, get better.

The tendon debate resulted in agreement that people needed to understand their problem and pain as a foundation from which different strategies could be used. The strategies chosen for the individual must reflect their needs and desired outcomes. I was asked if brain and pain could explain why a tendon gets better, and I argued that we are more than a brain, and in fact the construct of self is made up of a number of facets: my physical presence, how I experience that presence, the story I tell myself about me, the sense of the environment in which I reside in this moment, my past (perhaps unreliably retold to me by me) and my anticipation to name but a few. It is the person who gets better and not the tendon or the back or anywhere else in the body, because we are that body as much as we are the mind (the mind does not just exist in the head or brain, instead we are our mind, often using our body to think — embodied cognition). We are necessarily all of these things together: body-brain-mind-environment.

The overaching aim must be that the person gets better as defined by themselves as only they know what it is like to be better. And when the person is better, they feel themselves again, which in terms of pain emerging from me (felt in a body area), it exists less and less in the thin slice of awareness that is consciouness — most we are unaware of; externally and internally (the biology in the dark). When we are better, we don’t think so much, if at all, about our body until we have an itch or have sat too long and become uncomfortable. Then we scratch or move and resume a state of non-body awareness, just focusing on what it is that we need to in that moment.

Pain Coach Programme to get better: t. 07518 445493Get better

 

07Dec/15
Women in pain

Pain Coach for vulvodynia

VulvodyniaPain Coach for vulvodynia and other persisting pains is an approach based on a blend of the latest thinking in pain science and strengths-based coaching. What does this mean?

Modern thinking about pain considers that the lived experience of pain is ‘whole person’, in other words, it is ‘me’ who is in pain and not the body part/area. By addressing the person, in effect steering thoughts, feelings and behaviours towards health, pain is overcome and a meaningful life is resumed, as defined by the individual themselves. Bearing this in mind, we can seek to achieve this with strategies that parallel the lived experience, becoming new habits that nurture change in a way that is healthy. Pain is embedded with the person, their life, their reality and how this is created by their whole self — body systems (including the brain, immune system), their body and the environment.

With pain being part of who we are at that moment, we need to be able to think clearly and logically about that moment, seeing it for what it is, and then respond in the best and wisest way. We are continually updating, with a fundamental design that means we change with every passing moment. The brain predicts what will happen next and the sum of the best guessed meaning to all sensory information is what we perceive in that moment. Each moment is of course in passing, with a new one on the way. Nothing is permanent, and this is also true for pain. Having a baseline understanding creates a new layer of thinking, which creates a new layer of lived experience each moment, and this is how we can overcome pain. You may ask why, if we are always changing, has my pain persisted; and this is a great question.

Why does pain persist? On one level, it is because there is on-going prediction of the need for protection against a perceived threat. The range of cues and triggers widens over time, as does vigilance and habits of thinking that underpin and flavour the lived experience. The sensory and sampling systems adapt and suggest threat, and the prediction goes on and on, until you take decisive action and create new thinking and behaviours to take the continual change in a new direction. To do this, as I said earlier, the new awareness and habits need to match the lived experience, and be employed moment to moment–in any given moment you need to be able to be witness to your thinking, emotional state and bodily sensations, then using this awareness to decide upon the best action (UBER-M is one of my self-coaching strategies that I have previously written about).

Putting this into practice for vulvodynia, we begin with the development of a working knowledge of the individual’s pain and what influences their pain (e.g. stress, anxiety, context, environment, anticipation, expectation, attentional bias, catastrophising, hypervigilance — to name but a few). Using this working knowledge, the person creates a sense of safety that is the foundation of the precise actions taken: specific exercises, training, general exercise, breathing/mindful techniques, re-charging (energy), movements that all form the healthy actions. This is becoming your own coach, so that at any given moment you can think and act to cultivate healthy habits, and in so doing, replace those that have been predictive of the need to protect.

The most frequently described pain experience is during intercourse with the clear impact upon the person and potentially affecting relationships and an ability to conceive. All are greatly emotive. There is often, rightly or wrongly, a sense of wanting to be healthy once again for their partner’s sake. Within this thinking, there can be a sense of guilt with the individual being hard upon themselves, the latter being a common characteristic, and one that needs to be addressed by developing kindness towards self.

UP | understand painAnticipation that a movement or activity will hurt sets up a cycle of protection — priming, expectant thoughts that drive tension and changes in perception, predictions of the need for protect then predominate and sure enough, the experience is painful and the cycle maintained through habit of thought and action. There are many points when new habits can be created from the moment of initiation of intercourse to during intercourse at different points (an anticipatory thought, a sensation of pain) and developing new thinking and reactions by practicing at other times — in essence reconfiguring the whole experience to resume the intimacy rather than fear of pain.

Pain Coach ProgrammeWe are designed to change, and we are changing continuously — it may not always seem like it, bit if you stop for a moment and note how your thoughts, feelings and body sensations shift and move like Constable’s skies, even within a minute or two, you will be aware of this in action. This awareness opens an opportunity to consciously decide to make changes in a direction of health, and in so doing, change your pain with new realisation and action. This all begins with the understanding of pain so that you can take wise action at every moment. The skills that you develop for overcoming vulvodynia you have probably noticed will be transferable to many areas of life because this is about your lived experience, moment to moment. Many women report feeling calmer, noticing more, responding and thinking with greater clarity and generally feeling well and healthy.

Pain Coach Programme to overcome persisting pain problems — t. 07518 445493

05Dec/15
40+60 Feet | Bark |https://flic.kr/p/7rvmbB

Henderson’s heel

40+60 Feet | Bark |https://flic.kr/p/7rvmbB

40+60 Feet | Bark |https://flic.kr/p/7rvmbB

Henderson’s heel has captured the front page of the Guardian sports supplement today. The article claims that he has been told to play through pain as there is no cure for plantar fasciitis–the plantar fascia is a strip of tissue spanning from the heel to the forefoot.

In the general population this problem exists and is typified by first steps soreness on getting out of bed. The pain is often noted on walking, standing and running, in some cases being sore and stiff to begin with before easing and then building again.

The usual explanation is overload, but there is more to it than that. As with any persisting problem, it is not just about the blamed tissue, but much, much more. Similar to tendon problems, when the focus is merely on the structure, the outcomes are limited as are expectations:

“…with my heel there isn’t a timescale, there isn’t really a cure….”, said Jordan Henderson, continuing to describe how he feels, “There have been times when I’ve been pretty down because we couldn’t find the answers”.

Pain problems need to be addressed in line with our modern understanding of what pain really is, a protective device in the face of a perceived threat. The point in time when something hurts is not in isolation to what has been learned or believed beforehand, the meaning, the context and prediction of what may happen. Consider the footballer who attaches great importance to the state and health of their body and their legs and feet in particular. Also think about how these problems are discussed and viewed within the culture of football; all the views and opinions and what they are based upon. An injury deemed to be chronic or long-term has great consequences for the career of a footballer and hence the meaning of this pain is different to an amateur player or someone who does not play football. Much like the violinist who cuts their finger, this is more pertinent when they are about to play a concert — we know that pain threshold is lower in violinist due to the meaning and context. There is no reason to think this is different in footballers and their legs. What is the relevance?

Our pain experience is determined by the extent of threat and not the extent of tissue damage. How threatening to the footballer is the notion of a chronic foot problem? Very. Does this impact on the experience of pain, definitely. Pain tells us little about the tissue state, but much about how the brain is predicting what the sensory input (about the body and the environment) is meaning based on what is thought and believed. Already you should be seeing how the ‘treatment’ of such a problem needs more than local interventions to change the way in which the body-brain-environment interactions are manifesting as pain, in this case in Henderson’s heel.

We are designed to change and hence pain can and does change when you understand it and take the wisest and healthiest action. This action goes upstream of where the pain is felt.

Where do we feel pain? In our body, because this is where we perceive our actions, largely created by brain networks and body systems, yet none in isolation and none predominating. All are vital to have a sense of what is happening right now. And what is happening right now? Our reality in any given moment is created by the sum of all the activity in our body and brain within a certain context. This incorporates habits and associations that create the backdrop for prediction; e.g./ Henderson arrives at the training ground, and even at the thought of running around, the systems that protect us are engaging and priming in preparation so that when he begins to run, threat is assumed based on what is known, what has been and what could be. Result, pain in the heel.

Now, of course there can be an inflammatory response as well, and this may well have been detected on various scans. However, there are different inflammatory mechanisms, the one we know well from injury: think of a sprained ankle; and then neurogenic inflammation that is a feature of on-going sensitivity, when the peripheral nerves are stimulated from on high to release inflammatory chemicals into the tissues they supply, thereby maintaining the cycle. Again, predicting that healing is required, the higher centres trigger this response, and it needs addressing, but not just locally. This is the big problem with tendon treatments currently, the focus on the periphery. There must be an interpretation of what is happening in the tissues and concurrent thinking and feeling to make the experience of pain a conscious one. There is not always central sensitisation at play, but there are always higher centres involved with a conscious sensation.

There is much more to discuss and note in relation to the points raised, but for now we can look at the principles that are important for overcoming an on-going pain problem in relation to Henderson’s heel. Considering that pain is about threat value, the over-arching aim is to reduce the perception of threat and hence the prediction of required protection. This begins with understanding pain so that the individual’s thinking is based on the working knowledge that they are safe. Safe that is, to perform specific and general exercises to nourish the body and move for health. The specific desensitising techniques are tailored to the person who feels the pain, considering the existing associations and triggers. A sensorimotor training programme works to normalise movement from the planning level to the actual execution, thereby creating a new layer of experience that forms the basis for the next prediction; the prediction of safety. Building the tolerance gradually, allowing for adaptation is key. There are a number of ways to go about this, but in essence, the programme is to be lived through the day, moment-to-moment to match the lived experience that is pain.

It is the person who feels pain, not their foot or their tendon. Their tendon or fascia is not a separate entity seeking help. They are merely the place or space in the body where the pain is felt. The biology of the whole experience sits within that that creates who we feel we are, and the richness of that experience in that moment. Hence, we must always work with the person: their body tissues, their environment, their neuroimmune system and how the sum of all of this creates their lived experience. Within each dimension, there are a number of actions that influence the whole. This is how people overcome pain — not their foot; the person. And who are these people that overcome their pain? What do they look like?

They look like you and me. They have a working knowledge of their pain that allows them to exercise and re-train on a basis of the true meaning of their pain, a feeling of safety, diminished threat, the creation of safety in situations once deemed threatening, and they match their lived experience of pain with a programme that is likewise lived, health based, strengths-based and they have a clear vision of where they are going based on their values.

Pain can and does change, beginning with understanding it.

Pain Coach Programme for persisting pain — t. 07518 445493

 

23Nov/15
Pain Coach Programme

Art of living

Pain Coach ProgrammeWe like to be good at things. Sport, work, parenting, music are all common examples. We practice, note what goes well and what does not, making changes, and essentially practicing to get better.

But what is common to all of these and everything else in our lives? What overarches all of these? Living. Living itself. There’s an art to living a life of content—and this does not mean that there is no pain or suffering. A life well lived is one of moment to moment skill, and this includes what we tell ourselves and what we do. The moment to moment experiences. These determine overall how content we are rather than the ‘biggies': new car, new iPad, and the so-called life events. Now, these are all significant (if they are significant to you) yet they make up fleeting moments much like anything else. They are passing through, like other moments. It really depends on how you are framing it; what do you think about it? That’s what makes it what it is, for you in this moment.

So, there is an art to living well that depends on what you are telling yourself over and over. A situation is just a situation until you rate the situation and then feel it and live it. Until that point, it is nothing. We create our reality in any given moment and this is an art form. And art forms need good quality practice just like sports, music, how we communicate etc. The great thing about this is that we have every moment to practice and get good at it. You don’t need to go anywhere or any kit to get good at the art of living. So what do you need? Nothing.

Whilst you are seeking to be somewhere else, you are missing what is happening now. And that is all that is happening. Have plans, have aspirations but see them for what they are—plans and aspirations. Work out how to get there, but see that for what it is—a plan for how to get there. Be excited, be nervous, be anxious, but see these feelings for what they are—feelings, emotions that will pass as everything else does. Impermanence.

Here’s a simple tip of how to enact this: cultivate the habit of standing or sitting talk, taking a normal breath in and paying attention to this breath. Do this every time you feel tense, anxious, happy, excited, angry, sad…… Try it and see what happens.

21Sep/15
Fear

Vulvodynia

VulvodyniaVulvodynia is a painful condition, often exquisitely so, located in the vulva, which is the skin surrounding the vagina. Usually unexplained, this troubling condition can arise seemingly from nowhere, interfere with intimate relations and hence attempts to conceive. Vulvodynia is also known as a functional pain syndrome–these are painful problems that lack a pathology of note that explains the extent of the pain and include irritable bowel syndrome, fibromyalgia, TMJ dysfunction, migraine and pelvic pain. Functional pain syndromes are often concurrent with hypermobility, anxiety and depression, a further common character trait being perfectionism and a tendency for the person to be hard on themselves thereby creating a cycle of chronic stress.

The pain of vulvodynia is often very localised and triggered by direct contact. Naturally this occurs during sex and touch, but sometimes sitting position can bring on the pain. As with any sensitisation, there is a primary location of pain but there can also be a secondary area surrounding that is due to central nervous system (and other systems) involvement. Suspected vulvodynia or other pains in the pelvis should be assessed and examined by a gynaecologist as a first step before beginning treatment, and by a consultant who knows and understands both the condition and the impact — Miss Deborah Boyle at 132 Harley Street.

With vulvodynia often being part of an overall picture of sensitivity, it means that there is a common biological adaptation that is upstream of the range of seemingly different conditions (the functional pain syndromes). As soon as the individual understands that pain is not an accurate indicator if tissue damage, but rather a reflection of the perceived threat and prioritisation by the body-person, there is a realisation that the pain can change. Pain can change because perceptions can change as we take on board new information and consequently think and act differently, creating new habits. The new habits set the conditions for on-going and sustained change that includes overcoming pain.

We have limited attention and hence can only be aware of certain amount of stimuli in any given moment. If pain is consuming much or all of your attention and consciousness, then this is all that is happening in that moment, with all other possible experiences being disregarded–it is a matter of prioritisation. When the perception of threat is reduced by a constructive thought or action, the pain moves out of our attention span and we become aware of other thoughts, feelings and experiences. How we respond to pain is unique and learned through our lifetime right up until that point; all those bumps and bruises as a child, how our parents reacted, more serious injuries or illnesses and the messages we received from doctors, teachers and other ‘big people’, then through adult life, moulding our beliefs about ourselves, the world, health and pain each time we feel it. The sum of all this activity, most of which we are unaware of, sets up how you respond to the next ache, pain or injury, blended of course with genetics. It seems that some people are genetically set up to be more inflammatory, meaning that responses to injury are potentially more vigorous and go on for longer. Understanding this means that the right messages and treatment can be given, thereby appropriately addressing the injury or pain. One of the big problems is that this does not happen, and the explanations are structural and based upon the body tissues. This ignores the fact that we have body systems that protect and these systems have sampling mechanisms in the tissues and organs but largely exist elsewhere–e.g./ nervous system, autonomic nervous system, endocrine system, sensorimotor system, immune system. We have to go upstream as well as improve the health and mobility of the local tissues.

Going upstream is vital in overcoming vulvodynia, and this is where the Pain Coach Programme works–this is my part of the treatment programme. You may also choose to work with a women’s health physiotherapist who will work more locally. So what is the Pain Coach Programme?

The Pain Coach Programme is a a blend of the latest neuroscience of pain with a strengths based coaching approach to success. Understanding your pain and that you have the biology and strengths to overcome your pain is a vital start point. You have been successful in the past using these strengths, and you can do so again by drawing on these characteristics and using them to develop your health in terms of how you think and act. Overcoming pain is all about resuming a meaningful life, engaging with activities and people as you want to, in a way that allows you to flourish. The Pain Coach Programme provides you with the knowledge and skills that you need to in effect become your own coach, moment to moment making clear decisions that take you towards your vision of how you want to live. This alongside treatment and specific training to develop normal movement and a healthy body-mind. The skills you learn also help you to fully engage in life, whether this be at home, at work or at play.

If you suffer vulvodynia or other painful problems, call us now to start your programme: 07518 445493

14Sep/15
Licorice Medusa| https://flic.kr/p/Hu2gG

Neuroplasticity and impermanence

Licorice Medusa| https://flic.kr/p/Hu2gG

Licorice Medusa| https://flic.kr/p/Hu2gG

I was asking myself whether neuroplasticity and impermanence are related and how this dynamic would work on a practical level. Concluding that there is some usefulness in relating the scientific neuroplastic characteristics to the Buddhist philosophical construct of impermanence, I have briefly shared my thoughts here.

Neuroplasticity refers to brain cells’ (neurons) ability to change at synaptic and non-synaptic levels. The synapses are where neurons communicate and hence the communication can change, whereas non-synaptic changes occur in the axons and dendrites (structures of the neurons). Impermanence is a fundamental part of Buddhism whereby it is agreed that nothing is permanent. In other words, change is constantly afoot as each moment passes to the next and so on.

On the basis that we are continually learning and changing with each and every new experience, moulding our reality in that given moment, it is highly probable that neuroplastic changes are underpinning our lived experience. We are of course on a continuum, begining with a blank slate to be filled as we progress through our life, genes being appropriately sculpted through exposure and meaning and creating what is a rich, textured existence. The fact that no moment is the same and each is so fleeting, fundamentally means that change is a constant and a definite and hence nothing about existence can be permanent.

Whilst we like to attach ourselves to various things such as our partner, our body, our beliefs, all of these are constantly changing too, alongside the changes that we are making. This constant dynamism is what makes life so fascinating, piquing our curiosity at each and every turn with the unfolding of events. It is worth considering for a moment (that has just passed) that the past does not exist anymore, except in our unreliable memory, and that the future does not exist, except in our minds that attempt to anticipate and guess what may happen. You can argue the usefulness of predicting the future in order to make plans or indeed the recall of a past event to learn. Whilst this may have some use in certain situations, the large problem remains that when we ‘re-live’ a moment passed or project ourselves forward, the whole person responds as if actually there with all the same emotions, physiological responses and on-going thoughts–we feel it and live it. Through these lived experiences, which are invented and illusory, we then further sculpt our biological machinery, priming ourselves for what is to come.

Think about someone who bumps into you on the train. If this annoys you, do you carry on thinking about it or do you let it go? What mood were you in when it happened? In a tired, grumpy state, you may retort with anger; whereas a compassionate mood would see you forgive or even laugh. And what happens next when you arrive at work? How has that moment framed the next? With ever passing moments, impermanence at play, the realisation of this moving film in which you are the author, director and the star who can make choices moment-to-moment is a potent one.

So, let us enjoy being plastic and discovering the full impact of neuroplasticity (much is said about this nowadays, yet there is a great deal to learn about how changes in synaptic activity translate into real-time experience, learning and behaviour) and impermanence as these are characteristics we can use to grow and develop to take on challenges. Certainly in terms of pain and chronic pain, to understand that we are constantly changing creates realistic hope that pain can also change. Pain does change when you understand it fully and take healthy actions based on sound thinking.

Much of my time is spent with people suffering chronic pain, coaching them and treating them, harnessing their own ability to grow and change with new knowledge and skills that are employed to overcome their pain. Witnessing their change is an incredible priviledge as well as a wonderful example of neuroplasticity and impermanence.

 

25Aug/15
Pain, loneliness, poverty and health

I am in pain

We often say I am in pain but does this really describe what is happening. Knit-picking perhaps, but I think that what we say, the words we use and the way that we use them are fundamental to being human and who we are as individuals. The innumerable phrases that have been passed down the generations will have their origins in a time was very different. So how relevant are they now? And how useful?

Someone says to you, I am in pain and instinctvely you know what they mean. You cannot possibly know what they feel or how they are feeling it, but you know that they are feeling something unpleasant and want you to know about it. There is a point to telling others about your pain, perhaps to seek help or advice, to gain sympathy or to give reason for non-participation for example. These are all accepted reaons for sharing, and would typically be known as part of the social dimension of pain.

However, we cannot really be ‘in’ pain. We can feel pain, pain can emerge from our very being (this includes our body) and pain can hurt, but you cannot be in pain. You can be in a house, a car or tent. Being in something suggests that you can get out. If you say that you are in pain, it suggests that you can get out of pain. Now, pain changes and is transformed (we are not in a constant state of anything, hence pain comes and goes like any other state–pain is part of a protective state), but you cannot get out of pain because you cannot be in pain. There is no entrance or doorway to pain that once you have entered requires you to find an exit.

Should we change our terminology and what effect would that have? I don’t think it will really change anytime soon, however when clinicians are thinking about the pain being described by an individual, it is more accurate to  consider the whole person from where the pain emerges in a particular location, with the underpinning biology involving many systems upstream of the lived experience. A story book requires a reader, words on a page and the book to be bound together. The book is the body that is read yet the reader must take the words and create a meaning, a story that makes sense, lived in his or her whole person–a beautiful description is felt and lived through the whole person involving complex biology that is a blended mind-body; embodied cognition. Our body is a story book yet the story is our experience. Changing the terminology will occur with time and as the understanding of pain evolves.

The growth of pain understanding is vital as a basis for informed choices and treatment choices–one of the biggest reasons for chronic pain being the number one global health burden is the lack of understanding, whereby the medical model continues to predominate treatment choices; i.e./ target treatment at the place where pain is felt in the body. This misses the point of pain as part of the way in which a whole person protects himself/herself, and indeed much of our common language contributes to an old belief system that our generation has been brought up upon. Evolution takes time and of course a new and more complex explanation to replace one that is simple, will be threatening. Nonetheless, this is where we will go as people experience failed treatments or do not reach the expected outcomes alongside developments in pain science that become increasingly known in the public domain. This knowledge will demand that things continue to change, and as a result so will our language. As is common though, this is a two way street and if we take opportunites to change our language, then we are using the social dimensions of pain to create learning opportunities that lay the foundation for perceptual shifts. And there’s one thing that changes pain, and that’s a perceptual shift.

Richmond with Georgie Standage co-founded UP | Understand Pain, a campaign to raise awareness of the problem of pain and what we can do to overcome pain — we are no longer managing pain, we are changing pain and coaching people back to a meaningful life. The next UP event is in October when more than 1000 singers will be performing; even more than last time! 

The Pain Coach Programme is a comprehensive strengths based approach to overcoming pain. Call us on 07518 445493 to start your programme.