Category Archives: Treatment Philosophy

13Nov/17
Whole person to treat chronic pain

It’s not your mind, it’s not your body, it’s you!

Whole person to treat chronic pain

Its not your mind, it’s not your body, its you!

Mind and body — what do we mean?

In essence it is good news. Loud messages in the media about mind and body being connected (read article by Rachel Kelly here), thereby trying to update society’s thinking from dualism to what actually happens. To philosophers, neuroscientists, cognitive scientists though, this is familiar ground. Mind-body has been the subject of discussion and investigation for eons.

Today there is further reporting upon schizophrenia research, highlighting the limitations of a dualist perspective, which continues to predominate within our health system. The system and huge swathes of society persist in divvying up the so-called ‘mental’ and ‘physical’. We even have different buildings dedicated to each bit of us, and within those buildings, and rooms that divvy us up even more. We have a liver location, a heart hub, a bones bit, and other parts of the institution that focus on a mere piece of us. Where is the room that puts it all together and acknowledges a human being who thinks, feels, moves, and perceives in distinctly human ways? Let’s talk qualia, and here’s Dan Dennett talking about consciousness.

need states

There are reasons why this maybe convenient, however the separation is not how it works in reality. And try being an end user: ‘Hello, I’m the knee patient’. Within our language and thinking must be the start point of the whole, for it is the whole person who perceives a need via a variety of bodily sensations: thirst, hunger, pain, discomfort and anxiety as examples. What do I need to do here?

‘In the past, we’ve always thought of mind and the body being separate, but its just not like that’ said Oliver Howes, professor of molecular psychiatry. Too right! Its never been like that! He goes on to say that the mind and body ‘interact constantly and the immune system is no different’. I would propose a step further that there is no connection per se because they are one and the same: me and how I experience me and the world. If you are doing a maths puzzle for example, you could argue that this is a mental task. However, there is always the ‘you’ doing the puzzle and you are there, present and embodied. Your mind does not slip out and do the job and then slip back in.

The recent schizophrenia research findings suggest that treating the immune system could be a way forward. I think that society maybe surprised by this news in certain quarters, yet people will understand how this can work. I have great faith in society;s ability to learn, grow and evolve because that is what we have always done, naturally. There is much greater ‘attunement’ to the completeness of being human, although we still have a long way to go before the scientific and philosophical understanding is mainstream in society. Again, this is not news to people who have been studying and following the work of brain-body-person-immune interactions over the past 15 years. A notable example was Dantzer’s paper in 2008 on inflammation and the brain.

inflammation is a likely biological mechanism that links up many common problems: e.g./ pain, depression

It sounds simple to ‘treat the immune system’. Of course in reality this is not the case because our body systems work as a whole and interact in many, many ways. Modern society is very familiar and comfortable with the notion of taking medication to solve a problem. Indeed this is one case when a pharmacological agent is needed. However, this still fails to teach a person how to live or to live their best. This take understanding, practice, time and perseverance. In the rush-rush world we live in, people often want the quick fix that simply does not exist. Getting real means we pay attention to the data that now tells us that certain practices or skills each day are what we need to do to be well. This is non-negotiable. You make a choice.

I finish as I start — this is good news. It is another way in which society can see the changes in understanding afoot. Our thinking needs a drastic update, certainly in terms of chronic pain and chronic health. For years we have been led to believe that pills are the answer, yet they are not. They may have a role, but the main role is the person and the choices they make in how they ‘do life’. Their life-style if you like. We have so many known ways of building health, no matter where you start, no matter whether you have a condition or not, we can decide to live our best. And to do this needs recognition of the fact that we are whole. There is no mind-body separation, instead just ‘me’.


Pain Coach Programme to get the best of you, overcome pain and live well; t. 07518 445493
20Jul/15

Zen and the art of human maintenance

Kitty Terwolbeck | https://flic.kr/p/nJ3oH4

Kitty Terwolbeck
| https://flic.kr/p/nJ3oH4

Zen and the art of human maintenance is not a spiritual blog but rather a practical one that considers a way of approaching hands on treatment–this is whether you are a massage therapist, a physiotherapist, an osteopath or any other clinician who uses their hands for examination and treatment. Equally it could apply to a person comforting a loved one.

How you bring yourself to the act has a huge impact upon the act itself. Setting the scene both in terms of the environment and the focus of your intention will play out through the treatment in subtle ways that effect the overall experience. A moment’s preparation in that vain allows the therapist to focus and be present meaning that the full experience is had, allowing for a sensitivity (via the therapist’s hands yet experienced through their whole person) that enables gentle responsiveness to adapt the treatment to the recipient’s needs. A classic example is being aware of how the muscles react to different levels of touch. Being aware means that you can detect even gentle guarding that indicates protection and need for both nourishment (improved blood flow and oxygen delivery to over-working muscles that are being told to tighten in an attempt to protect–yet this comes at a cost, both of energy and a build up of acids) and a sense of safety so that the systems that are protecting the body can ease up.

Take a moment: before you begin the treatment, 3 easy breaths to become aware of what is happening now, how you are feeling, what you are thinking; continue to maintain awareness of the present moment, letting go of distracting thoughts that interfere with your focus.

Zen is a sense of oneness with the present experience, what is happening right now, free from distractions and letting life flow. There are many situations when this state of simply being is very useful–before exams, interviews, when negotiating, discussions with your employer, before performing etc. However, cultivating this skill on a moment to moment basis is hugely beneficial as it allows you to see and think clearly, even when thinking about the past or future, which can cloud what is really happening now. These are all just thoughts, but when we become embroiled, the body reacts and responds because we are our body as much as we are our mind, and all that this means. So, just thinking about being in an argument or giving a speech creates similar responses in the body as if you are there; but you are not.

In giving treatment to another person, being fully present means that you fully experience the moment. You will be completely engaged in all that is happening ‘now’, creating a potency that cannot be otherwise reached with a wandering mind that has no connection with the treatment. This is undoubtedly a practical skill that can be developed, some calling it ‘focused attention training’ and others ‘mindfulness’. Everyone has the ability to focus, even for short periods, and to enhance the skill with practice. There would be some benefit of simply taking a few breaths as described above, yet there is even greater advantages to be had from further practice with 5-10 minutes of mindful breathing each day; more if you are so inclined.

Not only does being present whilst treating enhance the treatment through a more responsive selection of pressures and movements, the clinician also benefits from the calm created, and the clarity of thoguht offered by being present and aware. In effect, the whole experiecne means that while you are treating, you are being treated. A good way to measure this is by noting how you feel at the end of the day. A mindful day will end with energy, and non-mindful day with fatigue. I know which I prefer.

* These are skills to be learned and developed in the Pain Coach Mentoring Programme for clinicians | call 07518 445493 for details

14May/13

Treatment is not in a vacuum | the patient experience and the healthcare approach

A phrase I often use with patients is ‘nothing happens in isolation’. This concept is about priming and how the neuroimmune system is set at the time of an intervention as this will affect the outcome. The question to ask is ‘how is this system likely to respond to the treatment I am about to employ based on what I hear from the patient and what I can see?’ 

How will this system respond to the treatment I am about to give?

This is the same for any healthcare practitioner whether it be a physiotherapist about to mobilise a joint or ask a patient to perform a movement, a doctor prescribing a drug or administering an injection.

The key factors that are somewhat controllable are the environment in which the treatment is taking place and the approach of the practitioner. Both of these can be created to optimise the patient experience and hence the effect of the therapy. We must also consider prior experiences and expectations of the patient. Here are two scenarios to illustrate.

1. A patient arrives at the clinic and discovers that there is a delay. There is no explanation given when they are directed to their seat. Naturally the patient is a little anxious about the forthcoming injection. They sit in a waiting room that is plastered with posters and leaflets about various health matters. And there is a pile of old magazines. Dogeared. Twenty minutes later the patient is called to Room 5 by an electric sign. They tap on the door and a gruff response permits entrance. There is no eye contact, no smile and no invitation to sit down because the practitioner is looking at the computer.

How would this prime a neuroimmune system? What would an aroused and threatened system do? Will it be readily acceptant of a needle? May the musculoskeletal tighten in response?

2. A patient arrives at the clinic and is greeted warmly by the reception team. On taking a seat the patient notices the artwork on the wall. The healthcare professional emerges smiling from his room and invites the patient to enter, welcoming them to take a seat and be comfortable.

What might this do to a threatened neuroimmune system (threatened because the patient has been thinking about the injection and is slightly anxious)?

Whilst it is always easy in theory to create scenarios, it is quite feasible to employ an approach that considers the influential factors upon the patient experience. In essence they do not want to be there, they do not want to have to have treatment but they must for the sake of their health. The neuroimmune system is on alert because of the actual health issue and also because of the experience of visiting the professional. We can certainly impact upon this in a positive way by thinking about our interface with the patient, use techniques to reduce anxiety and construct an environment that is conducive to better outcomes. Nothing happens in isolation. 

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