Tag Archives: back pain

20Jul/15
vintage typewriter by philhearing | https://flic.kr/p/9pRzps

Gillian’s story | back pain and mindfulness

vintage typewriter by philhearing | https://flic.kr/p/9pRzps

vintage typewriter by philhearing | https://flic.kr/p/9pRzps

Many thanks for Gillian’s story | back pain and mindfulness

MY PAIN STORY – GILLIAN WESTON

I am always a busy person; I play short mat bowls several times a week and have represented my County and England, I run a Junior session for bowls, I love to swim and I am a member of Horsham Rock Choir. I use a computer as the main part of my job of Practice Manager for a charity.

My problems began in 2010 when I slipped on some ice and inadvertently tried to break my fall with my left arm. I had restricted movement and upper arm nerve pain but after some physio my situation improved.

In Dec 2012 I developed pain in both arms after lifting a heavy object at work. I was referred for physio in Jan 2013 when I was diagnosed with tennis elbow in my right arm and shoulder impingement/tennis elbow in the left. After some exercises my right arm improved but I had further physio in the following months for my left arm. During this time the worst aspect was the nerve pain from my elbow to my hand – no painkillers relieved it, and I was in constant pain with or without movement, even scratching my face or lifting a kettle were agony!

In September 2013 when I was still in a lot of pain and had a further condition added – ulnar nerve entrapment – I was given 2 steroid injections. There was an improvement but of course the underlying problems were still there and in January 2014 there was a return of my intense pain. A further course of steroids followed, but the actual injection was excruciatingly painful and I was left with numbness in my ring finger. I was pain free until Nov 2014 when I moved a pot in the garden and experienced a twinge in my elbow, the problem was exacerbated when I used a simple screwdriver in Dec at work and I ended up in the worst pain I had had for some time.

By Jan 2015 I was at the end of my tether and rather than go the NHS route saw a physio who I knew privately. She felt that my neck was also the cause of my problem plus bad posture. Her approach was more holistic and she gave me some acupressure to try and calm me down from my very distressed state. She even suggested counselling as she was concerned about my mental health as a direct result. I was at various times loaned a TENS machine, given ultrasound and massaged. She helped me address by posture and gave discussed calming techniques. She discussed with me how my mental state was affecting my pain but I was sceptical about this at the time and more or less dismissed it. There was a degree of improvement in my condition over the following month thanks to the new physiotherapist but I was still struggling day to day.

During all these periods in and out of pain I have had to stop playing bowls and going swimming, use my right hand more – particularly with the mouse at work, been unable to sleep on my left side, been restricted doing the dance moves at choir, and not been able to do many day to day things that I used to take for granted.

In March 2015 I attended Heathrow Airport with Horsham Rock Choir where Georgie Standage my choir leader and Richmond Stace were hosting an event for UP. I took one of the flyers and did my research via the UP website. I found the videos very interesting – in particular the one explaining how “all pain comes from the brain” (Lorimer Moseley). I took particular interest too in the mindfulness videos. But I also found the written information really useful too. Over the following weeks I used mindfulness apps and also ‘talked’ myself out of pain. When I felt pain I closed my eyes and tried to focus on other parts of my body; if I hit my weakened elbow (as I do frequently!) I told myself that it was fine, it would hurt for a while and then I’d be OK. I used Mindfulness to keep me calm and I found that my nerve pain lessened in the weeks that followed.

By May I was able to resume my bowls for short periods to use my mouse at work left handed, do my Rock Choir moves without pain and return to swimming. Significantly I can sleep for periods on my left side without pain – which I haven’t done for a long time!

It is now July 2015 and I have been pain free for just over 3 months–other than the odd elbow bash! I do get the occasional twinge, and very interestingly if I am stressed about anything I get a bit of nerve pain in my arm! Looking back some of the worst pain ties in with significant stressful times in my life. I am still wary and careful about exacerbating things, but importantly I feel that “yes I do have pain sometimes, but pain doesn’t have me”. I am indebted to UP for giving me my life back, and I continue to use the techniques I have learnt – in particular the Mindfulness Breathing – to keep me calm and in control.

11Jun/15
Stiffness and low back pain

Stiff low back. Why?

Stiffness and low back painHave you got a stiff low back? Stiffness is often part of the picture of low back pain. Why is this?

Stiffness is a conscious experience–a feeling that we sense, interpret and then label as ‘stiff’, usually describing difficulty moving a body part. And just like any other conscious experience, there are the embodied dimensions as well as cognitive and emotional elements: how does it feel? What does it mean for me? Hence to think about stiffness is to think about the body-body systems that create the feeling and meaning.

Stiff low back: there are three common types of stiffness that are addressed in different ways.

  1. Stiffness from actual shortening of the muscles and their compounding tissues
  2. Stiffness from muscles being told to be ‘on’
  3. Stiffness from changes at the joint

Stiffness from actual shortening occurs due to sustained positions or repeated positions being held so that the tissues change in their length. In so doing, there is less freedom of movement at the joints. This tends to gradually worsen as time progresses, with less and less movement at the joint causing further shortening. Regular movement, nudging into the limitation is key in overcoming this aspect of stiffness along with manual treatment that gives you the experience of movement into that part of the range. The manual treatment must sit alongside your understanding of what is happening and why this therapy is being applied, otherwise ‘top-down’ influences can interfere with success (see next section).

Stiffness from muscles instructed to be ‘on’ by the brain is part of the way that the body protects. Otherwise called guarding, the body-brain’s continual planning, expectation, anticipation and desire are embodied, responding to the environment and the context of the situation at that moment. Within our consciousness, different experiences seemingly appear and then fade away as others emerge. Stiffness and pain are no different in this respect, however they may emerge repeatedly in response to normal situations that pose no actual threat. But, due to the sensitive state and vigilance to the environment, non- or low threat stimuli are now interpreted as potentially dangerous and therefore the body responds. The first we know about this is the pain or tightening — the stiff low back. The pain and stiffness are motivators for us to take action, both in thought and behaviour. These thoughts and behaviours seek to reduce the threat and therefore reduce the pain (pain emerges in the person as a result of a perceived threat) and how the body is responding with it’s natural armour, the muscular system. As the need for defence diminishes, so the muscle tension eases and movement improves.

What reduces the threat and muscle tension?

  • Relaxation–this is a skill to learn
  • Mindfulness
  • Understanding pain and knowing that you are ‘safe’
  • Motor imagery

Changes at the joints can, but not always, affect the quality of movement. It is not a given that if your joints show arthritic change, movement will be problematic. Many people have arthritis but suffer no pain or stiffness. Whether you feel pain and stiffness or not is determined by many inter-related factors: e.g./ genetics, gender, past experience, beliefs, expectations, the environment; also known as pain vulnerabilities that all have an underpinning neurobiology that is becoming increasingly understood.

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09Jun/15
Persisting low back pain

Do you have persisting low back pain?

Persisting low back painPersisting low back pain is common. It is the number one global health burden (Vos et al. 2012) and hence is the cause of much suffering,  and personal and societal cost. We need a re-think, because the misunderstanding of pain is at the root of this vast problem, especially when it comes to chronic low back pain: persisting or recurring.

I see people every day with chronic low back pain. It is one of the main vehicles that brings patients to my clinic. In many cases, chronic low back pain is part of the presentation with other complaints and problems including widespread pain, anxiety, irritable bowel syndrome, headaches, migraines, pelvic pain, disturbed sleep, poor concentration and performance at work, relationship disharmony and fertility issues. Is there a connection between these seemingly disparate issues? Yes. And by focusing on the whole-person, as suggested by the latest thinking in pain neuroscience, neuroscience and philosophy, we can create a tangible way forward.

So what can we think about? Here are some ideas with examples:

1. What is pain all about in this person?

  • Protection

2. How is the persisting back pain emerging in the individual?

  • Where in the body is the protection emerging?
  • Which (protective) body systems are interacting?
  • What is the context for the pain?
  • What features of the individual’s narrative suggest a vulnerability to persisting pain?
  • What habits of thought and action (the two being utterly entwined) exist?

3. What are the person’s beliefs about pain?

  • Pain = damage?

4. Why is the pain persisting?

  • Vulnerabilities to chronic pain
  • Is there a good reason for the pain to persist? Is it useful somehow, indicating a need for more action?

5. What needs to be done?

  • Understanding — the right thinking, pain can change
  • Create the opportunity for change
  • What action is required on a moment to moment basis?
  • Development of motivational skills and resilience
  • Persistence, courage, focus, determination

This is merely an insight, and conveniently broken into sections. There is no prescription, just facts about pain that we must work with and employ within a whole-person centred approach to overcoming persisting low back pain and other persisting pain problems.

For further information about treatment and coaching programmes to overcome pain, call now: 07518 445493

* Specialist Pain Physio Clinics: Harley Street | Chelsea | New Malden

 

11May/15
Pain Coach Programme

The language of back pain

Low back pain specialist LondonThe language we use when we talk about back pain is revealing and worthy of noting. This is both the language of the back pain sufferer and the clinician or therapist. Why? Because it highlights the beliefs held about back pain. Why is this important? Because the beliefs underpin the thoughts and action taken in response to the back pain.

Common descriptions that patients use when I ask them to narrate include the ‘slipped disc’, ‘wear and tear’, ‘disc bulge’, ‘worn out joints’, ‘weak spine’, ‘weak muscles’, ‘weak core’, ‘worn out spine’ and let’s not forget the range of expletives that can be attached the the above as well, ‘my ****** spine’, ‘it’s ********’, ‘when he looked at my x-ray, he told me I was ******’ — and I am not joking when I state these are just a few of the things I hear. Do bear in mind that I spend my days listening to people’s stories, making sense of their experience so that we can create a way to move forward.

And where do people obtain such language? They have been told that this is the case, they have read it on the net or heard from well-meaning significant and not so significant others. Sadly, these terms are not useful in any shape or form and in most cases create the wrong image, construct the wrong beliefs, leading to the wrong action and on-going threat and hence protection and pain (pain is about protection as regular readers appreciate).

Clinicians need to watch their language as they are in a position to deliver the right messages at key moments. This creates understanding, which emerges as behaviours and actions that are healthy and groove a way forward to overcome pain. The clinician will have a set of beliefs about pain, and perhaps suffers chronic pain himself/herself. Sticking to the facts about pain, being honest about what we don’t know, avoiding extrapolating a research finding to the populous when it has only been validated in a small number of people and focusing on the ‘cans’ rather than the limitations are just a few notable strategies. I am not going to tell you how to treat or deal with back pain here, merely highlight some observations that I have made over the years.

Back pain is a huge problem the world over and we need to think about it in a different way; a whole-person way, just like any other pain. Considering what we say, how we say it and when we say it is vital. The potency of language and communication should not be underestimated. The words we use will form an internal dialogue in the back pain sufferer’s mind, flavouring their pain perception. Let’s get it right.

Pain Coach ProgrammePain Coach Programmes for chronic and persisting low back pain — coaching you to overcome pain.

Call us on 07518 445493

 

16Apr/15
George Clooney chronic back pain

George Clooney’s back pain

George Clooney chronic back painBack pain can affect anyone, and does affect most at some point in a lifetime. In fact, it is probably more unusual not to suffer back pain!

George Clooney has been suffering persisting back pain since 2005 when he sustained an injury whilst filming. Reports described a torn dura that can result in severe pain, and certainly did for Clooney. With so many nerve endings, an injury will trigger excitement locally. Danger signals are transmitted from the area to the spinal cord and then to the brain–note that there are no pain signals, but rather danger signals.

It is the normal inflammatory response (the release of inflammatory chemicals) that causes increasing excitement (sensitivity) in nociceptors, reducing their threshold for firing. This means that it becomes easier to stimulate the nerves to fire the danger signals. The bombardment of danger signals causes (plastic) changes in the spinal cord that in effect operates as a volume switch.

So if all these responses are normal, how does pain persist and become chronic? This is the BIG question. The answers are complex as is a pain response, but I would argue that within this complexity lie opportunities to change pain and overcome the problems.

Pain is not a structure, it is a response to a perceived threat — very different! Pain is a response that is influenced by context, environment, beliefs, prior experiences, the state of protective systems at the time of injury, gender, intentions to move, fatigue, emotional state and more. Pain is not a disc or a joint or a dura. Pain does not come from a disc, a joint or a dura. Yes, that is where you may feel it, in that part of your body, but those structures do not have the properties of pain. Your nose does not have the properties of a common cold, yet it will stream. There is an upstream biology that involves many body systems that are designed to protect. This biology is a complex blend of all the influences I have mentioned, interpreting a situation as being threatening and hence protecting: pain, altered movement, altered thinking, altered emotions–if you suffer on-going pain, how rational are you when in pain? Can you think clearly? We lose precision.

We lose precision of movement, sense of the body, where a stimulus is being presented to the body, where we feel pain (does yours move or grow?), as well as precision of thought and emotion. Our discrete ability to plan and execute thoughts and actions is marred, ‘smudged’, blurry.

So, to the way we can overcome pain and in particular chronic pain. It has to start with thinking differently, and changing our relationship with pain. On doing so, the way that pain is experienced changes. This, alongside strategies and training the develop precision of thought, movement and sense all reduce the perceived threat. Reduce the perception of threat, reduce the pain — you are answering the demands of your body. The caveat of course is that we are not separate in body and mind. There is no separateness to pain as it is part of you, part of every cell. To overcome pain then, you must become aware of what you are currently thinking and doing (habits) and then consciously change until it becomes unconscious and normal.

Pain Coach ProgrammeThis is an insight into the Pain Coach Programme that addresses the whole person as we must to overcome chronic pain. We are constantly changing and those who suffer chronic pain have been changing towards more and more protection in response to normal activities–how many normal activities now hurt? They shouldn’t!

It is time to take the science of pain and translate it into action to change your pain. Call us to start your programme for chronic back pain or chronic pain. 07518 445493

28Oct/14
Low back pain specialist London

Top 5 back pain myths

Back pain myths

Back pain myths

Welcome to my top 5 back pain myths. What are these you may ask?

Around pain and in particular back pain, there are many phrases and explanations used to try to educate the patient. These have been handed down through the generations and can appear to be logical. Fortunately, the science has moved on and we know better.

Here are 5 common beliefs that have been challenged:

**I have not included the myths of core stability because this has been well documented previously. Pulling in your abs does not solve the complexity of back pain, especially chronic back pain.

1. Bending is dangerous

2. Discs slip

3. Nerves are trapped

4. Pain comes from facet joints, discs etc

5. Low back pain is in isolation to everything else in your life.

Comments below:-

———————————-

1. Bending is normal. Sure it can hurt when the back is being protected, and when we have back pain the muscles are guarding and this can reduce the amount of movement. In the acute phase, most positions and movements hurt, but this is protection and it is meant to be unpleasant in order to motivate action. Moving little and often, changing position and breathing all help to keep blood and oxygen flowing.

2. Discs are not actually discs and they do not go anywhere. Yes they can be injured like any other tissue. They can bulge and affect the local environment, and they can herniate, triggering a healing response — both can hurt because protection is initiated. The fact that there are so many nerve endings around the area mean that sensitivity can arise in a vigorous manner. Again, this is a normal if highly unpleasant experience. Remember that a 1/3 of the population have such changes in their spine but without any pain. The body as a whole must rate the situation as threatening for it to hurt.

3. Nerves do not get trapped. Local swelling and inflammation can sensitise the nerves meaning that they send danger signals. There is not too much room either, so if there is swelling or a bulge, this can affect blood flow to the nerve itself and cause sensitivity to movement and local chemical changes. Again, this can happen without pain as well, so it is down to the individual’s body systems and how they respond. Understanding, gradually moving and breathing can all help ease you through this phase.

4. Pain is whole person and involves many body systems that are protecting you. There is no pain system, pain centre or pain signalling. Pain is part of a protective response when the body deems itself to be under threat. We feel pain in the body but the underlying mechanisms are upstream of the body part that hurts. To successfully overcome pain we must go upstream as well as addressing the health of the body tissues.

5. Low back pain is embedded within your lifestyle. It is not separate to how you live — e.g. lack of exercise, postures, work, stress, emotional state, previous experiences, understanding of back pain, gender, genetics, just to name a few. This maybe more complex, but this provides many avenues for overcoming pain.

Suffering with persisting back pain? Have other seemingly different problems such as irritable bowel syndrome (IBS), headaches, migraines, other joint pains, muscular pains, pelvic pain, jaw pain, recurring bladder infections? Contact me today to learn how you can move forward and overcome your pain: 07518 445493

30Jul/14
20140730-225623-82583871.jpg

When is a door not a door? When it’s a jar – a perspective on back pain

This old joke springs to mind when I think about back pain. We can think simply about a doorBack pain and create an image of how it appears but in fact a door consists of at least some of the following: a piece of wood (or another material), a handle, some hinges, a lock and a frame. All of the physical components need to be made from raw materials and require the skills of an individual or a machine to make door. These skills must be learned or a machine need be designed for the specifics of making a part. In this sense, a door is not a door until all these come together. In fact, this can only make a door when the person looking at the door or using the door knows that it is a door and has the function of a door. Otherwise it is just a collection of abstract items. We can say the same for many things that we take for granted when we know what they are and their purpose.

Back pain is such a common problem that it seems as though we should experience this pain at some point in our lives. Certainly the way we live nowadays has a huge impact on the likelihood of suffering back pain. There are many simple habits that we can form to deal with the problem but all too often, we just don’t. Why? Because it is not at the top of our priority list. That said, when is back pain not back pain? When it’s understood. So this must be the start point. Understanding pain and back pain can make an enormous difference to the suffering that spans from mild discomfort to disabling agony.

Back pain is pain in the back — this may sound obvious and it is, yet there is much more to it, somewhat analogous to the door. What is the back? It is made of many components that together form the back. To know it is the back, we must have a construct of the back. We must know what is the back and what is ‘my’ back; the ‘mine-ness’. Similarly with pain, we must have a construct of pain that is learned. These are both the ‘what’, yet we need a ‘how’ to experience them. In the case of back pain, the way in which we are experiencing the back is with pain. Pain is how we feel the back at that moment.

Just as the back is constructed by physical ‘parts’ with a conscious aspect that is non-physical (the two create the whole), the ‘parts’ involve all the systems of the body as much as the self. Back pain is the end result of an enormous amount of multi-system activity, emerging in a body location that is felt. This is the ‘is-ness’ of the experience produced by the whole person that is the sum of every cell in the body. Pain as an emergent property of the whole person is a biological response to a perceived threat. This includes when the body is injured, pathologised and in anticipation that something could be dangerous. Consider a moment when you anticipate that it will hurt. What do you think? What do you do?

Practically, what does this all mean? It means that we cannot use a structural or component basis for treating back pain. The relationship between the body tissue state and the pain state is poor, perhaps even non-existent. Pain is emergent from a whole person who is embedded within a social setting, a culture and a context that all create a meaning for that individual who has a mind that needs a brain, yet the mind is unlikely to reside simply in that brain. The mind resides in that whole person much as the pain that emerges. Hence we must think about the whole if we are to be successful in treating pain.

If you are suffering with chronic pain, come and see us and discover what you can do to understand and change your pain

t. 07932 689081

Specialist Pain Physio Clinics, London

13Jan/14
Lumbar spine MRI scan

MRI for back pain – does the report content affect the management?

Lumbar spine MRI scan

Lumbar spine MRI scan

Lumbar MR Imaging and Reporting Epidemiology: Do Epidemiologic Data in Reports Affect Clinical Management? This is the question posed by the authors of this recent study, seeking to determine whether adding details about changes seen on an MRI scan in those without symptoms had any impact. The conclusion was: ‘Patients were less likely to receive narcotics prescriptions from primary care providers when epidemiologic information was included in their lumbar spine MR imaging reports’. 

Why may this be?

We can start by saying that jumping down the route of an MRI scan for back pain is not a given, but rather it requires wise thought. The American College of Physicians published a paper in 2011 stating: Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and downstream costs. In this area, more testing does not equate to better care. Implementing a selective approach to low back imaging, as suggested by the American College of Physicians and American Pain Society guideline on low back pain, would provide better care to patients, improve outcomes, and reduce costs’. 

One immediate issue is that an MRI scan can show structural changes that could be assumed to be the cause of the back pain. On making that assumption, both the clinician and the patient can be pulled down a route of thinking to somehow alter the structure, or remove the tissue will henceforth change the pain. Of course there are many cases of intervention, including surgery, that lead to pain relief. Is it simply because the structure has been removed? The same is true of joint replacement when relief is frequently obtained. However, there are many cases when this does not happen, with pain and other symptoms persisting. We know that this is because pain is not an accurate indicator of tissue damage — see Lorimer Moseley talking about this here. Phantom limb pain is the ultimate example of pain without body.

A scan does not show pain

A scan does not show pain

Including information about common scan findings in people without back pain appears to be a potent message that affects the patient journey. In essence that is what we are seeking to change, the trajectory of the condition and the patient experience, for the better. Cultivating the conditions for the body’s physiology to adapt and develop in such a way as to emerge with healthy function.

What are we doing with this message? Normalising. The key point is the fact that we can have certain changes in the body, in the spine, that do not cause problems. Clearly, the person sitting in the clinic does have a pain problem that needs to be solved, but not necessarily via an MRI scan. If a scan has been taken and shows no serious pathology, this is great news. Having said that, many people describe uncertainty and anxiousness at the lack of a structural explanation for their pain. This is entirely understandable as they have not had their pain explained to them at that time, hence there is no meaning. No meaning creates further worry and this most certainly affects pain.

So, the first point of action once all the information has been scrutinised, is to create a perspective based upon what we know about the body and pain. Describing the pain mechanisms, the underpinning biology that involves many body systems, and the influences upon pain such as fatigue, previous experience, self-analysis of the situation, stress, anxiety, movement and other factors that are all biological. Everything is biological — this is a key data point. A movement, a thought, an emotion; they are all underpinned by brain activity that often creates and colours sensations in the body. We can use the different yet inter-related dimensions of pain (physical – cognitive – emotional) to construct bespoke programmes to tackle both the sources of pain and the influencing factors.

The second point of action is to plan an individual programme that encompasses specific training to re-programme the way in which the body has been working. This sits alongside techniques to develop confidence and awareness of the body, both vital for normal functioning. The patient’s role in this training cannot be over-emphasised, hence why motivational factors, and barriers, must be considered and addressed.

The third point is the monitoring and progression of the training and treatment, sculpting the change in pain and function that is entirely possible once the right conditions have been set for both understanding and action.

The questions regarding MRI and other investigations will continue to be asked and rightly so. We must continually challenge our own thinking about the best route forward for each individual patient. Understandably, patients will continue to expect and hope for the fullest assessment including MRI, the gold standard, and from this we must use the information wisely and objectively, explaining the findings and creating a perspective that makes sense and propels the best possible treatment.

If you are suffering with back pain or persisting back pain, perhaps with leg pain — sciatica — come and see us to find out how to move forward 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

 

18Oct/13
Pain beliefs

The virus that is pain beliefs | A brief view on the ‘meme-osity’ of pain

Pain beliefsWe develop beliefs about pain very early in life through experience of injury, by the things we are told by significant others and via observation. These become ingrained and emerge later on when we experience a painful situation. This is part of how we decide what we should do when we are injured. At some point, we have learned that if we knock our elbow on the door frame, we should check it out by having a look, rub the area to make it feel better and move it to ensure that it still works.

Our culture plays a significant role in the development of our beliefs. This includes the meaning of pain and what is signifies and how you should respond; e.g./ ‘the stiff upper lip’. These messages like many others are passed down through the generations. In a sense, the beliefs spread much like a virus, or others such as Richard Dawkins describe the ‘meme’, which is a construct that is passed from person to person, and much like a gene can self-replicate and mutate.

The meme that is, “Don’t bend your back if it is painful” has become a widespread belief that I often hear in the clinic. If you have acute low back pain with accompanying spasm, the chances are it is going to be difficult to move, so bending may not be an option. We do condition very quickly as humans and construct a story from the facts, albeit the story may not be true, but it makes sense at the time. For example, on sending an email, the response does not come back immediately and therefore the receiver is rude, uncaring etc. That is the story whereas the fact is that you have merely sent an email. There is a significant difference, the former creating discomfort whereas the latter is easy to accept.

On bending if we experience acute pain we can quickly assume that bending is dangerous. This maybe confirmed by someone you go to see for some help and very soon this is a strong belief that guides our choices of how to move.

This message has spread across many cultures and could be termed a meme or even a virus. How can we change this? Through education and creating positive experiences for people to then inherently know that they are safe to move in particular ways. All of this takes time and perseverence as the message predominates. However, as we know that memes can mutate as can viruses, we should seek to culitvate accurate understanding of pain with the continuance of resaerch and translation into clincal practice. The idea of the meme then, can be a useful way of thinking about the reconceptualisation of pain for better treatment and care.