Tag Archives: Chronic back pain

21Sep/15

Andy Murray wins despite back pain

Andy Murray back pain, Back pain, chronic back pain, Chronic low back pain, Chronic pain, Chronic pain in sport, , , ,
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Andy Murray wins despite back pain, a classic example of how the meaning and situation flavours the lived experience. Simon Briggs of The Telegraph said: “Not many players are capable of winning three points in a Davis Cup semi-final, as Andy Murray did to put Great Britain into the trophy match against Belgium in late November. But to do so with a bad back – an issue that Murray revealed only once the combat had finished – was a different story again: a quite exceptional feat of courage and stamina”. Pain is not well related to the state of the body tissues (joints, discs etc) but instead the perception of threat detected by body systems that protect us: nervous system, immune system, autonomic nervous system, endocrine system, sensorimotor system — one only has to consider phantom limb pain to realise this fact. One of the biggest reasons why persisting pain is feared is the belief that the severity equates to more damage or something more serious. You may also consider that some cancers remain painless and this is certainly serious. Pain is a protective device that motivates thinking and action to reduce the threat and restore normal physiological activity (homeostasis); it is a need state lived by the whole person — with ‘back pain’, it is the person who is in pain, not their back.

In Murray’s case, he was quite capable of focusing on the game, his body allowing this due to the context and the significance. There are many stories of sportsmen and women sustaining injuries and only knowing when the game is finished. We also had the scenario a few years ago when Messi collided with the keeper and experienced such pain that he thought his career was over. It was a bruise and he played the next weekend. The pain was still severe at the time though, reflecting the situation and the need as deemed by his body systems that protect. It works both ways.

Between games Murray may well have felt some stiffness, but he was able to re-focus. A few simple movements to nudge fluids around, ease off the muscular tension that is initiated and executed by the brain sending signals down via the spinal cord, perhaps a few reflexive messages contributing alongside the immune and autonomic activity. Context remained king though, as it was wholly more important to put all his attention on what was required to win than to start worrying about his back. That could be dealt with later, and indeed this is what happened as Murray did what he knew he needed to do to be victorious. All those top down signals, cultivated and delivered from a neuroimmune system, which countered those danger signals coming from his back (not pain signals — there are no pain signals or pain centres) — top down signals generated from his beliefs, expectations, mastery of focus and attention, as he hit flow, that state of being utterly in the moment. That’s a wonderful place to be and not a room where pain can enter.

Now that the game has finished, familiar aches and pains will flood Murray’s consciousness. There maybe additional and new feelings that evoke new thoughts and a need for re-assessment for the next best steps. These steps will need to include consideration of how Murray’s neuroimmune system and other systems that protect have learned to react (priming or kindling), the possibility of sub-conscious and environmental cues, expectations and of course an assessment of tissue health and function. From thereon in, a comprehensive treatment, training and coachng programme can address movement, body sense, neuroimmune-sympathetic-sensorimotor interactions to name but a few. It is worth pointing out here that such a programme is not unique to elite sports people, but a modern approach to pain and injury that should be accessible to all.

Richmond is the co-founder of a pain awareness campaign called UP | Understand Pain. Together with Georgie, they are using music and song to deliver the right messages about pain, particularly chronic and persisting pain; which are:

  • Pain can and does change
  • You can overcome pain and lead a meaningful life when you really understand it and know what you can do

** Pain Coach Programme for chronic pain, complex pain, persistent pain — t. 07518 445493

 

11May/15

The language of back pain

Back pain, chronic back pain, Chronic low back pain, Chronic pain, Low back pain, , ,

The 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’s back pain

Back pain, chronic back pain, Chronic low back pain, Chronic pain, Chronic pain treatment, , , ,

George Clooney’s back pain — Back 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

23Mar/15

I used thirst to help someone understand pain

Back pain, chronic back pain, Chronic low back pain, Chronic pain, Understanding pain, , , ,

I used thirst to help someone understand pain. He had been given the structural explanation for recurring low back pain (trapped nerve that runs all the way to the toes), which naturally leads to a tissue based focus on ways to get better. Whilst this is a common way to describe pain, it is wrong. Pain is a protective response to a perceived threat.

Yes, if a nerve is sensitised by inflammation or injury, it will transmit danger signals to the spinal cord and then the brain. All the while, signals are being sent down from the brain to mingle with these ascending signals, the sum of which will be scrutinised by brain networks to determine whether a threat exists. If there is a threat deemed tangible, then the body will protect itself with pain, altered movement, altered thinking and altered behaviours:

  • it hurts in a location
  • you limp or limit how far you move the painful area
  • you consider how bad it is and whether you can go to the party, game, work etc
  • you don’t go to the party, the game, work etc

This is all very useful at the outset, but becomes less so as time goes on and the body is healing.

Often there is a kindling or priming effect. The first acute painful episode calms down but then recurring bouts of pain become more intense and with less and less time between–familiar? In the first instance, the systems that protect do so effectively, slowing you down and enforcing action to allow healing. This would usually be in response to inflammation, and is all entirely normal whilst being an unpleasant experience. Not nice, but nothing to worry about. Of course, you would be wise to take heed and do everything that you can to fully recover, which means that the tissues heal and the protective systems switch back to normal modus operandi. There is a chance that you will need some guidance.

It appears that there are some people who maybe vulnerable to developing on-going pain, which is on-going protection. There is likely to be a genetic aspect to this, and certainly a prior experience that may have primed the systems so that they kick in more vigorously, or simply do not turn off when they need to. An over-protect or sensitivity. The priming event(s) may happen much earlier in life so that when the body perceives a threat some years later, there is recognition of the need to protect based upon what has been learned before. Detecting this potential vulnerability is really important in the assessment so that the right action can be taken to counter on-going pain.

Back to thirst.

Where do you feel thirst? Think about it for a minute. Where in your body is thirst? It is not a dry mouth; so it is not your mouth (a dry mouth is a dry mouth and that is all). Is it in your stomach or chest? We have a sense of discomfort that can include a dry mouth, and when we note that sense we give it a meaning. That meaning is “I am thirsty’. The point of this is to motivate us to take action and seek water to quench the thirst.

The same happens in pain. We have a feeling or sensation in our body that grabs our attention. This sensation is given a meaning: this hurts, and then we look for a cause, why does this hurt? What have I done? What is going on? What are the implications, now and in the future? Naturally this happens very quickly, in a split second. The pain then motivates us to take action, like thirst. We rub, cry out, seek help.

In both thirst and pain it is the meaning that defines the experience, and whilst we feel things in certain places, it is how we think about them that gives the richness and implication. We therefore have these experiences with our whole body and self. We feel and experience thirst with our whole body, the sensation not distinct from how we then think and act. The same in pain. To se the whole creates marvellous opportunity for change, growth and moving forward. In most cases thirst is easily overcome, chronic pain being far more challenging.

Chronic pain is about on-going perception of threat as body systems adapt, we adapt and the world around us adapts. We are on a continuous timeline of development that we can influence by our knowledge, understanding and use of skills. Understanding your pain is the first step, creating a foundation for overcoming pain.

Pain Coach

Pain Coach courses for clinicians and therapists: a practical way to coach chronic pain sufferers how to overcome their pain; small group learning and 1:1 mentoring. Call us on 07518 445493

28Oct/14

Top 5 back pain myths

Back pain, chronic back pain, Chronic low back pain, Chronic pain, Chronic pelvic pain, Low back pain, Pain beliefs, Pain Education, , ,

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

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

Back pain, chronic back pain, Chronic low back pain, Chronic pain, Chronic pain treatment, Pain, Pain Education, Pain philosophy, Pain treatment, Philosophy, , ,

This old joke springs to mind when I think about back pain. We can think simply about a door 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

28Mar/14

Relieving low back pain — keeping it simple but effective

Back pain, Brain and behaviour, chronic back pain, Chronic low back pain, Chronic pain, Low back pain, Pain treatment, , , , ,

Back pain is very common and most people will experience it. Many reasons are given for back pain, usually blaming the discs (they are not discs but rather amazing structures that work with the vertebrae to allow movement and force transduction — they are also very robust), joints, muscles and posture.

The simple fact is that the pain we feel in our body is not because of a structure. It is because our brain thinks we are in danger, or the tissues in the area of pain are in danger or potential danger, a warning. Pain is an output from the brain that is detected in the body, driving and motivating protective behaviours. This can be helpful in the acute stages of pain, but as time moves forward and the tissues heal (if they have been injured), these learned strategies become part of the problem. The pain persists, the alarm bells go off during normal activities (e.g. sitting, standing, walking) and we continue to behave as if we need to protect healing tissue. This on-going guarding, change in movement and adapted activities causes many problems including pain and fear.

Breaking the habits of protection and guarding are essential. The increased and inappropriate use of muscles in the back means that they work hard, too hard. Similar to a challenging workout, there is post-exercise soreness and pain, except this is happening on a day to day basis. Re-training the way the brain is activating muscles is vital but to do this, firstly you must understand that you are safe. The movements that re-educate normal movement are simple and can be done at home, at work, in the garden, in the park, anywhere that promotes safe and varied actions. This safety comes from an individual’s understanding of pain. So, this is the first step, making sure that pain is understood in the context of the patient’s narrative.

Understanding pain plus simple movements to develop body sense, nourishment for tissues (‘motion is lotion’) on a consistent basis (again very simple moves with feedback and a sense of safety) and skills to calm systems that are on alert to protect such as mindfulness or relaxed breathing. A basic movement can be primed and used in many different ways to represent the variance we experience every day. The brain loves variety and if it feels safe, you will be able to gradually build your activities back up to recover and get back to having fun.

Here are my formulae:

Understand pain + simple movements + confidence + feedback = reduced threat

Reduced threat + gradual increase in activities + mindfulness = pain relief and resolution of normal activities

13Jan/14

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

Back pain, Back surgery, chronic back pain, Chronic low back pain, Chronic pain, , , , ,

MRI for back pain –> 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.

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.

 

19Dec/13

Low back pain & neck pain | a very common problem

Back pain, chronic back pain, Chronic low back pain, Chronic pain, Chronic pelvic pain, Neck pain, Pain, Pain Education, Pain treatment, , , ,

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

 

10Jul/13

Women and Pain Clinic @ 132 Harley Street

Chronic low back pain, Chronic pain, Endometriosis, Fibromyalgia, Functional Pain Syndromes, Joint Hypermobility Syndrome, Pain, Pelvic Pain, Women and pain, , ,

The Women and Pain clinic is dedicated to providing contemporary treatment, training and coaching for females who suffer persisting pain.

Common examples of on-going painful problems include:

  • pelvic pain: including pain from endometriosis, bladder problems, muscular spasm & guarding of the pelvis and abdominal area
  • back pain
  • joint pain (often multiple)
  • abdominal pain (irritable bowel syndrome or similar sensitivities)
  • migraine & headache
  • jaw pain & dysfunction
  • fibromyalgia

It is not uncommon for there to be several painful areas that are seemingly unrelated. However, with the advancing understanding of the neurobiology of pain, we know that there is a common thread that ties these problems together. This is termed central sensitisation and refers to adaptations within the nervous system that both amplify pain and reduce our natural ability to dampen sensitivity. The body areas that hurt can expand and involve a range of body systems, hence why the pain can manifest in different regions and organs. The pain is an expression of this underlying sensitivity that needs to be targeted at a nervous system-immune system-endocrine system level as well as addressing the health of the body tissues. We use a contemporary and neuroscience-based programme of treatment, training and coaching to tackle the problem of pain, focusing upon the inter-related dimensions of pain: physical-cognitive-emotional.

Working closely with leading gynaecologists and gastroenterologists in Harley Street, you will have a detailed assessment that includes diagnostics as indicated, a full explanation of the nature of the pain and symptoms (pain education) and a comprehensive treatment programme designed for you. 

How do we treat these problems?

A pathological or structural basis for pain only explains part of the problem or in some cases not at all. It is the adaptations within body systems that create the pain experience to which we respond in thought and action. Whilst acute pain serves a vital survival purpose, drawing our attention to a body region that needs protecting for healing, a persisting pain becomes increasingly about the neuroimmune system and endocrine system responses. Pain certainly emerges from the body yet there is an underpinning correlate of activity within a vast network of brain cells that actually drives the experience. This network monitors the activity in the body systems and responds according to need. The response can be protective when the brain perceives the body to be in potential danger and includes pain, changes in movement and a range of other actions. In the early stages of a condition this is useful and adaptive, however if these responses continue beyond a useful time they themselves must be targeted alongside body nourishing strategies.

How can we target these systems? In an integrated manner, these systems can be re-trained with a range of sensorimotor techniques, specific exercises designed to restore a normal sense of the body and movement, strategies to deal with stress and anxiety that both affect the body systems, techniques for the progression of day to day living (work, home, sports), and general activity and exercise with confidence. Interlaced with these strategies, pain education (reduce the threat by developing your understanding of pain and the body’s ability to change), mindfulness-based stress reduction, focused attention training, resilience, coping and motivational skills, are used to optimise outcomes that are based upon improving your quality of life, sense of wellness and performance.

For further information, to book an appointment or to refer a patient please call us on 07932 689081