Tag Archives: headaches

04Jun/17

Headache

Headache is a leading cause of suffering

Headache and migraine are in the top 12 of the Global Health Burden of Disease Study (2011)

 

Headaches

If you watched Doctor in the House on BBC recently, you would have gained an insight into the terrible suffering caused by cluster headache. This is one of the many conditions characterised by chronic pain. In this case, there was significant improvement as the family made some important changes. More on this shortly.

Chronic pain is the number one global health burden, costing more that cancer, heart disease and diabetes put together. There are millions of people across the globe enduring chronic pain states. They have little or no understanding of why they continue to suffer and no knowledge of how to overcome their pain. This can and must change, and to do so means that society needs to understand pain ~ this is the reason for UP | understand pain. Pain is a public health problem of huge significance.

The programme hosted by Dr Rangan Chatterjee highlighted the impact not only upon the brave lady Gemma, but also upon the family. It was their shift in thinking that resulted in new habits, which create the right conditions to get better. That was a choice made based upon new understanding. Realising that we have a choice is a key first step. We can make the decision to commit to doing the things that will change our health, our relationships, our performance and our pain.

Pain always occurs in a context and involves life’s habits. On realising the range of influences upon pain, the person can instigate changes that make a huge difference. In the family setting, this involves all members, including children. There are huge numbers of children who suffer pain (1 in 5) and huge numbers who support a parent. This is a vast problem in itself.

A brief look at pain ~ what is it?

Pain is a whole person state of protect based on the existing and prior evidence that there is a threat or possible threat to the person. Much of the processing is subconscious, our biology in the dark (e.g./ you don’t know what your liver is doing right now), emerging as a lived experience or perception. Anything that poses a possible threat can result in pain. It is important to consider that something only becomes a threat when we think it so, and hence the meaning we choose to give a situation makes it what is it.

It is not only when we are thinking that something is a threat to us of course. Our biological systems interpret sensory information and predict that it indicates possible or actual danger. Working on a just in case basis means that we can get it wring. When we are sensitive,m this can happen more often than not, which is why pain can become so dominant. The range of contexts and situations widen and we notice the pain moments over and over. This does not have to continue. We can actively infer something else with new understanding, new actions, new habits and new patterns — that’s the programme.

Pain and injury are words often used synonymously, but they are simply not the same. Pain is part of a protect state, very similar to that of stress, and injury is something you can see. The former uniquely subjective and a perception constructed by the whole person

What can we do about pain?

The short answer: a lot!

The first step with any change is to make the decision to commit to practicing new habits that lead towards your desired outcome. This decision comes off the back of understanding pain because then you realise that there is plenty you can do to change and overcome your pain.

This always starts with developing a working knowledge of your pain so that you can coach yourself: the right thinking and the right actions to get the best outcome. Initially you are likely to need advice, treatment and coaching to ensure you remain on track.

When you understand pain, you do not fear it or try to avoid it, instead you face your pain, learn about your pain and overcome your pain. This is different to taking a pill or having an injection, which circumnavigate the issue. Only by facing the challenge can we transform the experience of pain. Many messages in modern society encourage us to avoid the difficult things in life but they are unavoidable. We are not typically taught skills to face the challenges that will come up, and so when we do have something to deal with, we suffer. This does not need to be the case, certainly when it comes to pain.

This is not to say that pain is not unpleasant. Of course it is, but we can learn how to minimise the impact and work to create a happy and meaningful life, by living and practicing the skills of well-being. By living I mean that you try to do the things that you want to as much as you can. More dated thinking about pain suggests that you have to get better in order to resume living, however I have turned this on its head and said that you get back to living by getting back to living. Getting back to living IS the way to get better.

In a sense there is a template of how your life and you should be, and there is no real separation between the two. When the template of what is actually happening is different to the expected one, this mismatch creates a drive to bring them together. Pain is one of those drivers. So, if we try to live as best we can, we are in fact bringing these two templates together. Of course there will be a certain tolerance, even perhaps a few moments in some cases, but this is the start point or the baseline. Working from your baseline, you can get ‘fitter’ and healthier with the practices you commit to, and thereby point yourself in a desired direction.

“what is your vision of success?

A treatment programme is therefore weaved into your life. You are in the driving seat. This is an important concept as healthcare often puts you in the passenger seat, or as one patient told me, ‘in the boot’. This is not right and will certainly not help the person to get better. The modern understanding of pain tells us a very different story, which is exciting, but must be told as far and as wide as is possible, which is the reason for UP | understand pain.

If you are suffering headaches, you should consult with your healthcare practitioner as a first port of call. You will want to know the possible reasons why you have headaches, but then you will want to know what you can do, what they will do to support you and roughly how long this will take. With an understanding and a direction, with a decision to commit to practices of well-being and determination, it can be transformative.

RS

 

 

 

 

10Dec/13

Uncomfortably numb

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

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

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

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

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

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

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

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