Tag Archives: pain

07Feb/16
Lego Family by the great 8 | https://flic.kr/p/9z3rus

Family and friends

Lego Family by the great 8 | https://flic.kr/p/9z3rus

Lego Family by the great 8 | https://flic.kr/p/9z3rus

Family and friends are vitally important in a person’s overcoming of their pain. For this reason, I have outlined some of the key reasons before moving onto the common advice that I give to individuals and their loved ones.

We are each enormously influenced by the people we grow up with and spend time with, as they have a role in shaping our beliefs about ourselves and the world in which we live. This includes of course, our thinking about health and pain that drive our choices of behaviour and on-going thinking. And therein lies an important notion, that of the choice we have to develop our thinking and take on a different perspective, thereby creating new perceptions and realities.

The influence referred to above can, if used wisely, be of immense value in overcoming pain. Wise use relies upon all parties both truly understanding pain and how it emerges in the individual, in other words a working knowledge that can be used practically to inform best action that is congruent with health.

The individual bears their pain, suffering the lived experience moment to moment, yet those around the person also suffer in different ways and for different reasons. In this sense, the fact that we are not existing in isolation, when the person gets better, so do those around them. It is a potent realisation that when we choose to take healthy action, the people around us appear to change, as do the world and our overall reality. This is exemplified by the character played by Bill Murray in the film Groundhog Day.

In short, an individual’s pain experience is flavoured somewhat by the attitudes, behaviours and actions of those around, and indeed those around are influenced by the way that the pain of an individual emerges. For this reason, a treatment programme should embrace these dynamics, which could be studied and described in far more detail than I have here, and lever effect for the benefit of all.

How? There are some simple steps and practices that can be taken, which I have outlined below:

  • Both the individual in pain and his/her family and friends have a working knowledge of the pain emerging in that person, noting the individualistic nature of their pain. A working knowledge permits clear and wise thinking in any given moment, continuing to choose a direction congruent with overcoming pain. Family and friends realise the changeable nature of pain, recognising the influences upon pain and how the intensity and suffering fluctuate moment to moment.
  • With a plan in place, encouragement, support and motivation can be provided by family and friends, using the right language, gestures and actions. The plan points toward the vision, giving direction and a steer to recognise whether the person is being distracted or heading towards health. The plan is devised with the clinician who advises upon day to day, moment to moment strategies and exercises.
  • Family and friends can play an active role in a selection of the treatments, including sensory work, touch based therapies, mindfulness and simply providing company whilst the exercises are performed little and often through the day.
  • Learning when to help and when to promote independence is an evolving skill that blends the practical with an understanding of the person.

People often ask whether family and friends should be involved in their recovery. I would suggest that it is not a case of whether, but rather how they can be involved.

 

06Jan/16
UP | understand pain

Onwards in 2016

UP | understand painOnwards in 2016 is my thinking. This is not a New Year’s resolution, but instead a commitment to developing the work thus far, upon raising awareness of the vast problem of pain across the globe. Whilst many organisations, governments and charities are focusing on particular conditions, and fine work many are doing, there is an overarching problem that needs addressing — the problem of pain: what it is? What it means to the individual? What is the impact? What can we do to overcome pain? This leads on to simple questions that we must answer swiftly: why am I in pain? What can I do? What are others going to do? How long will it take?

Pain appears in injury, in stress, in anxiety, in cancer, in heart disease, in diabetes, inUP | understand pain schools, in homes, in workplaces, on the playing field, in men, in women, in children, in the existence of disease, in the absence of disease, it comes in a moment and passes in a moment. Pain is everywhere, and whilst it plays a necessary role in our learning and survival, in many cases the pain is prolonged, amplified and causing on-going suffering when it need not. We have an obligation to change this situation because we can. We have the knowledge, we have the skills and we have know-how and it needs to be used across the board. This is a societal problem that we can tackle together, starting with understanding pain.

The UP campaign that we started last year has gathered great momentum, capturing our imagination and those who were touched by the events at T5 Heathrow, and creating a platform for our plans in 2016 and beyond. This year we will gain charity status and be taking our message as far and as wide as we can — each new person who knows about UP and that pain can change will be a messenger, and this way we can reach out across society. The facts that I give people each day, the knowledge and skills that we work upon together to create the conditions for change in a direction that the person desires, steers them towards sustained health and a life well lived. We are changing all the time, every moment is new and an opportunity, so we can learn to embrace this and keep moving onward!

Onward for me is continuing to develop the blend of pain sciences, philosophy and coaching to get the best out of each and every individual. We all have great potential that is to be realised, and this includes people overcoming their pain. There are too many negative messages given, wrong messages given and subsequent self-talk that predicts poor outcomes. This is not necessary at all and needs to be reversed. Let us talk of health and feeling good as much as we can! There are always challenging times, yet we can view these as difficult or as an opportunity to learn. We will not always be happy, but we can learn how to recognise thought viruses and old beliefs that we can update and change perspective upon in order to view things differently and hence feel differently as our embodied mind evolves.

So, with great gusto, onwards and UP!

07Dec/15
Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

Central sensitisation and higher centres

Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

There is a difference between central sensitisation and higher centres. In recent months I have seen people confuse the two, so I thought it best to differentiate in brief.

Central sensitisation is actually a laboratory based phenomenon that describes changes in the nervous system that result in modulation of the signals from the periphery. In addition, the inhibitory processes are dulled with consequential increases in sensitivity. This can mean that things that hurt will hurt more, and things that would not normally hurt now do. This can be transient but in some people with these mechanisms at play, they experience on-going pain as there is a predicted on-going perception of threat.

The role of the higher centres in pain include interpresting the meaning of the signals from the body (all body tissues and systems) and the brain makes a best guess. This best guess is our perception of reality at any given moment. What translates biological activity within hierarhical systems (networks, processes etc) into what we perceive, we do not understand–this is consciousness. We need the higher centres to convert biology to a lived experience, and the two are different, much like a scan does not tell us about pain. The scan is obective, pain is subjective. It is the person who brign spain to life and flavours it with their experience that is made of bodily sensations, thoughts and feelings culminating in what is.

So, whilst there may not be central sensitisation at play in all cases of chronic tendon pain, if you are feeling pain in that location, the higher centres are doing a protective job that is your lived experience; it hurts in the area where the tendon occupies — we have established that pain occupies a space and not a tisse; e.g. phantom limb pain. And because any pain experience requires higher centre activity, we must address this as much as the health of the body, the tissues, the person.

Pain Coach Programme for persisting and chronic pain. t. 07518 445493

Science | Compassion | Sense

23Nov/15
Pain Coach Programme

Art of living

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

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

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

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

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

30Oct/15
UP | understand pain

What’s next for UP?

UP | understand painAfter last week’s huge success once again, we know that we are on the right path! The support from the members of Rock Choir and the public was incredible, demonstrating that people recognise the scale of the problem. They also acknowledged that the situation is changeable, and we will certainly be driving this change with both our messages at events and with the Pain Coach seminars. Pain Coach is an approach to persisting pain that incorporates the latest pain sciences, the latest thinking in pain and strengths based coaching for successfully overcoming pain and resuming a meaningful life — watch out for the dates. This is all about the individual understanding their pain and knowing what action to take at any given moment to take them towards the life they envision.

UP | understand painHere are our immediate objectives that we are now working upon:

  • Achieving charity status
  • Pain Coach seminars for people suffering persisting pain and their carers
  • Pain Coach seminars for clinicians and others who need to understand pain (e.g. lawyers, human resources, occupational health, managers within business)
  • Develop the website as a high quality resource for pain information
  • The next events that will always include music and song; simply because it makes us feel great!!

UP | understand painOur aim is to develop and mature UP, widening our net gradually as we support and educate society about pain and how we can go about changing and overcoming pain. If you would like to help us grow, please do get in touch: [email protected] and visit our website at www.understandpain.com and on Twitter @upandsing

UP | understand painWe will announce Pain Coach dates and the next event very soon. Please tell your friends and colleagues about us and ask them to join our journey — a fun way of delivering a serious message and taking definite action.

We look forward to seeing you at the next event!

12Sep/15
Chris Jackson | https://flic.kr/p/e9U1Ku

The interoceptors

Chris Jackson | https://flic.kr/p/e9U1Ku

Chris Jackson | https://flic.kr/p/e9U1Ku

The interoceptors. It sounds like the latest box set action hero series in which the heroes, the interoceptors, save the world from a terrible threat in the shape of _________. You can use your imagination to fill in the gap. Close your eyes and think of something that causes on-going suffering to millions of people.

Alas no, for the interoceptors are the actual sufferers. You may have filled the gap with an alien-shaped villain, or you may have thought of chronic pain–no surprise for regular readers.

Interoception is the term used to describe the inner sense of your body’s physiology — some reading here and here. This ties in inextricably with your sense of ‘self’, who I am. Some debate that the sense of self is an illusion and Buddhists purport the belief in non-self; just to give you some background on the subject of self, which is indeed absolutely fascinating and relevant to pain.

Another term used in the literature and sometimes in the clinic as a result, is hypervigilance. This is often paired, or followed by catastrophising. What a couple of words! Anyhow, in essence they mean that the person is readily aware of feelings and sensations in their body, in themselves that is (the two are not distinct), and then attribute these to something bad and hence provoke on-going negative thoughts and feelings. This is one of the contributing cycles to pain, as the persistent negativity affects thoughts and behaviours that impact upon the pain itself–intensity, on-going attribution, moment-to-moment choices etc.

Interoception being the very sensing of physiology from within (exteroception is without), that is apparently amplified in many cases of on-going pain, mean that people feel sensations in their body (some pain, some non-pain) and are so aware, that this completely occupies their experience in that moment–there is only one real moment, and that has just passed, as has that one, and that one; the point being that past and future are in our minds, the only real moment is the one passing..now…now etc etc. We can really only attend to a few foci at any one time and if much of our capacity is taken up with monitoring how our body, how ‘ourself’, feels and what this means, there is not much room for anything else! It is exhausting and increases perceptions of these sensations including pain. It is a habit.

Pain is all about threat. When your body systems that protect you are activated in the face of a perceived or actual threat (the former occurs more and more and in relation to non-threatening cues in chronic pain), the ensuing protection includes pain as well as a range of other responses. When the perceived threat diminishes because it goes away, heals up or we comfort ourselves for example, the pain subsides, sometimes very quickly. When we are vigilant to body signals and then over-worry about what they mean, including normal feelings that then become misinterpreted, this increases the threat, and hence the likelihood of pain.

For all these reasons then, understanding pain and the associated aspects of the pain experience are key: e.g./ attention, focus, expectation, awareness, thoughts, feelings, emotions.

The interoceptors*, in case you haven’t twigged, are people who are very aware of the feel of their bodies, logging many of the normal sensations and worrying that these feelings are problematic or part of their pain issue as well as feeling aches and pains and considering them to be signs of danger, and hence increasing the threat. Most people with persisting pain develop this habit and need guidance and experiences to change this, re-focusing their energies on the right thinking and actions.

* Just a brief note on this apparent labelling — I am not a fan of labelling, hence this note. No-one is any ‘one’ entity; we all have different and unique blends of characteristics that change according to how we are feeling, perceiving the current moment, where we are, who we are with, what our brains are predicting we may do with that person or in that environment etc).

The Pain Coach Programme for chronic pain | 07518 445493

25Aug/15
IMG_0175.JPG

I am in pain

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

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

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

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

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

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

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

20Aug/15
puppy love by Porsche Brosseau https://flic.kr/p/cu9h5h

Pain and compassion

puppy love by Porsche Brosseau https://flic.kr/p/cu9h5h

puppy love by Porsche Brosseau https://flic.kr/p/cu9h5h

Pain and compassion are being explored at a forthcoming British Pain Society Conference, so I thought that I would comment on a couple of important aspects.

Firstly, as clinicians compassion plays a role in our desire to guide and treat others in pain and most likely coloured our choice to become a health-carer in the first instance. Secondly, I find that the vast majority, if not all those I see are compassionate people to everyone (or most!) except themselves. Here are some brief thoughts.

Compassion is defined as ‘inclining one to help or be merciful’ (Oxford Dictionary). The Dalai Lama describes compassion from a Buddhist viewpoint: ‘Compassion is said to be the empathetic wish that aspires to see the object of compassion, the sentient being, free from suffering’. There must be an object of compassion that is another individual or of course the one that is often forgotten, oneself.

The feeling of compassion is often described as a warmth across the chest; the type of feeling associated with seeing a small, defenceless animal, or perhaps a newborn child. This feeling enhances our empathy, which drives actions of kindness towards that being. As a clinician there are clear benefits of cultivating a compassionate approach towards patients who suffer the consequences of pain, particularly on-going pain. Certainly compassionate listening and actions are skills to be nurtured as they envelope the therapeutic encounter with essential authenticity. Compassion also creates an environment and a context for effective and skilful communication; an openness that encourages the patient to express themselves as themselves, revealing the challenges that can be surmounted with a joint therapeutic effort. The importance of the clinician being kind to himself or herself is akin to that of the patient. Looking at ways to grow and flourish, to be a better clinician requires acknowledgement of the current standing, acceptance and a desire to improve, yet without self-criticism.

Frequently patients will illustrate their harshness towards themselves. This punishment and criticism fosters angst, frustration, anger and other negative emotions that are draining, damaging and ultimately wasteful as energies are put into everything but clear thought and action towards improvement. At any given time, one does his or her best based on their knowledge and skills — everyone makes mistakes, which the wise learn from and see the opportunity in errors, the opportunity to develop. Learning to be kind to oneself, often breaking a habit of some years (many people I see are perfectionists; but in some arenas this trait is very useful and a strength that enables high performance resulting in success; so let us learn how and when to utilise it), is a vital part of learning how to overcome pain, especially persisting pain.

Here are several videos that are useful to that end:

Learning about compassion towards oneself and others is part of the Pain Coach Programme for overcoming and transforming persisting and chronic pain. Call us to book your appointment: 07518 445493 | Clinics in London | Sessions available on Skype on request

12Aug/15
Trust Strength Focus | DiddyOh | http://bit.ly/1ToCvPt

Using your strengths to overcome pain

Trust Strength Focus | DiddyOh | http://bit.ly/1ToCvPt

Trust Strength Focus | DiddyOh | http://bit.ly/1ToCvPt

Using your strengths to overcome pain is a fundamental principle of the Pain Coach Programme. Everyone has strengths such as focus, creativity, self-confidence, compassion and empathy. We have used these strengths during our lives to achieve success, at work for example. What I find however, is that people are not using their strengths to overcome their pain, and instead fall into a passive role and hope that something or someone will help — medication is a common one of these! ‘That will solve my problem’, but of course pills do not teach you how to return to a meaningful life, that only comes from the lived experience.

In the first meeting we discuss your pain, problems, story and life so that we can identify where we must begin and the strengths that you have that will enable the necessary actions. You will be using strengths in certain arenas, but probably not in that of your health and pain. The focus is absolutely on your ‘cans’ and not your ‘can’ts’, developing these with strategies and progressions so that the former facilitate the latter with time, practice and perseverance.

One very common example of practicing a strength on a day to day basis but not for oneself is compassion. This means that the person is kind, caring and giving, but not towards themselves. To give is rewarding and health giving, but you must be kind to yourself to do this with most effect. In fact, it is distinctly unhealthy to be repeatedly hard on yourself as it creates much angst, worry and anger that creates chronic stress that in turn creates a chronically inflamed state. Developing kindness and compassion towards oneself then is part of developing your strengths to overcome pain.

The Pain Coach Programme is all about developing your strengths and using them to effectively face the moment to moment aspects of pain as well as an overall approach to desensitising and relieving pain. To follow the programme of exercises and techniques, you need motivation, resilience, focus, energy and an ability to deal with distractions from your end goal. Pain Coach prepares you and guides you so that you become your own coach and move forward to a meaningful life once again. There is only one person who changes and transforms pain and suffering, and that is the person who is currently suffering. They just need to know how to do it!

To start your Pain Coach Programme for chronic and persisting pain, call us now: 07518 445493

Common reasons for starting the programme: back pain | neck pain | RSI | CRPS | sports injuries | arthritis | pelvic pain | IBS | migraine | headache | dystonia | chronic pain | sciatica

05Aug/15
Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

Messages about pain

Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

When someone seeks help for their pain and injury, they will be given messages about pain that are potent. They are told a, b and c, and hence often take these messages and become them via their own thinking and actions. This is the reason why the early messages about pain need to be accurately based on what we really know about pain and that they motivate people to focus on what they must do to recover. The way in which we think about and hence perceive our pain has tremendous impact on the extent of suffering and how we actually experience the pain itself. Put simply, a lack of understanding that can create concern, worry and anxiety, will raise the threat value of the whole situation, and therefore the body (you) protects further, including an increase in the intensity of the pain itself. All these experiences of thought and action are chemically based — depending on which chemicals are working with which receptors determines how the body systems are functioning and underpinning what we live out.

So what should the messages contain?

1. Facts about pain and the injury, including the poor relationship between the two, that pain is part of a protective response that includes other protective means such as altered movement (e.g. limping) and that the way we think and feel influence both the amount of suffering we endure as well as the actual intensity of the pain itself.

2. The person has an active role in overcoming pain — based on (new perhaps) understanding of pain and person, what is happening, why it is happening and what action needs to be taken.

3. Other relevant information to develop the person’s understanding, and in so doing, gain their trust, respect to follow a programme that motivates through positive thinking and experience towards their vision of how they want to be and live their life.

Undoubtedly, as with any problem we must understand it before we can deal with it. In the case of chronic pain, explanations incorporate the biological changes, behavioural changes and cognitive-emotional changes afoot and how to address these comprehensively–whole person.

The whole person approach recognises that there are many inter-related dimensions of that person, and that we must consider the individual as a whole rather than a back or a knee or any other structure or pathology. The experience of pain and other symptoms is a conscious leap from the underpinning biology, and no-one fully understands how our bodies, our ‘selves’, make that leap from biology to the lived experience. However, listening carefully and compassionately to the individual provides many clues as to why they are in protect and survive mode, emerging as pain and other symptoms, behaviours, thought processes and ultimate actions. This becomes the start point for designing a bespoke, proactive programme, beginning with the right messages.

Whilst the first meeting may identify where the actions taken by the individual are incongruent with recovery, it is worth remembering that this person is doing their very best with the knowledge and skills that they possess at that moment. Everyone has strengths with which they attained success in a range of arenas. Elucidating these strengths creates a start point and also allows that person to know and start feeling that they have the tools to overcome pain, but need guidance on how to best use them. That is our job.

This approach is part of The Pain Coach Programme for individuals to overcome their pain problem and for clinicians seeking to learn the Pain Coach approach for chronic pain. Contact us for more details if you are suffering chronic pain or a therapist wanting to advance yourself in the field of chronic pain: 07518 445493