Tag Archives: pain

18Jun/16
Pain now

Biology of pelvic pain

Pain nowMost of the biology of pelvic pain does not exist in the pelvis. The same is true for any pain — back pain, knee pain, neck pain etc. Much like the screen turning blank in the cinema, the problem itself is not the screen but instead the projector or the power source. In other words, to think about pain requires us to go well beyond the place where it is experienced.

Pain is of course lived and whilst it must have a location, the relationship between pain and injury is unreliable. With a huge number of factors influencing the chances of feeling pain in any given circumstance, there is a requirement for a perception of threat that is salient and exceeds other predictions in terms of a hierarchy. Once felt, pain compels action much like thirst and hunger. Again, like thirst and hunger, context and meaning we give to the sensations influence that very experience, which clarifies to a greater extent the difference between on-going (chronic) pain and that of labour.

To feel pain we need a concept of the body, which itself is constructed elsewhere as the sensory information flowing from the body systems is predicted to mean something based upon what is already known and has been experienced, we need a nervous system, an immune system, a sensorimotor system, a sense of self and consciousness to name but a few. Where in the pelvis do these reside?

This is not to ignore where we may feel pain as this is an ‘access’ to the pain experience that should be used in terms of movement and touch. However, it is the person who is in pain and not the body part. My pelvis is not in pain, I am. My pelvis does not go and seek help, I do. My pelvis does not ease its pain, I do. So when ‘treating’ a person, we must go beyond the place where the pain is felt to be successful. And it is vital that the person is considered a whole; there is no separation of mind-body. The notion of physiological, body, psychological division etc. etc., just does not fit with the lived experience; I think, and I do so with my whole person — embodied cognition.

Locally one will usually find evidence of protection and guarding, which themselves manifest as the tightness, spasm, painful responses to touch and movement. This is all manifest of an overall state of protection, co-ordinated largely unconsciously accompanied by a range of behaviours and thinking that quickly become habitual — they are certainly learned from priors, our reference point. This is simply why delving gently into the story is important, as we can identify vulnerabilities to persisting pain such as previous experiences of pain, functional pain syndromes, stressful episodes in life; all those things that put us on alert when the range of cues and triggers gradually expand so now I am vigilant and responding to all sorts of normal situations with fear.

The start point is always developing the person’s working knowledge of their pain, which also validates their story. So many people still report that they feel that they have not been believed, which I find incredible. How can someone work in healthCARE and not believe what a person says? Baffling. Once the working knowledge is being utilised and is generating a new backstory, new reference points emerge. We create opportunities for good experiences over and over, moment to moment, day after day, in line with their desired outcome, the healthy ‘me’ that is envisioned from word go. This strong foundation that opens choices once more then permits exploration of normal and desired activities supported by sensorimotor training and other nourishing movements, alongside techniques in focus, relisience and motivation. Realising and actualising change in a desired direction must be acknowledged as the person lives this change knowing that they can.

Pain can and does change when you understand it, know where you want to go and how to get there, quickly getting back to wise, healthy action when distracted (i.e./ flare ups, mood variance, loss of focus etc). The biology of the pain is one aspect, hidden in the dark within us, and the lived experience is another. The two are drawn together to give meaning and to develop an understanding of the thinking and action that sculpt a new perception of self and pain, resuming the sense of who I am, as only known and lived by that person.

09Jun/16
Pain and injury

Pain and injury

Pain and injuryPain and injury are poorly related. Unfortunately most of society continues to believe in a stimulus-response relationship between these factors, but in reality it does not exist. This was raised by Pat Wall in his classic 1979 article entitled ‘On the relation of injury to pain’.

Since then we have learned an enormous amount about pain; what it is and the purpose it serves. Why should the relationship between pain and injury be so unreliable? The answer is because pain is contextual, motivating appropriate action for that moment depending upon a range of factors. These include the injury itself and what it means, prior experience, beliefs about pain, the environment, who is there, how one is feeling before and at the point of injury and what is going on at the time. Here are some examples:

* a carpenter hitting his thumb with a hammer — despite the fact it will hurt, this is not unexpected, an occupational hazard if you will, and soon dismissed.

* an electrician electrocuting himself — similar to the carpenter; the context is key

* spraining an ankle in a cup final — there are many reports of injuries being sustained whilst playing sport that are not painful at the time, because playing on is more important

* battle hospital reports — severe injuries but no pain initially; the same in many accident and emergency reports

* a concert violinist who cuts his left index finger the day before his most important gig — what do you think this experience could be like versus a chef?

These examples demonstrate the variability in lived experience despite the biology of healing being similar (effectiveness may vary depending upon existing and prior health) — the two lives, that of our biology and that of our lived experience. The clinician’s role is to marry the two for the person so that they understand the hows and whys before focusing on what needs to be done to get better.

When my knee hurts, or any other body area, the vast majority of the biology that is involved resides elsewhere. Pain is located to my knee, although I can’t possibly know from where exactly; where is the stimulus? Yet to feel pain in my knee I need the systems that protect me to detect certain sensory activity, predict that the causes are threatening and then translate this to a sensation that is pain; i.e./ the biology becomes ‘conscious’. Whilst there are signals from the knee to the spinal cord and onwards, this is not necessary for us to feel pain. Think about phantom limb pain.

There are many levels whereby signals and predictions are modulated until the most credible prediction emerges as a lived experience. This is why prior experience, beliefs, emotional state and our thinking play such a role in pain as all can modulate the meaning and level of perception of threat.

An analogy is watching a film at the cinema. The film is on the screen yet for this to happen and be experienced, there must be a projector, electricity into the projector, and this electricity comes from the grid. Most of the necessary elements are not where you watch the film. The same can be said of pain, when it is made up of many non-pain factors that come together to create that lived experience. The point there is that when we address these in a comprehensive treatment and training programme, we can change pain and get better. But to do this we must think beyond the structure (the cinema screen) and consider the person, their beliefs, their thinking, their lived experience, the phenomena of their life, in order to be successful, which we can.

Pain is not related well to injury, but instead to the level of predicted threat.

Pain Coach Programme for persistent pain | t. 07518 445493

 

07Jun/16
Pain, loneliness, poverty and health

Depression and inflammation

Depression and inflammationFor some years there has been thinking about depression and inflammation being related in as much as when we are in the throes of inflammation, our mood changes. Think about when you feel unwell and how your mood drops, which is part of the well known sickness response. In some people, probably a large number, these sickness responses are the norm. In other words, they endure a level of this sickness response consistently that is underpinned to an extent by on-going inflammation.

Reports today about a study at Kings College London describe how inflammatory markers in the blood could identify a ‘type’ that would benefit from a certain antidepressant drug — read here. This would make the prescription specific for the person, so rather than trialing a drug, we would know which would be most likely to be effective for that person by identifying the blood markers.

Many people I see with persistent pain are low in mood and some have been diagnosed as being depressed. In my mind, it is entirely understandable why someone suffering on-going pain, who cannot see a way out, would be in such a state. In simple terms, the person with chronic pain may well be chronically inflamed. We know that people who perceive themselves to be under chronic stress will be inflamed as the body continues to protect itself via the immune system and other systems that have such a role. Typically and understandably, someone in a chronic pain state is stressed by their very circumstance and hence can be inflamed.

It is very common to suffer an enduring pain state and generally feel unwell; a sickness response. We all know what a sickness response feels like — we don’t feel ourselves, aches and pains, loss of appetite, irritability, emotional, sleepy, tiredness, poor concentration etc. This is underpinned by inflammation and how this drives a range of experiences and behaviours, all designed to create the conditions for recovery. In the short term this is adaptive but if prolonged, the symptoms are enormously impacting and potentially maintaining a cycle of stress and anxiety.

Like any problem, understanding its nature is the start point so that problem solving can be effective; i.e. think about it in the right way and take the right action, congruent with recovery and the desired outcome. Realising the links between health state, depression and inflammation helps to distance oneself from the lived experience, being less embroiled with that particular ‘film’, instead focusing on what needs to be done to overcome the problem.

A loss of the senses of self is often a part of a persisting condition such as chronic pain or dystonia. The overarching aim of a followed programme is for the individual to resume living their life with a sense of self worth which they can identify: I feel myself again. This self feels normal to that person, and only that person knows how that experience is lived. As best they can, I ask them to describe that experience, and this forms the desired outcome. The sense of self is at least a unification of body sense, interoception, exteroception, the inner dialogue and our past experiences. Improving body sense with exercises, some general and some specific, is a simple way of stepping towards that outcome. And of course there are all the other benefits of exercise to consider.

It will undoubtedly be very useful to identify who will benefit from which antidepressant drug, yet we must still consider each (whole) person. A comprehensive programme of treatment for pain for example, includes developing working knowledge of pain so that the person can independently make effective choices as well as eradicate fears, specific training, general activities, gradual progression of activity, and mindfulness to name but a few. However, it is not just the exercises that are important. The person also needs to be motivated, resilient and focused, all strengths that they have likely used before in other arenas but now need to employ here and now with their health — this is the strengths based coaching aspect of the Pain Coach Programme. In cases of depression, the chosen drug maybe more specific and hence more efficacious, yet there are other actions that are also important such as understanding the links as explained and consistent physical activity. Great work in the aforementioned study; it will be interesting to watch how this progresses.

Pain Coach Programme | t. 07518 445493

14May/16
Pain distraction

Kids know about pain distraction

Pain distractionI overheard an interesting conversation this week that demonstrated kids know about pain distraction.

Driving my kids to swimming, my eldest daughter was giving us an update on her wobbly tooth and the fact that it hurt. She was concerned that it maybe too painful to go swimming. My youngest daughter, 6 years, then piped up with an insightful suggestion: don’t worry about your tooth because when you are in the cold water you will forget about it’.

To me, as a pain-head (a term sometimes used to describe someone who is obsessively interested in pain and what it is), this was fascinating. Life in action, a natural comment based on some experience that my youngest must have had at some point, or at least heard about. I would think the former is more likely as the message surely stuck with her to the extent that her model of the world in relation to safety-threat has been updated to consider distraction as a way of changing pain and reducing the threat value — pain is a lived experience, compelling action in the face of a prediction of a perceived threat based on the hypothesised causes of the sensory information in relation to prior experience.

RS

10May/16
Pat Wall Lecture 2016 | British Pain Society ASM

Pat Wall Lecture 2016

Pat Wall Lecture 2016 | British Pain Society ASM Listening to Professor Stephen Hunt give the Pat Wall lecture 2016 this morning at The Pain Society ASM evoked a number of thoughts. The meat of the talk addressed recent molecular experiments that could provide new forms of treatment; very much a mechanism-based approach to modifying peripheral and central adaptations (sensitisation) — of course the two are not exclusive, instead being part of a spectrum of changes in respect of an initial insult (usually), and in those vulnerable, a state of persistency ensues. Whilst fascinating and relevant of course, it was the references to Pat Wall that really interested me due to the insights that still hold true.

I was struck by Professor Hunt’s point that many do not consider pain to be a need state. A need state that is a conscious means of motivating action that is the thin slice atop biology in the dark that prepares and operates the healing process, most of which is unbeknownst to us — we feel pain, note swelling and the feel of swelling as it occupies space, changes in the way we move, feel and think. The notion of pain being a need state has been a big part of my thinking over the years, and to me it would seem strange not to consider pain this way. Having been educated by Dr Mick Thacker, who spent a great deal of time with Pat Wall, it is no surprise that these messages have been handed down.

Everyone has examples of the unreliable relationship between injury and pain if they stop and think for a minute. Often quoted are phantom limb pains, paper cuts and battlefield wounds to illustrate the enormous variance. The tissues themselves simply do not explain pain. So what does explain pain? The meaning, the context and ultimately the level of perception of threat (predicted top-down): more threat = more pain, which is why it usually hurts more when you don’t understand your pain and worry about it! And why pain feels better when you, the person feels better. Again it was Pat Wall who provoked this realisation.

It is always valuable to go back to the original lectures and writings as they remain so relevant. We desperately need to address pain globally, it is the reason for so much suffering. New questions to provoke new thinking and research will add to the already gathering hope, steering society towards a modern understanding of pain: what is pain? What is it’s purpose? Knowing that it changes and taking action to enact that change. The coming together of philosophy and neuroscience is really helping us to see pain in a different light, explaining it to patients so they can understand how they have got from A to B and then how to coach themselves to overcome their suffering.

09May/16
GB: Get Better

Get better

GB: Get Better

GB: Get Better

Regular readers will know that I firmly believe in getting better when it comes to pain and persisting pain. This should be our aim with each person. This thinking also needs to underpin research, policy making and clinical decision making across the board.

Recently I was asked to speak at an event that considered the question ‘how do tendons get better’, and my area of focus was the brain and pain. More on this shortly, but it was a pertinent question because for some time I have been pondering why people do get better (from persistent pain), what does getting better actually mean and who gets better?

To answer these questions experientially, I thought through many cases that I have seen to identify the common features. Not especially scientific, but a start point. People getting better meant that they would report that they felt more like themselves. A common phrase that we use, ‘I don’t feel myself today’, tells the world that all is not well, and equally saying ‘I feel myself again’ reports that what is happening in my world is what I expect to happen; a match up in other words. And who are these people who get better from a persisting pain state in the face of messages from society that chronic pain is here to stay and needs to be managed or coped with?

In short, these are people who take on board the true messages about pain and what it really is based on our modern understanding. Not only do they listen and put in into perspective within their lives, but they use the new information as working knowledge to be applied consistently, challenging previous thinking to drive new actions that are congruent with being healthy. With this working knowldge, moment by moment they are able to make clear decisions and groove new habits, pointing themselves via their perceptions and actions towards their desired outcome, as defined by themselves at the outset.

Everyone has experienced success in one or more arenas of their life, whether at home, at school, in work or playing sport. This success is achieved by focusing upon the desired outcome and then taking every opportunity to get there, even if things go wrong along the way. Distracting (unhelpful) thoughts and unforseen events are dealt with as learning experiences, and soon enough the person is back on the path towards their vision of success. Take a moment to recall a success and note how you did it. What strengths did you use? How could you bring them into this arena? The people that use their strengths and focus on their vision consistently, get better.

The tendon debate resulted in agreement that people needed to understand their problem and pain as a foundation from which different strategies could be used. The strategies chosen for the individual must reflect their needs and desired outcomes. I was asked if brain and pain could explain why a tendon gets better, and I argued that we are more than a brain, and in fact the construct of self is made up of a number of facets: my physical presence, how I experience that presence, the story I tell myself about me, the sense of the environment in which I reside in this moment, my past (perhaps unreliably retold to me by me) and my anticipation to name but a few. It is the person who gets better and not the tendon or the back or anywhere else in the body, because we are that body as much as we are the mind (the mind does not just exist in the head or brain, instead we are our mind, often using our body to think — embodied cognition). We are necessarily all of these things together: body-brain-mind-environment.

The overaching aim must be that the person gets better as defined by themselves as only they know what it is like to be better. And when the person is better, they feel themselves again, which in terms of pain emerging from me (felt in a body area), it exists less and less in the thin slice of awareness that is consciouness — most we are unaware of; externally and internally (the biology in the dark). When we are better, we don’t think so much, if at all, about our body until we have an itch or have sat too long and become uncomfortable. Then we scratch or move and resume a state of non-body awareness, just focusing on what it is that we need to in that moment.

Pain Coach Programme to get better: t. 07518 445493Get better

 

03Apr/16

Knowing about your condition

Knowing about your condition can be a double edged sword, as illustrated by Ian Jack in @guardian yesterday — read here. Jack describes his experience of anosmia, the loss of the sense of smell. However, he goes on to describe how reading an article about anosmia made him consider ‘that I was in fact a member of a disabled and neglected group’, which he was ‘happier not to think about’.

The piece raises a number of important issues. Firstly that losing one of our five senses has an impact on our ability to predict the world and hence our lived experience, secondly that this impact can be underestimated by the individual in some cases and by society looking in, and thirdly that knowledge about a problem does not always help per se. Everyday people are learning that they have a condition, generally more accurately from a diagnostician and more precariously via the Internet. The latter is of course quite able to ‘diagnose’ in response to a list of words (symptoms) but the danger is that the list of possibilities still require adjudication, and it is the same person choosing an answer. It is a little like your doctor giving you a list of conditions to choose from when you tell him your symptoms, and you then choose the most sinister. Oh yes, and the computer, device, phone etc. does not examine you or try to understand you as an individual.

I write and speak regularly on the fact that people need to understand their pain in order to know that they can overcome their pain, with an emphasis on both the quality of the explanation (teaching – learning scenario) and the context in which the information is delivered. Reading an article as did Ian Jack, or finding some information online, or someone else sharing their experiences must all be put into context. These are other people’s stories and not yours is the first point, so extrapolating to your unique story has its dangers unless you have someone to clarify and provide perspective — that’s my job. Spending time giving meaning to the person’s story is important, identifying the key points and explaining what can happen in order to arrive at the present moment. Nothing happens in isolation because we have had a prior experience to flavour this one. Looking back, however, can be done in an objective way, recognising the limits of the reliability of our memory, yet it is the question ‘what do I think and do now?’ that is important.

A common scenario in modern healthcare is the interpretation of the scan result for musculoskeletal pain. Back pain for example, frequently leads to an MRI scan to look for a structure to explain the pain. Yet pain cannot be seen. You can see the state of the discs and joints according to a picture taken in a moment (a snapshot), but what does this tell you about the person’s lived experience of pain? One is objective (a picture) and one is subjective (pain). But how often is the disc or joint used to explain pain as the healthcare professional shows the person (patient) the picture, pointing to the culprit on a screen? Now that the person has ‘seen’ the picture, it becomes part of the story with the solution becoming the need to do something to that disc or joint. They have new information that is now influencing their outcome, yet they will not be thinking this as it is all part of the subconscious processing that shapes our thinking and experiences. However, when a scan result is used within the context of modern pain science, we can use the information to sculpt a positive outlook but this relies upon time with the person to fully explain and answer questions as opposed to finding an article online or in the media when thoughts arise with no-one to qualify or ask. Thoughts interpreted as threatening have protective consequences from pain to feelings of stress and anxiety.

In summary, we need to be judicious about the information we expose ourselves to and use rational thinking to determine the relevance to ourselves. We are all utterly unique with our own stories and lived experiences, so when you pick up an article, bear this in mind. You would also be wise to write down any concerns or questions and ask a trusted adviser to put perspective on those thoughts so that they form part of how you overcome your problem.

Pain Coach Programme for overcoming pain | t. 07518 445493

13Feb/16
40+60 Feet | Bark |https://flic.kr/p/7rvmbB

Tendon pain

40+60 Feet | Bark |https://flic.kr/p/7rvmbB

40+60 Feet | Bark |https://flic.kr/p/7rvmbB

Tendon pain has been a big topic for some years. The problem is seen commonly in the clinic and frequently poses a challenge because so often tendon pain persists. Local factors and nociception are typically blamed, yet when treatment is focused at the tissue level, the limitations are exposed. As an aside, tissue based strategies are cited, yet there is really no such thing as a tissue based treatment simply because the tissues are not separate from the person. They are the person, and of course the person knows that something is being done to them and hence emotions and thoughts are at play, affecting the outcome — consider the person who observes your hands whilst you mobilise or massage whilst remaining calm and curious versus the person who is anxious, guarded with their hand poised and ready to grasp your hand as you start treatment; the latter person demonstrating why it is vital that the threat value be diminished before starting any intervention.

Pete’s excellent blog about tendon pain acknowledges the person, perhaps for the first time in tendon literature, which is music to my ears. Having been heavily influenced by Oliver Sacks, my philosophy has always been to consider the person as much, if not more than the condition as it explains how a particular issue manifests uniquely in that person. Certainly in my mind, the ‘initial assessment’ for me is about getting to know the person, which then rolls into their own experience of pain.

I first started looking with interest at tendon pain some ten years ago as an example of a persistent condition in sport. With an interest in chronic pain, it appeared that the discussions about tendon pain remained within the boundaries of where the pain emerged, yet our understanding of pain had advanced to the higher centres and many body systems involved in the experience of pain. Even nociception was discovered as being an incomplete picture as this biological process can be afoot with or without pain. Detection of threat does not mean it has to hurt, and indeed nociception itself is not something we actually feel. However, when the brain (which is of course part of the person and not separate, although our language does sometimes suggest this) predicts the need for protection, pain emerges in the person in a location deemed under threat or potential threat. This complex activity, which includes consciousness and the mind (these are both small subjects……..), is a whole person experience that is lived moment to moment and hence a focus on what happens in the tendon is only part of the picture. There is still very little acknowledgement elsewhere within the hierarchy, so here are a few thoughts I would like to share.

Previously I have expressed the view that we treat, advise and educate a person; a whole person. The approach that I favour is one that delivers the (working) knowledge and skills for the individual so that they can overcome their pain problem and resume a meaningful life as defined by themselves. Fragmenting for convenience is common, breaking down a whole into parts, yet this can never give a full picture. Medicine and healthcare typically specialise and whilst this has value, in the case of a persisting pain that often means that people fall between the cracks. For example, a female with fibromyalgia, IBS, migraines and pelvic pain may be seeing a rheumatologist, a gastroenterologist, a neurologist and a gynaecologist, and whilst elimination of anything pathological is important, there is an understood common upstream biology. Interestingly, many of these cases also have tender tendons that can be a surprise to the person when the tendons are pressed, especially considering that they are not the primary reason for seeking help.

Nothing happens in isolation (is one of my favourite phrases), and hence the biological expressions in and around a tendon are not separate from the mechanisms that underpin how pain arises in our consciousness. We cannot explain how this happens — how do chemical reactions in our body become a lived experience? Despite the lack of an answer, it clearly involves more than the tissue or structure alone.

This is not to say that the brain and the mind alone are responsible. Where is the mind? Where is the seat of the mind? Again, we do not know. Yet surely the mind is not just in the brain, an argument put forward by supporters of embodied cognition. It is me that thinks, not my brain or my mind, but me. And I think with my whole person because I am a whole person, and indeed when I feel pain, it is me that feels pain and not the body part where I feel it. Because I am more than that body part, the experience of pain must involve the whole person in that moment in that context. It is also true to say that to be in pain, we must be thinking that we are in pain as much as experiencing the sensory qualities of pain. Thinking draws our attention to the said experience, otherwise it is subconscious and hence not occurring to me.

For tendon pain, practically speaking, we must of course consider the health of the tendon itself and surrounding tissues, but also the person’s general state (who are they, how are they), prior experiences relevant to the problem (e.g./ tendon pain, pain, general health), beliefs, expectations, vulnerabilities to developing persistent pain, their story of how the pain emerged, their movement patterns (and why they are moving in such a way; both at the planning stages of movement and actual movement), body sense and sense of self at the very minimum. This information is gathered within the first conversation, setting the scene as trust and rapport develops naturally from exploration of their story that validates and empathises.

This is a mere and brief overview of my thinking about tendon pain, which poses a significant clinical problem, often persisting for longer than is expected. Whilst the focus remains on the tendon and nociception, there will be limited results in my view as this only tells a part of the story of the person in pain. This is true for any pain, and not just tendon pain. Pain emerges in the person and all that that person means and embodies, hence we must address the person as much, if not more than the condition. As Oliver Sacks wrote on his father, a GP: ‘He knew the human, the inward side of his patients no less than their bodies and felt he could not treat one without the other’. So true and this has always been my abiding principle.

Pain Coach Programme | t. 07518 445493

08Feb/16
Pain Coach Programme

Hip replacement

Having seen Eamonn Homes on Twitter up and about on crutches after a hip replacement (good work), I thought I would share a few tips that I give to people undergoing orthopaedic surgery. Hip replacements and knee replacements are common nowadays but there is always a person going through the procedure with his or her hopes, dreams, fears and past experiences. As one of my greatest influence’s, Oliver Sacks, would always say, it is as much the person as the condition. Each person’s experience is unique to them and necessitates validation and respect.

  • Pre-operatively, understand your pain so that you have a working knowledge to enable you to deal with it effectively. The pain is normal, not to be feared, instead to be overcome with the right actions post-operatively. In many, many cases the operation results in pain relief and a much improved quality of life.
  • Post-operatively the pain needs to be well controlled. Conversely, a predictor of on-going pain is poorly controlled pain at the outset, so keep talking to your doctors and nurses and inform them if you are suffering. On another level, the pain can dissuade you from that early movement and mobilisation that is important for recovery.
  • Relaxing and calming techniques help your body to focus on healing. If you are unnecessarily stressed, anxious or fearful, important resources are diverted to protection and survival rather than healing. Common methods that I teach people are to use their working knowledge of their pain to reduce the threat and choose the right healthy action, mindfulness, visualisation, sensory exercises and breathing.
  • Using motor imagery activates and exercises the areas of the brain that plan and execute movement. When movement is limited, these are great exercises to keep the higher centres working for you. The quality and precision of the way we move depends upon these representations and they need to be accurate. Some of this accuracy is lost when we are in pain or not moving normally. Imagine moving your hip, knee, foot and walking; all these are simple and you can do them as often as you like. Visualisations are also a great way of creating calm and motivating you to take the right action. Remember, when you think about something, your brain and mind are very active but with your body — our minds are embodied, in other words an extension of, and part of our thinking (embodied cognition).
  • If you are anticipating that a movement will hurt, visualise the end position (e.g. standing up) and then imagine the act of standing up over and over (10-15 reps) and then do it.

Pain Coach ProgrammeThere are many other sensorimotor execises and techniques that a person can use over and above the standard movements and post-operative exercises (and pre-operatively), to get the best outcome. In essence, it is about creating the right conditions for healing and recovery, holding a vision of how you want to be and then work towards that vision (dealing with distractions on the way — e.g. fears, worries, negative messages) of health and a meaningful life.

This is the way of the Pain Coach Programme | t. 07518 445493

08Feb/16
Cold shower by Thomas8047 | https://flic.kr/p/oi7RaM

Lingering colds

Cold shower by Thomas8047 | https://flic.kr/p/oi7RaM

Cold shower by Thomas8047 | https://flic.kr/p/oi7RaM

A number of people have described their lingering colds, which have been persisting for a few weeks. This is longer than anticipated, and of course rather annoying and inconvenient. Daytime sniffling and night time disturbance whilst low on the list of ailments in terms of seriousness, they do impact upon life: tiredness, aches and pain, disrupted appetite, reduced concentration for example.

Beyond the normal symptoms, someone who has a degree of sensitivity at play, in other words a pre-existing painful problem, will frequently endure an amplification of their pain. It is common for the body to ache when we have a cold, and when we have an existing painful body area, it will typically hurt more during this period as the immune system pumps out pro-inflammatory cytokines (messengers) that increase sensitivity. A further noteworthy observation is that of prolonged symptoms when the person tries to exercise, discovering that their usual post-gym or post-run soreness is worse and continues for a few days. The overall symptoms of the cold can persist for longer as well unless the conditions for recovery are met, and this means meeting basic needs: what we eat, what we drink, enough rest and recuperation, enough sleep and dealing with situations that cause stress and anxiety.

Some people believe that we catch a cold by being cold. As far as I know this has never been the case. The feelings and sensations of having a cold are the body’s responses to a virus (no need for antibiotics then) or bacteria (may need antibiotics but not always — judiscious reasoning needed by your doctor). You cannot feel a cold, only the emergent experiences of the body that are mortivators for action to rest, recuperate, hibernate, protect etc etc. If you ignore these clear motivators, you are probably going to prolong the cold and your suffering as well as all those around you at home, at work and on the tube (ever had someone with a cold next to you on the tube? And when I say next to you, I mean squeezed right up to you).

So, loPain Coach Programmeok after your basic needs. In fact, this is vital anyway and will reduce the risk of catching a cold in the first place! And from suffering the effects of survive rather than thrive. Wouldn’t you rather flourish, engage and perform? Be wise. Be health wise.

Pain Coach Programme to overcome chronic pain and live a healthy & meaningful life

t. 07518 445493