Tag Archives: pain

16Apr/15
UP | Understanding Pain

Bec’s Story — overcoming chronic pain

In support of the @upandsing chronic pain awareness campaign by UP | Understand Pain, Bec has very kindly written her story of achievement. Bec illustrates how we can change our pain and overcome chronic pain by understanding her pain, and taking action based on this knowledge. Enjoy.

“I suffer from chronic pain. This is when pain persists beyond the normal expected healing time. In writing this story, I wanted to describe to you the affect that living in chronic pain had on me as a whole person, since understanding this is vital in order to improve our understanding of both ongoing pain and its treatment.

‘YOU CAN IF YOU THINK YOU CAN.’ Norman Vincent Peale

‘Life can only be understood backwards; but it must be lived forwards.’ Soren Kierkegaard

I didn’t crawl before I started to walk. I have never had a good sense of direction or spatial awareness – I get disorientated coming out of a shop, not knowing which direction I need to turn. I have hypermobility in my joints. I have perfectionist tendencies. I fractured a vertebra when I was eighteen. I have always placed a great deal of importance on exercise and struggle to be as happy without it. Doctors told me I would live in long-term persistent pain.

These are all facts about me. Facts that at first may seem to have no connection. But since nothing works in isolation, everything about us – our experiences, our personalities, the words we hear and stories are told, create a whole. And in order to overcome chronic pain we must learn to deeply understand it, not just from an external objective perspective, but also from a uniquely personal and internal one. Chronic pain comes from and affects the whole person and it therefore must be the whole person who is treated. Once this happens, it is possible not only to overcome chronic pain, but to redefine old stories, undo unhelpful thoughts, alter perspective of past experiences, develop healthier habits and ways of living, know that we can change. Not just our pain, but ourselves…in any way we wish to.

‘Movement anchors thought.’ Cara Hannaford.

I don’t believe that our minds and bodies are separate entities and I have always found a joyous energy in movement that I could not create in any other way. I am told that as a baby I was desperate to get moving and began walking at nine months. On my first trip to the swimming pool as a toddler, I jumped straight into the water the moment I saw it. Growing up, I spent hours outside, climbing trees, building dens, riding my bike. And I was always trying out new sports: dancing, gymnastics, trampolining, roller-skating. From the age of 10 to 18 I played competitive netball. But it was horse riding I really loved once my family moved to Norfolk when I was five. As I grew older, I recognised the deep sense of connection to the world I found when I was engaged in physical activities. It wasn’t the technical aspects of riding I enjoyed the most, but the sheer physicality of it – both whilst in the saddle and working on the yard.

In 2000, aged-18 (during my gap year before university), I had a seemingly uneventful fall during a riding lesson. But an awkward landing caused a compression or vertebral fracture to my spine. Looking back now, it was my first experience of the ambiguous nature of pain. In the first moments after the fall it was incredibly painful, but this quickly eased and I thought I had just winded myself. I got up, walked the horse back to the stables, untacked her and lay down for a rest. But in the following thirty minutes I experienced excruciating pain in my back. I was taken to A&E and x-rays and scans revealed the fracture – it was a clean break without any splintering. This was a fortunate discovery, not only because it meant an operation wasn’t necessary, but also because a splinter could have severed my spinal cord as I moved around after the fall. I remember the consultant berating me for this, which created an intense feeling of fear of how different my life could so easily have been, of the fragility of a life well known – a fear that never completely left me from that moment onwards.

I spent a week in hospital lying as still as possible until a back brace could be fitted. I can recollect the high level of pain only through memories of pleading for more morphine before it was allowed; and from attempts to writhe around to try to redistribute the pain to other parts of my body (although I was held still by the nurses). I spent the following four months in my back brace permanently, a rather unattractive bulky white contraction aimed at preventing kyphosis (curvature of the spine) while the fracture healed. For a further two months I used it only when I was out of the house for long periods. Occasionally, I used a wheelchair when a lot of walking would have been involved. But the pain subsided after just weeks of the accident.

Within six months I was back in the gym, running and horse riding again. I spent the two months I had left before starting university travelling around Europe: I ran the streets of waking cities; mountain biked in the Alps; paraglided off the coasts of Greek Islands; and went whitewater rafting in Austria. These are the parts of the trip I remember vividly due to feeling enormous gratitude that I was still able to do them. It was the type of gratitude created by a near miss, a lucky escape, the insight that life can change in a second. My accident made me realise the ability to move our bodies is a gift. It is a gift that not everyone is given, or gets to keep. Running became a prayer. The heightened awareness of the ground beneath me in those first few steps provides immediate comfort. And then as I settle into the rhythm, the motion becomes an energy, which is like life waking up inside me. Running gives me a connection to something bigger, something both within and beyond myself. I am mindful, totally present in the moment, immersed in the feeling of moving and, if outside, in my surroundings.

‘People will forget what you said. People will forget what you did. But people will never forget how you made them feel.’ Maya Angelou.

For the majority of the following twelve months my back gave me few problems, but towards the end of my first year at university I began getting bouts of terrible pain in it. A new MRI scan and x-ray revealed what I was told was Degenerative Disc Disease, and that the fluid from inside one of my discs had leaked, pressing on nerves – the cause of the pain. I received some physiotherapy and the pain subsided over the next couple of months.

I have since learnt that Degenerative Disc Disease is a very general term used to describe changes in the spine – a normal part of the ageing process. Aged 19, one of my discs had degenerated faster than was usual for someone my age, (but not an uncommon result of a spinal trauma), which it was why it was used to describe the cause of my pain at the time. However, what the label actually meant wasn’t explained to me, and the power of the word ‘degenerative’ (suggesting progressive deterioration) and ‘disease’ (implying impairment or abnormal function), remained long after the pain had disappeared. I became more cautious of activities that may threaten my back’s ‘safety’, especially falling, and concerned that in the future I may have further problems relating to a condition I now believed I irreversibly had. A more accurate description of the situation would have been to simply state that one of my discs had degenerated.

‘There is nothing either good or bad, but thinking makes it so.’ William Shakespeare, Hamlet.

Throughout my twenties I experienced pain in my back on a fairly regular basis, but nothing too debilitating or lasting much longer than a month or so. I remained very active: as I was now living in London, mostly running and going to the gym. However, from the age of 26 I also began getting a recurrent pain in the outer part of my left knee – not an uncommon for problem runners. Various physiotherapists informed me it was Iliotibial Band Syndrome (a tightness or inflammation of the ligament that runs down the outside of the thigh from the hip to the shin), and gave me exercises to treat it. But they never provided a long-term solution and I began to find it increasingly irritating as the pain reoccurred more often; for five years it prevented me from running more than a few miles, and sometimes appeared when I was just walking.

In March 2013, the knee pain began again and this time I set out to find an alternative treatment since traditional physiotherapy hadn’t worked. Whilst I did so, I stopped running altogether. The knee pain simmered down but in May 2013 I noticed soreness in the front of my hip – it felt like I’d pulled a muscle. Yet despite reducing exercise even further over the summer, it didn’t improve – in fact the soreness heightened and spread around the back of my hip (a burning-like pain), and for a few weeks acute tenderness in my calves and shins developed.

In September 2013 I began seeing Christian Poole, a Sport and Exercise Rehabilitation Coach (specialising in running) who uses an Applied Functional Science approach, which targets the cause rather than symptom of an injury, unlike previous physiotherapy I’d received. Since my focus was very much on the returning knee pain, which I saw in isolation, in my naivety, I didn’t mention the other more recent pains I had. Short-term injuries were common because I exercised a lot, so I still didn’t think much of the hip pain. I presumed I simply hadn’t rested it enough yet.

We began a running re-education and rehabilitation programme targeting the potential cause of my knee pain, which would change my running form and improve the overall movement of my body. However, within weeks we had to discontinue because the soreness around the back and front of my hip worsened significantly, spreading into my right gluteus muscle and lower back. I also got sharp shooting pains down my right leg and in the outer left knee (a different type of pain to what I’d experienced in this area before). My emotional response to this was stress and further frustration: I’d finally found what I believed would be a way to alleviate my returning knee pain, only to be faced with a new set of problems.

I will never know for certain, but it seems probable that the following factors: whatever injury originally caused my hip pain; the importance I placed on running (or not running); my emotional response to pain at this point; and the prolonged and incorrect belief there was a structural abnormality in my spine (‘Degenerative Disc Disease’) contributed to what happened next – a persistent, ongoing pain response. Scans in 2014 showed that there is now no degeneration to my discs that wouldn’t be expected for my age, yet for many years I had a misguided perception that this wasn’t the case. What I had always attributed as the cause of my reoccurring back pains didn’t exist. Therefore, it is possible that for a long time my central nervous system was becoming gradually sensitized, firing pain as protection, when no protection was actually necessary…Perhaps the injury to my hip was just the final trigger.

‘When you are courting a nice girl an hour seems like a second. When you sit on a red-hot cinder a second seems like an hour. That is relativity.’ Albert Einstein.

By December treatments were reduced to symptomatic relief as the pain spread further up my back and neck, more intense, ever present and distracting. Moving hurt. Not moving hurt. Walking and simple everyday activities (loading the washing machine, cooking, getting dressed) became challenges. My general level of energy dropped significantly: being in constant pain over a prolonged period is tiring.

Initial investigations didn’t reveal any obvious cause of my pain and I began to feel as though I was going insane: I would go to sleep with pain in one area only to wake with it somewhere else instead or in addition. The moving of the pain felt like a cruel game – like one of those tricks where someone hides the ball under a cup, moves it around, and no matter how carefully you watch, it’s never under the cup you think it’s going to be. I saw my pain as a separate entity, a small gremlin of a creature, which merrily jumped around my body parts, taunting and laughing at me as I tried to pin it down, unable to catch it and hold it still. My knowledge of pain at this point was that for pain to be present, there had to be a physical injury or illness. This idea – this myth – is embedded in most of us. If I’d had a better understanding of pain before this experience, then I would have felt less fearful. But I didn’t understand, and as a result I felt anxious and even more stressed.

Fortunately serendipity had been kind to me. It was lucky I’d decided to see Christian about my knee, because he did understand what the behaviour of my pain now suggested. He began educating me about the neurophysiology of chronic pain using the work of Professors Lorimer Moseley and David Butler. However, in order to rule out a physical cause for certain, I went for x-rays and MRI scans on my back and hip. Due to NHS waiting-times, it was further seven months from the referral in December before these were carried out and the NHS would offer me no treatment until we had the results.

Consequently, because the behaviour of my pain strongly indicated it, in the meantime Christian and I treated my pain as chronic – a result of an unstable central nervous system. Over the following months we used a variety of strategies to begin to overcome the pain: mobilisation and massage, trigger-point therapy, specific exercises, and graded exposure and pacing of physical activity. I educated myself as much as a could about chronic pain and neuroscience-based treatments. As a result, I understood that gradually increased activity was part of the treatment process and that movement, even if it hurt, wasn’t going to physically harm me (aerobic exercise at the correct level calms the central nervous system, and controlled movement prevents secondary pain from muscular deconditioning and joint stiffness). But moving parts of my body through pain was counterintuitive and the complexity of chronic pain scared me. My prior experience of pain, which stayed in one area, was familiar and felt concrete. There is damaged tissue or bone, which is treated in some way: the pain goes away. Now pain itself was the problem and this felt abstract and evasive. Despite this, in January I made some significant progress and even began introducing some very short run/walk exercises.

However, in that seven-month wait, in my mind there still remained a degree of uncertainty – and sometimes hope – as to the cause of my pain, that it still might be the result of an injury or structural issue. This option felt like it would be less complex to treat and more understood (by myself, doctors and those around me). The waiting for the MRI scans undoubtedly impacted negatively on my pain, mindset and therefore effectiveness of the treatment. It was a liminal space to live in for over half a year and to have been without the care of a private clinician at this stage (and as it turns out at any stage) would have made remaining at work and coping with my pain impossible, especially as my interactions with medical practitioners working for the NHS were largely a source of frustration and anxiety rather than supportive and constructive.

‘There is something about words. In expert hands, manipulated deftly, they take you prisoner.’ Diane Setterfield.

I saw numerous GPs over these seven months as they coordinated my care (providing medical notes when I needed to work reduced hours; sending me for and receiving the results of scans; and finally referring me to the pain management team). I also later saw a number of physiotherapists and a pain psychologist. With the exception of one physiotherapist I saw just once, but who I will forever remember for her positivity about my situation in a culture of different beliefs, all delivered a similar message: there is no cure for chronic pain. I would have to learn to live with it. They only ever talked of “pain management” as a long-term solution, usually with the help of painkillers. In the earlier months what my GPs said to me planted enormous doubt around my chances of getting better. These were medically trained doctors and I was no expert. Why would they say this to me if it wasn’t true? I couldn’t shake what they’d said: and what they said terrified me. I was very social, outgoing, active. These things were already becoming difficult to keep up in a constant pain-state.

I was desperate for reassurance from other sources that there was a way to overcome my pain. However, websites of the NHS and pain management clinics, along with those of pain charities, all delivered a similar message: it was possible to learn to manage chronic pain to gain a greater quality of life, but not to cure it. I was – and remain even more so now – confused as to why they all repeated this message when scientific, evidence-based research around the brain, pain and neuroplasticity has proved this no longer needs to be the case. Newer treatments have proved effective in overcoming chronic pain conditions. I am now evidence of this myself.

But back then I searched for blogs written by survivors of chronic pain who had made recoveries…I found none. Instead I found blogs and posts written by desperate people who had been living in pain for many years, possibly typed out sitting in the darkness at their computers, just like I was. I was left with two opposing messages. There is a Chinese proverb that says: ‘When faced with two points of view – better to choose to believe the more positive one.’ I made a conscious decision at this point to do just this and returned to what I knew to be the latest biopsychosocialist treatment approaches, adding the work of Dr. Adriaan Louw to my list of pain educators.

However, this was constantly tested as the GP who took on my case was frustrated by my determined attitude: he repeatedly told me I needed to accept that there was no cure for my pain and that private practitioners who said otherwise did so because they had a vested interest (i.e. my returning ‘business’). He was also annoyed I wouldn’t accept painkillers. I was adamant I didn’t want to begin a process of relying on them or want to mask the pain: I needed to feel it so I could work to overcome it, not a short-term fix. His response was to tell me I was in a state of denial, and that people who refused painkillers always came back in the end for them, often in a worst state. I felt criticised rather than cared for.

I believe that all the NHS practitioners I saw were well intentioned but either that their pain education is out of date and inadequate, or that the system doesn’t allow for necessary treatments to take place due to short-term cost demands. I have since spoken to a number of GPs, who informed me they know little of the latest neuroscience-based research around pain, yet they are the first contact for a chronic pain patient and what they say matters. I often wonder what would have happened if I hadn’t by chance been seeing Christian during this time: the only voices I’d have heard would have been of those who told me there was no way to fully recover…

The additional anxiety caused by negative medical prognosis and information on the Internet impacted on my pain – now living alongside it was fear. Fear that my pain would never go away. I tried to ignore it, but in the ever-presentness of the pain, the fear gnawed away at me in the background. And despite the progress made in January, by March the pain had spread to more parts of my body and significantly heightened. Some places, such as below my ribs became incredibly sore, I had stabbing pains continuously down the entire right side of my body, turning my right hip caused an intense shooting pain… And although my resolve to overcome my pain didn’t waver, Christian, and some practitioners whose research I’d read, were lone voices of hope in my world. I didn’t doubt the science, or the treatment approach, but I did often doubt myself. I knew it was necessary to manage my stress and fears to overcome my pain, but was struggling to do so. No one else I knew could offer me reassurance because most found it difficult to understand that there was no physical cause of my pain and were genuinely perplexed by what was happening to me.

‘My suffering left me sad and gloomy.’ Yann Martel, Life of Pi.

My pain, the gremlin, was winning. The constant state of discomfort had an ever-increasing affect on my life. Events that required I stay for a given length of time, (a birthday party, a wedding, a dinner out, a meeting at work), or imposed activities and environments (crowds, travel, sitting or standing for long periods) evoked a claustrophobic feeling.

My general health started to deteriorate. I couldn’t sleep, was fatigued and easily caught viruses. I felt guilty if I visited someone and then felt unwell. I often had to cancel plans to meet friends. My parents began travelling from Norfolk to clean my flat. Activities I could take part in were restricted. Walking and driving became problematic because my neck was too rigid and painful to turn – I had to rotate my whole body to cross the road or check at junctions. I have a physically and cognitively energetic job as a teacher and senior leader in a primary school, and although I remained at work for the majority of the time, my capacity and performance were affected.

And I deeply missed running and exercising. Not just because these had previously formed large parts of my identity and social life but because of what moving my body, and physically pushing myself means to me. Because of the clarity of thought and inner-calmness I find in them. Without them, I couldn’t see a way out: I saw myself standing, dressed in my running kit, alone in the middle of an empty road, enclosed by a thick fog. Being unable to run, felt like an ironic joke. What once had been a source of comfort, a means of escape, was an activity I associated with pain. And by March 2014 I was overwhelmed by how physically fragile I perceived myself to be. There was a total disconnect between my mind and my body, which scared and frustrated me in equal measure. By now just thinking about running made my pain worse. I was unable to truly imagine ever running again.

Pain infiltrated every movement, every thought, every plan, every conversation, every interaction. It was there in my body, in my facial expression, in my words, in the tone of my voice. It was there in my laughter. It was there in the reflection of light as I poured water into a glass. Others couldn’t see it, but I could feel it. It painted the world in muted colours. It was like watching each moment through a dirtied window, everything slightly marked and smudged, and always from a three-step distance from everyone else. My experience of the world now felt different because pain added an extra unpleasant sensation to every moment. My perceptions of space and pace altered: sometimes action around me became too fast, sometimes it became disorientatingly slow; busy, thriving, energetic places became threatening, oppressive. These things sometimes provoked a type of loneliness that was engulfing. A kind of detaching loneliness. A kind of loneliness at its most acute when I was surrounded by people. A kind of loneliness that made me want to be alone – because it was the least lonely place to be.

Courage does not always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow.’ Mary Anne Madmacher

However, there was progress and hope – days when my pain lessened, and although initially just for short periods, moments when I was completely pain free. In these I experienced a lightness of body akin to floating. The same feeling as that very first day of spring after winter – that feeling that lasts only a second in the very moment you step outside and suddenly notice the air is warmer. Shapes and colours returned with a more intense clarity and brightness.

And I was intent on not being completely reduced by my pain. The deterioration in the quality of my life and my passion for running only made me more resolute. I refused to be signed off work, and as my pain improved I began volunteering at running events to reconnect with the community I missed. I felt a deep sense of identification and belonging here and was reminded that runners believe that our bodies achieve what our minds believe. Reconnecting with this helped me enormously to get back up each time I was knocked down. I gained resilience from recognising progress, no matter how small. And for a reason I cannot explain, throughout the whole experience, a notion that good would eventually be born from it drove me on. Some very close friends supported me in remaining focused on this when I became fearful or doubtful. These people still saw me, as me – a person beyond my pain. This too was important.

From April to June 2014 more steady improvements in my condition were made. Finally, in June the scans and x-rays were completed and showed there were no structural causes of my pain. I was put on a waiting list to see a NHS pain management team. By now, my pain was consistently at a much lower level and had settled along my right side in a line from hip to neck. Changing my pain so that it remained only in this area was significant progress and a relief. My pain was no longer a gremlin that jumped around, but a crocodile that rested along the side of my spine. Yet each time I attempted to increase my activity – walk a little further, cycle for a few minutes, or just be more active in day-to-day tasks – my pain flared up. The crocodile dragged me under water again every time I moved too much or whose presence I couldn’t ignore if I stayed still for too long.

I was told it would be at least another three months before an assessment with a NHS pain management team. I also understood by this point that whatever they might offer me in terms of support, would be from a viewpoint of helping me ‘manage’, rather that ‘treat’, my pain. This wasn’t what I wanted. I had no interest in engaging in a process of this nature: I knew it would feed my fears, and fear knocked me off course. I knew that my pain could go, but not that it would, or when this would happen. This, and worrying I’d never be able to run or exercise again was a limiting issue, preventing me from moving forward again. As a result, Christian referred me to Richmond Stace, feeling that at this stage a new voice; his expertise in chronic pain conditions specifically; a change of clinic I didn’t already associate with pain (or running), could help me to overcome my pain further.

‘When you become aware that pain can change you’ve started on the right path, when you know that you can change your pain, then you’re really moving forwards. Don’t fear pain – change it.’ Richmond Stace.

During my first appointment with Richmond, I described my pain to him. But he listened to and heard me – the whole person. He saw the altered sense of self that it had created. This was the first step that really enabled me to know, rather than just be aware of, my pain experience as one within a whole. My pain was not in isolation from the rest of my self. One of the first things he did was to get me to refer to my pain as my pain, rather than the pain as I had been doing. My pain was coming from me, my brain, and therefore was part of me. I felt fully seen for who I was at that moment. But he also reassured me that this wasn’t who I had to remain, since someone who was continually living in pain, was someone I desperately didn’t want to be.

We began a programme that built on the treatment I had already received, continuing to incorporate specific exercises, manual therapy and mobilsation techniques. We also added in a graded motor imagery programme. This included: mirror feedback (performing very precise movements in front of a mirror in order to provide visual feedback to rewire the neuro network within the brain to create new maps); and an online imagery recognition programme to treat my altered nervous system by exercising the brain in measured steps. But as well as treating my pain neurologically, we also began to look at improving other aspects of my life: ways to treat my fatigue, insomnia, and weakened immune system; ways to tackle my fears; ways to manage the demands of life that had become challenges in pain. I had already begun mindfulness meditation as I had read about its benefits in managing living in chronic pain. Richmond coached me how to use and apply it to improve my quality of life as a whole, and explained how it changes pain given its calming affect on the central nervous system’s ‘fight or fight’ mode. We also set very specific targets of what I wanted to achieve in the long-term, such as running a marathon.

Over the following months we began working on this goal. But since just thinking about physical activity would make my pain worse, we started by using visualization techniques to prepare my brain for these in a way it would perceive as non-threatening. First there was an imagery recognition process using photographs of other runners, and then by watching other runners themselves and imagining myself in their position. I then applied specific visualization techniques, which used brain and body, to imagine myself running. Over the course of the following months I would practise these daily, often with the help of music, words and mantras, and gradually, imagining running and other physical activities no longer made my pain worse. Within a couple of months my pain levels had reduced further, and I was able to walk and move more without my pain worsening. I was also experiencing longer periods without pain and by August I felt confident enough to do some yoga. In June, this had seemed like an impossible idea. In October I started running again. In November I completed a 5km. In February 2015 10km. In March (almost two years since the pain had begun) a half-marathon. I still had regular pain during these periods, but bit by bit I learnt to disassociate it from movement, learnt to nudge into it, work around it, sometimes even use it to my advantage. It didn’t all suddenly become easy – at times the process felt relentless and exhausting. However, I was now in control of my pain, rather than my pain being in control of me.

Key to the process was individualisation. Not only did we work towards the goals I had set – things so important to me they would drive me forward – but we also incorporated strategies to challenge the affect that negative words had previously had on my progress, as well as aspects of my personality, mindset and beliefs about past experiences that may be causing the persistence of my pain. As a result, even in times when my pain flared up, I could increasingly remain feeling focused, positive, safe and reassured. These strategies were taken from a variety of fields – from writing, philosophy, sport, psychology, and science. It was finding what worked best for me. I deepened my understanding of chronic pain to understand my own particular pain so well that I could overcome it. I now perceive any flare-up as an opportunity to learn, rather than something to be feared – although these flare-ups are becoming fewer and further between each month now.

‘YOU CAN IF YOU THINK YOU CAN.’ Norman Vincent Peale

Overcoming my chronic pain was the most physically, mentally and emotionally challenging thing I have ever done. But in retraining my body how to move, my mind how to think, myself how to be, it has left me not only running further than I have in eight years (with no knee or back pain). It has also taught me to find the same joy and energy in stillness as I find in movement. It taught me to live my life with greater positivity, confidence, compassion, gratitude, and to be more fully in the present moment.

And to anyone living in persistent pain: it is possible to overcome chronic pain. You do not have to learn to live with it, or manage it. You can treat it and change it. No matter how out of reach this may seem, know that it is true. ‘You can if you think you can.’

16Apr/15
Mindfulness is a great skill

Mindfulness is a great skill

Mindfulness is a great skillMindfulness is a great skill to learn at any age. To be mindful simply means to be aware of what is happening right now and without judgement–notice how you judge your thoughts and how that makes you feel.

Everything that we are aware of is our own, unique interpretation that emerges from our belief system. We appraise our thoughts, our actions, others, and the environment around us. This appraisal evokes an emotional and bodily response in many cases, even if it is just a shrug of the shoulders. It is important to clarify that emotions, body responses, thoughts and actions are all part of one and the same; i.e. the whole person. Sadly, much of the thinking, particularly in health, remains Cartesian and separates mind and body. This is despite reams of research papers and common sense telling us otherwise. What does your tummy do when you think about giving the presentation tomorrow? Your body reacts in response to the thought, and that reaction involves the nervous system, the motor system, the brain, the immune system etc etc….WHOLE PERSON.

So, if the appraisal or our perception guides how we respond, then we have a buffer between any give situation or thought and what happens next. We have a choice — ‘the greatest weapon against stress is our ability to choose one thought over another’ said the great philosopher William James. Shakespeare had insight: ‘there is nothing either good or bad, but thinking makes it so’.

Mindfulness is the skill that allows you to observe thoughts and interpretations rather than become embroiled, living out thinking that is felt in the body as emotions and tensions. You notice with quiet curiosity how your body is responding, lifting the veil of suffering.  We have that choice, but most don’t realise, operating on automatic overdrive leading to repeated stress physiology that affects every body system.

A stress response is designed to protect us from the dangers of wild animals. The same responses kick in to a threatening thought–the most dangerous things we face are our own thoughts and interpretations: a shadow after watching a horror film is threatening because of the way you think about it and create a story of a murderer lurking behind the tree. Actually, it’s a cat but that story does not feature. What stories do you tell yourself to create fear? How useful is fear? Not very.

Fear triggers further negative thinking, and that gets us nowhere. Respect and understanding create opportunities to learn and grow. Much better.

How are you mindful? If you look on the bookshelves, tome after tome sits there awaiting your mind. It seems that everyone has something to say on the matter. The reality is that mindful practice is simple. Practice is a habit that needs to be grooved. You must fail and fail and fail again. That is how we learn. And when you think you are good, fail again to get better. Learn to love failing because then you are getting better!

Start being mindful by noticing what is happening now. Where are you? What are you thinking? How are you feeling? Take a breath and observe it. The rise and fall of your chest and tummy. It’s a wonderful feeling to sit still. Especially in this crazy, high speed world with demands pouring in digitally and otherwise. Simply recall that whatever comes your way, it is your perception that counts. You are in charge of that perception. Make a choice. Create calm so that your body systems can do their job and slip out of protect mode and into health mode. On-going stress accounts for and contributes to most of the modern day ills–chronic pain, infertility, headaches, chronic inflammation, IBS etc etc. To think effectively about stress we need to look at it as a societal, cultural, physiological, personal phenomena.

So, I thought I would write a book about it as well. A very short one. Coming soon.

Mindfulness practice is part of the Pain Coach programme; a complete strategy to overcome chronic pain | t. 07518 445493

11Apr/15
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50 strokes

Ajahn Brahm tells the story of a monk who thought he deserved punishment for breaking a monastic rule. He had knowingly done wrong and expected reprimand, yet this was not the way. The monk insisted, so Ajahn Brahm prescribed 50 strokes. The thought of this ancient punishment undoubtedly filled the monk with fear yet he knew this was his fate. However, no whip was produced but instead a cat, which the monk was ordered to stroke—50 times. After the 50 strokes of the cat there was peace and calm and the passing of a learning experience. Change was afoot. 

In physiotherapy we use our hands to treat and create calm in a body that is protecting itself, perceiving a range of cues to be threatening. It has been thought that moving joints, muscles and nerves bring about the desired changes (or not if unwisely applied) because of a change in the structures. Science has since taught us otherwise, and that in fact what we are really doing is changing the processing in the body systems and then the recipient has a different and better experience—pain eased and movement more natural and thoughtless. 

Touch is very human. Touch is a part of the way we develop in the early years, a lack of touch being detrimental to normal development. So potent when the meaning is aligned with a sense of creating wellbeing and soothing woes both physical and emotional, touch should be part of therapy for any pain condition. Interweaving hands-on treatments during sessions, teaching patients how to use touch themselves, teaching carers and partners how they can use touch, all create the conditions for healthy change. 

Touch send signals from the nerves in the skin and muscles to the spinal cord and then onwards to the brain. In this way, the body is an extension of the brain and the brain an extension of the body, demonstrating  how we are  a whole person with no system or structure being in isolation to any other. Using touch is literally sculpting the representation of the body that exists in the brain, like moulding clay into a humanly shape. And of course, a shape has a function and the two are not distinct. The more precise the shape, the better the function. The manifestation of this being a normal sense of self in how we think and feel and a move. Normalising, desensitising, to me are one and the same. 

– 50 strokes of the area of the body being protected, much like stroking the cat then, sculpts our ever changing brain and sense of physical body. The physical body exists and occupies space with the ever-potential of action, yet this does not exists without thought—it is my thought, the meaning that I give to my body that creates what it is in any given moment. When the strokes feel pleasant, or at least not painful, then this is your body and brain perceiving the action as being non-threatening and learning that the area is safe. The more of this the better. The same applies with movement: any action that is tolerable or feels good is the body (your whole self) saying ‘yes, that’s ok’. And that’s what we practice and practice. 

To overcome and change pain is to normalise and to alter one’s relationship with pain and overall perception. We have much more say in this than most people realise but once they understand their pain, what pain really is and what they can do, change occurs in the desired direction. 

Puuurrrrrrrrrrrrrrrrrrr. 

05Apr/15
The art of batting

The art of batting

With the cricket season about to begin, I thought it timely to use a batting metaphor to illustrate how thinking can obstruct free flowing movement. For the cricket lover, there is great joy watching a batsman lean into his front foot, head towards the ball, eyes focused through the grill, as the bat arcs guided by fast hands, the wood kissing the leather ball in the briefest of seconds before accelerating to the rope.

Seeing an expert perform in any field has the common denominator of ease. They make it look so natural and effortless, whether playing a musical instrument, dancing or stroke play. The movements have been rehearsed and honed thousands and thousands of times before, the motor patterns in the brain grooved with the synaptic efficiency that results from hours of practice.

Most people are ‘experts’ at walking. We don’t think about it in this way necessarily but the walk is a movement pattern that has been practiced since we started, well… walking. It is only when things go wrong does the motion change. A limp for example. Walking can also change when we start thinking about it rather than naturally, unobservedly going about our business of ambulation. Note how much activity is afoot from the simple stepping action, involving the whole body, the whole person and his or her mood and the environment in which the individual resides at that moment. Of course, the perception or even attention upon the environment is affected by one’s mood — ‘how did I get here? I didn’t even notice’.

With movement and posturing being an expression of who we are and what we are thinking and feeling, there are characteristic styles that identify us to others and to self — you will recognise a friend from afar by the way he walks; and you will know that you are moving well and normally by detecting self, or rather when the self feels different. When all is well, the act of walking is not noticed, yet as I have said, this changes at the point of being conscious of how the arms swing, the legs lift and the body sways, and if heavy or light thoughts crowd into the mind.

It is well known that the batsman must concentrate on the ball until the last: ‘watch the ball onto the bat’. This happens quickly and hence any unnecessary thought can affect the end result. ‘He looks quick’, or listening to the banter from behind the stumps, and oops, it could be the long march back to the pavilion. Some high quality players have in recent years been subject to depression, which has certainly affected their ability to hit the ball. Thoughts crowding in. The art of batting then, is a mindful task whereby the mind must be quiet to allow for the free flow of movement. There is no difference between this and movement on a day to day basis.

The person suffering chronic pain moves differently. The body is protecting itself, the individual consciously protects and hence simple movements, once take for granted, are now anticipated, planned and executed in a timid and fearful way. This pattern is encoded and passed back into the sensorimotor system to plan the next movement and other possible actions that the brain predicts may happen. Where this does not match the normal pattern, a threat value is created, evoking activity in the salient network that detects when something is physiologically amiss. Part of this network’s role is to trigger responses that motivate behaviours and attention to the relevant areas of the body. Once satisfied that all is well, protection is lifted and wellness ensues.

Movement is fundamental to health and feeling normal. We can tell when someone is not well in many cases by the way they move and hold themselves. To restore flow and ease of movement often requires that we target fears and anxieties that are caused by thoughts that can obscure. Much as the batsman needs clarity, so does the person overcoming pain. And whilst sometimes we need to think about the way we move, most times we just desire natural, unconscious and purposeful action that results in a reward.

In rehabilitation and in overcoming chronic pain, just like batting, we need a clear mind so that we can focus upon the job in hand. Thoughts come and go, but if we let them interfere with the action rather than letting them pass, there will not be the same result. Practicing mindful movements where you learn the skill of focused attention allows for the right kind of concentration and attention, eradicating the effects of fear and anxiety that can so commonly be associated with normal movements and activities. Understanding pain is another key element of reducing these fears and their potent effects.

To set up the right conditions for recovery, we must consider beliefs, thoughts and fears as well as the environment and the vision of where the person wants to be. From here we can create an individualised programme that addresses all dimensions of the pain experience: the physical, the cognitive and the emotional; and how theses dimensions interact. This is the complete and whole person approach to pain that is necessary and indicated by modern pain neuroscience.

For informationPain Coach Programme or to book onto the Pain Coach Programme, please call us on 07518 445493

 

 

23Mar/15
Mindfulness is a great skill

I used thirst to help someone understand 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

20Mar/15
Stress, PTSD, pain

Pain and trauma 

The smell of freshly mown grass would be enough to trigger feelings of panic and pain in Clive. He didn’t know that this normally innocuous odour was a cue for protection and re-ignition of memories of a car accident that occurred several years before. This is a classic example of the co-existence of pain and trauma.

Equally in others the cue could be a piece of music, a particular place, a person or a taste. We are multisensory and at the time of a trauma, the context creates a multisensory (molecular) memory that has high emotional valency due to the unpleasantness of the situation. At the time of an incident we may cope but afterwards there can be a trauma response that is when the coping fails and the person becomes ridden with anxiety. The physical dimension of anxiety commonly manifests as tension, discomfort, feelings of unease and pain that can gradually become increasingly widespread. Initially localised to where an injury may have been sustained, often it does not take long for the sensitivity to increase and the pain map widen.

Post-traumatic stress disorder (PTSD) is a relatively well known term and describes how a person continues to experience  the trauma despite that fact that it has passed. They continue to replay the tape and suffer the consequences: pain, tension, anxiety. The simple fact is that when we think about something, if we are embroiled with that thought, we live it out through our entire self: that is the physical feeling, the emotions and the thoughts all emerging as the one experience. The different dimensions are not in isolation to each other but rather integrated into the reality of that moment.

The problem appears to lie with the attempts to numb and avoid the trauma whilst repeatedly re-experiencing the event. This struggle causes great suffering whilst the body pain continues and often amplifies, vigilance to bodily sensations increase and other symptoms can begin to emerge: digestive problems, abdominal pain, headaches, disrupted sleep and concentration.

In essence the body is in protect and survive mode. All resources are being diverted to survival and hence the motor system is on alert ready to fight an opponent/wild animal or to run away (muscle tension, overactive muscles), the immune system is primed for healing initially but then drops off, digestion falters and vigilance is high for threat. With continuous feelings of anxiety, it seems like all life presents to you is dangerous.

Pain associated with PTSD is a good example of the need to think about the whole person and all the inter-related dimensions of pain: physical, emotional and cognitive. It is always about the individual as much as the condition, and the environment in which they reside. For pain to get better, the person must get better.  There are a number of newer approaches based on top-down mechanisms (brain focused), however my belief is that we have an embodied mind. In other words, our (physical) bodies are as much the experience as the thought itself and therefore we must consider this in any treatment programme. Promising techniques may exist in reprogramming memories or learning how to re-interpret thoughts, but where do we feel the sensations? In the body.

Example programme

Foundation:

  • understand pain and symptoms—the biology of pain and stress, what influences pain and stress, what triggers pain and stress, how thoughts and feelings are part of the pain experience, other influences such as tiredness, the environment, beliefs, gender and prior experiences. Setting the scene with modern pain science reduces fear and anxiety as the patient starts to see all the opportunities for change.
  • re-training body sense and normal movement that is commonly affected in pain and PTSD.
  • learn skills to ease muscles tension and over-activity, how to switch from sympathetic to parasympathetic to create the conditions for change, easing out of survival and into well-being in both thought and action.
  • create the vision of where the patient wants to be and plan how that will happen
  • check patient’s language (verbal, body and the ‘internal voice’) and change if necessary

From the foundation the above skills are developed alongside motivation and resilience training, focused attention training for clarity of thought. The patient must be able to problem solve moment to moment and use their skills and techniques independently whilst being fully supported and progressed along, always Molina at moving forward. There may be a need to plan a return to work, return to sports or increasing other limited activities gradually.

Clearly any programme must be individualised and monitored closely alongside treatment given for the purposes of pain relief. I commonly use my hands to desensitise and reduce pain, often teaching the patient how to do this themselves or how to involve their partner.  The notion that hands on therapy does not have a role in dealing with pain is wrong in my view. We need touch for normal healthy development and it plays an important social role. Judicious use of touch therapies can help to develop trust between care giver and recipient and change the processing of signals from the body, also having a top-down effect when explained.

We are complex, pain is complex, pain relief is complex; however this creates many opportunities for change. And our role is to facilitate change, to focus on our own natural ability to create health and wellbeing. We must acknowledge and validate pain, teach patients about their pain but then we must focus on moving on, so the less attention on pain the better. Let’s think about what we can do — the CAN mentality and start changing the largest global health burden. Because we can.

Pain CoachContact us for details about the treatment, training and coaching programmes for pain sufferers and for clinicians wanting to become a Pain Coach (small group training and 1:1 mentoring): call 07518 445493

 

03Mar/15
Treatment of pain and injury

Joe’s pain story

Up LogoJoe’s pain story told by his mum Jenny as part of the UP | Understanding Pain Campaign that launches this Saturday with 700+ singers performing at Heathrow – follow us on Twitter @upandsing to show your support

It was the morning of Tuesday 27th November 2012 and the usual school morning rush was well underway when my son, aged 11, lent forward and picked up his school bag. Straight away he complained of back pain, he was unable to fully stand up straight but by no means was in agony. I explained to my son that I felt his muscles were in spasm and the best thing for him to do was to keep moving. I work in a sports injuries clinic and said that I would book him in after school for a massage. I’d only been in work 10 minutes when the school called to say that Joe had ‘got stuck’ bending down at this locker and could I come and collect him. Joe shuffled out to the car in a manner that I had seen many patients at work walk and knew he must be in a fair amount of pain. On the subject of pain I would like to point out that Joe was no stranger to pain, he’s broken bones in his foot and not even muttered anything about it until I noticed the lovely purple bruise. He’s been a keen cyclist since the age of 5 and has had crashes resulting in loss of skin and friction burns; crashing at around 30 mph dressed in lycra is always going to hurt! Thinking back over Joe’s life he had never complained of pain and he was always one of those people who would rather get on with it.

Joe’s muscles where indeed in spasm and the physio treated Joe as much as he could but he recommended further investigations at our local hospital. The local hospital listened to what had happened and sent us home with paracetamol. That evening Joe’s pain became worse. He was only comfortable lying on his side and struggled to walk, I started rotating paracetamol and ibuprofen every two hours but nothing was touching the pain. We tried every distraction technique we could think of, hoping that once Joe slept he would feel better in the morning. Joe was literally screaming with pain by midnight, we had no way of moving him to the car so we called an ambulance.

To cut a very long story short this first hospital visit was the first of many. Joe would be screaming in pain day in day out. It was the most heartbreaking thing to witness as I had no way of controlling his pain. Our local hospital had no way of controlling Joe’s pain either, they had tried everything they could think of but where unable to pinpoint why Joe was in so much pain. Our experience at the hospital soon became very stressful, we became in a loop of ambulances and ward stays. One day they sent us home and within two hours of being at home Joe started screaming, ‘blacking out’ and screaming again, it was relentless and we had no option but to call for another ambulance. Thankfully by now they were used to seeing Joe so started the morphine and we thought it would just be a matter of time before the pain was under control. Three hours later Joe was still screaming non stop and my husband and myself were at breaking point. Consultant after consultant came in to see Joe, they all did the exactly the same leg lift test and left. No one except the A&E nurses seemed to care that Joe was still screaming and that nothing was helping him. Eventually one of the nurses said she had had enough. He had enough morphine to knock out a rugby player and she was moving Joe round to adult A&E as she said they couldn’t ignore him there. Within five minutes we were surrounded by consultants who decided that Joe needed to be put under so that they could perform a lumbar puncture. The relief when he fell asleep was overwhelming. I cannot begin to describe what it feels like to see your child in so much unbearable pain. Every time Joe ‘blacked out’ for a few seconds it was a relief only for him to wake again and continue screaming.

Joe was awake when we next saw him and surprisingly in no pain. The consultant said that maybe his brain had forgotten to turn his ‘pain switch’ off and going under had ‘reset him’. At the time I didn’t care why the pain had stopped I was just so glad it had! Joe was admitted and over the next day his pain started to return. His results had come back negative so the hospital decided to refer him to Great Ormond Street Hospital (GOSH). After spending a very surreal New Year’s Eve in hospital we were transferred on New Years Day. GOSH started him on a different mix of medication that started to work within a coupe of days. Their physio’s worked with Joe several times a day with his first goal being able to sit up for 10 seconds. They re-ran loads of tests on Joe but they were also unable to come up with a definite answer. They explained that unfortunately as it was 5 weeks since the Joe had injured himself, the injury could have already healed. They felt that the best course of action was to continue with the medication, pain killers and tens machine and to go to our local hospital to continue the physiotherapy.

We returned home after a week in GOSH with Joe’s pain under control with medication and plenty of telephone help from the Pain Team. After our experience with the local hospital I felt that attending physio with them would be a waste of time. I started searching on the internet for private physio’s and Richmond Stace came up again and again. I spoke with the GOSH Pain Team and they were happy for us to attend a private physio. I contacted Richmond and briefly explained our story and asked if he could help, ‘Of course’ was his reply. I remember putting the phone down half smiling and half in shock. Had I just heard right? He knew how he could help Joe. I was so shocked as apart from the staff on Koala ward at GOSH no one, I repeat no one had any idea what was going on with and how to deal with it.

Our first meeting with Richmond was such a positive experience, he listened and understood Joe’s pain. He explained that Joe was not the first person he had seen with that level of pain and it was something he could help us with. Joe started to improve over the weeks that we saw Richmond and we started to lower his medication. He was also managing more school that ever before and I could finally see a glimpse of the future and Joe being well. Richmond has this amazing ability to calm you, take the stress and worry out of the situation and just help you focus on the here and now. We learnt that our surroundings, state of mind, belief in what is wrong etc all have such a major impact on how we perceive pain and how we deal with it. For me, as Joe’s mum, I felt in control for the first time in months and I have no doubt that the feeling of being in control rubbed off on Joe. Listening to Richmond speak to Joe made me realise there was hope. I had truly started to question whether Joe would ever be pain free, how can no one know what caused the pain? How can they not know how to stop it? If we didn’t know what caused the pain could it happen again?

After everything that Joe had been through it had changed him. No longer was Joe my fearless boy, he was now cautious, carried himself differently and seemed different from his peers. In my opinion there is no doubt that pain changes you, makes you aware of your immortality and causes you to protect yourself when, most of the time that protection isn’t actually needed. Maybe our brains are too clever for their own good! Richmond helped Joe realise he was ok. In fact his was better than ok he was Joe again. Not Joe who screams in pain, not Joe who is fragile and unable to do much more than lie in bed but old Joe — Joe who loves school, riding his bike, playing football, going out with friends and playing his guitar. Richmond helped Joe see that and he helped him see that he can control his pain, giving Joe the belief in himself again, proving that he was not at the mercy of a painful back, destined to take painkillers and other medication for the rest of his life. The belief and the tools Richmond gave Joe changed his thought processes, enabling him to progress through his physio, lower and eventually stop his medication.

If anyone reading this is suffering with pain please, please see Richmond. Your life doesn’t have to be ruled by pain. Pain is exhausting and all consuming and it doesn’t have to be that way.

05Feb/15
Persisting sports injuries

Today’s talk at QMUL | pain in sport

Today’s talk at Queen Mary University of London (QMUL) for the MSc Sports & Exercise Medicine group focused on modern concepts of pain, in particular the problem of persisting pain. Using plenty of clinical examples and anecdotes, we explored a range of topics including:

  • The enormous (global) issue of pain
  • The dimensions of pain (physical – cognitive -emotional)
  • The importance of the whole person as much as the condition
  • The relevance of the meaning of pain to the individual and how this flavours the pain experience
  • The vital early messages when we talk to someone with pain, and how this can shape their thinking and actions
  • The importance of using the science of pain in dealing with sports injuries.

Richmond holds clinics for pain and chronic pain problems in Harley Street, Chelsea and New Malden

If you would like Richmond to come to your practice and talk about pain and chronic pain, please contact Jo on 07518 445493.

09Jan/15
Bono's injury

Bono’s arm

Bono's injuryAnyone who has read Bono’s recent post will know that he believes that he may not play his guitar again. As a rock and roll icon, this is a strong message that reveals the mortality of man.

Many times I have heard people tell me that they cannot do what they used to do. This is usually because of pain or a physical limitation. Often this pain and limitation has been in existence for some time before they come to see me, and hence the body has physically adapted, thinking has narrowed and avoidance assumes the default position. For this reason, the early messages about pain and injury are a vital because they set the scene for the action taken.

I do not know the full details about Bono’s arm aside from reports in the media. The injury sounded complex and nasty, requiring surgery to fix the damage. Healing always ensues, pain usually accompanies healing as do a range of other biological mechanisms such as change in movement, change in thinking and responses to different environments. Additionally we can feel unwell (the sickness response), our mood can vary, sleep is disrupted with knock-on effects, appetite may change and thinking can lose clarity. There is a very individual response to an injury, especially when it affects something very important to our self.

When helping patients to understand their pain I often tell them about the pain threshold differences in violinist’s hands — lower on the left because of the meaning of the left hand in terms of playing. If a carpenter cuts his finger, this may not be a great problem. It is certainly not unexpected. If a violinist cuts his left index finger, this could be a significant problem in terms of being able to play. Same type of injury, different meaning, therefore a different outcome: more pain, more negative thinking, more worry. This would be similar for a professional vs an amateur footballer who injures a knee ligament — the financial consequences, the loss of a place in the team etc.

The way in which Bono’s body responds to the injury will be unique to him, will reflect his health and the way he views his situation. This is the same for everyone. The uniqueness of the injury, the context, the environment and the person. For treatment and rehabilitation, this is how it must be viewed to optimise the outcomes.

Hypothetical case study

When a patient comes to see me with a complex injury, I focus on the person as much as the problem (this is one of my overarching principles). This is because it is the person who tells and lives their story, and it is the whole person I am treating, training and coaching back to a state of well-being.

Assessment would include:

  1. Exploring the narrative: gathering all the information about the injury — e.g./ the circumstances, how it happened, health status, lifestyle status, past experiences, beliefs about pain and injury
  2. Pain types: e.g. nociceptive inflammatory (possible neurogenic), neuropathic
  3. Protective measures that have been adopted: e.g./ guarding, avoidance
  4. Adaptations: e.g./ altered body sense, altered movement patterns
  5. Influences upon pain: stress, thoughts/beliefs, fatigue, emotions, other health factors, rumination

Then —

Pain understanding:

  1. This is the start point. Making sure that the person understands their pain, relevant to their condition and the action needed to overcome the pain.
  2. Getting their thinking in alignment with what we really know about pain and what it means to them to overcome pain. Achieving success is about the meaningful return to living; what is this to the patient?
  3. Cultivating the belief that their pain can be overcome and that they CAN do things with the right knowledge and ‘know how’. This is the pain coach concept.
  4. Develop the growth mindset — you may not be doing things YET; NOT YET rather than ‘I will never’. Never say never. Give it your best shot. Dedicate yourself to the fullest recovery and a return to wellbeing. Sign a contract stating this is need be, and know that you will be supported and motivated at every step.

Treatment & rehabilitation:

Depending upon the pain types (biology) and the influences upon pain, specific training is designed to achieving normal body sense, normal movement and confidence in being active and engaging in life again.

If playing the guitar is what they want to do, from word go that is how the training begins; even in plaster! Sensorimotor training begins immediately, or even before an operation. Working the sensorimotor areas is vital from a top-down perspective with specific exercises and can be started whilst immobilised with a range of imagery and visualisation techniques that work the motor centres.

When the immobilisation period ends, actual movement begins to nourish the stiffened, healing muscles and joints. After immobilisation it is normal for the area to appear different — perhaps red and swollen, a different skin quality, hair and nails can change too. Movement and sense of the area is altered and needs specific attention in the early stages because a normal perception of the body is key for healthy movement.

An early focus on function for a guitarist would include thinking and training dedicated to the fine control required to play. The actual movements are part of a sensorimotor feedforward-feedback loop that must be addressed. Adopting the right mindset is key for rehabilitation and should be practiced from the outset: a coaching model for a growth mindset.

We often do not know our full potential, so until you have given it your full dedicated attention, never say never.

09Nov/14
Pain specialist clinic in London

My top 5 pain myths

In my view, it is the lack of understanding that causes so many problems with pain in terms of how pain is viewed, treated and conceived as being changeable. Pain can and does change when you understand it and think about it in accordance with the modern (neuroscience-based) viePain specialist clinic in Londonw and have a definite plan that is followed with big action towards a vision of where the you want to be. Having seen many individuals put this into practice, I am confident that the start point is always how we think because this is from where the action emerges. The right thinking begins with understanding your pain.

In the light of this, here are my top 5 pain myths:

1. Pain comes from a ‘structure’ in the body — e.g./ a disc, a joint, a muscle.

2. The amount of pain suffered is related to the amount of damage or the extent of the injury.

3. Pain is in your mind if there is no obvious cause in the body — i.e./ via scans, xrays etc.

4. There are pain signals from the body to the brain.

5. Pain is separate from how you feel or think.

There are many others.

Now, this all sounds rather negative and I like to turn this on its head and look at how we can positively influence health in order to change pain. The programmes that I create with individuals for them to follow are all about creating the right conditions in the body systems, all beginning with the right thinking that often challenges existing ideas and notions about pain.

Struggling with pain? Persisting pain? Call me 07518 445493 | Specialist clinics for pain and persisting pain in London