Tag Archives: pain

05Apr/17

5 ways a partner can help you

Chronic pain can be the source of huge strain upon a relationship. Partners and other people close to the suffering individual can be at a loss as to what they can do to help. Sometimes their assistance is welcomed and other times not. It can be confusing and stressful. There are many ways that a partner can help and some will be individual to those involved. Here are 5 ways a partner can help you:

Be an extra pair of ears and eyes

During consultations with specialists or therapists, it can be useful for a partner to come along. Beforehand you can decide upon their role. The possibilities include:

  • listening and note taking
  • offering observations about what has been happening
  • watching and learning exercises so that they can provide feedback at home
  • just being there for moral support

Sometimes having someone else in the room, even a loved one, can be distracting depending upon what is being practiced. So do discuss this with your clinician for the best outcome.

Understand pain

When your partner understands pain they will be able to further empathise and act through compassion rather than fear and worry. We do respond and are influenced by the people we are close to, meaning that if they have a working knowledge of pain they will better provide support and encouragement.

Pain can and does vary as each pain experience is as unique as each unfolding moment. Knowing that pain is related to perception of threat rather than tissue damage or injury, along with some of the main influences (e.g. emotional state, context, tiredness) helps to navigate a way forward. To overcome pain the person learns to coach themselves, making best choices in line with their picture of success. Sometimes we need help or someone to listen to us whilst making these choices.



A hug

Touch is healthy, especially from a loved one. Someone recently told me about how a hug from her children relieved her pain. Why? The release of oxytocin for a starter. The feelings of compassion and love can cut through all other emotions and feelings, which is why the development of self-compassion is one of the key skills of well-being.

Sometimes a hug can be painful of course, depending on where you feel your pain. If this is the case, then simple touch somewhere else is enough. Seek to notice the good feelings that emerge in you: what do they feel like? Where do you feel them? Concentrate on them. And if you are not with that person, just imagine a hug or a loving touch. This triggers similar activity, just like when you think about that beautiful scene in nature, your body systems respond as if you are there ~ our thinking is embodied.

Practice the skills of well-being together

A good example is metta or loving kindness meditation that cultivates self-compassion. It is best to gain instruction 1:1 to start with and then use a recording as a prompt until you are familiar with the practice. Group practice is also good when the collective or community creates a soothing atmosphere in which to practice.

At home, practice metta with your partner. Doing it together, you form a bond as you spend meaningful time together. You can also practice the exercises together. These are nourishing and healthy movements with the purpose of restoring confidence as well as layering in good experiences of activity to overcome pain.

Spend time together doing something meaningful

We are designed to connect. The chemicals we release and experience as that feel-good factor, do so when we have meaningful interactions. Pain all too often appears to limit choice and our tolerance for activity. However, on thinking about what we CAN do rather than what we cannot, we begin to build and broaden the effects of choosing positive action.

Positive action is all about focusing on what we can do: e.g./ I can go for a coffee with a friend for half an hour to gain the benefits of connecting, moving, a change of scene etc. and I will concentrate on these benefits. Make some plans, working within your current tolerance level, knowing that you are safe to do so, and follow them through by keeping yourself pointed towards the picture of success*. You can then gradually build your tolerance by pushing a little with increasing confidence.

There are many other ways that a partner can be involved. The key is to communicate openly and make plans together ~ here is a great insight into communication by Thich Nhat Hanh.


* Clarifying your picture of success gives you a direction and the opportunity to check in and ask yourself: am I heading in that direction or am I being distracted?

Please note: Whilst the practices above can appear to be straightforward, you should always discuss your approaches with your healthcare professional

13Mar/17

3 ways to ease suffering

We all suffer. Suffering is part of living and so is unavoidable. There are many reasons for suffering and they are unique to that person and the way that they view life. The Oxford Dictionary defines suffering as “The state of undergoing pain, distress, or hardship”. We are all subject to these states regardless of age, gender, culture or class. In fact, we could say that humanity is connected by the universal experience of suffering. Bearing this in mind and essentially normalising suffering as part of life, it would be prudent to develop some skills that allow us to face suffering, transform, learn about, and ease it. Here are 3 ways to ease suffering.

These are simple practices for everyone that can be integrated into day to day life. Moment to moment awareness creates the opportunity to practice healthy habits resulting in living well.

Acceptance

Accepting what is happening right now dissolves any resistance. Resistance results in suffering because we are not happy with how we are or where we are or what we have. This is a common cause of discomfort and resistance can certainly drive tension and pain in the body. Accepting is NOT giving up. Instead it is actively being open to what exists now as a lived experience, allowing it to transform as it always does with each passing moment. Acceptance allows us to move forward in a chosen direction whereas resistance does not.

Mindful practice

There are simple mindful practices that give us insight into the way we think and feel, help us to be acceptant, allow us to let go of unhelpful thoughts and to be open to experiences as they unfold. By the very nature of these practices, a sense of well being emerges as we fully engage with the joys of life as well as think clearly about how to surmount the inevitable challenges we face. Here are a few examples:

  • take 4-5 slightly deeper breaths at regular intervals during the day, being fully aware of the ‘in’ and ‘out’
  • pay full attention to what you are doing, whatever that happens to be
  • formal practice of mindfulness meditation ~ this is best done with a coach or instructor to start, or in a group
Practicing gratitude

There are great benefits of practicing gratitude as a skill of well-being. Next time you are feeling glum, in pain, feeling anxious, try thinking about something you are grateful for. This does not need to be anything momentous, instead something more day to day such as the clothes on your back, the sun in the sky or a text from a friend. It needs to have some kind of meaning to you. Practicing gratitude can change the way we relate to an issue of concern. We release some important and healthy chemicals by actively generating the feeling (the feeling is underpinned by those chemicals as best we know), which creates the conditions for more clarity. Clarity of thought means we can focus on the thinking/actions that can result in face a challenge successfully.

The Pain Coach Programme to overcome pain and to live well | t. 07518 445493

08Mar/17

Find peace

In a sense I think that we are all trying to find peace. We week to find peace within ourselves and the world in which we find ourselves — the two are entwined.

We often hear the word peace nowadays. This is because peace is a state we strive for globally in the face of threats that are often purported in the media. There are fewer who seek the polar opposite; people who appear to welcome violence, war and other destructive states. This can only be because of wrong perceptions of the world resulting in wrong thinking and wrong actions.

In terms of chronic pain, perhaps we can say that we strive for a state of peace. This is an idea that came from a conversation with a learned friend some months ago. It was based upon thinking about the ‘opposite’ of pain, which cannot simply be pain free. When we are pain free, we are not thinking ‘I am pain free’, instead just acting, thinking and perceiving as a blended trio within each moment. To find peace seems to be a good place to start overcoming pain.

What is a state of peace?

By definition, peace means ‘quiet, tranquility, mental calm, serenity; a state of friendliness’ (Oxford Dictionary). Consider how we feel and think when in pain. We are suffering, fighting, surviving, emotionally turbulent, living the storm of physical sensations and the turmoil of the thoughts and feelings about these sensations. The former appears to be a good place to be in comparison. There is however, one issue, and that is the effect of resistance to what is happening right now.

Resistance itself causes great suffering. Not wanting to be here, instead wanting to be there. Not wanting to look like this, instead wanting to look like that, are two common examples. This is being non-acceptant and fighting the present moment. But it does not necessarily seem natural to do anything else other than resist. Why would you not want to feel better? Look better? etc etc.

This is an issue of desire and the grip that it can have upon us that causes suffering. The problem is that if you are strongly focusing upon how you want to be and resisting how you are or what you have, you are missing the opportunity that exists now. This is in the form of acceptance, which is simply acknowledging and being open to what is happening right now without resistance. Accepting what is happening right now relieves the suffering and allows us to take the right actions to find peace. These actions can only happen now because now is the only real moment. Thinking about what you might do or what you did only exist in your (embodied) thoughts. Concrete action can only be in this moment.

By being present we can find peace. This emerges from simple practices such as mindful breathing and mindful activities that mean you are present, aware, open, insightful and accepting in a compassionate way.

Where is peace?

There is only one place that we can find peace. That is within ourselves. I recall a pertinent moment a few years ago when a friend said to me ‘I hope you find peace’. It is something we appear to look for, yet we don’t need to look because it is right here. We simply need to create the conditions for peace to emerge and be felt. Does this mean no pain? No, not necessarily. Can you feel pain and be at peace? Yes, absolutely. And in this state, the pain transforms and our suffering eases. So, when we find peace that was already there, just overladen with our day to day fears and worries, the pain rents less and less space. Then we can concentrate our efforts on living well, which is the way to overcome pain.

How can I be present and find peace?

Everything that ‘happens’ does so now, in this moment. It is called being present and we can be fully aware, attending to this moment to gain all the rewards. To be present we can start with a few simple practices:

1. Take our attention to our breathing, even just 4-5 breaths, and do this regularly through the day ~ set a reminder

2. Fully attend to what we are doing, whatever that may be. ‘An unhappy mind is a wandering mind’ was a recent study title. We are happier when we are attending to what we are doing in this moment.

You may also choose to regularly practice mindfulness and other meditations such as metta, or loving kindness meditation. The formal practice each day develops our ability to accept, let go, be open, be tolerant, gain insight into our own and others’ thinking. In so doing, in the wake of the practice comes a sense of peace and calm that deepens in time. There are well described healthy benefits of regular mindfulness practices yet it is important that we practice for the sake of practice and not to ‘become’ something else. This is a challenge but you will recall that trying to be someone else or be somewhere else creates resistance. By far the best way to begin practice is with a teacher but there are some excellent apps and videos aplenty on you tube; for example Thich Nhat Hanh, The Dalai Lama, Matthieu Ricard, Ajahn Brahm, Jon Kabat Zinn.

Pain and peace

Pain is as complex as any other lived experience. It involves the whole person, their biology, their consciousness, their past experiences and their genetics to name but a few factors — it is complex! Equally as complex is pain relief that involves all the same factors. Where we feel pain is not where pain is ‘generated’, instead this is where there exists a perceived threat.

Regular readers of modern pain science literature will know that pain is related to being threatened or potentially threatened, acting in the name of survival. The location of the pain is really a projection of all the biology involved with protecting us, emerging in a specific place where we are compelled to attend. If there is actually an injury there it seems to make sense. Often in cases of chronic pain there is no obvious injury or pathology. This is because pain and injury are poorly related. Despite this, the pain felt is the pain felt. Pain cannot be seen so we must listen to the person as it is the individual who feels the pain.

“Pain and injury are poorly related

Existing under a state of threat results in a range of thoughts and behaviours that can be combatant in nature. Consider what we have said about peace. To find peace we must be acceptant, open and demonstrate compassion towards ourselves and others. If we ‘fight’ the pain, we are only fighting ourselves. Creating a sense of peace allows us to choose to focus on the actions (e.g./ exercises, re-framing our thinking to reduce fear, socialising, practicing mindfulness, gradually becoming more active, and many more) that create the conditions for living well.

Overcoming pain is an active task. The person needs guidance, motivation and support but the to begin with the basics to sustainably move in the desired direction. This includes a working knowledge about (your) pain with skills and practices to use day to day, moment to moment. The new knowledge about pain creates a sense of safety rather than threat, peace if you like. This clarity that emerges from understanding pain means that the person can truly focus on what they need to do to get better. This starts with thinking like the healthy person who is living well: ‘what would they think and do here?’ you can ask yourself, before doing exactly that, albeit with certain limitations at the start. These limitations can and will be worked upon: ‘can I?’ turns to ‘I can’ and ‘will I?’ turns to ‘I will.

From a place of peace and clarity come right perceptions about oneself and the world. To find peace is to find it in oneself. It is there and may need uncovering. When you do, the world looks to be a different place. One that is far less threatening and one in which to thrive and to live a meaningful life.

The Pain Coach Programme to address suffering by learning to live well | t. 07518 445493
20Feb/17

Pain is whole person

Pain is whole person

There is only one way to approach the problem of chronic pain as it emerges in the individual, and that is by addressing the whole person. This way demonstrates a true understanding of pain: the lack of any pain system, pain signals or pain centres and that the vast majority of the biology of pain is not where we actually feel it in the body or body space in the case of phantom limb pain. Much like when you watch a film in the cinema, most of what you need is not on the screen.

With pain being absolutely individual, coloured by the context, the environment in which it is being phenomenologically experienced, prior experience and beliefs (about pain, health, danger, ‘me’, the world etc.), the action we are motivated and compelled to take, existing health and level of threat perception to name but a few. In short, this includes activity in the brain and central nervous system, immune system, endocrine system, sensorimotor system, visual system, and the autonomic nervous system. Most of this is not where the pain is felt.

Pain and injury are notorious for being poorly related. There are countless stories of people suffering great trauma (tissue damage) and reporting minimal or no pain, some sustaining minor injuries and describing agonising pain and a huge variation in between. Considering the factors in the previous paragraph, one can start to understand why. In essence it is due to pain being a better indicator of the level of perception of threat; i.e./ more threat, or existence of threat = pain.

Bearing this in mind, and this is the current understanding of pain, you can see why the whole person approach is necessary. It is as much about the person as the condition, as Oliver Sacks wrote and practiced, and indeed this is a vital principle to work to. Understand the person and their circumstances and you go some way to seeing a way forward. Listening deeply in the first instance creates the opportunity to gain insight into the reasons for the person’s suffering — the reasons for pain and what is influencing that experience. From this foundation, one develops a rapport, not just as a clinician or therapist but as a trusted advisor, giving the person the knowledge and skills to overcome their pain and live a meaningful life.

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Pain Coach Programme to overcome chronic pain ~ t. 07518 445493 or email: [email protected]

 

18Feb/17

Pain and choice

Pain and choice

There is one thing that pain does and that is narrow down our choices. A sense of choice has a major role in the sense of ‘me’ and who I am. Losing choice impacts upon us significantly as we feel less and less like ourselves and who we are meant to be. This is a very common description of the impact factor that I hear when listening to people enduring states of chronic pain.

Talking to people with pain as we seek to gain insight into the causes of their suffering. This provides a way to offer support, guidance and a way forward. Of course we can only move forward, but sometimes it does not feel like that! Groundhog day.

Enabling one to see their choices then, becomes a valuable and important exercise. We have many, but sometimes we just need a little help to realise and then actualise. I believe that the greatest steps are taken when this happens as the person feels empowered to steer their ship once more.

We need to know where we are going of course, a direction created by clarifying what we want as opposed to what we do not want ~ “I don’t want pain” versus “I want to live well”. Focusing upon living well motivates actions and behaviours in line with this whereas thinking about getting rid of pain keeps our attention on pain. We will only be successful, and we can be, if we have the right approach, mindset and attitude that we may have to cultivate and practice. Most I see do need to work upon these skills of attention, resilience, self-belief and determination. That is the first choice.

We can choose our approach. We can choose to engage in healthy activities. We can choose to take every opportunity to live well. We can choose to create the conditions to feel better. We can choose to have meaningful interactions. We can choose to leave some thoughts alone if they make us feel bad. We can choose to move and gradually move more as we adapt. We can choose to learn about our pain and our responses to pain, and then change them if need be. There are many choices we can make.

Of course it sounds easy when written and the doing is different. It is an experience. However, it is perfectly do-able. We are designed to change and do so every moment that passes. We can harness our potential and opportunities with simple measures, practices and skills based on new knowledge. Achieving success is with everybody’s reach although sometimes we need some help and guidance. But we can do it. This is the ethos of UP. Let us make choices to live well, create joy and face challenges with a sense of ‘I can’.

Choose ‘I can’.

01Feb/17

The inner dialogue

The inner dialogue ~ what do you listen to and what do you tell yourself?
You are beautiful by La Melodie https://flic.kr/p/99ACEa

You are beautiful by La Melodie https://flic.kr/p/99ACEa

One of the things that makes us human is the inner dialogue or inner voice that is fairly continuously ‘speaking’ to us. Of course the voice is part of each and everyone of us and is not an outside agent. To some people it can appear to be coming from somewhere or someone else as in the case of psychiatric disorders. That must be frightening.

The inner dialogue is part of the workings of our mind. Our minds play a significant role in our actions and perceptions but it is not a one way street. The physicality of our existence can impact upon the way in which we think. The branch of philosophy named embodied cognition has much to say on this matter, addressing the notion that our thinking is embodied. A simple example is when thinking about hunger and food, we would typically feel that in our body, interpreting the sensations as being in need of food. A further example is the way we gesture with our hands to demonstrate a point, freeing up resources for further thinking. Consider how you feel when you think of a loved one or a difficult situation in the past — where do you experience it? Certainly not ‘in the head’.

There is a skill in choosing whether to listen to and act upon our inner dialogue or our thinking. It is true that we do not choose the workings of our mind, however we can learn about how it works, our habits of thought and realise how we embody these thoughts. In so doing, we have the opportunity and responsibility to become increasingly skilful in deciding whether to pay attention or to let go of thoughts and the inner dialogue. Being mindful is just that. We are aware of the thoughts, noticing their impermanence, recurrent nature, the way they create feelings in the body, but we are not engaging or becoming embroiled. There is a monumental difference between being in the film and watching the film. You are still experiencing the full richness of the feelings and emotions but with curiosity, with compassion and with an intent to only act with kindness, towards self and others.

Learning to be observant of the inner dialogue allows you to make choices. We have choices and often need to realise them. How am I choosing to feel or think about a particular situation? Even asking yourself that question gives you space to decide what you can do. Shifting the thinking to take another perspective can give a very different feel to the experience. Knowing that you can do this is very empowering, as you know that you can face challenges with skill and insight.

The story we tell ourselves can be so impacting upon our reality, lived experiences and ultimately our health and sense of well-being. If you persistently tell yourself that you are not good enough, have not tried hard enough or blame yourself for all sorts of things that may not actually be your fault, this will create a range of unpleasant feelings in the body as well as paint a bleak picture of life. Being hard on oneself causes our protect systems to switch into action. A range of common ailments manifest if these systems are ‘on’ too much without adequate refresh and renew time. Such problems include chronic aches and pains, sleep disturbance, gut issues, mood variance and exhaustion; very common presentations in my clinic. This need not be the case by learning some simple skills of well-being and day to day practices that stoke up our healthy systems. This is the bulk of the work we do to overcome pain and health problems — see here.

The inner dialogue and pain

Pain and the inner dialogueThe inner dialogue can tell us our story; the story of me. The self that I experience moment to moment, which is continually updating. Our implicit ability to change creates great hope as we can transform our suffering by gaining knowledge and insight into our existing habits. From this awareness we can choose to create new habits that are based upon our value system (what is important to you in life) and are by design all about sustainably living a meaningful life.

Many people with chronic pain have received messages that suggest pain must be managed or that they must just cope. This lowers expectations and hence our story and the inner dialogue is based on this belief. We can and must do better. Changing our story, and this is applicable to any story we tell ourselves, creates a new way onward. This begins with understanding pain. Countless people have told me how much better they feel on starting to understand their pain when we discuss their experiences at the first meeting. There is no magic here. We feel better when we have understanding of a problem and insight into how we can address the issues — feelings of agency, choice and empowerment feed and motivate us to take action; the right action. The Pain Coach Programme is all about the right action based on the right thinking. Understand your pain, write and see a new story and then live it. This is the story of your success, whether it be overcoming pain, setting up a business, writing an essay, doing an exam or playing a game of football. Use the story wisely, make it count and use every moment in a way that encourages and motivates more and more great action.

The Pain Coach Programme is a blend of strengths based coaching and pain sciences for your to achieve your success | t. 07518 445493

 

30Jan/17

CRPS Diagnosis

CRPS Diagnosis

CRPSComplex Regional Pain Syndrome (CRPS) is a collection of signs and symptoms that define this particular condition. A syndrome according to the Oxford Dictionaries, is a ‘group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms’. Therefore, we can clump together any set of symptoms and give it a name, which is really what has happened over the years in medicine. The important point is that when we use the term, we should all know what we are talking about and know what we should look for to make a diagnosis. In other words, a set of guidelines.

The Budapest Criteria delivers guidelines for CRPS, which you can read about in this paper by Harden et al. (2013). The clinical criteria (see below) acknowledge the sensory, vasomotor, sudomotor/oedema and motor/trophic categories that really highlight the complexity of CRPS. Pain is often the primary concern, with people describing their incredible suffering in a range of graphic ways. However, it is not just the pain that causes suffering but the way in which the life of the person changes together with their sense of who they are and their sense of agency seemingly lost. One of the roles of the clinician is certainly to help restore that sense of who I am, a construct that is built from many of life’s ‘components’.

Budapest Criteria

1. Continuing pain, which is disproportionate to any inciting event

2. Must report at least one symptom in three of the four following categories

  • Sensory: Reports of hyperalgesia and/or allodynia
  • Vasomotor: Reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry
  • Sudomotor/Edema: Reports of edema and/or sweating changes and/or sweating asymmetry
  • Motor/Trophic: Reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

3. Must display at least one sign at time of evaluation in two or more of the following categories

  • Sensory: Evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement)
  • Vasomotor: Evidence of temperature asymmetry and/or skin color changes and/or asymmetry
  • Sudomotor/Edema: Evidence of edema and/or sweating changes and/or sweating asymmetry
  • Motor/Trophic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

4. There is no other diagnosis that better explains the signs and symptoms

Importance of diagnosis

A diagnosis made in the same way, based on the same criteria means that clinicians, researchers and patients alike are all discussing the same condition. This may seem pedantic but in fact it is vital for creating a way forward. Clinicians mus know what they are treating, patients must know what they are being treated for and researchers must know what they are researching. Sounds obvious but let’s not take it for granted. So the Budapest Criteria has pointed all those with an interest in the same direction. Consequently we can focus on creating better and better treatments.

As with any painful condition, the start point must be understanding the pain itself. The following questions arise that we must be try to answer:

  • why am I in pain?
  • why this much pain?
  • why is it persisting?
  • what influences my pain?
  • what do I, the bearer of the pain, need to do to get better?
  • what will you do, the clinician or therapist, to help me get better?
  • how long will it take?

New thinking, new science, new models of pain over the past 10 years has advanced our knowledge enormously. Understanding how we change, how our body systems update, how we can make choices as individuals, and the practices we can use to change our pain experience to name but a few, create great hope as we tap into our amazing strengths and resources as human beings. Detailing the treatment approaches is for another series of blogs, but here the key point is that the first step in overcoming pain is to understand it. It is the misunderstanding of pain that causes erroneous thinking and action, which we can and must address across society — pain is a public health issue. Chronic pain is one of the largest global health burdens (Vos et al. 2012). It costs us the most alongside depression, and I believe that this need not be the case if and when we change how we think about pain, based on current and emerging knowledge.

“The first step to overcoming pain is to understand it”

upandrunThis is the reason for UP | understand pain, which we started in 2015 with the aim of changing the way people think and then approach their pain, realising their potential and knowing what they can do. We are about to launch the new website that is packed with practical information for the globe to access online. Alongside this we have plans to create a social enterprise that will purport the same messages, coming from the great thinkers and clinicians who are shaping a new era in changing pain.

In April I will be running the London Marathon to raise awareness of the work of both UP and CRPS UK. You can support the work that both are doing to change pain by donating here

Thank you!

 

21Jan/17

Engaged physiotherapy for pain

Engaged physiotherapy for pain and the modern world

Engaged physiotherapyEngaged physiotherapy is an approach embracing full awareness of oneself as a clinician, full awareness of the person you are working with, full awareness of the context and past, compassion (self and others), insight, and modern sciences (the facts ~ what we know). I have ‘borrowed’ the term from Thich Nhat Hanh who describes engaged Buddhism, which is the practical use of the philosophical principles such as mindfulness, mindful breathing and mindful walking.

Cultivating our awareness as clinicians and gaining insight into the causes of suffering affords us the opportunity to think clearly about the best action for the individual, in this case in pain. Together with an understanding an use of modern sciences, especially pain science, cognitive science and neuroscience (there is vast overlap of course), and philosophy, we can consider each person’s story and create a way onward that is grounded in understanding, compassion, belief and the right attitude to succeed.

There are simple practices that clinicians can use each day that develop and grow awareness and insight. Here are some examples:

  • The greeting
  • Being present during a consultation using the breath
  • Deep and active listening
  • Compassionate speech
  • The creation of a calm and peaceful environment
The greeting

The initial contact often sets the scene. We can think about how we present ourselves with posturing, gestures, language and the simple smile. I would suggest always going to the patient to greet them in the waiting area, and behaving very much like you are welcoming an old friend into your home.

Being present

Using the breath we remain present and aware of what is happening right now. What is passing through me (my mind)? Any bias? Preconception? Judgement? Being aware allows us to let these go so we can focus on active and deep listening. Practicing mindful breathing each day formally for 5-10 minutes helps us to develop this skill that we can use through the day, every day for professional and personal relations to benefit

Deep listening

One of the most valuable gifts we can give to another person is ourselves and our time. Being fully present to listen to the patient (or colleague or family member or friend) creates the conditions for a meaningful interaction. All involved parties benefit from meaningful interactions as we release certain healthy chemicals in these contexts. In deep listening we can hear and understand the suffering of the other, enabling the best and wisest course of action, which may simply be to continue to listen without interruption. Learning to be comfortable with silence is a valuable skill. Much can emerge from moments of silence. (Reading here)

Compassionate speech

Choosing our words carefully, considering their effects, is an important skill to develop. The words we utter have potent effects on others as they hear, process, imagine, think and react. Of course using kind, compassionate words can create the conditions for calm and insight, enabling the person to see a way forward. A focus on health and being well maintains the desired direction, hence the use of words that encourage this thinking and vision helps the person to orientate themselves towards a desired outcome.

We have the spoken word and we have the inner dialogue. Being skilful with both is important as we need to consider which thoughts we are fuelling, or which seeds we are watering by the way we think and what we say. An example would be the effects of engaging in idle gossip. In the long-term, gossip can create issues of trust and miscommunication that breeds suffering.

As a clinician, we should always be thinking about delivering the right messages based on truth, and that provide a compassionate way forward. Helping the patient develop their skills of self-compassion is frequently needed in cases of chronic pain. Understanding that self-compassion is one of the skills of well being helps individuals to practice and benefit from the nurturing of the care-giving systems in the body that play such a big part in our health and happiness.

Creating a calm environment

We are very responsive to the environment. Consider how you would feel working in an office with no windows and in the basement of a block compared to an office with a view over a park or a river.

Clinicians need to think about how the patient might think and feel coming into the clinic. We seek to create a peaceful space for people to experience feelings of calm and gain insight into how they can be, how they can transform their state of being and how they can use these practices in their day to day lives.

The simple practices are just some of the ways we can use our knowledge and skills to create the conditions for people to get better. We no longer have to think about managing or coping, instead use engaged physiotherapy and approaches to give people the belief, understanding and skills to coach themselves, fostering independence and a sense of agency, restoring choice and meaningful living.

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These practices are part of the Pain Coach Programme, which is a focus upon getting better and achieving success in overcoming pain. The programme for patients is a comprehensive way forward addressing a pain problem by focusing on getting healthy and well, and the programme for clinicians is to develop their skills and knowledge to coach patients. If you would like further information, please email us: [email protected] or call 07518 445493.

15Jan/17

Creating peace

Creating peace is vital for suffering individuals and for society

Creating peaceCreating peace should be the aim of all society but of course peace must reside in each individual for this to happen. One of the greatest proponents of peace is Thich Nhat Hanh, a Vietnemese monk who works tirelessly to bring engaged Buddhism to the world. This means simply teaching simple practices that can be used by everyone, not in a religious sense, but instead as a way of creating peace through compassion and insight. Mindfulness is the main vehicle, and to be mindful is to be fully present, to be aware, to have insight, to have clarity, to experience emotions and thoughts in this moment, to be judgmental, and to be accepting.

Mindfulness is a simple practice ~ anytime, anywhere

Mindfulness is a practice that can be used through each day in different ways to gain these healthy benefits. Some describe a practice like this as a skill of well-being, or the skill of being well. These skills form a major part of the Pain Coach Programme, which is a comprehensive approach not only to overcome pain and chronic health issues but to create the best health to live a meaningful life within our ever-changing circumstances. It is much like learning to sail a boat when the sea is sometimes calm and the sea is sometimes ferocious. The wandering mind is an unhappy mind, read the title of a well-publicised piece of research. Whilst we also know that to permit mind wandering can be useful for ideas and creativity, having control over when this starts and finishes maybe important. Certainly being able to attend to what you are doing in this moment is a valuable health skill afforded by mindfulness practice.

Those who have practiced mindfulness will know that creating peace is one of the emerging experiences. We cannot quieten our mind directly, but the mind can calm within the context of being mindful. Thoughts just come, and we cannot stop them much like King Canute could not stop the sea. Yet we learn how to become insightful and skilful as these thoughts pop in, seeing them as just thoughts and opinions that are often very different from reality and truth. Being observant and curious about our thoughts, or the story that we tell ourselves, gives us space to choose how to respond. How can you respond? You can decide to re-focus your attention on what is happening now by using your breath, you can let the thought go (they pass by anyway), you can purposely generate a positive feeling, you can engage in a meaningful interaction or you can perform an act of generosity. All of these you can do in a way that is informed with self-compassion, being kind to yourself, a key skil of well-being.

Individually we are responsible for creating peace within ourselves. It is an error to think that somehow peace or happiness comes from somewhere or someone else. Mindfulness teaches us that we can come back to ourselves at anytime in order to feel at home and secure. That sense of safety, warmth, comfort and peace we can generate ourselves with increasing effect by practicing the skills of being well and cultivating our awareness and insight. In doing this, we are regularly promoting our own health by activating the care-giving systems in our bodies. These play a vital role in day to day physiological functioning: nourishing body systems, diverting resources to healing, repair, refreshing and renewing, digesting food and building energy levels that we need to live and feel well. This is in contrast to the protect and service systems that are designed to work in short bursts. It is when the protect mode is operating consistently that we can develop a wide range of common ailments: IBS, migraine, pelvic pain, wide spread aches and pains, chronic pain, fibromyalgia, and fertility issues to name a few. Choosing to lead a hectic life full of habits that promote survival without adequate deep relaxation only results in health issues. However, we can always make the choice to make a change in a new direction.

We are changing every moment, you just need to choose your direction in line with your vision of the well-you and groove new habits

There are many issues with modern society and its impact upon the health of all, however we also have a great deal of knowledge we can use to make an impact. There are many simple practices that we can use each day to improve our world. This all begins with a shift in thinking beyond oneself towards a mindset of how we can best give and serve our world and the people in the world. We are interconnected in many ways and collectively we can be responsible for social developments that benefit all. We are seeing this increasingly with social enterprises emerging in different sectors. This work is vital for all of us.

Creating peace within ourselves with a simple practice each day is the basis for a collective peace within society. On an individual basis, the creation of peace within is the same as creating the conditions for health as the parasympathetic nervous system predominates. There is so much to be gained from practices that can be learned by all ages (children, teenagers, adults and seniors) in different environments (nurseries, schools, workplaces, homes and healthcare facilities). Low cost, easily implemented and science-based there are a number of initiatives across the world that we can build upon and develop. However, it starts with the individual.

Pain Coach Programme to overcome chronic pain by using the skills of being well to lead a meaningful life | t. 07518 445493 or contact us using the form below.

14Dec/16

In pain ~ what is said, what is heard?

In pain ~ what is said, what is heard?

Anyone who has tried to describe their pain knows how incredibly difficult it is to find words that truly represent what they feel. The same could be said for many lived experiences, the ‘what it is like to……’ that we attempt to transmit to another person. But of course the other person cannot actually know or feel what you feel. We only know what it is like to be ‘me’.

Acknowledging this issue, when we ask people to describe their pain, they are permitted to use any words from their own vocabulary and any comparison or metaphor that emerges from their thinking because this is as close as they will get. Whilst they are telling us what they feel, as well as words that attempt to describe the raw feel of pain, others will demonstrate the degree of suffering and emotional distress that are the additional factors, or second arrow in Buddhism terms. We experience a raw feel, which would be the first arrow, and then the thoughts and emotions that have their own ‘feel’ and typically are the source of the greatest suffering, which are the second arrows.

The raw feel of pain is the raw feel of pain. The add ons are all the thoughts and feelings associated with the pain that are the cause of great suffering. 

Active or deep listening allows us to really hear what the person is saying to us. This is sitting in a state of calm and non-judgement, allowing the person to express themselves in their own unique way. Silence maybe part of this ‘exchange’ that the clinician can become increasingly comfortable residing in, with the knowledge that from silence can emerge important dialogue. Only through deep listening can we hear the words of the other that emerge within a particular context that must also be recognised ~ i.e. the difference in the way someone behaves in different situations such as the clinic when they may be anxious. We must get as close as we can to hear what the individual is saying: have I truly heard what they have said?

We can enhance the flow of communication with our posture and the way we move within the dialogue. A simple movement towards the person shows engagement whilst eye contact can be used judiciously. It is worth considering that for some people eye contact can be challenging or threatening, hence awareness and being present are important.

Our way of being, when filled with compassion and empathy, creates the opportunity for the person to speak and tell their story that is full of all the information that we need as clinicians to gain insight into their suffering and the causes of their suffering.

Pain Coach Programme for chronic pain | skills of well being to live a meaningful life | t. 07518 445493