Tag Archives: pain

18Jan/12

Pain – some things you may not have realised

Pain is multidimensional. Pain is 100% produced by the brain in response to a perceived threat. The brain allocates a location using the cortical maps, hence why we feel pain in our backs or knees. The brain tries to make sense of the situation, scrutinising what is going on on the basis of past experience (learning) and comparing to the information being received from ALL body systems. This is the reason for the term ‘multisystem output’ as a way of describing what is happening when we are in pain.

The most obvious reason why the pain worsens is that we move, exercise or sit for too long. All of these activities are ‘physical’, asking the tissues to take the strain either rapidly or gradually. On reaching a certain level of strain, lower than normal in cases of sensitivity, nerves start sending danger signals to the spinal cord. From the spinal cord messages are relayed to the brain, still on the subject of danger. Theses are not pain signals. It is only when the brain interprets the information as threatening that the experience of pain is produced – an output from the brain. This is typical in acute situations when the injury or problem is new. The pain is vital, useful and motivates action.

A key point to understand is that the brain does not actually need the tissues to produce pain. Think about phantom limb pain. There is no limb. There are no tissues. But it hurts. It seriously hurts in may cases. So, there are other ‘triggers’ for pain besides actually moving or asking the tissues (muscles, tendons, ligaments, bones etc) to take the strain. Common ‘non-tissue’ circumstances that can amplify pain include stress, circadian rhythms, menstrual cycle, fatigue and thoughts. I think that to take this on board is an enlightening experience. To understand that your pain can be as a result of other reasons besides what you are doing physically can help to explain why it hurts at times when you have not done anything differently and you really cannot comprehend why the pain has increased.

A further influential player in our experiences is vision. I’m really interested in this as the process of ‘seeing’ is much aligned to the way pain is experienced. Information is received by the brain via the optic nerve. The brain must make sense of this data and create a credible outcome, again very much using past experience to judge the present. We still see a bird in his cage despite slender lines dividing his body (the struts of the cage). We don’t see ‘slices’ of a bird. Also consider optical illusions. A great deal of work has been done looking at the use of vision for therapeutic effect, i.e. the graded motor imagery programme. Clearly the mirror box is creating the illusion that the affected side is moving and appearing to be normal. Imagined movements requires us to ‘see’ and feel movement although we are keeping very still. The premotor cortex is very active during these imagined movements, and this part of the brain is involved in the production of pain.

What we are seeing is deemed to be an illusion in some quarters. We all have different experiences and backgrounds. Our beliefs about life and ourselves vary. This will influence what we ‘see’. If you have just watched a scary movie and then go outside into the dark to put the rubbish out, a shadow could be ‘seen’ as something more dangerous than if you have just laughed at a comedy show. Also consider when we see someone injure themselves, again on TV or watching sport. We often wince, grab our corresponding body part or take some other defensive action. Our brains are interpreting someone else’s danger and imprinting this onto our experience, perhaps as a way of helping us to learn that it is dangerous to be in their situation. This is likely due to the mirror neuron network and that when we watch someone else move or position themselves, our virtual body that exists in the brain mimics that position. There are also aspects of empathy in sharing someone’s pain. But, if that position is ‘threatening’ to our brain, we will hurt.

What do we do about that? We use strategies to desensitise and habituate, similar to dealing with any fear. The modern way of tackling pain states, especially those that persist, is using a biobehavioral approach. This means that as well as addressing tissue health with movement and treatment, we must concurrently target the brain and other systems that are involved in the pain experience, e.g. immune, endocrine. It is called ‘top-down’ – ‘bottom-up’. Top-down referring to the brain and our beliefs, understanding, thoughts, how the brain is controlling movement and protecting us; bottom-up signifying the need to nourish the tissues with movement. These exist on a spectrum and both are addressed in a contemporary biopsychosocial treatment programme – see www.specialistpainphysio.com/treatment

Below are some interesting abstracts in relation to this blog:

Pain. 2010 Feb;148(2):268-74. Epub 2009 Dec 11.

Pain sensation evoked by observing injury in others.

Osborn J, Derbyshire SW.

Source

School of Psychology, University of Birmingham, Edgbaston, UK.

Abstract

Observing someone else in pain produces a shared emotional experience that predominantly activates brain areas processing the emotional component of pain. Occasionally, however, sensory areas are also activated and there are anecdotal reports of people sharing both the somatic and emotional components of someone else’s pain. Here we presented a series of images or short clips depicting noxious events to a large group of normal controls. Approximately one-third of this sample reported an actual noxious somatic experience in response to one or more of the images or clips. Ten of these pain responders were subsequently recruited and matched with 10 non-responders to take part in an fMRI study. The subjects were scanned while observing static images of noxious events. In contrast with emotional images not containing noxious events the responders activated emotional and sensory brain regions associated with pain while the non-responders activated very little. These findings provide convincing evidence that some people can readily experience both the emotional and sensory components of pain during observation of other’s pain resulting in a shared physical pain experience.

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J Cogn Neurosci. 2007 Jan;19(1):42-58.

The neural substrate of human empathy: effects of perspective-taking and cognitive appraisal.

Lamm C, Batson CD, Decety J.

Source

INSERM Unit 280, France.

Abstract

Whether observation of distress in others leads to empathic concern and altruistic motivation, or to personal distress and egoistic motivation, seems to depend upon the capacity for self-other differentiation and cognitive appraisal. In this experiment, behavioral measures and event-related functional magnetic resonance imaging were used to investigate the effects of perspective-taking and cognitive appraisal while participants observed the facial expression of pain resulting from medical treatment. Video clips showing the faces of patients were presented either with the instruction to imagine the feelings of the patient (“imagine other”) or to imagine oneself to be in the patient’s situation (“imagine self”). Cognitive appraisal was manipulated by providing information that the medical treatment had or had not been successful. Behavioral measures demonstrated that perspective-taking and treatment effectiveness instructions affected participants’ affective responses to the observed pain. Hemodynamic changes were detected in the insular cortices, anterior medial cingulate cortex (aMCC), amygdala, and in visual areas including the fusiform gyrus. Graded responses related to the perspective-taking instructions were observed in middle insula, aMCC, medial and lateral premotor areas, and selectively in left and right parietal cortices. Treatment effectiveness resulted in signal changes in the perigenual anterior cingulate cortex, in the ventromedial orbito-frontal cortex, in the right lateral middle frontal gyrus, and in the cerebellum. These findings support the view that humans’ responses to the pain of others can be modulated by cognitive and motivational processes, which influence whether observing a conspecific in need of help will result in empathic concern, an important instigator for helping behavior.

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Hum Brain Mapp. 2009 Oct;30(10):3227-37.

Empathic neural responses to others’ pain are modulated by emotional contexts.

Han S, Fan Y, Xu X, Qin J, Wu B, Wang X, Aglioti SM, Mao L.

Source

Department of Psychology, Peking University, Beijing 100871, People’s Republic of China. [email protected]

Abstract

Recent brain imaging studies indicate that empathy for pain relies upon both the affective and/or the sensorimotor nodes of the pain matrix, and empathic neural responses are modulated by stimulus reality, personal experience, and affective link with others. The current work investigated whether and how empathic neural responses are modulated by emotional contexts in which painful stimulations are perceived. Using functional magnetic resonance imaging (fMRI), we first showed that perceiving a painful stimulation (needle penetration) applied to a face with neutral expression induced activation in the anterior cingulate cortex (ACC) relative to nonpainful stimulation (Q-tip touch). However, when observation of the painful stimuli delivered to a neutral face was intermixed with observation of painful or happy faces, the ACC activity decreased while the activity in the face area of the secondary somatosensory cortex increased to the painful stimulation. Moreover, the secondary somatosensory activity associated with the painful stimulation decreased when the painful stimulation was applied to faces with happy and painful expressions. The findings suggest that observing painful stimuli in an emotional context weakens affective responses but increases sensory responses to perceived pain and implies possible interactions between the affective and sensory components of the pain matrix during empathy for pain.

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Neuron. 2007 Aug 2;55(3):377-91.

The cerebral signature for pain perception and its modulation.

Tracey I, Mantyh PW.

Source

Centre for Functional Magnetic Resonance Imaging of the Brain, Clinical Neurology and Nuffield Department of Anaesthetics, Oxford University, OX3 9DU Oxford, England, UK. [email protected]

Abstract

Our understanding of the neural correlates of pain perception in humans has increased significantly since the advent of neuroimaging. Relating neural activity changes to the varied pain experiences has led to an increased awareness of how factors (e.g., cognition, emotion, context, injury) can separately influence pain perception. Tying this body of knowledge in humans to work in animal models of pain provides an opportunity to determine common features that reliably contribute to pain perception and its modulation. One key system that underpins the ability to change pain intensity is the brainstem’s descending modulatory network with its pro- and antinociceptive components. We discuss not only the latest data describing the cerebral signature of pain and its modulation in humans, but also suggest that the brainstem plays a pivotal role in gating the degree of nociceptive transmission so that the resultant pain experienced is appropriate for the particular situation of the individual.

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Neuroimage. 2009 Sep;47(3):987-94. Epub 2009 May 28.

The influence of negative emotions on pain: behavioral effects and neural mechanisms.

Wiech K, Tracey I.

Source

Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK. [email protected]

Abstract

The idea that pain can lead to feelings of frustration, worry, anxiety and depression seems obvious, particularly if it is of a chronic nature. However, there is also evidence for the reverse causal relationship in which negative mood and emotion can lead to pain or exacerbate it. Here, we review findings from studies on the modulation of pain by experimentally induced mood changes and clinical mood disorders. We discuss possible neural mechanisms underlying this modulatory influence focusing on the periaqueductal grey (PAG), amygdala, anterior cingulate cortex (ACC) and anterior insula as key players in both, pain and affective processing.

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Disclaimer: this blog is for informational purposes only. If you are concerned or unsure about your pain or condition, you must consult with your GP or a health professional.

09Dec/11

Mindfulness

Mindfulness has grown in popularity over recent years, and for good reason. Those who regularly practice mindful meditation and mindfulness on a day-to-day basis will tell you about their clarity of thought, their sense of ease and their good physical health. The practice is recommended by NICE for depression as well as the frequent teaching of mindfulness as a way to deal with pain.

At the clinic, I encourage mindful practice to help the individual be released from the pull of negative and unhelpful thinking about pain. We all have thoughts. This is the action of the mind and is a normal process. Automatic thoughts pop into our head and trigger emotional and physical responses–think about a waxy, yellow lemon resting upon a plate; you take a knife and cut into the rind, releasing the citrus odour as you divide the lemon in two, the pieces rolling away from the blade; you further cut the two halves into quarter segments, each time triggering a small burst of juice into the air around; imagine taking one segment and gently placing it into the front of your mouth; what are you experiencing? Thoughts change our physiology because our brains respond to thinking or imagining, just as if we are present. This is why it can hurt when we watch someone else move their body in a way that would be painful for us.

Automatic thoughts are just that. How we respond next we can decide. By being observant of our thoughts we can avoid following an automatic thought with another thought and another that lead to persisting physiological responses and emotions that are unpleasant and unhelpful. In particular those thougths that often recur and create unease and anxiety. They are simply thoughts. They are not us and they are not reality. They are just thoughts. But, they can be powerful unless we can find a way to be observant, non-judgmental, aware and present. That ‘way’ can be mindfulness.

Here are some great people talking about mindfulness and meditation

 

There has been and continues to be a great deal of work looking at mindfulness and how it may work. The Oxford Mindfulness Centre (OMC) undertakes research and provides training.
‘The OMC Team does ground-breaking clinical and neuroscience research on mindfulness. It assesses the efficacy of different forms of mindfulness practice for different types of problem, and is building up a peer-reviewed body of knowledge about what forms of mindfulness intervention best suits which type of person.’
A list of the OMC publications is available here

For further information on our use of mindfulness for pain, please email [email protected]

09Dec/11

Top 3 recommended books

These three titles I frequently recommend to patients to help develop the necessary deeper understanding of pain, stress and the role of the mind in physical health. They are all extremely well written and designed to educate to promote change towards more healthy behaviours. This sits exactly with my approach to physiotherapy for painful conditions that are complex, chronic or often both.

Painful Yarns by Lorimer Moseley

‘Moseley is pain management’s answer to James Herriot. This book capture that illusive ability to both educate and entertain’. Dr Micheal Thacker, Pain Sciences Program, Kings College London

‘I love a good story…..but the best thing was that when the stories were compared to how pain works, it made sense’. Dimos, lorry driver with chronic back pain

Available from NOIgroup 01904 737919

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Why zebras don’t get ulcers by Robert Sapolsky


Now in a third edition, Robert M. Sapolsky’s acclaimed and successful Why Zebras Don’t Get Ulcers features new chapters on how stress affects sleep and addiction, as well as new insights into anxiety and personality disorder and the impact of spirituality on managing stress. As Sapolsky explains, most of us do not lie awake at night worrying about whether we have leprosy or malaria. Instead, the diseases we fear – and the ones that plague us now – are illnesses brought on by the slow accumulation of damage, such as heart disease and cancer. When we worry or experience stress, our body turns on the same physiological responses that an animal’s does, but we do not resolve conflict in the same way – through fighting or fleeing. Over time, this activation of a stress response makes us literally sick. Combining cutting-edge research with a healthy dose of good humour and practical advice, Why Zebras Don’t Get Ulcers explains how prolonged stress causes or intensifies a range of physical and mental afflictions, including depression, ulcers, colitis, heart disease, and more. It also provides essential guidance to controlling our stress responses. This new edition promises to be the most comprehensive and engaging one yet.

Available from Amazon here

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Mindfulness by Mark Williams & Danny Penman

‘If you want to free yourself from anxiety and stress, and feel truly at ease with yourself, then read this book.’ –Ruby Wax

‘You would do well to put yourself in the experienced hands of Mark Williams and Danny Penman, and give yourself over to their guidance and to the programme that they map out.’ –Jon Kabat-Zinn

‘Want a happier, more content life? I highly recommend the down-to-earth methods you*ll find in ‘Mindfulness’. Professor Mark Williams and Dr. Danny Penman have teamed up to give us scientifically grounded techniques we can apply in the midst of our everyday challenges and catastrophes’ –Daniel Goleman, Author of ‘Emotional Intelligence’

‘Peace can’t be achieved in the outside world unless we have peace on the inside. Mark Williams and Danny Penman’s book gives us this peace’ –Goldie Hawn

‘Want a happier, more content life? I highly recommend the down-to-earth methods you’ll find in ‘Mindfulness’. Professor Mark Williams and Dr. Danny Penman have teamed up to give us scientifically grounded techniques we can apply in the midst of our everyday challenges and catastrophes’ –Daniel Goleman, Author of ‘Emotional Intelligence’

Available from Amazon here

21Oct/11

Using neuroscience to understand and treat pain

I love neuroscience. It makes my job much easier despite being a hugely complex subject. Neuroscience research has cast light over some of the vast workings of our brains and helped to explain how we experience ourselves and the richness of life. An enormous topic, in this blog I am briefly going to outline the way in which I use contemporary neuroscience to understand pain and how we can use this knowledge to treat pain more effectively. This is not about the management of pain, it is the treatment of pain. Management of pain is old news.

Understanding pain is the first step towards changing the painful experience. Knowing how the brain and nervous system operate allows us to create therapies that target the biological mechanisms that underpin pain. Appreciation of the plastic ability of the nervous system from top to bottom–brain to periphery–provides us with the opportunity to ‘re-wire’, and therefore to alter the function of the system and make things feel better. Knowing the role of the other body systems when the brain is defending us, is equally important. The synergy of inputs from the immune system, endocrine system and autonomic nervous system provides the brain with infomration about our internal physiology that it must scrutinse and act upon in the most appropriate way. We call this action the brain’s ‘output’ which is the responses that it co-ordinates to promote health and survival.

Excellent data from contemporary research tells us that understanding pain increases the pain threshold (harder to trigger pain), reduces anxiety in relation to pain and enhances our ability to cope and deal with the pain. We know that movement can also improve after an education session. This is because the perceived threat is reduced by learning and understanding what is going on inside, and knowing what can be done. The vast majority of patients who come to the clinic do not know why their pain has persisted, what pain really is, how it is influenced and what they can do about it themselves. For me this is the start point. Explaining the neuroscience of pain. Facts that we know people can absorb, understand and apply to themselves in such a way that the brain changes and provides a different experience.

It is the brain that gives us our experience of ourselves and the world around us. This includes the sensory and emotional experience of pain. The brain receives information from the body via the peripheral nervous system that suggests there is a threat to the tissues (input). In response, the brain must decide whether this threat is genuine based upon what is happening at the time, the emotional state, past experience, the belief system, gender, genetics, health status, culture and other factors. In the case that the brain perceives a threat, the output will be pain. The Mature Organism Model developed by Louis Gifford describes this beautifully (see below).

Pain is a motivator. It grabs our attention in the area of the body that the brain feels is threatened based upon the danger signals it is receiving from the tissues via the spinal cord. The brain actually ascribes the location of the pain via the map of the body that exist in the sensory cortex. On feeling the pain, we take action. This is the reason for pain. It motivates us to move, seek help or rest. Pain is an incredible device that we have for survival and learning, necessary to navigate life and completely normal. The brain constructs the pain experience and associated symptoms in such a way that we have to take note and do something about it immediately.

29Sep/11

Mastering your rehabilitation – Part 1: why exercise & train?

When we sustain an injury or experience a painful condition, our movement changes. In the early stages this can be obvious, for example we would limp having sprained an ankle. Sometimes the limp, medically termed an ‘antalgic gait’, persists without the individual being aware. This is the same for other forms of guarding that is part of the body’s way of protecting itself. By tightening the affected area or posturing in a manner that withdraws, the body is changing the way that we work so that healing can proceed. Clearly this is very intelligent and useful. The problem lies with persisting guarding or protection that continues to operate.

 

We know that when the brain is co-ordinating a response to a threat, a number of systems are active. This includes the nervous system, the motor system, the immune system and the endocrine system (hormones). This is all part of a defence in and around the location that is perceived to be under threat. It is important to be able to move away from danger and then to limit movement, firstly to escape from the threat (e.g. withdraw your hand from a hot plate) and then to facilitate the natural process of healing by keeping the area relatively immobilised. Interestingly, at this point our beliefs about the pain and injury will determine how we behave and what action we take. If we are concerned that there is a great deal of damage and that movement will cause further injury, we will tend to keep the area very still, looking out for anything or anyone who may harm us. Over-vigilance can lead to over-protection and potentially lengthen the recovery process. This is one reason why seeking early advice and understanding your pain and injury is important, so that you can optimise your potential for recovery.

We have established that we move differently when we are injured and in pain. In more chronic cases, the changes in movement and control of movement can be quite subtle. An experienced physiotherapist will be able to detect these and other protective measures that are being taken. These must be dealt with, because if we are not moving properly, this is a reason for the body to keep on protecting itself through feedback and feed-forward mechanisms. Re-training movement normalises the flow of information to and from the tissues to the brain. Often this process needs enhancement or enrichment as the sensory flow and position sense (proprioception) is not efficient. Movement is vital for tissue and brain health, nourishing the tissues with oxygen and chemicals that stimulate health and growth.

To train normal movement is to learn. The body is learning to move effectively and this process is the same as learning a golf shot, a tennis stroke, a language or a musical instrument. Mastery. You are asking yourself to master normal movement. What does this take? Consistency, discipline, practice (and then some more practice), time, dedication, awareness and more. The second part of this blog will look at mastery as a concept that can help you understand the way in which you can achieve success with your rehabilitation.

26Sep/11

Dysmenorrhoea and Pain

Dysmenorrhoea and pain — You may wonder why I am writing about dysmenorrhoea. It is because in a number of cases that I see, there is co-existing dysmenorrhea and other functional pain syndromes. These include irritable bowel syndrome (IBS), migraine, chronic low back pain, pelvic pain, bladder pain and fibromyalgia. Traditionally all of these problems are managed by different specialists with their particular end-organ in mind—e.g./ IBS = gastroenterologist; migraine = neurologist; fibromyalgia = rheumatologist. The science however, tells us that these seemingly unrelated conditions can be underpinned by a common factor, central sensitisation. This is not a blog about dysmenorrhoea per se, but considers the problem in the light of recent scientific findings and how it co-exists with other conditions.

 

Central sensitisation is a state of the central nervous system (CNS)—the spinal cord and the brain. This state develops when the CNS is bombarded with danger signals from the tissues and organs.  It means that when information from the body tissues, organs and systems reaches the spinal cord, it is modified before heading up to the brain. The brain scrutinises this information and responds appropriately by telling the body to respond. If there is sensitisation, these responses are protective and that includes pain. Pain is part of a protective mechanism along with changes in movement, activity in the endocrine system, the autonomic nervous system and the immune system. Pain itself is a motivator. It motivates action because it is unpleasant, and provides an opportunity to learn—e.g./ do not touch because it is hot. This is very useful with a new injury but less helpful when the injury has healed or there is no sign of persisting pathology.

Understanding that central sensitisation plays a part in these conditions creates an opportunity to target the underlying mechanisms. This can be with medication that acts upon the CNS and with contemporary non-medical approaches that focus upon the spinal cord and brain such as imagery, sensorimotor training, mindfulness and relaxation. In this way, dysmenorrhoea can be treated in a similar fashion to a chronic pain condition although traditionally it is not considered to be such a problem. The recent work by Vincent et al. (2011) observed activity in the brains of women with dysmenorrhoea and found it to be similar to women with chronic pain, highlighting the importance of early and appropriate management.

The aforementioned study joins an increasing amount of research looking at the commonality of functional pain syndromes. We must therefore, be vigilant when we are assessing pain states and consider that the presenting problem maybe just part of the bigger picture. Recognising that central processing of signals from the body is altered in a number of conditions that appear to be diverse allows us to offer better care and hence improve quality of life.

* If you are suffering with undiagnosed pain, you should consult with your GP or a health professional.

12Sep/11

Physiotherapy in Chelsea

Physiotherapy in Chelsea — Situated just off Sloane Square in Chelsea at 2, Lower Sloane Street, the physiotherapy clinic is in a convenient location close to the tube (Sloane Square) and bus stops. The Specialist Pain Physio Clinics are dedicated to treating pain and injury with modern strategies and therapies based upon the latest neuroscience to promote normal movement and healthy participation in an active lifestyle.

T 07518 445493

Visit the profile on The Chelsea Consulting Room website that provides a brief outline of the clinic. The main Specialist Pain Physio website has details about the modern approach to the treatment of pain and chronic pain, the other clinic locations and links to useful sites.

Knowledge and healthy movement for normal self

Local residents, people from all parts of London, across the country and overseas visitors have come to the clinic for treatment of chronic conditions and pain.

Come and visit our blog for regular articles and information.

We see a range of complaints including back pain, neck pain, RSI, recurring and persisting sports injuries, complex regional pain syndrome (CRPS), tendinopathies (e.g./ Achilles, patella, shoulder, elbow & wrist), functional pain syndromes (e.g./ IBS, dysmenorrhoea, pelvic pain, fibromyalgia, chronic back pain), conditions that have failed to respond to treatment and medically unexplained symptoms.

T 07518 445493

09Jun/11

Complex Regional Pain Syndrome – ‘it feels weird’

Complex Regional Pain Syndrome (CRPS) often presents with a number of signs and symptoms. The main complaints are usually pain, colour change (minute to minute sometimes), temperature change, swelling, sweating changes, skin/nail/hair changes (trophic) and an altered perception of the affected part. It is this last sense that I am going to focus upon in this blog.

I hear many different descriptions of the symptoms of CRPS and actually encourage the use of a wide range of words. This is so that I can develop a really good picture and insight into the individual’s experience which is exactly that, individual. One aspect that I am particularly interested in is the perception of the affected area. In the vast majority, if not all, cases there is an altered sense of the region. For example, in the case of the hand it can feel bigger (sausage fingers often a good description of the feel), swollen, distorted, out of place, detached, like it belongs to someone else, like it is not there unless looked at (visual input to confirm presence) or denial that it is there at all (denial – similar to those who suffer strokes).

This variety of descriptions paint the picture of a ‘stranger’ aspect of the condition, often claimed to be ‘weird feelings’ as they are so abstract and like nothing before. Clearly this can be worrying and sometimes I hear that when the descriptions are given to others there maybe disbelief. Any aspect of a problem that creates fear or anxiety can affect pain and must be addressed.

So what is going on? When we have an on-going painful problem and we are not moving normally, changes occur within the central nervous system to give us this different experience. In the brain we have maps, virtual maps, that the brain uses to work out where sensory information is coming from and control movement. These maps are well defined under normal circumstances with a genetic blueprint that is moulded by experiences. This precise definition relies on a constant stream of information coming in from the tissues. In the case that this flow is altered or stopped, the map changes. We know this from fMRI studies that demonstrate reorganisation of the brain in certain areas. Certain representations of body parts are found to be in different locations in pain states. In fact, many brain changes have been found in chronic pain, these changes underpinning our different experiences of the body. The good news is that with effective treatment of the pain, these changes are reversed. Effective treatment will be the subject of another blog, but this includes such therapies as graded motor imagery and others that seek to ‘redefine the maps’.

In summary, chronic pain states, including CRPS and back pain, we know that the cortical (brain) maps change and that this is the reason why the affected area can feel ‘weird’, out of place and just not right. The map is ‘smudged’. In a sense this is useful as it draws our attention to something that needs dealing with imminently. The focus of treatment for this is upon ‘redefining’ the maps, the same for a range of conditions. In fact, my view is that this is what modern rehabilitation is really about in essence, via normalisation of sensation, motor control and the congruence of these factors, alongside the traditional strength gains and tissue changes. Our understanding of smudging and cortical reorganisation has triggered a change in thinking for rehabilitation, targeting the brain, training the brain and offering science based solutions for chronic pain.

 

05May/11

Managing your flare-up

A flare-up is when the symptoms increase for a period of time. Sometimes it is clear why this happens such as after new activities or exercise, an increase in activity levels, when you are unwell, stressed or fatigued. In other cases there is no obvious reason as the routine has not changed and you cannot think of a reason why the pain has worsened.

Your brain will know why as it is responding to a potential threat. The brain is constantly monitoring the body and the environment through the senses and other body systems (e.g. endocrine, immune) and responds accordingly. Visual input has a significant effect and when we see others moving in a particular way or doing certain tasks, a threat value can be determined even though it is not ourselves doing it! For example, observing someone bend over and pick up a heavy box can evoke pain in our backs. The message is that our pain and perception of our body can change in response to things that we see.

So what do you do?

To manage a flare-up actively means that you can ride the storm more effectively and also learn about the process for greater effect if there is a further flare later on. In essence it is trying to remain active but tolerably.

1. Continue to break up sustained activities into chunks (pacing) as instructed by your therapist in terms of the timing. I would suggest as a ball park figure that 50% of the time it takes for the pain to enforce a change or cessation of activities should be a start point.
2. ‘Little & often’: change position, move affected body part (avoid the area stiffening and provoking a worry about then moving) and other areas.
3. Use your prescribed exercises but in a calm way, i.e. Relaxed or meditative breathing before to ‘calm the seas’, think positively rather than dwelling on negative thoughts that can evoke other brain responses. Be flexible in the repetitions, for example, split the sets into shorter bouts but spread out over the day.
4. Before moving the affected area or undertaking the exercises, move regions that are remote or on the other side first. For example, if it is a foot problem, move the other knee and foot first, or the hip and knee on that side initially.
5. Pain relief as prescribed
6. If you are feeling unwell with a flare-up, manage as if you are sick. Your body is in a restorative mode and you must treat it as such, including rest periods.
7. Remember that this flare-up will pass.

Take the advice of your health professional in terms of the timings, repetitions and exercises. All activities should not be causing further increases in symptoms. It should be tolerable.

Little and often
Motion is lotion
Be consistent with your activities

For further information contact us on 07518 445493

21Apr/11

Aches & pains, stresses & strains

 

Treatment Programme for life’s ailments

Aches and pains are a normal part of life, reminding us that we are doing too much, too little or something potentially injurious. Classically, sitting at the desk for hours, using a computer mouse repeatedly, texting and emailing on phones with small keypads, going from being sedentary all day to exercising furiously in the morning, at night or at the weekend, all can lead to aches and pains. Much of the time we expect this to be the case such as after a good workout, when re-starting at the gym or following an unusual bout of DIY. We can explain it, the pain has a meaning and often a short lifespan.

Whether we experience pain or not is not as simple as ‘we do some physical activity and then the tissues hurt’, but rather it comes down to the brain’s analysis of whether there is a threat to our tissues or not. So, we can do all sorts of activities, but it will only hurt when there is a perception of danger. The brain receives signals from the body tissues and organs, maintaining an ‘online’ monitoring system via a huge network of nerves that send messages to the spinal cord. These messages are then passed upwards to the brain for scrutiny. If, and that’s a big if, there is a sense of danger based on this information and past experience, the brain will protect the affected area and make it hurt. If there is no perceived danger, it simply won’t be painful. Good examples of this are phantom limb pain that is a sense of pain in a limb that is no longer present and battlefield stories of severe trauma yet no pain. The long and the short of it is that pain is not an accurate indicator of tissue damage as borne out in huge amounts of research that has been done over the years. This knowledge has advanced our ability to understand pain and treat it in a better way (for further information see our page dedicated to pain).

The aches and pains that we feel are influenced by a number of proven factors. These include stress, emotional state, fatigue, hormones, the immune system, past experience, culture, our beliefs about pain, gender and expectations to name but a few. Understanding this is very important for successful management and treatment as these factors need to be identified and dealt with appropriately. This approach is called the biopsychosocial model of care and deemed to be the best way of looking at and treating pain. We consider the biological mechanisms, the psychology and social impact. For example, a violin player cuts his index finger: biology includes inflammation that hurts, healing and changes in blood flow; psychology that would be thought about how this will affect his/her ability to play, ‘it’s a disaster’, anxiety about the future, I believe this will heal quickly; and social impact considers the fact that he/she cannot play and therefore there is no income this wee. Clearly there is more to it but this brief overview helps conceptualise the model and that the components are inter-related.

So the aches and pains of life are there and common and can become persistent, annoying, frustrating and affect ones ability to enjoy life. Our tolerance for the challenges we face may diminish and activity levels can drop and the downward spiral can begin. It could be that it is an old injury that recurs periodically or improved but never really resolved. Whatever the scenario, if the aches and pains, stresses and strains of life are too loud and bothersome or just there in the background nagging away, we have a programme for you that provides integrated treatment, strategies to develop resilience, relaxation and education so that you can understand what is happening to increase awareness allowing for change. The course is based on the latest understanding of pain, stress and health to offer informative, active, fun and effective ways of enjoying your body and life.

The basic programme consists of an assessment to determine the nature of the problem(s) followed by six 30 minute sessions. During these sessions you will receive an explanation of the problem including the causes and influences, treatment (this can include soft tissue massage, joint mobilisation, acupuncture), an exercise programme to focus upon stretching, mobilising or strengthening particular body regions, mindfulness techniques and breathing exercises. The programme parts create a synergy that targets body, brain and mind for better physical and psychological health.

Having completed the programme you are welcome to add sessions for ‘top ups’ on a individual or a single session basis.

To book, call now 07518 445493

Please note that if further investigations or a referral to see a consultant are required, a letter will be provided and recommendation made so that this can be actioned rapidly. Subsequently the programme or specific treatment can be started.