Tag Archives: understand pain

18Feb/17

Why am I running the London Marathon?

Why am I running the London Marathon?

We are 10 weeks away from the London Marathon and I am getting excited about the day. The training is going well, and I am using others experience and knowledge as a yardstick, reaching 16 miles so far. A bit more nudging in March and I’ll be set to join the thousands of other runners, coursing round the great city of London.

So why am I doing this? The answer is simple. To raise awareness and money to address the biggest global health burden, chronic pain. It costs us the most economically but of course the amount of suffering worldwide is immeasurable. This must change and we can change it by shifting our thinking to be in line with what we know about pain. With an understanding of pain, individuals realise their potential to overcome their pain and live meaningful lives. This is achievable, and in this day and age we have the means to reach across the globe to give people the knowledge and skills. This is the story of UP | understand pain, which was co-founded by myself and Georgie as a pain awareness campaign. Now we have big plans to take the project to another level to achieve our aim of changing the way society thinks about pain.

Complex Regional Pain Syndrome (CRPS) can be a terribly disabling condition, characterised by intense pain. Many people have not heard of CRPS and within healthcare diagnosis is often delayed. This is a problem because like most conditions, early identification allows for treatment to begin. The treatment must be based upon the person’s understanding of the signs and symptoms, for there is an understandable fear that drives on-going protection. Therefore, as with any injury or pain problem, the early messages must be right and make sense.A person’s belief drives their behaviours and subsequent thinking, so a good working knowledge of pain is vital ~ understand pain to change pain.

CRPS UK gained a place in this year’s London Marathon, and having spoken twice at their conferences and being in regular contact, I ‘volunteered’ to be the runner. I was very excited to be chosen and gratefully accepted, which is now why I am out in the Lycra every other day (I will not be posting a picture of that!). CRPS UK is a charity dedicated to advancing the understanding of the condition and supporting people with CRPS. The people involved are doing incredible work to raise the profile and have achieved so much through their dedication. Please visit their website here.

You may be someone suffering chronic pain or know someone who is regularly in pain. Most of us do know someone and can see the effects upon their life. This is not just pain from backs and joints but pain related to cancer, heart disease, arthritis, irritable bowel syndrome, headaches, migraines, rheumatological diseases, pelvic pain and many other conditions that hurt. The work being done by CRPS UK and UP aims to change this and provide resources and training that gives individuals and society a way forward, to overcome pain and live well.

Please show your support here and donate generously

Thankyou!!

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!

 

29Jan/17

Pills, injections & surgery don’t teach you how to live

Pills, injections & surgery don’t teach you how to live ~ pain is a public health and social issue
Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

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

In chronic pain, everything changes. The way you think, feel, move and body sense are all impacted by this on-going state of protection that keeps you in a defensive mode. Even the world looks different as perceptions of the environment are distorted (Ref). The changes that we live and experience have biological underpinnings that have and continue to be studied. Clarifying what is happening at this level aims to give rise to new clinical approaches, both pharmacological and non-pharamcological.

This short article is by no means anti-medicine or anti-surgery because these methods have their place. In that place they must remain, viewed as an option within an overall plan or programme that delivers the outcome of overcoming pain. My point is simply that understanding pain means that we realise that explanations relying upon tissue structure or pathology do not hold up. Pain is not a structure and pain cannot be seen on any scan or x-ray. Pain is a lived experience emerging in a person, which is a culmination of multilevel neuroimmune processing and consequent prediction of the existence of a possible threat. Pain exists within our perception of the current moment that is informed by context and past experience (priors): what we are thinking, what we are doing, who we are with, where we are.

Only I can experience my pain under these circumstances, with some ‘components’ being conscious and many being subconscious. For example, I know that I am anticipating pain in the form of a thought: ‘I expect my back to hurt when I put on those shoes’. Yet I do not know and cannot ‘feel’ the activity of my brain, instead living the biological processing as a conscious experience of what it is like to exist in this moment. Here if course we are contemplating consciousness and what it is like to be me, and we do not know how biology becomes this experience.

Pain emerging in the person makes it as complex as the person; and we are complex! Equally, pain relief or achieving a pain frePain Coach Programmee state is as complex. Neither are permanent states as we are continually changing as our body systems and models of the world update. Our ability to shape our body systems with experience creates such opportunity and with that hope. But it is the individual who shapes their systems by making choices based on understanding. This is why understanding pain is so important as a starter. By this I don’t mean knowing all the chemicals and receptors, instead a working knowledge of pain that can be used practically at any given moment so that the person knows what to think and do. In essence, they learn to coach themselves, which is the basis of my Pain Coach Programme.

There are many influences upon the pain experience itself as well as the likelihood that we will feel pain. Unsurprisingly these include stress, anxiety, thoughts, emotional state, environment, other people, fear, context, memory, tiredness and past experience. The person can understand these influences and develop practices that lessen and ease their impact, learning new habits that are pointed towards health and happiness. This is a significant part of the programme of getting and living well. Pills, injections and surgery do not provide such a learning opportunity. Indeed there maybe relief in the short term and there is a potential role here, yet we are interested in long term change in a desired direction.

Suffering chronic pain has many effects upon the person. Certainly their biology has adapted and changed meaning that they can be in a protect or vigilant state more often, and therefore more reactive with emotions and behaviours. Body sense often changes resulting in altered movement patterns, which in turn cause issues navigating the world as well as providing sensory information that can be continually interpreted as evidence of a threat. Recall that pain is in the face of a perceived threat: more threat = more likelihood of pain. Learning the skills of wellbeing together with specific training sculpts biology towards that underpinning lived experiences of health and wellbeing. Again, pills, injections and surgery do not provide such an opportunity.

Overcoming pain to live a meaningful life requires understanding, effort, practice, resilience, motivation and the right attitude. Everyone has the ability to use their strengths and values to motivate actions (thoughts and acts — remember that a thought is an action) that steer change in a positive direction. It is realising that we can choose. We can choose the attitude we take towards a challenge, and the challenge of chronic pain can be one of the greatest faced by an individual.

Rightly so, an argument has been put forward that pain should be considered an issue of public health. Pain is certainly a societal problem, and in looking at it in this way, we are more like to be able to address the issue that costs us an extraordinary amount of money each year. Financial cost is one thing, but the amount of suffering across the globe and in particular in poorer regions, is another. We are compelled to think differently and we can to do this with the knowledge that we have about pain emerging from science, social and philosophical fields. This is a desperate situation needing collaborations between countries and organisations. Fundamentally, the picture of the modern pain epidemic can be changed, beginning with changing society’s thinking about pain. This involves practical and engaged education projects.

Pain education has been trumpeted and righty so. However, there has been a focus on the neuroscience of pain, especially the role of the brain to the point that the brain is described as somehow being separate from the person. Very contemporary philosophical thinking together with neuroscience has nudged us towards the whole person and viewing pain as a lived experience emerging in the person. This allows us to consider a range of ways to educate the person about how they can change their pain, overcome their pain and live a meaningful life. Of course this is always work in progress and it continues with great gusto. The emphasis on chemicals and receptors has moved on. Whilst interesting to know the microbiology of pain, what the person on pain really needs are practical ways of changing their pain in that moment.

Reflecting on the points made, one can see that the biomedical approach to pain is limited by the fact that pain is a social and public health problem, not a medical problem. Some of the recent best thinking about pain has come from historians, public health experts, English scholars, philosophers, artists, and poets. People ask me how they can learn more about pain. The answer lies in listening and looking at society and people who live the experience. Pain and suffering are ubiquitous. They do not live in a book and certainly not a medical textbook!

So what next?

UP | Understanding PainAt UP | understand pain we are working on several projects that will deliver the latest information and thinking about pain to society. Very soon the new UP website will be launched, giving us an online reach across the globe, allowing people to access this information. UP is a social project, working to evolve the way societies think about pain so that suffering can be reduced. With pain being such an individual matter, when only I can feel my pain that is defined by my knowledge, beliefs and experiences to date, the projects must be culturally sensitive. This does not mean going about it carefully, indeed we need to be shouting the current understanding of pain from the rooftops, instead referring to the fact that there is a significant cultural dimension that blends with all other dimensions of the pain experience.

For example, one place that I intend to have an impact is Cambodia (I will explain my reasons in a later blog). The first steps have to include a deeper insight into the current thinking and what factors and beliefs underpin that thinking. We know that it is not simple to replace an existing model with another, even if the latter is more logical and accurate.

Delivering skills and knowledge to people suffering and to those providing the care in principle is straight forward. Much of what is delivered is straight forward, understandable and does not rely on expensive or complicated equipment. The Pain Coach Programme is easily taught and scaled for example, not only giving people what they need to point themselves towards being healthy but creating habits from which emerges healthy, meaningful living. In so doing, pain becomes less and less of a feature, simply because the person is engaged with their life, feeling that sense of being able to make a choice, having meaningful interactions with others, resulting in fulfilment.

Pain is a social issue, a public health issue. Pills, injections and surgery will not solve this problem and in fact can be the cause of increasing reliance on such measures, meaning the individuals have no understanding of what they need to do to get better. Medical interventions do not teach people how to live and whilst there maybe a place for this kind of relief, it must be within the bigger picture, a model of that person’s life that includes all dimensions: e.g./ social, psychological, cultural, gender, biological. The risks of using medication have been well publicised in terms of opioids and this remains a significant social issue.

It is the person who feels pain, the whole person, not the body part. Society’s thinking can evolve in line with what we really know about pain and make a huge impact upon the vast amount of suffering that comes at such great expense. This starts now.

Pain and Communication

The problem of pain

Pain and communicationCommunication has a large role in pain from the perspective of telling someone that you are suffering but also in the treatment of pain. At the BASRaT Symposium last week I outlined some of the key features that I will summarise here.

Before discussing communication I highlighted what is the one of the most significant and costly problems on the planet: pain. There are vast costs to society and individuals as the numbers of people suffering chronic pain are enormous. The British Pain Society recently called it the ‘silent epidemic’.

It is thought that 20% of the population suffer on-going pain, including 1 in 5 children. Whilst we can say that the former is a significant number necessitating action, the latter absolutely needs to change. We must understand why this is the case. What is it about modern living and culture that is creating a generation of pain and anxiety? There are some obvious candidates: pressure to achieve at all costs, a lack of self-esteem, narcissism encouraged by popular culture, and obsession with social media at the expense of developing connections and communication skills (including addiction to devices).

One of the main reasons for the scale of the pain problem is the misunderstanding of pain through society. The biomedical model still predominates when there is the search for a structure or pathology to explain the pain and extent of the pain. The preferable biopsychosocial model takes into consideration the important psychological and social dimensions, but often the ‘bio’ receives most attention. Modern understanding of pain would suggest that actually, a better framing would be a sociopsychobiological model because whilst understanding the pathophysiology and molecular aspects of pain is important for scientists and clinicians, the person in pain just needs to know what to do when they are in pain. They need a process to follow with an understanding as to why this is important. Neuroscience education has a place in the treatment of pain, but not a primary one.

Pain is a subjective experience emerging in the person, influenced by a range of social, cultural, contextual and environmental factors, past experiences and beliefs, in the face of a perceived threat. Pain is about protection and survival.

Pain & communication

With the size of the problem in mind alongside the understanding that pain is poorly related to injury and tissue health or pathology, we looked at some important aspects of communication.

One of the communication streams that is often forgotten is the inner dialogue. This is the story that you tell yourself about you and life; that little voice that is so familiar and if not trained can be so disruptive. This is the inner dialogue that can cause such suffering when we berate ourselves for not being good enough. This is relevant for the person with chronic pain as self-criticism is a common feature when in fact kindness and self-compassion is a key driver in getting better. Equally, the clinician’s inner dialogue will affect his or her approach and decision making. Think of a scenario when you are tired, you were late for work, you stubbed your toe on the bed and then you are faced with your first patient who has not improved. You need clarity of thought to approach this situation, not a mind cluttered with annoyance and frustration.

What are you telling yourself? What are you convincing yourself? How are you choosing to think?

How we communicate pain to the person has an impact on their understanding, which is paramount in validating their story to date, and in helping them engage with the programme. Firstly we must listen deeply so that we can know the person as much as the condition ~ the two are not separate. Listening deeply is a skill allied with active listening when you are fully present, in contact via body position, your eyes and expressions (verbal and non-verbal), and allowing them the space and time to tell their story. This narrative holds many clues so our full attention is required, jotting down key points and phrases. In sum, there are different communication dynamics co-existing: the inner dialogue of the person, that os the clinician and the (outer) communication between the two.

Compassion and empathy

Cultivating compassion and empathy as a clinician is an extremely worthwhile exercise. Those who have chosen the caring professions have already demonstrated these characteristics by the very nature of the choice ~ we care and want to help others to live their lives. It is interesting and reflective to consider the question: why do I care?

Not only is this important for the clinician, but also for the patient to learn such skills, especially if they are hard on themselves. It is very easy to pick up on this when they speak to you. The problem with being a self-critic without control is that it is very threatening and hence is provoking the self-protect systems that exist to make sure we survive. These systems have a significant role in pain and hence we are aiming to do the very opposite: active the care-giving systems and effect parasympathetic actions. In a sense our job is to help the person realise that they are safe, how they can safely build up their meaningful activities and adapt in a way that means they are living meaningfully.

What are compassion and empathy?

  • Empathy ~ the capacity to share the feelings of others
  • Compassion ~ feelings of warmth, concern and care for the other…with a strong motivation to improve the other’s wellbeing (Singer & Klimecki)

These will be familiar to clinicians and therapists, but what may not be so familiar is the fact that we can train and practice simple skills to improve our capacity.

It will not be a surprise to many that our brains change when we practice and learn, and this is no different for compassion. Neuroscientists have been looking at these mechanisms for some years now, gathering data on these brain changes and how they manifest in the person. Aside from the science, developing a compassionate society has obvious benefits for all:

Love and compassion are necessities, not luxuries. Without them, humanity cannot survive ~ Dalai Lama

These are skills that should be practiced from an early age with purpose, in homes, schools and workplaces. And just to be clear, compassion is not characterised by weakness or femininity as can be said; not at all. Compassion takes courage and is for all.

Simple practices

There are a range of practices that clinicians and therapists can use for both themselves and their patients. Remember that there is an interaction between the care-giver and receiver, both benefitting from a kind action on a chemical level. Fostering and nurturing every opportunity means that we set the scene: the welcome, the greeting, the opening question or comment, the engagement, the demonstration of care, the calm environment, and much more. Being aware of the present moment and crafting each unique session is a skill to be fostered.

It is beyond the scope to describe the following in detail, but as an indicator, these practices are easily started, often a challenge to continue, but immensely worthwhile for the individual and society:

  • mindfulness
  • lovingkindness meditation
  • the practice of gratitude
  • cultivating an ability to control the wandering mind
  • purposefully generating positive emotions

It is worth remembering that as a clinician, you are the treatment as much as any approach you apply. There is no separation. Developing your capacities hence will have a significant impact on your clients and patients as you increasingly set the scene and communicate in such a way that the person feels trust towards you, a sense of being cared for and a belief that they can get better.

Here is a great video from one of the foremost researchers in the field of compassion, Richard Davidson

For further information on the Pain & Wellbeing Coach Programme or clinician/therapist 1:1 Pain Coach Mentoring contact us below or call 07518 445493

09Oct/16

We have done the run

upandrunThe Royal Parks 1/2 marathon today (9th October 2016) ~ we have done the run!

Team UP completed the run around the Parks and London today to raise awareness for UP and money to launch our campaign. It was a great success!

The Team: Richmond Stace, Jonathan Vickers, Peter Brown, Chris Mutch & Ann Dunmall

On a beautiful morning, we completed the course in good time. Ann even sang in the Rock Choir performance on the main stage!! Awesome!

We were very well supported by Jo, Lucy, Lucy H, Georgie, Mark and of course the volunteers and staff. A big thanks to Sally!

#upandrun

#upandrun

This success means that we will do it again. And again. The #upandrun will now be one of the ways in which we continue to raise awareness through exposure and conversations with people and other charities. UP will support runners in the UK and beyond by funding their place and supplying a running shirt while the runner raises money for UP. So if you want to run for us, get in touch ~ [email protected]

You can still support us here: upandrun

And now for the feet to go up!

08Oct/16

The day before the run

The day before the run ~

upandrunI am excited about the run now. I have never run a 1/2 marathon before and so it is a step into the unknown. Having said that, each day is a step into the unknown as we can only ever try and predict the future based upon what we know. In that sense, why worry?

It is tempting to have a little run today to keep the legs moving. I have been told that having run for over an hour and now used to plodding along for this time, the last 45 minutes to an hour will be fuelled by the event atoms sphere created by the people and the place. I’ll let you know.

The UP team have had incredible support in many ways including the very generous donations that continue to be made. You can give here to contribute to our mission of changing the number one global health burden that is chronic pain ~ click here

The aim was £5000 and we have already achieved over £7000 demonstrating how people feel about the scale of this problem. It is around 1:5 people, 20% of children, that experience and live with persistent pain. This is an enormous number of people and of course the reasons for the pain are far and wide as are the contributing factors. Many people do not realise that tiredness, stress and emotional state play a significant role in an individual’s pain.

~ Pain is not well related to injury. Consider phantom limb pain for a moment. There is no limb yet there is pain in that limb; in that space. We don’t need a physical presence to suffer pain and this is because most of the biology of pain does not exists where we actually feel it. You don’t need to hear a joke laugh, you may just think of something funny. When you are at the cinema and the film appears on the screen, where are all the components that make this possible? Most are not on or involving the screen. There is a the projector, the software, the power source etc etc. In understanding pain, we think more widely and hence develop therapies and ways forwards ~ this is the essence of UP and the research we are supporting.

The money that has been raised so far will allow us to set up a strong foundation. We will apply to become a charity, which will enable us to grow and develop. We hope to link with other charities who are in aid of conditions where pain is a problem. The website can now be transformed into a great resource for all to access and learn about pain ~ understand pain to change pain has always been our motto. Like any problem, when we understand it, we know what to do.

The understanding of pain has moved on enormously over the past 10 years and this will continue. In particular my optimism comes from the incredible research that is being undertaken, which we will be reporting upon and supporting. Interestingly, the main thrust comes now from a blend of disciplines drawing upon their knowledge to create a fresh and testable model that is by far the most exciting model that exists. It would not surprise me if this model were to explain many of life’s conundrums.

So now it’s back to the run. The people have supported us and our job at the UP team is to put one foot in front of the other and have fun tomorrow at the Royal Parks 1/2 marathon. Look out for the logo and come and say hello!

What else can you do to help UP?

Follow us on twitter here @upandsing and use #upandrun for the hashtag of the day and on Facebook; retweet our tweets, tweet your own, tweet a picture of the UP logo, grab a picture with one of the UP team!

RS

08Oct/16

UP supports research into pain

UP | understand painUP supports research into pain ~ one of our main objectives is to raise money to support vital research that will make a significant difference to the way in which pain is understood and treated. Such research is underway here in the UK. This is both exciting and necessary in moving forward our thinking so that we can have a significant impact on the global problem of pain.

Mick Thacker has been an enormous influence upon my work and beyond, and in fact I blame him entirely for my obsession with understanding pain! I still recall the lecture he gave when I had my ‘aha’ moment, realising that there was a way forward. Not looking back since, there have been incredible steps forward to where we are now. Mick has had a huge impact upon so many people over the years and this continues. We have a lot to be thankful for and I am grateful for the opportunity to support the work he describes below. I believe that this research is by far our best opportunity to truly understand pain.

‘We propose an interdisciplinary programme of research that focuses on a new approach to pain based on the Predictive Processing Framework (PP) set out by Profs Andy Clark, Jakob Hohwy, Anil Seth and Karl Friston. The main feature of this proposition is that pain arises from circular influences that link the body (including a brain) with the world. This approach sees pain as an action-orientated perception that attempts to both identify and alleviate/limit the potential causes of actual, potential or ‘imagined’ danger to the self. We believe that this approach will extend well beyond the current bio-psychosocial model.

Working closely with philosophers and neuroscientists we will reframe our current understanding of pain using models of PP and will marry empirical based experiments into nociception with current philosophical perspectives. We plan to use these newly acquired perspectives to propose and plan a series of empirical studies that examine pain from the perspective of PP. The direction of these studies are likely to employ many different approaches across the (cognitive) neurosciences including human psychophysics and neuroimaging as well as the development of modelling paradigms involving artificial neural networks and related techniques allowing us to fully understand and evaluate pain and it’s impact on the person.’

Mick Thacker PhD. MSc. Grad Dip Phys. Grad Dip MNMSD. HPC. FCSP.
Senior Consultant AHP (Pain) Guy’s & St Thomas’ NHS Foundation Trust &
Centre for Human and Aerospace Physiological Sciences. King’s College London.
Pain Section, Neuroimaging. Institute of Psychiatry. Kings College London.
Adjunct Senior Research Fellow, School of Health Sciences. University of South Australia.

06Oct/16

Some strong words about pain

#upandrun

#upandrun

Here are some strong words about pain because this is what drives the UP | understand pain campaign (www.understandpain.com). Chronic pain is the number one global health burden — it costs us the most and then consider the personal cost and suffering endured by each individual. We are not just talking about musculoskeletal pain (e.g., back pain, neck pain, osteoarthritis etc.) but all pain: headaches, migraines, pelvic pain, irritable bowel syndrome, cancer related pain, pain related to conditions such as diabetes, heart disease, lung disease and all the other situations in which we hurt and can continue to suffer.

Traditionally the search for the reasons for pain consisted of looking for a pathology, an injury or other structural explanation in the body. The biomedical model needs something to find, something to see with the naked eye or on a scan. Pain can never be seen.

Pain is the ultimate example of a conscious experience, and conscious experiences are built by the individual based on a number of factors that are biological, psychological and sociological. Typically it is the biology that is focused upon with some psychology, which means that the biopsychosocial model purported for some years now, is not really used except in name.

The reality is that you cannot separate these dimensions. How is psychology not biological or sociological? How is biology not psychological? It makes no sense to divide what is a lived experience, a first person experience that embraces the unification of thoughts, perceptions and actions. Fortunately for society, there is a model that is most likely to be able to reflect this unification and the research needed to test the model is going to be supported by the UP campaign (charity-to-be).

As society has evolved so has our pain. Chronic pain is a societal phenomenon — on certain parts of the world, back pain did not exist until the concept was introduced by modern healthcare. That is a societal issue, not a medical issue. And by this regard, society needs a shift to support a new understanding of pain to relieve that very society of this on-going pain problem. This is not a medical problem. As time moves away from the initiation of the pain experience, it shifts rapidly towards the need for a sociopsychological model — what does the person in pain need to understand? What do they need to do? How do they engage with their family? How do they engage with their work? How do they communicate their pain? What actions do they need to take day to day to get better?

This is a public health problem that needs addressing as such. It is not dramatic to say that world leaders and policy makers need to be having conversations about the health problem that costs the globe the most and taking action now. It is absurd that the main reason for seeking help, the vehicle taking people to healthcare is frequently pain. How much formal training do healthcare professionals receive?

The passion behind UP | understand pain emerges from the absolute need for an enforced change from the bottom up. Society needs to be instrumental in the change for its own good and so this is where UP is taking the campaign. To the people. The voice of the people to enforce the necessary change.

This weekend UP has a team at The Royal Parks 1/2 Marathon, raising funds that will be the foundation for all that is described above. So join us and spread the word as we raise the profile of this problem into the consciousness of society for action to be taken now.

Join us on Twitter @upandsing using #upandrun 

27Aug/16

If pain

If painIf pain was understood, there would be less suffering.

If pain was understood, the right messages would be given from a young age, sculpting behaviours based on what needs to be done.

If pain was understood, there would be no fear about it.

If pain was understood, we would focus on what we can do to feel better.

If pain was understood, it would be known that listening deeply is the first step to help someone transform their pain.

If pain was understood, it would be known that understanding pain changes pain.

If pain was understood, there would be an enormous amount of money available for a better society.

If pain was understood, it would sit in the realm of public health and not medicine.

If pain was understood, there would not be the reliance on medication.

If pain was understood, what would the world be like?

— this is the mission of UP | understand pain; to globally change the understanding of pain, because put simply, the world would be a better place if pain were understood.

www.understandpain.com