#upandrun Pain Points (2): pain and injury are not the same

CRPS UK running vest for the Brighton Marathon

Pain and injury are not the same

There is a straightforward difference between pain and injury. Pain is subjective and injury is objective. Pain is a lived experienced. An injury is a disruption of the body tissues. You cannot see pain. Usually, you can see an injury.

Unfortunately the words are often used interchangeably. Further, there is the belief that pain and injury are well related. However, we have known that this is not the case for many years. Pat Wall, one of the forefathers of modern pain medicine and science, spoke about this in his famous 1979 lecture. Since then there have been countless studies showing that pain is part of how we protect ourselves and related to the state of the person within a particular context.

We have many stories of varied pain responses to different injuries. Sports people continuing to play with sprains and fractures, soldiers sustaining severe physical trauma reporting no pain, and the large proportion of people suffering the symptoms of IBS without any notable pathology. More-so, there are no investigations that show pain. Pain cannot be seen on an X-ray or an MRI scan.

We must be clear. People suffering pain must understand why they feel pain, why and how it can persist, and then focus on the steps that they can actively take to move on and get better. Misunderstanding pain is one of the main stumbling blocks. Erroneous thinking results in wrong decisions about treatment and self-care, but also impacts upon the sense of empowerment, belief in oneself to improve and hope.

Truly understanding pain helps the person to let go of unhelpful and fearful thoughts and to build confidence (in moving for example). It creates a strong foundation from where the person can build and gather momentum towards their picture of success.

RS

Pain Points (1) with #upandrun

Pain Point (1)

Pain is what the person says it is

This may sound obvious but I think that we need this to be loud and clear. There are still too many people who say that they feel that they are not believed when they describe their experience.

I started my career in healthcare in ’93 training to be a registered general nurse. My fascination with pain began in the theatre recovery rooms when I noticed how propel responded so differently. The ‘size’ of the operation did not seem to matter. How the person was, in other words their state, really did.

Studying pain, I inevitably came across the quote from McCaffery (1968) on pain: “whatever the experiencing person says it is, existing whenever the experiencing person says it does“.

This has ever-stuck with me. Everyone behaves in such a way as to meet their needs. When a person describes their pain experience, these are not merely words. It is an expression of need. In chronic pain, we must ask why is pain a predominant feature of this person’s life? What are the needs that must be met for the suffering to ease?

To understand this, the person must be free to express their lived experience from the first person perspective. As clinicians and therapists, we can only gain insight through deep listening within a supportive, encouraging and compassionate environment.

Deep listening involves being present and paying full attention to the person. Not only do we hear their words but we see how they are embodied and delivered. Getting to know our own biases and beliefs allows us to let these go so that there is no ‘filter’, just pure awareness. This begins the therapeutic process.

See the latest #upandrun post here >> Brighton Marathon to raise awareness of the problem of pain and what we are doing to drive social change

RS

Count down to Brighton Marathon

#upandrun

This is the hashtag to look out for! Please share and let’s get the wheels turning

Less than a week to go until the Brighton Marathon 2019 for CRPS UK and UP. It is going quickly!

This week is just easy movement: simple, short, easy runs, lots of ‘motion is lotion’ (a phrase I use with people day in, day out), fuelling and other relaxing things.

Each day until the marathon on Sunday, I will share a Pain Point. After all, UP is all about raising the awareness of the massive problem of pain and delivering the right messages based on what we really know about pain to society. The way we deal with pain, especially chronic pain, must be revised in line with new knowledge. At the moment, the bulk of the understanding remains in theory — in academic and research circles. We need this to be ‘out there’, with the people.

‘The people’ includes everyone. Those millions and millions of sufferers and those providing care. The basic problem is the misunderstanding of pain, which results in the wrong messages and treatments and the poor outcomes that we see. The numbers are not improving in our society that we can argue is a suffering society, with chronic pain being a major symptom. More on this later.

Map of Brighton Marathon

So, what can you do? Share these blogs and messages within your circle of friends and colleagues and let’s drive this forwards. We can reduce suffering in society but we must do it together, ‘bottom up’. People demanding that they are give the right information about pain and what they CAN do to move forward with their lives.

You can support our work here >> Richmond’s sponsorship page for the Brighton Marathon: click here

Come along to the free Understand Pain Talk on May 22nd >> tickets here

And the fun quiz on the evening of May 22nd in Surbiton at Wags N Tales >> tickets here

Thanks for your support and helping to build a better society by easing pain and suffering!

RS

Taper time for #upandrun

Less than 2 weeks before the Brighton Marathon (Sunday 14th April), which means tapering. The last road marathon was the London in 2017, and I didn’t get the final preparation right. However, it’s all about learning and improving. At that stage I thought that long distance running did not require much planning…

I completed the final 20 + miler on Saturday and it felt great. It is Monday and I am pretty much recovered — the 175 stairs upward at Russell Square this morning left me with a little burn deep in the calf muscles. They need some attention: stretching, rubbing, easy contractions.

Initially I had thought about running Brighton and then next day doing 40k in readiness for the ultras in May and July. Taking advice, I scrapped that idea, however I need to get back to the mileage and some hills soon after the marathon. There is only a few weeks before the trot around the Isle of Wight: 106k over two days.

There is a different feel to the (road) marathon and the (off road) ultras. The obvious contrasts are the distance and the terrain, but for me it’s the whole vibe of trail running that energises me. There’s no great talk of times, instead completion, camaraderie and countryside.

So, the next couple of weeks will be light runs, getting lighter, lots of resting, stretching, meditating and fuelling up.

Don’t forget the quiz on May 22nd in Surbiton >> tickets here

And the Free Understand Pain Talk also on May 22nd at The Groves Medical Centre, New Malden for people suffering chronic pain who want to understand their pain and move on to a better life. The workshops and talks are one of the ways that we intend to share the right messages about pain and what people can do to improve their lives. To scale this we need to continue to raise funds, the reason for the #upandrun series.

If you suffer chronic pain or know someone who does, you will realise the size of the problem, the mismatch of the needs of millions of people and what is offered. The misunderstanding of pain in society often leads to the wrong choices and treatments — frequently a narrow focus on the area that hurts rather than on the person. Pain is poorly related to tissue state. Pain is well related to the state of the person. Most people realise this when we reflect on the changes in state and how the sensations of pain vary. It’s experiential rather than a concept.

The bottom line is that pain can and does change, starting with understanding it. Many people often realise an immediate reduction in suffering when they blend what we know about pain with their own narrative and experience. The knowledge of how the brain processes information, how we embody our thoughts, feelings and actions, and the emergence of conscious perceptions are all delivering great insights for us to distill into practical ways of improving our lives.

upadnrun

You can support our work here by sponsoring me…thanks!

RS #thepaincoach @painphysio

Understand Pain Talk & Workshop 22nd May

Richmond at The Understand Pain Workshop

The Understand Pain Talks and Workshops are our way of getting out into communities and listening to people: the voices of society. A suffering society. At UP, our purpose is to contribute to society by showing people practical ways of reducing their suffering by living their best lives.

Understand pain and move on to live a fulfilling life

On Wednesday 22nd May, Richmond will be talking and running an UP workshop in New Malden.

This event is free, although we always welcome donations to fund our going work.

Click here to get your place

 

Training so far

Richmond Stace in Glasgow
Running in Glasgow

Touch wood things are going pretty well. Training is totalling 70-80 km per week with 1-2 longer runs, interspersed with shorter dashes and trundles. As a trainer friend said to me once, ‘Just get to the start line without an injury and you’ll be ok’. There is some truth in this of course, but with the Brighton Marathon coming up soon, followed by the two ultras in May and July, the mileage is key.

If you’re interested in running, the following  section outlines my plan. Feel free to skip on!

#upandrun ~ hashtag on Twitter to follow and tweet

Last week I set myself a plan to run 1 x 30 km and 4 x 10 km, totalling 70 km. It felt good and was easily slotted into the working week. This week I am practicing two longer runs back to back and will continue with this trend. Today was just over 22 km and tomorrow I will do a minimum of 30 km on slightly tired legs. Either side will be a few 10 km runs when I try to push the pace.

Map of Brighton Marathon

There are 5 weeks until the Brighton Marathon (Sun 14th April). The last week or so will be tapering and fuelling. Prior experience of ‘the week before’ tells me that I need a good plan. This includes plenty of mindful practice, imagery, easy movements, eating well and rest. I have found it to be a twitchy time with a unique restlessness of mind-body. This will be a good test.

Map of the Isle of Wight Challenge

Soon afterwards comes the Isle of Wight Challenge. There will be a few weeks of continued training with back to back longer runs and again the tapering a week or two before the 2-day event at the start of May. A longer gap before Race To The Stones (July) means resuming the mileage in warmer weather.

One of the pluses of these ultras is the scenery. I have been to the Isle of Wight and enjoyed the spectacular views from certain well known spots. The Challenge allows for the experience of the complete tour! That excites me. As does the route from The Chilterns, across the top of the North Wessex Downs, along the ancient path–5000 years!

Map of Race To The Stones

The Brighton Marathon #upandrun is a joint project, UP and CRPS UK. The money we raise through sponsorship, the quiz night (details soon), auction and raffle will support our on-going work to make a contribution to people’s lives and to encourage society to revise the understanding of pain.

Further, look out for the run of UP workshops. The aim is to offer these across the UK if we can raise sufficient funds. You can support us << here >> . If you suffer chronic pain or know someone who does, you’ll understand the importance of this project.

RS

#upandrun 2019 series

#upandrun 2019
Training in Glasgow

Brighton Marathon 2019

Recently we have added another event to the #upandrun 2019 series — running to increase the awareness of the problem of pain; the No.1 global health burden.

On 14th April I will be running the Brighton Marathon jointly for UP (Understand Pain) and CRPS UK, two years after a similar project with the London Marathon. The Brighton Marathon is celebrating 10 years, so congratulations to the designers and organisers for achieving the milestone. The weekend is packed with different events including mini races for younger runners. And it is all by the sea, so we can be breathing in that sea air as we run along the route. I can’t wait!

The CRPS UK team will be in the Charity Village so do come and say hello. I will also be around before and after the race to chat.

Fundraising, an UP workshop and quiz night

This is a fundraiser as well as an awareness event. The money that is kindly donated goes towards the work of both CRPS UK and UP. There will be several associated events: (1) an Understand Pain Workshop for people suffering chronic pain to learn about what they can do to move forward with practical knowledge and skills (2) a quiz night at Wags N Tales in Surbiton. The quiz night we held in 2017 was a great success. People came from from far and wide to support us, enjoying the quiz, the company and the food. As soon as dates and other details are confirmed, we will broadcast the information.

Isle of Wight Challenge

The next event is in May when I will be spending the Bank Holiday weekend trotting round the island coastal path.

I am really excited about this run because it will be my first ultramarathon, covering 106km over the two days. The scenery is stunning around the Isle of Wight, so a combination of the beautiful coast and the camaraderie with fellow runners awaits.

Race to the Stones 2019

Two months later in July, The Race to the Stones will take me… ‘from the Chilterns to the mystical North Wessex Downs past mighty iron age forts, ancient monuments and through some of Britain’s most stunning landscapes’, along a 5000 year old route. I love the mystical element, but I will not be dressing up!

With these great events coming up soon, training is occupying a good amount of my ‘spare’ time. Clocking up the plodding miles so far has been surprisingly enjoyable, despite tough periods of running with tired legs, various tightnesses and twitches and restless nights. One of the main reasons is the purpose behind #upandrun. Knowing and reminding oneself of the purpose is a strong motivator to both get out there and to keep going. These are also metaphors for life, and many can be found in the running world.

On my shirt is the UP logo, and just seeing that and knowing what it represents drives me onwards. Behind it is the day to day work of sharing the latest understanding of pain so that as a society we can reduce the suffering and the financial burden. Recent figures suggest that the annual cost of chronic pain in Europe is in the region of €441bn. The stats are similar in the US. And then there is the rest of the world. This is truly a global problem of enormous scale that I believe we can make an impact upon by developing our thinking in line with current understanding and models of pain.

RS

Getting the best of Christmas

5 top tips if you suffer chronic pain

If you are suffering chronic pain, here are 5 tips to maximise your festive spirits and joy. You can decide upon your approach and give it your best by following some simple principles.

1. Make a plan

What is your picture of success? How do you want Christmas to be? What can you focus on that would make it memorable for the right reasons?

The questions we ask ourselves, we will always answer. So, make sure you come up with ones that self-encourage, helping you to focus on what you want, rather than what you do not want.

Think and act like the person you want to be

Make a plan each day, prioritising the key moments, punctuating them with rest and recovery time. You can share your plan with those you’ll be sharing the day with so that everyone is on board. Of course, the best plans do not always turn out the way we want, so we need to be flexible. However, if we try to stick to it in the best way that we can, often made easier by writing it down, then we are doing all that we can to be successful.

2. Motion is lotion

This is a way of nourishing your body (tissues — muscles, joints, tendons etc.). The key is to be consistent through the day. In essence, the movement is ‘pumping’ blood and hence oxygen into the tissues as well as removing the build up of toxins (that cause sensitivity).

The brain is embodied, and needs movement to survive — the brain needs a body. Pretty much everything that we do requires movement. Anything that gets in the way of the movements necessary to meet our needs will raise the perceived threat value. As many readers will know, pain is well-related to perception of threat and the state of the person, and poorly related to the tissue state.

Move to groove >>> any movement is a good movement!

A simple way of using ‘motion is lotion’ is to move and change position every 15-20 minutes, and then stand up and move around every 40-60 minutes. These are ball-park figures and it is important to work out your own need for movement. Further, you may like to use prompts and reminders until this becomes a habit.

3. 3 breaths

As often as you can remember (use reminders for this as well), stop and pay attention to three full breaths. Notice the moment when you first breathe in, the sensations in your body, and as you breathe out, the sense of letting go.

Attention is one of the skills of being well. A famous study was entitled, ‘the wandering mind is an unhappy mind’; in other words, the more we can pay attention to what is really happening, the happier we feel. Paying attention to your breath is a simple way to develop this skill.

Notice how you relax and muscles ‘let go’ as you breathe out. This is because on the out-breath, the parasympathetic nervous system is more active. This branch of the autonomic nervous system is responsible for all the important healthy functions behind the scenes: digestion, sleep, energy, anti-inflammatory activity and more.

5/5 breathing >>> count slowly to 5 as you breathe in, and count slowly to 5 as you breathe out. Continue for a minute or two, or longer

We have no direct access to our biology. It is in the dark, so to speak. However, there are one or two things we can choose to take control over to an extent. Breathing is one, with all the benefits that come with the innumerable practices that have been ‘breathed’ over the centuries.

A further use of the 3 breaths is when you feel tense, pain, frustrated, angry, upset or any other emotional state. Notice how when you pay attention to the breath, those feelings ease. This is because you have stopped fuelling them with the thoughts.

4. Meaningful connections

We need each other. We are design to connect and share and be generous. Have you noticed how your feelings change when you do something for someone else, no matter how small or insignificant that it may be? In fact, it is the little things, consistently, that make the difference, especially in a relationship.

How great does it feel to be with people who care about you, and you care about? Notice how that feeling builds when you pay attention to it (re-read the bit on attention above if necessary). Become aware of those great feelings and sensations in your body when you merely think about a special person.

Even when you don’t know the person you are encountering, can you make the connection meaningful by passing the time of day, and smiling? Of course you can! This can become the way you do it; your style.

Watch other people interact, share and be kind to each other. You will change state and feel it. Pay extension.

One way of connecting is by touch. Again, by design we have a system dedicated to light touch that is a direct way of soothing another, showing care and concern and evoking a healthy biological response. This is also a simple way for a partner to share a moment with you.

The key to feeling the effects, is to be present. This is the only moment, right now…it’s gone, and here is another…gone, and so on. Being present means that you can pay attention to what is actually happening, rather than being embroiled in the mind’s wanderings. To be present is also a skill to practice.

5. Smile. Just because you can

Notice what happens when you bring on a gentle smile. A soft upturn of the corners of your mouth. You can choose to tie this in with the now well-known practice of gratitude. The (biological) state of gratitude is one of the healthiest and an ‘antidote’ to suffering states.

Before the practice, it is important to acknowledge that all states are normal and part of the spectrum of feeling states. We need all of these states of course, as they communicate a need.

What are my needs right now? This is a great thinking tool, as you step back from being caught up in it all, and realise what it is that you need to do in this moment: move, breathe, eat, re-frame a thought etc.

What are my needs right now?

To practice gratitude is to become aware of something in your life that you are grateful for. There are many things that we can chose. Of course, whether they become apparent depends on your mood. A handy mantra here is: for a good mood be grateful, in a bad mood be graceful.

Practice: think of a moment in your life when you felt truly grateful for something. Focus your full attention on this memory, re-living it using all your senses, noticing which senses amplify the feelings. Is it the sights, the sounds, the feel? As you continue to focus on the feelings as they arise in your body, notice how they build.

Moment to moment noticing of things to be grateful for and those that bring you joy is a practice; a skill. For instance, you can decide to approach the day by looking out for things that make you laugh or smile. Then you practice.

The fact of the matter is simple in principle. The challenge is to keep focused and pay attention to what is really happening in the face of the many distractions. It is to realise that we live out a story that can appear to have been written for us. There’s some truth here in as much as we are fed beliefs from a young age, many of which are wrong, yet can limit us as we grow. Realising that you do not have to continue with the same story if it is full of suffering, is the first step to moving onward. Many don’t realise their potential, feeling that somehow, this is it. Not true. Is it time for a new story for you?

What will be your story from now?

And so, what will be your approach? How are you going to do Christmas? How are you going to do life? What is your picture of success? What principles must you follow each day to get those little wins on the way forward? Make a plan, get the right support and encouragement around you, and go for it. Each person is a miracle when you think about how we came into existence and how we are designed to grow and serve a purpose.

Merry Christmas.

Next challenge: Race to the Stones

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For some time I have been eyeing up the idea of ultra running. Having spent the past few years training for and completing several marathons and half-marathons, the urge to take it onto another level overcame me. I booked myself a date with Race to the Stones.

An old friend completed the 100k run this year. I went down to collect him and watched the runners coming in. There was such a great vibe! Much like a mini-festival; relaxed, encouraging, inspirational and lots of smiles…in amongst some pain of course!

The course follows an ancient path. We will be running and walking in the footsteps of Vikings, Romans, dragons and Kings — not in fancy dress I hasten to add!

Journey from the Chilterns to the mystical North Wessex Downs past mighty iron age forts, ancient monuments and through some of Britain’s most stunning landscapes

As ever, the run will be for Understand Pain, #upandrun. You can keep an eye on progress and other running events here and on Twitter and Facebook and Instagram.

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Race to the Stone 2019

On we go!

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Beachy Head Marathon 2018

 

UP 6 Week Programme go-ahead

There’s been a lot of work going on behind the scenes at UP. One project that I have been creating is a 6 week UP programme to be delivered to NHS patients. The beauty of the programme is that whilst the content is based upon the latest thinking in pain and associated scientific fields, the actual practices and tools are really simple.

The aim of the UP Workshop is to help people to understand (their) pain and to lead fulfilling lives. This is achieved by following certain principles during day to day living, towards a picture of success.

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Currently we are towards the end of the design phase. This involves deciding upon the content and how it will be layered week by week. Whilst the aim is to deliver knowledge, skills and know-how, we will also be measuring the effects together with a cost analysis. Such data will be important for scaling the Workshops to address the huge problem of chronic pain that exists in society (€441bn per year, SIP).

RS