Author: Richmond Stace | The Pain Coach

What training do I do?

Richmond Stace | The Pain CoachLeave a comment

My own practices each day

IMG_4275

During our conversations in the clinic, people often ask what I practice to keep well. The simple answer to the question is that I have grooved several key practices that enable me to think clearly, and see things for what they really are. Now, to qualify this, yes I have been practicing for a long time, and no I am not perfect at them! They are always work in progress as we learn more and more about ourselves, the world and how the two come together.

So, the main practices are mindfulness and exercise. Sounds simple! It does actually get easier and easier to live them as they become second nature and part of who are are. More importantly they are part of your ‘why’, or your purpose in life. Starting with a vision of success, you can then choose to orientate you thinking and actions toward this picture. To achieve something takes practice and focus and learning. Mindfulness and exercise are both important for this as ways to improve performance, but of course they themselves are to be practiced.

The idea of the Pain Coach came to me having thought about the best way we can address the huge problem of chronic pain. I wanted a way to authentically reach the person and encourage them to take the steps to success, feeling inspired by what they are doing and achieving. In essence, the person is coached to become their own coach, simply because we are with ourselves all the time and need to make decisions and take action. To overcome pain, which we can, this needs to be consistently in-line with the health ‘me’. But, we are all coaching ourselves. That inner dialogue we all generate and experience can be so influential in our perceptions, actions and thinking.

~ how am I choosing to feel?

One of the areas I have worked upon in my practices is the inner dialogue. The realisation that the inner dialogue is saying ‘……….’ and that I do not have to listen and instead choose another route, is empowering. Of course that does not mean that the ‘negative’ voice is not heard. It means we can choose to think in a different way, feel a different way by actively carving a new thought pattern or action. How am I choosing to think? How am I choosing to feel? Two great questions to ponder as they create space to make a decision in line with the best you captured by the vision.

Mindful practice

Mindful practice takes a number of forms. I find the practices described by Thich Nhat Hanh and Pema Chödrön to be highly relevant and effective for the modern world in which we live ~ here’s an example.

The formal practice of sitting and being mindful or mindfulness meditation develops our skills in paying attention, knowing our mind’s habits, experiencing a healthy flexibility with our emotions and often a calmness that is welcomed. However, in practicing, we are not trying to get anywhere or actively creating a certain state. Instead, we are open to whatever arises each moment, whether pleasant or unpleasant, seeing things for what they are.

~ paying attention and being present gives us great insight

Day to day practice, or through the day practice, string together awareness of what is happening in this moment. Our mind’s natural state is to jump around, into the past or future, which if unskilled means that we embody this flitting to the point of discomfort and suffering. There is a difference between being aware that you are holding a memory about a particular event and re-living it. Both will be emotional, but one causing much more suffering than the other. In being mindful, one learns to let go instead of gripping on and replaying the tape, building the emotion with the knock on effects for the day.

A simple way of achieving this is by consciously taking 3 breaths and slowly breathing out. Setting a reminder of having a prompt can be helpful until it becomes second nature.

Learning to ease your own suffering

To learn to ease your own suffering allows one to present the ways to others, so that they might ease theirs. Undoubtedly, everyone experiences suffering through their lives as it is unavoidable. This suffering, when transformed, becomes one of the most valuable learning experiences that can be used to benefit others and society. The great people people we listen to about the ways we can ease suffering have suffered enormously and this is no coincidence.

The most potent example of suffering is the loss of someone you love. And whilst the pain may never go, the suffering can and does ease. Indeed, when the experience is then looked at, if some good were to emerge it would be a deeper compassion for others’ suffering and an ability to help and support others to move onward in a chosen direction.

On a more day to day basis, suffering comes on the form of anxieties, fears and wanting to be someone or somewhere else. Resisting what is happening and how you are right now causes great tension and discomfort. People can behave in unpleasant ways when they feel they are not getting what they ‘deserve’.

Mindful practice, which is simply being open to all experiences, seeing how they naturally transform and pass, letting go of attachments and being non-judgmental, relieves all of the causes of suffering mentioned above. We can also develop the insight to understand the causes of our suffering: ‘know thyself’. Exploring the question: ‘who am I?’ can be most challenging, but most revealing and the way to perform our best at home, at work or on the field of play

We can all develop our own ways of practicing according to our philosophy of life. Starting by defining that philosophy and writing it down alongside the clear picture of what the desired life looks like, sets the stall. These are some of my tenets:

  • We are designed to change and we can choose the direction we take by choosing an attitude to life
  • We are great learners and opportunities to learn exist all the time
  • We all have incredible potential
  • We can choose to do our best each day
  • We have the basic tools, but it is down to the individual to take responsibility and flourish

What will you choose?

RS

Every picture tells a story. Or does it?

Richmond Stace | The Pain Coach1 Comment

Where is the pain on this picture? On any picture?

When it comes to pain and injury, the two are frequently thought of as synonymous. There is the well trodden path of reporting pain resulting in a scan or x-ray resulting in a finger pointing at an area on the picture as the culprit resulting in some pills, an injection or perhaps even surgery.

We must qualify the importance of eliminating serious pathology or tissue damage requiring intervention. Once this has been done, and in the vast majority of cases of chronic pain there are no serious findings, the focus must be on getting better.

However, the truth about pain and pictures is rather different. Yes, you may be able to see on an image an area of ‘wear and tear’, a disc bulge, a disc herniation, signs of osteoarthritis, or other visible changes. You cannot, however, see pain. So when pointing to one of these ‘structures’, how can you say that this is the cause of pain. How do you really know?

Consider a recent paper, ‘Systematic literature review of imaging features of spinal degeneration in asymptomatic populations’ (2015) that concluded: ‘Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal ageing and unassociated with pain. These imaging findings must be interpreted in the context of the patient’s clinical condition’.

Further, Herzog et al. (2017) considered the experience of a person being scanned at 10 different centres over 3 weeks. They found a ‘marked variability in the reported interpretive findings and a high prevalence of interpretive errors in radiologists’ reports of an MRI examination of the lumbar spine performed on the same patient at 10 different MRI centres over a short time period’, concluding, ‘that where a patient obtains his or her MRI examination and which radiologist interprets the examination may have a direct impact on radiological diagnosis, subsequent choice of treatment, and clinical outcome’.

~ drugs and interventions do not teach us how to live or overcome pain

The poor relationship between pain and injury has been a known fact for many years. Pat Wall stated this as far back as 1979, with a huge number of studies and observations in the wake of this since. This poses the burning question, why does healthcare and society continue to ignore this fact and continue to concentrate upon a senseless search for a structure to explain pain? Followed by the question of why people are so often offered drugs and interventions as the way forward instead of understanding their and learning about how to overcome pain and live a life. Whilst drugs and interventions can have a role, they do not teach us how to live. Sustained change takes understanding and the practice of healthy skills.

Other pictures

Brain scan studies have given us incredible insight into the activity of this magnificent organ. It is like porridge. There are areas that show themselves to be ‘working’ during the experience of pain, and this has generated much excitement. Perhaps these are the ‘pain areas’, some people thought. Unfortunately not. There are no pain areas, and for that matter, there are no pain signals or pain nerves. Instead we have systems that play a role in our survival and protection including the nervous system, immune system and autonomic nervous system.

There are two important points here that we must consider. Firstly, we are more than a brain, much more. I am a whole person, embodying my thoughts, feelings, intentions, perceptions and actions. Secondly, as with MRI scans, we cannot point to an area and say that it is pain. We simply do not know how measurable and observed physiological activity becomes a lived experience. A question posed in an excellent paper by Krakauer et al. (2016) is this, ‘how does the brain lead to behaviour?’. Whilst the article is not about pain per se, they state ‘neural circuits do not feel pain, whole organisms do’. This thinking is very much in line with the very modern approach to pain: whole person.

Pain is subjective

The bottom line is that pain is subjective, only ever to be experienced by the person who’s pain it is, and never to be seen. A disc is a disc, not pain. A joint is a joint, not pain. A swelling is a swelling, not pain, etc. These observable features are objective and hence by definition not the same. It is essential that society and healthcare shift away from the predominant and existing thinking, and take on the facts of pain as we have known them for over 30 years.

Pain is a body, or whole person state. Pain is about protection when a threat or a danger is perceived, consciously or unconsciously. If the weight of evidence suggests danger, it makes sense that we should shift into a protect state. However, in chronic pain this state emerges because there is a frequent interpretation of possible danger. On the basis that we work on a ‘just in case’ basis, there might be a threat, so a protect state comes forth as the primary state just in case. You may argue the point that if there is nothing ‘wrong’, and that there is no damage, why should it continue to hurt? In short, this is because the interpretation based on what has happened before (priors) maintains a level of existing threat. You could ally this to habits and habitual responses based on what has happened before and expectations of what is likely to happen, again based on priors. More on this in a subsequent blog.

For now, to simply say again, pictures do not show pain.

RS

 

Compassionate abiding

Richmond Stace | The Pain Coach1 Comment

A way to approach unwanted feelings by Pema Chödrön

Man and woman holding hands at a table

Pema Chödrön writes with deep compassion about the challenges we face in the modern world. Pema and Thich Nhat Hanh are two of my favourite reads, as they bring the philosophy of Buddhism to the people in a practical way. The practices do not need to be considered spiritual, instead ways to gain insight, patience and build compassion toward ourselves and the world. They offer a great deal more than that too!

My Pain Coach Programme is a range of simple and practical skills that you use to overcome your pain and live your life meaningfully. These skills are based on understanding your pain, the key foundation from where new healthy habits emerge. Here is a wonderful practice from Pema, compassionate abiding, which is a way to bring warmness to your feelings of discomfort. We all experience uncomfortable emotions and feelings, yet we are rarely trained how to face them, instead encouraged to avoid them. These feelings are a NORMAL part of life and hence unavoidable. Therefore, having the skill to be open to these feelings is a way to ease suffering.

In relation to pain, we have many associated feelings and emotions that increase suffering. There is the pain itself and then the suffering we live from the way we think about it. When you realise that you have a choice, it is hugely empowering. ‘How am I choosing to think about this pain?’ is the question to pose to self. As you step back from being embroiled, you gain insight and actualise the opportunity to make a choice to think differently and feel better. This is why it is so important to understand pain. To understand pain is to know that you are safe and free to make choices, and to live.

The practice

When you realise that you are hooked, which is that familiar feeling you have when a habit is about to arise, you use this practice. We all have many hooks that lead to the unpleasant or unwanted emotions and feelings, from seeing that the loo seat is up to the way a partner says something, from Monday morning blues to the craving for a cigarette. Other examples include addictions, phobias, fears, prejudice, shame, and rage

The embodied feeling emerges often with a familiar inner dialogue. However, we can choose to write a new script, a positive script. Interestingly, our self-confidence is determined by what we are telling ourselves and listening to (these are different) in this moment ~ watch here. Remember though, it is normal to feel the range of emotions. We need them all, even if we don’t enjoy some of them. No-one ever said life was wholly enjoyable!

In 2 parts

Breathing in

Being in touch with and open to the feeling of being hooked, breathe in deeply, allowing the feeling to really be there. Allow the feeling to exist. We can be tempted or in the habit of pushing away. You will be aware of the urges and discomfort, and that is normal. You can be ok, you can be comfortable with being uncomfortable. You abide with the feeling.

Breathing out

As you breathe out, you ease the tension that is part of and surrounding the discomfort. The out-breathe frees us from this tension as the space in which the embodied feeling exists becomes apparent.

When to practice

There is no limit to how much you can practice. I think a useful start point is to sit somewhere familiar and practice for a few moments and over time gradually increase the length, or blend with other mindful practices. Of course, drip-feeding our selves through the day, so little and often, has a really beneficial effect because we form a healthy habit. We can also practice as we become aware of the feelings of discomfort as they arise, touching the experience with our own natural warmth and compassion. You will notice how your typical reaction softens.

We are not pushing the feeling away. Instead we are fully there and present as the feelings transform, as all feelings, thoughts and emotions do. Nothing is permanent. No matter how ‘bad’ you are feeling right now, it will change because we change, every moment, like the water of a river that continues to pass by. This fact and the science of pain that gives us a new understanding of our potential, gives great hope and reason to be optimistic. Be inspired to live well, because we can.

A life of appointments

Richmond Stace | The Pain CoachLeave a comment

When life is dominated by the next appointment


Most people I see have a long story of pain. Frequently there has been years of suffering that has and does impact upon their life.  For some their days are strung together by appointment after appointment as they search for an answer to their pain. The key that unlocks that door is understanding pain. To understand pain is to know what you can do to move onward in a chosen direction. Undoubtedly, we can be successful in overcoming pain because it can and does change. We are constantly changing, like the water of a river, there is constant movement in one direction. Embracing and harnessing our potential enables us to live a meaningful life.

Whilst seeking an answer, there are always boundless doctors and therapists who offer solutions. Skipping the understanding bit and hastening to a remedy or treatment is often the way, yet the foundation is not in place. We must understand our pain to gain a sense of meaning, to know that we need not fear pain and instead to focus on certain practices and skills to enable change.

Expectations are typically low in chronic pain, which affect outcomes. The promise of success followed by yet another failure hits hard. Some people even blame themselves as the self-critic chips in. Developing self-compassion is a key skill as we learn to be patient with ourselves, let go of blame and focus on living well. To be harsh towards oneself is to provoke the same biological protection as when we feel pain. Of course our expectations are based on what we know, past experience and in the moment adjudication of the likelihood the treatment will work (based on what we already know again). In essence it is a prediction as is our current perception. The wonderful thing about being human is that we can change the prediction and infer something else. It is time to expect to get better. To expect that life will be full of challenges, but to expect to face them, learn and move on in a meaningful way. This starts with understanding pain.

One of the issues with on-going appointments is that the person maintains their focus on pain in their life. There is plenty more to define the person than their pain. What we focus upon we get more of, is a loose rule. If pain becomes dominant and rents much space in our conscious capacity, then there is little room for anything else. We must make space and while we are attending appointment after appointment, no space is being carved out. But I need the appointment because I must check and see if I have…….. etc, you may say. It is true that we must elimate any serious pathology or injury that necessitates repair, but beyond that, if the focus is upon living well and practicing such skills, then getting better is possible. The roundabout of consulting rooms is not.

~ pain and injury are not synonymous 

Regular readers know that pain and injury are not synonymous. They are different. And they are poorly related. We have known that for years yet the modern approach persists in a search for a structure or pathology to explain pain. There is no such thing as pain is a body, or whole person state. Like fear, like love, like hunger. You can see none of these because they are lived phenomena, experienced by a person and embodied by a person. A herniated disc, a disc bulge, an inflamed tendon, none are pain. Pain is a state of protect that emerges in the person in the face of perceived threat. Yes, these visible changes can co-exist with pain, of course. But they are not pain and not the cause of pain. The cause of pain is a perceived threat. It is how we and our body systems (they are not separate) interpret what is going on in our body but within the context of this moment (emotional state, environment, who we are with, what we are doing, prior events etc) that determines whether we feel pain or not. You will note from this description all the opportunities we have to change pain, because pain is part of me as much as my ears or my hair so it is mine to change. The change begins with understanding pain.

So, once you have seen the relevant specialists and determined that there is no serious pathology or injury that needs repair, and it has been confirmed that this is a problem of pain, then you can focus on getting better. This is through the practice of the skills of well-being whilst maintaining a course towards your picture of success, the healthy you with purpose.

Open space in your life to live well and be inspired to reach your potential, because you can.

RS ~

A grudge against pain

Richmond Stace | The Pain CoachLeave a comment

Forgiveness ~ Wanting a yes but getting a no and being at peace with it

funny evil gray striped cat

Frederic Luskin describes forgiveness as an ability to be at peace with what is, with the vulnerability that is inherent in human life. It is to accept this moment in a way that allows the next moment a chance. He talks about not getting what we want, receiving a ‘no’. In other words, I wanted a healthy life but I got a ‘no’ ~ I am not leading a healthy life, I am in pain. To forgive is to be resilient when things do not turn out the way we desire.

I feel that there are several themes here that are very relevant to pain. You may have already considered this point. If you have pain, you are getting a ‘no’ because that is not what you want: “I want to live a pain-free life. I got a no”. How are you dealing with that no? You can make the choice to forgive.

The effects of pain often result in many no’s because of limitations and avoidance: exercise, work, social events. The challenge is to turn this around, and forgiveness is one way in which you can, because you have the choice. We all need to realise the choice we have and how they can result in success, happiness and living well.

~ acceptance is not the same as giving up

To accept where one is and acknowledge one’s capacity or tolerance is a key first step. This is not, I hasten to add, giving in by any means. Instead, it is simply accepting your current status or fitness, to enable moving onward in your chosen direction. The opposite is to resist, resulting in continued frustration, annoyance and upset that does not take you in your desired direction. To do this we need to be able to forgive in the sense of forgiveness described above.

When we forgive another person, we are actively creating the conditions to move onward in a positive direction. This does not mean we condone the perceived offence or suggest that it was acceptable. Instead we acknowledge that we can move on, talk about the issue in such a way as to breed healthy learning. This is the case for both parties. Continuing to hold resentment on the other hand is distinctly unhealthy. ‘Who is holding the burning coal?’ one may say. How many festering resentments exist? How does this inform the next moment or next relationship? How many people act out with their current partners as if they were the prior abusive or unloving partner?

So who do we forgive for our pain?

The answer depends on who or what you blame. The continuance of habitual thinking, both consciously and subconsciously, about the causation of one’s pain often leads to further frustration, annoyance and upset. All of these states make it more likely that we suffer more and hence we are not heading in the right direction. These hooks, as Pema Chodron describes, are what trigger repeated patterns of thinking and emotion. But, we can become increasingly aware and practice skills to let go of such hooks and ease our suffering. Pema recommends developing your awareness when the ‘hook’ happens, taking 3 breaths and practicing letting go. This simple practice works, and gets easier like all things we focus upon and do the best we can.

~ take 3 breaths and let go

The pain that we feel is ours. It emerges in me, felt in my body, perceived within the context of my life to this point and relevant to this moment and the situation I am in. Pain is all about protection and often ‘just in case’. When we have an injury, pain is a vital survival mechanism that motivates action to promote healing. However, pain is poorly related to the amount of tissue damage, instead representing a body or whole person state of protection. It changes the way we think, feel and act, which is useful in the acute scenario. This becomes less useful as time goes on, as healing progresses and as we try to resume normal activities. In many people, despite the healing, the protective state continues to kick in as the body systems detect possible danger, based on learning or what has happened before. Pain itself become the problem.

Whom or what we attribute the blame for your pain then becomes the subject of our forgiveness. Here are Luskin’s 9 steps:

  1. Know exactly how you feel about what happened and be able to articulate what about the situation is not OK. Then, tell a trusted couple of people about your experience.
  2. Make a commitment to yourself to do what you have to do to feel better. Forgiveness is for you and not for anyone else.
  3. Forgiveness does not necessarily mean reconciliation with the person that hurt you, or condoning of their action. What you are after is to find peace. Forgiveness can be defined as the “peace and understanding that come from blaming that which has hurt you less, taking the life experience less personally, and changing your grievance story.”
  4. Get the right perspective on what is happening. Recognize that your primary distress is coming from the hurt feelings, thoughts and physical upset you are suffering now, not what offended you or hurt you two minutes – or ten years – ago. Forgiveness helps to heal those hurt feelings.
  5. At the moment you feel upset practice a simple stress management technique to soothe your body’s flight or fight response.
  6. Give up expecting things from other people, or your life, that they do not choose to give you. Recognize the “unenforceable rules” you have for your health or how you or other people must behave. Remind yourself that you can hope for health, love, peace and prosperity and work hard to get them.
  7. Put your energy into looking for another way to get your positive goals met than through the experience that has hurt you. Instead of mentally replaying your hurt seek out new ways to get what you want.
  8. Remember that a life well lived is your best revenge. Instead of focusing on your wounded feelings, and thereby giving the person who caused you pain power over you, learn to look for the love, beauty and kindness around you. Forgiveness is about personal power.
  9. Amend your grievance story to remind you of the heroic choice to forgive

 

Finding peace is a skill. There are many reasons why life can be turbulent. Choosing to create the conditions for peace by being aware of your habits, or hooks, and letting go results in a happier existence. Together with the skills of wellbeing, such as acts of generosity, noticing positive emotions as they arise, learning to pay attention, and resilience to name a few, this forms a healthy way onward. We can enjoy the good times, appreciate each moment and face the inevitable challenges in life with insight, knowing that time will always pass like the water of a river. Forgiving is a way of finding peace by letting go.

Henderson’s foot

Richmond Stace | The Pain CoachLeave a comment

Plantar fasciitis is a lot like a tendon problem

Foot prints. Vector watercolor illustration

Liverpool footballer Jordan Henderson is suffering plantar fasciitis. His manager, Jurgen Klopp, is monitoring his progress but cannot confirm whether Henderson will be able to play again this season ~ report here. Lower limb injuries and pain are an occupational hazard for footballers, particularly those who make a career from the game. Here are some important considerations.

Pain and injury

Pain and injury are not the same. Are you injured? Or does it just hurt? An injury can be from an inciting event such as a twist or contact with another player. Or it can a ‘slow burner’ when there is a gradual breakdown of tissue. The point that this is detected by the body systems that protect us and interpreted as dangerous is the pain moment. It can take a long time for this to brew into something conscious. You will note from this that there are at least a few layers of activity before we actually feel pain.

Pain and injury are poorly related. We have known this for many years both scientifically and anecdotally. Yet the predominate message in society through implicit thinking is that pain must be due to an injury. Then the search for a structure begins. Pain is a body state of protection, compelling us to take action. A motivator if you like. Pain is poorly related to the state of the tissues. Consider phantom limb pain when there is no limb yet there is pain in a space. The body systems and our brain, which has a significant role in all conscious experiences including pain, work on a just in case basis. Recognising patterns, drawing on past experiences and predicting what the sensory information currently suggests are all part of the processing that underlies our lived experience. Pain does not have a simple physical basis.

The injury moment

At the point when an actual injury occurs, the context plays a big role in what happens next, as does past experience. In this moment there is a rapid assessment of threat. If the weight of evidence suggests danger, then it will hurt. If something else is more important, such as escape or wanting to win the final, it is quite possible for the pain to be minimal or non-existent.

There are other factors that play a role in the processing: where am I? What am I doing? How am I feeling? Who am I with? Have I been here before? What does this mean?

The meaning of foot pain to Henderson is very different to the meaning for me. For me it would be unpleasant, inconvenient and prevent me from being as active as I might otherwise be. For Henderson, it means he cannot work, therefore impacting upon his career. This then, would be far more threatening and hence create a context for more protection. It would be similar if a violinist injured his or her left hand compared to the right. Meaning is key and must be considered.

Persistent pain

Problems that involve tendons, and we can include plantar fasciitis here, typically go on for months. There has been huge amounts of research and work undertaken to look at this problem, most of which has focused upon the tissues themselves. Whilst tissue health and tolerance for force is important, a much wider approach is needed starting with recognition that it is the person who feels pain. This being a fact, it points us towards addressing the person as much as the condition, and even more so thinking about how that person uniquely interacts with the condition. There is a key interface.

Most of the biology of pain is not where the pain is actually felt. Much like the film you watch in the cinema involves much more than the screen. The adaptations that occur in chronic pain are in the emotional centres of the brain, the connectivity between the thinking and planning areas and emotional centres, and in the sensory areas. We are more than a brain of course and all the habitual changes we observe and those that occur in the dark (e.g. neuroimmune) somehow emerge as a lived experience. This delves into questions of consciousness and self.

To address plantar fasciitis then, we need to think about a range of factors, beginning with the person’s understanding of their pain. This understanding sets the scene, reduces fear and promotes engagement in the training and practices needed to overcome the problem. We have to create the conditions for this to happen, which is why the person needs to focus on a clear direction and the means to achieve this. Fears, worries and anxieties will of course intervene, but the more quickly this energy can be transformed into the practices of well-being and specific training, the more efficient will be the recovery. Just as an insight, practices would include body sense training, proprioceptive training, nourishing movements and mobilisations, sensorimotor training, mindful practice, graded exercise (strength, endurance etc). But this is all based upon a mindset focused on success, so the practices of resilience and attention come into play. The aim is sustained learning and change to overcome the problem by facing it and transforming it, not trying to get around it by just using pills, injections and other means of avoidance.

Looking back through the story and knowing the person creates the opportunity to understand how the problem emerged in the case of a slow burner. An acute injury can also be analysed to discover if there were any factors increasing the vulnerability to injury and indeed vulnerability to develop a more persistent problem.

In summary, the bigger picture is always important. Considering the person as much as the condition and ensuring that pain is understood. Understanding pain is the key.

RS

We are more than a brain

Richmond Stace | The Pain CoachLeave a comment

Brain On The Wall

Have we gone brain mad!

There was a great step forward when the brain was considered to be part of the pain experience. The recent popularisation was in part due to the work of Lorimer Moseley who has been researching pain and delivering insights that have definitely caused a shift in thinking. However, it was Pat Wall and Ron Melzack who were the original thinkers, inspiring work in the field of pain science and medicine, with their Gate Theory of Pain (1965).

Brain explanations have captured the popular media as the ‘neuro’ tag is shunted onto the front of words to add scientific validation. We must always check to see if the claims are truly grounded in neuroscience of course. As much as we have people writing and blogging about how science pans out in real life, there are those who sift through the literature and comment critically. We are thankful for the latter as society is regularly hit with breakthrough claims that are sensationalised. How often do we then find out that these claims are unsubstantiated or they quietly go away?

When discussing pain, and this is a complex area, the brain is rightly included. The brain is certainly involved in any conscious experience as best we know, but we are more than a brain. Pain illustrates this well. However, we commonly hear experts talk about pain in the brain, or that we feel pain in the brain. This is not true.

If I am hammering and I accidentally rap the end of my finger instead of the nail, it is very likely to hurt. The pain that I feel will depend upon context. If there is someone else present and watching me, I will have a different experience compared to if I were alone. I may wish to show that I am ‘hard’ and brush it off whilst feeling the intense pain localised deep in my digit. Being alone, I may shout out and wave my hand around, grip the finger with my other hand and ask myself why I am doing this job anyway. There are many possibilities and many different influences upon that pain experience in that moment. This involves the brain, and if I happened to be wearing a portable functional brain scanner (that does not yet exist), you would be able to see activity in certain parts of the brain. These areas are not specific to pain.

There are no pain signals, pain centres in the brain, pain messages, pain nerves or anything else specific to pain. Pain is a ‘body state’ according to Wall (1979), and one that sets us up to heal and get better through motivation. We are motivated or compelled to take action. The relationship between pain and injury is poor and often non-existent, especially in chronic pain states. Pain is about protection and survival.

~ pain and injury are poorly related

Back to my finger. The message that the pain is in my brain is still out there in society. I have just hit my finger. Where do I feel it? Where is my brain? Can I feel the pain there, in my brain? Or do I feel it in my finger?

Pain emerges in the person (Thacker, personal communication) and we feel it in an area of the body deemed in need of protection. Even just in case, which is likely to be the reason for much chronic pain. The body systems that protect continue to do so in accordance with a range of influences and situations, in particular contexts. This is predicted to be ‘dangerous’ or threatening to the (whole) person and hence we experience the phenomena of protection, i.e. pain. Pain is allocated a location in the body where we feel it. The brain is involved in this projection and hence strategies and practices that target known brain mechanisms are to be encouraged. But we also need to address where it hurts and the local tissues and associated areas that adapt to the protect state.

It is the person who suffers pain, not the brain. It is a body area where we feel pain, not in the brain. The brain is involved but we do not feel things in there. Even in phantom limb pain when there is no body part, the sensation and experience of pain is felt in that space. Tissue state and existence has a minimal role, and less so as pain persists. It is about the interpretation and prediction of what the sensory information means based upon prior knowledge that determines our conscious experience.

In our drive to change the way society thinks about pain, this is one of our messages:

Pain is about the person. Let’s treat the person because when the person feels better, the pain feels better. We can change pain. We can live a meaningful life.

RS

Societal Impact of Pain 2017

Richmond Stace | The Pain CoachLeave a comment
Valletta panorama, Malta
Valletta Panorama: Andrey Danilovich

Societal Impact of Pain 2017 Meeting, Malta

The working group topics to be discussed:

  1. Pain as a quality indicator for health systems
  2. Building platforms to address the societal impact of pain
  3. Impact of pain on labour and employment
  4. Challenges, models and lighthouses in pain policy
  5. Evolving concepts in the definition of chronic pain: a dynamic process

I will be attending this symposium to take the opportunity to meet and talk to clinicians, policy makers and others who want to address the social issue that is chronic pain.

Regular readers will be aware that one of the first steps for UP as a social enterprise is to relaunch this website as a practical resource. This work is well under way. UP will the reach across the globe, connecting with people and clinicians who are seeking to be involved. There is great urgency in the need to tackle the problem of pain, not just for the current times but the next generations. We simply have to create new thinking that permeates across society. At UP we will be supporting the next generation of clinicians and healthcare professionals in various ways including sponsoring attendance at Pain Coach Workshops. UP also has plans afoot for the youth who we feel need to understand pain as a simple skill of well-being.

My hope is that I will connect and have discussions with like-minded and determined individuals who seek to drive change. If you are attending SIP and would like to meet for a conversation, please contact me here or via the form below.

Updates and news will be posted here, including during the SIP symposium.

RS

← Back

Thank you for your response. ✨

Last week before the London Marathon

Richmond Stace | The Pain CoachLeave a comment

The London Marathon is next Sunday, 23rd April. This means a week of relaxing, putting my feet up, being fed grapes and generally letting everybody run around after me. Well, that’s the dream….

It’s an interesting time during the tapering. I feel that I should be doing more. My body behaves like a dog waiting at the door with lead in mouth, yet I know (from some excellent advice) that the opposite is what is needed right now. A few easy, short runs will be just fine, I keep telling myself.

It has been hard work but a thoroughly enjoyable test of one’s ability to keep going and maintain a training routine of 40+ miles a week. That’s a lot of time. Some may say ‘me time’. I am grateful for those close around me for allowing me to spend a good chunk of time out there and then putting up with my stretching, moving, twitching and generally fidgeting to ease the aches and pains. I have also probably become a bit ‘boring’ as I talk about the times I have run….

It is hard to avoid thinking about a time. Initially I was just aiming to finish but now I am eyeing four and a half hours. But who knows! I have never done this before so it is a leap into the unknown!

I doff my hat to all my fellow runners and wish them all well on their individual quests. By all accounts the London Marathon day is a great one and I am thankful for the chance to experience the crowds, the buzz and the bobbing heads of the sea of runners.

If you can come and support CRPS UK and UP, you’ll be a welcome voice from the crowd! You can also support our work by coming to our quiz on Thursday (20th April) (click here) or donate here

Happy Easter!

RSunnamed

5 ways a partner can support and encourage you

Richmond Stace | The Pain CoachLeave a comment

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

Be an extra pair of ears and eyes

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

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

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

Understand pain

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

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

IMG_4241
A hug

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

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

Practice the skills of well-being together

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

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

Spend time together doing something meaningful

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

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

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

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

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