chronic pain

We need a new pain definition

Richmond Stace | The Pain CoachLeave a comment

What should the definition consider?

Marsaxlokk market with traditional Luzzu fishing boats

Tomorrow I head off to Malta for the Societal Impact of Pain Conference 2017. The areas that will be discussed include:

  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

Overarching the meeting is the multi-stakeholder platform (SiP) that is described on the website as:

The “Societal Impact of Pain” (SIP) is an international platform created in 2009 as a joint initiative of European Pain Federation EFIC® and the pharmaceutical Grünenthal GmbH and aims for

  • raising awareness of the relevance of the impact that pain has on our societies, health and economic systems
  • exchanging information and sharing best-practices across all member states of the European Union
  • developing and fostering European-wide policy strategies & activities for an improved pain care in Europe (Pain Policy).

The platform provides opportunities for discussion for health care professionals, pain advocacy groups, politicians, insurances, representatives of health authorities, regulators and budget holders.

The scientific framework of the SIP platform is under the responsibility of the European Pain Federation EFIC®. Co-operation partners for SIP 2017 are Pain Alliance Europe and Active Citizenship Network. The SIP 2017 symposium is co-hosted by the Malta Health Network and the No Pain Foundation. The pharmaceutical company Grünenthal GmbH is responsible for funding and non-financial support. SIP 2017 is made possible with the financial support of the Ministry for Finance in Malta.

There are some very important conversations that need to be had, and these must then be translated into positive work. I am absolutely focused on the positive work aspect because we need change, society needs change and we need results. I believe that this is achievable. Of course with all this talk of pain, the question is whether we are talking about the same thing?

The IASP definition of pain:

“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

This was published in 1979 and based on work from 1964 by Harold Merskey. Perhaps it is time for an update! The IASP definition certainly captures some of the features but there is one major bit missing as far as I am concerned. The person.

Pain is a whole person experience. Regular readers will have an understanding of pain now, and the fact that pain is not grounded in any structure or pathology (the biomedical model). Instead, pain is part of a whole person state of protection when there is a perceived threat. The key word is perception and much of perception involves biology in the dark and the hidden causes of sensory events; i.e./ we are aware of certain expectations with regards to pain, but most of the biology is going on without our conscious knowing.

A person suffering chronic pain spends a significant amount of time in a state of protect, much by habit. The range of contexts within which the experience emerges in the person widens as threatening situations are increasingly interpreted (biologically and consciously via habits of thought) as threatening.

I would encourage people to think about a definition of pain encompassing these key features:

  • the whole person
  • perception
  • threat

This would be a good start point. From there we can consider the sense of self and how our understanding of this contributes to the experience of pain. I love the notion of ‘expecting yourself’ as put forward by Prof Andy Clark, a leading philosopher who’s work I think will impact enormously on our thinking about pain, together with Dr Mick Thacker and others who are leading the way.

Exciting times and exciting times ahead. There is MUCH hope now and so there should be. This thinking needs to pervade society and this is the purpose of UP, to deliver the right messages and to deliver solutions with results. Positive work to be done!

RS

Pain Coach Workshop for GPs

Richmond Stace | The Pain CoachLeave a comment

Why should GPs understand pain?

Audience Applaud Clapping Happines Appreciation Training Concept

Sat 3rd June Education Morning at New Malden Diagnostics Centre

~ Do you understand pain?

Can you confidently answer these questions:

  • what is pain?
  • what do we currently know about the causes of pain?
  • what can the person in pain do to overcome their pain?

Pain is one of the commonest reasons to seek help. And we are not only talking about back pain or neck pain, instead thinking about all the circumstances and conditions that feature pain. Digging deeper, whilst the pain is unpleasant by its very nature, it is the suffering that drives the act of going to the doctor. We can even take this a stage further and suggest that the causes of suffering result in consulting with the GP. For example, the person who cannot work, cannot play with their children, cannot play sports etc. It appears as if life’s choices have disappeared. By definition, suffering refers to the loss of sense of self, and indeed the person with persistent or chronic pain can feel such loss.

The existing understanding of pain has taken us a long way away from the biomedical model. The biopsychosocial model has gained some traction but the predominant approach continues to be driven by the search for an injury, a pathology or a structural explanation. For many years it has been known that pain and injury are not synonymous ~ the famous paper by Pat Wall was published in 1979:

“The period after injury is divided into the immediate, acute and chronic stages. In each stage it is shown that pain has only a weak connection to injury but a strong connection to the body state.”

Pain features when we are in a state of protect in the face of a perceived threat. The intensity of the pain relates to this state and not to the extent of tissue damage. Pain and injury are fundamentally different and hence any explanation or treatment for pain based upon the thinking that a ‘structure’ or biomechanics is to blame is at odds with our understanding of pain. In fact, it is this misunderstanding that contributes significantly to chronic pain being the number one global health burden. This can and must change, which is the raison d’être for UP | understand pain.

~ understand pain to change pain

This being the case, this workshop will be a brief look at this enormous societal issue, a public health concern of vast importance considering the massive costs and immeasurable suffering. Not only will we review current thinking and understanding, we will consider the role of the GP and practices that can be readily used.

  • understand pain yourself
  • know your role
  • how can you help the person understand their pain?
  • setting the person on the right course: what is their vision of success?
  • practices you can choose to use in clinic

This overview is based on the Pain Coach Programme. The programme delivers results for people who make the decision to commit to practices that bring about change in a desired direction. They understand that we are designed to change and that we have great potential to be harnessed and used to overcome pain and live a meaningful life.

1:1 Pain Coach Mentoring: for clinicians who choose to pursue understanding pain to a greater level together with the practice of Pain Coaching.

RS

Sense of self Conference

Richmond Stace | The Pain CoachLeave a comment

Who am I? 


For the next couple of days I will be immersed in conversations about the sense of self and consciousness ~ see here. This is becoming a bit of a ‘buzz’ area, and rightly so. This is something we need to really understand and draw into healthcare. We are, or should be, treating people and their unique lived experiences. The predominant thinking remains dualist and is condition-focused rather than viewing a whole person, their life, their prior experiences, their beliefs and how this informs ‘now’. 

Two of the best examples of conscious experiences are love and pain. In the moment of the phenomena, both absolutely dominate the ‘self’, the ‘me’. But what is the self? Some argue that the self does not exist. It is an illusion. I have some sympathy with this view because to answer the question of self, we must know where it exist ~ where is my ‘self’? And with different ‘selfs’, to which are we referring: physical self? Narrative self? Where is the ‘I’? It encompasses the whole person, but is this ‘I’ the same one that other’s experience? Whatever I consider to be my ‘self’ may not be the same that others perceive. 

“Where is your ‘self’?

For some years I have supported an approach that addresses the person as much, if not more, than the condition. This means that together we consider the continuous story that results in the present moment and the context within which the person’s pain exists. The person describes their pain but digging deeper reveals the suffering they endure, and the two are different. Suffering emerges from a loss of sense of self. We even use the phrase ‘I don’t feel myself’ to describe this loss and then ‘I feel myself again’ when we are complete once more. Therefore I maintain that in treating the whole person, we are seeking to restore their sense of self according to their definition of ‘me’. 

Treating a person so that they may feel a sense of complete self requires us to look at their unique causes of suffering. We can then design a bespoke programme that addresses the existing patterns by creating a new pathway, carving a way onward with new habits. A focus on what the person wants, their clarified vision of success, is vital as this provides a direction and reference point: am I thinking and acting in line with this picture? The decision to commit to this journey then becomes the day to day, moment to moment practices. 

The ‘I’ reference in a particular context is what we are treating. Gaining greater insight into this sense of self will help us to sharpen our messages (explanations) and tools. Together with our ever-increasing knowledge of pain, this becomes a potent force. We seek to deliver results by providing the means to carve that new pathway forward: both the tools and the know-how. This is the essence of Pain Coaching that taps into an individual’s vast potential to get better and live meaningfully, leaving behind concept of coping and management. This is about living well because we can by making certain choices. Pain Coach presents these choices to the person. 

The Sense of Self conference will enlighten this whole person approach. I look forward to bringing you cutting edge thinking and how we can use it to continue our pioneering work to change the way society thinks about and addresses 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 ~

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

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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

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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

Pain and choice

Richmond Stace | The Pain CoachLeave a comment

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

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

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

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

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

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

Choose ‘I can’.