CRPS UK Conference 2015

Understand pain to change pain

Richmond StaceSpecialist Pain Physiotherapistwww.specialistpainphysio.com

pain is…

• Painful….it hurts• An emotion, a feeling, a sensation,

unpleasant, horrible, scary….• Personal• Subjective• Experienced now, in this moment• Felt by the person….I am in pain• Not an accurate indicator of tissue damage

You are….

• ….a person, and not a condition– The CRPS patient NO

• ….a person, and not a body part– The man/lady with the ______ pain NO

• ….a person, and need an approach that addresses the whole person

Why do we feel pain?

• To protect• Protect from a perceived threat• Who is perceiving?– Me– The person in pain– Not a body part– i.e./ I am thirsty, not my mouth

What influences pain?

• These factors we must address:– Emotional state• E.g. stress, anxiety, fear

– Tiredness• More tired = more sensitive and less resilient

– Environmental cues• Associations

– Perceived tissue state• Including thought that more pain = more damage

Where do we feel pain?

• In our body• Where perception of threat exists in that

moment• In a space– Cross hands or feet

• Phantom limb pain

What is persisting pain?

• Textbooks say 3 month…. Really?• Mechanisms begin at injury or the initial pain

moment– How was I at this moment?

• Health• Emotional state

• Pain that persists beyond a useful time– But is health optimised in that person?– Is there a reason for on-going protection?

Persisting pain features

• Pain impacting on life & life impacting on pain– Pain is embedded within that person life

• Loss of agency• Learning, associations, habits• Biological changes– Brain– Immune system– Behaviours, thinking, emotions, fears

Pain & CRPS

• CRPS– Increased response to an injury, perceived injury

or perceived threat• Why?– Increased inflammatory (normal) response– Early uncontrolled pain– Early management• messages, thoughts, behaviours

Pain & CRPS (2)

• Why (continued)?– Priming or kindling• How has the person’s neuroimmune system evolved to

date?

– Prior experiences of pain– Pain vulnerabilities• Genetic• Early life stressors

What can we do?

• Understand pain– To solve a problem you must understand it

• Coach yourself– You are with you all the time, so what do I

think/do now?– Pain is a lived experience so strategies need to be

lived• Pain Coach

Pain Coach

• Strengths based coaching + pain science = Pain Coach– What are your strengths?– What are your values?– Why do you want to get better?– What is your vision of how you want to be?

• Moment-to-moment decision making– You are your own coach– Working knowledge of your pain– Skills to employ

• BUT, it all begins with understanding your pain

Examples of strategies (1)

• UBER-M– Understand pain

• I am safe

– Breathe (mindfulness)– Exercises– Re-charge– Movement

• What do I do in this moment to shape the next?

• Desensitising– Touch– Multi-sensory• Move + look• Touch + look• Touch + look + move

Strategies (2)

• Motor imagery– Watch others move– Left or tight judgements– Imagine movements– Imagine activities– Visualisation

• Mental rehearsal develops precision and reduces threat

• Graded exercise– Sensorimotor training– Proprioception– Graded exposure– Returning to chosen

activities including work

Strategies (3)

• Working knowledge– What do I know?– I am safe– What can I think?– What can I do?– What takes me towards

my vision?

• Mindful practice– Focused attention

training– Mindful of thoughts

rather than grasping/embroiled

– Clarity & calm– Refresh & renew– Practical skill

Mature Organism Model

Success

• We are designed to change• We are always updating• Think about your strengths and how to use

them for success• Who is successful?• Who overcomes their pain?• What do they look like?

Overcoming pain

• What is overcoming pain?– Living a meaningful life defined by you

• Who gets better?– A person who consistently applies their working

knowledge– Actively deals with flare ups, learns and moves on– Has a clear vision of where they are going– Lives whilst they incorporate their strategies

• Starts with UNDERSTANDING PAIN

UP | understand pain

T5 #upandsing

UP | understand pain

• Pain awareness and education campaign– Increase awareness– Widely deliver accurate messages and advice

• Events• Fundraising– Pain Coach workshops– Website resource

UP

• www.understandpain.com

• @upandsing

• Facebook

Thank you

• [email protected]

• www.specialistpainphysio.com

• @painphysio