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That’s not my Pirate!

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When my children were small they had a book that I had to read every night (as you do to small children). The book was called ‘That’s not my Pirate’, it was about a little girl looking for her lost Pirate, she looked at different Pirates that were nearly the same but not exactly. They might have different hair, different clothes or a different smile but they just were’t the right Pirate.

I was reminded of this book today when I was trying to explain how the body went through changes in a persistent pain state. I explained that there are changes not only in the tissues after an injury but also in the messages that go to the spinal cord and the brain, conveying information about stuff happening in the body. In chronic or persistent pain this gets a bit muddled, I likened it to Chinese whispers or predictive text. What you put in -or indeed think you put into the body- doesn’t always produce the response you expect. This may be more due to changes in the central nervous system and the brain rather than in the periphery.

Just like the Pirate in the book, pain can look different from one person to another, maybe someone in pain may shy away from activity, someone else will face it head on and ‘push through it’, others may look tired or adopt a protective posture to help alleviate symptoms. Pain can feel different, no two pains are identical and no-one experiences the same pain as the next person -fact! Finally pain can show itself in different ways, perhaps someones language will change, they may become withdrawn or low in mood as a result or it changes behaviour – you’re just not you.

Sometimes the person you see in the mirror looks like you but just isn’t you. 

 

Pain is a complex thing, it relies on previous experience, feelings, context, understanding and origins of current knowledge. It isn’t linear and once it becomes persistent, there is no longer a direct link between cause and effect. This is why everyone experiences pain differently and there is no one pain or one pain centre in the brain, we all bring our individual quirks to the party.

This fact alone makes life tough when trying to explain pain. I use a lot of examples, stories and sharing of information with my patients and try to put a point in a number of different ways. I hope this helps people to pick the right analogy that fits with their life and understanding. Sometimes this works, sometimes not so much but I do my best.

As I finished explaining a little more about persistent pain changes on the body he became quite animated, saying he found it really interesting and that he would like to know more. He told me the brain was a fascinating thing and he totally believed that thoughts and feelings had significant impact on the physical self. He said he had read about this kind of stuff before.

Hooray I thought, after a weeks of trying to scratch the surface and show him a different way of looking at pain he’s got it, just enough to want to know more and then he said this…”but that’s not my pain!”

Sally Allbrighton

BSc (Hons) Physiotherapy, MSc

Physiotherapist, Lecturer noiUK

F**k Pain

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It can’t be denied that we love to swear! In Britain we swear to express happiness, sadness, love and pain amongst other emotions. Particularly pain. It’s funny how when we hurt ourselves the first thing that often comes out of our mouth is “oh s**t” or “f**k that hurts”. We are all guilty that’s for sure. Maybe it’s a cultural thing, maybe is environmental or social or maybe it’s purely that language and culture have evolved from swearing being taboo to it being mainstream. Right or wrong, that’s just how it is.

I saw a Meme once that said “when I bang my toe it’s like I’ve pressed play to shout all the swear words I know”. Totally can’t argue with that statement!

Why am I talking about swearing? Well it seems that when we are in pain we swear a lot and rather than it representing an increased pain experience to the outside world, it actually appears to reduce our pain experience.

Some studies asked volunteers to put their hands in a bucket of ice for as long as they could stand. There were two groups, one shouted swear words (the most popular were f**k, s**t and b****r apparently) and the other group used other non-swearing vocabulary. The findings showed that not only could swearing help volunteers to keep their hands in iced water for longer, but also it reduced their pain score reporting and lowered the heart rate.

Interesting that our physical expression of verbalising and externalising our pain experiences reduce the actual rating and experience of pain. Think about women in labour, they really do go for it in the swearing stakes, I pretty much shouted the dictionary of swear words when I was in labour! If you’ve been there, you know you have to get through it somehow and I’m glad I didn’t choose to have a Scientology silent birth that’s for sure!

I get it though, it’s a bit like sport, channelling aggression through sport is cathartic, we learn to externalise how we feel through various means. Sport may help reduce work stress and life stresses through kicking a ball or smashing a tennis racket around or punching a bag, and swearing helps to reduce our pain experience.

This is a great example of how intrinsically linked our brains and bodies are in their output mechanisms. We experience pain, swear to release and externalise our emotional response, this lowers the heart rate and reduces pain rating. Funny how this all happens without any amount of conscious thought. Fascinating research looking at how language and pain are so connected, not only by how we understand others and to express ourselves, but also the physical effect our choice of words has on the physical body.

Moral of the story, swearing is good for you, f*****g go for it!

 

More than the sum of my parts

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This week a chap said to me “I am more than just a bunch of scans and tests”. I spoke to a lady this morning on the phone who said exactly the same thing.

Both these clients had experience of attending numerous medical appointments over a long period of time, test after test and scan after scan came back inconclusive or ‘clear’. But these people are still in pain.

It reminds me of my A’Level Psychology lessons about the Gestalt Theory stating ‘the whole is other than the sum of it’s parts’. Objectively we can look at individual aspects, get results and analyse each separately to come up with an answer as to what is going on in the body. Unfortunately when we look at individual parts, we can fail to see the bigger picture.

The ‘lived in’ experience of the patient is totally different from the individual test results that sit on our desk. Although it is impossible to experience the life of another and ‘walk in their shoes’, we do need to listen to the whole story from the person in front of us. This will give us a much better indication for correct management  and give them faith in us as clinicians. We need to see the bigger picture. As my client said to me this morning “stops looking at numbers and scans and start asking me how I feel”.

Sally Allbrighton

BSc (Hons) Physiotherapy, MSc, Lecturer for NOI, Physiotherapy Clinician

More than the sum of my parts

pexels-photo-164531.jpeg

This week a chap said to me “I am more than just a bunch of scans and tests”. I spoke to a lady this morning on the phone who said exactly the same thing.

Both these clients had experience of attending numerous medical appointments over a long period of time, test after test and scan after scan came back inconclusive or ‘clear’. But these people are still in pain.

It reminds me of my A’Level Psychology lessons about the Gestalt Theory stating ‘the whole is other than the sum of it’s parts’. Objectively we can look at individual aspects, get results and analyse each separately to come up with an answer as to what is going on in the body. Unfortunately when we look at individual parts, we can fail to see the bigger picture.

The ‘lived in’ experience of the patient is totally different from the individual test results that sit on our desk. Although it is impossible to experience the life of another and ‘walk in their shoes’, we do need to listen to the whole story from the person in front of us. This will give us a much better indication for correct management  and give them faith in us as clinicians. We need to see the bigger picture. As my client said to me this morning “stops looking at numbers and scans and start asking me how I feel”.

Sally Allbrighton

BSc (Hons) Physiotherapy, MSc, Lecturer for NOI, Physiotherapy Clinician

A constant battle

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Pain is a big problem. All of us suffer from pain from time to time and for various different reasons, most of us heal if there has been an injury, the tissues settle, pain reduces and we get on with our lives. In some cases this doesn’t seem to happen. In fact the opposite can happen, the pain experience becomes greater and with less and less stimulation this continues to increase. The brain perceives something to be dreadfully wrong and a number of systems in the body become activated in order to deal with what it thinks is a significant threat. This becomes the number one issue, the first thing people think about when they wake up and the last thing before they go to bed. It’s a constant battle to even get by day to day.

I was teaching this weekend in Wales (it was actually quite warm and sunny – which never happens in Wales apparently!), we had a great group discussion about the things that people say when they are in pain and how emotive this can be. Words are one of our only forms of expression in order to try to convey how much pain you may be in and the suffering you are experiencing as a result. Sometimes words are used that conjure up a vivid picture of the day to day battle of living with persistent pain.

A great example from this weekend was someone who explained their lifelong battle with chronic pain as though “the body is attacking me”. The word ‘Attack’ brings to mind a violent and aggressive act resulting in injury and destruction, something that will leave a scar both physically and mentally. Can you image waking up every day to the same battle? The feeling that you are being attacked from the inside and no matter what you seem to do the violence increases and increases, drowning out all other thoughts and affecting your ability to focus on anything else.

How utterly drained you must feel, completely wiped out day to day by the second by second fight to go about mundane and ordinary daily activities. Yet there seems no answer, no pill to take or medicine to swallow to ease the suffering. Such an emotive turn of phrase that really makes you think about just how much of a challenge living with persistent pain must be.

Our bodies and brains are plastic and we have the ability to change our thoughts, feelings and behaviours through getting the right treatment at the right time.  Frida Kahlo said that “we can endure much more than we think” and maybe one day there will be a cure, or at least a softener to reduce the artillery and call a ceasefire, even for short periods. We live in hope. Continue reading “A constant battle”

Gin’s a tonic

I opened the door tonight to a lady who looked radiant, she jumped up from the reception seats and smiled from ear to ear. She announced with delight that she had been on a long walk and called in at the local posh bar for two gin and tonics. She was very pleased with herself and couldn’t stop smiling, and with very good reason. This was the first trip out that she had been confident to take in four months.

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It is very common for people in persistent pain to become socially isolated, it starts quite easily by turning down coffee or a night out with friends, they keep calling and texting but you just don’t feel like going. The first time is quite difficult, you feel as though you are letting people down but then it gets easier and easier to do.

After that you don’t feel like going shopping or out at the weekend, then you don’t want to go to the school gates, then you don’t want to go to work. The problem can escalate to the point where you actually don’t leave the house. It spirals very easily and suddenly you are out of control.

People say things like ‘Pull yourself together’, ‘what’s wrong with you?’ and ‘Why are you being miserable?’. Of course this doesn’t help and you retreat even further into yourself, falling further out of touch. Then the phone calls from friends stop and you’re on your own, feeling down and isolated. That’s not what you wanted but it’s what has happened and it’s difficult to see a way out.

Often people focus on the DIMS (Dangers in Me) like their worry about what people think, beliefs that they no longer live up to expectations or that people don’t believe them, concerns with their jobs and families and it all gets too much. But there is a balance, SIMS (Safety in Me) focuses on remembering the things you enjoy, taking small steps to get that back and being brave. Bit by bit you can learn to get back on your feet and with support, remember who you are and formulate a path back to that person.

This is why that gin and tonic for that client was so important. For the first time in four months she had built up the confidence to go out, every week we set a new goal, and she had the guts to go into a bar and order a drink. She was glowing and I couldn’t help but give her a hug. The best thing was when she said ‘I think I can do this on my own now, but I know where you are if I need you’.

Perfect!

The many faces of pain

I often say when I am teaching that clients are complex beings, they often have a long history of psychosocial aspects to their pain and they are not in someone else’s clinic, they are in ours, we just have to pick up the breadcrumbs of information to uncover the underlying contributions to pain.

I see many faces throughout each day in my clinic, some young, some old, some fit and some sedentary. Some appear outwardly happy and bubbly and some anxious and depressed. Some say they “just get on with it” and others “can’t do anything they used to”. They all have one common feature, they all present with pain.

Often I see young children of 4 and 5 years old helping Mummy or Daddy to put on their shoes or coats. They tell me that Mummy’s back hurts and they have to fetch a wheat bag or help her to sit and rest. This child is learning a lot at this point, wellness behaviour, illness behaviour and passing down of constructed beliefs about what should be done if you are in pain. It’s interesting to watch families as they work together to support each others behaviour. Are we reinforcing the wrong thing here? Do we need to educate people more and as clinicians should we take a longer look at the integration of a family unit when we get the chance?

Our understanding, experiences and behaviours are shaped by those we interact with each day and our family, friends and in some cases Health Professionals have an enormous impact on constructing our understanding of the world we live in. We have a unique ability to change how people and their loved ones think about pain and its effect on the person we love.

There is not one type of pain, we all look different, feel differently and behave differently during a pain experience and how we deal with it is different for everyone. We can’t separate the lived in pain experience from the world around us and vice versa. So ask the right questions of your patients, you may uncover the key to changing the way they feel about their pain and get them back on the road to recovery.