PAIN and INJURY Preaching in a wilderness.          Mark Cranswick       Senior Physiotherapist       Pain Management Unit
“L’operazione Chururgica”(Gaspare Traversi, 1753/54)
Data from 2006/07 New Zealand             Health Survey   1 in 6 (16.9%) of New Zealanders    report chronic pain   Near...
Epidemiology   N# 85,088 in 17 countries   Between 10% and 42% report    chronic back/ neck pain in the    previous 12 m...
“Pain is a passionof the soul”Aristotle 300BC      Acknowledgement to:               Lorna Fox               NZPS 2007
Rene Descartes 1662                      Acknowledgement to:                      Lorna Fox, NZPS 2007
Descartes When it is not in our power to determinewhat is true, we ought to act according towhat is most probable.     Dis...
“ What is Pain? …… …incapable of definition,  or even of accurate description”                                         Lan...
“Pain … is known to us byexperience and described byillustration … we have noknowledge of pain beyondthat derived from hum...
Definition of Pain         IASP 1979Pain is an unpleasant sensory andemotional experience associatedwith actual or potenti...
Analogy serves a remarkableand unique function, enabling   the inexpressible to becommunicated by reference tosomething el...
“Were it not for thepossibility of sensing bodystates that are inherentlyordained to be painful orpleasurable, there would...
“Chronic pain turns a life into a mere existence. The effects are devastating and often demeaning. It has a negative impac...
Some observations   We live in a time when science seems    to be bursting with promise   We are told to expect cures  ...
Some observations cntd   Back pain in the workplace is just    one window on human predicament   Global illness narrativ...
Paradigm shift   Adopt a “salutogenic model” with    relationship understanding between    health, stress and coping   “...
Paradigm shift cntd   We should question just what in the    workplace is compromising their    ability to cope   We sho...
Pain isMy pain as it grows, is an imperative,an obsession, a compulsion, adominating, engulfing reality. Yourpain is a dif...
Pain and Injury: Preaching in a Wilderness
Pain and Injury: Preaching in a Wilderness
Pain and Injury: Preaching in a Wilderness
Pain and Injury: Preaching in a Wilderness
Pain and Injury: Preaching in a Wilderness
Pain and Injury: Preaching in a Wilderness
Pain and Injury: Preaching in a Wilderness
Pain and Injury: Preaching in a Wilderness
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Pain and Injury: Preaching in a Wilderness

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Mark Cranswick
Senior Physiotherapist, Waitemata District Health Board
(P11, Thursday, NZI 4 Room, 12.30-1)

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  • I would like to take you on a journey. A historical journey of moving and handling, but also of pain and injury. I suggest to you that much of what we do is based on interpretation. Interpretation is therefore an evolving process and the legacy is often faddish. Let us have a look at some history, some present observations and see how we might influence the future.
  • THE CREATION OF ADAM by MICHELANGELO around 1511 on Sistine Chapel. Illustrates the biblical story from the Book of Genesis in which God the Father breathes life into Adam, the first man. God is depicted as an elderly white-bearded man wrapped in a swirling cloak while Adam is completely naked. Gods right arm is outstretched to impart the spark of life from his own finger into that of Adam.
  • CRUCIFIXION OF ST PETER by CARAVAGGIO in 1600. The painting depicts the martyrdom of St Peter by crucifixion- Peter asked that the cross be inverted so as not to imitate his mentor, Christ, hence he is depicted upside- down, his lifting requires the efforts of three men, as if the crime they perpetrate already weighs on them.
  • THE ENTOMBMENT OF CHRIST by CARAVAGGIO 1602-1603. A diagonal cascade of mourners and cadaver- bearers descending to the limp, dead Christ and bare stone. There is an emotional diagonal represented from a somewhat hysterical Mary, through subdued emotion to death as the final emotional silencing.
  • Translates to the surgery. The wounded sufferer grimaces with intense pain. This was painted 100 years before the use of ether in surgery(1846) and 150 years before the commercial use of aspirin(1899)
  • The straps of the corset seem to be all that is holding the artists body together and upright. An ionic column, broken in several pieces takes the place of her damaged spine. The yawning cleft in her flesh is taken up in furrows, scarring the bleak, fissured landscape behind, which therefore becomes a symbol both of her pain and her loneliness. Even more powerful symbols of her pain, however, are the nails sticking into her face and body. Polio at age6 in her right leg. At age 18 involved in a accident, tram vs bus. Right below knee amputation at 46, died at 47. Over 30 operations.
  • Prevalence increases with age from 8.6% to 28.1%. People with chronic pain have poorer health related quality of life and limitations in daily functioning. 12,488 New Zealand adult residents aged 25 years and older NZMJ 24 June 2011. vol124 no1337 pg63-76 Chronic pain ranks as an economic and social problem of enormous magnitude.
  • Mental disorders among persons with chronic back and neck pain: results from the world mental health surveys PAIN: 129 (2007) 332-342 NZ 1:6 NZers at some time in their lives will experience depression. It is most common in 16-24 year olds but it can happen at any age. NZ Guidelines Group 2009 New Zealand Mental Health Survey 2003- 2004 face to face household survey of 13,000. 40% reported they had had a disorder at some time in their lives. 21% in the past 12 months. Anxiety disorders were the most common (lifetime prevalence 25%), followed by depression and other mood disorders like bipolar and dysthymia (20%) and substance abuse disorders (12%) Pain is decisively shaped or modified by individual human minds and by specific human cultures.
  • A Greek philosopher, a student of Plato and teacher of Alexander the Great
  • A French philosopher, mathematician, scientist, and writer. The Father of Modern Philosophy. “ I think therefore I am” “thought cannot be separated from me therefore I exist”
  • Started in 1823. Longest running medical journal in the world.
  • A British Cardiologist. Cliché: Pain is a learnt response. This is however not useful for those with chronic pain. Pain is always personal and always cultural.
  • Geoffrey Schott. National Hospital of Neurology and Neurosurgery Queens Square, London
  • A Portuguese Behavioural Neurologist and Neuroscientist working in the USA. His main interest is in the neurology of the mind, especially neural systems which subserve memory, language, emotion, and decision making
  • Pain may keep us from working, push us in to a role of invalid, drive away friends, and wall us up in a personal prison of isolation.
  • We just have to ask Professor Google. We are not well equiped for what happens when our pills fail. Our culture has succeeded in persuading us that pain is simply and entirely a medical problem. When we think about pain we almost instantly conjure up a scene that includes, doctors, drugs, ointments, surgery, hospitals, laboratories and ACC forms.
  • Pain and Injury: Preaching in a Wilderness

    1. 1. PAIN and INJURY Preaching in a wilderness. Mark Cranswick Senior Physiotherapist Pain Management Unit
    2. 2. “L’operazione Chururgica”(Gaspare Traversi, 1753/54)
    3. 3. Data from 2006/07 New Zealand Health Survey 1 in 6 (16.9%) of New Zealanders report chronic pain Nearly half (48%) use some form of medical treatment A fifth (21.4%) report severe or very severe recent pain Two-thirds (67%) have lived with chronic pain for 5 or more years
    4. 4. Epidemiology N# 85,088 in 17 countries Between 10% and 42% report chronic back/ neck pain in the previous 12 months Between 20% and 45% of persons with back and neck pain also met the criteria for depression Approximately 25% meeting criteria for anxiety
    5. 5. “Pain is a passionof the soul”Aristotle 300BC Acknowledgement to: Lorna Fox NZPS 2007
    6. 6. Rene Descartes 1662 Acknowledgement to: Lorna Fox, NZPS 2007
    7. 7. Descartes When it is not in our power to determinewhat is true, we ought to act according towhat is most probable. Discours de la Méthode Acknowledgement to: Lorna Fox, NZPS 2007
    8. 8. “ What is Pain? …… …incapable of definition, or even of accurate description” Lancet 1887 In G D Schott Communicating the Experience of Pain : the Role of Analogy Pain 108 (2004) 209-212
    9. 9. “Pain … is known to us byexperience and described byillustration … we have noknowledge of pain beyondthat derived from humanexperience …” Sir Thomas Lewis 1942 In G D Schott Communicating the Experience of Pain : the Role of Analogy Pain 108 (2004) 209-212
    10. 10. Definition of Pain IASP 1979Pain is an unpleasant sensory andemotional experience associatedwith actual or potential tissuedamage, or described in terms ofsuch damage.
    11. 11. Analogy serves a remarkableand unique function, enabling the inexpressible to becommunicated by reference tosomething else. This is never more important than in the expression of pain. In G D Schott Communicating the Experience of Pain : the Role of Analogy Pain 108 (2004) 209-212
    12. 12. “Were it not for thepossibility of sensing bodystates that are inherentlyordained to be painful orpleasurable, there would beno suffering or bliss, nolonging or mercy, no tragedyor glory in the humancondition.” Antonio Damasio From Descartes’ Error
    13. 13. “Chronic pain turns a life into a mere existence. The effects are devastating and often demeaning. It has a negative impact on relationships inside and outside the home. It involves the loss of independence, dignity and control” International Pain Summit IASP Montreal, Sept 2010
    14. 14. Some observations We live in a time when science seems to be bursting with promise We are told to expect cures The hype serves to delude us into thinking that each of us is the sum of our genes The hype drives a reductionist philosophy Created industries based on diagnostic entrepreneurs
    15. 15. Some observations cntd Back pain in the workplace is just one window on human predicament Global illness narrative- the worried well The illness of work incapacity If you have to prove you are ill, you can’t get well
    16. 16. Paradigm shift Adopt a “salutogenic model” with relationship understanding between health, stress and coping “health-ease” versus “dis-ease’ continuum The choice to be a patient is just that, a choice Accepting that to be “well” is not to be free of symptoms
    17. 17. Paradigm shift cntd We should question just what in the workplace is compromising their ability to cope We should guarantee workplaces that are comfortable when we are well and accommodating when we are ill “common sense” is seldom common and not always sense
    18. 18. Pain isMy pain as it grows, is an imperative,an obsession, a compulsion, adominating, engulfing reality. Yourpain is a different matter. I observe youand listen to you. I sympathise with youby guessed analogy . . . Patrick D Wall

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