Slides from my talk at the CRPS UK 2015 Conference today in Bath

1. Understand pain to change pain
Richmond Stace
Specialist Pain Physiotherapist
www.specialistpainphysio.com

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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?

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Mature Organism Model

17. 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?

18. 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

19. UP | understand pain

20. T5 #upandsing

21. UP | understand pain
• Pain awareness and education campaign
– Increase awareness
– Widely deliver accurate messages and advice
• Events
• Fundraising
– Pain Coach workshops
– Website resource

22. UP
• www.understandpain.com
• @upandsing
• Facebook

23. Thank you
• painphysiolondon@gmail.com
• www.specialistpainphysio.com
• @painphysio