QMUL MSc SEM | pain in sport lecture
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Chronic pain in sport is a problem. The modern understanding of pain sciences should be applied in the world of sport and exercise. We looked at the contemporary science and thinking about pain including: pain is multi-system (e.g./ nervous, immune, autonomic), multi-dimensional (physical-cognitive-emotional); the meaning of pain to the individual; the context of the injury; the importance of the right early messages.
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QMUL MSc SEM | pain in sport lecture
- 1. February 2015 Persisting pain in sport Richmond Stace MCSP MSc (Pain) BSc (Hons) | Specialist Pain Physiotherapist Thursday, 5 February 15
- 2. Behind every pain... ✤ ...is a story ✤ Know the person to know the pain ✤ “It’s as much about the person as the condition”. Oliver Sacks ✤ When a person gets better, their pain gets better Thursday, 5 February 15
- 3. Picture this... ✤ 16 year old girl with pain in both shins ✤ 2 years; worsening ✤ continues to play sport at school most days + training ✤ exquisitely tender to touch ✤ occasions when unable to walk ✤ first thoughts? Thursday, 5 February 15
- 4. ..and then she says this.. ✤ 8 year h/o migraines ✤ disturbed sleep ✤ widespread tenderness ✤ high-flyer at school ✤ thoughts? ✤ who is this a case for? Thursday, 5 February 15
- 5. Puzzled by a lack of signs? ✤ is it an injury? ✤ is it sensitivity? ✤ hamstring ‘re-injury’ ✤ damage or feels like damage? Thursday, 5 February 15
- 6. Acute pain ✤ is it an injury? ✤ "I sincerely thought it was the last ball I would be touching for a long time because of the pain," Messi (2012) Thursday, 5 February 15
- 7. Acute injury ✤ damage? ✤ damage = pain? Thursday, 5 February 15
- 8. Pain is... ✤ normal ✤ unpleasant ✤ alerts us to danger in the body ✤ motivates action ✤ a vital survival device Thursday, 5 February 15
- 9. My definition of pain is... ✤ _________________________ Thursday, 5 February 15
- 10. Pain definition ✤ IASP definition: ✤ An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Thursday, 5 February 15
- 11. Pain is a huge global health burden ✤ A systematic analysis for the Global Burden of Disease Study 2010 ✤ Health systems will need to address the needs of the rising numbers of individuals with a range of disorders that largely cause disability but not mortality (Vos et al. 2012) ✤ Most burdensome global health issues ✤ Number 2 -- depression ✤ Number 1 -- chronic back pain Thursday, 5 February 15
- 12. The problem ✤ Pain is poorly understood ✤ Pain is poorly communicated ✤ Chronic pain outcomes often low ✤ Expectations low ✤ WE MUST CHANGE THE UNDERSTANDING OF PAIN Thursday, 5 February 15
- 13. ✤ A problem in sport -- yes! ✤ Professional vs amateur ✤ Stops return to full participation ✤ Financial/career ✤ Affects performance ✤ Playing with pain ✤ No pain, no gain ✤ Is this different to non-sporting population? ✤ Context ✤ End goal ✤ Should we think differently about pain in sport vs non- sport? ✤ NO Persisting pain in sport Thursday, 5 February 15
- 14. What can we do? ✤ Understand pain ✤ Reconceptualise pain ✤ Neurobiology ✤ Neuroimmunobiology ✤ Neuroimmunoendobiology ✤ What influences pain biology? Thursday, 5 February 15
- 15. What is pain?What does it involve? ✤ Protection in the body region deemed to be under threat ✤ Perception of threat + normal biological response ✤ Multi-system ✤ nervous, immune, autonomic, endocrine ✤ there’s no pain system, message, receptors... ✤ Multi-dimensional ✤ physical, cognitive, emotional ✤ Biopsychosocial model in sport Thursday, 5 February 15
- 16. Reconceptualisation story ✤ Melzack & Wall ✤ Melzack -- pain matrix theory ✤ Pain as an output ✤ Mature Organism Model (Gifford) ✤ Pain is emergent ✤ Salient network Thursday, 5 February 15
- 17. ✤ Consider: ✤ Pain is not an accurate indicator of tissue damage -- phantom limb pain ✤ Pain is allocated a ‘space’ - cross the midline ✤ Pain is dynamic ✤ Accuracy of recall -- how well do we recall a pain? Thursday, 5 February 15
- 18. Influences on pain ✤ Context/Situation ✤ ‘the meaning’ ✤ Emotional state ✤ Anxiety ✤ Stress ✤ Fatigue ✤ Prior experience of pain and injury (they are different) ✤ Environment ✤ Who we are with ✤ Attentional bias ✤ Beliefs Thursday, 5 February 15
- 19. Pain in sport ✤ Normal ✤ Expected ✤ Part of training and playing ✤ Accepted risk of injuries that hurt, BUT.... ✤ What about the pain that doesn’t get better? Thursday, 5 February 15
- 20. Injury ✤ First observations? ✤ First thoughts? ✤ First questions? Thursday, 5 February 15
- 21. Injury moment ✤ Context ✤ Mechanism ✤ Meaning to the person ✤ Body responses ✤ Pain intensity ✤ Stress/anxiety/traumatic ✤ Early care ✤ Treatment choice ✤ Messages given ✤ Investigations ✤ Others’ responses ✤ facial ✤ verbal Thursday, 5 February 15
- 22. Injury -- not in isolation ✤ The story ✤ The person ✤ Circumstance ✤ Priming factors ✤ Genetics -- epigenetics, vulnerability ✤ Fitness ✤ Body sense -- e.g. hypermobility ✤ Pre-existing sensitivity ✤ Fatigue ✤ Inflammation ✤ General health ✤ Prior experience of injury ✤ CLIMB OUT OF THE TISSUES Thursday, 5 February 15
- 23. Responses to tissue damage ✤ Thoughts ✤ Acts ✤ protective ✤ Pain ✤ Change in motor control ✤ Healing ✤ Autonomic responses ✤ Inflammation -- immune ✤ Behaviours based upon beliefs ✤ Normal to hurt Thursday, 5 February 15
- 24. There is no pain system Or pain signals Or pain receptors Thursday, 5 February 15
- 25. Pain persists ✤ Why? ✤ On-going perception of threat ✤ What are the perceived threats? ✤ Tissues are healing but pain persists ✤ Pain is not an accurate indicator of tissue damage ✤ Biological mechanisms e.g./ neuropathic pain --> central sensitisation ✤ Influences upon pain biology Thursday, 5 February 15
- 26. Persisting problems ✤ Tendinopathy ✤ Anterior knee pain ✤ Back pain ✤ Repeated muscle ‘strains’ ✤ Hamstring ✤ Groin Thursday, 5 February 15
- 27. Functional pain syndromes ✤ IBS ✤ Pelvic pain ✤ Migraine ✤ TMJ dysfunction ✤ Anxiety/Depression ✤ Gender -- females predominate: immune/endocrine factors + reporting Thursday, 5 February 15
- 28. Persisting pain features ✤ Pain ✤ Altered body sense ✤ Altered motor control ✤ Beliefs - Behaviours ✤ Thinking Thursday, 5 February 15
- 29. Modern approach ✤ Consider whole person ✤ Understanding ✤ Skill development ✤ Coaching ✤ Pain dimensions ✤ Physical - cognitive - emotional ✤ How they interact ✤ Adaptations ✤ Cortical ✤ Loss of precision (disinhibition) ✤ Body systems that protect: ✤ Sensorimotor ✤ Nervous - immune ✤ Autonomic Thursday, 5 February 15
- 30. Summary ✤ Pain is not an accurate indicator of tissue damage ✤ The meaning and context are key ✤ Early messages are vital ✤ Biology of pain + influences = how much it hurts ✤ Whole person | multi-system | multi-dimensional Thursday, 5 February 15
- 31. ✤ painphysiolondon@gmail.com ✤ Twitter @painphysio ✤ www.specialistpainphysio.com Thursday, 5 February 15