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Understanding pain and how to overcome the FEAR to MOVE is a big issue with CHRONIC PAIN

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  1. 1. OVERCOMING THE FEAR TO MOVE Presented By Yousuf SYED
  4. 4. OVERCOMING THE FEAR TO MOVE Do you have a client who is in a persistent pain cycle  Is your patient an over achiever  Does your patient work more on good days and less on bad days  Is your client a people pleaser and finds hard to say NO  Is your client a Can’t Do Person 
  6. 6. EXPLAIN PAIN • More they understand it is easier for them to cope with pain • Complex • Sensitized Central nervous system • Soft Tissue healing 36months • Pain Tissue Damage
  7. 7. EXPLAIN PAIN Your brain has the final say about what is painful.  You do not feel pain in your tissues.  You feel pain in your brain.  “Are you saying that the pain is all in my head?” 
  8. 8. EXPLAIN PAIN Yep, no brain, no pain!  But, your pain is very real.  As your time living with pain increases, the involvement of the tissues reduces and the involvement of the nervous system increases. 
  10. 10. Emotional INJURY Physical Stressor/s (ILLNESS) Stressor/s PAIN Restricted Movement Thoughts SPASM Guarding BODY Postural MIND Changes Feelings Muscle Tension PAIN AMPLIFICATION
  11. 11. Chronic Pain Pain Signal Emotions – Fear, anger may amplify pain signal Thoughts- Self defeating thoughts “I can’t stand this” – Giving up make experience worse Behaviours – feed back to brain about severity of problemEg asking help for simple tasks, giving up enjoyable activity turning down invitations, staying in bed Social Responses – negative messages “you are a burden” extra help – if told sick, helpless difficult to not feel that way
  12. 12. INVESTIGATIONS After the age of 25, most of us will have some NORMAL degenerative changes. One study showed that up to 35% of people who have never experienced low back pain had herniated discs (Weishaupt D et al). Instead of dwelling on what was seen on the image, we should be more concerned about dysfunctional joints and muscles. Maybe it’s bad posture, joint restriction, poor lifting habits, or instability that needs rehabilitation.
  13. 13. SELF MANAGEMENT 1. 2. 3. Acceptance of pain …… the moving on Building a Support Group – friends, family, Dr, PT, OT, Dietician, Psycologist, Pain Support Groups. Pacing       4. Goal Setting Being Patient with themselves Learn to prioritise and plan out everyday Activity – Exercises and Stretches Dairy – Track progress Have a set back Plan Learn Relaxation Skills , Distraction, Mindfulness, Cognitive Behavioural Therapy
  14. 14. GOAL SETTING  Activity goals should be set in three separate domains.  The physical domain is the exercise program the patient follows and includes the number of exercises to be performed, the duration of exercise, and the level of difficulty.  The functional domain involves tasks of everyday living such as housework or hobbies.  The social domain relates to pleasurable social activities (e.g., visiting friends, going to church or the movies, going for a walk). Goals must be personally relevant, interesting, measurable, and achievable.  Goal setting should be a matter of negotiation between the patient and the therapist.
  15. 15. GOAL SETTING The use of goal-setting charts is essential  Set a target for activities each week  Record your achievements on the chart,  Note the nature of any difficulties and how these will be tackled next time, and make other comments.  For example, comment on your performance or on the appropriateness of the goals you had set. In this manner you and your PT can monitor your progress and improve you accuracy in goal setting 
  16. 16. PACING • Pacing involves a daily activity routine that is easily achievable. • Discuss activities pts used to enjoy doing but avoid due to pain • Activities can be gradually increased by number of movements, distance or time.
  17. 17. PACING  Gradual, controlled increases in general activity level will avert triggering sudden increases of pain that lead to reduction of activity.  Eg. Can be used for any type of physical activity including specific exercises, household tasks, hobbies or work duties. ACTIVITY Can do on a BAD DAY Can do on a GOOD DAY BASELINE Walking 1km 2km 1.4km Sitting at a computer 10min 15min 11min Bending forwards Reaches hand to mid thigh Reaches hand to floor Reaches hand to knee
  18. 18. PACING     Pain is not directly related to strength of pain signal, disease severity and tissue damage Don’t Use- no Pain no Gain, let pain be your guide UNDERSTAND YOUR PAIN so you don’t fear it Hurt does not always equal harm but doesn’t mean you go do a marathon Too Much Activity In order to catch-up EFFECTIVE PACING NO Activity In order to recover
  19. 19. SET BACK PLAN It is almost inevitable as CNS is so sensitive and trying to “protect body”  Relapse may be due to an individual physical event or it may result from cumulative physical and psychological stresses  Patients must Discuss with GP, nurse, PT to help to identify situations that are challenging and develop strategies to cope with them.  Strategies may include setting criteria to visit health professionals, to use pain medication, or to briefly rest and relax, meditation. 
  20. 20. SET BACK SELF-MANAGEMENT Activity modification (e.g. changing the pacing parameters, altering the time of day, even the room and other contexts),  Active rest periods (breaking up activities into sections including having rest breaks),  Relaxation (e.g. breathing, music, gentle stretches),  Mindfulness based stress reduction and distraction. Remember : flare-ups end and more angst triggers further physical responses and pain. 
  21. 21. Short Term & Long Term Goal Setting What is patient’s baseline? Create the Pacing Diary Start Pacing Include progression + Set Back Management
  22. 22. REFERENCES Butler, David S., and Mosley, C. Lorimer. Explain Pain, First Edition. Australia: Noigroup Publications, 2003.  Doidge, Norman. The Brain that Changes Itself. USA: Penguin Books, 2007. 
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