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CRPS UK Conference 2015

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Richmond Stace MCSP MSc (Pain) BSc (Hons)
Richmond Stace MCSP MSc (Pain) BSc (Hons)

This document discusses understanding pain to change pain. It explains that pain is a personal, subjective experience that is influenced by emotional, environmental, and perceived tissue state factors. Persisting pain features include pain impacting life and life impacting pain, with biological changes in the brain, immune system, and behaviors. The document recommends understanding pain, coaching yourself, and employing pain management strategies like movement, desensitization, motor imagery, graded exercise, and mindful practice to overcome pain and live a meaningful life. The overall message is that understanding pain is the first step to applying knowledge and strategies to shape one's experience of pain.

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Understand pain to change pain Richmond Stace Specialist Pain Physiotherapist www.specialistpainphysio.com
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
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
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
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
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
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?
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
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
Pain & CRPS (2) Why (continued)? Priming or kindling How has the persons neuroimmune system evolved to date? Prior experiences of pain Pain vulnerabilities Genetic Early life stressors
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
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
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
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
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
Mature Organism Model
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?
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
UP | understand pain
T5 #upandsing
UP | understand pain Pain awareness and education campaign Increase awareness Widely deliver accurate messages and advice Events Fundraising Pain Coach workshops Website resource
UP www.understandpain.com @upandsing Facebook
Thank you painphysiolondon@gmail.com www.specialistpainphysio.com @painphysio

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CRPS UK Conference 2015

  • 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 persons 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
  • 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
  • 21. UP | understand pain Pain awareness and education campaign Increase awareness Widely deliver accurate messages and advice Events Fundraising Pain Coach workshops Website resource
  • 23. Thank you painphysiolondon@gmail.com www.specialistpainphysio.com @painphysio