Pain relief

How well do you understand how pain works? Answer these questions and find out. We'll publish the answers after the pain education class this Saturday.

Pain Neuroscience Questionnaire

True or False?

1 When part of your body is injured, special pain receptors convey the pain message to your brain.

2 Pain only occurs when you are injured.

3 The timing and intensity of pain matches the timing and number of signals in danger messages.

4 Nerves have to connect a body part to the brain in order for that part to be in pain.

5 In chronic pain, the central nervous system becomes more sensitive to danger messages from tissues.

6 The body tells the brain when it is in pain.

7 The brain can send messages down your spinal cord that can increase the danger messages going up the spinal cord.

8 Nerves can adapt by increasing their resting level of excitement.

9 Chronic pain means an injury hasn’t healed properly.

10 Receptors on nerves work by opening ion channels (sensors) in the wall of the nerve

Chronic pain is epidemic. It is estimated that 25% of American adults live with chronic pain and the costs in terms of medical expense and lost productivity run into billions of dollars every year. It is impossible to calculate the cost in terms effect on the quality of so many people's lives. 

We are excited to be offering a two hour pain education class at Forest Park Community College on Saturday, April 12, 2014. The class, Explaining Pain: Help Manage Chronic Pain, is for anyone who lives with chronic pain, anyone who lives or works with individuals with chronic pain, or anyone who wants to better understand chronic pain. Professionals, non-professionals, people with pain or people without pain are all welcome.

This two hour lecture will introduce you to what modern pain science has learned about chronic pain and ways that may help you manage it more effectively. The class will be based on the book Explain Pain by Butler and Moseley. 

When people say, “I have TMJ,” they usually mean that they have temporomandibular joint dysfunction, a condition that can cause jaw pain that can be difficult to treat. Chewing may be painful and it can lead to headaches and neck, shoulder, and upper back pain. They may experience popping, clicking, and shifting when they open and close their jaw and their mouth may even get stuck in an open position if they yawn or open their mouth too far.

These are notes from a presentation given at the Skeptical Society of St. Louis Skepticamp on Saturday, September 14, 2013. Links to some of the resources and studies mentioned during the presentation, as well as additional links that may be of interest, are provided for those who would like to look at them.

A Skeptical Look at Back Pain: Notes from Skepticamp 2013

In 1995 I was working at St. Mary’s hospital when I heard about this study which examined 98 people who had no low back pain (LBP) and found that a large percentage had herniated discs. ("asymptomatic" means without symptoms i.e. no pain)

 http://www.nejm.org/doi/full/10.1056/NEJM199407143310201

            98 asymptomatic individuals ages 20 – 80

            36% normal discs at all levels

            52% bulging disc at at least 1 level

            38% abnormal at more than one level

            Findings similar in men & women

            Abnormalities increased with age

If I could make only one recommendation to individuals living with chronic pain, it would be to read the book Explain Pain by David Butler and Lorimer Moseley.

Directed at both clinicians who work with chronic pain patients and patients who live with chronic pain, Explain Pain shows how the discoveries of modern pain science can be put to practical use. Written in understandable language with a touch of lighthearted humor, Butler and Moseley take a complex subject and make it possible for the average person to understand and use. One client remarked that she thought it would be hard to read and was delighted that she did not find it difficult at all. 

One of the things I particularly enjoy about having my own independent practice is that I'm able to take time with my clients. Most of the time I have to stay within the bounds of a schedule or my day would be unmanageable. However, I'm able to control my schedule so that I don't have to feel rushed. If something comes up near the end of a session, I can take a few extra minutes if that seems necessary. 

Not long ago a new client came with a difficult pain problem. She had a complicated history. I wanted to be able to listen to it carefully, to be able to ask pertinent questions, and not be rushed. I had a break after the appointment so I asked the client if she was in a hurry. Even if I had the time, perhaps she didn't. However, she had no appointments to keep and so we were both able to relax and discuss her history in detail. 

During the past couple of years I've learned a lot about how pain works and have become convinced that pain education can make a valuable contribution to managing chronic pain. I thought this particular client might find this information helpful, so we discusses how pain works and how she might make use of that. 

Graded exposure can be a useful technique for persons living with chronic pain. Graded exposure is a method of finding movement that is pain-free and building on that. The idea is to break the brain's association between a particular movement and pain.

Got back pain? Call us!

Low back pain is one of the leading causes of disability in the United States. Everyone knows someone who suffers from back pain and most Americans will suffer from it some time in their life.  In spite of its prevalence, successful treatment of low back pain remains elusive. No one has consistently good statistics in the treatment of low back pain.

What can we offer you?

We cannot promise results. However, we can promise this:

Low back pain is one of the most common and persistent pain problems, affecting millions of people. Besides working hands-on with clients, I try to help them understand how pain works and to find ways they can continue to help themselves at home.

Cory Blickenstaff is a physical therapist in Vancouver, WA. My clients have found his videos on "edgework" and "novel movements" to be helpful and enjoyable.

"Edgework" is finding the point in a movement where it begins to transition from easy and comfortable to slightly guarded or painful. Movements should be done slowly, watching carefully for the first sign of holding the breath, muscular tension, or pain. The movement presented in the video is one possible movement. Other movements can be used as "edgework" using the same approach.

"Novel movements" are movements that are a little different from the way we normally move. As Cory says, they are movements about which the brain has not yet formed an opinion. By practicing novel movements, we can try to find movements that are not painful and break the association between movement and pain.

We massage therapists are taught a lot about muscles. We also study bones, joints, ligaments, tendons, fascia. We learn a little about physiology, about other systems of the body, and some lip service is paid to the role of the nervous system in the relaxation response and to how the brain mediates the changes brought about by massage. But mostly we pay attention to muscles. We talk about which muscles are tight, find “knots” in them, and “release” them by pushing into them and/or stretching them with our hands, fingers, forearms, and elbows.