BrainWorks: A Coaching Approach to Chronic Pain
No-one should live with severe, chronic pain. The experience of pain is generated by the unconscious mind usually in response to an injury or inflammation (such as you get in arthritis). However sometimes the unconscious continues to run the pain programme when it is no longer needed. This can be for a variety of reasons. It might be to prevent us doing the very thing which caused the injury, or it might be a distraction from emotionally painful memories.
For this to make sense we need to understand the nature and purpose of pain. Most pain is an experience, like an alarm signal, which the unconscious mind creates in order to let us know that something is wrong. So for instance if you catch your arm on a hot iron, the pain tells you and prevents you doing any more damage. You certainly wouldn’t want a burn to be pain-free. This is acute (short-term) pain and it is necessary to survival.
So what happens in chronic pain?
Chronic pain is by definition pain which has lasted for more than six weeks. It may be due to an injury which has healed but is still painful, it may be caused by osteoarthritis or rheumatoid arthritis, or it may be the pain of fibromyalgia. Injuries normally heal within about six weeks although some tissues take longer than others. If pain persists months or even years later, it is not because the injury hasn’t healed.
For instance Johnny injured his back playing rugby when he was 27. He played on and off for a year or two and then gave up because the pain was so bad. At 58, he still gets back pain on a daily basis and has learned to live with it. Why? Because his unconscious mind has found that the pain prevents him from playing rugby and thereby ensures that he does not re-injure his back. However it is as if his unconscious has not figured out that at the age of 58 Johnny is never going to play rugby again.
In fact by continuing to run the old pain programme, Johnny’s unconscious is sabotaging his efforts to improve his fitness and has resulted in Johnny taking pain-killers which are causing him stomach problems.
Fortunately, long-term pain is not inevitable. There are a number of ways of dealing with it, including understanding how it works, pacing, becoming fitter and more active, and focusing on goals. I use a variety of methodologies to support clients in their journey out of pain. I always start with Explain Pain, which is just about helping you to understand the neuroscience of pain. Then there are short-term methods such as OldPain2Go®. For those where the pain is more intractable, it is possible to get a shift over a longer period, using methods such as Graded Motor Imagery and Acceptance Commitment Therapy.
As I am an osteopath, I will also include a full osteopathic consultation and examination, if you wish. This is included in the price.
To book an appointment you can call 01234 409538 and ask for a BrainWorks Initial Consultation, or book online.
Understanding how pain works underpins all the other methods of non-pharmacological pain relief. The idea that there is a one-to-one correspondence between tissue damage and pain is a bit like the old idea that the sun revolves around the earth. When you understand that pain is more than just a response to tissue damage, then everything starts to make sense. Pain is in fact an experience generated by a network of different areas within the brain. Some of these areas are involved in conscious thought, but most of them are in the unconscious part of the brain.
Pain may be a response to nerve signals from the tissues (but not always – think of phantom limb pain). And is also a response to thoughts, feelings, memories and beliefs. This explains why pain is usually worse when we are having a stressful day or if we’re angry or worried about something. As time passes the proportion of the pain which can be explained by tissue damage reduces and the proportion which is due to beliefs, memories and emotions increases.
Pain is also affected by activity and exercise, whether it be too much or too little. Getting activity at the right level (pacing) is the first step and then you can gradually build on it to increase your fitness and bring down your pain levels.
Helping you understand how pain works and what you can do to turn down the volume on your pain is an important part of the groundwork. I would usually expect to do this in your first BrainWorks session.
Sometimes it helps to understand what role the pain may be playing in your life. As we already saw, it may be a distraction from something distressing or it may be ensuring that you don’t do something likely to lead to injury. Coaching can help to uncover what it is that the pain is giving you. If you are then able to see that it is not actually necessary, or you don’t need it anymore, it is easier for the unconscious mind to let go of it.
In OldPain2Go® the practitioner acts as an intermediary between your conscious mind and your unconscious. Using this process, I am able to ask your unconscious mind to either switch off the pain altogether or turn it down to a level which is tolerable (say 2 or 3/10). Typically OldPain2Go® only requires one session, though in some cases, one or more further sessions may be needed to reinforce the message.
An important part of this method is that it allows the unconscious mind to retain the ability to generate new pain messages. So part of the process is to reassure the unconscious mind that it will still be able to generate new pain messages when necessary.
Imagine if you will that you have an arthritic knee. Every day your phone rings and when you answer, I am there on the line telling you “You do realise you have an arthritic knee, don’t you? You need to be careful.” After a week of this you’d be getting really fed up. But this is exactly what that pain is doing – it’s reminding you on a daily basis that you have arthritis in your knee.
The pain is like the telephone call, and it’s your unconscious mind which is making that call. If you could agree with your unconscious mind that you will be careful and look after your knee, then it might be willing to stop making that pain call. In most cases, the unconscious mind will turn the pain off altogether, knowing that if something new happens, it’s free to generate a new pain message, which you will listen to.
Acceptance & Commitment Therapy (ACT)
Once you understand how pain works you are in a better position to take stock of where you are and where you want to go. Again understanding how things work is so important for moving forwards. If like the old flat-earthers, your beliefs about pain are inaccurate you cannot benefit from methodologies which are based on a different model of pain. If you believe that your pain is entirely due to what is going on in your tissues, then you won’t appreciate the importance of examining things like emotion, memory or beliefs.
Acceptance is about accepting where you are now; commitment is to moving forwards towards something you value. ACT gives us a framework for coaching which will enable you to explore new ways of living your life and again allow you to turn down the volume on the pain.
Graded Motor Imagery (GMI)
In some cases there may be certain activities which are extraordinarily painful. For instance typing can be excruciating for someone who has had carpal tunnel syndrome. In this case, there is a series of stages we can go through in a measured way. This allows the brain to recalibrate so that the pain is no longer out of proportion to the activity level. Generally GMI begins with imagining doing the activity (of typing for instance). We then move you gradually towards actually doing the activity for longer periods.
To book an appointment call 01234 409538 and ask for a BrainWorks Initial Consultation, or book online.