tag:blogger.com,1999:blog-24334220726441867122024-03-21T09:32:33.126-06:00Reclaiming LifeAnonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.comBlogger26125tag:blogger.com,1999:blog-2433422072644186712.post-21937038959995469782017-01-03T19:07:00.000-07:002017-01-03T19:07:38.902-07:00Meet on the Same Stage (Stages of Change and Pain Management)<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKzrXomTqz48CFaHAdIIuMcdaT-DUdBH74W8uX-C83suuNLqmS-x7Xiu1cjykDRrrVjEM7o03_yTaWOCRG6olVJYQNqt1iqWS-bxswbStr_YNYGTV2r92x6FessUIiaoKROUd0jloLA_Kl/s1600/Same+Stage+Final+small+.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="change and chronic pain " border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKzrXomTqz48CFaHAdIIuMcdaT-DUdBH74W8uX-C83suuNLqmS-x7Xiu1cjykDRrrVjEM7o03_yTaWOCRG6olVJYQNqt1iqWS-bxswbStr_YNYGTV2r92x6FessUIiaoKROUd0jloLA_Kl/s320/Same+Stage+Final+small+.png" title="Meet on the Same Stage: Stages of Change and Chronic Pain " width="320" /></a></div>
<span style="font-family: "arial" , sans-serif; font-size: 12pt; text-align: center;">Imagine you are acting in a play. Your goal is to follow instructions
from the director, in order to tell a story. The problem is that the director
is in a different room, and can’t see the stage you’re acting on. The director
calls out instructions, but they don’t seem to fit with the set or the props
that you’re working with. You know the director is experienced, and has spent a
lot of time studying this play, but his cues just don’t make any sense. He
seems to become increasingly frustrated with you, as the play is not
progressing in the way he intended. You are equally frustrated with him,
because it feels like he does not understand your situation or respect the
effort you are making. You are both trying to achieve the same goal, but it
seems like you’re on two completely different pages. </span><br />
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;">Now imagine that instead of being an actor, you are a person in pain.
The “director” is someone trying to help you. It could be a health care
provider, family member, or simply an acquaintance who read something on the
internet. Whoever it is, they are well-meaning and have something they want to
share with you. No matter how much they know about pain, you are the one who is
living with it every day. Unless they understand your unique set of
circumstances, their suggestions may not work for you. They may seem frustrated
with you, because their attempts to be helpful are not resulting in an
improvement of your situation. At the same time, you may feel frustrated with
them because it seems like they simply do not understand. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;">Now let’s look at the word “stage” a little differently. Instead of
thinking of a stage as a platform for acting out a play, let’s think of the
other kind of “stage,” a point in a process. Just like it is essential for a
director to understand the set and available props, anyone who intends to help
someone in pain needs to understand where the person is, and what their
strengths and challenges are. <o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;">When it comes to managing chronic pain, self-management is often an
essential component. But simply giving people a one-size-fits-all list of steps
to take may not be effective. This type of approach will likely result in
a similar scenario to the one described above with the actor and the director.
The clinician and person in pain will become increasingly frustrated with each
other, and the intended goals will not be achieved. Clinicians can sometimes
assume people will follow every single recommendation and it can be a source of
tension for both parties. There can be a multitude of reasons for this
disconnect, such as the information clients have previously been given about
their pain, their stress level, their responsibilities (looking after children,
keeping a job, etc), and their beliefs and values.<o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;">The clinician needs to start by understanding where the client is. One
model that can be useful is the <a href="http://www.cpe.vt.edu/gttc/presentations/8eStagesofChange.pdf"><span style="color: blue;">stages of change</span></a>. Today we’ll make some
suggestions about how we believe the stages of change apply to lifestyle
changes that people want to make, such as pain self-management strategies.
Please note, there is no right or wrong stage to be in. Telling someone they
are in the wrong stage of change would be like telling someone they’re in the
wrong stage of grief after a loss. Everyone deals with challenges in their own
individual way, and it may change over time. <o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiydoUQhOekudmf0bT7E3AOA7dXrDQRgOBPMMxILi-Nt53_PISex6iO8iqDQLsLJe8qor6uDVkQ1T0PgLhog7x5a7h0oK1BhsAggfUQNzO1mHSLfXZzgmr2EvuBqmPjbcDgo9iz8BHpnyho/s1600/Stages+of+Change+Final+2+small+.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="stages of change and chronic pain" border="0" height="392" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiydoUQhOekudmf0bT7E3AOA7dXrDQRgOBPMMxILi-Nt53_PISex6iO8iqDQLsLJe8qor6uDVkQ1T0PgLhog7x5a7h0oK1BhsAggfUQNzO1mHSLfXZzgmr2EvuBqmPjbcDgo9iz8BHpnyho/s400/Stages+of+Change+Final+2+small+.png" title="Stages of Change in Chronic Pain " width="400" /></a></div>
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<b><u><span style="font-family: "arial" , sans-serif; font-size: 12pt;">Precontemplation:</span></u></b><b><span style="font-family: "arial" , sans-serif; font-size: 12pt;"> </span></b><span style="font-family: "arial" , sans-serif; font-size: 12pt;">“I don’t have any control over this.”</span><span style="color: #4a86e8; font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> </span><span style="font-family: "arial" , sans-serif; font-size: 12pt;"><o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;">In terms of coping with chronic pain, a person in this stage is looking
for someone or something outside of themselves (a medication, a new doctor, a
new treatment, etc.) to make their pain go away. This might mean they feel
completely helpless and that their pain is out of their control.</span><span style="color: magenta; font-family: "arial" , "sans-serif"; font-size: 12.0pt;"> </span><span style="font-family: "arial" , sans-serif; font-size: 12pt;"><o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">If you are in this stage<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">If you are reading this
blog, you are probably not in this stage. Unless someone suggested you
read the blog, in which case, thanks for checking it out</span><span style="color: magenta; font-family: "arial" , "sans-serif"; font-size: 12.0pt;">.</span><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;"><o:p></o:p></span></li>
</ul>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">If you want to help someone
in this stage<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Support them as they look
for answers.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Express that you believe
them and how pain is affecting their life.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Let them know you’ll be
there for them along their journey.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Note: If you give a lot of
suggestions about self-management to a person in this stage, it may not
go over well. This is like the actor and director we described above. You
may end up feeling frustrated that they are not taking your suggestions,
and they may end up feeling like you don’t understand their situation. If
you do give them suggestions, it may work best to frame it as something
to keep in the back of their mind.<o:p></o:p></span></li>
</ul>
</ul>
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<b><u><span style="font-family: "arial" , sans-serif; font-size: 12pt;">Contemplation:</span></u></b><b><span style="font-family: "arial" , sans-serif; font-size: 12pt;"> </span></b><span style="font-family: "arial" , sans-serif; font-size: 12pt;">"Maybe I can have some control
over this.”</span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;">In the world of pain, a person in this stage may be dissatisfied with
the symptom relief they experience from their current treatment, and they may
be looking for more options. They may begin to feel that there could be
something they can do about their pain, but they are not yet confident that change
will make a difference. <o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">If you are in this stage<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Look to reliable sources of
information and support. This may include your health care providers,
support groups, books, and other sources. (We like to think of ourselves
as one of these reliable sources!)<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">It may be helpful to make
notes or jot down ideas that seem interesting to you<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Try not to get overwhelmed
by all the different perspectives out there<o:p></o:p></span></li>
</ul>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">If you want to help someone
in this stage<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Recognize that their
interest in change may rise or fall, and that’s okay<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Try not to overwhelm them
with too many different suggestions<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Try to encourage them
without pushing<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Remember that this is their
journey. <o:p></o:p></span></li>
</ul>
</ul>
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<b><u><span style="font-family: "arial" , sans-serif; font-size: 12pt;">Preparation:</span></u></b><b><span style="font-family: "arial" , sans-serif; font-size: 12pt;"> </span></b><span style="font-family: "arial" , sans-serif; font-size: 12pt;">“This is how I’m going to try and take
control.”</span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;">A person in this stage is formulating a specific plan. <o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">If you are in this stage<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Decide on one small,
sustainable change that you want to start with<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">When deciding what change
to make, consider what changes might take the least effort and/or have
the most reward<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Eliminate barriers that
would stand in the way of achieving your goal<o:p></o:p></span></li>
</ul>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">If you want to help someone
in this stage<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Identify the positive
results that this change would bring about<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Express that you believe in
them, and their ability to carry out the change<o:p></o:p></span></li>
</ul>
</ul>
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<b><u><span style="font-family: "arial" , sans-serif; font-size: 12pt;">Action:</span></u></b><b><span style="font-family: "arial" , sans-serif; font-size: 12pt;"> </span></b><span style="font-family: "arial" , sans-serif; font-size: 12pt;">“I am taking control now.”</span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;">A person in this stage is carrying out their plan.<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">If you are in this stage<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Don’t be afraid to start
very small. Walking for two minutes more than you have been is a huge
step in itself.<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Don’t be too hard on
yourself if it doesn’t work some days<o:p></o:p></span></li>
</ul>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">If you want to help someone
in this stage<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Encourage them on rough
days<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Make the change along with
them, if you’re a family member or friend<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Help them celebrate their
accomplishments - both the small successes and the big ones<o:p></o:p></span></li>
</ul>
</ul>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in;">
<b><u><span style="font-family: "arial" , sans-serif; font-size: 12pt;">Maintenance:</span></u></b><span style="font-family: "arial" , sans-serif; font-size: 12pt;"> “I have tools and resources that I can use to help
manage my pain”</span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">If you are in this stage<o:p></o:p></span></li>
<ul type="circle">
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Recognize that there will
be ups and downs<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Keep learning and trying
new strategies to add to your “tool belt”<o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: normal;"><span style="font-family: "arial" , "sans-serif"; font-size: 12.0pt;">Celebrate how far you’ve
come<o:p></o:p></span></li>
</ul>
</ul>
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<span style="font-family: "arial" , sans-serif; font-size: 12pt;"><br /></span>
<span style="font-family: "arial" , sans-serif; font-size: 12pt;">We purposely put these steps in a circle because although they are a
logical progression, they are not necessarily linear. People may move
backwards, forwards, or sideways depending on what’s going on in their lives.
What may feel like a set-back may just be part of the journey. Remember that
just like the actor and the director at the beginning of this post, the person
in pain and someone who wants to help them will both find the experience more
rewarding if they are on the same stage.<o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com9tag:blogger.com,1999:blog-2433422072644186712.post-53703362226584695242016-08-17T10:49:00.000-06:002016-08-17T10:54:13.947-06:00Pain Theory Applied<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh04NFDq-cBWqe_A3o4HWWQleXSDtIQGNL7ye8a_SJK3IYKNfM8DcD44iQY5m1Jxdoq2r8fppCBfUxlxSuq16IWYHFWl3TqnvB3XuWJAoKZ17hTb7HwRcCcXyDm93qHLGitewVZPIODxGn2/s1600/Knee+Post+.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="Knee Pain " border="0" height="268" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh04NFDq-cBWqe_A3o4HWWQleXSDtIQGNL7ye8a_SJK3IYKNfM8DcD44iQY5m1Jxdoq2r8fppCBfUxlxSuq16IWYHFWl3TqnvB3XuWJAoKZ17hTb7HwRcCcXyDm93qHLGitewVZPIODxGn2/s320/Knee+Post+.png" title="Knee Pain " width="320" /></a></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">This post will be a little different from our typical chronic pain post. This is a real-life story about a woman who was able to use strategies based on pain theories to minimize disability from her pain. This post will bring together points that have been made throughout our previous posts.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">This woman, let’s call her Abigail, had a knee injury a couple of years ago. At that time, the knee pain got pretty bad. It definitely interfered with her function. She wanted to go jogging, but that caused the pain to flare up, so she stopped doing it. Sometimes she even had trouble walking. She had a really hard time getting up and down off the floor with her young children, and it interfered with her enjoyment of spending time with them. She went to her doctor, who diagnosed it and referred her to a physiotherapist (PT).</span><span style="background-color: transparent; color: #9900ff; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The PT taught her how to strengthen her quadriceps to put less strain on her knee. She had custom shoe inserts made to support her flat feet (which can cause her knees to go inward, and was thought to be contributing to the pain). She iced her knee and took anti-inflammatories only when the pain got really bad, thinking that she should avoid taking too many meds. She wore a knee brace for a while, because she felt scared to do things without it on. All these things seemed to help, and she felt good that she had a few strategies, but it took months until the pain gradually went away.</span><br />
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Now fast forward a couple of years. Abigail is in better shape overall, and her knee hasn’t been bothering her, unless she does too many squats. She likes to go to a zumba class a couple of times per month. She wants to be able to go jogging, because she has enjoyed that in the past. She’s a little worried that her knee might bother her, but she wants to try it. She starts a running routine with some co-workers, taking it easy at first and gradually building up, with a goal of reaching 30 minutes. She registers for a 5km fun run, hoping she’ll actually be able to run it. The first few weeks of training, her knee feels fine. She’s pleasantly surprised, but still careful.</span><br />
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">When she gets to a point where she’s running 20 minute intervals, the knee pain is suddenly back. It’s relatively mild at this point, but it’s got her attention. She knows she doesn’t want to go back to the moderate/severe pain that affected her so much two years ago. </span><br />
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">This time, she sees an occupational therapist and a physiotherapist who both specialize in pain. Her health care team explains some theories and science around pain.</span><br />
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1. The “Pain Alarm” </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> (see<a href="http://reclaiminglifefrompain.blogspot.ca/2015/08/normal-0-false-false-false.html)" target="_blank"> this post</a>)</span></div>
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<li><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">The pain alarm can be useful, so it is probably telling her something. </span></li>
<li><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Since the pain clearly started when she began to run 20 minutes at a time, she thinks it’s probably telling her she’s pushing herself too hard, too fast. </span></li>
<li><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">But if she blindly listens to that alarm, or misinterprets what it’s telling her, and she stops moving completely, it will likely get worse.</span></li>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">2. Pain related fear and avoidance (see the <a href="http://reclaiminglifefrompain.blogspot.ca/2015/09/your-brain-is-trying-to-protect-you.html" target="_blank">diagram on this post</a>)</span></div>
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<li><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">If she stops doing activities that can hurt (like running, zumba, or playing with her kids), the decreased activity could actually make things more difficult and painful. This in turn could increase her avoidance of these tasks, creating a cycle that results in decreased functioning. </span></li>
<li><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">If she completely ignores what her body is saying, and continues trying to increase her running endurance by trying harder and harder to push through the pain, well, that could potentially cause serious pain. Which would lead to avoiding activities because her knee truly can’t tolerate them. This in turn could lead to more fear, and more avoidance, and more pain. </span></li>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">3. “Safety in Me” vs “Danger in me” (see <a href="https://noijam.com/2015/03/12/dim-sims/" target="_blank">this website</a>)</span></div>
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<li><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;"> There is value in anything that helps build her confidence in her body’s ability to move without causing her pain to get worse.</span></li>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">So basically, Abigail knows she has to pay attention to the acute pain “alarm.” She needs to find the balance where she continues to do activities, but doesn’t overdo it. Understanding these concepts, she works with her health care team to explore how her new knowledge applies to her situation, and develops some strategies:</span><br />
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<li><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">She knows that she needs to keep moving, but aims to “fly under the radar” (see last post) of pain, meaning that she will do movements that bring her just to the point of discomfort, but not past it into pain. Basically, she wants to stay in the pushing-herself-but-safe zone.</span></li>
<li><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">With that in mind, she scales back on running, but doesn’t stop. She knows that when she was running for 16 minutes, her knee pain didn’t flare up. So she decides to go back down from 20 minutes to 16, and stay there for a couple of weeks. She plans to increase her time only if she feels the pain is well under control. </span></li>
<li><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">She decides to replace Zumba classes with water aerobics for a while, to give her the chance to focus on running. She realizes that both running and Zumba involve impact on her joints, and decides she needs to choose one to focus on. She wants to increase her running endurance, so that's the one she chooses.</span><span style="color: red; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span></li>
<li><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">She learns different exercises from her physiotherapist. This time the exercises are more personalized to the specific reason for her knee pain. </span></li>
<li><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">She ices her knee and takes anti-inflammatories any time she feels the pain and swelling coming, instead of trying to be “tough” and taking meds only when she can’t take the pain anymore. She knows she wants to keep the inflammation at bay so she can keep moving. </span></li>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Abigail finds great success in this plan. She’s absolutely thrilled that she was able to do it, and is so glad that she didn’t stop running when the pain first started. She’s also glad she took the pain seriously and came up with a plan. She’s grateful for all of the pain theory that she was able to build into her plan. The best part - in another month, she’s able to run the 5 km fun run without experiencing knee pain! </span><br />
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<u><b><i><span style="font-size: x-small;"><span style="background-color: transparent; color: black; font-family: "arial"; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Acknowledgments:</span></span></i></b></u><br />
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: x-small;">Diagram by Reclaiming Life. Graphics from <a href="http://freepik.com/" rel="nofollow" target="_blank">freepik.com</a> </span></span>Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com7tag:blogger.com,1999:blog-2433422072644186712.post-69902828810361725702016-07-30T18:45:00.000-06:002016-07-30T19:57:46.520-06:00How Can Pain be Changed? Brain Based Treatment Ideas<div style="text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKSFfAF62laRH2UKYPwF3FHDozfOrRQqEkSdup7xyPSQWKLgG6nRmSlgcJF5AewhLEQE41REbVSYdbtgk-vxf5JURwoEFERjj0B-EWZ7TpD7UTuvbdw6m2kyj_Jg78vaGd-TzZOmOdJIOd/s1600/Treatment+title+Graphic+done.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKSFfAF62laRH2UKYPwF3FHDozfOrRQqEkSdup7xyPSQWKLgG6nRmSlgcJF5AewhLEQE41REbVSYdbtgk-vxf5JURwoEFERjj0B-EWZ7TpD7UTuvbdw6m2kyj_Jg78vaGd-TzZOmOdJIOd/s320/Treatment+title+Graphic+done.png" width="212" /></a></div>
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<span style="font-family: "georgia"; font-size: 16px; font-style: italic; line-height: 1.38; text-align: center; vertical-align: baseline; white-space: pre-wrap;">"If we’re in pain, it's changes in our total body that </span><span style="font-family: "georgia"; font-size: 16px; font-style: italic; line-height: 1.38; text-align: center; vertical-align: baseline; white-space: pre-wrap;">hav</span><span style="background-color: white; font-family: "georgia"; font-size: 16px; font-style: italic; line-height: 1.38; text-align: center; vertical-align: baseline; white-space: pre-wrap;">e lead to chronic pain, but it is changeable." </span><span style="background-color: white; font-family: "georgia"; font-size: 16px; font-style: italic; line-height: 1.38; text-align: center; vertical-align: baseline; white-space: pre-wrap;">- David Butler</span><span style="background-color: white; font-family: "georgia"; font-size: 16px; line-height: 1.38; text-align: center; vertical-align: baseline; white-space: pre-wrap;"> (2015)</span></div>
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<span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; text-align: center; vertical-align: baseline; white-space: pre-wrap;">At the end of our <a href="http://reclaiminglifefrompain.blogspot.ca/2016/05/the-brain-and-pain-is-chronic-pain.html" target="_blank">last post</a> </span><span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; text-align: center; vertical-align: baseline; white-space: pre-wrap;">we talked about how pain treatment is evolving and growing as knowledge of pain increases. We described some neurophysiology concepts in that post, and how they relate to pain. Now let’s go one step deeper and look at an overall approach and some specific treatments that apply these concepts to clinical practice.</span></div>
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<span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">The neuromatrix approach described by Moseley (2003) leads to a clinical framework that involves using this knowledge of brain mechanisms to change the experience of pain. Research into neuroplasticity has opened the door to the idea that our brains can, and do, change throughout our entire lives. The great thing about this is it creates new possibilities in the treatment of pain.</span></div>
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<span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">All of these ideas are based on some common themes</span><span style="font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">: </span></div>
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<li><span style="font-family: "georgia"; font-size: 16px; line-height: 22.08px; white-space: pre-wrap;">Many areas of our brain work together as part of the pain response. The network that makes up this response is unique to each individual. </span></li>
<li><span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">Pain is an alarm telling us that something is wrong - but the alarm can malfunction. It can respond to the wrong type of information, or require less activation of the network to produce a pain response.</span><span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">“Smaller and seemingly less relevant inputs are sufficient to...produce pain” </span><span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">(Moseley, 2003, p. 4). </span></li>
<li><span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;"><span style="line-height: 22.08px;">If we can decrease the threat value of the signals our brain receives, or allow more of the network to be activated before the pain response is triggered, we can decrease the pain (Moseley, 2003).</span></span></li>
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<span style="font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;"><span style="line-height: 1.38;">Moseley (2003) explained three steps to treatment based on these concepts. Today, we’ll examine each step and how a variety of treatment ideas could be incorporated into the process he described.</span></span></div>
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<span id="docs-internal-guid-59da20e3-3bec-7025-e1aa-fdcf7861ca47"><span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">1. An initial step in treatment involves reducing the threatening input and/or the threat value the brain assigns to these signals. The idea</span><span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; text-decoration: line-through; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: #fdfdfd; font-family: "georgia"; font-size: 16px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">is that if the signals coming from the body are decreased or interpreted as less of a threat, then the alarm doesn’t need to sound as loud. There are several ways to achieve this. One way is by fixing physical issues in order to reduce the actual input. This can be done through manual therapy, exercises, heat/ice as appropriate, pain medications, etc. Another approach is to reduce the threat value of the inputs. This can be done by things like education about pain, and techniques that calm your nervous system like relaxation, deep breathing, and even laughter yoga. </span></span><br />
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<span style="font-family: "georgia"; font-size: 16px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">2. The next step is to figure out how to activate components of the “neuromatrix” without triggering pain. Like we talked about <a href="http://reclaiminglifefrompain.blogspot.ca/2016/05/the-brain-and-pain-is-chronic-pain.html" target="_blank">last time</a>,</span><span style="font-family: "georgia"; font-size: 16px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;"> the neuromatrix is a network comprised of different areas and processes within the brain. When enough of the network is activated the pain response is triggered. The goal with this step is to activate some components of this network without activating the pain response. Some examples of ways to do this include: </span></span></div>
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<li><span style="font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">visualization (imagining pain free movement)</span></li>
<li><span style="font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">breaking activities down into simple movements </span></li>
<li><span style="font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">reducing the physical demand of a task</span></li>
<li><span style="font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">changing the way tasks are done </span></li>
<li><span style="font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">changing the context surrounding tasks</span></li>
<li><span style="font-family: "georgia"; font-size: 16px; line-height: 1.38; white-space: pre-wrap;">changing the language we use to decrease the “threat” associated with a particular movement</span></li>
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<span style="font-family: "georgia"; font-size: 16px; vertical-align: baseline; white-space: pre-wrap;">3. Then, the next step is to gradually increase how much of the neuromatrix is activated, so that more and more of it can be activated without resulting in pain. The key to achieving this without causing flare ups is to be aware of </span><span style="font-family: "georgia"; font-size: 16px; vertical-align: baseline; white-space: pre-wrap;">the threshold </span><span style="font-family: "georgia"; font-size: 16px; vertical-align: baseline; white-space: pre-wrap;">(how much of the neuromatrix can be activated without pain), and </span><span style="font-family: "georgia"; font-size: 16px; vertical-align: baseline; white-space: pre-wrap;">very gradually increase that threshold. </span><span style="font-family: "georgia"; font-size: 16px; vertical-align: baseline; white-space: pre-wrap;"> One way to conceptualize this is the idea of flying under the radar, as described in the graphic below.</span><span style="font-family: "georgia"; font-size: 16px; vertical-align: baseline; white-space: pre-wrap;"> The idea is to avoid triggering enough of the neuromatrix to cause a flare-up, and gradually push the limits. This will increase how much of the neuromatrix can be activated before a flare up is triggered. </span></span></div>
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<span id="docs-internal-guid-59da20e3-3bec-7025-e1aa-fdcf7861ca47"><span style="font-family: "georgia"; font-size: 16px; vertical-align: baseline; white-space: pre-wrap;">Modern science and knowledge about the brain and nervous system has opened up a variety of treatment options. Treatment can be done in several different ways, depending on the individual’s needs, and the approach can change over time as needed. Note, we have to be careful attributing everything to the brain. The brain clearly plays a huge role in pain, but human beings are vastly complex, and so is pain. In order to understand pain, clinicians need to understand “several domains...neuroscience, immunology, endocrinology, psychology, sociology, and philosophy”. (First-person neuroscience and the understanding of pain. Thacker and Moseley. 2012). We would like to suggest that because so many factors contribute to pain, there is hope that all of these factors can be used to change pain. Even though we don’t have a cure for chronic pain yet, we do have solutions; methods to reduce and manage it, and learn to function better.</span></span></div>
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<span id="docs-internal-guid-59da20e3-3bec-7025-e1aa-fdcf7861ca47"><span style="font-family: "georgia"; font-size: x-small;"><span style="line-height: 17.94px; white-space: pre-wrap;"><b>Acknowledgement:</b></span></span></span></div>
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<span id="docs-internal-guid-59da20e3-3bec-7025-e1aa-fdcf7861ca47"><span style="font-family: "arial"; font-size: x-small;"><span style="background-color: white; line-height: 15.6px; white-space: pre-wrap;">Diagrams by Ashley and Colleen. Graphics are from <a href="http://freepik.com/" rel="nofollow" target="_blank">freepik.com</a></span></span></span><br />
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<span id="docs-internal-guid-59da20e3-3bec-7025-e1aa-fdcf7861ca47"><span style="font-family: "georgia"; font-size: x-small;"><span style="white-space: pre-wrap;"><b>References:</b></span></span></span></div>
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<span id="docs-internal-guid-59da20e3-3bec-7025-e1aa-fdcf7861ca47"><span style="font-size: x-small;"><span style="background-color: white; font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Butler, D. via Arthritis Victoria. (2015, August 3).</span><span style="background-color: white; font-family: "arial"; font-style: italic; vertical-align: baseline; white-space: pre-wrap;"> Treating Pain Using the Brain - David Butler </span><span style="background-color: white; font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">[Video File]. Retrieved from </span><a href="https://youtu.be/4ABAS3tkkuE" style="text-decoration: none;"><span style="background-color: white; font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">https://youtu.be/4ABAS3tkkuE</span></a><span style="background-color: white; font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"> on April 22, 2016. </span></span></span><br />
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<span style="font-family: "arial"; font-size: x-small; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Moseley, G.L. (2003). A pain neuromatrix approach to patients with chronic pain. </span><span style="font-family: "arial"; font-size: x-small; font-style: italic; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Manual Therapy,</span><span style="font-family: "arial"; font-size: x-small; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;"> 8(3), 130-140.</span><br />
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<span id="docs-internal-guid-59da20e3-3bec-7025-e1aa-fdcf7861ca47"><span style="font-size: x-small;"><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">Thacker, M.A., & Moseley, G.L. (2012). First-person neuroscience and the understanding of pain. </span><span style="font-family: "arial"; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">The Medical Journal of Australia</span><span style="font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;">, 196(6), 410-411.</span></span></span><br />
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<span style="background-color: white; font-family: "arial"; font-size: x-small; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Melzack, R. (2001). Pain and the neuromatrix in the brain. </span><span style="background-color: white; font-family: "arial"; font-size: x-small; font-style: italic; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Journal of Dental Education, </span><span style="background-color: white; font-family: "arial"; font-size: x-small; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">65(12), 1378-1382.</span></div>
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</span>Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com4tag:blogger.com,1999:blog-2433422072644186712.post-30820177757193935882016-05-13T21:45:00.000-06:002016-05-14T11:33:48.005-06:00The Brain and Pain: Is Chronic Pain Changeable? <div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtNtTFvWIk-JFnhJPCKsRsAetI8ttj53f3eWD1rNLX_fkwQzQvxLvBoofFd9C4mZsmkVjcBSfaUSjH9ZptaZrxKcAiwkkC9Hz4fmlzL8LwpSNadfs4OB0fKGqbeOl0JdZXnTSSTARnN-2K/s1600/Brain+and+Pain+.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="Brain and Pain " border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtNtTFvWIk-JFnhJPCKsRsAetI8ttj53f3eWD1rNLX_fkwQzQvxLvBoofFd9C4mZsmkVjcBSfaUSjH9ZptaZrxKcAiwkkC9Hz4fmlzL8LwpSNadfs4OB0fKGqbeOl0JdZXnTSSTARnN-2K/s320/Brain+and+Pain+.png" title="The Brain and Pain " width="261" /></a></div>
<span style="clear: left; margin-bottom: 1em; margin-right: 1em;"><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">A while ago, I (Colleen) was having a discussion about pain with a friend who has fibromyalgia. One of her comments was that she believes it’s “all in her head.” (I cringed as she said that, but then listened to her reasoning.) She feels like there isn’t anything wrong with her tissue and body. It seems like her brain is hypersensitive to “pain signals,” just like it is to many other things (stress, sound, etc). I stopped cringing, and commented how cool it is that our brain’s perception of those signals can be changed.</span></span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Her reply was “Do you really think that can change?”</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">I responded: “Absolutely”</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Why that answer? Back when we were in OT school we didn’t learn a lot about chronic pain other than, it was chronic. But since then, we’ve learned enough to convince us that it isn’t as static as we once thought. Yes, it is persistent, and yes, it is real. And no, there aren’t any magic wands to make it completely go away. But the research suggests that it is definitely possible to change our nervous system and our experience of pain.</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">So let’s take a peek at this idea. How did it become a part of the pain picture? And what is the evidence?</span><br />
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<span style="color: black; font-family: "arial"; font-size: 14.6667px; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Some</span><span style="color: #9900ff; font-family: "arial"; font-size: 14.6667px; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="color: black; font-family: "arial"; font-size: 14.6667px; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">(Very) Basic Neurophysiology </span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">This idea of looking at the brain’s connection to pain is relatively new. A lot of it has come into play in the last few decades as new technologies have become available. We are now able to see what is going on in the brain during different activities (fMRI). Researchers and clinicians have begun to understand just how much the brain can, and does, play a role in pain. For the sake of this post, we are only touching on a few ideas. </span><br />
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<li><span style="font-family: "arial"; font-size: 14.6667px; font-weight: 700; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Neuroplasticity: </span><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">One of the key points that has come out of this research is the idea of neuroplasticity - that is, our brains are changing every day and will continue to change for our entire lives (Butler, 2014).</span></li>
<li><span style="font-family: "arial"; font-size: 14.6667px; font-weight: 700; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Neurotags:</span><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;"> Our brain is made up of tons of neurons that are interconnected in a complex way. A neurotag is a network of neurons from different areas of the brain. When this network is activated, it “generates a particular experience”</span><span style="color: magenta; font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">(</span><span style="background-color: white; font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Cundiff & Schellinck, 2015; Moseley, Butler, Beames, & Giles, 2012).</span><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;"> We have all kinds of neurotags, for a variety of different experiences, and the components that make up these neurotags are individual. For example, if you have experienced food poisoning after consuming a chicken burger, you could have a “food poisoning neurotag.” This neurotag would include neurons that are related to the smell of chicken, the appearance of a burger, the type of bun used, the restaurant you were at, etc. When enough of these neurons are activated, the whole neurotag gets activated, and you experience nausea (</span><span style="background-color: white; font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Cundiff & Schellinck, 2015)</span><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">. </span></li>
<li><span style="font-family: "arial"; font-size: 14.6667px; font-weight: 700; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Activation threshold: </span><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">The activation threshold is the amount of input that is needed to cause a nerve cell to fire. Just like nerve cells have an activation threshold, neurotags need a certain amount of stimulation to be triggered. The activation threshold is the amount of the neurotag that has to be activated before it produces an output (</span><span style="background-color: white; font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Moseley, Butler, Beames, & Giles, 2012).</span><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;"> In the above example, maybe just seeing a similar burger wouldn’t be enough to activate that whole network, but seeing the burger at the same food truck in the summer would activate the nauseous sensation. </span></li>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img alt="neurotag, activation threshold, brain, pain" height="368" src="https://lh3.googleusercontent.com/1EEMCxW5A-zPOxcxPxEodwz3RbGIokBkUsvj_z1x7iGwYhPWXeOjYUeWEJiXwQLzCLrqIaQRQxJzljjbmENQEN8TyhU0-ue5cYwQuVtz7IJHntmRhUJdfiWJikySPftpnR1wX0Qs" style="border: none; transform: rotate(0rad);" title="Neurotags and Activation Threshold" width="501" /></span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">There is a prominent approach called the neuromatrix theory of pain that takes all the concepts we explained above, and turns them into a way to explain and address pain.</span><br />
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<span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">Back in an earlier <a href="http://reclaiminglifefrompain.blogspot.ca/2015/08/normal-0-false-false-false.html" target="_blank">post</a></span><span style="color: magenta; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">we talked about how pain is not simply a representation of what is happening in our tissues, but rather a judgement about the signals from our body. Our brain makes decisions about what these signals mean. Basically, “pain is produced whenever the brain concludes that body tissue is in danger and action is required” (Moseley, 2003).</span><span style="color: red; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span><br />
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<span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">Now combine this definition of pain with the neurophysiology described above. All the concepts like neurotags and neuroplasticity can be applied to pain. The brain is always receiving signals, or messages, from the body. These signals have the potential to trigger a “danger” or “pain” response in the brain (neurotag). If enough of the neurotag is triggered (activation threshold), then the whole network is triggered. Many areas of the brain become activated at the same time and they work together to produce pain as a way to bring your attention to the threat. Because of neuroplasticity, this whole process can change over time (Moseley, 2003; </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">Moseley, Butler, Beames, & Giles, 2012). These concepts can guide treatment planning.</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjMmCnriltL_PEJ6N-AyJHlRDERCzZgcbL9wXavOVR6MZZL_ixF4lIsoySOL7PNrL0PzPwXPekUVAGV2uJp1Ye1HcUxtvaNxZRjDNXsKZgwAjCpErfHziuf4xY1Grvx5xKjf0Rkve6ItwO/s1600/DB+web+sized+.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img alt="" border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgjMmCnriltL_PEJ6N-AyJHlRDERCzZgcbL9wXavOVR6MZZL_ixF4lIsoySOL7PNrL0PzPwXPekUVAGV2uJp1Ye1HcUxtvaNxZRjDNXsKZgwAjCpErfHziuf4xY1Grvx5xKjf0Rkve6ItwO/s320/DB+web+sized+.png" title="David Butler Quote" width="197" /></a></div>
<span style="background-color: white; color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">The idea that pain involves many areas of the brain interacting with each other can also be helpful when considering treatment options. It means there are many more mechanisms involved in pain than previously thought.</span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> As David Butler (2015) said, this is exciting because it “underpins the ENORMOUS power of context. Say 500 areas of the brain are in action when we’re in pain - it means that there is kind of a formula for your pain. We’re all different, and it can be changeable.</span><span style="color: #a64d79; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">” </span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">So back to our initial question “is chronic pain changeable?” As our knowledge of the brain changes, so does our view on pain. Chronic pain is not as static as once thought. Current research on the brain’s role in pain has led to new ideas and theories about treatment. This post has been all about the idea that pain can change, and why we believe this is important. In future posts, we will discuss techniques and strategies that are built on these concepts.</span></div>
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<span style="font-family: "arial"; line-height: 1.38; white-space: pre-wrap;"><span style="font-size: xx-small;">Diagrams by Ashley and Colleen. Graphics are from <a href="http://freepik.com/" rel="nofollow" target="_blank">freepik.com</a>. </span></span><br />
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<span style="font-family: "arial"; font-weight: 700; line-height: 1.38; white-space: pre-wrap;"><span style="font-size: xx-small;">References</span></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: xx-small; font-style: normal; font-variant: normal; font-weight: 400; vertical-align: baseline; white-space: pre-wrap;"><span style="color: black; font-family: "arial"; text-decoration: none; vertical-align: baseline;">Butler, D. (2014). noijam blog: </span><span style="background-color: #fdfdfd; color: black; font-family: "arial"; text-decoration: none; vertical-align: baseline;">Explain Brain. Retrived from </span><span style="background-color: #fdfdfd; font-family: "arial"; line-height: 1.38; vertical-align: baseline;">https://noijam.com/2014/12/09/</span><span style="background-color: #fdfdfd; font-family: "arial"; vertical-align: baseline;">explain-brain/</span><span style="background-color: #fdfdfd; color: black; font-family: "arial"; vertical-align: baseline;"> on April 16, 2016. </span></span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: xx-small; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="background-color: white; color: black; font-family: "arial"; vertical-align: baseline;">Butler, D. via Arthritis Victoria. (2015, August 3).</span><span style="background-color: white; color: black; font-family: "arial"; font-style: italic; vertical-align: baseline;"> Treating Pain Using the Brain - David Butler </span><span style="background-color: white; color: black; font-family: "arial"; vertical-align: baseline;">[Video File]. Retrieved from </span><a href="https://youtu.be/4ABAS3tkkuE" style="line-height: 1.2; text-decoration: none;"><span style="background-color: white; color: black; font-family: "arial"; vertical-align: baseline;">https://youtu.be/4ABAS3tkkuE</span></a><span style="background-color: white; color: black; font-family: "arial"; vertical-align: baseline;"> on April 22, 2016. </span></span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: xx-small; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="background-color: white; color: #161617; font-family: "arial"; vertical-align: baseline;">Cundiff, L. & Schellinck, S. (2015). The Physiology of Pain. In </span><span style="background-color: white; color: #161617; font-family: "arial"; font-style: italic; vertical-align: baseline;">Occupational Therapy Best Practice: Chronic Pain Management</span><span style="background-color: white; color: #161617; font-family: "arial"; vertical-align: baseline;"> [Course Manual]. </span></span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: xx-small; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="color: black; font-family: "arial"; vertical-align: baseline;">Moseley, G.L. (2003). A pain neuromatrix approach to patients with chronic pain. </span><span style="color: black; font-family: "arial"; font-style: italic; vertical-align: baseline;">Manual Therapy,</span><span style="color: black; font-family: "arial"; vertical-align: baseline;"> 8(3), 130-140. </span></span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: xx-small; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="background-color: white; color: #161617; vertical-align: baseline;">Moseley, G.L., Butler, D., Beames, T.B., & Giles, T, J. (2012). </span><span style="background-color: white; color: #161617; font-style: italic; vertical-align: baseline;">The Graded Motor Imagery Handbook. </span><span style="background-color: white; color: #161617; vertical-align: baseline;">Adelaide, Australia: Noigroup Publications. </span></span></div>
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Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com3tag:blogger.com,1999:blog-2433422072644186712.post-52502951207031960492016-04-23T08:55:00.001-06:002016-05-14T11:33:58.873-06:00Neuroscience and Pain<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgExOOF-H4LwRuBOW9hEVCmiZakH2_EK5UXRmm0d_BQxagi-mxOdb8DlEgTe07zu8UssS1LZWhHz2Z00985-PYrvt55UnpKToiW5uT6uPuMBKnI7SGXB_VJXNikA11B0D19PmVbt9815lwz/s1600/Done+Test+13.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="Brain and Pain, Neurotags" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgExOOF-H4LwRuBOW9hEVCmiZakH2_EK5UXRmm0d_BQxagi-mxOdb8DlEgTe07zu8UssS1LZWhHz2Z00985-PYrvt55UnpKToiW5uT6uPuMBKnI7SGXB_VJXNikA11B0D19PmVbt9815lwz/s1600/Done+Test+13.png" title="Neuroscience and Pain " /></a></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Acknowledgement: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Diagram by Ashley and Colleen. Graphics from <a href="http://freepik.com/" rel="nofollow" target="_blank">freepik.com</a> with the exception of the mosquito and the tent. They are by Julia Makotinsky from <a href="http://shop.scrapbookgraphics.com/Julia-Makotinsky/" rel="nofollow" target="_blank">JMDesigns</a>. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">References: </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Arthritis Victoria. (2015, August 3).</span><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Treating Pain Using the Brain - David Butler </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">[Video File]. Retrieved from </span><a href="https://youtu.be/4ABAS3tkkuE" style="text-decoration: none;"><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">https://youtu.be/4ABAS3tkkuE</span></a><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> on April 22, 2016. </span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Moseley, G.L. (2007).</span><a href="http://www.bodyinmind.org/resources/journal-articles/full-text-articles/reconceptualising-pain-according-to-modern-pain-science/" style="text-decoration: none;"><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Reconceptualising pain according to modern pain science.</span></a><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Physical Therapy Reviews</span><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, Volume 12, 169-178.</span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Moseley, G.L., Butler, D., Beames, T.B., & Giles, T, J,. (2012). </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The Graded Motor Imagery Handbook. </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Adelaide, Australia: Noigroup Publications. </span></div>
Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-52254818351509341362016-03-14T20:29:00.003-06:002016-03-15T13:47:43.417-06:00Strategize: A Mini-Post<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
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<span style="background-color: white; clear: left; color: #222222; float: left; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; margin-bottom: 1em; margin-right: 1em; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="267" src="https://lh4.googleusercontent.com/SSeDlF9w1d5zv4BKIWHt82hOiSDUZRTdNle0Zwv3d7bBy8477wACz592Nih785fKIpzBWIkNEGWAtfozO2AaReQi0ZaqcQHMaVEmmiCDURMSa07iD_j_QXge4m7NRAhlf0hcQktf" style="border: none; transform: rotate(0rad);" width="267" /></span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Strategize: “to make a plan for achieving a goal” </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(Merriam Webster, 2016).</span></div>
<b id="docs-internal-guid-70a79489-7861-6ccc-6552-1e6197ffc422" style="font-weight: normal;"><br /></b>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Goal-setting is essential in providing effective health care (and most other areas of life where you want to achieve something), but it needs to go beyond having a vague idea of what you want to achieve. Goal-setting needs to go a bit deeper, into </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">how</span><span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> you will achieve it. </span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Imagine this: There was a woman who wanted to start ice skating again. She happened to mention this to a health care provider one day. This health care provider, trying to help her regain some of the activities she lost, told her that her homework for the week was to go skating. However, the client just didn't feel comfortable or safe going skating - so she didn't. Every week the health care provider asked if she had gone yet, and expressed disappointment that she hadn’t. This left the woman feeling disappointed in herself, and never led to her going skating.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fast forward a bit. The client had moved on to a new health care provider This one listened and </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">acknowledged her concerns about balance and the risk of falling while skating. He also</span><span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: line-through; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">recognized that she was worried that a fall on the ice could lead to being in pain for a </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">long</span><span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> time. </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The woman and her health care provider discussed which movements were likely safe (even if they hurt), and which movements were still best to avoid. He gave her simple strategies for improving balance, activities where she could succeed and see improvement. Though time, experience,and support, she learned skills that could help her achieve her goal. She also became more confident that she could deal with the effects of a potential fall. And finally, the health care provider shared in the excitement when the client did go skating on her own...and didn't fall!</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">There are a few different ideas that could be pulled out of these examples. Perhaps the biggest lesson in this story is the value of health care providers who listen to their client’s concerns. In the second example, the provider created plans </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">with</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> his client, rather than </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">for</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> her. He helped the woman achieve her goal by strategizing. The process of strategizing involved finding out what the woman’s goal was, digging deeper to find out what factors were interfering with that goal, and addressing those factors. In this way, the health care provider was able to make a true difference in the woman’s life.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: xx-small;">Acknowledgements:</span></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: xx-small;">Skates from freepik.com (Modified by Colleen and Ashley.)</span></span><br />
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<span style="color: black; font-family: "arial"; font-size: xx-small; font-weight: 700; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">References:</span><span style="color: black; font-family: "arial"; font-size: xx-small; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="font-size: xx-small;"><span style="background-color: transparent; color: #222222; font-family: "arial"; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Strategize. 2016. In </span><span style="background-color: transparent; color: #222222; font-family: "arial"; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Merriam-Webster.com</span><span style="background-color: transparent; color: #222222; font-family: "arial"; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">.</span></span></div>
<span style="color: #222222; font-family: "arial"; vertical-align: baseline; white-space: pre-wrap;"><span style="font-size: xx-small;">Retrieved March 14, 2016, from http://www.merriam-webster.com/dictionary/strategize</span></span>Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-32880932385858591442016-02-20T20:49:00.001-07:002016-05-14T11:34:09.786-06:00The Pain Management Prism<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Let’s take a look at the goal of pain management. It’s a pretty good goal. We’re betting that this goal would resonate with a lot of readers, either for yourself, for a loved one or for a client. But how is it achieved? The more we learn, the more we see that pain management really can be divided into a few inter-wound, but different paths. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img alt="Text straight .jpg" height="325" src="https://lh3.googleusercontent.com/FkMn6Or0LVX8i-L10REZj45fZWBWwhteWXpn1BdSqS5vuuaRYCdtpzsUoT4QsIv3Nrh5iGoyW32oJnVDwNvNGd9WeCDOSwo0Q1qMX2i94Srchu__SnC8SvNjh4NwVlYxOo7lMrKH" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="624" /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Let’s use the image of a prism to explain how the different aspects of pain management work together. As you see in the image above, when a beam of light hits a prism, the light is separated into a rainbow of colours. For the purposes of this post, let’s think of pain management as that beam of light. Then we can divide it into several components to examine how they connect with each other to achieve one cohesive goal. </span><br />
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<span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">To begin with, let’s take a brief look at what components go into our experience of pain and how we can impact those components. To greatly oversimplify the process, first your body senses something (pressure, temperature, etc) and </span><span style="color: black; font-family: "arial"; font-size: 14.6667px; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">creates a message</span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> about it. Your nerves then </span><span style="color: black; font-family: "arial"; font-size: 14.6667px; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">transmit this message </span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">up to your brain. Your brain then combines this message with other information to come up with an </span><span style="color: black; font-family: "arial"; font-size: 14.6667px; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">interpretation</span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> of what is happening in the body. If your brain decides this is something you need to be aware of immediately, it lets you know through pain. </span></div>
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<span style="color: black; font-family: "arial"; font-size: 14.6667px; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><b>How This Relates to Pain Management</b></span><br />
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<span style="color: black; font-family: "arial"; font-size: 14.6667px; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">The message creation:</span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> One aspect of pain management is to look at what is happening in the tissue. That is, focus on what is causing the sensory neurons to fire. For example, is there a broken bone, too much pressure, or damaged cartilage? Are the muscles tense or stiff? This may be the most common approach to pain management and is particularly beneficial in acute pain situations where there is an immediate problem in the tissue. Treatment involves techniques such as stretching, strengthening, realigning, using ice or heat, massage, and electrical stimulation.</span><br />
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<span style="color: black; font-family: "arial"; font-size: 14.6667px; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">The message transmission:</span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> Another aspect of pain management is to look at quieting or blocking the signals that your brain receives from the nerve cells in your body. The theory behind this is that if you can quiet the message, you can reduce or eliminate the pain. The nervous system is more complex than a simple messaging system. It modifies the messages sent to the brain, sometimes amplifying the message. This is problematic for us when it results in chronic pain, so some treatments try to dampen the message or cut it off completely. These treatment methods include nerve blocks and some pharmaceuticals.</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">When most people think of pain management, they focus on treatments that address these two mechanisms. However, there is a third mechanism that is also essential in addressing the complexity of chronic pain.</span><br />
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<span style="color: black; font-family: "arial"; font-size: 14.6667px; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">The message interpretation:</span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> The final aspect of pain management we’ll discuss in this post is how the brain interprets these signals. When your brain gets a signal that something is going on in the body it gathers all the information it can to make a decision about this signal. It looks at past experiences, what you know about that area, and other sensory information. Things like mood, fatigue, and a multitude of other factors impact how these sensations are interpreted. The brain then makes a decision about the significance of the information. It decides whether an alarm is needed, and how loud the alarm will sound. We then experience this “alarm” as pain. </span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Researchers have turned this concept around and speculated that if the threat value of these incoming signals could be lowered, then the volume on the alarm could be decreased. Therefore the pain could also be reduced (Moseley, 2007). Some examples of treatments based on this concept include relaxation techniques (telling the brain that things are okay), visualization (telling your brain that you can complete the movement pain free), and graded exposure (learning that awful pain doesn’t happen with every movement). This is the aspect of pain management that we’ve focused on the most in our blog so far, because it’s an area that we find really exciting. It’s an area that’s relatively new and full of possibilities.</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">The entire spectrum works together</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Just like white light is made up of a spectrum of colours, we believe that effective pain management is made up of a combination of treatment techniques. There is benefit to looking at tissue based mechanisms as well as brain based mechanisms, and everything in-between. All three components discussed in this post (creation, transmission, and interpretation) have an impact on the pain message and open up possibilities for intervention. This generates a whole range of tools that can be explored and new ways to potentially change and reduce pain. But more than simply reducing pain, this opens the door to improving functioning and quality of life for individuals with chronic pain. For us, this means there is always hope.</span><br />
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Acknowledgements:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Diagrams by Ashley and Colleen. Nervous system graphic and brain drawing from freepik.com</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">References:</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="font-family: "arial"; font-size: 13.3333px; vertical-align: baseline; white-space: pre-wrap;">Moseley, G.L. (2007). <a href="http://www.bodyinmind.org/resources/journal-articles/full-text-articles/reconceptualising-pain-according-to-modern-pain-science/" target="_blank">Reconceptualising pain according to modern pain science.</a> </span><span style="font-family: "arial"; font-size: 13.3333px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Physical Therapy Reviews</span><span style="font-family: "arial"; font-size: 13.3333px; vertical-align: baseline; white-space: pre-wrap;">, Volume 12, 169-178.</span></div>
Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com2tag:blogger.com,1999:blog-2433422072644186712.post-22298488070501096902016-01-23T22:32:00.000-07:002016-01-23T22:32:55.467-07:00Perspective Matters: A Mini-Post<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Check out this sign for a minute. What would you think if you saw it? Would you be surprised? Confused? </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBZLIe1OOfE1pYPQ5tprAeHoO5jNiwleP65SfSZgmQNJEt1x0VAOFg9gqZ1u7n8PpAp3O580h2as3GDYZMGEzioyBY1EvrDlvSR88WGcauhRrSCYlI07TD3I-H3wofzgYRuu9kEOB07RoC/s1600/free+gun+downloaded+from+blogger.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="173" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBZLIe1OOfE1pYPQ5tprAeHoO5jNiwleP65SfSZgmQNJEt1x0VAOFg9gqZ1u7n8PpAp3O580h2as3GDYZMGEzioyBY1EvrDlvSR88WGcauhRrSCYlI07TD3I-H3wofzgYRuu9kEOB07RoC/s320/free+gun+downloaded+from+blogger.png" width="320" /></a></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">We actually came across this sign one day as we rounded a corner. At first, we could only see the one portion of it (the part shown above). We were both caught a little off guard and thought it was really strange. We kind of said “What?!?” We had to go back and have a second look. Then we laughed and realized that this is an example of how seeing the whole picture really makes a big difference! You’ll be able to see the whole sign at the bottom of this post, but first we want to share a few thoughts.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">We all have moments in life where we have a tendency to hyper-focus on one aspect of a situation, but looking at the bigger picture can change everything. What does this have to do with reclaiming life from pain? A lot, actually. In the pain course we were at in October we all had to describe pain. One group described it as looking through a paper towel roll at life. Pain demands attention. It can be like losing your peripheral vision, or in other words, the ability to fully engage in other aspects of life. </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">This can happen whether you’re the person in pain, the supporter, or the health care provider. </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As the person in pain, the other aspects of your life can get overshadowed by the pain. </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As a supporter, you may find it difficult at times to keep your perspective on who the person really is. This is especially true when they are not acting like the person you know and love, and it can be difficult to understand what they are experiencing.</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As a health care provider, it is easy to get ahead of your clients and give them an amazing plan with all the tools to succeed, then get frustrated that they aren’t following through. But if this happens, you may need to take a step back and look at the bigger picture. Keeping a holistic view leads to appropriate goals, which lead to recommendations that can effectively address the client’s needs.</span></div>
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<br /><span style="font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">If your situation makes about as much sense as the “free gun” sign, then maybe it’s time to shift your focus. We’re not trying to tell you to put on rose-coloured glasses, ignore reality, or expect a perspective change to be a magic cure. Basically, what we’re suggesting is: sometimes it’s worth re-examining your perspective and assumptions.</span><br />
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<br />Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com5tag:blogger.com,1999:blog-2433422072644186712.post-47616095024222565152016-01-16T22:40:00.001-07:002016-02-17T18:59:43.463-07:00Back Pain: A Tale of Two ER Visits<div class="separator" style="clear: both; text-align: center;">
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<span id="docs-internal-guid-5fa000e0-4e1e-8fd8-ccf9-e6ffb433f55d"><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"><span style="color: #45818e;"><u>Imagine this:</u></span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKJBExFzlWYL229qjz0PWCLXjRl4CZTlaK-tEld_wTw5Xx9MR9LByH9nhFvIB6zgGJNZkf-7yZ3QGJ2mCLJtsrJ9ywTgh3fnFr1FYbtTUhkIpWZ8kzvEalykTja-vX8wPAb4dVz1Cs5RcE/s1600/Untitled-99.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKJBExFzlWYL229qjz0PWCLXjRl4CZTlaK-tEld_wTw5Xx9MR9LByH9nhFvIB6zgGJNZkf-7yZ3QGJ2mCLJtsrJ9ywTgh3fnFr1FYbtTUhkIpWZ8kzvEalykTja-vX8wPAb4dVz1Cs5RcE/s200/Untitled-99.png" width="170" /></a></div>
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">You are 25 years old. Your back has been hurting lately and it's been getting worse. You haven't seen your doctor about it yet. You've been pushing through it, popping over the counter painkillers, and hoping it'll get better. Then one day at work it suddenly gets a lot worse. The pain extends down your leg, and your leg gives out under you. You can't ignore this anymore. Your over the counter drugs aren't even touching the pain and you feel like you can't take it anymore. You call your partner, who drives you to the hospital. </span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Now imagine you get into the emergency room and the nurse says "oh man, you must have a herniated disc" with a look of absolute pity. You wait a few hours to be seen by a resident doctor, who does an exam that you can only describe as excruciating. He says you need an MRI and tells the nurse to give you narcotics. The narcotics kick in and you finally fall asleep, leaving your partner to sit there wide awake wondering what's going on. A while later, another doctor comes in and does the same excruciating exam. Even with narcotics this one hurts. You try to tell them that the resident already did this, so please don't do it again, but the doctor proceeds anyway. You wait another few hours and get your MRI. Another doctor comes in and again examines you in the same, horribly painful way. This doctor says "it's definitely a severe herniated disc. This pain is never going to go away unless you have surgery. But the reality is there's way too many people with painful herniated discs. If a surgeon will even take you, it'll be at least a two year wait. If you had neurological symptoms, then you could get surgery right away. But since it's “only” pain, good luck. Here's a prescription for two days worth of narcotics. I can't give you any more because I don't know you, so I can't be sure you won't abuse or sell them. Follow up with your family doctor.” Later you call the family doctor, only to find out she's on vacation for three weeks, and the covering doctor does not prescribe narcotics. </span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Can you imagine the feeling of absolute helplessness and frustration that you would feel? The key message you receive seems to be “your pain is here to stay, and we don't care.” </span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;"><span style="color: #45818e;"><u>Now imagine this version of the story:</u> </span></span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">When you get to the emergency room, the nurse reassures you. She tells you they have very good doctors here, and they'll be able to figure out a plan for how to deal with this. You wait a few hours to be seen by a resident doctor, who explains that he needs to do an exam to figure out whether there are any neurological symptoms accompanying your pain. The exam is painful for you, but he’s compassionate about it. After the exam, he tells you that the good news is he isn’t seeing any neurological deficits, and because of this he doesn't recommend advanced imaging, like an MRI. He explains that you could have a herniated disc. He also explains that research is now showing that a lot of people who have herniated discs don’t actually have any symptoms, and doing surgery on the people who are having pain is not necessarily helping them. Sometimes it even makes their pain worse. He does prescribe appropriate pain medication to help you get through this current bout of pain, but he also tells you that there are many strategies that can be used to better manage the pain, and medication is only a part of the answer. He tells you that the emergency room is great for dealing with medical emergencies, and it’s good you came here to rule out any neurological symptoms. But at this point, there are better places to further assess the cause of your pain and help you learn how to deal with it. He refers you to a pain specialist who can help you along the way and also advises you to follow up with your family doctor. He tells you to come back to the ER if you do develop neurological symptoms.</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">What do you think you might feel in this scenario, and what overall message would you receive this time?</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;"><span style="color: #45818e;"><u>What are the differences?</u></span></span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">In the first example the whole situation is the opposite of how we would like to see pain treated. There is no empathy or reassurance. The wording used only increases the threat value of the symptoms. (“Oh no, this is really bad!”) This can take a nervous system that’s already on high alert because of the sudden worsening pain and escalate the system’s response. It also does not provide any hope that things can change. (Which could be argued to add a whole new threat: this will NEVER go away!)</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">In our ideal situation the client is treated with caring, respect and compassion. Decisions are discussed with the client and education is provided. The overall approach hopefully made the client feel supported in a scary situation. </span><br />
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<u style="color: #45818e; font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Points to ponder:</u><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">We’ve packed a lot of concepts into these two short examples. These topics could be posts in themselves, but we just wanted to introduce the ideas here. We would love to hear your thoughts on them.</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">1.) Respecting the client - In the first example we saw three different doctors do the same painful exam three different times. We totally understand each doctor wanting to an assessment before they make decisions. But if a colleague just did the very same thing, you trust their judgement, and the assessment is very painful for the client...is it necessary? At this point what are you looking for with your assessment and is it a good reason/justification to put the client through the assessment? If it is necessary, explaining the benefits to to the client might put them at ease. </span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">2.) Language - As we mentioned above, the language clinicians use to describe the pain can either reassure or terrify the person in pain. Clinicians are often rushed, trying to see many people in a short time frame. However, in our example above, it really wouldn’t take any longer to communicate in the encouraging manner used in the second scenario.</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">3.) Imaging - Imaging for pain is a topic that is currently being researched and discussed. As Bronnie Thompson so succinctly stated “We know that most people with back pain are not going to benefit from having X-ray, CT or MRI because these images either don’t show anything useful (no image shows pain) or show something irrelevant that might look interesting but is actually unrelated to back pain. We know this, and there have been numerous treatment guidelines and algorithms and education indicating not to give imaging for low back pain without neurological changes” (Thompson, 2016).</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">4.) Surgery - Again this is a topic that is currently being researched and discussed. There are many articles on this topic, and some suggest that surgery has been “overprescribed” (Senelick, 2014).</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">5.) Pain Education - Educating the client on their own condition can begin at any stage and with any health care provider. While there may not be time to address it in detail in the emergency room, it can be further explored with healthcare providers who specialize in pain. These could be physicians, occupational therapists, physical therapists, psychologists, physiatrists, pharmacists, or a team of providers working together.</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;"><u><span style="color: #45818e;">And a parting thought:</span></u></span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">The first scenario is based on a real story. We don’t share it as a criticism, but as a starting place for a discussion on how pain is approached in assessment and treatment. For health care providers, we hope to draw attention to the impact your information and language can have on clients and their outcomes. If you’ve happened to be the client or family in an ER visit that resembles the first one, please don’t give up. There are health care providers out there who are treating people with compassion, kindness, and care. And there IS hope that your pain</span><span style="color: #c27ba0; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">and your life can get better.</span><br />
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<span style="font-family: "arial"; font-size: x-small;"><span style="line-height: 17.94px; white-space: pre-wrap;"><b>Acknowledgement: </b></span></span><br />
<span style="font-family: "arial"; font-size: x-small; line-height: 1.38; white-space: pre-wrap;">Diagram by Ashley and Colleen at Reclaiming Life. Graphics from Freepik.com. </span><br />
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<span style="font-family: "arial"; font-size: x-small; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">References:</span></div>
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<span style="color: black; font-family: "arial"; font-size: x-small; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Senelick, 2 (2014). MRI Back Scans Do Not Predict if you Need Surgery. Retrieved from </span><a href="http://www.huffingtonpost.com/richard-c-senelick-md/sciatica-_b_4098475.html" style="font-size: small; line-height: 1.38; text-decoration: none;"><span style="color: #1155cc; font-family: "arial"; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">http://www.huffingtonpost.com/richard-c-senelick-md/sciatica-_b_4098475.html</span></a><span style="color: black; font-family: "arial"; font-size: x-small; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;"> on January 16, 2016</span><br />
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<span style="font-family: "arial"; font-size: x-small; vertical-align: baseline; white-space: pre-wrap;"><span style="vertical-align: baseline;">Thompson, B. (2015). HealthSkills: How to Spend Money You Don’t Need To. Retrieved from </span><a href="https://healthskills.wordpress.com/2015/02/02/how-to-spend-money-you-dont-need-to/" style="text-decoration: none;"><span style="color: #1155cc; text-decoration: underline; vertical-align: baseline;">https://healthskills.wordpress.com/2015/02/02/how-to-spend-money-you-dont-need-to/</span></a><span style="vertical-align: baseline;"> on January 16, 2016</span></span>Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com1tag:blogger.com,1999:blog-2433422072644186712.post-53707869459025088182016-01-02T21:35:00.001-07:002016-01-03T11:48:46.784-07:00A Year in Review<div class="separator" style="clear: both; text-align: center;">
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">It seems like everywhere in blog-land reviews of 2015 and goals for 2016 are abundant. As 2015 is the first (half) year of our blog, we thought it would be fun to look back on our beginning.</span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Back in July we decided to start a blog, sat down, came up with a name and wrote our <a href="http://reclaiminglifefrompain.blogspot.ca/2015/07/a-beautiful-life-of-contradictions_25.html" target="_blank">first post</a>. Neither of us knew what to expect or where it would go, but we definitely had a lot to say on the topic - our list of ideas just kept growing and growing. </span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">For us the blog has been a journey. Writing some of these posts has brought tears. Others have challenged us both personally and professionally. We’ve learned a lot and read journal articles for “fun.” We’ve tried out some of the things we’re learning in our own lives. We’ve met some really great people, both online and in person. We get excited as we see our number of readers and our e-mail list grow. One of our first e-mails to each other went like this:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">C: We’ve had 118 views on our blog. Do you think that was all us dealing with our formatting? </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A: Well, I have a confession to make. I looked at it 118 times yesterday. (Totally joking)</span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">So, like any good blog review post, here’s a look back at some of the key points we’ve learned in 2015:</span></div>
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<span style="font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">1.) It’s all about the </span><a href="http://reclaiminglifefrompain.blogspot.ca/2015/10/its-all-about-nervous-system-what-we.html" style="line-height: 1.38; text-decoration: none;"><span style="color: #1155cc; font-family: Arial; font-size: 14.6667px; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">nervous system</span></a><span style="font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">. Well, we’ll admit, there are some other pieces in there. But we’ve come to realize that any helpful approach to pain management needs to take the nervous system into consideration. We’ve also realized just how much this is NOT discussed in conventional pain management. </span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">2.) Pain asks to be respected. There will be more on this topic in the future. Pain is, at the very basic level, an alarm. Ignoring it can lead to your body sounding the alarm louder. </span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">3.) There is lots of amazing information out there. And lots of people who are super excited about pain management and doing really cool research and clinical work.</span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">4.) There are many tools that can help individuals take back some control of their lives. These tools can include: energy conservation, pacing, and planning. We’ve both had some very cool “reclaiming” moments in our own lives this past year. </span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">5.) There are people who are “pain superstars” and we can all learn from each other. In fact, everyone has their own superstar moments. </span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">6.) Sometimes pain doesn’t need to be viewed as the enemy or something that needs to be overcome or beaten. Sometimes a gentler approach is what is needed. We love Bronnie Thompson’s use of the term “flexible persistence.” </span></div>
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<span style="font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">So what’s next for our blog? Well, that picture is still forming. We have lots of ideas and topics we want to explore. This includes things that we’ve discussed lately but also questions that we’ve been asked by our readers. Please feel free to continue sharing your thoughts, experiences, insights, and questions.</span><span style="color: #8e7cc3; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">We love receiving your e-mails and comments! </span><span style="font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">The ideas around pain management are expanding and changing at the moment. We really want to learn all we can and share this information with you in the coming year. While we don’t know exactly what 2016 will look like for our blog, we’re excited to see where it goes. We hope it’s full of lots of interesting, useful posts and over time becomes a place of encouragement, information and celebration of successes. </span></div>
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Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-41037376402999531282015-12-25T06:00:00.000-07:002015-12-25T06:00:05.265-07:00Merry Christmas <table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrrxd9MzTwnO8-ESSVhRFwhjfQVzd1TX3KD7prfWvhC11f7p_gqU1f-IcUPb7R6JHsOxWsla3ogHsinDBuAtT4fs__qS672g-7E-CGvOnbb2kxEO7SFxg3h8P3PBxPH63O8vQ1oCB9YQGs/s1600/Blog+Merry+Christmas+png.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="287" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrrxd9MzTwnO8-ESSVhRFwhjfQVzd1TX3KD7prfWvhC11f7p_gqU1f-IcUPb7R6JHsOxWsla3ogHsinDBuAtT4fs__qS672g-7E-CGvOnbb2kxEO7SFxg3h8P3PBxPH63O8vQ1oCB9YQGs/s400/Blog+Merry+Christmas+png.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;"><span style="background-color: white; font-family: arial, sans-serif; text-align: start;">Chickadees and Berries from </span><a href="http://www.mandyartmarket.com/" target="_blank">Amanda Ilkov</a><span style="background-color: white; font-family: arial, sans-serif; text-align: start;"> Snowflakes from <a href="http://dihiller.blogspot.ca/" target="_blank">Di Hiller Designs</a>.</span></span></td></tr>
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<br />Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-23264350435825477972015-12-05T15:39:00.002-07:002016-05-14T11:34:20.451-06:00 Spa or Bootcamp: A Case For Considering the Nervous System in Pain management<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Once upon a time there were two ladies who had fallen and ended up with a neck injury. Both had visited the ER and were sent home with a brace. One of the ladies was super relaxed about the whole thing and was somehow okay with what had happened. The other one was still in a bit of shock about the fall and completely wound up. Even just a gentle touch made her jump and scream like she had been hit. </span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">What was the difference between these two individuals? Mainly it was the state of their nervous systems. One had processed the fall, her injury, and was ready to get better. (How she did that so fast is amazing!) The other lady’s nervous system was still on guard, ready to pounce on anything that might be a threat. </span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">So the question today is: How effective is therapy when the nervous system is so wound up? It’s pretty hard to do effective therapy if you can’t even touch the person!</span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">One popular pain center described their program as a balance between a spa and a boot camp. You mostly saw the boot camp part in the gym; they would encourage people to push harder, keep going when they were tired, etc. And yes, their clients did see improvement...muscles were strengthened or stretched, there were increases in people’s endurance and the amount they could lift. Progress on charts. But looking at that program we just wondered, how much more progress could have been made if they emphasized the spa part too. If they took the time to lower people's nervous system response, and didn’t add to it by the “bootcamp” approach. What would have happened?</span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">Our guess is that they would have seen longer term, sustainable changes. From what we’ve seen, pain and all that comes with it throws a huge amount of stress on our systems. Calming the nervous system down (so that it is not constantly on edge), opens the door for you to really benefit from any other therapy. This gives you a chance to integrate it, learn from it</span><span style="font-family: "arial"; font-size: 14.6667px; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">and move towards healing. </span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">So, how can we do this? Well, there are many ways</span><span style="color: cyan; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">therapists</span><span style="color: cyan; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">can help to bring the nervous system back to a more balanced state. Here are just a few ideas:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Calm the nervous system through “relaxation” methods: visualization, acupuncture, breathing exercises, yoga, laughter, massage,</span><span style="background-color: transparent; color: cyan; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">etc</span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Create a relationship of trust with your client and validate their experiences. They don’t have to “prove” their pain, it’s just accepted.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Reduce disability. Enabling your clients to do the things the need to do (teaching them a different way, changing the situation, etc) reduces the impact of the pain on their lives and in turn reduces the stress it places on their body. </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Address client's fears. Listen, educate, and try to come up with a solution. There are about a zillion new worries that come with pain and even acknowledging them can take some of the pressure off the body. </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Give your clients permission to rest. Often people in pain feel the need to keep pushing, which again adds more stress to the body. </span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">You might have noticed on this blog we talk a lot about the nervous system. Well, this is why. We believe the process of learning to live well with pain can be only be enhanced by calming the nervous system. </span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">It’s kind of funny that this little post about the “spa vs bootcamp” concept has been hanging out with our draft posts since the beginning. It asked a lot of questions, provided some speculation based on experience, but didn’t provide a lot of answers as to why the boot-camp approach wasn't enough. And then we went to a <a href="http://reclaiminglifefrompain.blogspot.ca/2015/10/its-all-about-nervous-system-what-we.html" target="_blank">course</a> that talked all about pain and the nervous system. Lightbulbs went off! In the new year we’ll carry on this discussion and talk a bit more about how the nervous system relates to pain and why it is so important to acknowledge this connection.</span></div>
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<span style="font-size: xx-small;"><span style="font-family: "arial"; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">Acknowledgements</span><span style="font-family: "arial"; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">:</span></span><br />
<span style="color: #3a3a3a; font-family: "arial"; line-height: 13.8px; white-space: pre-wrap;"><span style="font-size: x-small;">Weightlifter silhouette from <a href="http://www.freepik.com/free-vector/gym-silhouettes-collection_802591.htm#term=gym&page=1&position=1" target="_blank">freepik.com</a></span></span><br />
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Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com1tag:blogger.com,1999:blog-2433422072644186712.post-52032328817886945882015-11-29T16:07:00.000-07:002015-11-30T09:19:57.910-07:00The Importance of Self-Efficacy: A Mini-Post<span style="background-color: white; font-family: "arial" , "helvetica" , sans-serif;">Hello, and welcome to our second mini-post. We don't have a post to share every week, so we thought we would try sharing some mini-posts on the "in between" weeks. Today we have a quote to share with you. </span><br />
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<tr><td class="tr-caption" style="text-align: center;">"I am not afraid of Storms, for I am learning how to sail my ship." ~ Louisa May Alcott</td></tr>
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<span style="background-color: white;"><span style="color: #6aa84f; font-family: "arial" , "helvetica" , sans-serif;"><span style="color: #222222; font-family: "arial" , "helvetica" , sans-serif;">One comment we've heard from many people in pain (an echoed in the literature) is the loss of control. The feeling that pain is making the decisions in life. Paying attention to <a href="http://reclaiminglifefrompain.blogspot.ca/2015/10/your-brain-is-trying-to-protect-you.html" target="_blank">self-efficacy</a> (and looking for ways to foster it) is so important because it can help us regain that sense of power and control. Knowing that pain isn't making ALL the decisions in our lives can have a huge impact on both the experience of pain and on quality of life. </span></span></span>Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-66691293172206380452015-11-17T21:53:00.004-07:002015-11-26T17:06:46.994-07:00The Torn Blanket: How Pain Can Challenge Our Sense of Security<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Recently I (Colleen) listened to an interview of Bill Moyers with Pema Chodron. In it they talk about security and the impact of challenging situations. When these situations arise, they can affect the parts of our lives that we see as stabilizing, the things that we use to create our sense of "ground." They discussed what happens when life removes this security and how we react to that sense of "groundlessness." </span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">This lead to a discussion about our reaction to pain becoming part of our lives. (That's what happens when you write a blog with your friend!) </span><br />
<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">We think in many cases chronic pain forces us to examine the whole idea of security. For </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">many</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">people our grown-up “security blanket” includes our idea of health and our bodies’ capabilities. Our health is also inter-woven with other pieces of this blanket, like being able to provide for a family, do a certain job</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">,</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">or other parts how we define ourselves</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. The pieces that make up the blanket are different for everyone and depend a lot on individual beliefs and values.</span><br />
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">When chronic pain (or disease) enters the picture it </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">can</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> change all this. It comes along and tears some pretty big holes in this nice secure blanket. This can be a scary place and a frustrating place. For some it can be a place of loss, for others a place of anger, or possibly confusion. All sorts of reactions can happen,</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> and they can change over time. The parts that are torn and what parts are left will be different for every situation, and it is important to look at both parts.</span><br />
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So what do you do when you’re left holding a shredded blanket and looking at the ga</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">ps</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">? We think that depends on individual beliefs and situations and</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">the way </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">each person handles obstacles in their life. We can't give you a </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">one-size-fits-all</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">action plan (as much as we would love to), but we can give you some things to think about</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">1. Be kind to yourself: This doesn't mean booking a $10,000 trip to your dream destination. It's more about treating yourself with kindness. Somebody once asked me (Colleen) to pretend it had been a friend in the accident, and to picture saying the things to her that I say to myself. I just started laughing and said "I would never say that!" It was a lesson that stuck - if I wouldn't say it to a friend, why is it okay to say to myself? </span><br />
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">2. Recognize the losses and allow yourself permission to grieve. It really is okay to not be okay sometimes. It's okay to be sad, frustrated, angry, confused or crying. Acknowledging the losses doesn’t mean you are weak or unappreciative of the good things in life. In fact we think it takes a lot of courage to really stop and acknowledge what has</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">changed</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Allowing yourself to recognize that the changes in your life are significant is a huge part of creating the space to carry on. Try to find a balance - acknowledge the loss, but don't get stuck there.</span><br />
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">3. Focus on the pieces that are still there. We know, we know, we can hear the groans through the computer. This isn't just one of those "glass half full" trivial comments people make. We realize this is so easy to say but not easy to do. We realize that sometimes it looks like the glass is totally empty and there isn't even a drop left. </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Even if there are big gaping holes in the blanket, there will also be pieces that are still whole.</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Look for these pieces, they might be hidden or frayed but they're still there. Celebrate them. </span><br />
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">4. Learn to live with the holes and adjust your expectations. By keeping your standard bar at the same level it was when you were “better,” everything you do now could look like a failure in comparison. When really that’s not the case at all! By thinking this way, you are limiting yourself from recognizing successes in the present. </span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">It`s a fine balance between accepting the now and still leaving room for increased functioning, coping, and healing. </span><br />
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">When all you can think about is making it through the day</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">,</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> it’s tough. But do yourself (or your clients) a favour, and focus on one tiny change at a time. You may feel like your security blanket is gone, but it will come back. It will look different than it once did, but it will still be beautiful. </span><br />
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<b><span style="font-family: "arial" , sans-serif; font-size: 10pt;">Acknowledgement</span></b><span style="font-size: 13.5pt;"><o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 10pt;">Thank-you
to all the people who have shared their stories and wisdom with us.</span><span style="font-size: 13.5pt;"><o:p></o:p></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 10pt;">If you're
interested here is the link to the interview:<span class="apple-converted-space"> <o:p></o:p></span></span></div>
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<span style="font-family: "arial" , sans-serif; font-size: 10pt;"><a href="http://www.pbs.org/moyers/faithandreason/portraits_chodron.html">http://www.pbs.org/moyers/faithandreason/portraits_chodron.html</a><span class="apple-converted-space"> </span>or here<span class="apple-converted-space"> <o:p></o:p></span></span></div>
<a href="http://pemachodronfoundation.org/videos/bill-moyers-on-faith-and-reason-with-pema-chodron/" style="font-family: arial, sans-serif; font-size: 10pt; line-height: 1.38;">http://pemachodronfoundation.org/videos/bill-moyers-on-faith-and-reason-with-pema-chodron/</a><br />
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Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-77779552360301229122015-11-07T19:01:00.001-07:002015-11-30T06:08:05.802-07:00Pain Superstar<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizuLRHaAhslkjBHxQugcOOyjuJ39_enONKhV2uw6BaX8HFEn6sYnG8eEPMjws4UmcDyUWmRIJtcKG2tJ5GuA7AtFEH3iJYGyi5D6uel3DOCLda-9XSgOTQjW0yC0zyQGb5ogzYat1VVIcd/s1600/Pain+Superstar+Use.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="131" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEizuLRHaAhslkjBHxQugcOOyjuJ39_enONKhV2uw6BaX8HFEn6sYnG8eEPMjws4UmcDyUWmRIJtcKG2tJ5GuA7AtFEH3iJYGyi5D6uel3DOCLda-9XSgOTQjW0yC0zyQGb5ogzYat1VVIcd/s320/Pain+Superstar+Use.jpg" width="320" /></a></div>
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="background-color: white; color: #444444; font-size: 15px; line-height: 21.3px;">Hello! </span><span style="color: #444444; font-size: 15px; line-height: 21.3px;">One of the things we hope to do with this blog is encourage individuals to start to take back control of their lives from pain. </span><span style="color: #444444; font-size: 15px; line-height: 21.3px;">We don`t have a post to share every week, so we thought we would try sharing some mini-posts on the "in between" weeks. Sometimes this might be a short youtube video that we feel explains something nicely, a quote or a resource. Today it is a `pain superstars' post where we highlight an example, story, or lesson from someone living with pain. </span></span><br />
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<tr><td style="text-align: center;"><img alt="IMG_5752.JPG" height="384px;" src="https://lh6.googleusercontent.com/qGBwNpPehx4Vq8lRjV3HFROK0SvBs8IxaRMKlZLC280IEDCjfvkgcH9jrp8Zwho3G-pfCzfZUtu9amjQKqD1Z37dSHb8VoVFpOLkKFbYRNlfHyiFKk1EyxvScb26ngnHQC40Q7A" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="288px;" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Verbal consent was give to share this photo.</td></tr>
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<span style="background-color: transparent; color: black; font-family: "arial" , "helvetica" , sans-serif; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I (Ashley) met this Pain Superstar at the Multiple Sclerosis Connections Conference in October 2015. She was making her rounds talking to as many people as possible, and she stopped to chat with me. She told me about how she had lived with pain for many years. She had 4 back surgeries before she was diagnosed with MS. She acknowledged the suffering she had experienced, but she was incredibly optimistic and positive. She explained that she had been asked in a recent art class to make a piece of art that described what MS meant to her. She made these glasses and this sign to show that to her, MS is something that “still allows you to see light and beauty”. She is a true example of living well with a chronic condition!</span></div>
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</span>Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-57980634172469167362015-11-03T01:41:00.000-07:002015-11-26T17:15:12.924-07:00The Ability to Cope<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbzaBtXJDApB0S0EEBuZbfwOY_6wh3cY30DxPlalzY5kTJK85LjdLrVIbreRtp_Oo4DlammG8hKYLlVXBdPhKbesrwDvLa8E-u__XzXQMS_pkCEl3zP-Etyy9Gh7VGz9tLPxvWcQgeF7C8/s1600/Coping+Graphic+.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbzaBtXJDApB0S0EEBuZbfwOY_6wh3cY30DxPlalzY5kTJK85LjdLrVIbreRtp_Oo4DlammG8hKYLlVXBdPhKbesrwDvLa8E-u__XzXQMS_pkCEl3zP-Etyy9Gh7VGz9tLPxvWcQgeF7C8/s320/Coping+Graphic+.jpg" width="320" /></a></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">How do you cope when your coping feels like it is gone? Sometimes all the pain, fatigue, stress, and everyday life challenges can feel like they pile up so high that one more thing is just too much. It’s like the figurative “straw that broke the camel’s back”. When we spend our lives close to that breaking point, it can leave us feeling easily annoyed, irritable, and frustrated with ourselves and others. It can feel like living in a really annoying itchy sweater, where every stimulus or stress becomes magnified, and so do our reactions. Sometimes our reactions add to the feeling of being broken, as we know that they are not in proportion to the problem and are different from how we would typically react to things.</span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">All people go through this sometimes, with chronic pain or not. Tami Brady, a woman who has chronic fatigue syndrome and fibromyalgia, commented that "People are people. Some look like they have it all figured out. Trust me, they don’t. They are just good actors" (Brady, 2008). When chronic pain enters the picture and demands to be part of your life, there are bound to be times when you feel like you’ve been pushed past what you can take. This feeling could be brought on by too many stresses, not enough sleep, or a bad pain day.</span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">These overwhelming symptoms can make it hard to deal with the other challenges life inevitably brings. One of the terms related to this concept is “frustration tolerance”, which is the ability to handle or deal with problems without getting upset (McCallister, 2013). It’s not surprising that when people develop chronic pain, their frustration tolerance changes. Their daily life stresses now include pain and the impact of pain. Other things that would not have been a problem before can suddenly become much more troubling.</span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">When we asked our readers to send us their definition of pain, one response was "Pain hurts and affects everything. If I don't react how you think I should, please blame the pain, not me, or you."</span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">"Please blame the pain, not me, or you." Such a short phrase but so very important. If you feel like you aren’t coping the way you should, like you’re too grumpy or irritable (or your loved one is), know that you are not just a grumpy, mean, short-tempered person. And like everything with pain, understanding helps. Understanding that pain affects our frustration tolerance and lessens our ability to deal with everyday stressors allows us to learn strategies to deal with it. After all, recognition is 50% of the solution, right? </span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">What comes next is realizing that even though life/stress/pain/fatigue has you down at this moment, it doesn’t have to stay that way. You can feel this moment, and then move on from it. You can gather your resources and strength and get through this. There’s a song by</span><span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; vertical-align: baseline; white-space: pre-wrap;"> <a href="http://www.katherinenelson.com/" target="_blank"><span style="color: #0b5394;">Katherine Nelson</span></a> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">that says “I was born to stand tall, I was born to face the wind, I was born to feel heart break and to heal again”. Even when it feels like we’re completely spent, and all our inner strength is gone, it’s still in there somewhere. </span><br />
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The key is learning how to access it. Those moments when life really has us down can be the hardest moments to remember how to find our strength. That’s why we love the idea Bronnie Thompson (2008) shared about “<span style="color: #0b5394;"><a href="https://healthskills.wordpress.com/2008/10/15/cue-cards-for-coping/" target="_blank"><span style="color: #0b5394;">cue cards for coping</span></a>.</span>” </span><span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">The idea is that you identify the unique set of strategies that works best for you, and write them down on a card small enough to carry around with you. That way, when you need the strategies most, you will have a simple reminder to help you get through the worst times. </span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sometimes it helps to have advice and reassurance for yourself in your own words. When it feels like no one truly understands how you feel, you might find your own words the most comforting. I (Ashley) had a difficult first pregnancy. After the baby was born, I knew I wanted to have another one, but I was afraid of what it would be like to be pregnant again. Over several months, I shared thoughts and strategies with my husband that I wanted him to remind me of if the next pregnancy was also difficult. Eventually he said “Why don’t you write all these thoughts down for yourself to read? You’ll believe your own words a lot better than you’ll believe me anyway”. There was some truth to what he said. I took his advice, and wrote myself a letter. Later on, when I did become pregnant for the second time, I read and re-read that letter whenever the challenges felt like too much to face.</span><span style="background-color: transparent; color: red; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">So our suggestion is to take some time when you’re feeling okay, and think about what helps you cope. Write yourself a letter to explain it, or make some point form reminders on a card you can carry with you. Your set of strategies will be unique to you, but they might include things like deep breathing, relaxation exercises, music, calling a friend, heat or ice (ask your health care provider for advice on which one to try when), distraction in the form of a favourite movie, book, or video game, a you tube video that makes you giggle, massage, yoga, or any number of strategies to reduce the pain or improve your energy. Your health care provider can help you explore specific tools, but ultimately you know yourself best, and only you will know what combination of techniques works most effectively for you.</span><br />
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<span style="font-family: arial; font-size: 14.6667px; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">Acknowledgements:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b id="docs-internal-guid-5c112ee0-cbcb-5169-88aa-f512a45f54fd" style="font-weight: normal;"><br /></b></span></div>
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<span style="background-color: transparent; font-family: "arial"; font-size: 10.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="color: #3a3a3a;">Rope image courtesy of scottchan at </span><a href="http://www.freedigitalphotos.net/images/Other_metaphors_and__g307-Breaking_Rope_p90175.html"><span style="color: #0b5394;">FreeDigitalPhotos.net</span></a><span style="color: #3a3a3a;"><span id="goog_141945744"></span><span id="goog_141945745"></span><a href="https://www.blogger.com/"></a></span></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b style="font-weight: normal;"><br /></b></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">References:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b style="font-weight: normal;"><br /></b></span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">McCallister, M.J. (2013). </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Institute for Chronic Pain: Understanding Chronic Pain</span><span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Retrieved from</span><a href="http://www.instituteforchronicpain.org/blog/fear-avoidance-pain/" style="text-decoration: none;"><span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></a><a href="http://www.instituteforchronicpain.org/understanding-chronic-pain/complications/depression" style="text-decoration: none;"><span style="background-color: white; font-family: "arial"; font-size: 10.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span style="color: #0b5394;">http://www.instituteforchronicpain.org/understanding-chronic-pain/complications/depression</span></span></a><span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> on November 2, 2015</span></div>
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<span style="background-color: transparent; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /><span style="background-color: white; color: black; font-size: 10.6667px; vertical-align: baseline;">Thompson, B. (2008). </span><span style="background-color: white; color: black; font-size: 10.6667px; font-style: italic; vertical-align: baseline;">HealthSkills: Cue Cards for Coping. </span><span style="background-color: white; color: black; font-size: 10.6667px; vertical-align: baseline;">Retrieved from </span><a href="https://healthskills.wordpress.com/2008/10/15/cue-cards-for-coping/" style="text-decoration: none;"><span style="background-color: white; font-size: 10.6667px; text-decoration: underline; vertical-align: baseline;"><span style="color: #0b5394;">https://healthskills.wordpress.com/2008/10/15/cue-cards-for-coping/</span></span></a><span style="background-color: white; color: black; font-size: 10.6667px; vertical-align: baseline;"> on November 2, 2015</span></span></div>
Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-67059763939303018622015-10-24T21:40:00.000-06:002015-10-24T21:44:06.657-06:00It's All About The Nervous System: What We Learned Last Weekend<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3cPRA9HPgjbGgiheapwi9_YwmPL8SyxUxNyPFGH4lEWEK33JDvWF0PTyA0cNQKdBGwbz6s4DLVHnOiXOZIokyxNw_PAcCbCpW_n3j35QIWGC0-nMt2V46MBzW-_OQKuYwEaQW7Da5c4Si/s1600/Light+bulb+6.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3cPRA9HPgjbGgiheapwi9_YwmPL8SyxUxNyPFGH4lEWEK33JDvWF0PTyA0cNQKdBGwbz6s4DLVHnOiXOZIokyxNw_PAcCbCpW_n3j35QIWGC0-nMt2V46MBzW-_OQKuYwEaQW7Da5c4Si/s320/Light+bulb+6.jpg" width="206" /></a></div>
<span style="background-color: transparent; color: #434343; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">We recently had the wonderful opportunity to attend a two day workshop, “Occupational Therapy Best Practice: Chronic Pain Management.” The presenters were Sue Schellinck and Linda Cundiff, Occupational Therapists who specialize in pain. After the workshop, we joked with each other that we could write hundreds of blog posts around what we had learned in those two days. Hundreds of blog posts take time to write, so today we just want to share a few key points with you.</span><br />
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<span style="color: #434343; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">It was so exciting for us to be able to attend a workshop meant specifically for occupational therapists. We believe that there needs to be a greater occupational therapy (OT) presence in pain management. After all, research is growing to support the concept that the primary reason people seek help for pain isn’t the pain itself, it’s the impact on their lives (Crombez, Eccleston, Van </span><span style="color: #434343; font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Damme, Vlaeyen & Karoly, 2012). Occupational therapists are all about function and helping people to engage in meaningful activities. Sounds like a good fit! Pain management gives us an excellent opportunity to look at the whole picture of what is going on in a person’s life and use a wide variety of OT skills. As a result we can have a profound impact in helping people navigate the world of pain and begin to reclaim their lives.</span><br />
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<span style="color: #434343; font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">An essential key point we took from this workshop is that management of persistent pain is all about calming the nervous system. Persistent pain is not necessarily an “issue in the tissue” (although it may start out that way), but a symptom of a wound-up nervous system. We may not be able to eliminate the pain, but we can definitely change the inputs that the nervous system receives. By calming down the nervous system, we can begin to increase function and over time reduce the pain response. And that’s really exciting! </span><br />
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<span style="color: #434343; font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">This workshop combined the concept of calming the nervous system with the Canadian Model of Occupational Performance (if you’re curious about the model, see our “About Us” page). Together, these two concepts helped us create a solid framework and foundation for a deeper understanding of pain. This was an excellent way to solidify and connect the concepts we have come to understand from our education, personal experiences, and continued learning, while at the same time building on this knowledge.</span><br />
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<span style="color: #434343; font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">As well as impacting us professionally, this workshop also had a personal impact. It helped both of us as we continue to make sense of our own lives, and how we can help others do the same. At a few points in the workshop, we turned to each other and said “it all makes sense now!” One of us even cried as a particular statement hit very close to home, so maybe going to the workshop was actually a form of therapy for us. </span><br />
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<span style="color: #434343; font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Overall, we are so glad we went, and we’re excited to share what we’ve learned with you. The workshop made so much sense in terms of what we each have experienced in our own lives and made us even more excited about sharing what we’re learning through this blog. You’ll definitely see concepts from this workshop in our future blog posts. Stay tuned for more!</span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Acknowledgment: </span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 10.6667px; line-height: 14.72px; white-space: pre-wrap;">Diagram by Ashley and Colleen at Reclaiming Life. Graphics used are from <a href="http://www.freepik.com/free-vector/study-and-learning-infographic_716476.htm#term=lightbulb puzzle&page=1&position=0" target="_blank">freepik.com</a>.</span></span></div>
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<span style="color: black; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">References</span></div>
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<span style="background-color: white; color: #434343; font-family: Arial; font-size: 10.6667px; vertical-align: baseline; white-space: pre-wrap;">Crombez, G., Eccleston, C., Van Damme, S., Vlaeyen, J.W.S., & Karoly, P. (2012). Fear-avoidance model of chronic pain: The next generation. The Clinical Journal of Pain. Volume 28 (6), 475-483.</span>Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-66112319273123414102015-10-21T17:01:00.000-06:002015-10-21T17:01:39.653-06:00Meet and Greet Hi Everyone,<br />
<br />
We are so excited to see that people are reading (and hopefully enjoying) our blog! We would love to get to know you and find out what topics you would like to see covered in the future. If you could take a moment to fill this survey out we would greatly appreciate it!<br />
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Thanks so much for your time,<br />
Ashley and Colleen
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P.S. Only the first two questions show up. Please scroll down for the other two. Thanks!<br />
<iframe allowtransparency="true" frameborder="0" height="600" scrolling="auto" src="//reclaiminglife.polldaddy.com/s/meet-greet?iframe=1" width="100%"><a href="//reclaiminglife.polldaddy.com/s/meet-greet">View Survey</a></iframe>Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-7738426285924424552015-10-13T23:22:00.000-06:002015-11-26T17:17:04.198-07:00Your Brain is Trying to Protect You, Part Three: More Tools<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoiSJ1aPxvh5wdhrGtEkR-Caqf8MwKlAbgTy3NYTfwaR3GnD0qFwhqbBbTXTCXZRqpaHobvNRXZMV3igNcufOMSzn28OW3FLARNmm1afecu6AaCDw_sfenHlQBAQW8z3U3Abl2Qzh8fFfS/s1600/Three+Large+.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjoiSJ1aPxvh5wdhrGtEkR-Caqf8MwKlAbgTy3NYTfwaR3GnD0qFwhqbBbTXTCXZRqpaHobvNRXZMV3igNcufOMSzn28OW3FLARNmm1afecu6AaCDw_sfenHlQBAQW8z3U3Abl2Qzh8fFfS/s400/Three+Large+.jpg" width="400" /></a></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">1. </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Knowledge: Understanding what is happening inside the body</span></div>
<b id="docs-internal-guid-4e041be2-64a7-1d74-b95c-a11b12ce9842" style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">One important way to begin to address fear avoidance is with knowledge. Some people with pain spend a lot of time learning about their condition through books, the internet, and other sources. The information they find may or may not be accurate, and this should be considered. Other people in pain may avoid the topic, wanting to spend as little time thinking and focusing on it as possible. Whatever the case, we believe that the person in pain is the “expert” on their own experience. Health care providers can be “experts” in current evidence, theory, and knowledge around pain, and sharing this information with clients can be extremely helpful.</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">The knowledge that is provided can take many different forms: </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">-What is happening inside the body?</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">-Which movements are good versus which ones could be harmful?</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">-Which activities are safe and which are unsafe?</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">-What does pain mean? Is it causing damage, or not?</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">-Coping strategies, techniques, and resources that are available.</span><br />
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<span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">Using knowledge and education to address fear avoidance sounds obvious, but there are many factors that affect the the outcome of education</span><span style="color: #9900ff; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">. </span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">For instance, a 2003 study on using education to address fear avoidance suggested that,</span><span style="color: #434343; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> as e</span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">xpected, people who were avoiding tasks</span><span style="color: #9900ff; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="color: #274e13; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">because of fear of pain </span><span style="color: black; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">benefited from fear avoidance based physical therapy. What the authors didn’t expect was that the same education could actually lower clinical outcomes in people who they considered “confronters”, meaning people who tended not to try to avoid pain (George, Fritz, Bialosky & Donald, 2003). We interpret this to mean that it is essential for the clinician to understand the client’s current beliefs about their pain in order to determine what kind of information might be helpful to the client.</span><span style="color: magenta; font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">2. Self-Efficacy: Believing that you can do something about the pain </span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Another essential tool is self-efficacy, a term that came from Bandura, a prominent psychologist in the 1990s. Some people may wonder - why talk about psychology when the problem is physical pain? The answer is that human beings are complex, and our minds and bodies impact each other. </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: line-through; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">To put it succinctly, “</span><span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">chronic pain is inherently both a medical and a psychological condition – what healthcare providers call a biopsychosocial condition” (McCallister, 2013). </span><br />
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<span style="background-color: white; font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">So what is self-efficacy? The textbook definition of self-efficacy is: “one’s belief about one’s ability to perform behaviors that should lead to expected outcomes” (Weiten, 2004). Basically, when it comes to pain, self-efficacy is the belief that you can manage the pain and continue living your life. Self-efficacy is essential to overcoming the effects that pain can have on everyday life. When people truly believe that they can do the things that are important to them and enjoy activities despite pain, they are well on their way to reclaiming their lives.</span><br />
<span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: white; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The great news is that health care providers can help people develop self-efficacy. One way is through information, as we described above. </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As Sandy Hilton explained, “when a person isn't afraid they are going to hurt themselves it allows them to act with more self-efficacy” (Hilton & Blickenstaff, 2015). So health care providers can encourage people to build self-efficacy by providing information about what movements and activities are safe to try. Once the person begins to try things and have success with them, the feeling of “I can do this” is reinforced.</span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Health care providers can also enhance self-efficacy simply by choosing their language and focus carefully. Sandy Hilton described this as “looking for opportunities instead of dysfunction in the way we describe things with patients.” By keeping our language ability-focused rather than impairment-focused, we emphasize people’s strengths, and reinforce that they can use these strengths to their advantage in managing pain (Hilton & Blickenstaff, 2015).</span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">If you are a person in pain, look for health care providers who encourage and support you to develop your own strengths and abilities in managing your condition. Also, keep an eye out for ways to foster this empowerment in your own life. </span><br />
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<span style="font-family: arial; font-size: 14.6667px; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">3. Re-introduce movements and activities: Gradually taking activities back from the thief </span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Re-introducing movements that have become worrisome is basically hypothesis testing and rewiring the connections in the brain. In a way it is creating that sense of safety for the body to progress. It is saying “You know that big, bad thing you're afraid of? Well maybe it just isn’t so scary as you think. Maybe you can deal with it.” There are different ways to create that sense of safety so there is room to increase activities</span><span style="background-color: transparent; color: #9900ff; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">but today we are specifically going to look at graded exposure. This part of our post will be geared more toward clinicians, as it will be detailed about the specific therapy approaches. Through graded exposure the hypothesis of “If I do this movement, then I will cause pain or harm” is being tested. </span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">It’s important to note that graded exposure is different from graded activity. Both have a role in pain management, but graded exposure specifically has a role in looking at fear avoidance behaviour. Graded activity is where you choose one specific action, and gradually increase the difficulty level (intensity, duration, speed, etc) to increase your ability (strength, coordination, and skill). Graded exposure is where you look at the activities you’ve avoided because of fear of pain, and work from the “least scary” task to the “most scary”, to increase your confidence. </span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">For example, if you’ve been avoiding carrying groceries in from the car, graded activity would be starting with a box of cereal, then gradually building up to heavier grocery items. The goal would be to build up muscle strength so you can physically carry all the necessary groceries. Graded exposure addresses the emotional and psychological side more than the physical side. For example, if your specific fear is that carrying the groceries will result in injuring yourself further, being in excruciating pain, or not being able to go to work the next day, etc, then graded exposure addresses this fear. In graded exposure, you are not necessarily grading the specific activity, but grading which activities you’ll try, in what order. You would grade the exposure by starting with tasks that cause less anxiety and working up to tasks that have more fear attached to them. </span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">You might ask - what if my fear is a worsening of pain, and the fear comes true? Prior to beginning graded exposure, the clinician would help the client develop strategies for addressing these situations. Then, even if the hypothesis is proven true, the client is able to cope, and confidence still builds. We would also anticipate that often the consequence may not be as severe as the client fears (for example, if the client fears they will “break their back” lifting the groceries, the reality is they may find their pain increases temporarily, but they are extremely unlikely to actually fracture a vertebra).</span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">When we first starting learning about graded exposure, we both wondered “why would anyone ever want to do this? It sounds awful and hard”. We’ve learned that the motivation for this particular method of re-introducing movements and activities often comes when people recognize that fear is affecting what they’re able to do, and they want to take back the control. This approach is also different from “flooding”, which is what some people associate with exposure therapy. In flooding, people do things no normal person would do - like climbing in dumpsters if they are afraid of germs. Instead, this approach focuses on realistic everyday activities. </span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">When deciding what activities to start with and what order to try activities it is critical to choose an activity that is both physically doable and emotionally achievable, and this is where the health care provider’s expertise and encouragement come in. The first consideration is the safety of the task, and whether the person believes it is safe. The second consideration is how realistic the task is - it has to be a task that the client can achieve. By starting with something that is achievable it creates that confidence and momentum to continue forward. Together both of these mean start small. Start with something that is just a tiny bit scary. Don’t give a grade one kid the New York Times and expect them to love reading. Instead you start with books that are at their reading level and gradually build up, and one day they just might grow up to be someone who loves the New York Times. </span><br />
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<span style="font-family: arial; font-size: 14.6667px; font-weight: 700; line-height: 1.38; white-space: pre-wrap;">All these tools work together </span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">To summarize, we will return to the example of the gentleman with back pain from our previous two posts. He was able to find success in regaining activities because of the combination of tools that met his individual needs. His doctor began by establishing trust and a working relationship. Then the doctor provided education on back pain and how “hurt does not always equal harm”, and movement can actually help improve symptoms. Next the doctor focused on building his self-efficacy by empowering him to realize that the tools he needed were within his reach. Then they discussed specific movements and activities that he had become hesitant about, even though they were important in his life. The doctor helped him understand how to start small in approaching these activities, and how to build on each success. The doctor encouraged him when needed and celebrated with him as he regained these activities. These tools together acted as a shield, protecting the man’s daily activities from the impact of pain. </span><br />
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<span style="font-family: arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Each person’s story is different, and in real life it may not be as simple as a person approaching their doctor and finding straightforward answers about how to implement these tools. It may be a different kind of health care provider, or a whole team of providers who do this. It may not be a linear process, and these are only a few of the many tools that can be used. The pain fear avoidance model does not address all possible factors that might be involved in a person’s pain experience. We’ve simplified it for the purposes of this post. But even though each person’s journey and tools will be different, we hope you have found this overview helpful in beginning to understand how health care providers can support people in reclaiming their lives. </span><br />
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<span style="background-color: white; font-family: arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><b>Acknowledgment: </b></span></div>
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<span style="font-family: "arial";"><span style="font-size: 10.6667px; line-height: 14.72px; white-space: pre-wrap;">Diagram by Ashley and Colleen at Reclaiming Life. Graphics used are from <a href="http://vectorcharacters.net/" target="_blank">Vector Characters</a>. </span></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">George, S.Z., Fritz, J.M., Bialosky, J.E., & Donald, D.A. (2003). The effect of a fear-avoidance-based physical therapy intervention for patients with acute low back pain: results of a randomized clinical trial. SPINE, Volume 28 (23), 2551-2560.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> Hilton, S., Blickenstaff, C. (Physical Therapists). (2015, June 9). </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pain science and sensibility Episode 1: Self-efficacy and fear of movement in chronic back pain. </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">[Audio podcast]. Retrieved fro</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.6667px; font-style: normal; font-variant: normal; font-weight: 400; vertical-align: baseline; white-space: pre-wrap;">m</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.6667px; font-style: normal; font-variant: normal; font-weight: 400; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 10.6667px; font-style: normal; font-variant: normal; font-weight: 400; vertical-align: baseline; white-space: pre-wrap;">http://ptpodcast.com/pain-science-and-sensibility-episode-1-self-efficacy-and-fear-of-movement-in-chronic-back-pain/</span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">McCallister, M.J. (2013). </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Institute for Chronic Pain Blog:</span><span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fear-Avoidance of Pain</span><span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. Retrieved from </span><a href="http://www.instituteforchronicpain.org/blog/fear-avoidance-pain/" style="text-decoration: none;"><span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">http://www.instituteforchronicpain.org/blog/fear-avoidance-pain/</span></a><span style="background-color: white; color: black; font-family: "arial"; font-size: 10.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> on August 31, 2015.</span></div>
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<span style="font-family: "arial"; font-size: 10.6667px; vertical-align: baseline; white-space: pre-wrap;">Weiten, W. (2004). Psychology themes & variations. California: Thomson Wadsworth.</span></div>
<br />Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-9263020020187960992015-09-23T06:25:00.000-06:002015-09-23T06:26:03.517-06:00Your Brain is Just Trying to Protect You, Part Two: What Can You Do?<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ-LeRhp4dEJI4wTUTxkSDabnBMLL49dJ9HLg99ucQVzqnhNUzP_cDpAsmO4QLBGjSnjLRc3qqt_zv3ttgW5JgIFuJcnOIPU0BJTyLPJGPugHHpLgWxp97MGPZ3UNnUgg4mUi73CQRqES0/s1600/Post+Two+Two+600.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJ-LeRhp4dEJI4wTUTxkSDabnBMLL49dJ9HLg99ucQVzqnhNUzP_cDpAsmO4QLBGjSnjLRc3qqt_zv3ttgW5JgIFuJcnOIPU0BJTyLPJGPugHHpLgWxp97MGPZ3UNnUgg4mUi73CQRqES0/s1600/Post+Two+Two+600.jpg" /></a></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">Today we are going to learn about the shield built by our
fictional gentleman and his doctor. The tools they used to build this shield
consisted of: respecting his body, therapeutic relationship, knowledge,
self-efficacy and re-introducing activities. Some of the tools were focused on
mitigating the effect of pain and fear on current and future behaviours. They
also had tools that were more designed to help them deal with the thief and
reclaim the activities that he had already taken. Their goal wasn’t to relieve
all the pain, but instead to reclaim his life by putting him back in charge.<span style="line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">It’s important to note that none of these tools work as well
in isolation as they do together. And that not every person will benefit from
every tool. Rainville et al. (2011) talked about how there are multiple factors
behind fear avoidance behaviour. There is misinformation (e.g. I will do harm
because someone said so), learned behaviour (e.g. this hurt, so I avoid it),
and emotional behaviour (e.g. fear driven). Recognizing these factors can give
a good starting point to identify which tools may be most helpful. <span style="line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>The Tools</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>1.) Respecting your body: Permission to not be okay</b><span style="line-height: 115%;"><o:p></o:p></span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">So often it is easy to fall into the “I shouldn’t feel like
this” mentality. A good first step is to allow yourself the courtesy to respect
whatever you are feeling. Part of this is simply acknowledging these concerns
and fears. It’s respecting the fact that pain avoidance is a logical reaction
and that it’s not a sign of weakness. Recently we both attended Bronnie
Lennox-Thompson’s course on Graded Exposure for Pain Avoidance. One of the
things she said during the course that really resonated with us was the idea of
creating space for the fear around the task and doing it anyways. The goal isn’t
to logic away the fear or ignore it but rather to acknowledge it and respect
that it is there. It’s something that happened with the injury that you have to
treat just as you do the physical symptoms. <span style="line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>2.) Therapeutic Relationship: Meet people where they are</b><span style="line-height: 115%;"><o:p></o:p></span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The creation of a relationship between the practitioner and
client is one of the first things that happens when a person seeks treatment.
This relationship can have a huge impact on the outcome. Because it is so
important we think it is worth it to step back and examine this relationship
for a moment. If you’re reading this as a health care provider hopefully the
explanation of this tool will give you a basis for understanding the importance
of how you interact with clients. If you’re reading this as a person in pain or
a family member, this can help you understand why it’s beneficial for you to
find health care providers who really connect with you.<span style="line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">There are many factors that go into creating a strong
therapeutic relationship. The way these factors interact may depend<s> </s>on
the two people involved. One if the key factors that is common across
situations is the idea of validating the person’s experience; allowing the
client to have a voice and be heard and to feel safe expressing their
experience, questions and concerns. Pain is often a sensitive issue
and like any “invisible illness” people can often feel judged. People in pain
may be bombarded with societal messages such as “your pain is not real” or
“suck it up and deal with it.” They might come feeling like they have to defend
the pain or justify their behaviour. They really need to know that their
health care provider believes them and is on their side. They need to be able
to trust that their concerns are valued, and that their questions won’t be
minimized. A supportive health care provider will look for the reason behind
the concerns a patient decides to voice. <span style="line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;">The person in pain also needs to know and trust that the
health care provider knows what they’re talking about. A client once told a
therapist “you’re like a friend who comes, but is full of knowledge.” Having
this type of therapeutic relationship can be the starting point that all the
other tools build on. A study on therapeutic alliance in the context of
treating lower back pain suggested that “factors related to the therapist
seemed to be as important as the therapy in pain modulation, and their
interaction may produce substantive clinical benefits”. The authors of the
study went further to say” The effect of accepted interventions can be improved
when clinicians interact positively with their patients” (Fuentes et al). A
good relationship is key to allowing any of the next tools to be effective. <span style="line-height: 115%;"><o:p></o:p></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><b>Up Next</b></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;">The two tools discussed in this post (respecting the body
and therapeutic relationship) are the foundation for the other tools we will
discuss. Next post, we’ll go into detail about knowledge, self-efficacy, and
re-introducing movements. We hope this overview will be helpful to you as you
begin to build a shield with your own tools.</span><o:p></o:p></div>
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<span style="background-color: white; font-family: Arial; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Diagram by Ashley and Colleen at Reclaiming Life. Graphics from Freepik.com (man, grocery basket, doctor, shield).</span></div>
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<span style="background-color: white; font-family: Arial; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">References</span></div>
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<span style="background-color: white; font-family: Arial; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Fuentes, J., Armijo-Olivo, S., Funabashi, M., Miciak, M., Dick, B., Warren, S….Gross, D.P., (2014). Enhanced Therapeutic Alliance Modulates Pain Intensity and Muscle Pain Sensitivity in Patients With Chronic Low Back Pain: An Experimental Controlled Study. </span><span style="background-color: white; font-family: Arial; font-size: 12px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Physical Therapy, 94</span><span style="background-color: white; font-family: Arial; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(4),</span><span style="background-color: white; font-family: Arial; font-size: 12px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: white; font-family: Arial; font-size: 12px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">477-489.</span></div>
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<span style="background-color: white; font-family: Arial; font-size: 12px; vertical-align: baseline; white-space: pre-wrap;">Rainville, J., Smetts, R.J.E.M., Bendix, T., Tveito, T.H., Poiraudeau, S., & Indahl, A.J., (2011). Fear-avoidance beliefs and pain avoidance in low back pain. </span><span style="background-color: white; font-family: Arial; font-size: 12px; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">The Spine Journal, 11, </span><span style="background-color: white; font-family: Arial; font-size: 12px; vertical-align: baseline; white-space: pre-wrap;">895-903.</span></div>
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Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-62755204255301945192015-09-05T18:35:00.001-06:002015-09-08T21:47:52.097-06:00Your Brain is Trying to Protect You: Part One<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="color: #222222; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">Did you ever touch a hot stove as a kid?</span><span style="color: red; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="color: #222222; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">It hurt, right? Hopefully you were leery about touching a hot stove after that, and learned that touching the stove when it's on leads to pain and should be avoided. </span><br />
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">The fact that you learned to avoid a hot stove is your brain at work protecting you. Likely you got the message after only one time, and didn't have to repeat that lesson over and over to learn not to touch that hot stove. Rick Hanson, a psychologist, talks about how we are wired to register negative experiences more quickly than pleasurable ones. He explains that for our survival it is more important for us to register that a certain insect bite can be fatal to a person than that the flowers beside us smell nice (Hanson, 2013).</span><br />
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">So when your brain learns (very quickly) that a certain movement or situation causes pain, it becomes cautious. Avoiding things that are painful helps us survive and helps us know what parts need rest so they can heal. </span><br />
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<span style="color: #222222; font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">This is great.....until it becomes a problem. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHUkm3Bc5Znz_diJxyuwVt4SepzrJ1si0j9Gh9W8Dqw4CJSmsI8S2VfChJxv5e3hncpgg_Rw3ppea8HsQqs75nbR8YfTISs_5lXW92iGEJuY78aZl9igV2_YcT9PVAcSvbm6BS1fTBliRw/s1600/600+x+600.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhHUkm3Bc5Znz_diJxyuwVt4SepzrJ1si0j9Gh9W8Dqw4CJSmsI8S2VfChJxv5e3hncpgg_Rw3ppea8HsQqs75nbR8YfTISs_5lXW92iGEJuY78aZl9igV2_YcT9PVAcSvbm6BS1fTBliRw/s1600/600+x+600.jpg" /></a></div>
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<span style="color: black; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">The problem comes in when this "what is harmful" map becomes outdated or overgeneralized and begins to steal activities from us</span><span style="color: #674ea7; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">.</span><span style="color: black; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> Sometimes injuries can heal, but when you move that part of your body, your brain still says "Bad news, Bad news! What are you doing?" Your brain can become hypersensitive to that part of your body, so any message from that area becomes an alarm.</span><span style="color: #674ea7; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Your brain can also begin to generalize and gradually become sensitive to more and more movements and situations over time. That insect that was dangerous, so maybe all insects that look similar are dangerous too, and your brain learns to avoid those. If your brain takes this even further, then maybe the field you were in when you encountered that insect is dangerous. Maybe all fields are dangerous. Maybe simply going outside is dangerous. </span><br />
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<span style="color: black; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"><span style="background-color: white; font-size: 14.6667px; line-height: normal;">We're not saying the pain isn't real or the fear isn't justified. However, sometimes this protective mechanism can began to limit activities</span><span style="background-color: white; color: #674ea7; font-size: 14.6667px; line-height: normal;">. </span></span><span style="color: black; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">An example of this process could be a person with chronic back pain that began after an injury from helping a friend move. The injury began by lifting very large objects in a way that caused tissue damage. Later it turned into chronic pain. The person could become reluctant to help anyone move after that. This probably won’t have a huge impact on the person’s day to day functioning, because this situation doesn’t occur frequently, and there are usually other options. The disruption to daily life comes if the same emotional reaction gets applied to similar situations that do occur frequently. For example, maybe the person notices that even lifting smaller objects like groceries now increases his pain. Or lifting his children or grandchildren. Or maybe he has a job that involves lifting and carrying, and he is now afraid of how his work will impact his pain (and vice versa).</span><span style="color: red; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"> </span><br />
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<span style="color: black; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">There are other valid reasons he may feel afraid to move. He may have been told by a well-meaning health care provider to avoid certain movements. He may have heard the idea that bed rest is the best thing for a back injury </span><span style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">(an old way of thinking, but still believed by many people) (National Institute of Neurological Disorders and Stroke, 2014). </span><span style="color: black; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">He may have been told over and over that pain always equals harm, so he may be afraid of doing more damage to his body. </span><br />
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">As his brain tries to protect him, this can translate into an emotional reaction. Where at first he was cautious, he may become anxious or fearful. Frustration occurs when pain and the fear of pain limits movements. If it is limiting activities that aren’t important to him, it’s not a problem. The problem comes when it affects movements that ARE important. </span><br />
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">In healthcare talk it’s about the pain related fear and avoidance model. At its root this is where the fear of creating or worsening pain causes a person to avoid certain activities or situations. Pain avoidance has received a bit of a negative reputation, but if you look a little deeper it is just one of your body’s ways of trying to keep you safe; it has its roots in protective behaviour. It’s a totally normal and logical process. It is not a character flaw or a weakness. So instead of feeling like pain avoidance is a “negative” give yourself (or your client) a pat on the back, your brain is just doing its job.</span><br />
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<span style="font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">If the way your brain does that job is becoming problematic for your life, then it’s time to make a decision about whether you want to change it. As a physiotherapist we know would love to say “acknowledgement is 50% of the solution”. In order to reclaim parts of your life, it can be helpful to examine the reasons and thoughts behind avoiding certain movements and activities. As you examine those, you can learn the difference between avoidance that is helpful to healing and fear that is disruptive for your life. If you are a health care provider, it’s essential to talk with your clients and find out their perspective on how avoidance is affecting them. Then you can empower them by tailoring your approach and utilizing individualized strategies that will help them live the life they want to live. </span><span style="font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">“</span><span style="background-color: white; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">If you can learn about [</span><span style="background-color: white; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">avoidance]</span><span style="background-color: white; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">, and acknowledg</span><span style="background-color: white; color: black; font-family: Arial; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">e it when it occurs, then you can begin to challenge it and change it. It’s not an exaggeration to say that overcoming fear-avoidance is essential if you want to self-manage pain successfully. It’s really that important” (McAllister, 2103).</span><br />
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<span style="background-color: white; font-family: Arial; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">Please join us next time as we look at some of the ways we can begin to challenge and change these behaviours. </span></div>
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<b><span style="font-family: Arial, sans-serif; font-size: 10pt;">Acknowledgment:</span></b><span style="font-family: Arial, sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif;"><span style="font-size: 10pt;">Diagram by Ashley and
Colleen at Reclaiming Life. Graphics used are from Freepik.com (background, man
lifting boxes, hurt and anxious man, thief, superhero, </span><span style="font-size: 13.3333px;">light bulb</span><span style="font-size: 10pt;"> and shield).
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<b><span style="font-family: Arial, sans-serif; font-size: 10pt;">References:</span></b><span style="font-family: Arial, sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">Hanson, Rick. [The Rush
on Shaw TV]. (2013). <i>Interview with Neuropsychologist - Dr
Rick Hanson</i>.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">[Video file]. Retrieved
from <a href="https://www.youtube.com/watch?v=9gK9DyvWuGA&feature=youtu.be"><span style="color: #1155cc;">https://www.youtube.com/watch?v=9gK9DyvWuGA&feature=youtu.be</span></a> on
September 5, 2015.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">McCallister, M.J.
(2013). <i>Institute for Chronic Pain Blog:</i> <i>Fear-Avoidance of
Pain</i>. Retrieved from <a href="http://www.instituteforchronicpain.org/blog/fear-avoidance-pain/"><span style="color: #1155cc;">http://www.instituteforchronicpain.org/blog/fear-avoidance-pain/</span></a> on
August 31, 2015.<o:p></o:p></span></div>
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<span style="background: white; color: #222222; font-family: "Arial",sans-serif; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman";">National
Institute of Neurological Disorders and Stroke. (2014). <i>Low Back Pain</i> [Brochure]. Bethesda,
Maryland: National Institutes of Health Department of Health and Human
Services. Retrieved from <a href="http://www.ninds.nih.gov/disorders/backpain/low-back-pain-brochure.pdf"><span style="color: blue;">http://www.ninds.nih.gov/disorders/backpain/low-back-pain-brochure.pdf</span></a> on
September 5, 2105. </span><span style="font-family: Arial, sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
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Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com1tag:blogger.com,1999:blog-2433422072644186712.post-42137328069685308472015-08-21T22:36:00.001-06:002015-09-01T19:23:34.831-06:00Spoon Theory<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-color: transparent; color: black; font-size: 15.3333333333333px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">No online discussion of a chronic condition would be complete without including the spoon theory. The spoon theory is widely shared on the internet, probably because so many people can relate to it. It was written by Christine Miserandino of </span><a href="http://www.butyoudontlooksick.com/" style="text-decoration: none;" target="_blank"><span style="background-color: transparent; color: #1155cc; font-size: 15.3333333333333px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">butyoudontlooksick.com</span></a><span style="background-color: transparent; color: black; font-size: 15.3333333333333px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. She is a woman with Lupus, but her words apply to many chronic conditions. From our perspective, this explanation applies very well to chronic pain and the associated fatigue.</span></span><br />
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<span style="color: black; font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; vertical-align: baseline; white-space: pre-wrap;">We may not do it justice if we try to summarize it, so before you read any further, please read the original spoon theory explanation <a href="http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/" target="_blank">here</a> or have a listen to the author <a href="https://www.youtube.com/watch?v=jn5IBsm49Rk&feature=youtu.be" target="_blank">here</a></span><span style="color: black; font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; vertical-align: baseline; white-space: pre-wrap;">. This theory creates a common language for people in pain and their supporters to understand the impact of pain and fatigue on everyday life. Please take a moment to review it, then don't forget to come back and read our perspective.</span><br />
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<span style="color: black; font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; vertical-align: baseline; white-space: pre-wrap;">Basically spoon theory is about having a limited amount of energy and endurance, and having to make hard choices every day about how to use it. Think back to the last time you felt under the weather, things like getting dressed and cooking seemed extra hard. With a chronic condition</span><span style="color: #674ea7; font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="color: black; font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; vertical-align: baseline; white-space: pre-wrap;">everything takes more energy. On top of this pain takes energy, so it’s a double hit. Things you didn't even have to think about before having a chronic condition, become very effortful. Even “simple” things like having a shower or visiting with a friend can take up a huge percentage of your daily energy. Before having a chronic condition, you may have been able to go about your day knowing that even if you were tired, you would have enough energy to get through everything. With a chronic condition, life becomes a giant balancing act. You have to juggle your basic needs and responsibilities with others’ expectations and activities you would like to do. This juggling act often includes multiple days at the same time. Questions such as: “If I go out today with a friend, while I be able to go grocery shopping tomorrow?” or “if I shower now, will I have enough energy to get ready after?” become a constant thought.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;">Spoon theory is a way of taking an abstract thought (such as "I need to decide wisely where I spend my energy”) and making it concrete so people can understand. It helps explain the concept to people who have never had to make hard decisions about daily tasks. Activities cost “spoons” and one has to decide how their going to spend their spoons for the day. If loved ones read and understand this, it can help simplify communication. Instead of having to say "I can't do that right now" (which might feel like you're letting them down), you can simply say "I don't have enough spoons for that."</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;">To put spoon theory into occupational therapy terms, it's all about pacing and energy conservation. It's about respecting yourself and your body enough to realize you don't have an endless supply of "spoons," and that's okay. You can plan your activities throughout the day to maximize your use of the "spoons" you have (pacing). You can also think about the way you do tasks, to reduce the amount of "spoons" they take (energy conservation).</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;">The ideas behind this spoon theory has helped both of us begin to reclaim our lives. The great thing about spoon theory is it helps you understand that you are not completely powerless. By understanding how much energy things cost, you can use it to help stop the cycle of pushing and crashing. You can learn ways to lower the cost of activities and develop strategies that will give you more spoons. Choices can be made about how to spend your resources. You can learn to recognize how many spoons you have available on a given day and how the cost of activities changes from day to day. You can borrow spoons from following days or save spoons from previous days. You can decide what tasks are the most important and what tasks would be a bonus. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;">For example, consider a man with fibromyalgia, who wanted to spend a day at the zoo with his wife and young children. He knew the zoo could be an exhausting and over-stimulating place to be with children, even for someone without a chronic condition. For him, the zoo could be a near impossible venture because of his pain and fatigue. But because of his understanding of pacing and energy conservation (spoon theory), he was able to not only go, but enjoy the day. He and his wife used every strategy they had to plan this day to be successful. They planned the zoo trip for a Monday, but kept Tuesday as a back-up plan in case of unforeseen circumstances like weather changes or a flare-up of symptoms. They also planned for the next day to be a rest day, so he could recover. That Sunday, he rested and saved his spoons. When Monday came, he (fortunately) felt up to the trip. He rented a scooter at the zoo to reduce the number of spoons he would need. He and his wife had no expectation of seeing every exhibit, and just decided they would enjoy the day and see what they could. When he needed a break, his wife took the kids on a ride and he rested. After the trip, he and his wife both knew he had used his spoons, and respected his body’s need for recovery. She took over the childcare and supported him in getting the rest he needed. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;">Understanding spoon theory doesn’t 100% guarantee success. Both the man and his wife were aware of the risk of a flare up. But by using the strategies they’ve developed they were able to set the stage for an enjoyable day. They had learned not to take the simple pleasures of life for granted, and they were both grateful that they were able to experience a memorable family outing.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; font-size: 15.3333333333333px; line-height: 1.2; white-space: pre-wrap;">One common feeling that can come with pain or any chronic condition is a sense of powerlessness. By using strategies to maximize your spoons and being patient with what you have, you regain some sense of control. Through this process, you can respect your body’s needs without letting pain make all the decisions. We hope this helps you create the freedom needed to do what matters most. </span><br />
<span style="font-family: Arial, Helvetica, sans-serif; font-size: x-small; font-weight: 700; line-height: 1.2; white-space: pre-wrap;"><br /></span>
<br />
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif; font-size: 11pt;">Acknowledgements:</span></b><span style="font-family: Arial, sans-serif; font-size: 11pt;"><o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif; font-size: 11pt;">Graphic designed using Tagxedo
at h<a href="http://www.tagxedo.com/" style="white-space: pre-wrap;"><span style="text-decoration: none; text-underline: none;">ttp://www.tagxedo.com/</span></a><o:p></o:p></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="font-family: Arial, sans-serif; font-size: 11pt;"><br />
References:</span></b><span style="font-family: Arial, sans-serif; font-size: 11pt;"><o:p></o:p></span></div>
<br />
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: Arial, sans-serif; font-size: 11pt;">Miserandino, C. (2003). <i>The
Spoon Theory</i>. Retrieved from <a href="http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/"><span style="color: #1155cc;">http://www.butyoudontlooksick.com</span></a> on August
21, 2015.<o:p></o:p></span></div>
</div>
Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-41708541879796168102015-08-08T19:35:00.000-06:002015-08-08T20:17:04.807-06:00What is Pain? Part Two: The Pain Alarm<span style="font-family: Arial;"><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Believe </span></span><span style="font-family: Arial;"><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><span style="font-family: Arial;"><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">it or not, pain is very useful. It is a
wonderful thing that our bodies are capable of feeling pain.</span></span> </span></span><span style="font-family: Arial;"><!--[if gte mso 9]><xml>
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</xml><![endif]--></span><span style="font-family: Arial;"><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Acute pain is protective, needed, and serves a
purpose. Imagine a toddler exploring the world without pain - that child would
sustain an unbelievable number of injuries while experimenting with different
ways of moving, with no indication that any of these movements could be
dangerous. The protective nature of pain can also be seen with conditions that
affect sensation, such as leprosy, diabetes, and quadriplegia. In these
conditions there is a loss of protective sensation that can result in serious
injuries and wounds. The following diagram is a simplified version of what
happens in the body and brain when pain is experienced. The painful stimulus is
recognized and our body reacts in order to protect itself.</span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrNzb0LfLEC75vtlZMWXT4Av4Jz69qTYEfRgN6vVeGkWsfvgOVKSeRqhstaA1AbAGp9-HmDJbXR_EPVPBmWKOAL3Cr90biaTfmDLvKlQVWxv0xVXLVjik22Y_6iSFNd1xHm7G4hACxVKWh/s1600/Acute+Pain+Loop.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjrNzb0LfLEC75vtlZMWXT4Av4Jz69qTYEfRgN6vVeGkWsfvgOVKSeRqhstaA1AbAGp9-HmDJbXR_EPVPBmWKOAL3Cr90biaTfmDLvKlQVWxv0xVXLVjik22Y_6iSFNd1xHm7G4hACxVKWh/s400/Acute+Pain+Loop.jpg" width="400" /></a></div>
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less helpful, and even insidious. Chronic pain is pain that is no longer
protective. Sometimes chronic pain may be linked to actual damage in the body,
such as in conditions like arthritis or cancer. Other times, there may be no
obvious physical reason for the pain to persist “If acute pain is Dr. Jekyll,
then chronic pain is Mr. Hyde. It is the body’s alarm system gone amok.”
(Richeimer, 2014, p.2)</span><br />
<br />
<span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Another </span><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><!--[if gte mso 9]><xml>
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</xml><![endif]--></span><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">way to think of it is that acute pain is like a
fire alarm, loudly informing you that there is a problem that needs to be
addressed immediately. Chronic pain is like the fire alarm is malfunctioning -
sounding regardless of whether there is a fire, or continuing to alarm long
after the fire has been put out (Thernstrom, 2010). Even though this alarm is
not signaling immediate danger, it is very real and can be so loud and
overwhelming that it leaves you unable to function or focus on anything else.
It can be undeniably disruptive to everyday life. There are many theories to
explain why the alarm may become dysfunctional. This diagram demonstrates a few
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</span><br />
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<span style="font-family: Arial;"><span style="font-family: Arial;"><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Unfortunately, </span></span></span></span><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">chronic pain isn’t as easy to “fix” as a broken
alarm would be. For a broken fire alarm, you would simply unplug it, or call a
repair technician. If chronic pain is telling us our system is out of
whack, we need to figure out why and then work to solve it, which is no easy
task! To fix the misfiring alarm you may need a team of “repair technicians” -
a physician, pharmacist, physiotherapist, occupational therapist, psychologist,
and other team members. Even with all these people on your side it is
still possible that there will be no way to silence the alarm. Managing chronic
pain is like reducing the volume on the alarm and learning how to function
while it’s still sounding.</span><br />
<br />
<span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">We </span><span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><!--[if gte mso 9]><xml>
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Chronic pain changes life, but it doesn’t have to define it. There are no
overnight solutions, but there are a variety of strategies that can lessen pain
symptoms and improve the ability of an individual and their family to function.
What are your strategies? What has worked (or not worked) for you? Please feel
free to share your thoughts with us through the comments below or <a href="mailto:reclaiminglifefrompain@gmail.com" target="_blank">email us</a>. We look forward to discussing these in future posts.</span></span><br />
<br />
<span style="font-family: Arial; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Thank-you fo<span style="font-family: Arial;">r. coming along on our journey as we work on fixing the broken alarms in our own lives. We hope this blog can create a community where we can inspire each other to live the best possible versions of our lives. </span></span><!--[if gte mso 9]><xml>
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<![endif]--><b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: Arial; font-size: 10.0pt;">Acknowledgements</span></b><br />
<div style="margin-bottom: 10.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<br />
<span style="color: black; font-family: Arial; font-size: 10.0pt;">Diagrams by
Reclaiming Life. Brain graphic from Freepik.com</span></div>
<div style="margin-bottom: 10.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="color: black; font-family: Arial; font-size: 10.0pt;">References</span></b><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial; font-size: 10.0pt;"></span></b></div>
<div style="margin-bottom: 10.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="color: black; font-family: Arial; font-size: 10.0pt;">Richeimer, S.
(2014) <i>Confronting Chronic Pain.</i> Baltimore,
Maryland: John Hopkins Press.</span><span style="font-family: Arial; font-size: 10.0pt;"></span></div>
<div style="margin-bottom: 10.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="color: black; font-family: Arial; font-size: 10.0pt;">Thernstrom,
M. (2010) <i>The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries,
Brain Scans, Healing, and the Science of Suffering.</i> New York: Farrar, Straus, and Giroux.</span><span style="font-family: Arial; font-size: 10.0pt;"></span></div>
</div>
</div>
Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com0tag:blogger.com,1999:blog-2433422072644186712.post-36800651092064887912015-08-03T12:53:00.000-06:002017-01-27T21:30:47.736-07:00What is Pain? Part One: Defining Pain <div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">What is pain? It sounds like a simple question, but we challenge you to take a moment to try and define it before continuing to read. </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> </span></span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white;"><br /></span></div>
<div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">It’s difficult to do without simply using synonyms (eg. “something that hurts”). It’s also difficult to come up with a definition that includes all types of pain, from the annoying sensation of a paper cut to the overwhelming pain of childbirth, from the sudden, sharp pain of a needle to the dull, aching pain of a strained muscle. There are countless sensations and experiences that can all be described as pain. None of us has any way of truly understanding what another person is feeling when they say they have pain. Perhaps this is one of the reasons there are so many stereotypes and misconceptions about pain. We think it’s very important to define pain, for two reasons: First, for a person experiencing pain, defining it can be the first step in understanding and managing it. Second, for friends and family, a basic comprehension may enable them to be more empathetic and supportive.</span></div>
<span style="background-color: white;"><br /></span>
<br />
<div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">We asked for your help in defining pain, and here are some of the comments we received:</span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: #f6f7f8; color: #141823; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f6f7f8; color: #141823; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Pain is discomfort that can occur at infinite levels of intensity (not just a scale of 1-10 like your doctor says).</span></div>
</li>
<li dir="ltr" style="background-color: #f6f7f8; color: #141823; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f6f7f8; color: #141823; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Burning, stabbing, achy. Exhausting, draining, overwhelming.</span></div>
</li>
<li dir="ltr" style="background-color: #f6f7f8; color: #141823; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f6f7f8; color: #141823; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Chronic pain is tiresome; it doesn't leave you alone despite all your efforts to make it go away.</span></div>
</li>
<li dir="ltr" style="background-color: #f6f7f8; color: #141823; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f6f7f8; color: #141823; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Pain is a feeling that interrupts something you may want to do. As it intensifies, it becomes all you can think about and you become obsessed with finding ways to relieve it so you can get back to your regular life routine.</span></div>
</li>
<li dir="ltr" style="background-color: #f6f7f8; color: #141823; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f6f7f8; color: #141823; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Pain can be dull or sharp. It can feel like a knife, like being bludgeoned with a club, or being burned anywhere and everywhere. As shallow as your skin or as deep as your bones; it can debilitate your body, distract your mind, detract you from your goals/dreams, and overwhelm your senses.</span></div>
</li>
<li dir="ltr" style="background-color: #f6f7f8; color: #141823; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f6f7f8; color: #141823; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">All of us experience pain in one form or another every day of our lives. Pain varies from the insignificant and fleeting experience of stubbing a toe to the gnawing and persistent pain of an abscessed tooth and the intolerable, totally absorbing, and endless type accompanying chronic diseases. We know the pain from a stubbed toe will pass and soon be forgotten. The toothache, too, is usually quickly remedied with penicillin or sulfur based drugs and a dental procedure. The pain of chronic diseases is the tiger let loose. It is only marginally controllable and its lifespan, completely undeterminable.</span></div>
</li>
<li dir="ltr" style="background-color: #f6f7f8; color: #141823; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: #f6f7f8; color: #141823; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Pain hurts and affects everything. If I don't react how you think I should, please blame the pain, not me, or you.</span></div>
</li>
</ul>
<span style="background-color: white;"><br /></span>
<br />
<div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white;"><span style="background-color: #f6f7f8; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">You can see how there are many different ways to define pain and the impact it has on life. Each of these comments adds more clarity and a more complete understanding of the experience of pain.</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;"> There are a few more definitions of pain that we’d like to share with you. These definitions seem to be very widely used and accepted. Like your comments, each of these definitions adds an essential piece to the puzzle:</span></span></div>
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">“an unpleasant sensory and emotional experience associated with actual or potential damage” (Merskey & Bogduk 1994).</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">“pain is produced by the brain when it perceives that danger to body tissue exists and that action is required” (Moseley 2003)</span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">“Pain is whatever the experiencing person says it is, existing whenever the experiencing person say it does” (McCaffrey and Beebe, 1989)</span></div>
</li>
</ul>
<span style="background-color: white;"><br /></span>
<br />
<div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">However, even with all these definitions together, there are still parts of the pain experience that remain unexplained. One reason it is so difficult to understand another person’s pain experience is because there are so many individual factors affecting it. One factor is our mood, as “pain viewed with stress, depression or anxiety is felt more strongly than pain experienced when you are hopeful, upbeat or encouraged” (Richeimer, 2014, p.16). Social factors also affect the pain experience. For example, boys may grow up believing it is unacceptable to cry in front of others (or at all). Even though boys and girls can have the same injuries, they may experience that injury differently because of the messages society has given them. Pain is also affected by previous experiences. For example, Ashley had a family member who had two herniated discs, who was is in excruciating pain and had emergency surgery. Less than 24 hours later,the nurse caring for him was astonished that he didn’t want any pain medication. She asked “Doesn’t your incision hurt?” and he responded “A little, I guess. But it just feels so good not to have the herniated discs anymore.” His experience clearly affected his perception of post-operative pain.There are many other factors at play in our bodies and environment. This graphic demonstrates some of them.</span><br />
<span style="background-color: white;"><br /></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIH3X4AoWFzS8Fg2yLkxQawsP0FFL7y_H3Y8A53C6yH604NabxojysyrP6it43kMBHT4IDcHvdBedPruA0oFHhMzKd1547ySuz9SNirOQAuRskho1BNsGWCumc5uk8Hfy_71twm-rd8ksy/s1600/Pain+Experiance+Updated.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIH3X4AoWFzS8Fg2yLkxQawsP0FFL7y_H3Y8A53C6yH604NabxojysyrP6it43kMBHT4IDcHvdBedPruA0oFHhMzKd1547ySuz9SNirOQAuRskho1BNsGWCumc5uk8Hfy_71twm-rd8ksy/s400/Pain+Experiance+Updated.jpg" width="400" /></a></div>
</div>
<span style="background-color: white;"><br /></span>
<br />
<div dir="ltr" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white;"><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">Adding to the complexity of pain is the fact that something so unpleasant is actually very much needed. Our next post will explain why and address the differences between acute and chronic pain. For now, we hope this post has brought some clarity and understanding. If you are experiencing pain, you are not alone. Pain is part of the human condition that we will all experience in some form or another throughout our lives. Understanding it is just the beginning</span><span style="background-color: transparent; color: red; font-family: "arial"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline;">. </span></span></div>
<span style="background-color: white;"><br /></span>
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<div style="margin-bottom: 14.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial";">Acknowledgements</span></b></div>
<div style="margin-bottom: 14.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="color: black; font-family: "arial";">A special thank you to
everyone who provided their definition of pain.<br />
Pain Experience graphic by Reclaiming Life. Brain graphic (center) from Freepik.com</span></div>
<div style="margin-bottom: 14.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "arial";">References</span></b></div>
<div style="margin-bottom: 14.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">
<span style="font-family: "arial";"><a href="http://www.paincommunitycentre.org/biblio?f%5bauthor%5d=1530"><span style="color: windowtext;">McCaffery, M.</span></a>,<a href="http://www.paincommunitycentre.org/biblio?f%5bauthor%5d=1531"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span><span style="color: windowtext;">Beebe, A.</span></a>, 1989.<a href="http://www.paincommunitycentre.org/biblio/pain-clinical-manual-nursing-practice-0"><span style="color: windowtext; text-decoration: none; text-underline: none;"> </span><span style="color: windowtext;">Pain : clinical manual for nursing practice</span></a>.
C.V. Mosby, St. Louis.</span><br />
<span style="background-color: white;"><br /></span>
<span style="font-family: "arial";">Merskey H, Bogduk N. 1994. Classification of
chronic pain. IASP Press, Seattle</span><br />
<span style="background-color: white;"><br /></span>
<span style="font-family: "arial";">Moseley,
G.L. 2003. A pain neuromatrix approach to patients with chronic pain. <i>Manual Therapy</i>, 8(3), 130-140.</span><br />
<span style="background-color: white;"><br /></span>
<span style="font-family: "arial";">Richeimer,
S. (2014). <i>Confronting Chronic Pain.</i> Baltimore, Maryland:
John Hopkins Press.</span></div>
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<![endif]-->Anonymoushttp://www.blogger.com/profile/17440005915886934397noreply@blogger.com1tag:blogger.com,1999:blog-2433422072644186712.post-90848012098580307882015-07-25T21:48:00.000-06:002015-08-07T21:05:16.817-06:00A Beautiful Life of Contradictions<br />
<div align="center" style="text-align: center;">
<i><span style="font-family: "Arial","sans-serif";">“To
be in physical pain is to find yourself in a different realm – a state of being
unlike any other, a magic mountain as far removed from the familiar world as a
dreamscape… Will you ever go home? You begin to wonder, home to your normal
body, thoughts, life?” (Thernstrom, 2010, p.5).</span></i><span style="font-family: "Arial","sans-serif";"><o:p></o:p></span></div>
<u1:p></u1:p>
<br />
<span style="font-family: "Arial","sans-serif";">Welcome to Reclaiming Life! <o:p></o:p></span><br />
<br />
<span style="font-family: "Arial","sans-serif";">This blog comes from a series
of discussions, tears and celebrations. Like you, we each had different paths
of getting here. One was quick and sudden. Fine one day and not the next. The
other was a more gradual process. Wondering what was going on, hoping it wasn't
serious, tests and appointments. Figuring out that life wasn't exactly going
where we thought it was, and that all our thoughts about the "future"
were just that...thoughts. <o:p></o:p></span><br />
<br />
<span style="font-family: "Arial","sans-serif";">If you had asked us five
years ago where we would be today, I don't think either of us would have
answered that we would be excited to discuss what we're learning about pain.
But here we are. We’ve been grateful to learn from each other, someone with the
opposite perspective, who understands. We have also been amazingly fortunate to
meet wonderful people who have inspired, taught and helped us along the way.
This blog is a way to share what we've discussed, what we've learned, and to
open up further discussion about pain. <o:p></o:p></span><br />
<br />
<span style="font-family: "Arial","sans-serif";">Through it all we've learned
that pain throws you into a world unknown. It changes things, and brings up
contradictions you would never have imagined before pain entered the picture.
For instance, if you have pain, you might identify with one or more of the
following dilemmas: </span><br />
<span style="font-family: "Arial","sans-serif";"><span style="font-family: Times New Roman;"></span><br />
</span><br />
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Wanting
to push through activities that are important, but also wanting to avoid things
that make the pain worse.</span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Knowing
the pain has changed you, but feeling like the same person inside.</span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Wanting
the pain to be taken away, but not wanting to be an over-medicated zombie.</span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Feeling
like your body is your worst enemy, but that it is the only one you have, so it
is also your best friend. </span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Wanting
to be understood, but not wanting anyone you love to ever feel how you feel. </span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Not
wanting pity, but wanting support.</span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Craving
movement, but knowing it’s become painful.</span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Wanting
to do something fun, but knowing the things you used to enjoy are painful now.</span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Wanting
to accept reality so you can cope with it, but also holding on to hope that
things will get better.</span></span></div>
</div>
<span style="font-family: "Arial","sans-serif";">
</span><br />
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
</div>
<span style="font-family: "Arial","sans-serif";">If you are a family member or
friend of someone with pain, you may also feel that you’ve been thrown into a
confusing new world. You may be experiencing your own set of contradictions,
such as:</span><br />
<span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><br />
<span style="mso-list: Ignore;"><br />
</span></span><br />
<div style="margin-left: 0.5in; mso-list: l1 level1 lfo2; tab-stops: list .5in; text-indent: -0.25in;">
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Wishing
less of the household tasks would fall to you, but also willing to do some
extra work if you know it will help your loved one.</span></span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Hurting
for the other person, but knowing you need to stay strong.</span></span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Wanting
your loved one to remember that you have feelings too, but finding yourself
putting aside your own feelings to be supportive.</span></span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Missing
the way your loved one used to interact with you and the way life used to be,
but loving him just the same.</span></span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Feeling
frustrated because some days the other person just doesn’t make sense, but
striving to understand. </span></span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Sometimes
finding her irritability annoying, but at the same time knowing it’s coming
from a place of pain, and you would probably act the same way.</span></span></span></div>
<div style="margin-left: 0.5in; mso-list: l0 level1 lfo1; tab-stops: list .5in; text-indent: -0.25in;">
<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;"><span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Watching
him suffer, and feeling incredibly helpless, but still wanting to find a way to
help.</span></span></span></div>
</div>
<span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">
</span><div style="margin-left: 0.5in; mso-list: l1 level1 lfo2; tab-stops: list .5in; text-indent: -0.25in;">
</div>
</span><span style="font-family: "Arial","sans-serif";">Some of these contradictions
may apply to you and your life, and others may not. Every person with pain in
her life is different, and every experience of pain is unique. Perhaps by
reading this post, you have felt understood, or gained some understanding
yourself. That’s what this post is all about. We want to not only give voice to
experiences of contradiction in our own lives, but we hope to give a voice to
others as well. <o:p></o:p></span><br />
<u1:p></u1:p>
<br />
<span style="font-family: "Arial","sans-serif";">As we begin this blog, we
want health care providers to understand that pain is not easy or simple, and
we want those experiencing it to understand that we’re right here with you. We
don’t have any magical answers, but we do have some insights. It’s crucial to
acknowledge the pain, and how these contradictions have changed our lives. We
don’t know what life with pain will look like for every person (or even what it
will look like for ourselves in five years), but we do know that there is hope,
and there is still beauty in life after the unexpected twists and bends in our
paths. <o:p></o:p></span><br />
<br />
<span style="font-family: "Arial","sans-serif";">Thernstrom, M. (2010) <i>The
Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans,
Healing, and the Science of Suffering.</i> New York: Farrar, Straus, and Giroux.<o:p></o:p></span><br />
<u1:p></u1:p>
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