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Taming the Beast, that is pain

Professor Lorimer Moseley explains how pain scientists are making amazing discoveries that can help you understand your pain, the first step in taming the beast.

As you’ll see, pain always involves the nervous system and how your nervous system can be retrained.

  • “How do you know if your pain system is being overprotective?”
  • “How do you retrain your pain system to be less protective?”
  • “How do you know if you’re safe to move?”

Learning a little about pain neuroscience education can be helpful. [1]

What complements this is not only learning but experiencing how YOU can change or modulate your nervous system.

Use the tools yoga has to offer; gentle movement, breath and awareness practices… to soothe and calm the system. To ‘Tame the Beast’.

You can find more information and resources at TameTheBeast.org.

[1] Louw, Adriaan & Zimney, Kory & Puentedura, Emilio & Diener, Ina. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice. 32. 1-24. 10.1080/09593985.2016.1194646.

The Person in Pain

Often, when someone has persistent or chronic pain, what’s almost forgotten amidst the assessments, tests, diagnosis, and treatments, is the person. This person is not just a body with all these parts. Rather, someone who has a unique story, history, perspective and perception about what is happening with them. How pain affects almost every aspect of their life. Their worries, concerns, uncertainty about the future.

The International Association for the Study of Pain (IASP) launched it’s Global Alliance of Pain Patient Advocates in 2018, stating “this initiative seeks to better integrate the patient voice to inform pain research and its translation into new interventions to treat pain.” Below, Joletta Belton, tells her story:

I’ve been following Joletta for a long while now. Not only an advocator for the person in pain, she writes a blog over at mycuppajo, and co-founded Endless Possibilities Initiative (EPIc), which is a “nonprofit organization intent on changing the way people get access to science-based information about pain.”

Joletta also wrote the first chapter in Yoga and Science in Pain Care: Treating the Person in Pain which I’ve mentioned here before on the blog.

She writes “My protective responses not only affected my breath, but my movement too. My muscles would tense up, my joints would become stiff, my movement braced and rigid. Being rigid and stiff affected the way I moved, the way I walked, the way I sat. The way I existed in the world. The tenser and more guarded I was, the more pain there was, so I started moving less. The less I moved, the more painful movement became. Fear of more pain, of more damage, made me move even less. A vicious cycle.”

She goes on to share what helped her most over the years. The first two, on her list:

  • “feeling heard and believed, supported and empowered
  • feeling understood, as well as understanding and making sense of my pain.”

“When we live with pain, it changes who we are as people. It changes how we see the world and how we relate to that world. We protect ourselves through isolation and withdrawal, through guarding and tension, through altered thoughts, beliefs, and movements. We disconnect from the people, places and activities that are meaningful to us.”

“It is hard.”

In her conclusion, she also goes on to say “… I want you to know it takes hard work to get out of those dark places, too. I want you to know that change is possible, but it’s not easy. It takes time and persistence, compassion and courage.
… there is so much that is possible, so much that can be done, no matter how long someone has lived with pain, no matter how many limitations they may have.”

Jolette also recently contributed, wrote, the first chapter in the Meanings of Pain, Volume 2, released last month. The interdisciplinary book – the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk “aims to better understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them”.

In my work as a yoga therapist and Pain Care Yoga teacher, probably the most important part of my work is to listen to what the person in front of me is saying about their pain, their story, their life. Provide safety and support, work to empower the person in pain as they might learn to move, breathe and renew their own sense of meaning and purpose in the world.

If you are someone who suffers from chronic pain, know that there are people out there willing to listen. There is hope. Your pain CAN change.

Let’s all continue to advocate for, educate and push for more services and support for the 1 in 5 Canadians who need it most. Each and every person, in pain.

I have chronic pain & you want me to do Yoga? Yes, the two can go together. Learn how.

What if you could learn how to move safely?
To live your life again, with more ease.

What if you could learn how to tune into your body’s signals in a way that can best guide you?

Pain is definitely complex and there can be a whole range of contributors to your individual experience of pain. It’s usually not just one thing which is why looking for the ‘thing’ to fix the pain doesn’t usually work. Particularly over the long term.

What if you had a safe place to practice what yoga offers?

  • gentle movement practice
  • breath practices
  • meditation or mindfulness practices
  • awareness practices

What if you had a community of others to be with who face similar concerns, uncertainty and questions, while you explore this?

What if you could learn that you are capable of changing or modulating your pain.

What if you could learn a little more to understand pain, what might be contributors, and what might best help to change your experience of pain?

What if you could learn how to work with your breath to help modulate your pain?

What if you could learn to notice stress and muscle tension which may contribute to your pain?  Often, these lay just under your current level of awareness.

What if you could learn ways that might help you to sleep, as we do know sleep is often a factor in the experience of pain.

What if you could learn more about your nervous system and your brain and how adaptable these are? What part they play and how this means your pain is adaptable as well.

If any of this is of interest, resonates with you or you’re curious to find out more there is still time to register for the next series of Pain Care Yoga Classes. You can find more information here, or feel free to send a question here or by emailing me at info@yogatoolsforlife.com

** Tuesdays and Thursday mornings in Stittsville, starting November 5th.

Peeling Back the Layers

Similar to the current biopsychosocial model used in the medical community when working with people suffering from chronic or persistent pain, yoga therapists utilize a comparable framework or philosophy, that being the panca maya kosha model.

The felted model above (by my colleague @meyogalune) beautifully illustrates how we might look at, explore and peel back the many layers of our existence when working with someone therapeutically. We are, after all, more than a body of tissue and matter.

What does this mean, exactly?

Let me provide a very general, simplistic idea of what each represents:

  1. Annamaya kosha. You can think of this generally, as the physical layer.
  2. Pranamaya kosha, or the energetic layer.
  3. Manomaya kosha, or the mental/emotional layer.
  4. Vijnanamaya kosha, or the mind. We might also refer to this as intellect or wisdom.
  5. Anandamaya kosha, or the spiritual, blissful layer. What I prefer to call the meaning and purpose of someone’s self, or life.

What happens sometimes in our current medical system is the person is looked at, evaluated by and treated in terms of the physical layer only or from a biomedical model, rather than a biopsychosocial model. This can be due to a multitude of reasons but I’ll highlight just a couple, below.

One, that may be surprising to you, is how many of our medical professionals are provided little training, specifically, in pain. (1) “In a review of 10 Canadian Universities across 7 provinces… 68% of programs were unable to specify any designated hours for pain education and veterinary students were shown to receive 2-5 times more pain education than that of health science students (Watt-Watson et.al., 2009).  Educational content also typically lacks integration of biological aspects with the psychosocial factors that contribute to the experience of pain (Wideman et. al., 2019b).”

Another reason might also be lack of time that’s allocated to people given our over-burdened system and/or accessibility into “self-management programs that educate people about their condition and build their capacity to take action.” (2)

What is now understood about pain and as stated in the IASP definition, pain is “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. ” You might think of it as an ‘actual, or potential threat to the system’, that system or organism, being YOU. Your whole person.

And often these threats to the system are just under your level of awareness. Or as David Butler says “DIMs and SIMs can hide in hard to find places”.  Referencing DIMs as being the Danger in Me, while SIMs as being the Safety in Me. (If you want a brief explanation of this concept, here’s a link.)

We will experience pain when our credible evidence of danger related to our body is greater than our credible evidence of safety related to our body. Equally we won’t have pain when our credible evidence of safety is greater than our credible evidence of danger (Moseley and Butler 2015, pp14).

categories-of-dimssims

People sometimes think that their pain problem is, or must be, something physical. Or, sadly, they think or are told, that its all in their head. Pain is complex and by bringing a sense of curiosity to explore many areas, layers or koshas and how they might be affecting you either positively (perhaps a SIM) or negatively (maybe a DIM) we might just change this human experience, we call pain. Your experience of pain.

If you’re interested in exploring this further, I offer both private sessions or group classes utilizing this approach. Along with awareness, exploratory and gentle movement practices, I always add in an educational aspect or some yoga philosophy in line with what we know about pain and how you can learn to be your own best resource. Click here, to see my current schedule. 

References above are from ‘A Report by the Canadian Pain Task Force, June 2019’. You can read the full report here, if interested. 

(1) “…the current state of pain education in Canada remains inadequate across disciplines, with significant knowledge gaps in both pre- and post-licensure contexts (NASME, 2019; Thompson et. al., 2018).” On page 21 of the report.

(2)  “Research in 2005-2006 indicated the median wait time for a first appointment at a MPTC was 6 months….. In a recent update to this work, researchers found little change in the wait times, noting in 2017-2018 the median wait time still hovered around 5.5 months, with some people waiting up to 4 years to access to multidisciplinary pain care (Choinière et. al., 2019).”  On page 18 of the report.

 

Yoga and Science in Pain Care

How might we blend yoga with science to provide pain care to people? A new book just released provides a way forward.

“Our vision is for this book to improve care for people living in pain, whether acute or chronic pain. We believe health care professionals and yoga therapists can enhance care through deeper understanding of pain, science and evidence-informed interventions. We also believe that professionals can enhance their work through integrating yoga concepts, practices and philosophies. As such, this book is meant to bridge yoga, pain science and evidence-informed rehabilitation … and will inform those committed to helping people with this largely undertreated issue that causes so much suffering in the world.” –  Preface, Yoga and Science in Pain Care; Edited by Neil Pearson, Shelly Prosko, Marlysa Sullivan

The first chapter by Joletta Belton is about the “Lived Experience of Pain” highlighting to me the need to listen to, acknowledge and consider first, the person and their experience.

“The authors provide an integrated, in-depth understanding of how yoga therapy can be incorporated within a modern understanding of pain as an experience. The book encompasses perspectives from people living with pain, summarises research progress in the field, debates theories of pain and pain management, considers the many different yoga practices, describes pain biology, self-regulation and examines breath, body awareness, nutrition, emotions and response to pain, and above all, integrates concern for practitioners and people in pain as humans sharing an intangible experience together. The authors write about how yoga therapy can provide a uniting and compassionate approach to helping people learn to live well.”

– Bronwyn Lennox Thompson, PhD, MSc, DipOT, Postgraduate Academic Programme Leader, Pain and Pain Management, Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, NZ

There are a lot of yoga books on shelves these days. Yoga for this, yoga for that. You name it; it’s being written about. The trouble with this and certainly when talking about pain is the approach is about the condition, the problem, the illness or disease. What’s often left out is the person. Which may be one of the reasons why we fail in helping people.

After all, your pain is not the same as my pain. Not only is the physical aspect different, my body different, my genetics, my structure. Almost more important is the rest of ‘me’ that’s different from ‘you’.

My life history is different from yours. My environment is different from yours. My stressors are probably not your stressors. My understanding of pain probably differs from yours. My expectations, beliefs and thoughts about my pain will be different from yours. My social structures, friends, family, work-life will all be different. So how might we believe we can just apply this ‘fix’ to everyone who experiences pain? It just doesn’t make sense, when you think about it. Particularly when we understand that pain… is… complex.

We, therefore, should look to explore and be curious about all the things that might be contributing to your particular experience of pain. Similarly, individualize the care, tools, techniques and practices with what research tells us might be useful, to change your pain.

You may have had pain for years. Like 30+ years or more. Still, there is an opportunity for change based on what we know about pain and how it works. There is much still to learn but we can change the nervous system, We can change the brain. We can change physiology and most likely all three of these have been changed if your pain has been ongoing.

Pain can change. There is hope. I will keep saying this over and over and over again …

If you’re the type that likes read and learn about this yourself, order a copy of the book, here.

If you’re the type that would like to learn from me in person or in a class setting with others, check out my updated schedule for the fall, here. New classes starting in September!

Additional notes:

Joletta Belton, as noted above, writes a blog “My Cuppa Joe” about the lived experience of pain. Among other things, she is a speaker, educator and advocate for people in pain. You can read her blog, here.

Bronwyn Lennox Thompson also writes a blog “Healthskills: For health professionals supporting chronic pain self management.” An exceptional resource for information, research, and discussion. You can check it out here.

Yoga Classes for Pain Care

My desire for this update is that in some way it might inspire, be of benefit and most importantly, bring hope to you or someone you know who lives with chronic pain.

Approximately 1 in 5 people in Canada suffer from chronic pain, with costs to the Canadian healthcare system between $47 billion and $60 billion a year – more than HIV, cancer and heart disease combined. One might say that my desire, my passion, is in helping people who feel stuck, in despair and without hope in terms of their lived, unique, experience of chronic or persistent pain.

About 5 years ago, I started studying pain. What pain is (or is not), what might contribute to it and what the current evidence and research tells us. My interest began as a result of my own experience with chronic pain, which dates back a few years prior. Well, actually it began about 2010 or 2011, so almost 9 years ago now. 

A year ago I decided to undertake training Neil Pearson offered to various regulated health professionals (doctors, physios, massage therapists, etc.) and yoga teachers, combining pain neuroscience education along with yoga practices and philosophy. The first workshop of the certification process he offered in Ottawa last year, happened to be part of the first module in a certified yoga therapy training program, also here in Ottawa (I subsequently applied to this program as well, and will start the second year of the 2-year IAYT Certified program next week).

Fast forward one year and I’m now certified to teach Pain Care Yoga classes!

WHY DOES THIS MATTER?

Neil trains both medical professionals and others in non-pharmacological pain care in the hopes of bringing knowledge, expertise and evidence-based practices into local communities. He is a physical therapist, a Clinical Assistant Professor at University British Columbia, and a yoga therapist. He has been a consultant with Doctors of British Columbia since 2013, to develop and implement clinical pain management continuing education. He is past Director of Pain BC, and the founding Chair of the Canadian Physiotherapy Pain Science Division.

His goal is “to help people living in pain and to assist others with the same desire to serve. We must shift many paradigms. Our views of pain, the people in pain, and the role and effectiveness of non-pharmacological pain care are mostly outdated.”  

My goal is to help serve this purpose as well, by bringing Pain Care Yoga to local communities.

The good news about pain is that it can be modulated, there is hope, and as Professor Lorimer Moseley (probably the most cited pain researcher globally, based in Australia) now says “recovery is back on the table”We know enough now about chronic pain that we can change lives.

In small group classes (or individual sessions), I hope to play my small part towards helping some of the 20% of our population in Canada who live with persistent pain.

Each time I meet with someone, listen to their experience, offer current explanations about pain, help them learn to move in safety with more awareness, attention and ease, it is clear to me WHY THIS MATTERS.

My classes start mid-April in Stittsville, with private sessions also available.

If you’d like details about my Pain Care Yoga Classes click here, or for more information or to register, contact me here.

If you know others who might be interested, please feel free to share this with them, by clicking on any of the share buttons below.

Tell me already – what is the thing?

When people want help with a problem (like pain) they most often want to know

  1. What’s wrong
  2. How to fix it
  3. How long it will take

My last few Instagram posts were shoulder movements that you might have found helpful. So, if you came to me asking for help in regards to shoulder or perhaps neck pain, would I choose to have you do them as the thing for you?

Maybe. Maybe not. It depends.

You see, the thing for you is likely not to be the thing that helped me or someone else for that matter.

Which is why looking to find the thing or the fix for chronic pain often leads to frustration. Or further along the line, a sense of hopelessness.

There are variables between you and I not only in our physical structure, but also other areas that affect what we might feel or experience in any moment, on any given day. Particularly when it comes to pain.

And most often, it’s usually not just one thing.

Over the last couple of months, I offered up some movements specific to feet, hips and shoulders that you might have found useful. Whether you’re seeking greater mobility, ease, gaining more awareness or perhaps you’re trying to overcome some issues with regards to chronic or persistent pain that you experience. It can take some time to make progress, or it can actually be rather quick in learning what does, or does not provide relief for you or at least the ability to move with more ease.

I find it most hopeful to know there many things we can try along the way.

And no, it’s not just cherry-picking, or somehow blindly choosing, either. What’s been learned over the years in regards to pain is quite different from our understanding of the past in terms of causation and most important, what might be effective treatments.

It’s now understood that long-term pain is poorly correlated to tissue health and science shows us that it is both complex and often has a multitude of factors. We do feel pain IN our body. However, it is often a nervous system issue… which often increases our sensitivity to pain. We can affect our nervous system. We can affect change. We can affect our physiology. Which is what makes this a hopeful message.

For the most part, any movement you add into your day and into your life will be of benefit. What’s key while moving is for you to build awareness of what works and what doesn’t for you. What feels right and what doesn’t, for you.

If you learn to pay attention to even the most subtle of sensations, you’ll begin to notice and learn all kinds of things about your body and your self which will lead to the other things, that often play a part in your unique experience of pain.

So it’s not just one thing. Or the thing. Or your thing. Or my thing.

What are the other things, that might be contributing to your experience of pain? More to come…

Yes, we are connected

skeletons

Though I’ve been focusing on the feet these last few weeks, if you’re having problems with your feet you may also want to make some other connections. Yes, similar to what we’ve been exploring there are things you can do physically that will help. But our feet are connected to our leg bones, our leg bones are connected to our hip joint. Our hips are connected to our spine and further it goes, up the whole body.

We tend to look where pain expresses itself… and think we will find the solution there.

Some people may have knee problems and look to ‘fix’ the knee when really what’s happening (or not happening) is at the hips or at the feet. Or elsewhere.

Imagine you have a cast on your ankle and how it might feel when you walk. How your body might compensate. You may end up with a sore back or shoulder muscles as you try to move as best you can with a stiff, unable to bend, ankle. We’re not usually walking around with a cast on, but many people don’t really use a lot of their ankle flexion for a whole host of reasons. Shoes, patterns of movement, previous injury, etc. Pain may be expressed in your back or shoulders when what’s really going on is down at your feet.

People will often say, “yes but I had an x-ray or ultrasound and they found this (insert condition here) is wrong with my feet”. Yes, I’ve been there too. Diagnosed with chronic plantar fasciitis in both feet, osteoarthritis in both big toes. Basically, I was told to wear rocker shoes, orthotics, and live with it.

Orthotics absolutely serve a purpose in many cases but I’m not sure of any other body part we are willing to cast or brace for a lifetime. We might need a collar brace, but not forever. We may need to wear a special boot to help with a foot injury or after surgery. The point is we work hard, physiotherapists and others work hard with us, to remove these external or artificial supports. Our feet and some orthotics, in my opinion, should be no different.

After my own diagnosis and subsequently learning that our body will most often adapt to what’s asked of it, I figured there must be another way. I have put some effort and focus on my feet in many of the ways shown last month but what was happening in my hips (lack of strength and stability) also played a part.

There are often many pieces to the puzzle of long-term, persistent or chronic pain.

For instance, why was it my feet didn’t always hurt? Why only sometimes? Some days?

Paying close attention I came to notice that when under stress, under too much ‘load’, my pain was likely to arise or increase.  If I was out enjoying myself, not a care in the world, doing something fun or even necessary perhaps, I didn’t seem to have pain. But at other times, it most definitely kicked in.

The biggest a-ha for me now is to realize that structural degeneration or tissue damage is likely to show up for me and everyone else at some point (Note: Brinjijki et al 2014 study as shown in the table below). Particularly by the time you’re my age (56). I need not ‘fear’ this, or fear making things worse, but rather utilize all the things I know I can do, that might help with the pain I sometimes experience in my feet.

  • Strengthening
  • Stretching
  • Keeping my feet soft, supple, agile
  • Adding load, good stress, to keep the bones healthy
  • Wearing appropriate footwear; allowing for space, mobility, flexibility
  • Keeping my overall ‘weight’ in a manageable range
  • Knowing that my levels of stress, fatigue, diet and a range of other factors may also play a part.

degenerative spine issues

In the month of November, we’ll explore our HIPS (Yes, I switched my focus this month from shoulders to hips. We’ll get to shoulders in December). This is where load and/or gravitational forces are primarily distributed through the body so how well we manage this, matters.

Along the way, I’ll throw in a few morsels about chronic pain that might help you make sense of your own personal experience with persistent pain in the hips, or elsewhere.

I hope you’ll join me.

 

The Evolution of a Practice

SimplifyWhen I used to write about yoga for a local magazine, the numbers of Americans practicing yoga was about 20 million. Today, about 6 years later, that number has nearly doubled, edging up towards to 40 million. Globally, the estimate is about 300 million and the number of over 50s practicing yoga has tripled over the last four years.

People often wonder what this thing called yoga actually is. Difficult to answer in just a sentence but to me YOGA is the exploration, awareness, and response that informs how I (might best) relate to the world inside myself and to the larger world around me.

A large part of this doesn’t involve the physical yoga postures or asana practice, but that’s usually where people begin. It is a good way into the wider exploration. Most, practice on a mat and typically in a group class. Certainly, it’s where I began.

Not knowing anything about yoga when starting out, I first practiced Ashtanga yoga and then when I began teaching it was a somewhat modified Vinyasa practice. Both involve strong, physical, almost gymnastic-like movements linked with the breath. Ashtanga, in particular, is meant to be practiced for 1.5hrs each day, 6 days of the week.

My practice today no longer resembles this in the least. Today, my physical yoga practice is interweaved throughout the day, with broader concepts in the background.

  • Most often it does not take place on my mat.
  • Most often it is less than 30 minutes at a time.
  • Most often it’s a response to whatever I feel might best serve me, at any given time.
  • No special place, clothing, or time.

Which I think might be a helpful way to practice for many who don’t have the time, money, or perhaps ability to get to a studio or gym.

What does this practice look like?

Join me over the next few months and we’ll look at little snippets of yoga, movement, breath practices that can be done in a couple of minutes or combined to make your own personal practice. On your own time, in your own space, that fits into whatever your life demands of you.

Most important to me is to teach people what they can do for themselves. Provide agency. The ability for you to have the tools and the freedom to make choices that enhance your wellbeing and your life.

  • In October we’ll focus on the feet.
  • November will be all about the shoulder joint.
  • In December, we’ll get into the hip joint.

I’ve chosen these particular areas to focus on as they tend to be where problems, pains, issues show up for most people I talk and work with.

You can find me talking about this on Facebook, and Instagram, if you want to follow along.

 

Great programs but why the disconnect?

disconnectAfter receiving basic information about the University of Ottawa Heart Institute’s Heart Wise Exercise program, presented at my yoga therapy training, I wanted to go back to learn more so paid them a visit earlier this week. Theirs is a program that helps to connect patients who have been through initial rehab programs after diagnosis, illness, surgery from heart disease, to community-based exercise programs and fitness professionals. It served primarily Ottawa but over the years has expanded in/around Ontario and a little into Quebec.

I mentioned a program in Alberta that I’d found on the internet a year or so ago. In Alberta the Prescription to Get Active Program allows you to visit your doctor, receive a ‘prescription to get active’ and then find a facility in your community offering all kinds of activities from walking, strength training, yoga, cycling, swimming, dancing, etc. The ‘prescription’ allows for free access (often a series like a 10-pass visit, free month, etc.) to get you started.

I often reference the excellent program the province of BC provides to health care providers and those living with chronic pain. The Pain BC program is one of the of the best (well, the only one of its kind I know of) in Canada in terms of information, resources and programs.

It’s too bad all these programs are rather piecemeal and for the most part unknown across Canada, rather than being coordinated. I give great credit to the people and work done to provide them.  It’s just our government or overriding systems that seem to be unable to provide the coordination, or funding or whatever might be needed so everyone can access them.

Regardless, for my Canadian friends and followers, feel free to check them out!

Links above, but for easy reference click on any of these links: