GUERNSEY'S

PAIN HEROES

Guernsey’s Pain Heroes

One of our key goals is to share helpful, accurate, evidence-based health information.

The Guernsey's Pain Heroes project aims to publish (on the THRIVE Physiotherapy Ltd Facebook page) the stories of Guernsey residents who have had persistent pain and been able to move beyond their pain problem. Telling the story of how they have dealt with pain may be highly informative and inspiring to others with persistent pain.

 

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Thanks for sharing your Guernsey Pain Hero story.

 

Our First Pain Hero - Paula

 

Paula was diagnosed with complex regional pain syndrome following knee surgery and was told that there was no cure. ‘My world fell apart’ she told us. “Having previously been very fit and active, I struggled to do normal daily activities. My family, even my children were having to do things for me that I should have been doing, like looking after them and my home – like I always had.  The roles were now reversed and I found it incredibly hard emotionally to be dependent on them.” Paula was diagnosed with clinical depression because of the impact of her pain. Later she developed persistent low back pain and facial pain and headaches. This caused her to leave work- “Because of my back pain and inability to sit, I had to make the devastating decision to leave the job I loved” she said. Her pain also affected her sleep and simple things like talking and laughing became really difficult causing a lot of facial pain and headaches. But today Paula is doing well- she exercises regularly, works part-time for a charity and her sleep has improved so much, she says it feels like she’s taken a sleeping tablet. “It is impossible for me to tell you about all the lovely things I have achieved. It has made my world a bright and happy one again and I am in a very good place right now.”   

 

So, what allowed Paula to move beyond pain. “It was no one specific thing, it was more gradual than that” she told us. “First, I saw a clinical psychologist 1-2-1 for 6 weeks who taught me how to think more positively and change the way I felt about pretty much everything. I was ashamed to find myself sitting in a room with a Psychologist, but once the talking started and the learning began about practicing relaxation and meditation to help reduce my stress and anxiety I felt about my pain, he helped me get my life back on track and it was the best thing I could have done.”  

What science says…

 

There is good evidence that how we think about our pain matters a lot for recovery from pain. When we look at how psychological treatments work, one of the main ways is in shifting our mindset. When we’re in pain we often get stuck in a negative narrative – focused on what we can’t do. Getting help to unstick this can be very effective. Further, mindfulness techniques like meditation have also been shown to be effective for reducing anxiety, improving mood and reducing some of the effects of pain, like how much it interferes with life. These are techniques that require continued practice but you can get good results from a little as 6-8 weeks regular practice.

Paula then attended the pain management programme and says she followed the course 100% to the letter. “The most important thing I learnt is that it’s all about movement and exercise that keeps my pain at bay. It seemed quite a task and I won’t under-estimate how incredibly difficult it was to get my body working again.  I also couldn’t see how enduring so much pain to begin with would help – but it did! 

What science says….

We know this is really hard when you’re in a lot of pain but the research is really consistent here- exercise is the best treatment for all types of persistent musculoskeletal pain from back pain to knee pain to widespread pain conditions like fibromyalgia. And there really is no one ‘best exercise’. When different types of exercise are compared, they show similar results. So, the best exercise is the one you enjoy and are likely to do regularly!  That said some people need guidance on what type and intensity of exercise is likely to suit them best.  If you have severe pain, or pain for a long time and you haven’t exercised in a while, starting off with small doses of something you are likely to enjoy is a good bet. You may have to work through some pain as Paula did, but research shows that even gentle exercise, taken regularly, can yield positive effects in those with persistent pain.

Part Two - Movement and Posture

There are three major lessons in Paula’s story about how movement helped her pain. The first is how she learned that movement and general exercise was critical to her move beyond pain and her overall maintenance. The second was that she had to change how she moved to gain pain relief for her back in particular. The third was how she used an innovative approach to movement called Graded Motor Imagery to help her pain. We come back to general exercise Graded Motor Imagery in other blogs. This blog focuses on changing how she moved.

 

As you know Paula had a long history of knee pain – diagnosed with complex regional pain syndrome back in 2003 after knee surgery. She subsequently developed low back pain- let’s return to her story:

 

“I had experienced mechanical back failure on pretty much a yearly basis since my knee op in 2003 (poor fatigue levels in my legs due to non-use hadn’t helped) and I suffered a trauma in April 2009 that would leave me with pain like I had never felt before.  My back was not to be the same again from a sitting down point of view. I just couldn’t do it comfortably. I was off work for 5 weeks, then I had 3 further episodes of back failure that year until I was no longer managing to maintain my hours at work and they got less and less as the months went by. My employer and fellow employees had been incredibly supportive towards me and my pain but by October I had to make the devastating decision to leave the job I loved.  I thought all I needed to do was take 6 months off and get things back on track with the help of my fantastic physio.  Sadly it didn’t work out like that.  It transpired that I had Central Sensitisation Syndrome, which was related to my Complex regional pain syndrome.

 

Now that I was off work and at home, I was lying on the floor or my bed for a good couple of hours at a time during the day, just getting up in between to do small jobs in the house.  I wasn’t going out with my husband or socialising with family or friends because it was so uncomfortable for me to sit for even 30 minutes.

 

I went through the Pain Management Programme again, which reinforced what I learned last time. Now I had my coping mechanisms in place for going out.  I would always have a swim first to loosen up and then do stretches before any outing that would involve sitting down.  I would attend shows at Beau Sejour and only manage half a show to begin with.  It was a start but I so wanted to try.  I would get up half way through the first half and go to the Ladies Room and do stretches in the cubicle for my knees and my back. Or I’d leave the building and go for a quick walk around the car park and do some stretches afterwards and then sit back down to enjoy the rest of the first half. I know I missed a good 10 minutes doing all of this but I felt it was worth it because I just loved being out enjoying the things I used to take for granted.

 

In 2017 I reached out to another therapist about my back pain.  I was doing okay with my back but I still wasn’t where I wanted to be with regard to my sitting tolerances, which meant I was only working a few short hours and was limited with social activities. After having a discussion about my pain, my back was examined. It came as quite a shock when the therapist told me that the muscles in my lower back were rock hard and I was to try and relax them, in fact relax everything, especially my stomach. I wasn’t entirely happy about that as I had always been brought up to have good posture with shoulders back and stomach in! It turned out that what I was NOW being asked to do was the complete opposite to what I had been tirelessly doing for the previous 7 years with my physiotherapist and that was to strengthen my core and build up muscles in my back, bottom and legs.  It was she who had been with me through the worst times and helped and supported me with my back pain to get to where I was in 2017, which was so much better.  I couldn’t have done what I did without her by my side, but now it would seem was the time for change. However, I let my tummy go completely and tried to relax everything else from the top of my head to the tips of my toes, because this was the right thing to do for me personally and for my pain. I began to relax and slouch a little while sitting. I also changed from doing strengthening exercises to doing some yoga exercises where I focused on moving smoothly and gently using breathing exercises to help relax and soften the movement. I now enjoy doing these exercises very much and use on a daily basis to help free me up with stiffness and pain.  Very quickly I was noticing that I could sit and stand comfortably for longer and I was astonished that something so simple, as to learn to relax more, could change my pain.  It is impossible for me to tell you about all the lovely things I have achieved on my own, or with my husband and grown up children since doing this. Now I sit through dinners, shows and events that may involve sitting or standing for 2-3 hours at a time. It has made my world a bright and happy one again and I am in a very good place right now.”

 

What science says....

Paula’s movement and posture story resonates strongly as something we see day in, day out in clinical practice. About 20 years ago the ‘core stability’ movement started based on some small studies that showed that people with low back pain had weaker core muscles (deep abdominal and back muscles). The pendulum swung too far in that direction though because as time passed it seemed you couldn’t get out of a physio clinic or an exercise class without being told your core was weak and you needed to strengthen it to get rid of your back pain. But the science has evolved and the research now tells us a different story. Here is a summary of the current research:

  • Exercise is the most effective treatment for most back pain but usually it doesn’t matter what kind of exercise you do – results for different forms of exercise are equal (On the whole core stability exercises are no better than walking or swimming).

  • People with persistent pain on the whole move more stiffly than those without pain. While muscles may be weak in some people, the idea that the spine is weak and vulnerable and needs ‘supporting’ is not justified by the research for most people. What we see in clinical practice and what this research supports is that most people with persistent pain need to relax their muscles and move more fluidly (rather than add more tension by holding muscles on tension all the time). This was certainly the case for Paula.

  • Healthy muscles are muscles that are strong when required to work but relax when they’re not being used- this is efficient muscle use. One myth is that we need to hold muscles on tension when we’re standing and sitting. Both standing and sitting are ‘low load’ activities that require very small amounts of muscle work. If you’re bracing your muscles during sitting and standing, you may be using too much muscle activity. This can be hard to sustain and can lead to more pain. This was key to Paula’s recovery- she was holding her trunk and abdominal muscles on too much tension and was unable to sit or stand for long periods, which limited her doing things she enjoyed. When she relaxed her muscles and even slouched a little bit, her pain improved and she began to tolerate longer periods of sitting, which ultimately led her to do more of the stuff she loved (great for those pain-relieving endorphins!).

 

This is a tough one though as most of us have been told to sit up straight, pull our shoulders back, pull in our tummy etc. It can be hard to accept that letting go and relaxing a bit would be better for us. So, you might be interested to know that studies show that there is no such thing as an ‘perfect posture’- how we sit or stand does not predict the onset of pain or predict recovery from back pain. Remember those core stability studies we mentioned earlier- well over the last 2 decades this body of research has expanded quite a lot and has found huge variation in how people move and recruit their muscles when they’re in pain. As we said, on the whole people with persistent pain move more stiffly with too muscle tension.

Now, sustained positions are associated with more pain, so we definitely need to move and change position regularly. But we don’t need to be so worried about achieving that so called ‘perfect posture’ we sit or stand. Not convinced? Check our Dr Greg Lehman’s video on this for more. Or maybe try a little self-experiment by seeing if you can find more comfort if you relax your trunk a little in sitting or standing; let your back and tummy muscles relax and breathe softly.  You might find this easier to start doing while seated with your back supported- repeat the exercise with your spine supported by the back of the chair.

Part Three - Thoughts and Beliefs

 

How we think about pain influences pain – it influences how our natural pain relief system works and it influences how we move and function when we have pain. Let’s hear from Paula first.

 

Paula tells us “I had experienced mechanical back failure on pretty much a yearly basis since my knee op in 2003 (poor fatigue levels in my legs due to non-use hadn’t helped) and I suffered a trauma in April 2009 that would leave me with pain like I had never felt before.  My back was not to be the same again from a sitting down point of view. I just couldn’t do it comfortably. I was off work for 5 weeks, then I had 3 further episodes of back failure that year until I was no longer managing to maintain my hours at work and they got less and less as the months went by. By October I had to make the devastating decision to leave the job I loved.”

 

Paula thought that all she needed was 6 months off and some physiotherapy to get back on track but that wasn’t how it rolled out. We know from her previous blogs that she spent years tensing her muscles, pulling in her stomach, perfecting her upright sitting posture but still had lots of pain.

And meet our second Pain Hero, Mark…

 

Mark also has a long history back pain. He tells us “ I’ve had back pain for over 20 years. It started when I slipped a disc at work. Every few months after that I’d have severe back spasms. Last year, we had to call the ambulance because I couldn’t move. I have several slipped discs in my back and had been told that this was causing my pain. Bad backs run in my family. My gran ended up in a wheelchair with her back and my cousin has almost the same back problem as me. It’s scary when it goes. It scares everyone – even my old physio said that it scares him. He told me not to bend and I don’t in case it will go again. ”

 

Let’s look at how these thoughts link up with pain. They’re common thoughts, right? If you’ve had back pain, no doubt some of these are familiar to you. Think about the effect of some of these words…. “mechanical back failure” …. “slipped discs” ….”wheelchair”….. “scary…even my physio was scared”. When we have thoughts like these, they are cues for protection and anything that cues the brain to protect us can cause more pain. It causes us to become protective about how we move – limiting how much we move. It stopped Mark from bending and made Paula sit up so straight her muscles were rock hard.

 

In addition to changing how we move, these thoughts can stop our natural pain relief from being effective. A part of our brain, the brainstem is home to our natural brain pharmacy – this part of the brain releases chemicals that can give pain relief – endorphins, serotonin, GABA amongst others. This brain pharmacy is controlled in part by other parts of the brain – parts related to how we think and how we feel. We’re not be aware of it but when we when we have these scary thoughts about what’s happening in our bodies, we have a stress response and if this lasts, this can signal to our brain pharmacy to stop working so well. So, we lose some of our natural pain relief!

 

This stress response can affect pain in other ways too. When we’re stressed we tense more – more muscle tension usually means more pain. Stress causes hormonal and immune system changes that put our bodies in a ‘pro-inflammatory’ state- more inflammation means more pain. And stress as we said interrupts our natural pain relief – it also sensitizes our nervous system, allowing warning signals to be transmitted more easily – this makes it easier to feel pain.

So, it’s all about stress eh? If I just stop stressing the pain will go away??

Well, hopefully as we explore our pain heroes’ stories, it’s clear nothing is so simple. But, changing how we think about pain and reducing our stress responses can definitely help to reduce pain and its impact and research bears this out. When we understand how pain works, when we feel more confident in our bodies and when we have lower stress levels we have less pain and are able to do more of the things we love and need to do.

 

Let’s go back to Paula… we know she changed how she moved and held her spine. She stopped believing that sitting upright was the only healthy way to hold her spine. Instead she started to relax her muscles, move more naturally and found a new-found comfort and confidence in her body. She no longer thinks about ‘mechanical back failure’ and while she does have the odd spasm, she can sit for longer and enjoy going out for dinner with her friends.

 

Mark tells us “I saw the pain specialist and he explained that discs don’t slip out and that bulges were really common. He showed me a table with how common it is to have disc bulges and that really got me thinking. If most of us have them, even if they were causing me pain, I didn’t have to be so afraid of them. Then I saw a physio who got me bending, twisting, and doing all sorts -  even lifting weights with a bent back. I couldn’t believe it! It was all this stuff I had been taught not to do. But none of it hurt. Actually, it hurt more when I stayed straighter.” “I think not being so afraid and then moving more without getting more pain made me see that I didn’t have to be so afraid of my back. I can do way more now. I do heavy lifting in the garden and don’t worry about bending so much. I do take breaks and make sure I exercise so I stay fit and healthy, and yeah…I still have some pain now and again but it’s nothing like it was”.

 

What science says....

Science tells us that many of the ways we have thought about back pain in the past was not so accurate. We now know that if you scanned everyone’s back, even if they didn’t have pain, there would often be changes like disc bulges or wear and tear. It’s the same for arthritis in other joints or if we look at tendons and muscles. This doesn’t mean we have to have pain or that we’re weak or vulnerable. Arthritic joints can be strong and function well…. backs with disc bulges can be normal…. tendons with tears can be pain free and strong. Becoming less afraid and more confident about our body’s capacity to heal and recover means we can take the steps to gradually get back on track in our move beyond pain. Becoming less afraid and more confident also means less stress and that’s better for our body’s inflammation and for getting our pain relieving system to work better.

 

 

Part Four - Mood

In this post we continue with Paula’s story - we look at how she tackled the depression that became part of her story.

 

Paula tells us that as a result of ongoing knee pain, “My world was turned upside down having been so well and active before surgery – I couldn’t believe I was now worse off.  I continued with my part-time job in finance, pushing through the pain and coming home so exhausted I was going straight to my bed until it was time to deal with the children and meal time.  I would then return back to bed, the pain being so intense from just standing at the sink sometimes that I would just cry.  My husband, parents and even my children (who were 13 and 10 at the time) were having to do things for me that I should have been doing, like looking after them and my home - like I always had. The roles were now reversed and I found it incredibly hard emotionally to be dependent on them.”

 

“Not surprisingly 12 months later I had become clinically depressed due to no change in my CRPS (complex regional pain syndrome) pain. By this time I deemed myself useless, but more importantly a useless daughter, wife and mother to my two lovely children with feelings of guilt and neglect towards them.  I had got myself into a big black hole and couldn’t see my way out.  I saw everything in a negative way, looking at what I couldn’t do rather than what I could and my confidence had hit rock bottom. I spent more and more time lying on my bed, always tired and hurting, and didn’t want to see or be with anyone at times.”

 

“They referred me to a Clinical Psychologist for one-to-one sessions over a period of 6 weeks.  I was on a lot of medication at the time, but by the time my sessions had ended, I managed to slowly wean myself off the painkillers and started to feel much better.  My knee condition had hit me so hard mentally, I didn’t know how to deal with it, but the Psychologist taught me how to think more positively and change the way I felt about pretty much everything, which had always been in a negative way. I was ashamed to find myself sitting in a room with a Psychologist, but once the talking started and the learning began about practicing relaxation and meditation to help reduce my stress and anxiety I felt about my pain, he helped me get my life back on track and it was the best thing I could have done. I was practicing muscle relaxation (my personal favourite), mindfulness and meditation on a daily basis and I was walking from 6 minutes daily progressing to 20 as the months passed by.”

 

“It was suggested to me by one of my rehab team to try some volunteering to have a purpose/focus to get out of the house.  I therefore went online at www.volunteer.gg and contacted a local charity who were looking for some help. I love the caring environment that surrounds me and feel very humble whenever I am there. It was the best decision I could have made and I would encourage anyone living with chronic pain to consider doing some form of volunteering to give them a purpose in life, regardless of how many hours they could manage. It has boosted my self-esteem and confidence being back in the workplace again and I always look forward to going.”

 

What science says....

 

When we listen to Paula’s story, we can deeply appreciate what it means to have a chronic pain condition – a condition that can erode every aspect of your life – can make you hit rock bottom. We know low mood and pain can go hand in hand, one feeding the other. Biologically, we now know that this relationship exists because both pain and depression can cause changes to our body’s chemistry as well as changes to how our nervous system works. Our body can develop a more ‘pro-inflammatory’ state. Our nervous system becomes more sensitive, allowing signals to fire more easily. We all know how this is when our mood isn’t great and we can become irritable really easily. It can happen with our mood…but this can happen with pain and our body tissues too- they become more sensitive, triggering pain more easily. These biological processes are very ‘real’ responses – and really challenge the common misconception that mood and pain are related because ‘pain is all in your head’. This is simply not the case.

 

So, we get that this is real and there is a good deal of science to show that now. But what can we do about it?

We see that Paula took a multi-pronged approach. It started with seeing a Psychologist. She felt ashamed to find herself at that point…. This a common feeling as we, as a society, are just starting on the road to de-stigmatising mental health issues. Psychologists can play a crucial role in navigating the course beyond pain. They help un-package some of the emotional effects of pain and provide the knowledge and skills for moving forward in a positive way. This was fundamental to Paula’s recovery. It helped get her life back on track! And she followed it up with her own exercises – mindfulness, meditation and physical exercises. All of these strategies have strong research evidence that they work for both mood and pain.  The last thing that Paula did, which may well be the most important, was volunteering. This gave her purpose and something to look forward to –crucial factors for a healthy mood and in turn, help us move beyond pain.

 

Reflection: Is stress, anxiety or low mood playing a role in your pain story?


Is it adding a few points to the pain intensity or adding to your overall suffering? If so there are a few things you could try:

  • Consider seeing a psychologist or counselor to talk things through and see what the best course of action for you is.

 

  • Try a daily meditation or breath control exercise- this could be as short as a 3-minute breathing exercise (see link). If you find this useful, add it in more frequently during the day.

 

  • Get some exercise…. Anything you like and preferably something you enjoy. Even better - get outdoors or do it with a partner or friend for extra benefits as both improve the physical and emotional benefits of exercise.

 

  • Start doing some activities that are meaningful for you. What did you love doing before you had pain? Try building a little of that into life again, even if it’s just in small doses.

 

Part Five: Sleep

 

As we come to a close on Paula’s story, let’s hear about how pain affected her sleep.

 

Paula tells us: The facial pain and headaches really stopped me in my tracks with discomfort and pain. My sleep was badly affected by this pain. I would spend hours awake at night, out of bed, as my head and ears hurt so much resting on the pillow due to high sensitivity and also from any talking that day. The more I spoke the worse my pain would be, particularly at night.”

 

What science says...

Pain and sleep are a two-way street with each influencing the other. It’s really common for us to recognize that pain can have a deep effect on sleep. As Paula says her facial pain and discomfort seemed to disrupt her sleep. However, often for many with pain, sleep has been an issue prior to pain becoming such a problem, and poor sleep can delay recovery. How can they be related? Well, sleep and pain actually have similar neurobiological pathways and neurotransmitters. Neurobio what? I hear you ask. Put simply, the pathways and the chemicals in our nervous system that help pain also help sleep. By the same token, the changes in how these pathways and chemicals work when we’re in persistent pain or have poor sleep overlap too. That’s why some of the pain medication people take helps sleep too.

 

Apart from tablets, what can help? Paula tells us “ The combination of graded motor imagery and body scans led to relief of headaches and improved sleep. My sleep is so deep now, it’s like I’ve taken a sleeping tablet. I can’t remember sleeping so soundly”.

 

What science says...

More can be learnt about the graded motor imagery that Paula is talking here. These are exercises to help lower the nervous and muscle systems’ automatic response of tension and protection. For Paula this was very much about a strategy to reduce muscle tension. The body scan is a mindfulness meditation exercise that again can have the result of reducing muscle tension and calming our nervous system. It works by stimulating the parasympathetic nervous system- this governs our ‘rest and digest’ response – the opposite to the stress response. And it’s key for helping sleep. Have a look at the specific blog on sleep for more information on this and how to improve sleep. You can also click here to bring you to a guided body scan exercise.

Thanks for following

Guernsey's Pain Heroes stories.

 
 
 
 

Terms And Conditions

By sending THRIVE Physiotherapy Ltd a Facebook Message via the THRIVE Physiotherapy Ltd Facebook page you are deemed to have submitted an entry to “Guernsey’s Pain Heroes”, and:

  1. Grant THRIVE Physiotherapy Ltd the right to publish your anonymised message (from hereon in known as “your story”), following editing by THRIVE Physiotherapy Ltd, on the THRIVE Physiotherapy Ltd Facebook page (https://www.facebook.com/Thrive-physiocouk-1863232780625511/).

  2. Must not be in breach of any confidentiality or data protection obligations owed by you to third parties.

  3. Acknowledge that THRIVE Physiotherapy Ltd will not publish the names, or identifying features, of any healthcare practitioners or other individuals included in your story.

 

Picking the stories to be published:

  1. “Guernsey’s Pain Heroes” is only open to Guernsey residents.

  2. The team at THRIVE Physiotherapy Ltd will choose several stories to be published on the THRIVE Physiotherapy Ltd Facebook page from all entries submitted, based upon the inspirational and informative nature of the stories.

  3. The decision of THRIVE Physiotherapy Ltd is final and no correspondence will be entered into.

 

Future use of published stories:

  1. THRIVE Physiotherapy Ltd may contact you after “Guernsey’s Pain Heroes” to discuss other uses of your story that may be helpful to other sufferers of persistent pain. However, no further use of your story will be undertaken without your consent.

 

If THRIVE Physiotherapy Ltd has reason to believe that your entry breaches these Terms and Conditions, they may disqualify it. THRIVE Physiotherapy Ltd reserves the right at any time and from time to time to modify or discontinue, temporarily or permanently, “Guernsey’s Pain Heroes” with or without prior notice due to reasons outside its reasonable control (including, without limitation, in the case of anticipated, suspected or actual fraud). The decision of THRIVE Physiotherapy Ltd in all matters relating to the “Guernsey’s Pain Heroes” is final and binding and no correspondence will be entered into.

 

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