Pain

• ‘An unpleasant sensory and emotional experience” (International Association for the Study of Pain July 2020)
• Feels like tissue damage (may or may not be there)
• What the person says it is

Transcript

Pain can be described in a simple way as being what the patient says it is. If you experience pain, it is pain. The more complex definition of pain made by the “international association of the study of pain” proposes that pain is an unpleasant sensory and emotional experience associated with or resembling that with, actual or potential tissue damage. Notice that this definition includes sensory as well as the emotional aspects of pain. Pain feels like tissue damage, but the damage doesn’t have to be present for us to experience pain.

Protective mechanism against actual or potential tissue damage

Pain -> behaviour change

Benefits

Preventing tissue damage

Behaviour change: not walking on a broken leg, seeking emergency advice for heart attack

Downsides

When we feel pain and there is no potential for tissue damage

Still can lead to behaviour change

Transcript

We get pain because we have evolved to feel pain as a protective mechanism for when there is actual potential tissue damage in the body. This is because when we experience pain, it changes our behaviour. For instance avoiding walking on a broken leg or seeking medical attention for emergencies such as a heart attack.

However we can still experience pain without actual or potential tissue damage, and this can still lead to a change in our behaviour, for instance stopping moving due to muscle pain all over the body. In this scenario the change in behaviour doesn’t protect us from tissue damage, and can also make the pain worse.

Catch 22 – The fear of pain can also prevent us from wanting to do things that may trigger a recurrence – but in pain such as arthritic pain the pain eases a little after the initial stiffness. Not maintaining the optimum range of movement ultimately reduces our ability to move without the restriction caused by pain – the use it or lose it scenario!!

This is a video explaining more on what type of pain we can feel.

An analogy to illustrate the different types of pain is of an electric guitar plugged into an amplifier. For nociceptive pain, the louder the guitar is strummed, the louder the volume from the amplifier. Problems with the wiring in neuropathic pain can cause interference which leads to noise from the amplifier. In central pain, the volume setting on the amplifier is turned up so that even low volume guitar strumming can be heard as loud.

The third type of pain is a problem with the pathways in the brain that regulate pain, so signals from the body that might not normally be felt as pain are interpreted as pain.

We can experience many different and overlapping forms of pain.

Managing your pain – Leeds Community Healthcare

Transcript

Living with long term pain can have many consequences, including poor sleep, reduced activity, fatigue and low mood. These in turn can make the pain worse creating a vicious circle. It’s important to consider this when looking at the conservative treatments for pain – things that can help that don’t involve medication.

• Identifying and understanding the history of the pain
• Treatment if there is an underlying medical condition, for instance if there is a new and unexplained pain
• Pain medications can be appropriate – (medications over the counter to strong painkillers)
• Non-drug treatment

Transcript

Management of pain is complex and different for every person.

The goal of management can sometimes be to control the pain to an acceptable level, where the person can live with the pain. Some people find that having a pain diary can help with identifying the history and triggers of  pain however for others focusing on pain may increase sensitivity to it.

Clinical assessments from doctors, nurses and therapist can help to find out what is causing the pain and what can be done to manage this. They may request tests but these are usually to rule out any life shortening causes of pain. These tests wont show persistent pain and that can feed into a fear of not being understood or worse still – having something missed.

If there are any medical problems causing the pain, it is important that these are assessed.

Pain medications may be useful in pain management, and the best type of medication depends on what is causing the pain, however they are often not the answer and there are also many interventions that don’t involve drugs that are used for pain.

• Understanding the triggers of your pain
• Relaxation techniques
• Sleep hygiene
• Appropriate physical activity
• Diet and weight management
• Regular support
• Knowing when to seek advice
• Distraction techniques
• Hot and Cold therapies
• Laughter
• Doing more of what you love
• Being outside in the daylight
• Pet therapy
• Music therapy

Transcript

Here are a few things that can help with pain management. Keeping a record of pain in the form of a dairy may help to identify the triggers of the pain. Relaxation techniques can help shift the focus away from the pain. Good sleep may help reduce the pain, as can appropriate physical activity, releasing endorphins and serotonin. Optimising your diet and weight loss if appropriate to you. Support from people around can help with mood, this might be from friends and family but also allowing for your own self compassion – it is exhausting enough managing pain without an internal bullying voice which berating you! Its important to know when to seek advice for your pain, for instance if you notice a change, or the pain is getting worse. Distraction techniques might include a puzzle, game, or doing something creative. Applying heat can ease discomfort; hot baths, hot water bottles and various types of heat pads, ranging from heat pads that can be microwaved to ones that use battery power and last for a longer period. Superficial heat relieves pain in a number of different ways. It stimulates thermos receptors in the skin and deeper tissues. Ice – cold compresses can help to reduce inflammation (if you experience that) and also may slow nerve impulses, which can interrupt the pain signals. Gel packs. Cold compresses can be used between 15- 30 minute time periods up to 2-3 times per day. Laughter is proven to release endorphins and decrease the stress response. Doing more of what you love, especially if can be outside in daylight as increases the release of Serotonin, which can have a positive effect on your mood. Pet therapy – if you’re an animal lover you know that feeling when you can stroke a pet can also help as can music therapy. Research has shown that listening to music can reduce anxiety, blood pressure, and pain as well as improve sleep quality, mood, mental alertness, and memory.

In your workbook have a think about what practical things you currently do or could implement that may help your pain management

The next slides are information on how your diet can impact on your pain.

Inflammation <——-> Pain

Too many pro-inflammatory foods and not enough anti-inflammatory foods

Transcript

If you live with pain you may or may not have considered that making some changes to what you eat could help your pain, health conditions and quality of life. Over the next 5 minutes we will go through the relationship between food and pain and how making some small changes to your eating can be beneficial to not just your pain but your general health and wellbeing too.

So how does food link with pain? The link is through inflammation. When the body is in pain it creates an inflammatory response.  What you eat can help with pain because certain foods can reduce inflammation in the body whilst other foods can increase inflammation in the body.

Proven anti-inflammatory properties

Reduces inflammation in the body and therefore can help to reduce pain.

Let us look at this in more detail….

Transcript

The Mediterranean style of eating has proven anti-inflammatory properties which means it reduces inflammation in the body and therefore can help to reduce pain. The research shows us that people with persistent pain who followed a Mediterranean style of eating for 6 weeks reported a reduction in their pain and those that followed this way of eating for 12 weeks reported an improvement in their mood as well.

This style of eating will involve increasing your intake of some foods and reducing your intake of others  but because it includes a variety of foods, this way of eating is relatively easy to follow long term compared to other more restrictive diets.

Wholegrains and fibre

• Swap white pasta and rice to brown
• Add in more lentils and pulses for example in stews or soups
• Swap white bread to wholegrain bread
• Add in nuts and seeds for example in salads, porridge or as snacks
• Swap to a wholegrain breakfast cereal

Fruit and vegetables

•  Look for ways to eat more fruits and vegetables
•  The wider the variety the better: eat a rainbow!
•  Fresh, tinned, dried, frozen all count
•  Aim for half a plate of vegetables or salad for your main meal

Omega 3, 6 and healthy fats

• Oily fish such as salmon, mackerel, herring, pilchards, sardines and trout contain the best sources of omega-3.
• Plant based sources include walnuts, chia seeds, flax seeds, edamame, soybeans
• Olive oils

Transcript

Lets start by thinking about what we can add into our diets to help us adopt a more Mediterranean way of eating.

As we know wholegrain carbohydrates provide a slower release of energy so help with fatigue as we mentioned in week 1.

Fruits and veg are high in fibre, they help with gut health and provide vitamins, minerals and phytonutrients which support immune function. Eating a rainbow means to eat a variety of different coloured fruit and veg as this will provide your body with a wider range of nutrients

Beans and pulses are a good source of protein and are healthier alternatives to meat.  Protein provides us with amino acids these are required to prevent muscle breakdown. Lean meats are best eaten in moderation trying to include some meat free days each week.

Fish is a good source of protein too and also provides essential fatty acids.  Some study’s show a diet with sufficient omega 3 intake can help with joint pain in people with arthritis, there has also been a suggestion that omega 3’s may help maintain good memory as well as helping with symptoms of depression.   Oily fish such as salmon, mackerel, pilchards, sardines and contain the best sources of omega-3. Note: omega 3 supplements have not been consistently proven to be beneficial therefore dietary sources are best

Check you’re drinking enough

6-8 glasses a day roughly 1500-2000ml a day

Non caffeinated fluids are more hydrating than caffeinated

Spread it out throughout the day

Use a measured water bottle to help you keep track

Alcohol

Impacts sleep quality

Worsens inflammation

Can interact with pain medications

Do not exceed 14 units a week

Spread out alcohol consumption and have some alcohol-free days each week

For more information see link: NHS Live well alcohol advice

Transcript

As you will probably of heard before it is really important to make sure you are drinking enough as all basic bodily functions require fluid, drinking enough helps regulate temperature, transport nutrients and lubricate joints.

Too much alcohol can have a negative impact on pain – it is important to check how much alcohol you are drinking and ensure you do not exceed the recommended safe limit of 14u per week.

Processed and ultra processed foods contain ingredients you wouldn’t find in a household kitchen.

Pro- inflammatory (increase inflammation in the body)

Typically contain other unhealthy ingredients such as salt, sugar and saturated fats

White flour foods

• Breads
• Crumpets
• Pancakes
• White pasta
• Pastry
• Some breakfast cereals

Foods that contain large amounts of salt, sugar or saturated fats

• Fast food
• Manufactured and mass-produced biscuits, cakes, breads
• Crisps
• Instant soups
• Processed meats such as ham, sausages, bacon
• Chocolate bars

Transcript

We’ve talked about foods that it is good to eat more of and now we move onto foods which are not helpful when it comes to managing pain and therefore we need to try and eat less.

These foods can broadly be referred to as processed or ultra processed foods.

If you can try to check food labels for ingredients and if there are ingredients listed that you wouldn’t find in a typical kitchen then it is likely to be a processed food.

We should all try to eat less foods made from white flours such as breads, crumpets, pancakes, white pasta and less foods that contain large amounts of salt, sugar or saturated fats

The slide shows some foods which are classed as processed foods. If you’re able to it is better to make some of these foods at home instead of buying them ready made as they will contain less additives and preservatives.

Being overweight increases mechanical stress on joints AND increases inflammation in the body

In the UK more than half the adult population are classed as being overweight

There is no easy solution or quick fix…

• Checking portion sizes can be helpful: British Dietetic Association Food Facts
• Eat regularly
• Limit processed foods
• Eat balanced meals
• Listen to your body’s hunger and fullness cues British Dietetic Association Intuitive eating explained

For help losing weight: NHS Better Health – Lose weight

Transcript

We know that being overweight can make pain worse however it is not usually easy to lose weight.  There aren’t any quick fixes but it is about making some small changes consistently.

In the UK with our busy lives we often eat on the go or whilst distracted by other things and it is then harder to know whether we are hungry or full.  Trying intuitive or mindful eating can be a helpful way of trying to listen to our body cues about when we are truly hungry and when we start to feel full.

Don’t feel overwhelmed! Every journey starts with a single step….

Write a plan and a shopping list

Make one change at a time

Start by including more anti-inflammatory foods

Set yourself a target and be specific

Think about what you can do to eat less pro-inflammatory foods

Transcript

It can feel overwhelming when it comes to making change to what you eat.

Remember not to take everything out of your diet that you enjoy eating as this will just make you miserable and resentful and you won’t make any longterm changes at all. Think about what you can change and those that you really can’t.  Those foods that you really want to continue eating just try and eat in moderation and as a treat.

Make changes one at a time.  If you make too many changes too quickly it is hard to sustain long-term and we are talking about making changes to what you eat for the long-term to benefit your health and quality of life.

See links:

Rethinking pain – Diet therapy

Live well with pain – Nutrition top tips

People who understand pain science have significantly better outcomes than those who don’t

Flippin pain

Transcript

Understanding pain science can be key in recovery. A great resource that I would encourage you to look at is flippin pain. It follows 6 key principles, that persistent pain is common and can affect anyone, Hurt does not always mean harm, everything matters when it comes to pain, medicines and surgeries are often not the answer, understanding you pain can be key, recovery is possible.

• Interrupt the unhelpful patterns or habits
• Make changes in manageable stages
• Have several tools in your pain management toolbox.
• Bodies and brains like variety

Transcript

The brain cannot distinguish between ‘good’ and ‘bad’, it will simply adopt the dominant message it receives. So if we believe that normal movements or activities are going to make our pain worse, they probably will. Successful management of persistent pain involves interrupting this cycle and giving the brain something different. Over time, the more you give the brain something different the more it will adopt it as the new dominant message, and the old unhelpful messages will fade.

It therefore makes sense to use something enjoyable and meaningful to you as a way of breaking the cycle, as this will help promote release of endorphins and may increase your sense of wellbeing. Start small, and make it manageable, being strict with yourself not to overdo things just because it feels good at the time. In this way you should recover more quickly and be ready to go again. Stay at the same level of activity for a while until you are sure your symptoms are not exacerbated, and then increase by another small increment.

Wherever possible, give yourself time and space to find methods of pain management that work for you. They might include pain relief, specific exercises, adapting the way you do things, or using breathing techniques/mindfulness/relaxation. See them as your own personal toolkit, and try to avoid relying on one method of pain management only – if this stops working it can lead to a sense of pain and increased symptoms.

Vary routines and activities as much as you can. This takes time to establish, but the result is that you can use your body in whatever way the task demands. Your brain will gradually get used to the fact it can be challenged to find new ways of doing things, bringing with it an increase in confidence to move.

(Circle/square analogy image)

Pain management aims to expand your quality of life rather than living a life trying to avoid or fight pain and suffering, to enable you to live a life doing whatever matters to you.

This video is how pain can impact your life  and how you can do more of what make you, uniquely you.

Some resources we recommend, Lorimer Moseley – excellent videos to explain pain, as is his book explain pain.

Also these websites are fantastic resources

Lorimer Moseley  – books and ted talk: https://www.youtube.com/watch?v=nifGFIuVkUk

Websites:

https://livewellwithpain.co.uk/

http://www.paincd.org.uk/home

https://www.tamethebeast.org/

https://leedscommunityhealthcare.nhs.uk/our-services-a-z/pain/managing-your-pain/

https://www.flippinpain.co.uk/event/fms/

• Pain is real
• Pain is common and disabling symptom.
• Pain feels like damage to the body, but it can occur with no damage to the body
• Pain varies from person to person
• Understanding the history and triggers of your pain will help you manage it

Transcript

So take home messages:

Your pain is read, and it’s a common disabling symptom

Pain feels like damage to the body but it can also occur without damage

Its very individual and understanding it, understanding your tiggers and how you can help yourself is key to managing it.