Monday 18 December 2017

Removing Pain - An Example Of Pain Expectation

I had an awesome experience regarding pain psychology and coaching this week. I've already written before about how pain can be amplified purely due to expectations of pain, but it's always great to have some real-world examples rather than only scientific studies.


I had a chronic-pain client come and see me in the past week after a particularly-stressful time period. As a result, her pain sensitivity through her neck and upper traps was through the roof, and she recoiled from only very light pressure from my hands.

Knowing that it wouldn't be productive to simply try and force my way into her muscle tissue and use physical means to get my client to relax, I instead did some education on pain.

I used this great example from Dr. Jarod Hall, on Facebook where he talked about how he experienced a splinter poking him in the back in a sauna. However, due to being in the hot sauna, his nervous system interpreted the "poke" sensation as "burning" due to the expectation of what kind of a sauna would typically cause. Yep, the body can be that easy to trick!


With that being said, I was able to use that experience to teach my client on how it's unnecessary to expect pain, especially when the oncoming stimulus isn't an appropriate one. By coaching her through self-talk to convince her that the pressure from my hands, while perhaps not being the most comfortable, wouldn't cause her any physical harm or damage, her pain sensitivity decreased dramatically. And just like that, without any other physical intervention, I was immediately able to apply more pressure to those sensitized area than ever before!

Remember, pain isn't all in your head! But the head sure can affect things!

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Tuesday 12 December 2017

Sleep and Pain

In the big picture, Canadians don't seem to do too bad in terms of sleep. Two thirds of adult Canadians are getting the recommended 7-9 hours of sleep. A third is still a very large number, though, and overall sleep quality may still be an issue. We all know the typical effects of sleep deprivation; the decreased mental function, the irritability, the mood swings. However, can sleep affect pain as well?

If I just never wake up, I'll never feel the pain.

The short answer is yes. It's been well-documented that poor sleep and increased pain have a strong correlation. Testing responses to specific stimuli before and after sleep deprivation in subjects has definitely shown an increased output of pain to all types of different pain sources. Heat, cold, pinprick, deep pressure, and other types of provocations all show these results.

However, when looking at sleep deprivation and the cascade of other symptoms it provides, it brings up another questions. Could these related conditions be the true cause for pain sensitivity? Indeed, some studies are finding that sleep disturbances are do have a more indirect link to pain, suggesting that increased pain perception is more-related to those depressive symptoms and how much attention to pain that these individuals may have.

So, perhaps we're looking at is a type of central nervous system fatigue. As I've discussed before, both physical and mental illnesses can propagate these chemical changes in the brain and contribute to pain.

No matter the cause, it's clear that poor sleep and pain ARE related, and unfortunately, this relationship is cyclical. Poor sleep heightens pain levels, and it doesn't take much thought to understand that chronic pain results in even more sleep disturbances.



Treating this, obviously, is a complex thing, and could very well require a comprehensive medical team, rather than one therapist, including sleep specialists, psychologists, and more. On my own, as an Athletic Therapist, what I can do is try to begin breaking that pain-sleep cycle, just like the pain-spasm cycle, and provide a bit of relief at a time in order to slowly improve sleep quality as the client and I go.

Sleep on that.

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