There isn’t an agreed definition of pacing, I would define it as flexible way of structuring your day in a way that supports both function and wellbeing.  Pacing essentially means breaking down tasks and activities into manageable chunks with consideration of the different types of activities, including enough short rest breaks in your day and flexibly adjusting things each day/throughout the day as needed.  Pacing needs consideration of different activity types, for example what activities are more physical/cognitive/emotional and how they impact you.  It needs a number of things which I will touch on in this blog, especially awareness, compassion, noticing what’s present in our experience within our body (what’s embodied), flexibility, knowing our values & what’s most meaningful, and exploration.

Pacing is helpful for us all and more so when living with persistent pain and/or other health conditions.  A quick note here, pacing for persistent pain is different to pacing for ME/CFS and long covid (where post exertional malaise is present), there are similarities but its a different.  This blog is focusing on pacing when living with persistent pain.

The way I suggest exploring pacing with the people I work with includes discussing what pacing is and is not, there are some examples of what pacing isn’t below, perhaps the commonest misconception is that it means doing less.  I also encourage an understanding of nervous system regulation through a cognitive understanding and an embodied understanding (body based).  Part of this includes developing a toolbox of strategies and practices that support compassionate awareness & nervous system regulation, both I see as key aspects of pacing.   I often use the window of tolerance model by Dan Siegel, polyvagal theory by Stephen Porges and the three circles model from compassion focused therapy by Paul Gilbert as part of exploring understanding nervous system regulation in an embodied way.  I explore what’s meaningful with people and what their values are for a number of reasons, including because it helps people make choices about which activities to prioritise and engage in.

As already mentioned pacing can be misunderstood (and often is), here are some of the things pacing is not:

• A rigid/restrictive daily plan
• Doing less
• It’s not another thing to be ‘done’
• Only being able to do certain things a certain way
• Only doing things that don’t cause a pain flare

Pacing is not a rigid daily plan, it’s a way of flexibly adjusting our day as we move through it.  It is helpful for us to bring a non-judgemental compassionate awareness to how we are relating to our world (both the internal and the external), which is changing moment by moment.  From a place of being the compassionate observer we can take conscious wise action, where it’s possible to meet what’s needed (part of pacing).  A quick note here, there isn’t really any division between our internal world and the external world (not something we are exploring in this blog).

Avoiding doing things that tend to increase pain because of worry of a pain flare is not pacing and doing this over time this increases threat in systems, decreases our tolerance levels for the activity being avoided and often also for different activities.  It increases sympathetic nervous system activation (fight-flight), essentially there is more threat in systems and a sense of safety is lacking or has significantly decreased (pain is part of our threat system).  Tolerance levels decrease for a number of reasons, mainly due to an increase in sensitivity levels to different stimuli and a decrease in fitness levels.  Stimuli that becomes overreacted to (sensitivity) often includes sitting and standing still, moving a certain way or when systems are super sensitive all movements can trigger a protection response, doing certain activities and even thinking about doing a particular activity.  A quick note here about cause and pain, rarely does one thing cause pain or an increase in it, it’s complex and there are many variables we don’t see.

Another thing that pacing doesn’t mean is ignoring pain and pushing on regardless, this tends to ramp up the protection responses and sensitises systems more.  This is the opposite of avoiding activities, it is sometimes referred to as the boom-bust cycle (not a term I use unless someone is using it and relates to it in a helpful way).  Both avoidance and regularly exceeding tolerance levels by too much are both problematic.  A quick note here, choosing not to do something that doesn’t come from a place of threat may well not be avoidance.  Doing a lot more than tolerance levels tends to result in having to do less for a few days, or even longer, it increases sensitivity and the threat in systems.  Doing a lot less also increases sensitivity and threat in systems, along with tending to decrease strength and fitness as well.  However, doing a little more with a sense of safety, understanding your nervous system and using practices that help regulate your nervous system can help to gently nudge tolerance levels over time.

Pacing is not another thing to be ‘done’, it’s a way of flexibility adjusting to how we are and what feels needed throughout our day.  The way I see it is that pacing becomes a way of being that supports both effective function and our wellbeing.  For example, compassionately relating to ourselves and others, taking regular pauses in the day (these are needed for everyone, whether living with pain or not) and having nurturing daily practices that are part of a way of being and living, these could be seen as helpful habits.

(Image: my Grandad when he was 90 doing a meaningful activity – time in nature with one of his grandchildren – made possible by having something to sit on & only walking a very short distance)

How Can Pacing Help With Persistent Pain?

Pacing encourages people to work around their normal tolerance levels, this means knowing your baseline for different activities and where your soft limit/soft edge/soft boundary is.  This means knowing what level of different activities is generally ok (the baseline) and also having an embodied knowing (an awareness from what’s present in your body related to your whole experience).  Knowing your soft boundary includes knowing the whispers from your body that indicate you are near this point and indicate that taking a rest break or changing tasks would be helpful.  I have found it helpful over the years, with myself and working with others, to combine the cognitive understanding of a variable baseline with an embodied knowing of the signs we are near our soft boundary or soft limit.  One reason combining these is helpful is because our baselines are always changing and are impacted by many factors/variables, for example lack of stress and increased stress, and our body will reflect dysregulation consistently – we can come to deeply know it’s whispers when we listen compassionately.

Pacing can help in many ways, here are some of the ways it can help with managing and changing pain:

•  People living with pain can often more consistently do what needs to be done and what’s meaningful to them by breaking things down into more manageable chunks of activity interspaced with rest
• As well as taking short rest breaks changing to a different activity, for example changing more of a physical task for more of a cognitive one can be helpful
• With a pain flare-up things may need to be broken down into smaller amounts with more rest breaks to help systems to calm down
• Pacing can help people to engage more often and more fully in what’s meaningful along with using the strategies & practices that help them to manage pain
• It can help to modulate pain, for example taking a break and doing a breath practice helps to regulate the nervous system – down regulating the threat system and can potentially modulate pain
• Pacing can help with nervous system regulation and can help retrain the nervous system.  This is part of both managing and changing pain
• It can help to decrease sensitivity to different stimuli, increase tolerance & fitness over time along with other things

Pacing Tips

It can be helpful to have an understanding of why pain doesn’t necessarily equal harm, knowing that we are safe to do things even with pain.  Having an understanding around this is one thing that can help people to pace activities and create a sense of safety.

As already mentioned listening to the body and integrating enough rest, along with having daily practices that help to regulate the nervous system is important.  Many things can help to regulate the nervous system and help with pacing when living with pain, for example, breath practices, meditation, gentle yoga or other mindful movement, singing/humming, time in nature.  Exercise and including this in pacing is important, finding what’s helpful for you needs exploration, there is a link to an exercise and persistent pain blog I wrote in the resources at the end of this blog.

It is important to explore what is restful for you and the sort of rest that certain things offer, there are a number of different forms of rest which I am not going to go into in this blog.  The picture below is child’s pose, this is often referred to as a pose of rest in yoga and is known to be calming, grounding, restful and restorative.  It is important to remember just because something is said to be calming and restful it doesn’t mean it will be for you, this highlights again the importance of embodied awareness (what is showing up in the body).  Understanding what is showing up in your body and how your nervous system is responding is part of developing an embodied awareness.  I encourage people who attend my 8 week Creating A Healing Path workshops for people with pain/fatigue/anxiety to do this.  Even though we didn’t specifically cover pacing people reported pacing better and being more able to engage in what was meaningful to them, you can find the link for more information on these workshops at the end of this blog.

As already mentioned pacing is not rigid, it needs flexibility as everything is changing moment by moment.  Our internal and external environments are constantly changing, our tolerance levels and nervous system state are in a constant state of flux (with everything else), it another reason why having an embodied awareness matters.  We need a cognitive understanding combined with an embodied awareness of what practices and strategies are helpful when, along with the different ways that we can adapt them.  Without a body based understanding (embodied awareness) we will be running on cognitive understanding alone and missing out on what our nervous system is communicating and the wisdom of our body.

Here is a common example of how our tolerance levels and nervous system state are always changing, imagine that you haven’t been sleeping well for a few nights and you keep on doing things in the usual way.  There are some common impacts of this, including: increased fatigue, increased stress, making poorer food choices, getting hooked in unhelpful thoughts, and increased pain which may also stop you sleeping (one of the many cycles in pain).   Lack of sleep in itself sensitises systems, increases threat system activation, increases the perception of pain, our baselines and soft boundary change, and it impacts our concentration and focus.  So, rather than keeping doing things in the usual way we need to explore what’s helpful and adapt what we are doing.  This might look like breaking things down into smaller chunks than usual, having more rest breaks during the day, including more meditation, or having a few minutes outside a few times during the day, and doing less exercise than normal (the body responds differently to exercise with lack of sleep and it responds differently with persistent pain too).  Making these adjustments like these are examples of pacing.

When there is something that’s important for you to do and you know it’s over your tolerance levels one way to manage this is to engage in what gives more safety messages to your body via your nervous system for a few days before the event, during it if possible, and again for a few days after.    Factoring in more rest afterwards and even before the activity/day can be helpful.

Remember what is helpful on one day, or in one moment won’t be exactly the same as what’s needed in another.  This is why we need an embodied awareness (body awareness) and a toolkit of practices and strategies that we have explored and used regularly.  This helps us to select what feels most helpful and then notice how our nervous system and body are responding, adapting what we are doing from this as needed.

Here’s a list of some more examples that can be part of pacing with a flare-up of pain:

Modulate your usual activities, like with the example above

Use additional helpful strategies from your toolkit if needed, a few examples are mentioned above

Do what helps to regulate your nervous system more frequently during the day

  Practice self-compassion, an example would be reframing your language (the self-critic can get loud when things during a pain flare-up)

For some activities where you are doing less than you normally would due to a flare-up remember to ensure that you have a plan to build things back up gradually as things start to settle (something which can be forgotten).

Some questions you can ask yourself:

•  Do you pace your activities in a way that’s supportive for your wellbeing
• Do you make adjustments to your day for factors like lack of sleep and increased stress?
• Do you know your baselines for activities and do you the know the signs of your soft limit/soft edge/soft boundary?
• Do you do what’s important to you or do you avoid doing it out of fear of making the pain worse?
• Do you push on regardless?
•  Do you incorporate the helpful strategies/practices into your day or just when the pain is worse?
• Do you know what helps give you a sense of safety with doing different things?
• What daily practices/strategies support you?

In Summary

This blog has covered what I see as the basic principles of pacing when living with persistent pain, these are:

• Breaking things down into manageable chunks
• Understanding different activities (physical/cognitive/emotional) and your tolerance levels for them
• Integrating enough rest (with consideration of different forms of rest)
• Changing activities for a break is helpful (alongside having rest breaks)
• Having a cognitive understanding and an embodied awareness (body based understanding/knowing)
• Knowing the whispers from your body that you are near or at your soft limit/soft edge/soft boundary
• Using the practices and strategies that support you and help to regulate your nervous system and manage pain
• Remember there isn’t a right or wrong with pacing and it needs flexibility.  There isn’t a perfect way to pace!
• We need to be able to flexibly adjust during the day, this needs an embodied compassionate awareness & ongoing practice

No-one paces the same way, no-one walks in the same shoes, yet we create similar footprints.  This means that we can learn from each other and use the principles of things like pacing and different practices and adapt them to meet what’s needed.  There are common tools/practices/strategies that can help regulate the nervous system, manage and modulate pain, support wellbeing and effective function, these need adjusting for each person.  This is something I explore with people as part of 1:1 work and it is part of my 8 week Creating A Healing Path workshop series.  With regular practice people understand the many ways they can adapt practices to meet their needs and as part of exploration and regular practice they create their own toolkit of resources to manage and change pain.

Learning how to pace and manage pain is a journey of exploration that takes many directions, there isn’t a destination/an end point with pacing, instead pacing supports pain management and engaging with what matters each day.  I would say that understanding nervous system regulation, noticing how we are relating to ourselves and practicing embodiment (noticing what’s present in our body) are all key parts of pacing.

I have written this blog from my understanding of working as a pain specialist physiotherapist & wellness coach as well as lived experience of persistent pain, ME/CFS & PoTS.  If you would like to learn more about pacing and/or would like help with management of persistent pain in general get in touch to book your free 15 minute call to see how I can help.

If you would like to find out more about the 8 week online Creating A Healing Path workshop series for people with any condition associated with pain/fatigue/anxiety click the link below:

https://unityphysio.co.uk/services/ahealingpath/

Pacing Resources

There are a number of resources specifically for pacing for persistent pain and related topics, here are a few:

There is a little about nervous system regulation in part one of my healing blog https://unityphysio.co.uk/healing-within-connectedness-love-part-one/

This is a blog that I wrote on exercising with persistent pain and can help with pacing of exercise/physical activities https://unityphysio.co.uk/exercising-with-persistent-pain/

A blog written about pacing in the context of neuropathic pain http://livingwellpain.net/persistent-pain-pacing

A short pacing video https://www.paintoolkit.org/pain-tools

Q&A: Pacing & Chronic Illness http://natashalipman.com/qa-pacing-chronic-lllness-resting-pain-fatigue/

(Images in this blog: icon with heart in hands and man walking are authors own, childs pose image is from Shutterstock by Rasterbird, time for change image is from Shutterstock by Trueffelpix)

The post What is Pacing & How Can it Help with Persistent/Chronic Pain? appeared first on Unity Physiotherapy and Wellbeing.

Aligning mind, body & heart

Terms like aligning mind, body and heart can seem a bit abstract so I’m going to define this in the way I see it before we explore connectedness more.  To me aligning mind, body and heart means living in a loving and embodied way aligned with our purpose and what’s meaningful, living from a place of love, compassion & connectedness.  By living in a loving and embodied way I mean noticing how, for example, our thoughts and feelings, are showing up in the body in a compassionate and non-judgemental way.  Part of healing is awakening our senses and being able to fully be in the present moment in an embodied and loving way.  We can’t do this if we are stuck in hyperarousal or hypoarousal, where we are stuck in our heads or rushing around all the time, disconnected from ourselves and the world around us, and not feeling safe/settled and secure.  Aligning body, mind and heart helps us regulate our nervous system, awaken to a deeper way of being and reconnect to the connectedness of everything.

Living in an embodied and open hearted way can also help us see that the obstacles and challenges that appear as part of life can help us awaken and grow.  We can ask questions that support with this like how can this help me grow? How can this help me serve myself and others?  How might this help serve my heartfelt intentions or aspirations?  Sometimes things are overwhelming, these times we won’t know the answers to these questions and we will struggle to connect to our bodies, these times we may need to find a suitable therapist to support us.

Love & connectedness in healing 

One of the things that is really important in healing is that our suffering is witnessed and acknowledged in a compassionate and non-judgemental way.  Suffering that is not witnessed and acknowledged, or done so in a critical way, often causes more trauma.   Love, compassion & connection are needed here because when we aren’t fully present and connected we can’t truly notice our suffering, or that of another, and without love and compassion there is judgement and criticism.

Acceptance is important in healing, it isn’t a one off thing, instead it’s ongoing and it can be said to be a moment by moment process.   Acceptance isn’t passive, it doesn’t mean putting up with something, or that things won’t change (things are always changing right down to each moment).  A great strength or courage is needed to be able to let go and trust in our inner wisdom and the process.  With curiosity, openness, courage and a compassionate loving presence (a heartfelt presence) we can notice and allow what’s present in the moment to be exactly as it is, even if it’s not how we would ideally choose it to be.  Being present with love & compassion helps us accept and allow what’s present to be without, for example, self-blame or self-criticism, and when these do appear they can be met with compassion and love too.   Allowing what’s present to be needs a sense of safety, or feeling safe enough in the present moment.  This means that we need the nervous system to be balanced or close to balance (where we are within our window of tolerance/ventral vagal system).

From a place of noticing what’s present in the body we can increase our understanding, connect to our inner wisdom and discern what’s supportive for us.  Any action comes from our inner wisdom rather than from a threat based reaction, for example a pushing away, trying to get rid of something, or avoiding.  It’s important for us to stop over controlling and resisting, this is part of being in a regulated nervous system (resistance & over control are part of our threat system and protection mechanisms), as it calms our nervous system and allows new possibilities to begin to surface.  Allowing what’s present to be with an acceptance or openness is a place where fear softens and we can start to see what’s resting underneath.  Holding whatever is present, in love compassion isn’t always easy and this is part of the practice and the healing.  Things can reappear that we thought we had dealt with once, that we had healed, new layers surface for healing, here again we practice acceptance and compassion.

We need trust to allow the healing process to unfold in its own time without wanting it to be a certain way or create a certain outcome, without pushing or resisting, easier said than done I know (that’s part of the practice too).  We naturally push away or resist what causes suffering and grasp what creates joy and the things we want more of.  Part of suffering is in the pushing away and grasping, we can learn to allow things to flow through (an ever ongoing practice).  We can, for example, notice that pain is present and allow it to be in the background as best we can, rather than trying to get rid of it and getting frustrated, angry or self-critical when nothing works.  This doesn’t mean we don’t take action to try and alleviate the suffering, instead it comes from a different place and we take wise action.  This may be no action sometimes, or something simple like after noticing what’s present and allowing it to be, offering ourselves some soothing words or soothing touch (this could be part of Tara Brach’s R.A.I.N practice or Kritsin Neff’s self-compassion break, for example).  We also need to learn to hold the outcome lightly, we cannot control this as there are many variable (some we don’t see) we can influence the outcome and control how we relate to it.

Often when we are suffering we lose trust in ourselves, I have seen this time and time again working with people with persistent pain, other long-term conditions and felt it myself.  The decreased trust, or the loss of trust, brings an opportunity to connect more deeply to it and develop more of a kind of unshakeable trust.  Part of trust is trusting that we have the skills, knowledge, resources/practices to manage, or if we don’t then believing that with support we can develop them.  Learning to trust the healing process is important and it means we need to trust in uncertainty too.  Trusting in uncertainty isn’t easy, it’s important because so much is uncertain in life, this means we need to let go of over control.  Being safely grounded in compassion and love links with trust in holding us steady enough within the uncertainty, within what feels like a vulnerable place.

Reconnecting to our inner wisdom is so important in healing, it supports and guides us.  Terms like inner wisdom and our true nature or essence, can seem a bit abstract, they aren’t tangible things we can see.  Our inner wisdom and true nature both hold love & compassion and connecting to them is important in healing.  Connecting to our inner wisdom through our body guides us in many ways, for example it can guide us when to explore something to deepen understanding and when to allow something to be in the background for the time being.  Sometimes we need help to access our inner wisdom especially if there is unprocessed trauma, the light of compassion and love can be hidden under layers.

Feeling the connectedness to love, nature and the wider whole is also important in healing and our overall wellbeing.  Research is showing us that it is not necessarily the amount of time that we spend in nature that is significant for our wellbeing, except in terms of physical wellbeing, there needs to be a sense of connectedness too (physical wellbeing needs this too, so again it’s not just the time in nature that’s important).  Sometimes we have disconnected from the interconnectedness of nature, reconnecting to this is part of our healing and it’s needed for natures healing.  Nature’s wisdom combines with our inner wisdom and can guide us when we listen.  If we haven’t lost the connection to the connectedness with nature then the sense of connectedness with this tends to deepen as part of healing.  Nature is part of us and we are part of nature, our wellbeing and natures wellbeing are inextricably interlinked, connecting to this helps our healing and also the healing that nature is desperately calling out for.

The interconnectedness with nature and something bigger than us may resonate with you or it may not, either way is ok.  If these things are of interest one of the books that I would recommend is called ‘Reconnection: Fixing Our Broken Relationship With Nature’ by Miles Richardson.

Common Humanity & Healing

As human beings we all experience joys and sorrows, love and loss, easier times and tough times, suffering and healing.  This is the common humanity we all share, we share many things as part of being human and connecting to this is important in healing.  Connection to others is important in healing, we are social animals.  We self-regulate and we co-regulate, our nervous system talks to other nervous systems.

Adapting to and processing many losses is part of being human and is often part of healing too  This can be for many reason, for example, from the multiple losses related to living with a chronic health condition, from life being different from the way you wished it to be, and/or from the loss of a loved one.  There isn’t a right or wrong way to grieve.  I wrote a grief and loss in persistent pain & other long term health conditions blog which you can find this here:

Part one https://unityphysio.co.uk/grief-loss-in-persistent-pain-other-health-conditions-part-one/

Part two https://unityphysio.co.uk/grief-loss-in-persistent-pain-other-health-conditions-part-two/

It is the tough times that we learn the most from and these times that we need a toolbox of practices to draw on, these can also be referred to as strategies or resources.  The tough times strengthen our heart and allow our heart to open more fully, to be present with love, compassion and courage, connect to the depth of our strength and to connect more deeply to the connectedness of everything with a sense of spaciousness.  We cannot heal until we learn what supports our nervous system regulation and have some resources/practices to support this and healing, we create more resources along our healing journey too.

What supports healing?

There are many things that can support us each day, that can become part of a way of being and part of healing, including: embodied self-awareness practices (awareness in the body), meditation, mindfulness, breath practices, self-compassion, yoga, exercise and movement, walking, time in nature, journaling, distraction (sometimes this is needed, for example when things are over whelming) and many more things.

When I had a really tough couple of years due to some health conditions I leaned deeply into my yoga and compassion practices and drew on many other resources that I had, my gratitude for these deepened and I developed many more resources through this time too.  I also reached out for additional support, remember we can’t heal on our own.

What practices and resources/strategies do you use to support you day to day?

Summary

To heal we need many things including: to restore balance and retrain our nervous system, a sense of safety and trust, an embodied loving awareness, acceptance, a variety of resources/practices along with a daily commitment to practice, belongingness, support of others, connection and connectedness, and of course compassion and love.  Healing takes time and a toolbox of strategies and practices, it’s not one thing that helps us heal it’s many things.  We can’t heal on our own, we need the co-regulation and support of others which can take many forms.  Sometimes support needs to be in the form of a therapist, other times it could be a coach or mentor, friends, or a wider community group that we are part of.

As we heal the confusion that we had in our suffering evolves into clarity and we awaken a little more to our true selves and the interconnectedness in everything too.  There are times that we think we have healed and everything is going smoothly and then something happens that opens up new layers that are ready to be healed.   Healing is something I have come to see as being ongoing, maybe you can relate to this too.  I don’t think there is a destination unless it is to return to our true selves and wholeness, to the alignment of mind body and heart and live from this place, and return again and again.  Each time there is a challenge or an obstacle it gives us an opportunity to grow and connect to our true selves, our inner wisdom, and more deeply to the connectedness within and around us.

We all already have what’s needed for healing within us, to access and nurture this we need to be able to safely connect to our bodies and we often need to change how we are relating to ourselves, from being critical, for example, to being more compassionate.  Sometimes we need help from a psychologist, or another psychological clinician to do this, for example when there is unresolved or unprocessed trauma.  We all have within us a core essence of compassion and love, this light never goes out, sometimes it’s under layers and we need help to be able to start to see it, and the more we connect to this place the more brightly it shines.

Healing has many aspects and perhaps we could see it as being rooted in connectedness and love, and aligning mind, body and heart.  I have come to understand that our healing rests within the love that is within and around us all and the connection to the interconnectedness of everything.  Healing is a place where enougness, okness, compassion, love, trust and freedom all rest.  Connecting to the wisdom of our body, heart, inner trust, compassion and love over and over again helps us to heal & develop an unshakeable inner core, or at least a less shakeable one.  The inner wisdom that is within us all, our core of love and compassion, is a place that we can come to know more deeply with time and once we have an embodied knowing (a felt sense in our body) we can return again and again to our true selves and a balanced state (our ventral vagal system/window of tolerance) that supports healing.  As we heal we can live more fully in an open hearted presence, developing a new way to be, relating to ourselves in a more loving and compassionate way and extending this love and compassion to others and the world around us.

To finish this blog I’m sharing a poem that I wrote called ‘Healing Within’:

Many things were unknown

Couldn’t be seen

In the darkness there was always some light

Flickering gently

Leading the way

Slowly, step by step

Pauses scattered through

Compassionate awareness enveloping

Body wisdom guiding to explore

What’s resting inside, to be seen, accepted and loved

Slowly, never to be rushed

Each footstep exploring

Heart trusting

A loving presence guiding

Exploring and listening

Natures wisdom shining

Deepening a knowing

Harmony evolving

Learning a new way to be

Compassion, love and trust united

Deeply embedded within

Shining brightly

Holding the steadiness

Resting in aliveness

Connected to the unity

Being & healing

You may also like to check out the poem I wrote called The Body Remembers The Trust

https://m.youtube.com/watch?v=2pgR3COJLPk

I would love to hear your thoughts on healing and this blog, do drop me an email if you would like to (info@unityphysio.co.uk) or share some thoughts in the comments on social media where I’ve shared this blog.

The post Healing Within Connectedness & Love (part two) appeared first on Unity Physiotherapy and Wellbeing.

Persistent pain (also known as chronic pain) is a specialist area/field in healthcare, it’s an area that I have specialised in and wanted to share a little on what this means.  A little background on physiotherapy training, following completion of a physiotherapy degree physiotherapists take different paths, traditionally this always started with a junior rotational post in a hospital.  This now varies, on graduating a physiotherapist may start work as a junior rotational physiotherapist working in different areas within a hospital, or they may start working as a junior therapist within a community therapy team, or they may go straight into private practice on a graduate development program, usually this is within musculoskeletal physiotherapy.  Some physios work generically and others specialise in one area or a few areas, doing additional training and having the appropriate level of support and experience to develop a specialism, which is always ongoing.  Physiotherapists work in many areas, here are some of them: musculoskeletal (MSK), respiratory, cardiac rehab, neurology, paediatrics, care of the elderly, falls, learning disability, mental health, persistent pain, ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), long covid and palliative care.  

Pain specialist physiotherapists have done additional in-depth training on top of their degree and usually have experience in a variety of areas.  Additional training includes exploring pain neuroscience more in-depth than at undergraduate level, psychologically informed practice training (includes integrating the core principles from, such as, acceptance and commitment therapy, compassion focused therapy and cognitive behavioural therapy), other pain related training and other related training including coaching.  They keep up to date with the evidence base on pain and understand the many myths that exist within healthcare and society about pain and the impacts of these.  Pain physios usually have many years experience of helping people learn to live well with pain and change pain too.  They value, listen and learn from the lived experience of those they work with and the wider lived experience community.

Pain physiotherapists use a whole person centred biopsychosocial model (many use a biopsychosocial-spiritual approach – this includes what’s meaningful and gives purpose) and take a holistic/integrative approach to care.  We aim to understand the whole person and their world and hold a compassionate non-judgmental space for understanding and hearings someones story/journey and to support exploration.  We encourage people to build compassionate self-awareness and to hold a curiosity and a willingness to explore what may be helpful and supportive for them.  Pain physiotherapists aim to empower people, for example, to be able to engage in what’s meaningful and develop a set of strategies to help manage and change pain.  We help people to be able to fully engage with life again and what’s most meaningful.   We work closely with other professionals involved in someone’s care, such as a psychologist and occupational therapist.

Pain physiotherapists understand that pain is complex and multi-faceted and that’s linked to the fact human beings are complex, this is why we have often done a variety of training exploring the different areas of being human.  Each pain specialist physio works by integrating all their knowledge and skills in a way that is blended with the knowledge, skills and experiences of each person they are working with, creating individualised care.  Each pain physiotherapist works a little differently as they integrate their knowledge, unique skill set and experiences into their work.  No one therapist has the same knowledge, skills and clinical experience, just as no-one person is exactly the same.  It is important to mention that we all follow the Chartered Society of Physiotherapy (CSP) guidelines and those of the Health and Care Professions Council (HCPC).  When using knowledge and skills that don’t class as physiotherapy (according to what is set out by the CSP), we adhere to the best practice within those professional guidelines as well.

How To know if Someone Has the Relevant Knowledge, Skills & Experience?

Read what qualifications, training & experience they have on their website and if it’s not available to read on there its ok (and I would recommend it) to ask.  It is ok to ask what someones experience and background is.  Some therapists will offer a free short call, I do this, one reason being it helps people decide if working with them feels potentially helpful.

My Knowledge, Skills & Experience In Persistent Pain

Following my junior rotations in a hospital I chose to specialise in neurology and persistent pain and over the years have done many trainings, lots of reading, had support from more experienced clinicians and worked with many people with persistent pain.  I have worked in chronic pain for over 14 years, in the last 3-4 years I’ve stopped my neurology work and transferred this specialism to being a special interest in working with people with ME/CFS, long covid and PoTS, alongside still working with people with persistent pain.  One of my roles has been working as an advanced practitioner physiotherapist in pain, I did this for 4 years alongside my private work.  

Here’s some of my training:

BSc (Hons) Physiotherapy

Life coaching qualification

NLP practitioner training

Yoga teacher training (200hr)

80hr trauma-informed yoga and embodied resilience course

Two weekend yoga courses for physios taught by physios who are yoga teachers

8 week psychologically informed practice course with the Physiotherapy Pain Association

 Compassion focused therapy (CFT) for healthcare professionals 2 day course

8 weeks CFT training

A few different ACT courses up to intermediate level

Pain coaching course

Explain pain course

Graded motor imagery course

Functional nutrition & chronic pain certification

The above list is a small percentage of the training I have done, there has been a lot more training and reading over the years in addition to what is listed above.  There is other training related to the special interests I have in ME/CFS, long covid and PoTS, and the yoga and coaching parts of my work.

Remember Chronic Pain/Persistent Pain Is a Specialist Area

Chronic pain/persistent pain is a specialist area and it it important that when people are struggling with persistent pain that they see clinician(s)/therapist(s) who have knowledge, skills and experience in this area.  Persistent pain includes many diagnoses including fibromyalgia, chronic low back pain, chronic headaches, CRPS, and many others.

This wasn’t the easiest thing to explain in a short (ish) blog post but hopefully it makes sense and you can see the value in seeing a pain specialist physiotherapist  or an MSK physio with a special interest in persistent pain.  Remember it’s ok to ask what someones background and experience is in working in chronic pain.

If you need help with persistent pain and would like to see if I can help please get in touch to book a free 15 minute call to discuss.

The post What is A Pain Specialist Physiotherapist? appeared first on Unity Physiotherapy and Wellbeing.

What Can Help

We need resources to help us in the grief process, resources help balance the challenges & vulnerabilities that arise.  A really important inner resource is compassion which I think this is foundational in many things including in grief & loss.  Other resources include the process of learning itself, the support of others, perspective taking, being able to connect to safety and trust, and mindfulness.  If someone is under-resourced they are more likely to need some support from a counsellor or psychologist.  Also this can be needed, for example, if the grief triggers into previous traumatic experiences, which I think it often does, especially if someone is under-resourced and it’s still needed sometimes even if someone is well resourced too.  It’s important to recognise when help is needed and also remember that there is no right or wrong way to grieve.

One way to identify what could be supportive for you to nurture is to ask yourself:

What’s challenging for you?

What would help if it was more present in your mind? (for example, compassion, love)

What would it help to connect to in your body? (for example, love, kindness)

You can then nurture what you identify would be helpful, the more we practice and work with something the easier to is to access as it becomes more hard wired.  There may be a time when growing what’s nurturing creates more sadness, it’s important we listen to the not yet and reassure ourselves it’s ok to feel these things and see if it feels ok to continue the practice.  A practice where you can nurture what you identify as supportive could be one like this one, to nurture what’s supportive in the body:

https://soundcloud.com/user-103516027/nurturing-whats-supportive?si=2ef7028b5d334d2e8f6860c9cbfcfebf&utm_source=clipboard&utm_medium=text&utm_campaign=social_sharing

Our self-talk matters, as mentioned in part one of the blog our self-critic can get over active and we take the losses and grief and turn them into a big stick to beat ourselves up with, when this happens the compassionate self can help.  Let’s look at a couple of examples and some compassionate reframes: “I need to stop wallowing and get on with living life”, perhaps you could notice how this statement lands in your body and what state of mind it’s associated with?  The self-critic’s view is not very helpful and doesn’t acknowledge the impact, that it’s normal to not feel ok and settled after a loss/losses for a while (how ever long that while is).  Here’s a compassionate reframe example, “my grief reminds me of how much I’ve lost, it’s completely understandable that I’ve been struggling and how I’m feeling is normal, everyone grieves and experiences losses and it’s not easy to navigate this.”  How does that land with you?  Here’s an example that combines guilt with the self-critic, “if I had worked harder to get rid of this pain I wouldn’t have lost my ability to walk further than I can, do the garden and the housework, I really should have stopped it happening, I just wasn’t strong enough to do it.”  Wow that’s harsh isn’t it, how does this land with you?  Let’s look at a compassionate reframe here, “this has been really hard to manage and I did my best to maintain my function and do what I needed to.  I had no control over how things have turned out and I’m doing my best to find what’s helpful for me.”  How does this land in your body, what about your mind?

Being aware of where our attention is automatically resting is helpful, pain and losses take our attention automatically and become a default until we become aware and start to change this habit (it doesn’t mean ignoring the pain and losses).  We have tricky brains in that they are wired for protection and survival and so have a bias towards things that are perceived as a threat.  If, for example, we rest in anger, anxiety or pain all the time it becomes a habit and what we are growing.  Also, when we do this we are functioning from our sympathetic nervous system way too much which impacts us in many ways.  Being mindful of where our attention is, acknowledging what is present and learning about it, then unhooking from this and choosing a more helpful place for our attention is part of creating space around pain and loss.  In this way we can learn from what’s showing up and deepen our awareness without being hijacked by it.

When I did Rick Hanson’s Grief and Loss course recently (linked at the end of this blog) he mentioned that Peter Levine talks about being like a pendulum swinging into the intensity and discomfort and back out.  The rhythm of the pendulum and how long it stays with the discomfort can be whatever is right for you, perhaps this could be helpful in being with the losses and grief and how it’s showing up without feeling overwhelmed.  Over time we can swing into the grief and discomfort and stay a little longer if it’s helpful.  If someone can’t create space in their pain and time and time again they get pulled into it, or maybe even are stuck in it, reaching out for help may be needed.

Dr Rick Hanson also talks about even as the storm passes through the mind for your own grieving there is a place inside, a knowing that a small part isn’t swept away and is alright, even if it’s a tenth of 1%.  Can you notice this?  This basic alrightness as he calls it can be a place of refuge, a soothing place to rest and grow.  Keeping returning to it and building this indestructible, trustworthy, reliable, unshakable core, as Rick says, is helpful.

It’s important to acknowledge the losses through pain or other health conditions, honour them and when we are ready create something meaningful, something that’s helpful for the self and others.  A ritual can be part of this, for example, drawing something, creating a memory scrapbox or memory box, lighting a candle, planting a tree or other plant, writing a letter, getting a group of people together to acknowledge & honour the person that once was with compassion and love.

Here’s a list of other things that help, I’m not talking about them all else this blog will be way too long (this is not an exhaustive list, there are many more things):

The post Grief & Loss in Persistent Pain & Other Health Conditions (Part Two) appeared first on Unity Physiotherapy and Wellbeing.

On a side note to exercising with ongoing pain we need to all remember to take regular movement breaks during the day.  Exercising or being active for an hour after sitting all day is not enough.  We lead much more sedentary lives than we used to thanks to, such as, advancing technology and more use of our cars.  With the pressures of modern living it is important we think of ways to add in more regular movement into each day, creating new movement habits with regular practice.  Maybe this could include walking to work, parking the car further away from work or getting off the bus a few stops earlier, going to speak to someone in the office instead of sending an email, doing some squats whilst the kettle boils, standing during a phone call and going lifting alternate heels, there are many possibilities!  During the day remember to take regular movement breaks, these little movement snacks will also help your concentration and attention as well as your body.

I have noticed some common questions from people with persistent pain, including:

1. What exercise is helpful?

When choosing the exercise consider:

• Does it help you achieve your goals, maximize or maintain function?
• Do you enjoy it?
• Is it meaningful?
• If there is a variety of the types of exercise (mix of cardiovascular, flexibility, strengthening)
• Is the level achievable for you at present or do you need to modify some of the variables (see dosage tips below). Think of the Goldilocks rule – not too little, not too much, just right.
• Do you feel confident in modifying the variables or do you need to explore this with a physiotherapist?
• Do you understand your pain and have a toolkit that helps when you have a flare up?
• Do you have an understanding of pain not necessarily being correlative of what’s happening in the tissues – hurt doesn’t equal harm?

2. How do I know what’s enough for me and how do I avoid pain flare-ups?

For ages 19-64 The World Health Organisation recommends 150 minutes a week (30 minutes a day) of moderate intensity aerobic exercise (e.g. brisk walk, cycling, slow swimming), or 75 minutes a week of high intensity/vigorous aerobic exercise (e.g. running, a game of tennis, fast swimming), and twice a week strengthening of all major muscle groups.  Moderate intensity and high intensity aerobic exercise can be mixed, it has been said 1 minute of vigorous/high intensity aerobic exercise equates to 2 minutes of moderate intensity.  This amount of exercise could be something for you to work towards.  For some people with long-term conditions it’s not achievable, which is ok as long as the level of exercise being done is enough for adaptability.

What’s enough for one person may be too little or too much for another so this needs exploration, if it’s not something you feel confident to do on your own a physiotherapist can guide you. Remember the goldilocks rule here – not too little, not too much, just right! The only way we find what’s best for us is by testing and exploring, we learn through experience.  It’s important to remember a little bit of pain flare-up with persistent pain is ok, by a little I mean that it settles within 24 hours and doesn’t affect your daily function.  We need enough challenge for adaptability of body and nervous system and this can mean a little flare-up, sometimes we initially aim for no flare-up to build confidence and calm things down, we need to remember to build things up.  Start where you are at, find your baseline, if you have persistent pain this baseline needs to be a level where you don’t have a big flare-up that lasts a few days or longer (in the traffic light system below that’s red).  Find a level that feels achievable and comfortable for you.

The traffic light system:

You mainly want to be exercising in the green, amber is ok yet either needs increased awareness, a little adjustment to proceed, or modulation to change to a green light.  An amber light can mean too much too fast and needs evaluation, red is stop and significantly modify what you are doing and possibly seek guidance from a physiotherapist if needed.

Red – there is a severe flare-up during the exercise, 7 or more on a 0-10 scale, you don’t feel safe/are worrying about causing more pain or damage.  The pain flare continues after exercise for between 3 days and several weeks and you have a significant loss of ability in your daily function.   You need to stop when in the red, seek advice from a physiotherapist if you are often in the red.

Amber – pain flares during activity of 4-7 on 0-10 scale, yet you know you are safe.  This is a pause and proceed with awareness light, notice what happens as you continue and if things are settling or not continuing to intensify continue for few repetitions or 1-2 minutes. Afterwards pain persists by up to 3 numbers above your baseline and settles back to baseline within 24-48 hours, and only minimal effect on daily function.  If the after affects are longer or function is more affected make sure the next time you are in amber you modulate to green.  You may need to use some tools from your pain flare toolkit to help things settle.

Green – pain flares during activity 0-4 on 0-10 scale and settles in less than 24 hours with no loss of function.

When you know your baseline work there for a week, with a green traffic light, and if you feel confident to increase this the following week add a small amount more e.g. 5 more minutes duration or a 1-5% increase.  Remember hurt doesn’t equal harm, yet with ongoing pain when the body and nervous system are sensitive we need to calm things down, so working in green is the most helpful place to be.  We need enough challenge for adaption which may mean a little flare up, as the green shows.

Dosage variables you need to consider and can modify:

(Think Goldilocks here!)

• Frequency – how often you exercise each week
• Intensity – exertion level or amount of weight lifting
• Duration – how long each session is
• Type – cardiovascular, strength, flexibility/mobility
• Load – all the things that affect your homeostatic balance (e.g. sleep & stress)

If every day is too much for moderate intensity exercise start with every other day or even twice a week, it doesn’t matter where you start, remember it is more important that you know your baseline and make a start.  You could split the duration into two 15 minute moderate intensity aerobic exercise sessions rather than one 30 minute one to start with.  Make sure you do a mixture of exercise to include cardiovascular, strengthening and flexibility/mobility.

3. What to do if you have a flare up

• If you have a big flare up it can be a result of a combination of factors, rather than just exercise, for example imagine you have slept badly for few days, have more stress at work (increased load on your systems affecting homeostatic balance) and you do your usual level of exercise and experience a big flare-up and instead of being in green on the traffic light system you are in amber tipping into red or maybe you are in the red.  When this happens reflection on all the factors affecting you is important, modulate what you can and seek help when needed.
• What traffic light are you using, make sure you are in the green and re-evaluate your baseline.
• What tools do you have in your toolkit to help (e.g modulate activity, a little more rest between activities, meditation, hot bath).
• If having repeated flare-ups that you are struggling to manage seek help from a physiotherapist.

A few tips for awareness & modulation of mind & body when exercising with persistent pain:

• Notice what you are thinking – do you feel safe or are you worrying about a pain flare? If you don’t feel safe, make some adjustments so you do and then re-evaluate.  If you are worrying about making pain worse it usually does as systems are already on high alert.
• How are you feeling? Do you feel confident and safe or do you feel unsure and anxious?  If it’s the latter what can you do to change it, what do you need to know or feel to feel more confident and safe to exercise?
• Notice what happens to your breathing, are you holding your breath? If so can you soften your breath. Remember your breathing will change with moderate intensity exercise.
• Are you holding more body tension than is needed? Can you modulate it? If not change what you are doing to make it a bit easier & re-evaluate.

Tips for sticking to your exercise routine:

• Know your strongest motivators.  I talk to people about peeling back the layers like removing layers on an onion until you get to the core.

• Exercise with a friend or family member.

• Make sure the exercise you choose is enjoyable and/or meaningful to you.  Have fun, play, and be creative.

• Vary your exercise, maybe every 4-6 weeks, even a small change is helpful.  This is helpful for physical adaption as well as mentally.

• Set aside some time each day, if something else gets in the way that’s ok you can adjust your timetable.   If it is commonly being replaced by other things look at why: maybe you haven’t yet revealed your deepest motivators, maybe you are anxious about causing more pain, maybe you don’t enjoy the exercise you are doing, maybe you are not seeing changes and are wondering if it’s really helpful (you may need to seek help if this is happening or you may be able to explore and make changes yourself).

• Keep a record of what you have done each day you exercise.  Reflect on this at the end of each week and then plan next week’s exercise.

Summary

In summary, understand: what exercise you enjoy and what exercise is meaningful to you, your motivators, where your baseline is and think green traffic light; that there are different variables you can modulate in the dosage.  Remember hurt doesn’t equal harm and change is always possible.  Make regular movement snacks part of your daily routine. Seek help from a physiotherapist if needed.

The post Exercising with Persistent Pain appeared first on Unity Physiotherapy and Wellbeing.

An increase in pain or fatigue that significantly disrupts your daily function and/or sleep for a few days or more is commonly referred to as a flare-up, some people use other terminology, for example a set-back.  Some things commonly go along with this including increased self-criticism, frustration, low mood, and loss of tolerance for some activities.

What is a compassionate flare-up plan:

A flexible plan, developed and implemented through a compassionate lens, of what you can do to self-manage what is happening, to calm things down and build things back up again.  It draws on previous experience of managing your pain and what is helpful for your wellbeing.

Why is compassion important?

Compassion is important in a flare-up plan as often people blame themselves, self-criticism and frustration commonly increase, which in turn turns up the pain volume and has other draw-backs like the impact on your mood.  Having a compassionate focus also encourages kindness, gentleness, courage and strength.  Compassion helps you support yourself and do what’s wise for you at that time, for example, asking for a little more help and support for a few days or weeks (there is both strength & vulnerability in asking for help).  Compassion has also been shown to help in many ways including decreasing self-criticism, rumination and stress, along with improving resilience & overall wellbeing.

Compassion encourages you to step back rather than pushing on regardless or stopping everything (neither of which are recommended) and ask yourself questions like ‘what can I do for myself out of kindness today’ (this is a question I love that I heard on a course with Dr Mary Welford).

‘Our compassionate self brings wisdom that illuminates the available choices & the possibilities flowing alongside them, along with what could be most helpful right now.’

What causes a flare-up?  There are many reasons and commonly it is a combination of things, including:

• Doing too much (this could be the boom-bust cycle if it happens regularly)
• Working to build tolerance and fitness levels up
• Choosing to do an activity outside of tolerance levels (some activities are worth this)
• A virus
• Increased stress
• Decreased sleep

It isn’t always easy to work out what has caused a flare-up, sometimes it helps to explore what had led up to it and other times it isn’t.  If you find you are having repeated flare-ups without any obvious contributors the best thing to do is usually to focus on actioning your compassionate plan.

Why do we need a flare-up plan?  Here are a few reasons:

• It helps you stay in control and feel confident with self-management.
• There are always flare-ups when living with pain and sometimes these are really difficult to deal with and sometimes feels like a million steps backwards have just happened at great speed.  A compassionate flare-up plan helps us remember the things that are helpful, what we can do to manage things, calm things down and build tolerance back up.  It’s not always easy when pain increases to think clearly, having a plan helps us take action away from getting caught up in things like self-criticism, rumination and anxiety.
• If we don’t have a plan we can end up getting stuck n a cycle of doing less and less, as a result we end up maintaining a new lower level as systems adapt to this and we lose fitness and tolerance for the activities we need and want to do.  This also affects confidence for doing daily activities amongst other things.
• Flare-ups can make people withdraw further from others, themselves and the world around them.  Retreat is a natural protection mechanism, this may be a helpful short-term strategy, however it is not helpful when it is repeated regularly in the long-term.  Retreat and disconnection are also things that turn up the pain volume and sensitivity, connection to others and ourselves is an important part of managing pain and overall wellbeing.
• Some things are worth the flare-up, these are the things that matter most to us.  You can make a mindful choice to do an activity, even though pain is likely to increase, because you feel the activity is worth it and knowing you have a compassionate plan to help you over the following days to find some ease can be reassuring.  So, a compassionate flare-up plan can help you take steps forwards towards your values and what matters most to you.

What to put in a compassionate flare-up plan?

This is individual to you and requires some exploration and reflection.  Grab a notebook and make some notes, if you are having a flare-up now use this experience and previous ones as you read to make notes, otherwise remember the last time or times you had a pain or fatigue flare-up that affected your function and sleep for a few days or more.

• Consider what may have contributed to the flare-up, if this is helpful (sometimes it’s not, notice if you get stuck in a look of self-criticism and guilt).  Compassionately acknowledge (a gentle tone, a helpful acknowledgement without criticism) this and what could be done differently next time, if anything.
• What helped you calm things down and build things up before?  What didn’t help before?
• Set yourself some easy short-term goals based on meaningful activities (what’s important to you, what do you most enjoy doing).
• Plan to gradually build things up to rebuild tolerance and fitness.  Align this with your goals and allow yourself flexibility to adjust things if needed along the way.
•  Moving little and often is usually helpful.  Remember to include movement in your plan.
• Prioritise what needs to be done and leave the rest or ask for help (it’s not a weakness to ask for help it’s a strength).  It can be frustrating leaving things, there are strategies that can help you manage this.
• Having flexibility & support from your employer is important, having open and honest discussions with them about what support could be helpful during a flare-up (for example, frequent short breaks) to helps things settle down again.
• Remember to change how you usually pace things for a short-time, you will have lower tolerance as the need for protection has be deemed to have increased (things are on high alert), pacing differently can help calm things down.  It is important to have a flexible plan for building things back up as you will otherwise adapt to the new lower level.
• Don’t stop everything and rest for more than a few hours at a time, it is usually better to do a small amount regularly with short rests.
• Notice self-criticism with self-compassion and unhook from unhelpful thoughts.  One way to do this is to say, for example, ‘I notice that I am thinking the thought that…’  Another is to write a compassionate letter to yourself to acknowledge how things are and that it’s not your fault, it is understandable & part of being human and living with pain.  There was a post on this on Unity Physiotherapy & Wellbeing’s Facebook page in September 2019 as part of Pain Awareness Month.  There is also guidance in The Compassionate Mind Workbook & Compassion Focused Therapy for dummies.  If you are unsure, or struggle with this, please get help from a suitably trained therapist.
• Practice self-compassion.  There is guidance in both books mentioned above, The Compassionate Mind by Professor Paul Gilbert and on Kristien Neffs website https://www.self-compassion.org
• Increase relaxation based activities, for example meditation, gentle stretching or anything you find calming.

• Integrate more things that stimulate the soothing system (this is part of the 3 circles model in compassionate mind training/compassion focused therapy).  I go through this in clinic with people, there is also guidance in the above books and this video by Chris Winson https://m.youtube.com/watch?v=peC-bB4DqXQ&fbclid=IwAR3b10RyukjKxkukeByQB4XQVeo0bMkVfjo1uvwggpamb09iTc0r-vpc07M
• Consider if you need medication in a bad flare-up or can you manage things effectively with other strategies.  If you need medication discuss this with your Doctor, Pharmacist or Non-Medical Prescriber, such as a Physiotherapist who has done additional training, how to optimize this.
• Focus on the present moment and the small steps rather than the set back and where you were.

Need further help?

Ask your physiotherapist or other healthcare provider for help if you are unsure of how to create your flare-up plan.  Creating individual compassionate flare-up plans is something I help people with at Unity Physiotherapy & Wellbeing.

‘A compassionate flare-up plan helps you keep returning to a life full of meaning & purpose with pain in the background’

The post A Compassionate Plan for Persistent Pain Flare-Ups appeared first on Unity Physiotherapy and Wellbeing.

Living well with pain means being able to do the things: that are important to you and that matter most; the things you need to do; and doing the things that look after your health & wellbeing daily (including practices that help change pain, such as nervous system calming activities, with pain in the background.

There are many aspects involved in living well with pain, these need exploring and tailoring to what is most helpful for each individual.  Living well with pain and full resolution of pain (in reality the latter doesn’t happen for many people) takes time, flexible persistence, practice and compassion, to name a few of the important things.

Living well with pain needs an understanding of the changes that happen when pain persists along with an individual toolkit of things that help look after your health & wellbeing.  This blog will look at some of the aspects of living well with pain (whilst it changes in the background), and how we can do what matters most.  All of the aspects covered in this blog are either already blogs and resources on the Unity Physiotherapy & Wellbeing website or they will be in the future.  At the end of this blog you will find a link to a pdf resource document that has a few tips for the different aspects mentioned in this blog, along with a list of resources that are I feel are helpful and use with people in clinic.  This resource list is not exhaustive and there are many more (you can also find a longer list of resources on the Unity Physiotherapy website).

Tina, who lives with pain and runs livingwellpain.net created the helpful 25 elements of living well with pain diagram below (used here with her kind permission), and she has written about 10 of these in a blogs here http://livingwellpain.net/category/25-ways-to-manage-pain, you will find some of these woven into this blog.

Understanding Pain

Ok, this is complex! I am not going to go into the complexities of pain or the neuroscience in this blog, although understanding this and how this relates to you can be helpful.  Many books delve into this in varying levels like Explain Pain & Explain Pain Supercharged (the latter is more technical read) and there are many great articles and blogs too (some are listed at the end of this blog).

Understanding the different aspects of pain can help you understand that pain is a protection mechanism and systems can become overprotective, how different systems adapt when pain persists and that they can adapt again in a helpful way.  Understanding pain includes understanding why, for example, things like hurt doesn’t necessarily equal harm, pain cannot be found on scans (we are much more than a sum of our parts), pain is a protection mechanism and a poor reflection of what is going on in the tissues, movements and activities become associated with pain and are not necessarily causing harm.  It’s helpful for your friends and relatives to also have an evidenced based understanding of pain and how this relates to you.  An evidenced based understanding means having an awareness or a more in-depth understanding of what the research tells us about pain, and knowing what myths exist in society (there are many myths!).

(image edited, Nivens, Shutterstock)

Everything that contributes to us being human can contribute to pain, so that’s a lot of things!  I would be here forever if I listed them all, to give you an idea here are some of the factors that can contribute to pain: biological factors (everything including thoughts are part of our biology), a sensitive nervous system and body (includes the immune system), not feeling safe to move, not trusting your body, beliefs, values, how we interact with the world, attention, opinions of others, previous experiences, myths about pain, expectation, self-criticism, thoughts, feelings and emotions, stress, lack of connection, avoidance, nutrition, overdoing and underdoing things, lack of purpose, feeling no-one understands, and much more.

Pacing

There is no agreed definition or set way to do this.  In my mind pacing is essentially a flexible daily structure of what’s helpful for you.  There are no set rules, no-one paces the same way because no-one walks in the same shoes, even though we create similar footprints.  What we learn from what the evidence tells us can help, as well as from each other’s paths and footsteps.  Learning how to pace and manage pain is a journey of exploration that takes many directions.

When pain persists people commonly either stop doing what matters most to them, lose purpose, or push on through things (boom-bust cycle) which commonly further sensitises things (creates more protection).  I have heard it said for pacing ‘stop before you think you need a rest’, as a general rule this is not needed, although it can be part of a strategy to calm things down when you are having a flare-up or with, such as, neuropathic pain.

Have a compassionate & flexible plan as a guide when things get challenging

Life is always changing there is no constant, things are in a constant state of flux and this includes pain.  Sometimes that flux changes significantly, sleep quality and function are affected, this is often referred to  as a pain set-back or flare-up.  It is important to know what helps when things flare-up, to help calm things back down, and approach things in a flexible and compassionate way.

Be compassionate with yourself, flare-ups are common and not a fault of anyone.   Self-compassion helps in many ways including: quietening self-criticism, modulating feelings like guilt, anger and frustration, and decreasing rumination (all of these turn up the pain volume and can contribute to anxiety).  Self-compassion can also help with pacing and knowing what’s helpful, as well as making wise choices that can help nurture overall health & wellbeing.  It’s important to not stay at the reduced level for too long, as you will accommodate to this; this is one reason a flexible plan, that incorporates building things back up gradually, helps.

Sleep

Getting enough good quality sleep is essential for our health and wellbeing, usually this is around 7-9 hours.  When living with pain, lack of sleep commonly means we notice more pain, are more sensitive to stimuli (eg react to less movement) and more easily feel stressed.  There are a number of things you can do to help give yourself the best opportunity of good sleep.  There are some tips in the resource accompanying this blog.

 Exercise

Exercise is essential for our health and wellbeing and is helpful in living well with pain, yet there are differences in how our nervous systems and bodies react to exercise when we live with pain.  Some people find exercising daunting due to significant increases in pain as a result.  It is important that the exercise you do is something that you enjoy doing and you explore what is the right level to start with.  Exercise is important for many reasons, even if it doesn’t modulate pain (it does for some), it helps you keep strength and tolerance to keep doing what matters.

There are a number of aspects you can modulate with exercise, like frequency, repetitions, speed, and intensity.    This is a link to a blog I wrote on exercising with persistent pain, it gives some more information and general guidance https://www.unityphysio.co.uk/exercising-with-persistent-pain/.  My blog and the following blog (written by physiotherapist Thomas Jesson) provide general guidance and are not intended to replace individual medical advice https://medium.com/@thomas_jesson/exercising-when-it-hurts-a8b70f7b1ebf?_referrer=twitter&fbclid=IwAR3ohbyxL7QSRzfkg1jmtHNRnxJW_ouHYD8Tm_Ql_8_88EtLBNGlPiS2pcQ

Language

What we say to ourselves (our self-talk) matters.  How we talk to ourselves is a habit that we can change.  Part of being human is we are wired to focus on the negative and to compare ourselves with others.  We can train our language and how we relate to ourselves to be more helpful.  Commonly when living with pain self-talk is often self-critical, this is part of our threat system and can contribute to systems staying on high alert which increases pain.  There are some tips about language in the resource associated with this blog and more information and exercises in my pending book. 

Acceptance

Acceptance is important for us all, life is tricky and we all have things to deal with that are challenging.  There is a common misconception that acceptance is passive and that it means giving in or that we are happy to leave something as is, it doesn’t.  It’s important to know that all any of us can do is accept things as they are in the moment, not as they will be tomorrow or next week, it’s an ongoing process not something we only do once!

Acceptance means being able to allow things to be present, with compassion, awareness and understanding, without pushing things away (avoiding), dropping the struggle and living well despite pain being present.   This doesn’t mean pain won’t change, it will, instead it means pain is no longer the focus, and we are not putting life on hold waiting for the next thing that someone says will get rid of it (this commonly increases the pain and affects our mood).  Instead of pain being the driver we can learn to put it in the back seat and let it be there, acceptance is one part of doing this without trying to push it out of the car (this uses so much energy and focus!).  Who knows one day it may move further away and we can move it to sit on the car roof!

It’s important to remember pain can, and does, change even though for many it doesn’t fully go away it can.  Acceptance helps us steer in the direction of what’s meaningful.  Accepting you have persistent pain helps you take pain out of the driving seat, take back control again and steer in the direction of the things that matter to you in life even if pain is in the background.

Meaning, Purpose & Connection

One of the things, ok three things, that are particularly important are meaning, purpose and connection, these are inextricably interlinked.  I have lost count of the number of times that someone has said ‘I feel like I have no purpose.’  This relates to not being connected to oneself and others, not living aligned with what’s most important (this is usually aligned to our values).  By knowing what your values are and setting goals alongside these you can start to reconnect to what’s most meaningful to you.  Our work can be part of our purpose and its helpful if it is, my work is connected to my purpose in life and my values.

When we stop doing what’s meaningful we lack connection to ourselves and others which is important for our wellbeing.  When we do what’s meaningful to us, and when we feel connected to others, helpful neurotransmitters are released (chemical messengers) too that help modulate pain and help us feel happy, content or relaxed.  Connection and compassion are both important for our wellbeing.

There is opportunity within the pain to steer towards what matters, to be guided by your values and let go of some things that don’t serve you and those around you.  A lot of people say to me they are grateful in some ways as they come to see what’s most important, living with pain I can relate to this.

*This blog is intended as general information and guidance and is not intended to be individual medical advice*

Link to tips for aspects discussed in this blog 

Resource alongside living well blog

Resources

Books:

• Explain Pain by David Butler & Lorimer Moseley
• Painful Yarns by Lorimer Moseley
• Pain Heros by Alison Sim
• Understand Pain Live Well Again by Neil Pearson
• The Compassionate Mind Workbook by Chris Irons & Elaine Beaumont
• Compassion focused Therapy for Dummies by Mary Welford
• The Mindful Self-Compassion Workbook by Kristin Neff & Christopher Germer.

Blogs:

• Livingwellpain http://livingwellpain.net
• My Cuppa Jo blogs https://www.mycuppajo.com
• Pain Chats https://painchats.com

Other resources:

• Pain Toolkit https://www.paintoolkit.org

The post Living Well with Pain appeared first on Unity Physiotherapy and Wellbeing.

I am referring to recovery from suffering with pain to living well in this blog as being able to live a values aligned life that’s full of meaning, with pain being in the background.  Let’s get the clouds cleared and say now that pain can and does change, it even fully goes for some people though this is a low percentage of people.

Very little in life is linear, recovery from suffering with pain to living well with pain certainly isn’t linear, it can look pretty messy.  If you tried to draw pain recovery it would most likely look like a child’s scribble.  Just as children learn through scribbling how to draw we can also learn through suffering with pain how to live well again.  There can be small ups and downs, big dips, sometimes steep rises and lots of back and forth moves.  Life in general is messy, it’s often not plain sailing and it can be helpful to recognize the resilience we have built in the tricky waters.  We have things that help as we sail including our crew, a lighthouse, a map of our favourite destinations, a compass, understanding the weather and the current changes, and of course an anchor (or a few different anchors).  Want to know what a compass, lighthouse and a crew have to do with recovery from persistent pain?  Keep reading…

What Has a Crew, a Map, a Compass, an Anchor & a Lighthouse Got to Do With Recovery From Suffering With Pain & Living Well?

All of these things work together, so for example when a rest is helpful if the water is not still enough to rest safely we can drop anchor to add some safety.  An example in life could be when things are busy, we have a lot to do and are feeling stressed, it’s is likely that if we simply sit to rest our minds will carry on and our fight-flight system doesn’t get chance to down regulate.  One thing we can do is sit and focus on our breathing and do a breath practice like soothing rhythm breathing (used in compassionate mind training), or we can practice a meditation or another grounding practice.  Anchoring our mind in our bodies, staying fully connected to the present moment and restoring some balance in the autonomic nervous system are all important and help us live well with pain and can help change it too.

Our crew are important, one really important crew member is our compassionate self, I see the compassionate self as the chief officer.  The chief officer shares compassion with the captain and all the crew and also extends this further afield to passing boats, helping everyone to navigate the tricky water.  We all have a critical voice, it’s part of being human, and when we are suffering with pain this voice commonly gets quite loud.  When we have a flare-up guess what the self-critical voice often gets even louder alongside more threat based feelings & emotions like guilt, frustration, anxiety and shame.  These all ramp up the pain volume, it’s one of the common vicious circles in pain.  Self-compassion has been shown to help decrease self-criticism and modulate threat based feelings & emotions.  Self-compassion is also a more sustainable place to motivate ourselves from than self-criticism, it doesn’t have the drawbacks that self-critical motivation has.  Compassion is also important because it’s been shown to help decrease stress, increase resilience and generally be helpful for our wellbeing.  Gilbert et al (2017) showed that self-compassion and self-reassurance overlap and that self-compassion mediates the link between self-reassurance and wellbeing.

Other crew members could be family and friends, maybe a pain specialist clinician, and things like exercise/movement and sleep.  Sometimes some of the people in our crew need teaching about pain as there are lots of myths and misconceptions around pain.  Everyone having an up to date evidenced based understanding of pain and how this relates to you is important.  Understanding pain could be seen as a crew member too.  All the crew members work together to nurture our health and wellbeing, all are important, some of the most important could be said to be: regular exercise/movement, sleep, good nutrition, connection and compassion.  Here’s a link to the exercise and pain blog I wrote about exercising with persistent pain  https://www.unityphysio.co.uk/exercising-with-persistent-pain/

Apart from nutrition different aspects that nurture our wellbeing (our crew) are all also discussed in detail in my book, Dancing Through Life: A Guide to Living Well.  The PACE’s & SIM’s, the key concepts in my book, could be a useful summary of the crew so I have included the PACE’s & SIM’s summary diagram from the book here.

A little note on exercise, some people prefer to relate to this as movement as they have unhelpful associations with exercise & it’s linked to threat for them (I cover this in my book).  Exercise is important for many reasons including that it helps enable us to do what’s most important (along with other crew members like sleep, nutrition and self-compassion).  Engaging in meaningful activities can in themselves be the exercise/movement, like in my second example in the meaningful activities & flare-up sections below.

The places we like to visit (things that bring things like joy), our compass and lighthouse help us navigate all the different changes in weathers and currents.  The places we like to visit are what’s meaningful to us in life and our compass is our values, our direction of travel (values as a compass metaphor – Hayes et al., 1999).  The lighthouse helps us connect to our purpose, what feels like home and is also meaningful, even when we are feeling lost at sea it glimmers in the distance.  Some people find it tricky to relate to purpose, if that’s you that’s ok, think of it like the deep why’s behind what you do and see if that helps.  Meaningful activities are commonly stopped when people are suffering with pain, reasons include fear of making things worse and/or not feeling able to do things.  The flip side of this is that by stripping life of meaningful activities this in itself turns up the pain volume as does the fact that we lose fitness and tolerance for different activities.  Meaningful activities also release feel good chemicals that nurture our wellbeing and may modulate pain in some instances, so there’s added benefit.

Meaningful Activities and Flare-Ups

Sometimes the word set-back is used instead of flare-ups, sometimes increased pain volume, or other terms, you can use which ever term you most relate to.  Some things when living with pain are worth a flare-up and some just aren’t!  Usually things that are meaningful and connected to our values are worth the pain volume being a little louder and we can plan to focus more on things like rest and relaxation for a few days after.  I usually ask people if the benefits of doing something outweigh the consequences as a way of helping their understanding, and mine, around their meaningful activities and being able to engage in them.  Sometimes the answer is no, this is usually when the value associated with the activity isn’t one of the core ones, or when pain is a strong leader, or flare-up management strategies are lacking.  Sometimes we need to consider specifically how a meaningful activity is done to make it possible too.

As well as having specialised in pain I live well with it too.  Here are two real life examples of meaning and values in action as part of living well with pain.  Recently I went to see my youngest niece on her birthday, within the new covid rules of meeting outside, she had received a trampoline for her birthday.  I noticed I wanted to have a go and I also noticed a memory of the significant pain flare-up from a very brief play on a bouncy castle at her party three years before.  So, there were some contextual similarities (my nieces birthday party, something bouncy (even though a trampoline’s different to a bouncy castle).  I knew that I was ok to do it, that I was safe (hurt doesn’t necessarily equal harm), my body and mind were calm, and so I connected to having fun and choosing to play.  What else helped, I also knew that I could rest and pace things differently over the next few days if it was needed.  What happened?  I didn’t bounce that long and had great fun (ok technically I had another go later!) and as it happened things didn’t flare up either so my systems are either less sensitive than they once were or it was because a trampoline is different to a bouncy castle, I suspect it’s both!  This was meaningful to me as I value time outdoors, play, and time with family.  Would I have been fine with choosing not to have a go?  Yes as two other values were still present and it was a meaningful event, yet I wouldn’t have known if it was possible and I would not have and the joy and energy from bouncing on the trampoline.

Following on from bouncing on the trampoline three days later I went for a walk with my sister, niece & nephew.  The children were on bikes so there was lots of running alongside the bikes!  I hadn’t planned this and noticed a couple of thoughts relating to pain & fatigue, I unhooked from these thoughts and went with it, knowing I could have two days where I could adjust how I paced activities and incorporate more rest if needed.  Ordinarily I would have paced running, however when young children are on bikes this wasn’t an option and I chose not to stay attached to this meaning doing more running than I have tolerance for!  It was great fun & brought much joy.  This again was a very meaningful activity that I made a mindful choice about engaging with.  This isn’t something I do regularly, the exercise I do regularly & other practices helped me to be able to do this.  I wasn’t bothered if things did flare as the activity was absolutely worth it and I knew I could find a way through any flare-up.  I have many more examples from myself and patients where some activities have increased pain volume for a little while and some that haven’t, as this blog is already pretty long let’s go to the summary.

Summary

• What’s on your compass (there’s an example below) – know your core values and how you can live aligned with them
• What does your map of your favourite destinations look like – what activities are most meaningful to you now and why (I will take a guess – they are linked to your core values)
• What’s your lighthouse- what gives you purpose or what is your purpose? What are the deep whys behind what you do?
• What are your anchors (what helps you be present and anchors you in your body, e.g. mindfulness practices, compassion practices, meditation or breath practices)
• What helps when things flare-up – e.g. do you pace things differently or focus on rest and relaxation for a few days, maybe you use your anchors more
• Who are your crew (compassionate self, family & friends, understanding pain, exercise/movement, sleep, nutrition, compassionate self).

References

Gilbert, P,. et al.  (2017).  ‘The development of compassionate engagement and action scales  the self and others.’  Journal of Compassionate Healthcare, vol. 4(1), pp 1-24.

Hayes, S.C., Strosahl, K,D., & Wilson, K.G. (1999).  Acceptance & Commitment Therapy: An Experiential Approach to Behaviour Change.  New York: Guilford Press (to the best of my knowledge this is where the values as a compass metaphor was first used).

Parkinson, A. (2020).  Dancing Through Life: A Guide to Living Well.  UK: KDP (all images except values compass)

Parkinson, A (2021) Values Compass Image.  First used in this blog and associated e-book.

Bibliography

Gilbert, P.  (2009).  The Compassionate Mind.  London: Little Brown Book Group.

The post Meaning, Purpose & Values in Recovery From Suffering With Pain to Living Well appeared first on Unity Physiotherapy and Wellbeing.

These things are common when struggling with pain and can be changed.  We are going to explore the invisibility of pain and the associated disconnection and isolation a little in this blog.

The invisibility of pain is linked to feeling isolated and disconnected from others, disconnected from ourselves (commonly disconnecting from our body and not trusting/loving our body) and our world in general.  Isolation can show up in many ways, for example feeling isolated from work colleagues and not understood/or feeling isolated from friends and family, stopping meaningful activates and disconnecting from the world around us.  Part of changing pain, healing and living well needs compassionate reconnection to ourselves, learning to trust and love our bodies again, along with reaching out and reconnecting with others.

People commonly say to me ‘people think I am ok as I look normal’ or simply ‘I look ok, so people think I am ok.’  Feelings of looking ok and not being understood can be a source of distress and disconnecting from those around us.  Something I often say to people is that you can’t tell by looking at someone how they are feeling, this includes how much pain they are in or even whether they are in pain at all.   Yes, things like, people’s facial expressions, body posture, voice tone and behaviour give us an idea how they are, yet we really don’t know and won’t understand unless we ask them and really listen.   Sometimes I use myself as an example and ask if they think I am in pain, usually the answer from them is no and the actual answer is yes.   A patient once said to me, towards the end of their initial assessment, their goal was to be like me and not show pain (which I sometimes do).  This is not about ignoring or avoiding the pain, we had a brief discussion about the threat system and the body and breath staying calm even in perceived threat to help create a sense of safety and calm systems down.  What we embody is part of our reality and how we are feeling, the way we show up can be part of our threat system or reinforce safety.   I’ve lived with pain a long time, how I show up (what I am embodying) with pain is mainly in a way that represents safety to the nervous system, or at least that’s the aim (it’s not always possible!).  This has helped change pain and has been part of me learning to live well with it.   Doing this does not mean things are plain sailing nor can I always embody what’s helpful and aligned with how intend to show up each day because nothing is possible all of the time.  Also it’s not easy living well with pain and, living with pain or not, our threat systems are constantly being stimulated and like most/all people I have times when I am in too much of my threat system which restricts connection and being able to take helpful values aligned action.

When we ask someone how they are the answer we get will depend on a number of things, including their perceptions of whether they will be fully heard and how they will be judged, what’s expected in society and their culture, their previous experiences of sharing how they are really feeling and how safe they feel in the context.  We need compassion and courage to share our distress and to be able to be fully present and hear what’s being said, to hold that safe space.  Judgement is part of being human and how our brains our wired, judgement can help to keep us safe and it can over protect us too.

One consequence of the distress (and contributor to it) of the invisibility of pain is stopping engaging in what matters most, disconnecting from our values and what’s meaningful.  Many people tell me they have stopped socialising as much or altogether as they don’t feel people understand, they feel that they are being negatively judged as they ‘look ok’ and that they ‘should’ be doing more.  Disconnecting and feeling isolated increases pain and can contribute to further secondary suffering (e.g., anxiety, depression, guilt, isolation, self-criticism).  I sometimes notice thoughts myself around ‘negative’ judgment, for example ‘they won’t understand why….maybe I should…’  These sorts of thoughts are common and part of being human, yet getting hooked in them and their associated feelings is part of the secondary suffering.   Becoming hooked in some of the many threat based thoughts, emotions and feelings that go alongside isolation and disconnection, for example, self-criticism, anxiety, guilt frustration and shame are all part of secondary suffering.  Stopping meaningful activities and disconnecting from others increases the perception of pain and makes pain more of a focus, it takes centre stage and what’s most meaningful (connected to our values) is backstage, this in itself increases the pain volume and the secondary suffering.  People also stop or reduce meaningful activities for other reasons like fear of a flare-up, although this is another discussion it’s looped into the isolation & the invisibility of pain too.

Our human minds are tricky in that they have been wired to protect us, so watching out for things that put our basic needs at risk is a priority that’s happening all the time to a degree and depends on our current context and previous experiences.  This is helpful until the parts of our brain that do this end up on hyper-alert, which means for example a feather blowing in the wind towards us could be perceived as something that could be harmful to us, so more like a rock than a light feather.  This happens for many reasons including when we are struggling with pain and have become isolated and disconnected from ourselves and others, combined with our previous experiences.

Being part of a social group is part of our basic needs, it’s how we have evolved as humans, so it’s no surprise that when our sense of belonging changes our threat system is on hyper-alert watching out for the things that may put us at risk and things that wouldn’t be a risk start to be seen that way, like the feathers blowing in the wind, and we start to disconnect more from those around us.  The irony here is that when our protect system is on hyper-drive our self-critical self, one of the versions of ourselves (we all have multiple selves), commonly shows up here and the threat system is then stimulated even more.  This becomes a vicious cycle until we explore different aspects and learn to stop the cycle.  Belonging is linked to perceptions, expectations and social norms.  My favourite work on belonging is that by Brené Brown, if you haven’t read her work I would recommend having a look.

Pain doesn’t have objectification and so is difficult to express, this along with the many myths about pain that exist in society, perceptions of being negatively judged and a decreased sense of belonging are all part of the invisibility of pain, disconnecting from ourselves and others and feeling isolated.  Lacking objectification makes pain tough to understand and explain to others, yet it is possible with understanding of what helps us to explain pain and by change the myths in society and cultivating a compassionate society.

(picture modified from Sergey Nivens Shutterstock)

Invisibility of pain and isolation can contribute to us blaming our bodies/ourselves, although this is a natural reaction over time it contributes to a lack of trust and commonly not liking or loving our body and what we feel is more pain and we may withdraw further from what matters to us.  It is common for people to have lost trust in their body and/or not like their body and to have disconnected from their body.  When we disconnect from our body in a loving way we only see it through the lenses of pain, shame and criticism which increase the pain volume and the secondary suffering.

We could summarise what happens when we feel isolated and have disconnected from ourselves, others, our world in general by remembering that the threat system is on hyper-drive, the secondary suffering increases, and we stop engaging in what’s most meaningful in life.   Some key points in this are:

• We feel like we don’t belong and feel disconnected from others
• People can be surrounded by others and yet feel alone if they don’t feel people understand or want to understand
• We feel ‘negatively’ judged by others from our perceptions of what they are thinking, or analysis of things that have been said
• We start criticising ourselves more and feel like it’s our fault
• Our threat system is on hyper-drive
• We withdraw from what matters most
• We disconnect from ourselves and connect in a certain way (commonly through self-criticism)
• We disconnect from our bodies and lose trust
• We get hooked in things like self-criticism, guilt, frustration, and anxiety – our threat systems become more dominant.

When we become aware of the actions we are taking, understand the feelings and emotions underneath in a compassionate way we can see the different choice points and take the most helpful action.

What can help?

• Break the stigma and keep talking to others rather than hiding and pushing how we are feeling away.  This takes courage and compassion from those sharing and those listening
• We can keep sharing our stories of living with persistent pain to help those living with and without persistent pain to understand pain.  I share stories in clinic every day, it’s what we all relate to and helps us make sense of things
• Creativity can be used to help explain pain to family, friends and healthcare professionals. It also helps the person living with pain understand things more and often be able to connect some more dots.  Creativity and explaining pain includes metaphors, telling our stories, and drawing/art
• Changing the myths in society about pain – there are many pain specialist clinicians & patient advocates (people who’ve learnt to live well with pain) working to do this
• Reading & sharing evidenced based literature on pain, check out the resources section on the Unity Physiotherapy & Wellbeing website for a list of some resources
• People living with pain can get involved in healthcare conferences, communicating with healthcare professionals on social media, and research, this is already happening
• Self-compassion practices.  These and compassionate mind training (self compassion is part of this) are being used more & more in pain management.  Compassion has been shown to help in many ways including decreasing self-criticism, guilt, shame & stress.  It’s also been shown to increase wellbeing in general and it connects us in a supportive way to ourselves and others
• Being aware of our self-talk and which version of ourselves is showing up (for example our compassionate self or our self-critical self) and changing this to be supportive and nurturing
• Creating a sense of safety within the bodies and around us
• Reconnecting to the body in a way that builds trust and changes how it’s seen (loved again).

There are many more tips, those above are ones I feel, from my own and clinical experience, to be some of the really important ones.  Remember we can’t judge what someone is going through as only they experience it, we can do our best to compassionately understand, walk alongside them and help if that’s what they would like us to do.  We can help to change the invisibility of pain by talking about pain, sharing our stories of lived experiences, reading and sharing evidenced based information, and nurturing compassion.  Compassion helps us turn towards what’s tricky or the distress, to share what feels difficult, to take the action that’s aligned with our values even if there are lots of tricky things that show up (we can overcome the blocks), it helps us stay connected to ourselves and others in a supportive way.  If you’re feeling isolated with pain know many have been there and change is possible by reconnecting to yourself and those around you, please reach out to someone, this could be a friend, colleague, family member, healthcare or other relevant professional.

The post The Invisibility of Pain, Disconnection & Isolation appeared first on Unity Physiotherapy and Wellbeing.