Ten principles to beat chronic pain !
Yvan CampbellKinésiologue
March 22nd 2017
Concordia UniversityMontreal, Qc, Canada
Stop telling them they should learn to live with their pain. # 10
• It is false.
Van der Velde and Mierau (2000) : réduction de 31 %Taimela S, et coll (2000): réduction de 50 % Leggett et coll (1999): réduction de 50 % Rainville et coll (1992): réduction de 32 %Edwards, et coll (1992): réduction de 30 % Witting et coll (2001): réduction de 23 %
Science is showing us that we can eradicate chronic pain :
There is only one pain that is easy to endure, it is that of the others
Martine, chronic pain for 3 years
Chronic pain is complex
# 9
• So, there is no simple solution, no simple method.
• Chronic pain is a multifactorial problem
• It requires a biopsychosocial approach
Use a systematic approach
# 8
• Build yourself a frame of references based on evidence-based exercise sciences
Scientific literature
Clinical experience
Client/patient preferences
Decision
• With time and experience : build your own method
• « Learn your stuff », in your field and outside your field (5 % law)
• The knowledge that is going to put you in the top 5 % of your profession is not related to your field, but from other fields
First, relationship
# 7
• Tell your client that you believe her
Educate
# 6
• If your patient wants to beat pain, he must know the enemy
# 9
# 9
There are two kinds of pain
# 5
• Nociceptive pain• Chronic (persistant) pain
Teach that there are two kinds of pain, and therefore two ways to treat them.
Nociceptive Pain
1
2
3
pain
alarm immobilisation return to movement
Time
Nociceptive Pain
alarm immobilisation return to mouvement
Time
Chronic pain
Pain
Increase pain
+ -Decrease pain
Chronic pain
• Chronic pain is caused by a dysfunction related to those two subsystems ;
• Chronic pain is now viewed as a disease of the central nervous system, mediated by neuroplasticity.
Concept of neuroplasticity
Fear avoidance or endurance related responses
# 4
Daniel, construction worker, back sprain, 3 months after physio/ergo
Systematic desensitization
• Educate
• Graduated exposure to movement
Roger, 4 back surgeries, chronic pain for 5 years
in 15-20 % of the cases, there is no kinesiophobia,
there is endurance – related response
• Patient will continue the exercise or the physical task even if the pain increases, until the pain is intolerable
• The no pain no gain approach
Gerry, 3 amputated fingers, chronic pain for 1.5 years
• Posterior horn is oversensitized by repetitive nociceptive signals
1
2
3
douleur
Concept of central sensitization caused by neuroplasticity
• Inflexion point of pain intensity• Re-adjusting the relation
between movement and pain intensity
# 3
• Physical training
# 2
Importance of
• There is a direct relationship between the relative effort of a given task and pain intensity
• As your capacities decrease, the relative effort will increase, and consequently pain intensity
Hope
# 1