Richmond M. Stace MCSP MSc (Pain) BSc (Hons)

Specialist Pain Physiotherapist

What is the issue? What is pain? Illustration What can we do?

…one of your patients

A women suffering pain What was the

story? How did she

present? What were the

problems?

Pain causes suffering 2nd arrow

Pain limits our choices At home At work Socially

Pain affects Our thinking Emotions Perceptions Sense of self

Visit doctor more than men

Use more pain relief Suffer more pain

ailments IBS, TMD, fibromyalgia

Report more clinical pain

There are sex differences Biologically

e.g./ hormones Perception of women in pain

Different treatment Time to receive Rx

Much of the research in males This MUST change

Chronic pain & depression => top 2 global health burdens

Figures 100 million Americans 20% of the population 1:5 children

Medical school Healthcare professional training Postgraduate training CPD

Pain huge global health burden

Main reason why people see doctor or healthcare professional

Poor understanding of pain

Outcomes?

Lack of compassion for self Perfectionist Giving to others but not self Minimal or no recharge time Frequent feelings of anxiety & worry Feelings of guilt

Starts with musculoskeletal pain Often a ‘physical’ focus The story emerges:

Aches and pains ~ gradually worsening Various life events Other health problems, e.g./

Sensitive gut Headaches, migraines Pelvic pain, vulvodynia, menstrual pain Fertility issues

Perception of our situation The story we tell ourselves All those annoyances and frustrations Hard on self Nearer the protect line Inflammation Off the agenda

Having children Digesting food

Pain(s) Suffering Loss of sense of self Stress Anxiety Hypermobile

Musculoskeletal pain Sensitive digestive system Pelvic pain, vulvodynia Period pain Dysmenorrhoea TMD Headaches/migraines Hypermobility

Overarching biological changes ~ sensitivity We need to join the dots

Switch to protect mode ~ survive mode More common in women Gradual decrease in activities Increase suffering ~ loss of sense of self

Proposed sex differences Evolved more sensitive systems to protect

Detect threat more easily Empathy ~ more sensitive to children’s pain Temporal summation

Gradual build up; fits chronic pain Change at puberty ~ a time to monitor

? The change that is important Systems detect change and update self model Salient network

More sensitive just before period Low oestrogen

A brief look at a complex social phenomena Society needs women to be healthy Huge economical costs of pain Including substandard treatment More likely to seek help Perceived role

Beliefs about themselves, life, role ~ conflict? Concern for society

Protection from a perceived threat Many body systems No pain centre or signals Is it salient? Is it a threat? Prediction that we need protecting

Predictive coding (processing) Poorly related to injury

Phantom limb pain

Perceptions Emotions Thinking Movement Body sense Outlook

Anything that is a threat to the self Pressure on self ~ worries ~ frustrations

Poor sleep Stress ~ unique perception Anxiety (about….) Environment Prior experience Genetics Context ~ situation

Change is definite ~ which way? Continual updating Circular causality

Pain Without any external stimulus Context Learning Updates = on-going protection

Treat the person Person feels pain, person gets better

Understand pain As a society If people understood pain, suffering would

decrease Deliver the right messages Give patients the knowledge and skills Coach themselves; ‘Pain Coach’

Understanding, resilience, motivation

Right messages about change Desired outcome

Am I heading towards it? Am I distracted?

Programme to follow Day to day, moment to moment Unified experience of perception, action &

thinking

Develop working knowledge Reduce fear, engage with living

Create new healthy habits Normalise body sense and movement

Specific sensorimotor training Refresh & renew Movement through the day Motion is lotion ~ nourishing

Mindful practice Create calm Focus See things for what they are Compassion ~ self & others

Gradual increase in desired activities Gain confidence with good experiences

Pain is a huge societal and global problem

Pain in women in a societal problem This must ne addressed Starting with understanding pain

www.understandpain.com @upandsing

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