"Expain Pain" newsletter, FYI

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"Expain Pain" newsletter, FYI

Postby Lernica » Wed Dec 19, 2012 5:20 pm

This is a recent edition of a newsletter put out by the Australian pain research team headed by Dr. Lorimer Mosley which is responsible for the "Expain Pain" book and related courses on treating chronic pain: https://mail.google.com/mail/u/0/?shva= ... 4417b746e7
Athlete until pain started in 2001. Diagnosed with PN in Nov. 2010. Probable cause: 3 difficult labors, 5 pelvic surgeries for endometriosis, and undiagnosed hip injuries. 60% better after 3 rounds of shockwave therapy in Cornwall, Ontario (Dec - Feb/12). 99% better after bilateral hip scopes for FAI and labral tears (April and July/12). Pelvic pain life coach Lorraine Faendrich helped me overcome the mind/body connection to chronic pain: http://www.radiantlifedesign.com
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Re: "Expain Pain" newsletter, FYI

Postby nyt » Thu Dec 20, 2012 2:14 am

Lernica, the link doesn't work.
2/07 LAVH and TOT 7/07 TOT right side removed 9/07 IL, IH and GN neuropathy 11/07 PN - Dr. Howard
6/08 Obturator neuralgia - Dr. Conway 11/08 Disability, piriformis syndrome - Dr. Howard
4/09 Bilateral obturator decompression surgery, BLL RSD - Dr. Howard
9/10 Removed left side TOT, botox, re-evaluate obturator nerve - Dr. Hibner
2/11 LFCN and saphenous neuralgia - Dr. Dellon 2/11 MRI with Dr. Potter - confirmed entrapment
5/11 Right side TG - Dr. Hibner 2012 Left side TG - Dr. Hibner
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Re: "Expain Pain" newsletter, FYI

Postby Lernica » Thu Dec 20, 2012 2:23 am

Sorry, here's the message that was sent to me. I guess you have to be a subscribed member to open the previous link.


Hi [Lernica]!

I guess we can broadly and boldly say that rehabilitation professions are making some headway with pain states that are broadly categorised as ‘musculoskeletal’ – the backs, the necks, the shoulders and other bits. And recently, since an awareness of the potential of brain changes gave a green light to researchers and some ‘withit’ clinicians, there appears to be some headway into better management for neuropathic pain states such as brachial plexus tears, complex regional pain syndrome and phantom limb pain. But a massive group is still suffering, missing out – and their pains are not yet even on the radar of researchers and clinicians…

Who is missing out?

There are two main groups – those with neurological disease and trauma such as stroke and a group we can broadly identify by anatomy such as pelvic pain. Please spend a moment to review these sorry stats:

Stroke hurts in many ways – experiencing pain that interferes with daily life is one way. Pain in stroke patients is reported as high as 53% and there is an incidence of CRPS in 23% of the stroke population (Cacchio et al 2009). ‘Novel’ pain (ie., excluding those that had pain prior to the stroke) was found in 39% of stroke patients (Kilt et al 2011), suggesting essentially that stroke can cause pain. Remember that nearly 3% of the population will have a stroke.

In spinal cord injury, at least 80% experience chronic pain, many regarded as severe. Parkinsons' disease is particularly painful – prevalence levels are reported as high as 83%, yet only 34% are on any analgesic medication. This pain is worse in females and has no association with age, or disease duration. In multiple sclerosis, pain prevalence is reported as high as 86%. Intensity ratings of 5/10 are common (Khan & Pallant 2007). Alzheimers hurts in 57%, so does Guillaine Barre (up to 89%), HIV/AIDS (up to 90%) and leprosy (50%) though the conventional wisdom is that leprosy should not hurt. See (Boorsook 2012) for a summary.

Researchers and clinicians appear to avoid certain body parts, in particular pelvic pain and also face pain. Pelvic pain in particular is hardly on the research radar. Endometriosis alone costs Australia at least 6 billion dollars per year and figures always hide the human burden. (Bush et al 2011)

What can we learn already?

I heard only last week from a physio colleague in regard to stroke treatment “we don’t worry too much about pain, we have to get them functional”. I guess if you don’t worry too much about it, then you won’t be aware of how much a feature of life it is in these groups.

But ponder – post stroke, Parkinson’s and other neurological injuries and disease once again informs us/forces us to understand how much pain is a brain construction – there is no injury to tissue structure in these problems. And in MS, the level of demyelination does not relate to the amount of pain. It’s sort of the same as in ‘musculoskeletal pain’ where the amount of arthritic change or disc pathology rarely relates to the level of pain. The only good thing is that it should be easier to provide therapeutic neuroscience education and talk about the brain in pain as there is no tissue injury.

And ponder too, how linear thinking hampers rational clinical pain engagement. Most people, including researchers think about the effect of pain on motor function as if it were linear yet the pain construction in the brain is in parallel with the motor construction, ie., the brain bits involved overlap. Pain treatment on the grounds it should help motor outcomes seems obvious. Pain is just forgotten – in MS, those with pain are more likely to be unemployed; in nearly 20% of spinal cord injured patients, pain was the factor limiting return to work, not their neurological disability.

What can we do about it?

In our very own small way, we are planning to do something. We have had our first course in neurological disease and pain last month and introduced therapies such as graded motor imagery and therapeutic neuroscience education for these once untouched neuropathic pains. There are more courses planned in Australia and later for overseas. We are well on the way in planning for pelvic pain courses under neuroimmune refreshed biopsychosocial thinking. And we will fund imagery studies on face pain, pelvic pain and therapeutic neuroscience education for stroke pain, but I think we can all start by listing awareness on groups that are missing out on the very first stage of treatment – "an understanding of why I hurt". Tell us who you think is missing out.

See you in 2013.

And by the way, thank you so much for all your great feedback from the NOI2012 conference. With over 600 turning up it was an affirmation that we are on the right track with our teaching.

November NOI Notes submission winner...
Last month we asked for ‘stories from the shadows’ - a story that makes us reflect the deepest on “what is going on here”. The winner's story of a complex patient state is not able to be published, however, their entry did win them a copy of The Graded Motor Imagery Handbook. Well done Adrian from Warrnambool!

Clinical blog starting 2013
We are working on a new blog with a clinical focus - due to start in January of the new year... watch this space!

Courses to kick start the new year Here is the list of courses scheduled so far for the beginning of 2013. The most exciting thing to announce here is that the Graded Motor Imagery course will, in some instances, be expanded to a two-day course. We found that since the NOI 2012 conference, the release of the GMI Handbook and further focus on research in this area, a one-day course is no longer sufficient. The courses will remain one-day when scheduled in tandem with an Explain Pain course but when stand-alone two days will be required.

18–19 Jan Graded Motor Imagery – Tamperer FI, T. Beames
19–20 Jan Mobilisation of the Nervous System – New Delhi IN, P. Sharoff
19–20 Jan Mobilisation of the Nervous System – *CLOSED COURSE* Chicago IL, USA, R.Johnson
8–9 Feb Explain Pain – Launceston, Tasmania AU, D. Butler
8–10 Feb Mobilisation des Nervensystems – Hamburg DE, I. Wicki
10th Feb 2013 Graded Motor Imagery – Launceston, Tas AU, David Butler
10th Feb Graded Motor Imagery – *CLOSED COURSE*, CA, S. Steinfeld
16–17 Feb Mobilisation of the Nervous System – New Orleans LA, USA, R. Johnson
NEW 2 day GMI 22–23 Feb Graded Motor Imagery – Adelaide, AU, D. Butler
23–24 Feb Explain Pain – *CLOSED COURSE*, USA, R. Johnson
3–5 Mar Mobilisation des Nervensystems – Klagenfurt, AT, G. Bucher-Dollenz
16–17 Mar Mobilisation of the Nervous System – Bournemouth UK, T. Beames

Search for and enquire about NOI courses here



References

Bermejo PE, Oreja-Guevara C, Diez-Tejedor E. Pain in multiple sclerosis: prevalence, mechanisms, types and treatment. Rev Neurol 2010; 50:101-8.
Boorsook, D. (2012). "Neurological diseases and pain." Brain 135: 320-344.
Bush P, Evans S, Vancaille, T. The $6 billion dollar woman and the $600 million dollar girl. The Pelvic pain report. http://www.fpm.anzca.edu.au/Pelvic_Pain_Report_RFS.pdf
Cacchio A, D. B. E., Necozione S, di Orio F, Santilli V. (2009). "Mirror therapy for complex regional pain syndrome type 1 and stroke " N Engl J Med 361: 634-636
Khan F and Pallant J. Chronic pain in multiple sclerosis: prevalence, characteristics and impact on quality of life in an Australian community cohort. Journal of Pain 2007: 8: 614-623.
Kilt H, finnerup NB, Overvad K, Andersen G, Jensen TS. Pain following stroke: a population-based follow up study. PLoS ONE 6(11): e27607.doi:10.1371/journal.pone.0027607
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Cheers and Merry Christmas, from the noisy noisters!

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Athlete until pain started in 2001. Diagnosed with PN in Nov. 2010. Probable cause: 3 difficult labors, 5 pelvic surgeries for endometriosis, and undiagnosed hip injuries. 60% better after 3 rounds of shockwave therapy in Cornwall, Ontario (Dec - Feb/12). 99% better after bilateral hip scopes for FAI and labral tears (April and July/12). Pelvic pain life coach Lorraine Faendrich helped me overcome the mind/body connection to chronic pain: http://www.radiantlifedesign.com
Lernica
 
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Re: "Expain Pain" newsletter, FYI

Postby Violet M » Thu Dec 20, 2012 4:00 am

Lernica I was curious what graded motor imagery is so I went to this website. http://www.gradedmotorimagery.com/
Do you know of anyone who has successfully tried this?

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Re: "Expain Pain" newsletter, FYI

Postby ezer » Thu Dec 20, 2012 6:15 am

From looking at their site, they are treating chronic pain with a set of techniques to overcome pain sensations. It looks very similar to the techniques described by Peter Levine in "Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences" and more recently "Freedom from Pain: Discover Your Body's Power to Overcome Physical Pain". Many mind exercises and visualization techniques have the capability of lowering and controlling the pain perceived by the brain.
2002 PN pain started following a fall on a wet marble floor
2004 Headache in the pelvis clinic. Diagnosed with PNE by Drs. Jerome Weiss, Stephen Mann, and Rodney Anderson
2004-2007 PT, Botox, diagnosed with PNE by Dr. Sheldon Jordan
2010 MRN and 3T MRI showing PNE. Diagnosed with PNE by Dr. Aaron Filler. 2 failed PNE surgeries.
2011-2012 Horrific PN pain.
2013 Experimented with various Mind-body modalities
3/2014 Significantly better
11/2014 Cured. No pain whatsoever since
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Re: "Expain Pain" newsletter, FYI

Postby Lernica » Thu Dec 20, 2012 2:00 pm

Violet, in answer to your question, I don't personally know anyone. But there is a chapter about a man with excruciating phantom limb pain who was treated successfully with mirror therapy in David Doidge's great book, The Brain that Changes Itself, linked here: http://www.normandoidge.com/normandoidge.com/MAIN.html

Also, here is a great Canadian Broadcasting Corporation documentary from 2008 about chronic pain and neuroplasticity. Featured in the documentary is a doctor in California who treats chronic pain patients with mirror therapy: http://www.cbc.ca/documentaries/natureo ... gesitself/. Here is 2010 documentary on the same subject: http://www.cbc.ca/documentaries/natureo ... gyourmind/

Finally, here is a link to Stephanie Prendergast and Liz Rummer's blog where Liz describes how their PT practice is incorporating these principles when treating patients with chronic pelvic pain: http://www.pelvicpainrehab.com/blog/201 ... -approach/

I hope that this approach to chronic pain becomes more mainstream. It's really fascinating.
Athlete until pain started in 2001. Diagnosed with PN in Nov. 2010. Probable cause: 3 difficult labors, 5 pelvic surgeries for endometriosis, and undiagnosed hip injuries. 60% better after 3 rounds of shockwave therapy in Cornwall, Ontario (Dec - Feb/12). 99% better after bilateral hip scopes for FAI and labral tears (April and July/12). Pelvic pain life coach Lorraine Faendrich helped me overcome the mind/body connection to chronic pain: http://www.radiantlifedesign.com
Lernica
 
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Re: "Expain Pain" newsletter, FYI

Postby Violet M » Fri Dec 21, 2012 4:02 am

Very interesting, Lernica. Thanks.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
User avatar
Violet M
 
Posts: 5464
Joined: Mon Sep 06, 2010 6:04 am
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