I perform a comprehensive pain assessment for those who want to understand why chronic pain exists despite current treatments and to set up a treatment plan. I consider the biological, mental, emotional and social inter-related factors related to chronic pain. The treatment plan is personalised to each patient which considers the physical approach to release tightened myo-fascial tissue with trigger point injections; postural correction with egoscue exercises; cognitive behavioural therapy (CBT) techniques of mindfulness, meditation, expressive writing and/or autosuggestion; and mind-body awareness to understand why the inter-connectedness of the human being is essential in understanding and alleviating pain. Trigger point injections are performed in weekly 10 minutes visits for 4-6 sessions to obtain an optimal response in most patients. Follow up sessions are available if required. CBT counseling sessions over 20 minutes are available on request. My ideal patient is one with chronic pain for more than 3 months who has failed traditional treatments and requires to understand why chronic pain persists in their life.
Trigger point injections are injections of lidocaine solution into tight tender muscle knots in the body. The muscle tissue is shortened in these areas with tenderness to touch and felt as bands on palpation. The sinew around the muscle and through the muscle, called fascia is the main structural tissue that holds the body together. The fascia tightens and thickens with age, trauma and stress which leads to painful areas with a reduced blood flow to the small nerves which then produce pain on movement or pressure, for example when lying in bed.
The release of fascia and muscle is how you achieve results and reduce and sometimes reverse the symptoms of tightness, pain, weakness, numbness or pins and needles.
It’s simple in trained hands and works for many.
Good posture is something our bodies desire for optimal health. Just stand upright with bending with your hips, shoulders and head forward and feel the tension mounting. As gravity pulls you down, your muscles within the musculoskeletal system pulls you up. Over time poor posture has this effect of fighting against gravity and your muscles have to work overtime to keep you upright and functioning as you go about your day. Simple general exercises for a few minutes per day don’t correct posture because many people sit, stand and walk the whole day in poor postures. Many people stand with their feet are pointing out, their shoulders curved forward and hands placed in front of their hips as this is programed in the unconscious state where we feel most comfortable. Poor posture is a postural adaptation to minimise muscular tension which leads to chronic pain.
I encourage many of my patients to read Pete Egoscue’s book, Pain Free and do the exercises advised. The book outlines the theory behind good posture being a fundamental human characteristic necessary for a healthy body. Specific exercises are illustrated and explained which serve as a guide to start the realignment process of the skeletal system with muscle releases. Improvement in pain is one positive outcome stated by the author from performing his exercises regularly. In chronic pain states associated with posture malalignment, it’s common sense to assume the body wants to return to its natural state of posture alignment.
Cognitive behaviour therapy (CBT) is the cornerstone of pain management these days. Multidisciplinary pain clinics have integrated this approach across the world but timely access can be a challenge.
Simple CBT techniques integrated by patients help reprogram the brain and mind to provide positive health outcomes.
I use the following techniques:
A technique developed by Émile Coué, a French psychologist and pharmacist who around 1910-1926 used this technique to reprogram the subconscious mind of his patients to help them achieve health goals. I use Autosuggestion to change the focus away from pain related thoughts and negativity to goal centred specific thoughts enhanced by visualizations and fueled by positive feeling. When repeated twice daily in a repetitive daily pattern, the brain literally changes, which in return leads the body towards a healthier state. Autosuggestion embodies Coué’s conscious mantra of “Every day, in every way, I’m getting better and better”.
Mindfulness is a state of being where you are aware of your thoughts, emotions and life around you. The core aspects of mindfulness are curiosity, openness to new ideas, acceptance without judgement and love for self and others around you. It all begins with acceptance without judgement. I encourage this process by simply starting to observe one’s thoughts. To replace negative thoughts with neutral ones or positive ones if possible. The journey then begins moving from an unconscious state of being to a conscious one. Scientific research over 3 decades has shown mindfulness reduces pain, suffering, depression, and anxiety with enhancing immunity and wellbeing.
Meditation helps to focus the mind and reduce stress. It’s a holistic technique which has been practised for 1000’s of years and modern science now confirms its proven therapeutic value in the treatment of chronic pain.
Reflection Technique is a daily practice of reflecting on one’s struggles or stresses and allowing them a space in your conscious awareness. The simple act of acknowledging and accepting these current experiences or past experiences as far back as childhood is how you transform them through self-compassion. It’s simple to do and can help heal past internal negative emotions. Most healthy people can practice this technique without negative consequences. Medical supervision is required if you have mental health conditions or if you become disturbed, anxious or depressed by this technique.
Expressive writing is a proven scientific method of helping patients in pain. The honest approach of expressing thoughts and emotions on paper or typing exclusively for the purpose of the writer helps shifts the mind toward improved health outcomes of reduced pain, anxiety and suffering.