Pain Consultation
Pain Treatments
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 multimodal approach. The physical approach is to release tightened myo-fascial tissue with trigger point injections (TPI) with tiny amounts of lidocaine 1% solution for the majority of patients to achieve positive outcomes. In more resistant cases a flushing technique is used to hydrate, irrigate and detoxify the chronic inflammation in the soft tissues to enable a healing response. This HydroTPI technique uses saline 0.9% / lidocaine 1% solution in 5:1 ratio with methylprednisolone 4mg maximum in each treatment. Postural correction with egoscue exercises are encouraged when necessary. Cognitive behavioural therapy (CBT) techniques with expressive writing, changing negative thinking, avoiding pain talk, repeated affirmations, conscious breathing and mindfulness are encouraged. Anti-inflammatory nutrition advice is advised to reset the intestinal microbiome away from an inflammatory state which leads to brain and nervous system chronic inflammation. Graded cold shower exposure and breathing techniques on a daily basis are encouraged as another way to reduce the body’s inflammatory state. Trigger point injections are performed in weekly 10 minutes visits for 4-6 sessions to obtain an initial 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
Trigger point injections are effective by releasing 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, stress, surgery and other factors 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. Advanced treatment techniques are needed for resistant cases, which relates to the more extensive inflammatory state of the tissues affected. That’s why the new HydroTPI technique is used to hydrates, irrigate and detoxify the stuck down fascial layers consistent with chronic inflammation and pain. The tissues are mobilised, blood flow improved, function returns and pain is reduced in the areas treated in most cases over weekly treatments.POSTURE CORRECTION
Good posture is something our bodies desire for optimal health. Just stand upright 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 pointing out, their shoulders curved forward and hands placed in front of their hips as this is programmed in the unconscious state where we feel most comfortable. Poor posture is a postural adaptation to minimise muscular tension which leads to chronic pain. When necessary, I encourage 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
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:
- EXPRESSIVE WRITING
- CHANGE NEGATIVE THINKING
- NO PAIN TALK
- AFFIRMATIONS
- BREATHING CONSCIOUSLY
- MINDFULNESS
Expressive Writing
Expressive writing is a proven scientific method of helping patients in pain. The honest approach of expressing thoughts and emotions on paper exclusively for the purpose of the writer helps shift the mind toward improved health outcomes of reduced pain, anxiety and suffering. I encourage starting with writing negative thoughts about pain and then change the negative words with neutral words. From there writing can be used as a tool or journal with deep dives into your life stories using different pronouns such as he, she rather than I, me or myself by viewing your life from different perspectives. In the end, writing about the good and joyful aspects of life are encouraged.
CHANGE NEGATIVE THINKING
After writing your negative thoughts about pain, you can view them as they are. With this awareness, you can choose to change your thinking. For example, “pain is awful, I want it to go away”, can be changed to “pain is here” or “it is in my back”. Neutral thoughts and statements are a good place to start to change the brain’s wired connections for pain.
NO PAIN TALK!
Talking about pain extensively drains the spirit and connects the brain’s nerve circuits for pain. This is to be avoided. There are many other interesting topics to discuss with friends and loved ones, it’s healthier to focus on these.
AFFIRMATIONS
I love the affirmation 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. He called it Autosuggestion but these days Affirmations is a more known term, 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 20X twice daily in a repetitive daily pattern, the brain literally changes, which in return leads the body towards a healthier state. I believe the more you repeat this statement aloud, the quicker the results as shown by some of my patients and myself. Coué’s conscious mantra is a tonic! “Every day, in every way, I’m getting better and better” “Every day, in every way, I’m getting better and better”
BREATHING CONSCIOUSLY
Conscious breathing is a direct way to reverse the flow of brain activity from the flight-fight-freeze response aka survival response to the relaxation response or calming response which sets up the environment of healing from chronic pain. I encourage my patients to STOP and breathe every hour of the day or if super busy, breathe between activities and BE AWARE of their breathing, through 3 cycles of Inhalation and Exhalation. This is the start of breathing meditation exercises towards reducing pain. Once mastered Abdominal Breathing can be practiced while doing this activity and during pain episodes. My favourite breath meditation exercise is called Binaural Meditation which trains the brain to learn relaxation and further enhance the journey of healing.
MINDFULNESS
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. Mindful 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.
NUTRITIONAL ADVICE
Anti-inflammatory nutrition advice is a core treatment approach to reduce the body’s inflammation associated with chronic pain and chronic disease. Research in the past decade has shown changes in food choices causes a change in the intestinal microbiome’s genetic code to switch off inflammation triggers and allow the body to heal. I encourage a graded approach or 100% swap to a nutritional lifestyle that has shown to reduce gastrointestinal symptoms, increase energy, improve sleep and wellness as well as reducing pain and weight in my patients.
WIM HOF METHOD
In 2020 I introduced the Wim Hof Method as a treatment modality to reduce body inflammation through the combination of graduated cold shower exposure, breathing techniques and commitment to the goal of improving health and pain reduction. This treatment stimulates brown fat tissue, increases core temperature stimulated by cold water exposure and improves oxygen utilisation in the cell. Positive outcomes in my patients include an increased energy, reduced weight, improved sleep, reduced anxiety and pain.
