Persisting Shoulder Pain talk 7th Feb 2014 Manchester Arm Clinic

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Information about Persisting Shoulder Pain talk 7th Feb 2014 Manchester Arm Clinic
Health & Medicine

Published on February 8, 2014

Author: RichmondStaceMCSPMSc

Source: slideshare.net

Persisting Shoulder Pain Richmond Stace MCSP MSc (Pain) BSc (Hons) Specialist Pain Physiotherapist Saturday, 8 February 14

Where is the pain? • Biomedical - “It’s in the shoulder” • Neuroscience - “It’s in the space deemed in need of protection by the brain”. Saturday, 8 February 14

Phantom limb pain Saturday, 8 February 14

VS Ramachandran Saturday, 8 February 14

Analgesic effect of crossing the arms Saturday, 8 February 14

Pain in space • • Pain allocated a space What is in the space? • • Junk - chemicals Why does it hurt? Space junk Saturday, 8 February 14

Why does it hurt? • • • • • Saturday, 8 February 14 Brain perceives danger Is there really danger? How dangerous? What is the context? Prior experience

Do you need tissues to hurt? • In most cases, initially yes • • Need a sense of body Persisting pain? • Saturday, 8 February 14 pain - tissue disconnect

Pain neurobiology • Pain is a conscious, neuroimmunoendocrinological experience • • Multi-system - homeostatic mechanism? (Craig) Saturday, 8 February 14 Multi-dimensional -- pain & pain relief • • • Physical Emotional Cognitive

Pain as an emotion • How is the patient feeling about their pain? • Emotional brain (Ledoux) • Danger signals flow to the emotional centres • Emotional state affects pain (Tracey) • Any less important than pain with movement? Saturday, 8 February 14

Pain & cognition • The bidirectional body-brain • Thoughts are played out via the body • Body feelings are interpreted • Attentional bias • Stress - anxiety Saturday, 8 February 14

Pain & stress • Shoulder - the emotional joint? • Stress • Perception of a situation • Automatic thoughts • Body responses • Autonomic NS -- on alert Saturday, 8 February 14

Movement and pain • Assumption: painful movement - movement is the problem due to structure • Movement end result of a process • Nothing in isolation • Neuroimmune priming • Prior experience, thoughts, mindset, beliefs, environment, who’s there..... Saturday, 8 February 14

Influences on pain • • • • • What you are doing • How you are feeling Saturday, 8 February 14 What you are thinking Where you are Who you are with What have you done there before • • • • • Past experiences • What others are doing Culture Gender Genetics What your brain thinks you may do (prediction)

A formula • Pain biology + influences (biology) - level of resilience + emotional state = pain • Where can we intervene? Saturday, 8 February 14

Treatment • Multidimensional • Foundation - the basics • Understanding the biology • Understanding the influences • Raise awareness to cultivate change Saturday, 8 February 14

Neuroplasticity Saturday, 8 February 14

Create the conditions for change • Neuroplasticity means we can learn & change • Early messages - “you can’t”, “you won’t” Saturday, 8 February 14

Pain is an output • A protective output • Emerges from the body • End result of a process • Target the processes Saturday, 8 February 14

Training • To re-programme • Thoughts & mindset • Specific sensorimotor training • Central sensitisation - e.g./ planning stages of movement, medication Saturday, 8 February 14

Healthy experiences • Multi-sensory feedback from the painful area • Movement and other input that does not hurt = happy brain • Safe • Knowing that ‘hurt does not equal harm’ Saturday, 8 February 14

Pain & mindset Saturday, 8 February 14

Look for the clues in the narrative Compassionate listening & communication Saturday, 8 February 14

www.specialistpainphysio.com @painphysio t. 07932 689081 Saturday, 8 February 14

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