Richmond M. StaceMCSP MSc (Pain) BSc (Hons)

Specialist Pain Physiotherapist

Moving on…… Pain is NOT in the brain Pain is whole person We are more than a brain Emerges in the person

As with any pain…. …it’s the person who is in pain, not the

______ Emerges in a space

Cross hands or feet A space predicted in need of protection Part of a bigger picture; e.g./

Functional pain syndromes Previous persisting pains – ‘vulnerabilities’

To feel pain needs the brain…. ….which is different to central

sensitisation These are not the same Some will have CS Some will not but… If they are in pain, it must involve the

brain

What do we need? Perceived threat

Forms of threat Inflammation Thoughts Expectations

It’s the perception that is key….like stress

The brain’s best guess, a prediction What does all this sensory information

mean? Based on prior experience Pain

Prediction that this sensory information means ‘threat’

Reduce the perceived threat Take action How?

Pain compels action Understand pain Normalise body sense & movement Improve tissue health

Well it’s only gettin’ better, and a change is gonna come my way

The person knows I can get better – what do I tell myself? I am better I feel myself again Pain affects us in so many ways

Thinking Planning Moving Sense of self – who I think I am

The person who understands their pain Working knowledge

The person who perseveres with the training

The person who learns and moves on from the challenges

The person who uses their strengths The person who expects to get better The person gets better, not the tendon How would a tendon know it is better?

Importance of ‘the person as much as the condition’ – Oliver Sacks

Person => brain-body-context More complex than tissue focus…. ….but more opportunity for change in the

desired direction

Person has working knowledge What do I think? What do I do?

Pain = a lived experience Programme = a lived experience At any given moment, make a choice

What to think, what to do The person creates the conditions,

expecting change Learn to become their own coach

The person feels pain Pain emerges in the person in the face of

perceived threat Pain changes because we change Address the person

Body-brain-context

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