Pain Management

If I could make only one recommendation to individuals living with chronic pain, it would be to read the book Explain Pain by David Butler and Lorimer Moseley.

Directed at both clinicians who work with chronic pain patients and patients who live with chronic pain, Explain Pain shows how the discoveries of modern pain science can be put to practical use. Written in understandable language with a touch of lighthearted humor, Butler and Moseley take a complex subject and make it possible for the average person to understand and use. One client remarked that she thought it would be hard to read and was delighted that she did not find it difficult at all. 

One of the things I particularly enjoy about having my own independent practice is that I'm able to take time with my clients. Most of the time I have to stay within the bounds of a schedule or my day would be unmanageable. However, I'm able to control my schedule so that I don't have to feel rushed. If something comes up near the end of a session, I can take a few extra minutes if that seems necessary. 

Not long ago a new client came with a difficult pain problem. She had a complicated history. I wanted to be able to listen to it carefully, to be able to ask pertinent questions, and not be rushed. I had a break after the appointment so I asked the client if she was in a hurry. Even if I had the time, perhaps she didn't. However, she had no appointments to keep and so we were both able to relax and discuss her history in detail. 

During the past couple of years I've learned a lot about how pain works and have become convinced that pain education can make a valuable contribution to managing chronic pain. I thought this particular client might find this information helpful, so we discusses how pain works and how she might make use of that. 

Graded exposure can be a useful technique for persons living with chronic pain. Graded exposure is a method of finding movement that is pain-free and building on that. The idea is to break the brain's association between a particular movement and pain.

Got back pain? Call us!

Low back pain is one of the leading causes of disability in the United States. Everyone knows someone who suffers from back pain and most Americans will suffer from it some time in their life.  In spite of its prevalence, successful treatment of low back pain remains elusive. No one has consistently good statistics in the treatment of low back pain.

What can we offer you?

We cannot promise results. However, we can promise this:

Low back pain is one of the most common and persistent pain problems, affecting millions of people. Besides working hands-on with clients, I try to help them understand how pain works and to find ways they can continue to help themselves at home.

Cory Blickenstaff is a physical therapist in Vancouver, WA. My clients have found his videos on "edgework" and "novel movements" to be helpful and enjoyable.

"Edgework" is finding the point in a movement where it begins to transition from easy and comfortable to slightly guarded or painful. Movements should be done slowly, watching carefully for the first sign of holding the breath, muscular tension, or pain. The movement presented in the video is one possible movement. Other movements can be used as "edgework" using the same approach.

"Novel movements" are movements that are a little different from the way we normally move. As Cory says, they are movements about which the brain has not yet formed an opinion. By practicing novel movements, we can try to find movements that are not painful and break the association between movement and pain.

We massage therapists are taught a lot about muscles. We also study bones, joints, ligaments, tendons, fascia. We learn a little about physiology, about other systems of the body, and some lip service is paid to the role of the nervous system in the relaxation response and to how the brain mediates the changes brought about by massage. But mostly we pay attention to muscles. We talk about which muscles are tight, find “knots” in them, and “release” them by pushing into them and/or stretching them with our hands, fingers, forearms, and elbows.

Recently an older, somewhat frail woman came into my office. She has a serious condition that requires ongoing treatment and the primary condition creates numerous other serious health problems. In spite of this, she maintains a cheerful disposition and endures it all with acceptance.

A dear friend of hers thought that she might like a soothing massage and sent her to me, trusting that my experience and training would allow for both a pleasant and safe experience. The client consulted with her doctor about what would be permissible and what should be avoided and had his consent to have gentle massage.

Besides her complicated and generally frail condition, the client had osteoporosis and had suffered several broken bones as a result. Clearly, this was someone who needed to be handled very gently.

And she had neck pain.

I've been learning a lot about the role of the brain and the central nervous system in our experience of pain. One of the people who studies this and writes about it is Lorimer Moseley, co-author of Explain Pain. His TED Talk explains, in 15 minutes, some important discoveries in pain research.

While low back pain may be one of the most common complaints seen by doctors, neck and upper back/shoulder pain is the most common complaint seen in my office. So many people spend their days sitting in front of a computer, head forward and motionless for hours at a time, it seems inevitable that eventually the neck and upper back are going to begin to  protest. I encourage clients to get up and move as often as possible and especially to move in directions that are different from or opposite to the direction in which they've held themselves for extended periods. The body wants to move and likes variety of movement.

The past year has seen a mental growth spurt for this therapist. After years of feeling isolated as an evidence-based massage therapist, I found an online community of MTs and related professionals with similar interests.