How your thoughts and emotions help create an environment conducive to healing in my opinion …..

As physiotherapist I am very interested in helping individuals create an environment conducive to healing and I personally do this in many ways including things that are outside the traditional physiotherapy parameters. However traditional physiotherapy helps individuals do this by assisting mainly the physical body, by ensuring muscle length tension around joints is balanced, strength of muscles is appropriate and that joints have the optimum range of motion. But often we forget that your mind has a lot to do with how quickly you get better and has a significant contribution in creating an environment conducive to healing.

There has been a strong understanding of the mind body connection in many ancient healing modalities but western allopathic medicine also knows this to be true and a double blinded placebo study shows how strong this connection is.

Randomized double blinded placebo control (RDBPC) studies is where individuals are randomly assigned to interventions. One group will be assigned to the ‘control group’ and given a placebo and the other will be given the intervention the group are researching. Placebo is when an individual is given a treatment that appears to look just like the actual treatment, this can be in the form of a pill, injection, liquid or procedure.

1 in 3 people who receive a placebo will have 2 things happen; they either have positive changes in their symptoms i.e they improve without the “real” treatment intervention OR they have a negative change and they get side effects, this effect is called Nocebo.

So what determines which way you will go?……………………………………………………….

YOUR MIND!!

It is your thoughts, feelings, beliefs and a big one …. your EXPECTATIONS which can change your body chemistry and allow a change either for better or worse.

An outrageous example of this is a study that looked at chemotherapy drugs for gastric cancer. Fielding et al., (1983) studied 411 individuals which were grouped into three categories; group A where given a placebo injection of normal saline, group B where given a cocktail of chemotherapy drugs and group C where given another mix of chemotherapy drugs. As you would expect group B and C had the largest group of people to get alopecia (loss of hair) but this isn’t the interesting part! GROUP A who were simply given a saline injection also had individuals who experienced hair loss, in fact 30.8% of them!!!

How?????

It was their BELIEF that chemotherapy drugs cause hair loss that created a physical change in their body chemistry resulting in a tangible physical result!!! It is a perfect example on how your thoughts and emotions can cause a physical change that will either help you heal or get worse!

Researcher and psychotherapist Kelly Turner , Ph.D, researched thousands of cases of spontaneous cancer remission only to find that these cases were not so spontaneous at all and that there were many factors that were contributing to these remissions. One of these factors was that these individuals understood the idea that thoughts and emotions have a direct effect on the body and this effect could be negative and illness producing or positive and health producing.

In her research she found that individuals understood that thoughts such as fear, worry, anxiety, anger, resentment, grief, sadness and depression had a negative impact on their health and healing. While non worry, calmness, relaxation, forgiveness, happiness, joy and love had an overwhelming positive effect on their health and recovery.

The healing journey can be a long road that can at times feel never ending, have you ever asked yourself what are the over riding thoughts and emotions that flow through your mind? What is your level of expectation that you will improve? Do you have faith that a particular outcome will occur?

Even though thoughts and feelings are difficult to change in an instant, it is important to at least acknowledge what your current thoughts and feelings are ……

References

Fielding, J. W. L., Fagg, S. L., Jones, B. G., Ellis, D., Hockey, M. S., Minawa, A., … Wrigley, P. F. M. (1983). An interim report of a prospective, randomized, controlled study of adjuvant chemotherapy in operable gastric cancer: British stomach cancer group. World Journal of Surgery, 7(3), 390–399. doi:10.1007/bf01658089

Turner, K (2014). Radical remission surviving cancer against all odds. NY. HarperCollins Publishing.

The sleep/pain cycle in my opinion ….

I’m sure most of us can vouch for the fact that when we don’t get enough sleep the following day can be a such struggle. You feel like you have stayed up all night partying and now you feel hungover, fuzzy in the head and the to do list barley gets a look at. To add insult to injury if you have pain often your symptoms can feel like they go from manageable to unbearable overnight.

There has been a substantial amount of studies showing correlations between decrease sleep and obesity, type II diabetes, blood pressure, heart disease and depression and now the literature is mounting showing a bidirectional interaction between pain and sleep or lack there of. As many have experienced, pain can interfere with the ability to have a full restful sleep and disrupted sleep can contribute to enhanced pain perception.

Have you ever noticed this within your own life (especially if you experience chronic pain) where your symptoms can feel significantly worse when you haven’t had a good night sleep? In fact sleep complaints are shown in 67-88% of chronic pain disorders¹.

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Across many studies the evidence shows that experimental disturbances of even just 1 night of sleep has the potential to increase clinical pain and that the quality of sleep on a given night was a predictor of pain the following day.

So why is sleep so important?

Sleep maintains homeostasis in our body and optimises function in all of our bodily systems, for example, sleep is involved in healing and repairing your heart and blood vessels.

With regard to pain, studies have shown that a lack of sleep reduces pain inhibition. There have been some possible explanations on how sleep and pain are associated, there seem to be some disruptions to the dopaminergic signalling and opioidergic signalling. That might sound like another language to you but basically disrupted sleep may result in inadequate pain inhibitory processing and therefore you won’t be able to access the amazing natural pharmaceutical cupboard that we house in our very own body!

So the next time you are experiencing a spike in your symptoms perhaps you can ask yourself “how did I sleep last night?” and if you find a correlation with your symptoms and the quality and the amount of sleep you had, you may be able to change your perception with regard to how you are feeling. Your deeper understanding might help you release that perhaps your increase in symptoms doesn’t mean that something more sinister is at play but rather your bodies natural pain inhibition processes isn’t working as well as it should.

References:

  1. Finan, P. H et al. (2013). The Association of Sleep and Pain: An Update and a Path Forward. The Journal of Pain, 14(12), 1539–1552. doi:10.1016/j.jpain.2013.08.007
  2. Edwards, R. R et al. (2009). Sleep continuity and architecture: Associations with pain-inhibitory processes in patients with temporomandibular joint disorder. European Journal of Pain, 13(10), 1043–1047. doi:10.1016/j.ejpain.2008.12.007

How meditation can assist pain management in my opinion …..

I recently saw a meme going around the therapy social networks, that I quickly resonated with, it showed a great reflection of how it can some times feel when discussing pain science and pain education in general. I mean “Sheriff Woody’s” body language says a thousand words!

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Pain is complex, I guess because humans are complex. At the National Pain Summit in 2010 an explanation for pain was described as “An individual human experience that is entirely subjective and that can only be truly appreciated by the individual experiencing pain”.  I think humans are multidimensional beings and to think of pain as simply being a biological process is limiting. Pain is complex because there is a significant amount of social and emotional suffering that comes along with the physical aspects of pain. Often we talk about treating pain within a bio-psychosocial model, that is a model that understands that pain is a dance between the biological factors, psychological factors such as mood, personality, behaviour and social factors such as culture and familial. To simply just treat the symptoms alone, I have found with my experience, keeps you in a positive loop pattern that only leads to more pain.

Professor in neuroscience Lorimer Moseley (late physiotherapist turned neuroscientist) once said “what are the barriers to really deeply adopting the bio-psychosocial model? Often the application results in clinicians suggesting that pain is in the ‘bio’ and suffering and disability is the ‘psychosocial”. It really is a dance, this is where I feel meditation comes in. I think it is a great adjunct to therapy, I mean we really are mind & body and not just the body so why just treat the body?

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The way I see meditation used as a pain mediator; is that it allows us to see our thoughts & feelings in a non-reactive way. Sure it takes practice to get to this point, but so does everything. To be able to feel discomfort and watch your thoughts, decreases the chance of feeding the symptoms and inevitably increasing them. It allows us to practice being non-reactive to every sensation. This might sound wishy washy but luckily there has been more and more evidence to back this up. In 2016 Cherkin Et-al studied mindfulness and chronic back pain in 342 adults and found that mindfulness based stress therapy resulted in greater improvement in chronic low back pain and functional limitations at 26 weeks compared to usual care.

Another factor that is strongly correlated with chronic pain is fear! Fear avoidant patterns of movement can often keep you in a pain loop = You move with fear, these movements are not bio-mechanically efficient. This causes your body to work in unusual ways likely to cause more stiffness and pain. In the study from Schutze Et-al found that low mindfulness predicts pain catastrophizing in a fear avoidance model of chronic pain.

In my experience meditation allows you to see your thoughts and perhaps the patterns that are so repetitive you may have never realised they are there …. in a loop. I find by seeing this you immediately press the pause button on that loop.

Of course I don’t think meditation alone will alleviate all physical symptoms, however as and adjunct to movement, strength and manual therapy you are definitely giving your body an environment conducive to healing from a mind & body perspective.

Ericka has completed a meditation teacher training and is a daily meditator. Ask her how to include this in your therapy. Meditation.

 

References:

  1. Checkin et al. 2016, Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain. March 22/29. doi:10.1001/jama.2016.2323
  2. Schutze et al. 2010, Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. January vol 148, page 120-127. doi.org/10.1016/j.pain.2009.10.030