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Know pain or No Gain
- 1. Museum ofHuman DiseaseDisease Discovery EveningKnow Pain No Gain
- 2. The Faculty ofMedicine and the University of New South Wales recognise the unique position of the Aboriginal and Torres Strait Islander peoples in Australia’s culture and history. That Aboriginal and Torres Strait Islander peoples have inhabited Australia for well over 50,000 years and that their unique cultures and identities are bound up with the land and sea. They acknowledge that the Aboriginal people are the original owners of the lands occupied and used by the Museum of Human Disease.I would like to acknowledge that this training is being held on Aboriginal Land and recognise the strength, resilience and capacity of Aboriginal people in this Land.We are on Facebook.com/MuseumofHumanDisease and twitter @diseasemuseum #MOHD #Diseasediscovery#painnight
- 3. DISEASE DISCOVERY 4Monday20 June 2011Dr John Booth:Know Pain or No GainWelcome to the Museum of Human Disease. Throughout the session and your visit to the Museum we would ask that you adhere to the following: - No food or drink is permitted within Museum Gallery. - Strictly no photography. - Specimens consist of generously donated human tissue. Please view specimens with appropriate respect and dignity. Thank you for your cooperation and we hope you enjoy your visit!We are on Facebook.com/MuseumofHumanDisease and twitter @diseasemuseum #MOHD #DDE4#painnight
- 4. We are onFacebook.com/MuseumofHumanDisease and twitter @diseasemuseum #MOHD #Diseasediscovery#painnight
- 5. Museum ofHuman DiseaseDisease Discovery EveningKnow Pain No Gain
- 6. KNOW PAIN ORNO GAIN!Dr John Booth (PhD) – Exercise PhysiologistSenior Lecturer, School of Medical Sciences, Faculty of Medicine, UNSW
- 7. A Painful Story!Thepurpose of pain
- 8. The nature ofpain
- 9. The problem withpersisting pain
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- 11. The sensationof pain originates in receptors located throughout our body
- 12. Pain isuseful! It motivates us do somethingto reduce tissue damage or potential damage Pain is useless! When it is telling us there is something dreadfully wrong we can do little about Pain system can be readily modulated by other factors
- 13. Sometimes paincan persist well beyond the expected healing time and termed ‘chronic or persisting pain’ Move it or lose it!Do something now!
- 14. DESCARTES, EXPECTATIONS, CULTUREPainoperates like a rigid fixed system and a particular injury generates a set amount of pain Pain is physical and mechanical so fix it!Renaé Descartes 1664
- 15. A Conundrum!Pain canpersist without tissue damage or injury (e.g. chronic back pain)Seemingly painful experiences aren’t painful (Aron Ralston, injured soldiers)Expectation can alleviate pain (placebo) Expectation can increase pain(nocebo pain)
- 16. Pain persists notonly in the absence of tissue damage but in the absence of any tissue (i.e. phantom limb pain)!
- 17. When pain persistsPreviouslynon painful stimulus can become painful
- 18. The central nervoussystem becomes more sensitive “turning up the pain volume”
- 19. The spinal cordand brains network of pain centres increases
- 20. The sympathetic or‘fight or flight’ nervous system kicks in and can drive the pain process
- 21. Pain is elevatedto the forefront of consciousnessAn unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage International Association for the Study of Pain 1975
- 22. With longer termpain, pain is elevated to the forefront of consciousness!
- 23. A Thoughtful Experiment!Whereyour thoughts unwavering?
- 24. Did your thoughtsflow and engage in one different thing after another?
- 25. Did different thoughtscompete for access to your consciousness?About Conscious Awareness
- 26. Conscious AwarenessThe consciousprocess tries to ‘make sense’
- 27. There is competitionfor consciousness awareness, with one perception tending to grab control
- 28. Some thoughts don’tget prioritised and are dealt with at a sub conscious level
- 29. Pain can commandattention even against determined efforts to resist it and attention increases with anxiety
- 30. A primary focusof treatments for chronic pain is to reduce pain information from dominating conscious thoughtTreating Chronic Musculoskeletal Pain Shift the treatment paradigm from doing the ‘Descarte’ (someone or something to fix it!) to improving function and managing and coping better
- 31. Most successful contemporary pain treatments involve a combination of education, knowledge, understanding and movement (in conjunction with appropriate drug therapy when necessary).
- 32. Decrease nociceptive information,anxiety and painful information and sensations from dominating consciousnessDESIRED OUTCOME
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- 34. The body’s responseto pain
- 35. The brain andpain
- 36. The role ofthoughts and emotions
- 37. Changes in painprocessing with longer term pain
- 38. Movement andpain Take Your Pain Medication – Exercise!Pain threshold and tolerance increases after an acute bout of exercise
- 39. Exercise activates theendogenous opioid system producing compounds with chemical structures reminiscent of opiate drugs (e.g. endorphins)
- 40. The endogenous opioids synthesised and released in parts of the brain that modulate pain perception
- 41. Bind to receptorsmaking some neurons that relay pain signals down the spine less excitable
- 42. Levels opioids mightbe higher with aerobic exercise and higher intensity exercise
- 43. Endogenous opioids alsoexplain acupuncture and placebosMovement is Medicine!The muscles, nerves and joints and tissues love movement
- 44. More oxygen tothe brain better mood and sleep and increased endorphins the body’s natural pain killers
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- 47. Increased relaxation andpromotes the ‘rest and digest’ nervous system
- 48. Tissue tolerance increases,pain threshold and pain tolerance increase
- 49. The pain centresin the spinal cord and brain become less sensitive and fire off less readilyPACING UP!Establish a baseline a manageable activity and gradually pace up
- 50. Choose enjoyable activitiesand include aerobic activities
- 51. Avoid doing moreon your good days and less on bad days
- 52. Discomfort with movementand exercise is a “yellow” not “red” light to continue
- 53. Flare ups arecommon, but rarely long lasting, with an increase in activitySummaryPain is complex and becomes more complex as pain persists
- 54. The pain experienceis specific to each individual
- 55. Pain and tissueinjury can be poorly related
- 56. Longer term painresults in significant changes in the body systems, tissues and brain
- 57. Treating chronic painrequires the focus to shift from pain abolition to improving function and managing and coping better
- 58. Exercise and movementare essential components of the treatment paradigm for chronic painSOME GOOD READS!N. Doidge (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. Penguin PublishersF. Toates (2007). Pain. Oxford University Press. D. Butler and GL. Moseley (2003). Explain pain. Noigroup publications.P. Wall (2000). Pain: The science of suffering. Columbia University PressGL. Moseley (2010). Painful yarns. Noigroup publicationsRM. Sapolsky (2009). Why zebras don’t get ulcers 3rd ed. Henry Holt and Publishing CompanyS.Blakeslee & VS. Ramachandran (2005). Phantoms in the brain. Harper Perennial Publishing
- 60. Gough SectionsRelated Specimens507.8specimennumberbay number
- 61. DISEASE DISCOVERY 5Monday18 July 2011Dr Ben Colagiuri:The Placebo effect