” These are exciting and challenging times for the manual therapy professions. I believe that the pain science world is handing extremely valuable information to clinicians. We now have a greater understanding of the behaviour of pain states and we are becoming aware of the molecular targets of manual therapy” , David S. Butler
Dear readers, I apologize for not writing a blog last month, but I have been sick with a cold that would not abate. Nonetheless, as usual I have still been pondering about the many issues that plague those of us with this demon that can be so debilitating. I search constantly for strategies that could be effective for pain management and my readings and searches often take me to places I had not been before. But no matter where I research I come back to pain and the brain and evidence/research based strategies. I will never find the cure for my own chronic pain. It is a question of what practices work somewhat and which ones would do more harm. Most importantly how I can avoid flare-ups and not to identify myself as my pain to the point where I don’t move coming from a place of fear.
Repetitive actions, long workouts, strenuous exercise is often harmful, not only to those who have fibromyalgia, but for most of us. I remember meeting my physiotherapist Nick Matheson for the first time and telling him I was aiming to speed walk for one hour a day. (I have made reference to Nick on other blogs). His question to me was”WHY?”. Now, I understand the reasons ‘why not’. It isn’t that walking for an hour cannot be pleasurable if one is so inclined and the weather is agreeable. It can even be relaxing and have direct positive effects on our brain . But to take this on as a long trek and as something that would provide physical benefits, the research has shown that after about 15 minutes repetition ceases to have many (if any) results. Living as I do in a climate that is rainy, damp and foggy, walking outside is not often a positive experience. Walking in a gym for that length of time is less than helpful for strength building and boring! So, I have abandoned both inside and outside walking for more than 15 minutes at a time. Evidence has shown that these short walks once or twice a day are more beneficial than a prolonged walk.
I have been thinking about this blog on and off for weeks now and it is difficult to summarize where it has taken me, in spite of the fact that I know it is directly related to pain control/management. One interesting experience I have had recently involves an elderly couple who have found pain control using a ‘foam roller’. Their stories about this apparatus intrigued me and so of course I had to immediately research the topic. It turns out to be something I had used in yoga classes two decades ago and in fact, own a modified version of it myself. Basically it is a very hard bolster which one rolls on to release soft tissue. One must be very strong to avoid pressing on bones or joints which could be damaged during the process of using it. Foam rollers seem to have been popular two decades ago in Canada among some physiotherapists, influenced by the yoga community and the “core strengthening” craze. In fact, it is a process of self massaging. According to the manufacturers, one must not have chronic pain to use it safely (that is, the pain must be an acute episode), nor any history of cardiac problems, such as taking heart medication, high blood pressure or blood clots and the person must have the strength to avoid coming in contact with joints or bones. Fortunately this couple are very strong physically, do not have a history of any cardiovascular problems, and can avoid damaging themselves using the foam roller. For them it has been highly effective in eliminating pain from their lives. Those of us with fibromyalgia could not safely use it, given our weakened muscles, and so that story ended, along with any other kind of apparatus intended to help with pain management in fibromyalgia. While it is possible for those of us with fibromyalgia to build strength, it takes awhile, particularly if we have had the condition for a long time. Obviously, the younger we are the better chances of developing strength at a faster rate.
I know that all of us have heard of various strategies that could help with pain other than medication and off we go to try a new technique or gadget only to find we have a flare up. I believe it is part of our hope for release from pain that we find a so called expert, or become enthused with the excitement of someone who has had a positive experience with pain control that leads us down a particular path. I think I have tried it all : acupuncture, yoga, Chi Gong, Chinese herbs, homeopathy, chiropractic techniques, massage therapy, naturopathy, reflexology, flower essences, jin shin, tens machines, osteopathy, Feldenkrais, the list is endless and of course expensive. Finally, after many years I have found that the issue of pain control lies within our own brain. It becomes our own responsibility to use the strategies that those neuroscientists and physiotherapists who have done the research and found the most effective ways of managing the pain on a daily basis. Once again, on my band wagon: light exercise that can progress to more moderate, movement, meditation, relaxing techniques, quiet, peaceful hobbies that bring joy and are creative for us are among the strategies for those of us with fibromyalgia. Not easy to incorporate in our daily lives, not frenetic, requires discipline, avoidance of alcohol, caffeine and sugar, keeping stress to a minimum are the ways in which serotonin will be released and pain will be managed if not obliterated. Struggling with pain and taking on the view that it must be conquered cannot do much except exacerbate our anxiety. The idea of being in pain can become hard wired in our brains; we need to believe in our own capacity to change this image of ourselves and work through it. For me it involves working on optimism rather than pessimism; not an easy task!
The issue of pain management is difficult for the lay person. I am challenged to understand the vast amount of research on pain and its relationship to the nervous system. The work undertaken by those in the Noigroup , Soma Simple, adiemus, Diane Jacobs (all found on Face Book) and of those I have previously cited brings us up to date on the neurobiological evidence, but it is nonetheless not easy to comprehend.
I have been muddling through this one by David Butler and the other books suggested to me by Nick and other international physiotherapists, occcpational therapists and neuroscientists for two years now and it has not been an easy task. This month being National Physiotherapy month, Nick was interviewed on TV this a.m. For several years he has been awarded “The Best Physiotherapist in Halifax” by The Coast magazine. I have been most fortunate to have learned so much from him and some of my other colleagues at Dalhousie University with whom I worked closely for many years. These are evidence based,PhDs with their own research programs, many of whom are bringing about change to old ways of thinking. I wish for all of you a physiotherapist who understands and, even more, one who can explain neuroplasticity and pain. If one is stuck in the old physio tradition one cannot proceed further unless time is spent by the therapist explaining in lay terms the ways in which one can train the brain and the strategies to employ so that one does not always rely on professionals. If your physiotherapist/physical therapist does not, or cannot explain neuroplasticity to you, search for one who can. It is the way of the future for those involved with helping people in pain. My own fibromyalgia flare ups have decreased by half during the past two years; for that I am grateful. But of course we are now faced with two dilemmas. First, what if a person cannot afford a therapist? For them I would advise that they either go on line or get the books I have highlighted over the past several years from the library. It is difficult to do reading by oneself, trying to understand the technical language of pain and the brain. PBS, among other TV stations have presented many documentaries on the brain which are very helpful. Face Book information is also available and up to date research is forthcoming on FB from the experts around the world. The second issue to be addressed is how to do strengthening, including aerobic exercise without becoming extremely fatigued. Once again, 15 minutes twice a week can suffice initially, longer only becomes repetitive. Those of us with fibromyalgia are subject to great fatigue, so we must proceed with caution and let our common sense guide us. The high tech gym with the ‘appropriate’ fashionable clothing has been part of the hype of the youth culture. The less we feed into it the more sensible we become. Frenetic activity, wild perspiring, hour long puffing is not the sign of a healthy person, rather one who is pushing to excess. Walking is still the cheapest and best way to begin a regime of getting fit.
So these are my musings of the past few weeks as I struggled with a month long cold. Off to do my daily meditation, then my 15 minute walk; after weeks of raining, the sun is out. 🙂