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Pain Recovery Coaching

With Hedd Piper BSC DC MRCC

'Pain Recovery Coaching' is how I describe a person centred approach to helping you overcome ongoing pain.  It is a way of working alongside a dedicated health care professional, where very aspect of the contact you have with me is focussed on helping you gain control of your body and start making plans to get back to the things in life that mean the most to you.

We can spend time talking about how much your pain bothers you and we can gradually piece together the things you can start doing to change your situation, because I'm optimistic that there's always a way to help you feel more like yourself again.

I am passionate about how the latest evidence informs us how to help those with ongoing pain.  The surprising and exciting truth is that ongoing pain is treatable and the best person to treat it is...you! 

To help you understand a little about this, and to prepare yourself for how I will work with you, the following information should be useful.

Not all pain is the same

Pretty much all adults will experience back pain at some point in their lives.  This usually settles well with taking it easy and getting back to normal activities over time.  This type of normal pain has a few names such as 'mechanical pain' or 'nociceptive pain'.  It is usually associated with inflammation in the area and it is known as the 'common cold of the orthopaedic world' because we all get it, it's not very nice - but it's not serious and given enough time and care it will work its way out.  It's not uncommon at all to have occasional episodes of this same pain, and this is termed 'recurrent' pain. 

 

Statistically, mechanical pain accounts for 90% of back pain.

 

If you feel that this better explains the problem you have and are looking for help with then click here.

Persistent pain is defined as pain which has been with you for longer than 3 months.  We now understand that this means that although it feels very much like you are suffering with ongoing damage, that the pain is now being produced by your nervous system.  This is technically known as 'nociplastic' pain.  It's estimated that of all of us who have an episode of back pain around 20% will go on to develop this type of problem.

It's as though the alarm system of your body, which is designed to warn you of danger, has forgotten to switch itself off once the threat has passed.

This is true of any type of pain, regardless of the original cause.  You may have been told you have a disc bulge or prolapse, or maybe an X-ray shows you have arthritis.  But pain scientists are now discovering that these are things that are found in the majority of adult spines and (again this may be difficult to grasp) do not necessarily explain why there is pain. 

A healthy, calm nervous system is capable of adapting to these changes and doesn't 'notice' that they are there - they have become a normal part of your body. Think of it like this: You probably have some scars on your body that once represented harm and your alarm system responded accordingly.  Once healing has taken place, the alarm deactivates and there is no pain even though the tissue looks a bit different.  This is no different to what happens to the majority of people who have normal changes on the inside.

Why is this important?

Because nociceptive pain and nociplastic pain need very different types of treatment. 

Treating one as the other gives poor results. 

Understanding which one you have, and accepting that we need a different approach is the first step to recovery...

You can be helped

Persistent pain (what used to be called 'chronic pain') is deeply unpleasant and affects pretty much all parts of your life.   I  help people with persistent pain who so often also describe how poorly they sleep, how down they feel about it and how it affects those around them.  

In the past you may have been given unhelpful information about your pain, although it probably came from a well meaning source.  Pessimistic messages such as 'there's nothing you can do about it', 'learn to ignore it', 'you have the back of an 80 year old' and (worst of all) 'it's all in your head' are unfortunately all too common.  

This only reflects the limited understanding we've had about persistent pain in the past and does not mean that you cannot recover.

How?

First of all we need to spend some time playing detective to bring together a few strands that may explain why you've developed a persistent problem.

By filling in an online questionnaire (Care Response) before your appointment I will already have an idea of some of the more obvious ways in which the pain is affecting you.

Your first full consultation will involve lots of talking about the problem, especially the story of what happened the first time you had the pain (in other words - how did nociceptive pain turn nociplastic?).

This is a personal story and involves aspects of your life that you may not think are relevant, but please be assured that when it comes to peristent pain all of the details may be crucial.

We will explore:

  • What was happening in your life at the time of the initial pain?

  • What did you think was going on in your body when you first had pain?

  • Did you see someone about the pain, and what did they tell you was the cause?

  • What do you do to manage the pain?

  • How well do you sleep?

  • How does it affect your mood - and the mood of those around you?

  • What movements, activities or environments are you concerned about?

Following this I will probably ask you to do some basic movements to assess what is going on.  We can then put together an individualised plan for you to work towards your goals.

I will then work as your educator and coach, helping you with:

  • Understanding your pain

  • Relaxing your back and body through gentle mobility and breathing exercises

  • Movement and exercise - gradually building up your confidence to move more

  • Bringing in other team members - we may need to work alongside another health care professional and I can help co-ordinate this.  It's likley that there will come a time when I recommend supervised exercises sessions with our personal trainer, Katja.  I may also suggest sessions of relaxing massage with Lindsay.

  • Identifying unhelpful habits that you may not realise you have

  • Identifying unhelpful beliefs around what you should and shouldn't do with your back

We will also need to look at lifestyle factors which are known to contribute to an over sensitive nervous system:

  • Poor sleep

  • Smoking

  • Diet

  • Stress

How Long does it take to improve?

For complex, long standing problems we need to expect change to be slow - up to 3 or 4 months is typical. 

How much does this cost?

Our first appointment lasts around 60 minutes and is £75.  This will also include me preparing some content that I will email to you so that you can reflect back on the session and check on any exercises we will have practiced.

You will probably need a few sessions.  Everyone responds differently, but guidelines tell us to expect anywhere between 4 and 8 sessions over the three to four month period.  

Follow up assessments last around 30 minutes and are £45.

If multiple visits to the clinic are troublesome for any reason then we have a couple of options for you: 

  1. Consider on-line coaching.

  2. Book a full clinic session with me which consists of the full initial consultation and 4 follow up sessions all rolled into one, three hour long visit.  This appointment costs £250 and must be paid for in advance and needs a 7 day cancellation.

How do I start?

Call us on 01970 611190 to discuss making your initial appointment.