Ten principles to beat chronic pain !

Yvan CampbellKinésiologue

March 22nd 2017

Concordia UniversityMontreal, Qc, Canada

Stop telling them they should learn to live with their pain. # 10

• It is false.

Van der Velde and Mierau (2000) : réduction de 31 %Taimela S, et coll (2000): réduction de 50 % Leggett et coll (1999): réduction de 50 % Rainville et coll (1992): réduction de 32 %Edwards, et coll (1992): réduction de 30 % Witting et coll (2001): réduction de 23 %

Science is showing us that we can eradicate chronic pain :

There is only one pain that is easy to endure, it is that of the others

Martine, chronic pain for 3 years

Chronic pain is complex

# 9

• So, there is no simple solution, no simple method.

• Chronic pain is a multifactorial problem

• It requires a biopsychosocial approach

Use a systematic approach

# 8

• Build yourself a frame of references based on evidence-based exercise sciences

Scientific literature

Clinical experience

Client/patient preferences

Decision

• With time and experience : build your own method

• « Learn your stuff », in your field and outside your field (5 % law)

• The knowledge that is going to put you in the top 5 % of your profession is not related to your field, but from other fields

First, relationship

# 7

• Tell your client that you believe her

Educate

# 6

• If your patient wants to beat pain, he must know the enemy

# 9

# 9

There are two kinds of pain

# 5

• Nociceptive pain• Chronic (persistant) pain

Teach that there are two kinds of pain, and therefore two ways to treat them.

Nociceptive Pain

1

2

3

pain

alarm immobilisation return to movement

Time

Nociceptive Pain

alarm immobilisation return to mouvement

Time

Chronic pain

Pain

Increase pain

+ -Decrease pain

Chronic pain

• Chronic pain is caused by a dysfunction related to those two subsystems ;

• Chronic pain is now viewed as a disease of the central nervous system, mediated by neuroplasticity.

Concept of neuroplasticity

Fear avoidance or endurance related responses

# 4

Daniel, construction worker, back sprain, 3 months after physio/ergo

Systematic desensitization

• Educate

• Graduated exposure to movement

Roger, 4 back surgeries, chronic pain for 5 years

in 15-20 % of the cases, there is no kinesiophobia,

there is endurance – related response

• Patient will continue the exercise or the physical task even if the pain increases, until the pain is intolerable

• The no pain no gain approach

Gerry, 3 amputated fingers, chronic pain for 1.5 years

• Posterior horn is oversensitized by repetitive nociceptive signals

1

2

3

douleur

Concept of central sensitization caused by neuroplasticity

• Inflexion point of pain intensity• Re-adjusting the relation

between movement and pain intensity

# 3

• Physical training

# 2

Importance of

• There is a direct relationship between the relative effort of a given task and pain intensity

• As your capacities decrease, the relative effort will increase, and consequently pain intensity

Hope

# 1