ten principles to beat chronic pain
TRANSCRIPT
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Ten principles to beat chronic pain !
Yvan CampbellKinésiologue
March 22nd 2017
Concordia UniversityMontreal, Qc, Canada
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Stop telling them they should learn to live with their pain. # 10
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• It is false.
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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 :
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There is only one pain that is easy to endure, it is that of the others
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Martine, chronic pain for 3 years
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Chronic pain is complex
# 9
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• So, there is no simple solution, no simple method.
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• Chronic pain is a multifactorial problem
• It requires a biopsychosocial approach
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Use a systematic approach
# 8
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• Build yourself a frame of references based on evidence-based exercise sciences
Scientific literature
Clinical experience
Client/patient preferences
Decision
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• With time and experience : build your own method
• « Learn your stuff », in your field and outside your field (5 % law)
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• 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
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First, relationship
# 7
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• Tell your client that you believe her
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Educate
# 6
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• If your patient wants to beat pain, he must know the enemy
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# 9
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# 9
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There are two kinds of pain
# 5
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• Nociceptive pain• Chronic (persistant) pain
Teach that there are two kinds of pain, and therefore two ways to treat them.
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Nociceptive Pain
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pain
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alarm immobilisation return to movement
Time
Nociceptive Pain
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alarm immobilisation return to mouvement
Time
Chronic pain
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Pain
Increase pain
+ -Decrease pain
Chronic pain
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• 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.
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Concept of neuroplasticity
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Fear avoidance or endurance related responses
# 4
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Daniel, construction worker, back sprain, 3 months after physio/ergo
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Systematic desensitization
• Educate
• Graduated exposure to movement
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Roger, 4 back surgeries, chronic pain for 5 years
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in 15-20 % of the cases, there is no kinesiophobia,
there is endurance – related response
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• 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
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Gerry, 3 amputated fingers, chronic pain for 1.5 years
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• Posterior horn is oversensitized by repetitive nociceptive signals
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douleur
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Concept of central sensitization caused by neuroplasticity
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• Inflexion point of pain intensity• Re-adjusting the relation
between movement and pain intensity
# 3
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• Physical training
# 2
Importance of
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• There is a direct relationship between the relative effort of a given task and pain intensity
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• As your capacities decrease, the relative effort will increase, and consequently pain intensity
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Hope
# 1