Pain & Control
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Pain & Pain Control


The Headache

"All pain is real, no matter how much you imagine it" - AJ Leigh 2001
Physiotherapy & Pain SPS Clinics Ltd


  • Physiotherapy is a rehabilitation profession NOT JUST a symptom relieving profession.
  • The most common symptom mentioned by patients is pain.
  • However there may be situations where maximising what a patient can do has to be done without a change in symptoms. Pain itself can be disabling — minimising / preventing disability is a major goal. It is worth noting the intensity of pain is often not a good "benchmark" for how bad the problem is.
  • Def: Disability — being less able; fear of moving due to what movement might do (i.e re-injury) can lead to disability. "... It is the reaction of the individual to the pain that is the most important factor in the development of disability" ... " reducing pain will help people avoid incapacity only if it is translated into as near possible return to their pre-injury / pre-pain activities at the earliest opportunity" - Watson P (2000) Psychosocial predictors of outcome from low back pain. In: Topical Issues in Pain 2. Gifford L (ed). 87. CNS Press, UK.

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There's a lot of it about - Def: SPS Clinics Ltd


pain, unpleasant or hurtful sensation resulting from stimulation of nerve endings. The stimulus is carried by nerve fibres to the spinal cord and then to the brain, where the nerve impulse is interpreted as pain. The excessive stimulation of nerve endings during pain is attributed to tissue damage, and in this sense pain has protective value, serving as a danger signal of disease and often facilitating diagnosis. Unlike other sensory experiences, e.g., response to touch or cold, pain may be modified by sedatives and nonsteroidal anti-inflammatory drug analgesics or, if unusually severe, by opioid narcotics. If sedatives do not suffice and if the cause of the pain cannot be removed or treated, severing a nerve in the pain pathway may bring relief.

Pain is occasionally felt not only at the site of stimulation but in other parts of the body supplied by nerves in the same sensory path; for example, the pain of angina pectoris or coronary thrombosis may extend to the left arm. This phenomenon is known as referred pain. Subjective or hysterical pain originates in the sensory centres of the brain without stimulation of the nerves at the site of the pain.

Progress has been made in the management of chronic pain and in the education of patients and physicians in such techniques as biofeedback, acupuncture, and meditation and the appropriate use of narcotics and other medications. Using advanced medical imaging technology, researchers have now located multiple pain centres in the cerebral cortex of the brain, offering promise of possible improvements in measuring and managing pain.

Roget's Thesaurus: Entry 378 (Physical Pain)

#378. Physical Pain. -- N. pain; suffering, sufferance, suffrance[obs]; bodily pain, physical pain, bodily suffering, physical suffering, body pain; mental suffering &c. 828; dolour, ache; aching &c. v.; smart; shoot, shooting; twinge, twitch, gripe, headache, stomach ache, heartburn, angina, angina pectoris[Lat]; hurt, cut; sore, soreness; discomfort, malaise; cephalalgia[Med], earache, gout, ischiagra[obs], lumbago, neuralgia, odontalgia[obs], otalgia[obs], podagra[obs], rheumatism, sciatica; tic douloureux[Fr], toothache, tormina[obs], torticollis[obs].

spasm, cramp; nightmare, ephialtes[obs]; crick, stitch; thrill, convulsion, throe; throb &c. (agitation) 315; pang; colic; kink.

sharp pain, piercing pain, throbbing pain, shooting pain, sting, gnawing pain, burning pain; excruciating pain.

anguish, agony; torment, torture; rack; cruciation[obs], crucifixion; martyrdom, toad under a harrow, vivisection.

V. feel pain, experience pain, suffer pain, undergo pain &c. n.; suffer, ache, smart, bleed; tingle, shoot; twinge, twitch, lancinate[obs]; writhe, wince, make a wry face; sit on thorns, sit on pins and needles.

give pain, inflict pain; lacerate; pain, hurt, chafe, sting, bite, gnaw, gripe; pinch, tweak; grate, gall, fret, prick, pierce, wring, convulse; torment, torture; rack, agonize; crucify; cruciate[obs], excruciate|; break on the wheel, put to the rack; flog &c. (punish) 972; grate on the ear &c. (harsh sound) 410.

Adj. in pain &c. n., in a state of pain; pained &c. v.; gouty, podagric[obs], torminous[obs].

painful; aching &c. v.; sore, raw.

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Headache SPS Clinics Ltd


Headaches are often caused by disorders of the neck or physical and emotional tension. Physiotherapists can successfully treat most headaches and show you how to prevent the pain recurring.

Is Your Headache Really a Neck Ache?

For many people, feelings of pain and tension start at the top of the neck. As the pain worsens, it may spread to the back of the head, the temples, fore head or behind the eyes. Moving the neck or bending forward for a long time tends to make it worse.

This happens because the nerves in the upper part of your neck are connected to the nerves in your head and face. A disorder of the upper neck joints or muscles can cause referred pain to your head.		 Headache can be caused by a tense posture. You may be hunching your shoulders without realising it.

Any of the following points suggest that your neck may be causing the headache:

  • Headache associated with neck pain. Does the pain radiate from the back to the front of your head?
  • Headache with dizziness or light-headedness.
  • Headache brought on or worsened by neck movement or staying in the same position for a long time.
  • Headache which always feels worse on the same side of your head.
  • Headache eased by pressure to the base of the skull.
  • Headache which persists after your doctor has checked for other causes.
Headache Diagram



Headaches from Other Causes

Emotional tension and anxiety can cause the muscles at the base of the head and jaw to become very tight, irritating the nerves and restricting blood flow. This produces a headache. If migraine, allergic reactions or other causes are suspected, your physiotherapist will recommend that you see a medical practitioner.

Preventing Headaches

Here is some useful advice to help you prevent headaches:

  • Posture
    Think tall: chest lifted, shoulders relaxed, chin tucked in and head level. Your neck should feel strong, straight and relaxed.
  • Work
    Avoid working with your head down for long periods.
    Stretch and change position frequently.
  • Sleeping
    A down pillow or urethane moulded pillow is best for most people. Talk to your physiotherapist.
  • Exercise
    Keep your neck joints and muscles flexible and strong with correct neck exercises. Your physiotherapist can show you how.
  • Relaxation
    Recognise when you are tense. You may be hunching your shoulders or clenching your teeth without realising it.



How Physiotherapists Can Help

Physiotherapists are experts in posture and human movement. They will be able to determine if your neck is causing the headaches. Physiotherapists may use:

  • Mobilisation
  • Manipulation
  • Massage
  • Remedial exercise
  • Postural assessment, correction and advice
  • Relaxation therapy
  • Laser, ultrasound, electrotherapy and heat treatment
Physiotherapists use a range of techniques to treat neck headaches.

Your physiotherapist can also offer you self-help advice on ways to correct the cause of headaches, such as practical tips for work and in the home, adjusting furniture, relaxation and exercise.

Manipulation can be an effective treatment for headache caused by neck problems. In some situations, it may do more harm than good. Your physiotherapist will carefully check your neck before manipulating it to see if other methods, such as mobilisation would be preferable.

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Nerve Root Pain / Radicular Pain SPS Clinics Ltd




Signs & Symptoms

  • Unilateral leg pain more than back pain.
  • Pain generally radiates to foot or toes.
  • Numbness & paraesthesia in the same distribution.
  • Nerve irritation signs (ie. reduced SLR which reproduces leg pain).
  • Motor, sensor or reflex changes limited to one nerve root.
  • Reasonable prognosis 50% recover within 6 weeks
  • Shooting or lancinating in nature *
  • Travels down the leg in a band less than 5cm wide. *
  • True nerve root pain "sciatica" is rare. *

Refs:
Clinical Standards Advisory Group (1994).Back Pain. Report of a CSAG committee on back pain. HMSO. London.
* Bogduk N (1994). Innervation, pain patterns and mechanisms of pain production. In: Twomey L, Taylor J (eds). Clinics in physical therapy. Physical therapy of the spine 2nd edn. Churchill Livingstone, New York 93 - 109
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Home Truth - Healing SPS Clinics Ltd


Healing goes on all the time: sometime due to injury, strain or degeneration. The body is always trying to repair — this is a process; sometimes silently and sometimes noisily — this is pain. It helps, helps to tell you what to do or avoid. It is amazing and takes time.

Healing

"Inflammation is mostly good for you - without it there would be no healing: so ask - is this inflammation I have useful or not?" A. Leigh 2001

Vitamin C and Anti-inflammatories are both made in a factory; only the anti-inflammatories are based on what your own brain makes inside you: so in fact anti-inflam's are supplements"

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TENS - Definition - Q&A's SPS Clinics Ltd




TENS stands for Transcutaneous Electrical Nerve Stimulation

Tens Machines work by placing electrode pads on or near the area of pain. Soothing electronic pulses are transmitted via the pads through the skin and along the nerve fibres. These pulses suppress signals to the brain and encourage the body to produce higher levels of Endorphins and Encephalins, the bodys own natural pain killing chemicals. Also different impulse can serve to block out the pain stimuli from reaching the brain. This is known as "The Pain Gate Theory". The idea is that if you do not feel the pain then you will not react to it by spasms, inflammation or adaptive postures, this then enables clinicians to either get a better clinical diagnosis or to provide more effective treatment regimes.

This method of treatment is highly effective for pain relief. Its recommended worldwide by Doctors, Sports Coaches and Physiotherapy Clinics.

Questions about TENS pain relief:

Q: How does TENS work?
A: Pads are placed on or near the area of pain. Soothing pulses are sent via the pads through the skin and along the nerve fibres. The pulses (controlled by the user at all times) suppress pain signals to the brain. TENS also encourages the body to produce higher levels of its own natural pain killing chemicals called Endorphins and Encephalins.

Q: What is the history of TENS?
A: Stone carvings from the Egyptian Fifth Dynasty in 2500 BC depict an electric fish being used to treat pain. Present day TENS began after the landmark paper by Melzack and Wall 1965, entitled "Pain Mechanism: A New Theory." An enormous amount of scientific research followed, resulting in the therapy used today.

Q: Will TENS work for me?
A: TENS (Transcutaneous Electrical Nerve Stimulation) is a highly effective treatment for pain. It is used worldwide and recommended by sports coaches, physiotherapy departments, pain clinics, doctors and other medical practitioners. A TENS unit will ease pain, and should result in a decrease of drug intake! For many the relief is dramatic.

TENS uses Numerous painful medical conditions can be eased with our products including:-

  • Rheumatoid and Osteo-arthritis
  • Back pain
  • Menstrual Pain
  • Labour Pain
  • Peripheral Nerve Injuries
  • Shingles
  • Headache and Migraine
  • Cancer Pain
  • Trigeminal Neuralgia
  • Phantom Limb Pain
  • Sports Injuries
  • Sciatica
  • Aching Joints
  • Post Operative Pain
  • Muscular Pain
  • Whiplash and Neck Injury and many others.


TENS has been used worldwide in both hospitals and the home. In some cases pain relief will continue (perhaps for several hours) after the unit has been switched off.

For many people, relief is so dramatic that using TENS has changed their lives.

TENS is a treatment well worth trying. It does not always offer a cure but what it does do is relieve pain.

Remember - pain is the body's means of warning that something is amiss. Before using any TENS unit, you should establish the source and cause of your pain.

Contraindications: TENS units must not be used by patients using a demand type pacemaker. Electrode pads should NOT be placed at the front or side of the neck. Units should NOT be used when driving or operating machinery.

Precautions: Pregnant women and patients who have heart disease or epilepsy should seek medical advice before using TENS. NEVER use TENS or any other method of pain relief to mask undiagnosed pain as this could require urgent treatment.

Q: Are TENS units safe to use with other medication?
A: Yes, and you may be able to stop taking pain killing drugs or at least reduce your intake.

Q: Will the treatment hurt?
A: No, the sensation felt is very pleasant and soothing and is totally controlled by you.

Q: Is a TENS machine easy to use?
A: Yes, extremely easy to use. Step by step instructions are provided with every machine. It is however recommended that your physiotherapist helps you with the set up for maximum efficiency.

Q: How long before I feel benefit from my TENS unit?
A: Some people's pain is relieved immediately whilst others need a little longer. You should also take into account that it may take a while to find the best position for the electrodes.

Q: For how long does the pain relief last?
A: Some benefit for days after only a half hour treatment, whilst others need to keep their TENS unit on for longer periods.

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Pain Links SPS Clinics Ltd


  • PainOnline
    http://www.painonline.org/

    "The Pain Beyond Pain"

    Central Pain is the name for a pain syndrome which occurs when injury to the Central Nervous System is insufficient to cause numbness but sufficient to cause central sensitisation of the pain system.

    The web pages listed in this site contain the thoughts and reflections of people who are attempting to cope with Central Pain Syndrome, along with other information that may help victims of Central Pain.  I hope that you may find something here which will help broaden your understanding of the various dimensions of Central Pain.

    It is vitally important for every victim of Central Pain to know that they are not alone, and that there are other people who have some idea what they are going through.

  • Pain.com
    http://www.pain.com/

  • The Pain Relief Centre (Nurofen.com)

  • painSupport
    http://www.painsupport.co.uk/survivalskills/
    Survival Skills - An excellent self help page

    All the essential skills for pain relief are here. These pages are absolutely vital to pain control and reduction.

  • The Physiotherapy Pain Association: http://www.ppaonline.co.uk


    For Chartered Physiotherapists and other practitioners involved in the treatment of patients with acute or chronic pain.

    The Physiotherapy Pain Association (PPA) was formed to bring together and provide information for Physiotherapists with the common interest of managing patients with both acute and long term pain. The PPA was established in 1994 for Chartered Physiotherapists and was recognised as a Clinical Interest Group of the Chartered Society of Physiotherapy (CSP) in 1996.

  • The Oxford Pain Internet Site: http://www.jr2.ox.ac.uk/bandolier/booth/painpag/

    This site is for anyone with a professional or personal interest in pain and analgesia. It is firmly based in the principles of evidence-based medicine and has pulled together systematic reviews with pain as an outcome. The site is free because the BUPA Foundation and Merck Sharp and Dohme provided funds to create it.



Other Useful Sites

  • Healthcare Professional sites

  • Consumer health related sites

    • Boots the Chemist

      A wealth of information from beauty tips to health advice.

    • Health Education Authority

      The HEA is England's leading provider of health promotion.

    • Health & Safety

      Useful information about Health & Safety compliance in the workplace for duty holders, company directors and safety representatives.

    • Department of Health

      Government site with information and news from the Department of Health.

    • Stress

      From Teamwork International, designed to help you recover from the past and to equip you for the future.

    • Consumer Health Information Centre

      Here to help you deal with common ailments such as cold and flu. Guidance from an expert panel on how to avoid ailments and explanations of the symptoms.

    • HELP - Helpful Essential Links to Palliative Care

      This project is part of an extensive programme being undertaken by the Centre for Medical Education, University of Dundee in collaboration the United Kingdom charity, Cancer Relief Macmillan Fund (CRMF).

    • IASP®

      International Association for the Study of Pain®


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