CRPS Bugle | March 2014

bugle-450-pic-rexfeatures-271436732Welcome to the March CRPS Bugle, an update on the latest research into complex regional pain syndrome, also known as reflex sympathetic dystrophy (RSD).

Visit our clinic site here for information about our specialist CRPS Clinics.


J Foot Ankle Surg. 2014 Mar 5. pii: S1067-2516(14)00007-6. doi: 10.1053/j.jfas.2014.01.006.

Incidence of Complex Regional Pain Syndrome after Foot and Ankle Surgery.

Rewhorn MJ1, Leung AH2, Gillespie A3, Moir JS3, Miller R4.

Complex regional pain syndrome (CRPS) is an uncommon complication of orthopedic surgery, and few investigators have considered the incidence in foot and ankle surgery. In the present retrospective cohort study of 390 patients who had undergone elective foot and/or ankle surgery in our department from January to December 2009, the incidence of postoperative CRPS was calculated and explanatory variables were analyzed. A total of 17 patients (4.36%) were identified as meeting the International Association for the Study of Pain criteria for the diagnosis of CRPS. Of the 17 patients with CRPS, the mean age was 47.2 ± 9.7 years, and 14 (82.35%) were female. All the operations were elective, and 9 (52.94%) involved the forefoot, 3 (17.65%) the hindfoot, 3 (17.65%) the ankle, and 2 (11.76%) the midfoot. Twelve patients (70.59%) had new-onset CRPS after a primary procedure, and 5 (29.41%) had developed CRPS after multiple surgeries. Three patients (17.65%) had documented nerve damage intraoperatively and thus developed new-onset CRPS type 2. Blood test results were available for 14 patients (82.35%) at a minimum of 3 months postoperatively, and none had elevated inflammatory markers. Five of the patients (29.41%) were smokers, and 8 (47.06%) had had a pre-existing diagnosis of anxiety and/or depression. From our findings, we recommend that middle-age females and those with a history of anxiety or depression, who will undergo elective foot surgery, should be counseled regarding the risk of developing CRPS during the consent process. We recommend similar studies be undertaken in other orthopedic units, and we currently are collecting data from other orthopedic departments within Scotland


Rehabil Psychol. 2014 Mar 10.

Thought Intrusion Among Adults Living With Complex Regional Pain Syndrome.

Lohnberg JA, Altmaier EM.


Purpose: This study investigated the presence and influence of intrusive thoughts among adults previously diagnosed with complex regional pain syndrome. Method: The present study used an Internet-based survey completed by a sample (N = 326) from two national organizations. Results: After controlling for age, gender, and pain level, intrusive thoughts were significantly related to disability and health-related quality of life. Conclusions/Implications: Intrusive thoughts about the inciting event that caused CRPS uniquely influenced pain and quality of life, suggesting a potential mechanism to target for intervention. Understanding factors that relate to maintenance of CRPS and its resulting disability will help in the development of treatments to improve quality of life.


Brain. 2013 Jul;136(Pt 7):2038-49. doi: 10.1093/brain/awt150. Epub 2013 Jun 13.

Secondary and primary dystonia: pathophysiological differences.

Kojovic M1, Pareés I, Kassavetis P, Palomar FJ, Mir P, Teo JT, Cordivari C, Rothwell JC, Bhatia KP, Edwards MJ.

Primary dystonia is thought to be a disorder of the basal ganglia because the symptoms resemble those of patients who have anatomical lesions in the same regions of the brain (secondary dystonia). However, these two groups of patients respond differently to therapy suggesting differences in pathophysiological mechanisms. Pathophysiological deficits in primary dystonia are well characterized and include reduced inhibition at many levels of the motor system and increased plasticity, while emerging evidence suggests additional cerebellar deficits. We compared electrophysiological features of primary and secondary dystonia, using transcranial magnetic stimulation of motor cortex and eye blink classical conditioning paradigm, to test whether dystonia symptoms share the same underlying mechanism. Eleven patients with hemidystonia caused by basal ganglia or thalamic lesions were tested over both hemispheres, corresponding to affected and non-affected side and compared with 10 patients with primary segmental dystonia with arm involvement and 10 healthy participants of similar age. We measured resting motor threshold, active motor threshold, input/output curve, short interval intracortical inhibition and cortical silent period. Plasticity was probed using an excitatory paired associative stimulation protocol. In secondary dystonia cerebellar-dependent conditioning was measured using delayed eye blink classical conditioning paradigm and results were compared with the data of patients with primary dystonia obtained previously. We found no difference in motor thresholds, input/output curves or cortical silent period between patients with secondary and primary dystonia or healthy controls. In secondary dystonia short interval intracortical inhibition was reduced on the affected side, whereas it was normal on the non-affected side. Patients with secondary dystonia had a normal response to the plasticity protocol on both the affected and non-affected side and normal eye blink classical conditioning that was not different from healthy participants. In contrast, patients with primary dystonia showed increased cortical plasticity and reduced eye blink classical conditioning. Normal motor cortex plasticity in secondary dystonia demonstrates that abnormally enhanced cortical plasticity is not required for clinical expression of dystonia, and normal eye blink conditioning suggests an absence of functional cerebellar involvement in this form of dystonia. Reduced short interval intracortical inhibition on the side of the lesion may result from abnormal basal ganglia output or may be a consequence of maintaining an abnormal dystonic posture. Dystonia appears to be a motor symptom that can reflect different pathophysiological states triggered by a variety of insults.


Int J Rheum Dis. 2014 Feb;17(2):156-8. doi: 10.1111/1756-185X.12140. Epub 2013 Jun 24.

Antioxidant profile in patients with complex regional pain syndrome type I.

Baykal T1, Seferoglu B, Karsan O, Kiziltunc A, Senel K.

Complex regional pain syndrome (CRPS) type I is one of the most important problems with regard to physical medicine and rehabilitation. CRPS may cause not only higher therapeutic costs but also greater work time loss. The mechanism and pathogenesis of CRPS still remains unknown. Some findings indicating oxidative stress have been reported. This study was carried out to determine the role of oxidative stress in patients with CRPS.
Twenty patients (13 women and seven men) with CRPS and 20 age- and sex-matched healthy controls were enrolled in this study. Complex regional pain syndrome was diagnosed according to the modified International Association for the Study of Pain (IASP) criteria. We evaluated demographic, clinical and laboratory characteristics of the patients. Antioxidant enzymatic activities consisting of serum superoxide dismutase (SOD), glutathion peroxidase (GPX) and glutathione S-transferase (GST) activities were measured using appropriate methods and compared with healthy controls.
The mean age of the patients was 39.5 years and the mean duration of symptoms was 5.5 months. Complex regional pain syndrome devoleped after a traumatic event in 90% of patients. In 10% of patients there were no traumatic events. SOD, GPX and GST levels were significantly higher in patients with CRPS than healthy controls (P = 0.012, P = 0.036 and P = 0.016, respectively).
Our findings suggest a possible role of oxidative stress in the pathogenesis of CRPS


J Pain. 2014 Feb 11. pii: S1526-5900(14)00565-3. doi: 10.1016/j.jpain.2014.01.500.

The Outcome of Complex Regional Pain Syndrome Type 1: A Systematic Review

Bean DJ1, Johnson MH2, Kydd RR3.

The purpose of this systematic review was to examine the outcome of complex regional pain syndrome (CRPS) type-1. We searched Medline, Embase and Psychinfo for relevant studies, and included 18 studies, with 3991 participants, in this review. The following data were extracted: study details, measurement tools used, and rates or severity scores for the symptoms/signs of CRPS at baseline and follow-up, or in groups of patients with different disease durations. A quality assessment revealed significant limitations in the literature, with many studies utilising different diagnostic criteria. The 3 prospective studies demonstrated that for many patients, symptoms improve markedly within 6-13 months of onset. The 12 retrospective studies had highly heterogeneous findings, documenting lasting impairments in many patients. The 3 cross-sectional studies showed that rates of pain and sensory symptoms were highest amongst those with the longest duration of CRPS. Additionally, most studies showed that motor symptoms (stiffness and weakness) were the most likely to persist whilst sudomotor and vasomotor symptoms were the most likely to improve. Overall, this suggests that some CRPS patients make a good early recovery whilst others develop lasting pain and disability. As yet little is known about the prognostic factors that might differentiate between these groups.
We found evidence that many CRPS patients recover within 6-13 months, but a significant number experience some lasting symptoms, and some experience chronic pain and disability. The quality of the evidence was poor. Future research should examine the factors associated with recovery and identify those at risk of poor outcomes


Eur J Neurosci. 2014 Feb;39(3):508-19. doi: 10.1111/ejn.12462

The neurobiology of skeletal pain.

Mantyh PW.

Disorders of the skeleton are one of the most common causes of chronic pain and long-term physical disability in the world. Chronic skeletal pain is caused by a remarkably diverse group of conditions including trauma-induced fracture, osteoarthritis, osteoporosis, low back pain, orthopedic procedures, celiac disease, sickle cell disease and bone cancer. While these disorders are diverse, what they share in common is that when chronic skeletal pain occurs in these disorders, there are currently few therapies that can fully control the pain without significant unwanted side effects. In this review we focus on recent advances in our knowledge concerning the unique population of primary afferent sensory nerve fibers that innervate the skeleton, the nociceptive and neuropathic mechanisms that are involved in driving skeletal pain, and the neurochemical and structural changes that can occur in sensory and sympathetic nerve fibers and the CNS in chronic skeletal pain. We also discuss therapies targeting nerve growth factor or sclerostin for treating skeletal pain. These therapies have provided unique insight into the factors that drive skeletal pain and the structural decline that occurs in the aging skeleton. We conclude by discussing how these advances have changed our understanding and potentially the therapeutic options for treating and/or preventing chronic pain in the injured, diseased and aged skeleton



CRPS Bugle 10/10/13 | #CRPS

CRPS BugleWelcome to The CRPS Bugle–a selection of recent papers to peruse:

Clin J Pain. 2013 Nov;29(11):e33-e34.

Favorable Outcome of an Acute Complex Regional Pain Syndrome With Immunoglobulin Infusions.

Medlin F, Zekeridou A, Renaud S, Kuntzer T.



To emphasize that complex regional pain syndrome (CRPS), a disabling disorder with the implication of aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity, might be treated with a high dose of intravenous immunoglobulin infusions (IVIG).


We describe a patient who presented with CRPS in the acute phase of the disease.


The CRPS developed secondary to sciatic compression in a young patient and was treated within 10 days by high-dose IVIG (2 g/kg). It resolved completely within days after infusions.


This observational study emphasizes that high-dose IVIG may be a treatment option in the acute phase of CRPS

RS: Interesting but bear in mind that this is a case study with one patient


Ann Intern Med. 2010 Feb 2;152(3):152-8. doi: 10.7326/0003-4819-152-3-201002020-00006.

Intravenous immunoglobulin treatment of the complex regional pain syndrome: a randomized trial.

Goebel A, Baranowski A, Maurer K, Ghiai A, McCabe C, Ambler G.


University of Liverpool, Clinical Sciences Building, University Hospital Aintree, Liverpool L9 7AL, United Kingdom.



Treatment of long-standing complex regional pain syndrome (CRPS) is empirical and often of limited efficacy. Preliminary data suggest that the immune system is involved in sustaining this condition and that treatment with low-dose intravenous immunoglobulin (IVIG) may substantially reduce pain in some patients.


To evaluate the efficacy of IVIG in patients with longstanding CRPS under randomized, controlled conditions.


A randomized, double-blind, placebo-controlled crossover trial. (National Research Registry number: N0263177713; International Standard Randomised Controlled Trial Number Registry: 63918259)


University College London Hospitals Pain Management Centre.


Persons who had pain intensity greater than 4 on an 11-point (0 to 10) numerical rating scale and had CRPS for 6 to 30 months that was refractory to standard treatment.


IVIG, 0.5 g/kg, and normal saline in separate treatments, divided by a washout period of at least 28 days.


The primary outcome was pain intensity 6 to 19 days after the initial treatment and the crossover treatment.


13 eligible participants were randomly assigned between November 2005 and May 2008; 12 completed the trial. The average pain intensity was 1.55 units lower after IVIG treatment than after saline (95% CI, 1.29 to 1.82; P < 0.001). In 3 patients, pain intensity after IVIG was less than after saline by 50% or more. No serious adverse reactions were reported.


The trial was small, and recruitment bias and chance variation could have influenced results and their interpretation.


IVIG, 0.5 g/kg, can reduce pain in refractory CRPS. Studies are required to determine the best immunoglobulin dose, the duration of effect, and when repeated treatments are needed.

RS: this study from 2010 demonstrated reduced pain but in a small group


Arch Phys Med Rehabil. 2013 Sep 27

Complex regional pain syndrome type I. Incidence and risk factors in patients with fracture of the distal radius.

Jellad A, Salah S, Frih ZB.


University of Monastir Tunisia, Faculty of Medicine, Department of Physical Medicine and Rehabilitation. Electronic address:



To examine the incidence and predictors of complex regional pain syndrome type I (CRPS I) after fracture of the distal radius.


Prospective study SETTING: University hospital PARTICIPANTS: A consecutive sample of patients (N=90) with fracture of the distal radius treated by closed reduction and casting.


Not applicable MAIN OUTCOME MEASURES: Occurrence of CRPS I, pain, wrist and hand range of motion, radiographic measures, Patient-Rated Wrist Evaluation, Hospital Anxiety and Depression scale and The Short Form 36 at baseline and at 1, 3, 6 and 9 months follow-up.


CRPS I occurred in 29 patients (32.2%) with a mean delay of 21.7±23.7 days from cast removal. Univariate analyses found significant differences between patients with CRPS I and patients without CRPS I at baseline for gender (p=0.021), socio economic level (p=0.023), type of trauma (p=0.05), pain at rest and at activity (p=0.006 and p<0.001), wrist dorsiflexion and pronation (p=0.002 and p=0.001), fingers flexion (p=0.047), thumb opposition (p=0.002), function of the hand (p<0.001), and physical quality of life (p=0.013). Logistic regression showed that risk for CRPS I was higher in cases of female gender (OR:5.774;95%CI:1.391 to 23.966), medium and low energy trauma (OR:7.718;95% CI:1.136 to 52.44), physical quality of life of the short form 36 < 40 (OR:4.931;95%CI:1.428 to 17.025) and patient-rated wrist evaluation pain subscale >16 (OR:12.192;95%CI:4.484 to 43.478).


CRPS I occurs frequently during the third and fourth week after cast removal especially in women who report severe pain and impairment of their physical quality of life. Additional prospective studies are required to verify these findings in comminuted and operated fractures of the distal radius


J Pain. 2013 Sep 21. pii: S1526-5900(13)01130-9. 

Motor Dysfunction of Complex Regional Pain Syndrome Is Related to Impaired Central Processing of Proprioceptive Information.

Bank PJ, Peper CL, Marinus J, Beek PJ, van Hilten JJ.


Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands; Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands. Electronic address:


Our understanding of proprioceptive deficits in complex regional pain syndrome (CRPS) and its potential contribution to impaired motor function is still limited. To gain more insight into these issues, we evaluated accuracy and precision of joint position sense over a range of flexion-extension angles of the wrist of the affected and unaffected sides in 25 chronic CRPS patients and in 50 healthy controls. The results revealed proprioceptive impairment at both the patients’ affected and unaffected sides, characterized predominantly by overestimation of wrist extension angles. Precision of the position estimates was more prominently reduced at the affected side. Importantly, group differences in proprioceptive performance were observed not only for tests at identical percentages of each individual’s range of wrist motion but also when controls were tested at wrist angles that corresponded to those of the patient’s affected side. More severe motor impairment of the affected side was associated with poorer proprioceptive performance. Based on additional sensory tests, variations in proprioceptive performance over the range of wrist angles, and comparisons between active and passive displacements, the disturbances of proprioceptive performance most likely resulted from altered processing of afferent (and not efferent) information and its subsequent interpretation in the context of a distorted “body schema.”


The present results point at a significant role for impaired central processing of proprioceptive information in the motor dysfunction of CRPS and suggest that therapeutic strategies aimed at identification of proprioceptive impairments and their restoration may promote the recovery of motor function in CRPS patients.

RS: we know that in many persisting pain cases, especially those with a neuropathic pain mechanism, there is an altered body schema. This must be targeted within the treatment and training programme.

Visit our main clinic page here: Specialist Pain Physio Clinics for persisting pain and injury


Pain metaphors (1)

Story telling | Narrative | MetaphorsA recent comment that I thought summed up several dimensions of the pain experience: ‘my life is contracted’.

Does anyone relate to this?

There can be a physical sense to ‘contraction’ whereby limited movement causes stiffness alongside the tension and guarding that limit mobility and reduce tolerance for activities. Pertinent is the fact that often these activities are the normal day to day pass-times and tasks that one can take for granted, until they become difficult or deemed impossible.

One’s thinking and sensory experience of the World can be ‘contracted’ as the pain becomes all consuming, occupying thoughts and movements to the point that there is little else.

Metaphors that spill from the individual’s thinking and experiences are such valuable insight. Expression of narrative and metaphor should be encouraged and then crafted into different language underpinned by a reconceptualised perspective as the mechanisms of pain and the influences upon pain are discovered and understood.

If you are so inclined, share your thoughts.

RS – Specialist Pain Physio Clinics, London

Posture | Just keep moving the best you can #posture #pain

Posture and ergonomics are both well documented and frequently discussed whne it comes to back and neck pain: “It’s my posture, I know it’s bad”, “I’m always being told to sit up straight” etc. On searching for images you will find the classic picture of someone sitting at a desk with a small arch in their low back, the knees below the hips and feet perhaps on a small stool. The question is, does this work? My answer is: if you sit like that for long periods, do you think this is a good idea? (Sorry, it’s more of a question).

As far as I am concerned, the best posture is one that you often change. It’s alright to sit slumped, feet up on the table, upright, leaning to one side etc etc, as long as you alter this position frequently and punctuate prolonged periods of sitting with movement out of the chair and around the room—at least every 90 minutes.

To do this you need to create a habit. Much of what we do and how we do it is automatic. That is fine as we cannot be aware of everything going on, however some habits are not directing us towards health and need to be changed. To do this we must create awareness and then change the routine. Easier said than done! But it is possible.

I use the phrase ‘MOTION IS LOTION’ amongst others to remind people to move and hence nourish their body and also the representation of their body that exists in the brain.

If you are suffering with persisting pain or acute pain, it maybe that you need to adjust these parameters. You can take the advice of your caregiver. If you have neither, and lucky you, then starting this habit is a good idea anyway. There are a range of work-related strategies that I use with patients and with those seeking to improve their performance at work. Reducing the distraction of pain and discomfort is one of those, hence being able to concentrate on the task in hand.

For more details about our healthy work programmes, contact us on 07932 689081 or visit our clinic website at Specialist Pain Physio Clinics, London

Pain is a construct | #pain #neuroscience

Pain is a construct that is unique to our own brain hence the individual nature of the experience. By definition, according to the International Association for the Study of Pain (IASP), pain is a sensory and emotional experience. Both sensations and emotions are also brain constructs, in other words our brains create the experience to be played out via the body. In essence this is why pain is so influenced by our mental state and attentional processes: most patients I talk to will describe an increase in pain at times of stress (stress can also reduce pain; stress induced analgesia–this being the case when something else is more salient at the time) and when they are unable to distract themselves.

Our language, pain descriptions, our inner voice are all brain constructs that emerge as are the movements we make–more on this soon

Pain emerges from the body tissues, or in the case of phantom limb pain (PLP) in the space that was once occupied. A great deal has been learned from PLP (see video below with VS Ramachandran talking about ‘The Tell-Tale Brain’) including the fact that pain cannot be created by the tissues as they are clearly not in existence, however the cortical representation (the somatosensory maps, motor maps etc) remain in the brain, igniting under certain circumstances to construct a pain experience via the salient network. The salient network exists to detect differences in physiological activity and respond accordingly, perhaps with protection in mind that would include pain in the area of the body deemed under threat. For pain is about ‘threat’. When the brain receives contextual information suggestive of threat, it must scrutinise this data and compare to what it knows before responding. On there being a perception of threat, regardless of the reality (eg/ light brushing, a simple movement, watching someone else move, thinking about movement–some readers will know only too well how the latter cues can trigger pain), the brain will protect, drive attention and motivate action via the experience of pain in the body.

Our individual belief system, our resilience at the time, our mood at the time and the context will all impact upon the pain perception and what happens next. The construct of pain, the common denominator being that it hurts in the body, is varied in its volume, location and pattern in many cases when the sensitivity has persisted for some time. In other cases, the pain can have a mechanical pattern (not implying that a structure is out of place and can be put back by manual therapy) meaning that certain movements or touch can hurt and be more predictable. However, the bottom line remains that the brain must perceive a threat.

On the positive side, although complex and modulated at many levels, pain is changeable. There are many access routes into changing the experience and a person’s belief that they can gain increasing control over their pain to be able to reduce the feeling and train to decrease sensitivity. The newer brain focused therapies all aim to do this by targeting changes and adaptations in the central nervous system, although I would argue that we are seeking to change the processing of the danger signals with any of the techniques used in the clinic. Light manual techniques that result in pain relief do not ‘put discs back’ but they can alter the threat value and hence change guarding, reflexive protection and the perception of touch leading to relief and ease of movement. We just have to think carefully about which techniques and strategies are most appropriate at the time, how we set the environment and context so that the brain is acceptant of the treatment and responds by reducing activity in the pain matrix or representation.

Undoubtedly treating chronic pain is complex but if we think about the pain mechanisms and the influences upon pain (stress, anxiety, mood, exercise, movement, sleep etc), we can build a comprehensive programme to address the different dimensions: physical, cognitive and emotional. Let us treat the tissues with care to nourish and promote healthy movement, but to do this effectively we have to think about the brain and how it is constructing the reality of the patient and get it onside.

Specialist Pain Physio Clinics, London

Painstaking research – tackling chronic pain

From the Wellcome Trust, here’s an interesting blog looking at some of the research for chronic pain by Mun-Keat Looi.

‘Pain is an important warning system in our bodies, but what if it never stops? It is estimated that one in five Europeans suffer from chronic pain, yet there are few effective treatments that offer adequate relief. Mun-Keat Looi talks to researchers from the London Pain Consortium, whose discoveries are prompting a surge in promising drug targets.’

Painstaking research – tackling chronic pain.

Can Diet Fight Chronic Pain? | Guest blog by Kaitlin Colucci, Student Dietitian @kaitlincolucci


Thanks to Kaitlin for writing this guest blog on diet. @kaitlincolucci

As a current student at the University of Nottingham studying a Masters in Nutrition and Dietetics, I have an interest in all fields of work to do with nutrition and diet. I aim to lead a healthy lifestyle and promote fitness and nutrition in all forms. I want to be able to inform the public and make them more aware of how diet is tied into every aspect of life. My blog aims to get people to think about how diet can influence men and women in new ways, and in ways that they would have never thought of before.

The internet and popular health magazines nowadays are littered with all sorts of nutritional advice on how some foods or supplements can help with chronic pain – arthritis, headaches, osteoporosis to name a few.

There are many foods that have anti-inflammatory properties, of which many are scientifically proven. Plans like the Mediterranean diet are built on the principles of the anti-inflammatory theory. When you talk about a diet that emphasises foods that are said to have an anti-inflammatory effect, the diets are going to look very similar. Each diet emphasises slightly different things but there is a main focus on antioxidant-rich fruits and vegetables, whole grains, little to no processed or refined foods, and an emphasis on omega-3 fatty acids like those found in fish oils.

red-grapesFor example, red grapes contain a powerful compound, Resveratrol, which blocks the enzymes that contribute to tissue degeneration. There is evidence that resveratrol is particularly useful in the prevention of osteoporosis, especially in women who do not benefit from hormone replacement therapy. The compound of resveratrol also found in red wine, which is popular in the Mediterranean, is more easily absorbed due to the form it is in.

Olive oil is another popular food used in the Mediterranean diet that due to its high content of mono-unsaturated fatty acids (the good fats) has favourable properties of antioxidant and anti-inflammatory effects. This is due to the compound known as olive oil phenols that have been shown to reduce the rate of cell death.Olive oil

One thing we must be aware of is that the majority of studies linking diet to disease are either too small or not reliable in the information they are receiving from the participants, such as an inaccurate recall of the foods they consumed. But this doesn’t mean anti-inflammatory diets are all bad. However, patients shouldn’t expect a miracle cure.

When it comes to pain caused by arthritis, which much of the ageing population is suffering from, it is evident that a bigger contributor to the worsening of this condition is body weight rather than diet. Physical activity has been shown to be significantly more effective at improving tiredness and pain caused by arthritis than any other diet including omega-3 supplementation, the Mediterranean diet and herbal medicine.

For decades old Chinese remedies and herbal medicines have been said to help with pain throughout the entire body. This is something that interests me more and more as old herbal doctors have sworn by these passed down family traditions, and they seem to work without fail. Proper clinical studies to date that have delved into this topic further have shown that herbs like turmeric work the same way in the body as ibuprofen to reduce inflammation and pain. Similar effects have also been found in ginger, long known as a digestive aid. In a recent study, ginger was proved to significantly help women with severe menstrual pain and also reduce muscle soreness after exercise.

Experts warn that diet is meant to enhance, not replace treatments that have been shown to work for eliminating chronic pain. However, following the advice that is out there won’t hurt, and most evidence leads people towards following a healthy and balanced diet, encouraging them to have a healthier lifestyle.

Pain – what is it? Here’s a great quote

‘..all pains are the result of a neurobiological process, – they’re all about impulses, bio-electricity, electro-chemicals, consciousness and vast levels of complexity in representational areas and homeostatic monitoring modules of the brain, far from the injured tissues and the location of the pain’. Louis Gifford

The great news is that understanding the neurobiology of pain means that we have many more access points to change the processing and hence the experience of pain. Our job is seeking the individual’s access points and levering the natural conditions for change and moving forward.

A goal in life is not to get rid of stress, but to get the right type of stress | Sapolsky talks | #stress

Stress is all about the individual’s perception of a situation. When something is perceived to be threatening, it kickstarts a range of biological and behavioural responses. The problem with the way we have evolved is that we can evoke these responses to our own thinking, and in doing so, affect every system in the body. Common problems associated with persisting stress include chronic musculoskeletal pain, irritable bowel syndrome, migraine, pelvic pain, fertility issues to name but a few. Cognitively, stress can negatively affect our ability to focus, recall and learn, thereby impacting upon performance at school or work.

The World renowned expert on stress, Robert Sapolsky talks:

Sleep and pain | Some tips on getting the rest you need

Create good sleep habits

Sleep is important. We do not feel good when we have missed even one or two nights. For those who suffer persisting sleep disturbance, this is a huge problem that requires multidimensional thinking.

Here are some tips:

1. Develop a routine of going to bed at the same time, i.e./ create a good habit.
2. Have a calming time before bed: within the routine practice mindful breathing for a few minutes.
3. Avoid stimulation via television, other devices with a screen (the light is stimulating) or reading thought-provoking material.
4. Check your evening diet. Avoid eating close to bedtime making time for digestion. If you are hungry before bed, try a bowl of cereal as this triggers the release of serotonin that may help sleep.
5. Avoid caffeine and alcohol that can both affect sleep.

Developing a good sleep habit can take some time. It is important to develop a routine so that the habit can be created and become entrenched. It is of course not just the moments before bed that are important, however, focusing upon this is a good start point. This alongside the regular practice of mindfulness, exercise, healthy work and social habits can make an enormous difference.

Visit our clinic site here: Specialist Pain Physio Clinics, London | treating chronic, persisting pain & injury with science and sense