Discover and read the best of Twitter Threads about #pain

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Work with people suffering persistent pain?

I’m sharing the story of how Pain Coaching came about at @LePubScientifiq ~ 26 Jan 7pm

With plenty of practical tips and tools to take away. Easily integrated into your approach.

🎟 lepubscientifique.com/le-pub-events/

#thepaincoach #pain

👇
Who have been my influences?

Pain Coaching adapted from strengths & positive approach. What is that all about?

Understand your lived experience.

Then…

Focus on what you want, not what you don’t want!

What can you do? Let’s build on it.

Use your positive history

👇
PC sees a whole person with strengths and potential to shape a positive future.

A person who lives a particular life in their lived world.

Opportunities over obstacles.

Possibilities over problems.

Play to strengths, manage weaknesses.

All very practical 👍

👇
Read 5 tweets
What’s the deal w/ people in #pain using #opioids? (Read entire thread.) We are not “drug addicts.” We are physically DEPENDENT on our meds, which we need to function w/out pain (i.e, to function). Physical dependence occurs on heart meds & #antidepressants too. #ThisIsUs
And I am not trying to stigmatize #addiction here. But rly, let’s talk; chronic pain patients (#CPPs) have been forced to KILL themselves due to untreated pain, due to bad #policy, due to the #stigma, foolishness & financial incentives of others. This has a name: opiophobia…
If you took me off ALL opioids, I (like most #painpatients) would go through ugly opioid #withdrawals (and make sure to poop/puke on YOU for causing them)! 😂

And even after months of “abstaining,” and withdrawals disappearing, I would be “clean” in the eyes of the world, but…
Read 10 tweets
#MedStudents, #Residents, #Fellows, and #Research Trainees - I recently had both a resident and fellow ask me how I got involved in research and published when I was a #trainee. I thought I would share my tips and advice in this thread. #MedTwitter #ACGME #MedStudentTwitter
1. Ask yourself👉what you want from this? To pursue research as career? To boost application for #residency #fellowship #employment? To get a recommendation letter? Regardless, aim for #publication (most value). Conference talks are cool, but publications stay on CV forever!
2. Basic science research=⬆️time+lab training vs clinical research. Study designs: RCTs, prospective, retrospective, case reports, review papers. Publishing case reports+review papers are most feasible endeavors during training! Best way to boost #publication numbers.
Read 22 tweets
Going on a health care placement?

A thread of tips.

#thepaincoach #pain
1. Decide to enjoy the placement

You can set your intent.

Perhaps you have some ideas as to how you are going to approach it.

Your attitude, enthusiasm, willingness etc.
2. See everything you can

When I trained to be a nurse, I made it my business to get around.

I loved the learning.

And seeing as much as I could.

Volunteered for everything.

Unbelievable experiences.

Mainly learning about human behaviour under difficult circumstances.
Read 14 tweets
A thread of key principles to overcome pain.

Of course there are other considerations.

But this is a start.

#thepaincoach #pain #Thread

👇
Understand your pain and symptoms.

A clinician or therapist should be able to help you. They must understand pain themselves and be able to explain it to you, making it personal and giving meaning to your lived experience.

#thepaincoach #pain
Be consistent with your practices through the day.

They could incl movement, specific exercises, ways to create calm, being present, coping skills, skills of being well.

There’s much more you can do in addition, so not limited to the above.

Plus, you’ll have your own ways.
Read 9 tweets
I wonder whose bright idea it was that if a #vagina managed penetrative #sexual activity, it must be pliable to #insertion of the speculum 😒. Whoever that was definitely disregarded the physiology of sexual #arousal & vaginal changes in the moment that facilitate #penetration.
@vagina_museum shows that everyone's apparatus is different then how can #Gynecology stick to a one size fits all model? #publichealth should strive to develop minimally invasive self administered #screening tests & #gynaecologist must #research on making procedures comfortable.
researchgate.net/publication/22…
This shows that topical #anesthetic agents reduce #pain and #discomfort during speculum manipulation. Why can't the usage of topical #anesthesia be a #standard process in #Gynecology? Why such blatant disregard for #patient #comfort? 😠 #misogyny much?
Read 5 tweets
How enduring use of 150-year-old speculum puts women off smear tests #cervicalcheck #pain independent.co.uk/life-style/wom…
I was invited by @NHSEngland for routine #cervicalscreening and despite the efforts of my practice #nurse, even the smallest available #speculum caused me greatest amount of #pain and we had to stop the #procedure within a minute after insertion.
I have been in pain for 9hrs now. 😑 No test designed for #screening #population should be thus. It is hardly conducive for #uptake. Why has #gynaecology stuck with this 'instrument of torture', despite advances in #medicalinstrumentation? Could it be #apathy? @MamaDoctorJones
Read 5 tweets
No-one relieves your pain - #thread

(1) There is no direct way to ease pain.

It is a change in state (biology) that underpins a change in how you feel.

The change in state comes about via circumstances that are created by the person, and sometimes with someone else

#pain
(2) The way we feel is changing all the time - impermanence.

This is what allows life to be possible.

Whatever state you are in now, it will change.

But, there are things you can do to change state.

Create the conditions for a better state to emerge.

#pain
(3) When someone ‘treats’ you, and I believe there is a place for this, they are working with you to change your state.

There is no button to press; no direct way of relieving pain.

We create the conditions, whether by understanding something, moving, breathing etc.

#pain
Read 8 tweets
There’s been an increasing interest in central sensitisation: eg/ a means of diagnosis, courses.

Great on deepening understanding.

But it’s only a part of the picture.

And certainly not an explanation for persistent pain.

(1/2) #pain
(2/2) It would be easy with this to get caught up in the wrong way of thinking about perception.

Input - something happens - output…is not what happens.

Sensory signals the brain receives is only part of the picture. They shape a prediction that’s already been made.
Central sensitisation is going on — it’s a biology.

But it is not a direct cause of pain.

Pain is a perception.

The signals the brain receives can be grounded in CS processes, but that does not automatically result in pain.

We have to generate our experience…. (1/2)
Read 5 tweets
A #thread on pacing for persistent #pain

Hope it’s useful.

If so, do share 🙏.

👇

#thepaincoach #pain
1. To pace, you need to know your baseline.

To know your baseline, you need to accept this start point.

Acceptance is tricky. But possible. Sometimes it’s easier and sometimes harder. It is definitely not giving up.

It’s acknowledging where you are now.
2. Pacing helps by organising your activities within windows of tolerance.

You curate good experiences to build upon.

Pushing through etc., is not needed to progress. In fact, pushing usually makes things worse.
Read 12 tweets
There are different barriers to overcoming #pain.

One is pre-existing beliefs: eg/ possible causes, the types of things that will relieve it, the types of things that won't, how much influence you have, other people fix me etc.

These are all conditioned, so no blame.

1/2
But some may be right and some maybe wrong.

The more we hold onto them without considering other possibilities, the more we may be following the wrong path.

It's tough.

#thepaincoach
Having expectations that exceed the current possibilities is a barrier.

Part of us says 'you should' or 'you must', so we push on.

Even though this is not the best decision right now.

#pain
Read 5 tweets
IMO, there is a place for hands on treatment to help a person suffering persistent pain.

Touch is soothing.

Touch can relieve.

There are different techniques we can show people to use upon themselves or to include loved ones who don’t know what to do.

#thepaincoach #pain Image
1. You can start somewhere that is not sensitive, or at least less sensitive, using mild pressure.

Observe how the person responds - twitches, change in breathing, utterances etc., to get the right level.

Notice the calming, soothing effects.

#touch
2. We can use mild pressure touch on ourselves to soothe and create calm.

This would then be a better state for movement.

In other words, we prime ourselves to move better.

#touch
Read 4 tweets
Pain Coaching is the approach I devised to help people who suffer persistent #pain.

What do I help them do?

Reconnect with what matters.

In so doing, their life improves.

To keep developing, I have daily practices.

Here they are: a #thread.

#thepaincoach

👇
1. Reading practice

Daily reading.

Some factual, some development, some fiction.

I take notes.

I read slowly.

Here are some great tips from @RyanHoliday



#reading
2. Daily exercise.

You choose what this looks like.

I choose running, 5 x a week.

I have a programme designed by @Ultra_Damo

The other days I walk.

I also practice different movements and exercises through the day.

So can you.

#exercise
Read 11 tweets
To understand pain, you need to understand:

A #thread expanding on the prior tweet.

#thepaincoach #pain

👇
1. The person

It’s the person who has a pain experience. Not a body part.

It’s the person we help, guide, treat, encourage.

What’s their story? What is it like being them?

Deep listening clarifies.
2. The person’s lived experience.

This is what it is like to be them.

In their own words, given time and a safe space to talk.

We create that space.
Read 13 tweets
Some important things about persistent pain.

A #thread

#thepaincoach #pain

👇
1. Persistent pain is a challenge because there are no quick fixes.

In fact, we don’t ‘fix’ anything.

There’s nothing to fix. Certainly not the person.

When you understand pain, this makes sense.
2. Pain is whole person.

It’s the person that experiences and lives pain, not the body part.

We help people.

We help them shape something better.
Read 10 tweets
Process over prize to get results.

A key principle in rehabilitation, overcoming pain and improving life.

A #thread

#thepaincoach #pain

👇
1. How you are now is the sum of genes, experiences, decisions, habits, social conditioning, beliefs, expectations and more.
2. What is your picture of success?

— You may have pictures.

Clarify this to know where you want to go.

Your direction.

Then move onto (3).
Read 8 tweets
So I was wondering today, as an eternal student, a regional anaesthetist,and Past @RegionalAnaesUK president - what would make me want to attend #RAUKISURA22 on the 5-7th May 2002 in Edinburgh? So - Here Comes a mini thread!
@RegionalAnaesUK has been working hard to change the way we deliver education in #RegionalAnaesthesia
Check out some of highlights from #RAUK19 in Belfast organised by @LloydTurbitt @rosie_hogg @PeterMerjavy @davejohnston24 & Mike Jones ra-ukmeetings.com/past-events
The Belfast meeting was the first time we used on stage symposia to bring an engaging feel to the event, & the first time we had such a North American & Canadian presence at our meeting + #POCUS with @KiJinnChin , @shaskinsMD , @SLKoppMD, @JanBoublikMDPhD
Read 15 tweets
Luboš Plný is a Czech painter and conceptual artist, usually classified as a creator of art brut ("raw art" or "rough art"), a label created by French artist Jean Dubuffet to describe art created outside the boundaries of official culture.
Plný is fascinated by medical iconography. An expert in the mysteries of anatomy, he devotes himself – when not drawing – to all sorts of performances where he confronts the limits of pain, which he experiences as an act of purification, transforming suffering into artistic work.
He incorporates organic materials, photographs from 19th century atlases, pictures of anatomical wax models, and clippings of models from fashion magazines in his work. These images form the foundation for his graphical compositions.
Read 5 tweets
How’s #HFPP affecting the care of patients w/#pain? Was there public input when this partnership was formed w/#CMS #payers, #LE? We start with info links & near the end of the thread, an example of one payer’s efforts to fulfill their part.
#cpp #opioids
downloads.cms.gov/files/hfpp/hfp…
Read 14 tweets
Dear @OptumRx & @SanfordHealth you are NOT his #physician. You know nothing of his #health hx. Two years ago #Sanford #Bismarck #pain clinic pulled all #patients off #opioid #pain medications. This was not #patientcentered care, but care deemed appropriate BY administrators 1
Now @OptumRx & @SanfordHealth #insurance sending out letters re #opioid #pain #medications. My son had to move from a #Sanford clinic to another clinic due to #abandonment. Yep, abandonment. Plain & simple what you did was harmful & not based on #patients needs. You need 2
to look at research, that shows the harms of what u r doing. @SanfordHealth administration in Bismarck informed me 2 years ago when all #patients pulled off #opioids that it was the ‘national standard’ of care established by @CDCInjury @CDCDirector. The guidelines are NOT 3/
Read 9 tweets
I know that there are #patient advocates that take issue with @BethDarnall work but I find it critical. I know many individuals in my community that have wanted to decrease their opioids or get off all together for various reasons. Listening to their stories are frightening. 1/
What I don’t condone, is #physicians & #antiopioid proponents utilizing work done such as @BethDarnall or other psychologist that work in the area of #pain to be dismissive of those with #acute or #chronicpain. Sadly, this occurs all too often and has caused a distrust by 2/
those with #acute or #chronic pain. I believe that we need a wide variety of options. I believe that care should be individualized. That this is often not occurring is NOT the fault of those working to provide options. Those in the field that dismiss patients by saying #pain 3/
Read 5 tweets
🧵THREAD

In honour of the #Hernia2021 congress hosted by the BJS strategic partner @eurohernias, here is a thread of recent hernia-related BJS papers.
European Hernia Society guidelines on management of rectus diastasis #rectusdiastasis #Hernia2021 #Hernia
academic.oup.com/bjs/advance-ar…
Reporting guideline for interventional trials of primary and incisional ventral hernia repair #OpenAccess #Hernia2021 #Hernia #VentralHernia
academic.oup.com/bjs/article/10…
Read 19 tweets
Here's my 5 min talk I just held at the 44th #ECDD:

<< Dear Expert Committee on Drug Dependence,
my name is Fabian Steinmetz. I'm from Germany and I'm an Eurotox-certified toxicologist and professional risk assessor at an international consultancy.
I speak here on behalf of the NGO #ENCOD, the European coalition for just and effective drug policies.
And now I'd like to speak a few words about #kratom (Mitragyna speciosa).
First of all I'd like to remind the committee that banning #hemp, #poppy & #coca was not very successful and even led to more potent derivatives and synthetic imitations. Also these bans fueled violent crime and human rights violations worldwide.
Read 15 tweets

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