Craig Allingham

Benedict Spinoza, a centuries old philosopher, described pain as ‘a localised form of sorrow’, and in just a few words summed up the physical and emotional components of pain. 

I heard Dr. Lorimer Moseley, esteemed pain researcher, speak at a conference some weeks ago and he made the point that all pain is perceived in the brain.  There is no pain in your leg, or shoulder or chin until your brain collects the signals and assembles them into a pattern you then label as pain.

Why am I writing on pain?  Because I can’t sleep. I have had surgery on an arthritic toe and my brain is paying particular attention to it.  In fact it has told me to interpret the sensations as pain.  And to stay awake to keep an eye on it.  In fact, I suspect my brain has allocated a larger ‘toe pain’ monitoring area to make sure it doesn’t miss a thing. 

This is what the brain does.  If something is deemed more important it will allocate more resources to monitoring.  It is particularly good at this in regards to pain.  It happens at other times too, for example if you are learning a new language, or a musical instrument or a new skill the brain will find some underused nerve cells and press-gang them into service to provide more computing power for the new activity. 

This is phenomenal, but it gets more interesting. As you gradually master the task the brain makes wiring efficiency changes and dismantles the extra zone bringing control back to as few nerve cells as needed.  Freeing up the extra computing power for another adventure!

That is not what I wanted to discuss, however.  Back to pain.  In my previous career as a physiotherapist I treated clients with new, fresh painful injuries and also those poor souls with long-term, chronic, persistent pain.  This second group initially had an injury, but their pain had not disappeared as the injury recovered.  Their back, or whiplash, or tennis elbow had healed but the pain remained in the brain. 

I loved treating these patients, perhaps because I had nothing to lose.  Their expectations of successful treatment were poor as many practitioners had failed before me!  However, for some we had great success.  They returned to work and sport, they resumed gardening and other yard work and they started a fitness program.

Sounds great, but not one of them got rid of their pain.  But it was OK, because I told them on day one that I would never cure their pain but I could offer other life improving enhancements.  Simply put I told each of them, ‘Today is the day you choose between two lives.  A life of pain and disability, or a life of pain and living life to the full.  Your choice.’

Most were stunned, having come in to get pain relief, many were disappointed, and some were really pissed.  Many of these clients went away, thought about my offer and never returned.  I was sad for them but not surprised, they were just not ready for my approach.  The clients who took a leap into the unknown and decided to give it a try were fantastic.  They were courageous, frightened, anxious and desparate.

We had some great outcomes,  and some didn’t complete the journey.  I wished them well and hoped they would find their answer elsewhere.  For the stayers, I set about reprogramming their brain using activity, words, gestures, encouragement and leadership.  But not much empathy!  When ever they tried to tell me about their pain I pointed out that I wasn’t really interested, and couldn’t treat their pain.  And refocused them on to getting fit and healthy. 

Know what? As the brain allocated more resources to learning new exercises and skills, as it got the occasional dopamine shot (your pleasure chemical in the brain) with success, it paid less attention to the signals previously interpreted as pain.  The brain stopped listening intently for pain,  and instead got excited about doing things again.

And it has worked again.  After writing this post, my toe pain has all but disappeared.  Time to go back ..to…… bed…… and ……..sle….

I must have been asked this question about a million times during my time as a clinical physio.  Plus another half million at various social events!  Perhaps I am exaggerating, but it sure is a common question from clients with neck pain; especially neck pain that interrupts sleep quality.

In my attempts to find the ‘perfect pillow’ I have recommended and sold many different pillows in the clinic – feather filled, contoured, tri-compartmental, latex, mixed, kapok, foam and probably a few others.  I have just had a look on Google and pulled up a whole new range from which to choose – Euro pillows, boudoir pillows, Lap pillows (shaped like a lap!), Pirate pillows (true), traction pillows, pillows filled with silk or wool, pillows that play music and even one that has an inbuilt alarm that lights up as it wakes you!  None of which will probably help my clients.

Research on the optimal pillow is not strong.  However Dr. Sue Gordon (a physio at James Cook Uni in Townsville) has done extensive research on sleep position and waking neck pain.  She found that ‘subjects who reported that they slept mostly on their side were significantly less likely to report waking cervical pain or waking scapular or arm pain compared with subjects who slept in any other position (1).  This is useful, but still doesn’t address the ‘which pillow’ question.

So I got thinking – a lot of my advice to clients when trying to change pain patterns associated with position is to ask them to avoid sustained positions.  To move the body area that is painful.  This alters postural loads, changes lengths of structures, pumps fluid through the area, dampens the incoming pain signal by stimulating proprioceptive afferent nerve fibres, distracts them and gives them a degree of control as opposed to being a ‘pain victim’.  Might not the same idea apply to pillows and neck pain?

For the last year or so my response to the ‘which pillow’ question has been ‘your next pillow’.  My advice is to have two or three different pillows and to rotate between them on a two to four weekly cycle.  My idea is to prevent them using the one pillow style for long enough to adapt to the particular support mode and posture associated with that pillow, and instead introduce a different support/posture interface on a regular basis.  The short turnaround seems to reduce the initial discomfort of a pillow change and the regular change might be the equivalent of a postural position change in (say) a workplace situation.

This is in no way a thorough study on pillows and neck pain.  But my initial impressions are that this system firstly does no harm and secondly can improve waking pain and sleep quality in some clients.  Whether this occurs at a higher rate than placebo or another intervention I cannot say.  I will leave this up to a research minded colleague to determine.

Meanwhile I would be interested in any feedback from clinicians out there as to whether they have tried anything similar, or indeed a different strategy that has proved effective. Feel free to leave a comment, below.  Meanwhile, Dr. Gordon has some useful information on pillow types, selection and sleep facts on her website – www.wakeupbetter.com

1. Gordon S.J., Grimmer K.A., Trott P.  2007  Sleep position, age, gender, sleep quality and waking cervico-thoracic symptoms. Internet J. Allied Hlth Sci. & Prac. Vol 5 No. 1.

 

Apart from the obvious fact that hospitals represent the greatest concentration of unwell people and thus are a risk by association, there is another reason: things don’t always go to plan in a hospital.

Sure, they don’t always go to plan any where, but in a hospital the consequences can be most unfortunate.  Is this a big problem?  In NSW during the 2005/2006 reporting year there were 499 highest level adverse ‘significant incidents’ out of approximately 1.5 million admissions.  This represents a one in 3000 chance of a serious incident occuring.  I wish I had those odds in the lottery!  What is a ‘serious incident’? They are things like retained instruments, wrong site/wrong procedure, suicide, medical device or equipment failure, medication or blood products problems and falls.

It is impossible to remove the ‘human’ from ‘human error’, but avoiding a one in three thousand chance of disaster seems a great reason to avoid a hospital admission. How?  By taking more personal responsibility for staying well.  By making better decisions on a daily basis about nutrition, activity, stress, work, relationships, sleep, play and joy.  Seems simple enough, which it is.  Simple.  But not easy.  If it was easy, we would all be healthy, lean, strong, have good skin and smile more. There is much in our lives that will (and does) undermine our noble attempts to make good decisions. 

I hope never to become one of the ‘health police’.  Those that advocate their health models with no consideration that life is here to be lived – not just regulated.  Health decisions should also allow for fun, sensations, excitement, ambitions, relationships, experiences, risk and joy.

However, removing a one in three thousand chance of disaster seems a very good reason to avoid hospitals.  And the best way to avoid them is to stay well.  So eat your vegetables, and go out and play.  It’s not rocket science.