Rainbows and Flare Ups: Applying SURG0130 Learning to My Work

In my first lecture for my latest pain module, Andreea Palcu introduced me to the concept of pain being a memory held by the body. I then read more about this marvellous metaphor in one of our course readings about manual therapy. This concept can be understood as the repeated stimulation of the spinal cord serving to lay down pain memories in the form of chemical and anatomical changes. What I like about this metaphor in comparison to the usual “habit”or “over sensitised alarm” paradigms, is that we can all identify with how hard it is to forget something once we know it. We understand that memory, like pain, also has elements of mental processing and perception.

I was able to use this metaphor with a client who has fibromyalgia. She learned the mnemonic ROYGBIV for the colours of the rainbow as a child. I asked her if she would be able to forget this memory - ever? She didn’t think so. I then suggested to her that we could update the old memory though. We talked about how indigo isn't actually in the rainbow but cyan is. Also - a rainbow is all the gradations of each colour from dark to light which doesn’t really sit comfortably in a memory device. Just as we could create a new memory about rainbows so too could we could start to change and update her body’s pain memories. But it was going to be a long process because that memory is very entrenched and we would need to repeatedly update it with new information. I checked in with her at our six week mark and this was her feedback

She now talks about her flare ups as her old memories slipping back through and recognises that neuroplastic pain requires neuroplastic retraining. I prefer this approach to the over sensitive alarm metaphor which likens the body to a machine. This is a passive concept to have of oneself, one that requires an outside person to “fix.” I don't use the habit metaphor because it creates a sense that the pain is your own fault and one is not self disciplined enough to overcome it.

I was approached by someone living with chronic lower back pain to join my last movement class of the year. A quick chat revealed that she was a mother of three with a fairly absent husband. She was packing; buying gifts; preparing to fly home for Christmas; contending with rail strikes; and had a difficult relationship with some of her extended family members. With all of the reading around pain flares I was doing I could not let her come to class. I encouraged her to start next year instead. I know that my class will be great for her at a time when she is not stressed, busy and probably not meeting her basic needs. I encouraged her to set some boundaries over the Christmas period, for example to set a time limit with specific family members. I asked her to plan her rests and to book in catch up walks with friends. I have never turned a potential client down before but I really think that it was in her best interests that I did. I think that if she had come to class it could have been the last straw for her and triggered a flare up.

For our presentation on flare ups I created a structure based on a NZ model of health so that a person could easily remember all of the elements to take into account ahead of their flare up. I then talked someone through this model and we made him a flare up plan. Happily he hasn’t actually had a flare up since we created the plan but taking a proper look at every element that contributes to his health and wellbeing was a wake up call for him. It has served as lifestyle nudge that he believes may protect him from future flare ups. He recognised that his triggers were positional and so now takes a movement break every hour and walks his dog most lunch times. I am happy to have a useful structure to take forward with clients. It is very easy to remember the parts of a house and reinforces the idea that health is not purely mental and physical.

This module has been relevant and applicable to my work. I have appreciated the extensive reading list and resources. I have also benefited from lecturers insights on how they find the balance between "let pain be your guide" and "no pain no gain" with their patients' exercise therapy. My learning has been more than can be encompassed in 800 words.