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Right Versus Left

COPE with Pain Training SeriesUp Pain Down Pain Good Brain Bad Brain

What is Chronic Pain and How can we COPE with Pain?

The important role brain and emotions play in chronic pain is well recognized in the psychological and medical literature.

Pain is both a sensation from an injury area as well as our emotional and brain response to the pain.

Pain is a deeply personal (subjective) experience; no one else can experience how your pain feels

The goal of the COPE with Pain program is to assist patients with chronic pain

(#1) understand their pain, (#2) increase function by COPING with their pain, and(#3) re-wire their brain-pain pathways

Your COPE with Pain Psychologist will introduce you to COGNITIVE BEHAVIORAL THERAPY (CBT) techniques that push through the emotions as well as the pain.

**CBT will be used in tandem with your physicians medical pain management therapies.

When the body has an injury

.neurotransmitter signals travel up the small peripheral nerves.through a gate and then up the spinal cord then to the brainThis is Up PainLets explain how the Pain Brain works so CBT makes sense!

This is Good Brain

then it passes through the emotional area of the brain

Pain first arrives in the fight or flight part of the brain

..then to the thinking part of the brainfinally to the action part of the brain

..and the plan tells the injured area to move out of harms way

the pain signal has to pass back though the gatethe action part of the brain sends a intention (plan) back down to the injured body areaThis is Down Pain

This is Bad Brain

When the brain turns on the pain receptors for a long period of time (Chronic Pain).

The brain smudges pain beyond the area of the original acute painThe Pain Switch can get stuck in the ON position

This is Bad BrainBut the way we think and feel about our pain has a significant and long lasting effect on our painbrain

It is natural to have negative, angry and fearful thoughts and feelings about our painOur primal brain starts a fight-flight or freeze response that triggers these thoughts and emotionsWe end up living in our emotional brain instead of our thinking brain

This is really Bad Brain

The long term opioid pain medications you may be taking sedate the thinking brain and reward the emotional brainOur emotional brain reward system becomes dependent on the drugs and leads to a drug craving that is associated as pain

We can learn Cognitive (the way we think) and Behavioral (actions we take) therapies to re-train the brain back to the way it was before the chronic pain.

We have two sides to the brain and each brain area controls specific movements

the RIGHT side of the Body is controlled by the LEFT side of the Brain the LEFTside of the Body is controlled by the RIGHT side of the Brain

and each body part has a different area in the brain that controls those movement

As we practice an activity (like moving our LEFT hand) we create a BRAIN MAP in a RIGHT BRAIN area dedicated to LEFT arm movements

The first exercise to re-train the brain will be to identify the RIGHT versus LEFT side of the body, therefore re-distinguishing the SMUDGED RIGHT versus LEFT sides of the brain

The second exercise to re-train the brain will be to to practice using your less Dominant HAND and LEG for day to day activities

The third exercise to re-train the brain will be to exercise the LOCALIZED motor areas of the brain that have become smudged, through exercises called Visualization and Graded Activity Pacing

First Exercise: Identifying LEFT vs. RIGHT

EASY

LEFT

Click on the Right or Left Arrowto identify the RIGHT or LEFT hand(it will not advance to the next slide until you click the correct arrow

First Exercise: Identifying LEFT vs. RIGHTHARDER

Click on the Right or Left Arrowto match the Hand in the TOP CENTER(it will not advance to the next slide until you click the correct arrow

First Exercise: Identifying LEFT vs. RIGHTHARDEST

Click on the Right or Left Arrowto match the Hand in the TOP CENTER(it will not advance to the next slide until you click the correct arrow

First Exercise: Now do these RIGHT versus LEFT exercises for a few minutes:

Work at your own pace, but try and get faster each time this exercise is repeated


RIGHT

Click on the Right or Left Arrowto identify the RIGHT or LEFT hand

LEFT


LEFT


RIGHT


RIGHT


LEFT


RIGHT


LEFT


RIGHT


LEFT


LEFT


LEFT


RIGHT


LEFT


RIGHT


LEFT


RIGHT


LEFT


RIGHT


LEFT

Click on the Right or Left Arrowto identify the matching hand(it will not advance to the next slide until you click the correct arrow)

Click on the Right or Left Arrowto identify the matching hand



Click on the Right or Left Arrowto identify the matching hand(it will not advance to the next slide until you click the correct arrow)



Second Exercise: Using your less Dominant HAND and LEG for day to day activities

****Skip this exercise if your physician has advised you to NEVER use this hand and/ or leg

****Skip this exercise if your physician has advised you to NEVER use this hand and/ or legSecond Exercise: the purpose of this exercise is exercise the THINKING part of the brain.

This decreases the activity in the EMOTIONAL areas of the brain, where we derive much of our pain experience

Second Exercise: Make a list of activities you can usefully do with your less dominant hand

****Skip this exercise if your physician has advised you to NEVER use this hand and/ or legDrinkEatOpen DoorsUse the remoteDial your phone/text

Which is your dominant hand? The one you normally write with.

Which is your dominant leg? The one you normally lead with when you get up from a chair.

RIGHT DOMINANT

Second Exercise: Make a list of activities you can usefully do with your less dominant hand

****Skip this exercise if your physician has advised you to NEVER use this hand and/ or legDrinkEatOpen DoorsUse the remoteDial your phone/text

Video demonstration is available at https://www.youtube.com/watch?v=QYCUviivvAg

Second Exercise: When using your less dominant leg,

be MINDFULL when you get up from a chair or start to walk,

and lead with your less dominant leg

****Skip this exercise if your physician has advised you to NEVER use this hand and/ or leg

Second Exercise: Practice a few of these now and then do them as HOMEWORK and Report back how this went

****Skip this exercise if your physician has advised you to NEVER use this hand and/ or legDrinkEatOpen DoorsUse the remoteDial your phone/textLead with your less dominant leg

Third Exercise

Exercise the LOCALIZED motor areas of the brain that have become smudged, through visualization and an exercise called Graded Activity Pacing

Visualization

Start with diaphragmatic breathingTake 6 deep, slow breaths in through the nose counting one-two-three, then exhale for a count of three from your mouth.

VisualizationNow with your eyes closed, visualize yourself the way you used to move before this injury or illness

Keep visualizing this activity

Each time you do this, you are re-energizing that part of the brain that used to control those nerves and motor function and extinguishing the pain map part of the brain

** research shows you will have to practice 2 to 3 times a day for 6 weeks to make this stick, but it can work!

Third Exercise:Graded Activity PacingRemember the GATE that was introduced at the beginning. We are going to use ACTIVITY to close the GATE and reduce the pain signals that are coming back down from the brain

A video demonstration is available at https://www.youtube.com/watch?v=TYMMh7i8qfM

You are going to bite down on your bottom lip with your top teeth

Use the Pain Scale from 1 to 10, and when you begin slowly increase the bite pressure from 1 to 2 to 3 to 4 and then only to a 5

(move to the next slide to begin)

You will put up a hand with your fist closed and put up one finger when you move to a 1, two fingers for a 2, etc(wait for the next slide to begin)

(Now move to the next slide for the next instructions)

OK, start biting: Harder to a 1Harder to a 2Harder to a 3Harder to a 4Harder to a 5

(Now move to the next slide for the next instructions)

Keep biting at a 5And now shake your handShake your handShake your handStop Shaking

Where did the pain go?The explanation is that the body has two sets of nervesThe small nerves are where pain travelsThe GATE sets a priority on the large nerves and shuts the GATE on the small nerves when we are activeSo as much movement as we can tolerate is very helpfulThe large nerves we use for movement

Graded Activity Pacing

(1) Choose an activity that increases your pain when you do it (or that could increase your pain)

(2) Keep track of how long you can do it without causing you more pain

(3) Redefine your activity time: its some minutes less than the time you considered at point 2

(4) Define your rest time: its the time you need to rest before restart your activity in order to avoid feeling more pain

When resting between activities, use the techniques introduced to you in CBT

(1) Deep breathing

(2) Progressive muscle relaxation

(3) Mindfulness meditation

(4) Self hypnosis

These techniques all promote increased oxygenated blood flow, anti-inflammation and a sense of emotional well-being, and will allow you to get back to activity sooner

Enhanced Recovery for Graded Activity Pacing

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