A Must Read For People in Pain: 'Explain Pain'

If I could make only one recommendation to individuals living with chronic pain, it would be to read the book Explain Pain by David Butler and Lorimer Moseley.

Directed at both clinicians who work with chronic pain patients and patients who live with chronic pain, Explain Pain shows how the discoveries of modern pain science can be put to practical use. Written in understandable language with a touch of lighthearted humor, Butler and Moseley take a complex subject and make it possible for the average person to understand and use. One client remarked that she thought it would be hard to read and was delighted that she did not find it difficult at all. 

Pain education can help

Research has demonstrated that pain education can help to reduce chronic pain. For instance, a recent study by the army followed 4,325 soldiers over a two year period and found that one session of pain education could help lower the incidence of low back pain. Understanding how pain works is not a magic bullet that will make pain go away immediately, but it can help to take some of the fear and anxiety out of the experience which can then begin to help alter the experience. With time, thinking a little differently about pain can lead to more successful strategies for reducing, limiting, and eliminating pain.  

Pain is useful and should not be ignored. Pain is a protective mechanism generated by the brain in response to perceived threat. However, when pain is chronic and there is no direct or immediate threat to the body, understanding how the body can get "stuck" in pain can suggest ways to help it get "unstuck." 

Butler and Moseley provide some amazing stories to illustrate the surprising discovery that pain is not directly related to tissue damage. While this concept may, at first, seem odd and difficult to grasp, they produce convincing evidence to support this idea. Consider this: a paper cut produces very little tissue damage, yet can cause a lot of pain. A soldier can get shot in battle, yet not realize he is injured until he is off the battlefield. Amputees may experience phantom limb pain in tissue that no longer exists. How does that happen? The part of the brain that corresponded to the amputated limb can still generate the sensation of pain, even after the limb is gone.

Pain can be influenced by context. If everyone around us seems to be in pain, we may also expect to be in pain. Athletes involved in vigorous sports ignore impacts that would upset most of us because to them it's all part of the game. In that context, it is expected and not a threat. 

Butler and Moseley describe how pain is generated by the nervous system. Understanding that pain is generated by the brain, rather than by damaged tissues, does not mean that pain is "all in your head" and should be ignored or dismissed as imaginary. In fact, understanding that pain is the body's alarm system highlights the importance of treating pain so that the alarm system does not become oversensitive. 

The book describes what happens in different systems of the body and how they may be affected by pain. Normal responses to painful stimuli are contrasted with what happens when the responses become altered. The influence of our thoughts and beliefs is examined for the role it can play in chronic pain.

Practical suggestions

The last few chapters of Explain Pain suggest practical tools that can be used to manage chronic pain. Using "the virtual body" is explained, as is the use of graded exposure to break the association between particular movements and pain and to cultivate successful movement without pain. 

Pain education should be part of every client or patient's rehabilitation.Explain Pain provides an excellent model for pain education.

One of my clients suffered for many years with a painful chronic condition and found this book immensely helpful. Although she had seen many doctors and therapists, she had never been given any pain education. After reading this book, she asked, "Why didn't anyone tell me this?" My response was, "They didn't know." Although Explain Pain was first published in 2003, pain science is still only slowly finding its way to practitioners. 

Since I've begun studying pain science, I've incorporated information the information presented in Explain Pain into my practice. It has been a useful tool for helping clients get out of pain and feel in control of their lives once again.

Additional resources

I've posted a fifteen minute TED Talk by Lorimer Moseley on Why Pain Hurts in a previous post. There is also, in the same article, a forty-five minute lecture to a professional audience for those geeky folks who want to understand details about the biology of pain. Recently, I've found a twenty-five minute video by Moseleywhich has become a favorite because he addresses how we think about conditions like herniated discs and how our thinking can feed and perpetuate fear, anxiety, and pain. If you watch only one of these videos, this is the one I recommend. These videos are educational and entertaining. Moseley, who is both researcher and clinician, has a charming Australian accent and a great sense of humor. Imagine Crocodile Dundee giving an introduction to pain science and you'll get the picture.

For more information about understanding pain, I also suggest the following: 

Painful Yarns by Lorimer Moseley (stories to help understand the biology of pain)

Also, check out this article about understanding how pain works by Paul Ingraham of SaveYourself.ca. 

Cory Blickenstaff, PT, has put together some useful videos of "novel movements." Here are links to the ones on the low back, neck, and hand, wrist, forearm, and elbow. 

This article originally appeared massage-stloius.com and was written by 'Ask the Massage Therapist'.
 

What Flotation Therapy Can Do For Depression

Study Demonstrates What Flotation Therapy Can Do For Depression, Stress, Anxiety & More

A study published in the journal BMC Complementary and Alternative Medicine explores sensory deprivation in a flotation tank as a form of preventative healthcare. Its results showed substantial reductions in levels of stress, anxiety, depression, and pain, and along with improved sleep quality and overall mood, proving that flotation therapy is an excellent way to prevent and treat many  emotional and physical ailments.

Sensory deprivation cuts off all the senses from the mind, removing it from the average barrage of stressful situations that most of us face each day. In the absence of distracting external stimuli, the mind enters a state of deep relaxation and meditation. The research shows how this state can actually be medicinal, as it has tremendous potential to reduce stress and thus the damaging symptoms that come with it.

Chronic stress expresses itself through things like depression, insomnia, and anxiety. Flotation therapy can directly relieve this, but how?

The relaxation response method (RR) is essentially the exact opposite of the fight-or-flight response. It is the physiological process that relieves stress, occurring during states of deep relaxation. RR is able to combat stress so efficiently because of its calming effects on the parasympathetic nervous system, the portion of the nervous system responsible for many physiological changes within the body including energy conservation and deep relaxation. It is through this process that RR lowers heart rate and blood pressure and slows down breathing.

The authors of the study noted that to successfully ignite the RR response while the body is under stress it is crucial to reduce all sensory input and movement by the body — which makes floatation therapy the perfect solution. The research described the mechanisms of this method: “During flotation-REST (Restricted Environmental Stimulation Technique) an individual lay in a horizontal floating posture immersed in highly concentrated salt water (magnesium sulphate) in a flotation tank. All incoming stimuli are reduced to a minimum during this period (usually 45 minutes), i.e. sound and light, and the water is heated to skin temperature. ”

The Study

Sixty-five participants — 14 men and 51 women — took part in the study. The participants were divided into a flotation-REST group, which consisted of 37 people, and a wait-list control group, with 28 people. The flotation group received 12 45-minute sessions over the course of seven weeks. Subjects were assessed for depression, anxiety, stress, sleep quality, energy, pain, and optimism before and after the study. These same measurements were assessed for the control group.

The flotation group displayed radically improved scores in comparison to the control group, with participants exhibiting reduced anxiety, depression, pain, and stress.

Here’s Some Data

The average score for stress before flotation treatment was 1.86; afterwards, it dropped to a remarkable 0.95. The control group scored 1.84 before and 1.89 after treatment, meaning their stress actually increased during this period.

The score for anxiety for the flotation group was 7.92 before treatment and 4.28 afterwards. On the other hand, the control group scored 7.03 before and 6.96 afterwards.

For depression, the flotation group started out with a score of 4.42, which then dropped to 2.25 after treatment. The control group started at 4.00 and ended the period at 4.30, another increase.

Researchers also saw an improvement in various lifestyle factors. Sleep quality, pain, optimism, and mindfulness were all measured and shown to increase with treatment. These results further strengthen the case for flotation therapy.

In the conclusion of the study the researchers were confident that flotation therapy can be an excellent practice to improve overall health by greatly reducing stress (and thereby stress related illnesses) while increasing psychological factors in healthy participants as well.

Final Thoughts

Isn’t it just amazing what a little bit of rest and relaxation can do for our mental and physical well-being? While it’s easy to say we should all just make the time to relax more, the issue here is that many of us won’t. If you actually make the effort to go to a float spa, which are becoming increasingly popular across North America, then you will be dedicating this time to yourself and will experience the ultimate form of relaxation. In fact, flotation therapy is one of the most potent methods of activating the relaxation response, and shows how our environment can directly impact our physiological and psychological well-being. Instead of taking prescription drugs for such ailments, consider giving this a try!

This article originally appeared on collective-evolution.com and was written by Alanna Ketler

Autism and REST Float Therapy

Float Therapy is being noted as a positive therapy for people with Autism, as well as a form of psychological therapy. This is due to the reduced stimulation and low sensory input required by the brain. The amount of information that has to be received, monitored and processed is significantly reduced in a sensory deprivation tank (float tank) and is being used as treatment to regulate the biochemistry of the brain and nervous system.

Q: What does Floatation REST stand for?

A: REST was an acronym coined by the research team of Dr. Peter Suedfeld and Dr. Roderick Borrie. It has two usages: Dr. Suedfeld preferred Restricted Environmental Stimulus Technique while Dr. Borrie preferred Reduced Environmental Stress Therapy, a term which is easier for laymen to understand and speaks more to the practical applications of floatation therapy.

REST as a Treatment for Children with Autism

Several studies suggest that average levels of stimulation may be too high for autistic children (C. Hutt, S. Hutt, Lee, & Ounsted, 1964; Margolies, 1977; Schechter, Shurley, Toussieng, & Maier, 1969; Suedfeld & Schwartz, 1983). Alternatively, others attribute the problem to a deprivation of sensory input (Moore & Shiek, 1971; Williams & Harper, 1974). Theories and evidence from clinical observations converge on a characterization of autism as an abnormal reaction to environmental stimuli or a dysfunction in the ability to adequately process average levels of stimuli (American Psychiatric Association, 1987; Fein, Waterhouse, Lucci, & Snyder, 1985; Ornitz & Ritvo, 1976; Wing & Gould, 1979). Bartak, Rutter, and Cox (1975) have shown that individuals with autism have limited or restricted interactions. Theories consistent with this evidence suggest that exposure to average levels of stimuli results in a cognitive processing breakdown and an abnormal (restrictive) response to the environment (e.g., Hermelin, 1976; Rutter, 1983; Shah & Wing, 1986). If these theories are correct, one would expect a reduction in the amount of stimuli these individuals are required to process to result in a reduction of autistic symptoms and a desire for stimulation.

Restricted environmental stimulation therapy (REST) as a treatment for autistic children.

This study explored the usefulness of 48 hours of Restricted Environmental Stimulation Therapy (REST) as a treatment for autistic children. In order to provide quantified objective measures for evaluating the effects of this treatment, a battery of psychological tests was developed which would be useful and practical for the assessment of these children in regular diagnostic settings. Several positive changes in learning, social and play behavior, and cognitive functioning were noted.

First Time in a Flotation Tank

I’d been wanting to try this for years. So for my birthday this year, my husband bought me three one-hour float sessions. This was my first session.

I mentioned it on Facebook before I went to float, and since then seemingly everyone has asked about it. Several FB friends private messaged me to see how it went. Some friends called. One gal from my church even stopped me in Target this weekend and asked about it. Plus, this morning I got a text from my mother-in-law saying, “I need to know how the sensory tank experience was.”

So here’s the rundown, start to finish.

I went to bed early the night before, and woke before anyone else in my house. They advised don’t eat a lot or drink caffeine before you float. (It’s called floating – I’m hip with the lingo now.) So I ate a protein bar and drank half a glass of water. Next I showered – you’re suppose to enter the tank clean and free of lotions, hair products, etc. I packed the kids’ lunches for school, and then slipped off in the early morning mist for my 7:30 AM appointment.

When I arrived, the owner of the establishment gave me a few pointers on what to expect and how to have a successful float. I’d already read a lot on this myself. (That won’t surprise any of you that know me well.) The idea is to not have information coming into your brain from your senses – sight, touch, smell, you get the idea. It’s also not to put any strain on the body – no need to move, support yourself, resist gravity.

The goal of all this depends on the floater.

• For some, it’s just to deeply relax the muscles. This is said to be great for rehabbing injuries, recovering from a strenuous workout, or for conditions such as fibromyalgia.
• For some, it’s to enter a deep state of relaxation. To escape the outside world, de-stress, lower the blood pressure, and feel the happy result which is a large amount of dopamine released in the brain.
• For some, it’s to gain rest. It’s been scientifically proven that an hour in the tank is equivalent to four hours of sleep. Those working shift work, experiencing jet lag, or wrestling with insomnia appreciate this.
• And some are after the reported enhanced focus and creativity that comes with the theta brain waves that result from the stillness and lack of sensory input. Theta waves they’re called – the ones we experience when we’re in-between asleep and awake.

Others, like me, are just intrigued by it all, and like trying new things.

She showed me around the tank area, then left me alone in the dimly lit room. I put in the provided wax ear plugs – this reduces noise and keeps the salt water out of your ear canals. I undressed. You can wear a swim suit but the idea is not to feel anything against your skin so they recommend you enter the tank naked.

Yep.

I stepped inside the warm tank. The water was about 10 inches deep. I knelt down, and closed the door to the tank – I’m now in total darkness. From my kneeling position I put my hands down on the bottom of the tank and walk my them backwards, kind of like a crab walk – and then stretch myself out as if lying down on a couch.

At that point, rather than sinking to the bottom of the tank, I remain suspended at water level. Weightless in warm water.

There’s about 1,000 pounds of Epsom salt in that water holding me up. Truly, one thousand pounds. The water itself has sort of a slick feeling to it, due to all the dissolved salt I assume. And it’s heated to the temperature of my body.  Because I am weightless in this liquidly saline solution, I can float perfectly still. And because the water and my body are the same temp, I get the subtle sensation after a while that my body has disappeared.

But that’s not the first sensation I get. The very first sensation I experience immediately after laying down is a spinning sensation. It felt like I had turned 180 degrees within seconds of laying down on the water. But I knew this wasn’t really possible. The tank is rectagular. And not wide enough for me to fit fully sideways in it.

The spinning sensation was easy to stop by moving close enough to one of the sides of the tank to touch it with my hand or toes. Touching the tank immediately “grounds” you and the sensation stops. Crazy how that works. After a short while, the rotating feeling ended and I no longer needed to touch the tank.

For the first maybe fifteen minutes – you lose track of time in there – soothing music played in the tank along with the sound of ocean waves. It helped calm me as I got used to this very new experience.  My senses were on high alert as I took in my new surroundings – or lack there of.  And I wondered if I’d be able to settle into the “theata state” or not.

Being a journalist by training and a writer by trade, one part of me was experiencing this – determined to relax deeply – while the other part of me was documenting it and analyzing it.

I discovered the tank is a good place to pray – no distractions. I prayed frequently as the spa-like music played. Meanwhile, as long as I remained still and didn’t create any movement or waves, I couldn’t really feel where I ended or where the water began.

When the music stopped, I was in silence. Dark silence. Stillness. Except that I could hear myself breathing. You can’t help but hear yourself breathing. And here’s another discovery I made about the tank. It’s not only a good place to hear yourself think, it’s the only place I can hear myself blink!

I opened my eyes when the music stopped. Blackness. I blinked. Inky blackness. I blinked again – and I could hear myself blinking. Did you know it makes a noise when you blink? It sounded a lot like the noise my iPhone makes when I snap a photo.

I blinked for a while, fascinated with the sound.

Several more minutes passed – maybe 10? – and I believe I briefly started to hear my own heart beat. Or maybe it was blood flowing and pulsing through my neck in that spot where nurses take pulses. I’m not certain – I only heard it briefly.  I remembering thinking this must be what it’s like to be in a womb. Then my breathing slowed down and grew quieter. I no longer heard the heart beat sound.

I entered the theta state.

I never fell asleep – I just remained relaxed and still and let my thoughts go where ever they wandered. I can’t tell you where they went because I don’t really recall, not totally. (It’s like trying to recall what you were thinking in the two minutes right before you fell asleep last night.)

I very much wanted to see what this state was like, and what my mind would think/do. At the same time, I was ever so slightly worried about it. During college, my roommate Amy and I watched a (fictional) movie called Altered States about a Harvard scientist experimenting with a sensory deprivation tank. During long floats, with the aid of psychotropic drugs, he would regress into a savage being. He’d wake up the next day and find himself in a local zoo, covered in blood, with the carcass of a antelope or something beside him. So you understand my slight apprehension over what I would think about in that tank!

I didn’t have any hallucinations or “out-of-body” experiences. I didn’t have any grand epiphanies or eureka moments either. I just floated. Suspended somewhere between sleep and space.  In calm and salt.

I do remember noting that I felt very nonjudgmental while floating there.

I knew that the owner would knock three times on the tank door when my hour was up. I was to knock three times in response, and then she’d leave the room again. If I’d fallen asleep inside, she’d keep knocking until I awoke and knocked back.

I suddenly came “up” out of thea state into a relaxed but more alert state. I wondered what time it was, how much time had passed, and how much time I had left? Very shortly after that, I heard three knocks. My time was up.

I survived my float with out freaking out. And without turning savage and eating a gazelle. (It’s safe, Amy.)

Here’s some questions I’ve been asked about it:

1)  Did your hands and feet get wrinkly?  No. Not at all. That only happens when salt is drawn out of your body into the surrounding water. Salt enters your body when floating – and that is a healthy thing.

2)  Did your skin or hair turn dry from the salt? No, not at all. In fact, they may have gotten a bit softer.

3)  Can you drown in there? No. It’s only 10 inch deep water. And at any time you can sit up or bend your knee and your foot will touch the bottom.

4)  Did it smell like salt water, like the ocean? No. And this may have been specific to the brand of tank I was in, but there was a slight rubbery smell from the rubber that rimmed the door to the tank.  My daughter asked if I got used to the rubber smell, and therefore it “went away”? I told her no, I smelled it the entire time – which didn’t help the sensory deprivation goal. My husband then reminded my daughter that I have a very accute sense of smell – he thinks others wouldn’t notice it like I did. He’s probably right.

5)  Did you get claustrophobic in there? I worried a little about that in advance. But I was determined not to. I decided to do the whole “mind over matter” thing and resist any feelings of claustrophobia. A couple times I reminded myself: I can sit up and open that door and get out of this any time I want to. But I did not spend the hour fighting against the urge to scream or claw my way out of the tank.

I left there in a good mood. Not a hyper-excited good mood, more a contented and relaxed good mood.

And here’s perhaps the best part.

I came home after my float, got into a hot shower – I opted to rinse off the salt at home rather than there – threw on some yoga pants and headed for my home office. I sat down and worked for 6 1/2 hours straight.

Super focused. Super calm. Super productive.

No coffee needed.

Relaxed and yet energized, I calmly and contentedly blazed through my to-do list. The same to-do list I’d been mostly ignoring for the last couple  few several days because I never felt like buckling down and making myself tackle certain pieces of it. Now I selected a task, started it, saw it thru completion, and then moved on to the next task. All.The.Way.Through.My.List.

I didn’t get bored, or antsy, or sucked into an internet rabbit hole. You know the kind where you find yourself 40 minutes later watching YouTube videos of laughing babies and you have no idea how you got there? Yeah, none of that.

So my verdict?

It’s an interesting experience. Slightly weird, yes – at least at first. Yet also relaxing once you make peace with the idea. It’s probably not for everyone. You probably could get many of the same benefits with a good massage and/or a hot tub. But this was definitely interesting. And I tend to like interesting so long as it’s not totally whack.

(I understand what is whack to one seems reasonable to another. To each his own. See, the tank made me less judgmental.)

Would I do it again? Yes. I think I need to in order to experience the full effect of floating because you spend a lot of time the first float trying to decide if you are going to like this or not, and wondering what will happen next. I think my second time around I’ll be able to relax into it more from the get-go.

Thankfully, Rick bought me three of these floats so I’ll let you know how float # 2 goes. And I’ll decide then if I’m going to use the third float, or trade it in towards a session in the infrared sauna they have – which I’ve also been wanting to try.

So, do you think would you try this flotation tank thing if you had the chance?

This article originally appeared on http://www.rachelolsen.com/time-flotation-tank/ was written by Rachel Olsen