Based on Logic – Any Science?

OldPain2Go® - A lightbulb moment in the treatment of chronic pain?

It's too early for scientific results so let us see what Drew Coverdale, a Chartered Physiotherapist, has to say about OldPain2Go®:

"The pain sciences movement has made remarkable strides over the past 20 years in studying the role of the mind in interpreting how we process pain. Many years ago pain was seen as primarily existing in the tissue but current research findings and the 'Explain Pain' (EP) work of Lorimer Moseley and David Butler have taught us that it is a construct in our mind based on our past experience, emotions, feelings, social circumstances and many other factors which influence how we express pain.

The success of the explain pain model in giving patients a route out of their problem is based on graded exposure to mechanical, social, environmental, cognitive, mood, systemic and pharmacological factors and has been proven to be helpful. It is amazing that patients in chronic pain now have a route where they could possibly become pain-free again, however, the process takes time with results taking weeks, months or up to a year to gain the desired results.

I would like to discuss a treatment approach for patients with chronic pain that offers a fast and lasting treatment effect and which sits comfortably within the EP mode. Its origins are based in the psychological therapies field. The technique is called OldPain2Go and is being used successfully by other therapy professionals.

OldPain2Go was developed by Steven Blake in 2011 after he trained in Neuro-Linguistic Programming (NLP). As a sufferer of low back pain, he experienced an NLP process called the '6 Step Reframe’ and it was through this process that he was alleviated from low back pain that he had experienced for 40 years. Although the process was successful with him he felt it had some flaws and could be improved which led to the development of OldPain2Go.

When we think about where we are with the current body of research around pain then the OldPain2Go approach fits perfectly. The article by Lorimer Moseley and David Butler shows how the 'Explain Pain' movement (EP) has developed over the past fifteen years. They acknowledge that pain itself is 'modulated by beliefs’ and that one of EP’s core objectives of treatment is ‘to shift one’s conceptualization of pain from that of a marker of tissue damage or disease to that of a marker of the perceived need to protect body tissue’.

They describe a frustration with the misinterpretation of EP in the past and highlight the flaws of the current widely used CBT model. EP uses a range of interventions and emphasises 'how any credible evidence of danger can increase pain and any credible evidence of safety can decrease pain’. They also acknowledge that the target of a conceptual shift of the patient in EP, may be difficult to achieve when they contentiously suggest the possibility of that shift not yet having occurred in the clinicians delivering current treatments. If clinicians have difficulty letting go of the structural pathology model of pain and hold onto the incorrect assumption that pain and nociception are one and the same, then it is unlikely the patients will begin to think any differently.

As they talk about the behavioural evidence behind EP they describe pain as ‘an output into consciousness which reflects the best-guess estimate of what will be an advantageous response’. The hypothetical mechanism therefore in EP is that it changes the threat value that is associated with a given suite of sensory inputs’. This is exactly the same point at which OldPain2Go enters the arena.

There are numerous studies that have shown the powerful effects on pain from shifting the threat value of a situation or stimulus and this leads to it being biologically plausible that there is a mechanism of cognitive modulation of pain. Although there has been a lack of brain imaging data and the effects of EP available they feel that the evidence is compelling.

The precise biological mechanisms and locations within the nervous systems may not yet have been discovered, but at his 2016 IFOMT presentation IFOMPT 2016: Lorimer Moseley. Professor Moseley discussed the work of Mark Hutchinson highlighting how certain molecular patterns have an effect on the neuro-glial synaptic connections in the brain and described how these synapses are 'primed' by these molecular patterns, thereby leaving them more sensitive to future nociceptive stimulus.

Damage-Associated-Molecular-Patterns (DAMPs), Pathogen-Associated-Molecular-Patterns (PAMPs) and Xenobiotic-Associated-Molecular-Patterns (XAMPs) all have this influence of making the nociceptive response heightened within the brain. What he goes onto suggest is that there are Cognition-Associated-Molecular-Patterns (CAMPs), which in essence mean the things that you think, affect your immune activation. Although he accepts that it is speculative, he quotes Mark Hutchinson saying that "your immune system moves towards a thought." and concludes that "When we think that we are in danger, it’s a reasonable prediction to say that our immune system upregulates in response to that thought." He accepts that this has not been proven scientifically as yet but offers the prediction that the evidence for such a cognitive pattern will be here by 2025.

So if we are beginning to move towards the scientific discoveries of these Cognition Associated Molecular Patterns (CAMPs) or in essence 'thoughts' and their effect on pain, then it can be considered no more speculative that there is the potential for a scientific basis for the effectiveness of techniques based around changing thoughts and thought processes and their effect on pain. OldPain2Go simply looks at a patient's thoughts on a conscious and unconscious level, changes them and has the potential to profoundly change a patients pain experience. It is fast, safe and the results have been remarkable.

When we consider the development OldPain2Go we can see that it has been designed with the assumption from its NLP origins that we have, in simple terms, a conscious and an unconscious mind. The unconscious mind holds all the ‘programmes’ that we run automatically, without conscious effort. The unconscious runs these programmes to ensure our survival and uses these programmes to make sense of all the data we receive from the world. It leaves the conscious mind to deal with the tasks of cognition, decisions and reason etc. The logic of the unconscious is that it worked in the past and you survived, then it will help you get through similar situations by the same means, no matter how misguided, painful, and unhelpful the results may be to you personally in the outside world.

When pain lasts longer than would normally be expected in a situation and becomes ‘chronic, ‘unnecessary' or ‘old’ then it is simply a programme that is running in the unconscious part of the mind, which has become unhelpful. If this is a programme, which as Lorimer Moseley describes as possibly reflecting ‘a best guess estimate of what will be an advantageous response’, then what if the programme is simply wrong? If that programme is based on a set of beliefs about a situation, circumstance or event, which has a variety of complex emotions attached, then that programme keeps running because it is done for your survival. In David Butlers 2015 talk Treating Pain Using the Brain, David Butler he describes how the nervous system can remain on alert for 25 years post injury and states ‘You may have activated an immune system that is simply looking after you.’ This description of the immune system looking after you is simply another way of describing an unconscious programme.

Therefore, if we are able to connect with the unconscious mind directly, without formal trance or hypnosis, then the patient has the opportunity to change that programme. That is the premise for the success of OldPain2Go. Patients must have been diagnosed by a Doctor and had all relevant tests investigations and treatments undertaken. If they are in the situation where they have simply been told that no more that can be done and that they have to live with the pain, then they are suitable candidates for this approach.

The process involves ‘Brain Bargaining’ as the initial discussion during the assessment where any beliefs about the origin of the patient's pain or problem are challenged. The technique then uses a direct connection with the patient’s unconscious mind through ideomotor signals which seem very unconventional initially and through a series of simple questions the ‘pain programme’ is removed, deleted or the pain turned down and then the treatment is completed with a guided relaxation.

This approach dovetails perfectly into the caseload of physiotherapists for example, as they currently see patients in these situations all the time. When the treatment is successful they are best placed to advise on the most appropriate pacing activities, exercises and progressions to continue and maintain recovery. The speed of the treatment effect is that which is the most remarkable aspect. Because the patient is guided to do the technique on themselves, then it is their conscious mind making the connection with their unconscious mind, which is the catalyst for success.

The programme that is running for their survival is no longer needed as all the necessary intervention has been undertaken so the pain or programme being produced no longer serves a purpose. Once the conscious and unconscious agreement is made, then the programme can be deleted, removed or the pain reduced to a lower level that the patient’s unconscious mind feels is safe for them to function. As their 'unconscious' thoughts change then so does their experience of pain and the results are immediate.

When you witness this change in the patient it makes you question what is possible with this approach. It is such a simple process to learn and the training can be completed in a day. There are currently about 830 practitioners trained in this approach but they are predominantly from the hypnotherapy, NLP, and psychotherapy field, although there are now a physio's and Doctors using the approach successfully.

You can read more about this approach at www.oldpain2go.com Please have a look to see if it's something that’s of interest to you."

Drew Coverdale MSc BSc MCSP MMACP

A Chartered Physiotherapist with over a decade of experience in the NHS, where Drew worked as a clinical specialist in musculoskeletal problems. He has a particular interest in spinal problems and, as a former professional footballer, he has broad experience in sports injury treatment and rehabilitation. Drew is a guest lecturer on undergraduate and postgraduate physiotherapy course at Teesside University and is a member of the Musculoskeletal Association of Chartered Physiotherapists.

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