A course in pain management

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A course in pain management

Post by pīwakawaka on Sun Sep 09, 2012 8:27 am

Several months ago I persuaded my GP to look for alternatives as I was getting nowhere with the public health system. I wasn't very hopeful of anything happening as he had previously told me there was nothing else available. So I was pleasantly surprised when in mid July I received a letter from Best Care Whakapai Hauora Charitable Trust advising me that I was being referred to Pain Management & Rehabilitation Services for assessment.

I was accepted and funded for 6 sessions of treatment. The first one (basically a "getting to know you"session for both the clinical psychologist and my self) was held mid August.

I'm hopeful that some good might come out of it even though pain isn't the most significant aspect of my migraines. I thought it might be helpful to myself and others if I posted my progress in this thread.

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A course in pain management - Session Two

Post by pīwakawaka on Sun Sep 09, 2012 9:10 am

22nd August. Tom (the clinical psychologist) wired me up to measure selected brain waves. Electrodes were placed on the skull at the front, top and base of the brain. It was much like one has when having an EEG but there were fewer electrodes. And much like with an EEG, I was asked to close my eyes for a period and listen to white noise etc. What was different, was that he spent some time with me going over the results.

The most significant finding was that I generate an extremely low level of alpha waves. Alpha wave are generated in a concious and relaxed state and usually increase when the eyes are closed. In my case, there was no significant difference between the eye open and eye closed states. Also at both the top and base of the brain, the levels were less than a third at what would be considered the low end of the normal range. At the front of the brain, the alpha wave were still below the normal range. but to a lesser extent.

Tom explained that this, plus some other measurements means I am in a constantly stressed and agitated state. That was strange, as I felt I was reasonably relaxed at the time. He explained that it's quite possible I've been living with the effects of migraines for so long that I'm no longer able to really relax, and this is what we would be working on in following sessions.

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A course in pain management - Session Three

Post by pīwakawaka on Sun Sep 09, 2012 10:21 am

5th September. Tom explained that a good way to relax is to learn to control ones breathing. He explained that as we breathe in, the heart rate increases and as we breathe out the heart rate decreases. As I understand it, the change in heart rate is more significant when one is relaxed.

Tom clipped a sensor to my ear to measure my heart rate. The first problem appeared when he tried to calibrate the instrument. He asked me if I was on any heart medication (I'm not) as my heart beat was quite irregular. To compound things further every so often I would miss a beat completely (once every 5 to 10 beats).

He then got me to try and relax and breathe slowly - 5 seconds in and 5 seconds out. To assist me in the breathing he had me watch an animation on a computer screen that cycled up and down over a ten second interval. He then showed me the results. The graph charted the changes in heart rate as I breathed in and out. What the chart was supposed to look like was a regular sine wave - the upwards curve representing the increase in heart rate as I breathed in, and the downwards curve representing the decrease in heart rate as I breathed out.

As I said. it was supposed to be a sine wave. Mine looked more the a seismic chart of Christchurch following the 2010/2011 earthquakes! For much of the rest of the session I practised the slow breathing and by the end of the session I got to the point where my heart rate followed my breathing about 20% of the time.

About half way through the session, he told me that warming the hands can reduce the severity of a migraine. I already knew this, but didn't know that you could learn to do this by mental exercise. What he got me to do while breathing in was to will my hands warmer. I can't say that I noticed any difference by the end of the session. However, my home work for the week is to practice the slow breathing and willing my hands warm.

I've been thinking about the irregular hear beat. I was quite aware of it during the session and for almost a day after. I do notice that my heart does seem to palpitate from time to time. I've never taken much notice of it before - it's just been a minor distraction. However I'm now wondering if this could be a trigger for my migraines. The palpitations continued most of Thursday and by the evening the first signs of a migraine appeared - brain fog. The migraine continued through Friday and Saturday and now on Sunday morning it's on its way out. The brain fog has cleared and the pain is mostly gone. Just the light and sound sensitivity remain. The more I think about it the more I'm sure that migraines have followed about a day after I have felt the palpitations. I'll need to record these incidents for a while to be certain. It's something I'll discuss with Tom at the next session.

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Re: A course in pain management

Post by pīwakawaka on Tue Sep 11, 2012 3:07 pm

Had another session with Tom today. This time he wired me to measure heart rate, hand temperature and perspiration of the hands, while we experimented with different breathing rates. I had found keeping a regular five respiration cycles per minute just a little bit difficult. Turns out my comfortable respiration rate is 6.75 cycles per minute. A bit difficult to time with a clock, but he has provided me with a CD with tracks that cycle a tone at this frequency.

One interesting snippet of information is that the skin temperature of my hands was 18°C (64.4°F). By the end of the session I was able to raise the temperature just over 1°C. With practice I'm told I should be able to raise the temperature significantly.

Surprisingly for someone in the medical profession, Tom as given me an "iron-clad 100% guarantee" that when I have learnt to control the temperature of my hands, my migraines will occur significantly less frequently. You know what they say about teaching an old dog new tricks.... I just hope I'm not that old.

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Re: A course in pain management

Post by Sarah on Wed Sep 12, 2012 12:20 am

I've heard of the hand warming technique before - I'd really love to give it a go.

I really hope this is helping you. It sounds very positive.
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A course in pain management - Session five

Post by pīwakawaka on Thu Sep 20, 2012 10:23 pm

I saw Tom again on Tuesday and we concentrated on trying to warm my hands. The idea was to breathe very slowly (6.5 breaths per minute) and think of warming my hands during each breath intake. My hand skin temperature was 17.4°C at the start, and try as I may, I couldn't raise the temperature, no matter what I thought of. Finally I thought of relaxing in a deep & hot spa and thought of heating my entire body instead of just my hands. Bingo! My hands started warming. The graph rose steadily except when my slow breathing was interrupted when Tom asked me some questions. Then it would dip slightly. When my hands got to about 22°C Tom got me to try cooling my hands, but I was unable to do so. My imagination couldn't escape that picture of me being so completely relaxed in the hot spa, that my hands continued to warm and got to 27°C and were tingling quite uncomfortably. It levelled off and start to very slowly decline only after I stopped the slow breathing and involved in a discussion about results.

I would never have believed it was possible to change the skin temperature of my hands by 10°C just by picturing a scene in my mind. But having seen the results I really have little choice but to believe. I've been assured that with practice I will gain better control of the warming process. And then by applying the technique at the right moment, stop a migraine from developing or significantly reduce its severity.

After having migraines which have been gradually getting worse over the last 50 years, I am hopeful that at last I may be able to halt or at least slow down the rapid increase in severity that has happened over the last 15 years. You never know, I may even be able to reduce the frequency of the attacks.

Next week is the final session under the current funding arrangements. I'm not sure yet whether I will be able to get a further 6 week extension, But I am hoping I can.

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Re: A course in pain management

Post by Sarah on Fri Sep 21, 2012 1:11 am

That is amazing! I'm going to try it...
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Re: A course in pain management

Post by pīwakawaka on Wed Oct 17, 2012 8:09 am

Somehow I feel let down (again).

The final session was a few weeks ago and I was suffering from a migraine at the time. Pain was moderate, but I had a definite "disconnect" - everything seemed distant. As usual I sat facing Tom with the windows behind him. It was an overcast day but the glare through the window was exceedingly uncomfortable. Tom didn't notice my discomfort even though I turned myself at right angles to him to avoid the glare.

We had a brief chat about progress so far.I felt that the hand warming seemed to be of some help, but except when I was wired up I really had no idea if the exercises were working. It was all kind of hit and miss. As I was not really "with it" I'm not sure if I explained myself very well, but I'm sure he didn't offer any suggestions as to how I could measure my success or failure.

He then had me put on a special pair of glasses with opaque lenses and connected by a wire to his equipment. He asked me to close my eyes and to tell him when I noticed anything different. Not having a clue what difference I was supposed to see, I waited quite a while until I noticed the red blackness I usually see with my eyes closed had turned into a blue blackness. This apparently was what I was supposed to see. Essentially the rest of the session consisted of me sitting there with my eyes closed and the headache pain gradually increasing in intensity.

At the end if the session he asked if I felt better. I didn't and told him so. He apologised and then said there was nothing more that he could do for me, but he would send some recommendations to my GP.

I left in a kind of daze. Fortunately I had my wife with me. On the way back to the car, she started quizzing me about what happened and I was not very informative. She took me right back to the pain centre, sat me down in the waiting room and demanded to see Tom. I couldn't hear the conversation, but I could definitely hear a raised voice (my wife's) from time to time.

It turns out she didn't get much more information from Tom, apart that I was an "unusual case" and he would forward his comments and recommendations to our GP.

And that's where we still stand. Still waiting for any recommendations. Still finding the hand warming exercises very hit and miss and not noticing any difference in frequency or nature of the migraines.

And I was so hoping that the pain clinic would result in some change.....

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Re: A course in pain management

Post by Sarah on Wed Oct 17, 2012 8:39 am

So sorry to hear it wasn't more useful to you. It's always devastating when we are told that there is nothing more they can do. Sad Really hoping that you find some relief.
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Re: A course in pain management

Post by Laura on Wed Oct 17, 2012 12:52 pm

Let us know what kind of recommendations he forwards to your GP. I am so sorry that you were let down again.
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