Exercise is one of the MAJOR keys to recovering from chronic pain.

There are many studies showing how exercise reduces pain and improves quality of life. However the exercise needs to be done in a certain way. Exercise for chronic pain works best when it is:

• regular
• safe
• aerobic

For anyone, quality of life is a big picture concept. However inside this big picture are five domains, and exercise helps with all of them.

Regular, safe exercise will improve:

• Pain levels – studies have shown that exercise is as effective for pain relief as taking anti-inflammatories and pregabalin (and with no side effects)
• Exercise improves mood, especially depression and anxiety
• Cognition – exercise helps you get a clearer head and better memory. This is partly because as it relieves pain, you can start to reduce medication which clouds your thinking
• Physical function – as your body gets stronger, you’re more able to do more, and be stronger
• Sleep – exercise helps you sleep better, and reduces fatigue. This is a huge factor in chronic pain recovery

Every single one of these domains have a big effect on your quality of life. Amazingly exercise helps all of them!

How Exercise Works on Chronic Pain

Here’s an image to help you see how exercise for chronic pain should be handled.

You’re high up in a burning building – this is what living with chronic pain is like. The only way to escape the building is thin plank, going out from the burning building to safe place. On either side of the plank is a huge drop.

The thin plank in this metaphor is exercise, and it’s how you’re going to escape the burning building of chronic pain.

If you choose not to go out on the plank, you’ll stay in the burning building.)

To escape across the plank, you need balance. This means going slowly and carefully. If you run full tilt at the plank and trying to race across. you’re likely to overbalance and fall.

This means that if you used to run marathons, or play 80 minute soccer games, that’s not how you start your exercise regime.

Instead, at Life After Pain, we use a very specific rule to get started exercising when you’ve been out of action for a while due to pain.

The ‘That’s Ridiculous’ Rule of Exercise when You’re In Pain

To begin exercising, choose he type of exercise you enjoy. It can walking, jogging, swimming or something else. Ideally, it should be an exercise can do regularly so becomes a habit.

The most important thing is to start with the amount of exercise that will not flare your pain system and and turn on your pain.

The amount of exercise you start with should make you say:

“That’s ridiculous! It’s way too little!”

If you ignore this rule, you’ll end up in boom and bust. Boom and bust is a great way to keep your pain system amplified and your chronic pain strong.

(Boom and Bust is when you overdo your exercise and your pain system flares. You’re incapacitated for a few days, and do nothing. And then, as soon as you feel better, you do overdo things again, and have a pain flare. And this repeats again and again and again.)

Don’t do this.

The best type of exercise for chronic pain is:

1. Aerobic. This means you get to 50-60% of your maximum heart rate. A simple way to test this is that when you’re moving, and you can talk to someone at the same time (or whistle.)
2. Manageable. Do a ridiculously small amount of exercise to start with
3. Incremental. Gradually increase the amount you do – a little bit more each day. After a month, you’ll be amazed how far you’ve come.

Types of Exercise for Chronic Pain Recovery

Most of the studies on exercise and chronic pain look at walking. Walking is a great mode of exercise, because it is:

• Anti gravity (which is important if you’ve been sitting or lying down a lot)
• Natural – our bodies designed to walk
• Well balanced – all your muscles get used when you’re walking
• Cardiovascular – walking increases heart rate and blood flow

In short, walking is great! And it’s proven it will increase your quality of life, especially when you slowly increase your speed of walking and your distance. (One fancy trick is to check the amount of steps you do each day with at Fitbit or similar.)

Other good forms of exercise are:

• cycling
• jogging
• swimming
• aqua jogging (low impact, very healthy)
• skipping (great aerobic exercise, good in winter, great for coordination)

Tools like a treatmill of cycling machine are useful to keep exercising through winter and the height of summer. You can set the exact level of difficulty, and track your progress. However, it’s just as possible to do this without any machines.

The main aim is to keep your exercise under the level that will turn on your pain system’s protective mechanism.

The other key is to be regular. You can exercise 3-4 times a week, however a little bit every day is even better. The evidence is clear, this type of incremental exercise is a powerful way to reduce your pain and increase your quality of life.

Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534717/

As you can see below:

This isn’t great Theracane technique (more of a back scratch really) however in the past I have treated dog’s trigger points. It’s tricky, because you can’t ask them what hurts, but the principles of ischemic pressure work the same, and switching off triggers means a happy dog.

What people often don’t understand is what medial branch blocks are and why we should do them.

They are really valuable. If they’re done properly, they can lead a particular group of people with chronic spinal pain becoming virtually pain free.

What is a medial branch block?

The thing to understand about medial branch blocks is that they’re a diagnostic procedure. They’re not a treatment at all. Their real purpose is to clarify the cause of your back pain.

Medial branch blocks answer the question: is your pain coming from a particular facet joint in your back?

That’s all they’re designed to do. They’re not a treatment for back pain, and are not intended to give long term pain relief. But they do lead on to things which can give long term relief.

Back Pain Coming from Facet Joints

The facet joints occur in the spine at each level of the spine between C2 and C3, and C3 and C4 etc, all the way down your spine to lumber (L5) and sacral (S1.)

From your top of your neck, right down to the right down to your tailbone, in between each level of the spine, there are two facet joints. These joints are part of the mechanism that allows movement and support in your spine. 

These joints can become damaged and this can cause chronic back pain in some people. However, they’re not the only structures that can do this.

Interestingly, if you look at the whole population of people with back pain, the commonest cause chronic lower back pain arises from the discs.

However, as you grow older, the facet joints slowly become more worn, and the incidents of pain arising from the facet joints starts to go up.

At some point, where people are in their fifties, facet, joints become more common than spinal discs as a cause of chronic back pain. 

The important thing is that there is no easy way to sort out whether your pain is coming from the facet joint or from some other structure.

If you do a x-rays, a CT scan, an MRI scan, or even a fancier PET or SPECT scan, all of these scans will give you different bits of information. But none of them tells you whether your pain actually comes from the facet joint or from another structure.

This is what medial branch blocks do.

Each facet joint has two parts to it: a segment which comes from the top vertebra and a segment that comes from the bottom vertebrae. These segments are the two facets, which rub together and help support your back and allow movement at each segment. There are two facet joints at each at each level of the spine – one on each side.

There’s also a little nerve that comes from the top facet and supplies feeling and sensation from the top facet. That’s the first medial branch. The second medial branch comes from the lower facet. These two nerves run together, join into the spinal cord and send messages up to your brain.

Therefore, the only reason that your brain knows the facet joint exists is because of information from the two little medial nerve branches that supply that joint.

Normally the information stream from these two nerves is so small that you’re not even aware of these joints. However, if the joint becomes damaged, the nerves will start to send messages of pain.

As you get into certain positions, a damaged facet joint will send a message of pain up to your brain. You’ll not only feel the pain where the facet joint is, but in a certain distribution – larger area of your back. It can feel like an ache, a tearing pain, or a lancing pain. 

If it gets particularly bad, then you can feel pain often, or even all the time. There may not only be one, but a number of facet joints causing you pain.

The issue is this: your back pain may be coming from the disc or the ligaments or the muscles or the tendons or the facet joint. It’s very hard to tell from a physical examination or even a scan which structure is truly causing your pain.

How Medial Branch Blocks Work

The way to answer the question: “is this pain from the facet joint?” is to put a tiny little needle onto the medial branch of that facet joint. You have to put local anaesthetic on the two medial nerve branches, and both parts of the facet joint.

The injection of local anaesthetic right on the nerve turns it off.

As soon as you do this, all information from the facet joint will stop being sent up to the brain. This works in the same way as if you have a terrible toothache, and then dentist puts in local anaesthetic: everything goes numb and the pain goes away.

If you numb the facet joint, then all the pain that was coming from the joint will be taken away. The doctor puts local anaesthetic on the tiny little medial branch nerves. He or she only injects 0.3 of a mil of anaesthetic, which is a tiny little amount.

This the test: if blocking facet joint nerve takes your pain away, then your pain is coming only from that facet joint.

It’s very specific test, and only works on the small proportion of people whose pain is only coming from their facet joints.

The Facet Joint Pain Test

Now, if the pain is truly coming from your facet joints, then when the doctor does the block, the pain shouldn’t be just a little bit better. 

It should be gone completely. After a successful the medial branch block, you should be able to move around, bend forward, shift around and do things that you can’t normally do.

This effect should continue only while the local anaesthetic is working. After a while, the anaesthetic will wear off, the feeling comes back into the facet joint, and the pain returns.  

Because you’re doing the nerve block as a diagnosis tool, you need to be doubly sure this test is correct. You need to negate a problem that occurs with all interventions. The problem is called the placebo effect.

The placebo effect works like this: when you’ve lived with a pain for such a long time, and you’re about to get the nerve block, you think: “Oh my God, somebody is going to do something about this.”

The doctor does the block, and because you are so relieved, the power of your mind switches off the pain from your facet joints for a short period of time.

This placebo effect means that well over 30% of the time, the medial branch block will give relief to people even if it’s not the main cause of their pain.

Medial Branch Nerve Block for Back Pain – How Long Does it Last?

To make the facet joint pain test more accurate, doctors have devised a further measure. Instead of just one nerve block, you do two nerve blocks, with a few days in between.

For one block, the doctor uses a short acting local anaesthetic. For the second block, the doctor uses a long acting local anaesthetic.

The person who’s having the nerve blocks has no idea which procedure uses long acting anaesthetic, and which one uses short acting. However the doctor does know.

What should happen is you get significant pain relief after each shot. By significant, the pain should go from 6 or 7out of 10, down to less than 1 out of 10. It should be an 80-90% reduction, not a 50% reduction.

There will be some discomfort because the doctor has stuck some needles in your back, but that should be greatly outweighed by the relief of having the facet joint pain switched off.

If the test is positive, the pain goes away for a short time with the short acting anaesthetic, and a longer time with the long acting one. 

If that’s the case, you have two positive concordant medial branch blocks. This meansyou can be very confident that your back pain is coming from the facet joint.

Radiofrequency Neurotomy

Why is it so important to have a definite positive test? Because the medial branch block is a diagnostic test and the next step is treatment.

The long term treatment for facet joint pain is called a radiofrequency neurotomy. Neuro is nerve, otomy is cutting or destroying or damaging.

If you have two positive and concordant medial branch blocks of the tiny little nerves in your back, then the doctor can go on and do the radiofrequency neurotonomy of those nerves.

The doctor puts a probe into your back, parallel to these tiny little nerves in your back. The nerves are just 10 or 15 millimeters long, and as thin as your hair. This probe is positioned under an image intensifier, so the doctor can be sure their probe is accurately placed.

He or she then very carefully runs puts the probe parallel to the nerve, and turns on a microwave. That’s the radiofrequency. The tip of the probe will slowly heat up one degree at a time until it reaches 80 to 85 degrees centigrade. At that temperature, it will cook the nerve. It’s a tiny burn deep in your back, and just the little medial branch nerve will get zapped.

If your test nerve blocks have been done correctly and accurately,  then you will the same pain relief from zapping the nerve as you did from the local anaesthetic injection.

In other words, if you had 7 out of 10 pain and it went down to 1 out of 10 with both nerve blocks, then after the radio frequency, you should get the same pain relief, but it’s going to be long term.

The pain relief now will last until the nerve grows back, which is an average of ten months to two years. For some lucky people, the pain never comes back.

Diagnosing and Treating Facet Joint Pain with Medial Branch Blocks

The process is:

• Do the medial branch blocks first to see whether those little nerves or the facet joints are the cause of the pain
• By numbing those nerves, you can make the pain go away, both for the long acting and short acting anaesthetic
• You come back and zap the nerves – a radiofrequency neurotomy

This procedure will then give you many months of pain relief. If your pain comes back, you can simply burn the nerves again.

It’s a very useful procedure, and the media branch blocks give you an enormous advantage. With them, you get to test first to see if the structure you’re targeting is the cause of the person’s pain.

This is unlike spinal surgery, where the surgeon looks at the MRI scan and says, “Oh, that’s the worst looking disc, I think will operate at that level.”

The surgeon has no way of actually knowing beforehand that the pain is definitely coming from that disc. It’s more of a best guess, because there’s no way of checking their hypothesis.

With successful medial branch blocks, you can be more than 90% confident that doing the radio frequency neurotomy will give the person the same pain relief as the blocks, long term. This is with caveat that the branch blocks have to be done accurately, under an image intensifier.

You can repeat the radiofrequency neurotomy as needed, because the intervention itself is actually minor. There’s no general anaesthetic involved, and most people take maybe four or five days for full recovery.

It’s an accurate and specific treatment for a very common cause of chronic spinal pain, either in your neck or your lumbar spine.

This procedure does require quite a lot of skill from the people doing the procedure, however it’s a repeatable and successful treatment. 

When the Medial Branch Block Test isn’t Positive

If the medial branch tests don’t take away your pain, what do you do next?

It’s important to recognize that the facet joint is only one of many causes of spinal pain. Other structures which cause back pain are the discs, the tendons, and the ligaments.

When the pain is caused by something other than the facet joints, then the medial branches blocks won’t give pain relief, and doing a radiofrequency in your autonomy is a waste of your time.

If you have pain from another source, then you need to treat that structure. It’s also important to know that when you’ve had pain for a long time, you will have sensitization of your pain system in that area.

Treating pain sensitisation is another process, and you can find out more about it below.

As a chronic pain specialist, I see many people who have anxiety that goes with the chronic pain. The thing that’s well recognized in the medical literature is that two go together. Something that makes you anxious will make your chronic pain worse. And your chronic pain getting worse will make you more anxious. They feed off each other to create a nasty spiral for both sets of symptoms.

The interesting thing is that the system that causes pain and the system that creates anxiety both have the same basic purpose. Their basic function is protection. Both these systems are there to keep us safe.

This creates some really interesting opportunities and gives the first clue as to why chronic pain and anxiety dance together so much.

The two systems that govern pain and anxiety

Your pain system is there to warn you of physical damage. The systems that govern anxiety are there to search for external threats and to react to them.

To really understand this, you need to go into the part that matters, which is your brain. Essentially, all human beings have two minds. We have what’s called the neocortex. The size of human’s neocortex is what separates us from most other mammals except dolphins and whales. The neocortex which is where we produce complex thoughts, reasoning and language.

Then you have your paleocortex and this is the part of your brain which we share with most mammals in the world. This is commonly called the lizard or reptile brain. In medical terms, it’s your midbrain. It’s the structures deep inside your brain, do amazingly important tasks, more or less on autopilot. It keeps your heart beating, keeps your blood pressure going, keeps your temperature constant, your bowels working, your bladder wall working.

These tasks are vital and necessary, but you don’t have to consciously think of them for them to happen. This is all driven by your lizard brain, or mid brain.

Now, we do have conscious control over some of these functions. For instance, all children learn how to control their bowels and bladders by usually ages two to four. Your bowel sends a message that it’s time to go to the toilet, but your conscious brain overrides the message until the appropriate time. So you have control over the working of your mid brain as long as you realize this fact.

If we come back to these two systems, there’s your pain system that malfunctions to cause chronic pain, and the system that creates anxiety. These are both there for your protection, and both of them are largely located in the mid brain.

They work through the thalamus, which has for pain, and through the limbic system, which is for emotions and anxiety. They are millimeters away from each other in this lizard brain.

How the lizard brain keeps you safe

We share the lizard brain with almost all moving creatures. So let’s take a fly as an example. Our fly is sitting there, doing what flies to best, and I have a fly swatter. I’m intent on dealing to this fly before it lands on my sandwich. As the fly swatter starts to descend, the fly has two choices.

It sees the swatter moving just out of the corner of one compound eye. It can either say to itself ‘danger!’ and get out of there, or it can say, “Isn’t it a nice day…” and splat! It’s dead.

This is how the midbrain works for a fly. It’s a smaller, simpler, system, but it still has this hair trigger reaction occurring in the midbrain when it perceives a threat.

This protective mechanism works as an on/off switch. It’s not a maybe/maybe not switch. Otherwise the fly would be squashed.

The flies that have survived long enough to reproduce were survivors, and always reacted fast to threats. It’s natural selection at work.

Let’s look at how you may get persistent anxiety from a system that should be protecting you. Something that separates human beings from most other creatures is that our brain is a forward looking machine. It’s constantly casting into the future.

A fly just reacts to what’s happening now. However humans trying to stay safe are always trying to look ahead for dangers. But because we live in a much more complex environment, it’s harder for us to recognize danger.

Our lizard brain is constantly looking for danger. Everything from a work email arriving to a traffic jam can signal danger to a primed lizard brain.

The role of traumatic memories

The next question is a key one. How can you make this danger-finding system as efficient as possible? What you do to recognize danger is that this forward-looking is informed by what’s happened in your past.

When your brain asks ‘is this dangerous?’ It immediately checks your memory banks to see whether memory of a similar situation where you ended up getting hurt or distressed.

In the brain, you have two tiny and remarkable structures called the amygdala. The amygdala is the shape and the size of an almond. It sits deep in the temporal lobe, right next to the limbic system. Whenever you have a traumatic event, the memories of this are stored here.

When I say trauma, it could be anything. It could be something, which was terrible at the time, like your older brother stealing your ice cream when you were three. Or it could be a truly terrible situation like child abuse or a serious car accident. It could the death of a loved one, or being caught in a war zone.

All of the memories that have a huge negative emotional impact on your life get laid down in the amygdala. They’re stored extremely close to the part of your brain, which is there to protect you from danger.

How anxiety drives pain

Supposing your in your house and I have to go down to the supermarket. But your lizard brain says checks your memory banks to see if it’s safe.

And in your memory bank, in the amygdala, it finds the memory of a terrible incident when you slipped and fell on the way to the supermarket. It decides that No, it’s not safe. Based on this memory, a trip to the supermarket is dangerous. As your lizard brain connects something in your past with what you plan to do in the future, it changes something.

The limbic system fires with a danger message. It sends this message to your hypothalamus, which sends a message to pituitary, which then pushes out a hormone which goes to your adrenal glands. 

It takes less about a second to do all this. As the blood treaches your adrenal glands, they pump adrenaline into your system. Because if it’s dangerous, this system is there to protect you. You’ve now shifted into fight and flight mode. That’s how we humans protect ourselves from an external danger.

All of this is triggered by the thought that you’re going to go off to the supermarket. That thought becomes real in your brain, and then extremely real in your body. As the adrenaline floods your body, your stomach starts to churn and your mouth dries. Your heart starts pumping faster in your chest. You’re starting to feel shaky. Your hands get cold and sweaty and you feel really awful.

This fight and flight response is great if something or someone is coming to attack you and you have to run away fast. But when it gets tied into a thought of the future, and a memory of past trauma, then it turns on anxiety.

Anxiety is a thought in the future that suddenly becomes unbelievably real for you, and can make your present self very uncomfortable by putting your body into fight or flight mode.

Fight and flight mode

The amount this system gets wound up will depend on how much anxiety you feel. You may feel a small amount, or you may find that just everything fires in an overreactive protective system.

There’s one other thing that happens. Your breathing changes. This is significant. Not only is your body now hyped up, but your breathing changes from relaxed diaphragmatic stress breathing. This is all an unconscious reaction produced by your protective lizard brain.

You simply thought “I’m going to the supermarket,” but your lizard brain did all these connections, and now you are wanting to escape. You start breathing as though you were running, or as though you were fighting. This breathing is known as hyperventilation. Your carbon dioxide levels drop, and this changes the acid base balance in your blood. This acid base balance sets the rates of all the reactions in every cell of your body.

Changing this will really mess with your fundamental metabolism. With this change, you get a feeling of impending doom. It’s a very scary feeling, and will feed back into the fight and flight mode, which causes more stress breathing.

If this carries on, the anxiety may turn into a full panic attack. So that’s the one protection system you have that governs anxiety.

Anxiety is a huge overreaction to a thought which is being fed from something in your past there to protect.

How pain is amplified

If you take pain you’re walking along and as you move, you’ve got little receptors all over your body, under your skin, in your muscles, tendons, ligaments, and joints. All these little receptors send information constantly into your brain from all over your body.

Normally, their messages simply say that everything’s fine. Now, supposing now you walk along and you step off a curb. And as you step off the curb, you twist your ankle. As your ankle twists, the outside of your ankle tears.

This is the important part. As the tissue tears, you don’t know what’s happened until the receptors send a message. The message fires up a specific nerve and comes to your spinal cord. All the messages coming into your spinal cord are from your peripheral nervous system. They reach a point which where the peripheral system joins the central system, which is the spinal cord going up to your brain.

Where they join there is a little connection between one nerve and the other, called a synapse.  The message has to jump across this little synapse.

This is another one of the big keys. When you twist your ankle, you don’t know you’ve hurt yourself until a danger message shoots up the spinal cord, jumps across the synapse and arrives in your brain.

In the brain, it cross from right side over to the left and ends up in the the midbrain, comes into your cortex where there’s what’s known as a homunculus. It’s the representation of your body in your brain.

The message ends up in the ankle portion of this homunculus, and your consciousness suddenly knows you have pain in your ankle. It takes less than a second, but as the message reaches your brain and your attention goes to it, you suddenly become aware of pain in your leg.

Over the next hours and days, you do whatever you need to do to heal. You put ice on your ankle, you go and see a physiotherapist or doctor. Over a few weeks the ankle starts getting better, and the pain messages of start getting less.

This is an example of your pain system protecting you exactly like it should.

How pain becomes chronic

However, there is another thing that can happen. When you look at the figures, what I’m going to describe now happens in perhaps 15% of the population.

What happens in this other scenario is that your ankle is starting to get better, but there’ve been pain messages coming up the synapses for weeks, going up a particular nerve pathway to your brain.  

So you’ve been feeling pain for a week or two. One you’re walking along and you come to a curb or step. Remember that both systems, your pain system and emotion or limbic system, are there to keep you safe. Your midbrain is always seeking ahead for danger and being informed about what’s dangers from your past.

As you come to step down, your lizard brain looks ahead and says, “Oh, there’s a step. Hang on a minute.” And it goes back and it says,
Oh no, the last time you went over the step, you twisted your ankle.”

It then sends a danger message.

This is the third key. The message goes flying down to the little synapse where one nerve talks to another in your spinal cord. When it gets there, it does something quite profound. It turns UP an amplifier in that synapse.

The messages coming from your ankle, which is starting to get better, become amplified. As the message jumps across the synapse, it shifts to a different receptor. The message changes from normal sensation to you feeling lot of pain.

As you take a step off the curb and put your weight on your ankle, you feel this amplified pain. Consciously, you’re thinking “Ouch! My ankle. Why is it so sore? I seemed to be getting better.”

You look down at it, and it looks okay, but your lizard brain has decided that, based on past experience, stepping down and putting weight on your ankle is a dangerous thing.

To keep you safe, whenever this situation arises, it amplifies messages from your ankle, so you feel pain.

In this scenario, even if you keep getting the right treatments, and your body heals, your pain does not get better. Your pain system combined with your lizard brain is keeping that message amplified and you continue to feel exactly the same pain. 

In some unfortunate cases, the pain may continue to amplify. It can spreads up into your lower leg. You go and see a specialist who gets an MRI and tells you there’s a tear in your ligament.

However the real problem is sensitization of your pain system. Now you have this horrible pain which is as real as if your damaged ankle was still damaged.

This scenario can happen anywhere in your body. Many people experience it after leg, back, neck and shoulder injuries.

How pain drives anxiety

This amplified pain problem is driven by your lizard brain, specifically the area called the thalamus. The thalamus lives right next to the limbic area, which runs your anxiety center.

When amplification becomes chronic, everything in this area is now on red alert. You’re hyper aware of danger.

The next time you’re walking along see a step ahead of you, not only does your pain system turn up its amplifiers, but also your protection center reacts to this perceived threat. It sends messages to push up adrenaline. So you become anxious even as you’re walking towards the step. You know your ankle is going to hurt, and these two systems malfunctioning ensure that you’re right.

This is the fundamental reason why anxiety and chronic pain are connected. They both have the same basic function: protecting you from harm.

When they work well, they keep you safe. If they malfunction like I’ve described, your life becomes full of pain and anxiety. Unfortunately, many health professionals do not understand this process.

Could this be happening to you?

It’s difficult to diagnose this situation because there are no objective tests for it. The only way you can really arrive at a diagnosis is to eliminate all other possibilities Unfortunately, MRIs will show all past damage, including injuries that have healed, which makes it easy to miss this as a cause of persistent pain.

If you have pain that’s not getting better, and you’ve ruled out other causes, the question is what to do to get better?

How to break the chain of pain and anxiety

The first thing is to understand this underlying process. These systems that keep you safe are supposed to be serving you. However, you are the boss. The second step is to use something which is a powerful tool. Inside our neocortex, somewhere mysterious is our consciousness.

Your consciousness has a fantastic tool: your attention. Wherever your attention goes, that will determine your reality. Until now, if you have anxiety and chronic pain, your attention has been going to both of these things, and as been feeding the whole process.

Now that you understand what’s happening, you can change this. The next time you’re at home, and decided you’re going to the supermarket, you may get this awful feeling combined with horrible anxiety. 

Step one is to recognize: this is your protection system overreacting. It’s creating all these symptoms. Take your attention away from your thought of the future, put it back on your immediate surroundings.

Use your five senses to analyse: is there anything dangerous here right now?

This process will take just a few seconds. What you’re doing is you’re taking your attention away from the horrible feelings of danger.

Once you can reassure yourself that everything’s safe and normal, you send a very firm message down to that little gremlin in your midbrain and to say it’s all safe.

The vital role of breathing

The next thing you do is become aware of your breathing. Close your mouth and breathe through your nose. This is important because when fight and flight mode switches on, you start breathing through your mouth to suck in more air, which begins hyperventilation. When you instead move air slowly in through your nose, you’re putting the brakes on this process.

You lean back and you take a very slow in breath. Count slowly to five for each in breath. Count of seven on each out breath. As you gently breathe out, you’re shifting your fight and flight system back to chill mode.

As you do these slow breaths, your heart rate slows down and you’ll find the awful feeling of impending doom just dissipates.

The earlier you get onto this the better, so you can halt the process before it ramps up. Understand you have immense power to change processes that used to be automatic.

Later on, you can start to work on any traumatic memories you have which turn on anxiety and pain. You can look at going deeper into the amygdala, and depending on what you find, you may need professional help.

To begin, though, this will help you get started, and if you practice it diligently, it may make a tremendous difference to the quality of your life. 

In this article, we’ll look at:

• The anatomy of the triceps muscle
• Triceps muscle function
• What causes tricep tendon pain
• What the treatment options are
• The best stretches and rehab exercises

Triceps Anatomy

The triceps is a fascinating muscle. Triceps means three heads. The three heads of the triceps are at the top, where the muscle attaches to the shoulder and upper arm.

Two heads attach to the long bone of your arm – the humerus. There’s a longer head, which attaches near the top, and a shorter head which attaches lower down. The third head is runs from the back of your arm and joins into the scapular (shoulder blade.)

In the end this means the muscle runs across two joints – the shoulder joint and the elbow joint. This makes their triceps an interesting, but complex muscle. 

At the top of each of these muscle heads is a tendon attaching to bone. Because they’re spreading their load out, these three top tendons tend to do okay.

However, these three heads then run down the back of the arm and join into a single muscle at the back of your arm. This larger muscle then runs down towards the point of the elbow, called the olecranon.

The olecranon (the point of your elbow) is in part of the ulna bone. Here, the triceps muscle becomes a single tendon and joins into the olecranon.

This tendon at the elbow is where all the tension produced by the muscle is concentrated. So if you have triceps tendon pain, it’s most oftes at this point where problems occur.

Triceps Muscle Function

As the triceps muscle contracts, the elbow straightens out. We use this movement a lot. It’s used for doing pushups, closing doors, swimming, surfing, tennis, throwing ball, wielding a hammer. All of these movements, and many, many others require the triceps to contract. 

These movements also require the tendon to tension up.

Tendons are a quite unique structure in our bodies. The tendon is made up of long coiled molecules of collagen, which is a very strong. Because they’re coiled, these molecules have a certain springiness to them.

They are also glistening and white, which means they don’t have lot of blood in them. The blood flow to the tendon is very limited. This means they are slow to heal.

Why Triceps Tendons get Injured

If you try to do a big pushup or lift something that exceeds the strength of the tendon, you may get a tear in your tendon. That’s one way to injure your tendon, but that’s not the commonest.

The commonest tendon injury by a long way comes from doing recurrent movements. If you were a baseball pitcher you threw a thousand times during a week, over time you may start to get lots of little tears. 

If you’re a builder and you use your hammer a lot, again, the same thing could happen. Recurrent overuse is the commonest cause of tendon injury, and this is certainly true for the triceps.

When there’s overuse, the tendon gets lots of little tears and because there isn’t a great blood supply, the tendon frantically tries to heal any way it can. So it becomes inflamed. And that is tendonitis.

Triceps tendonitis means the tendon at the back of your arm, where it joins into the tip of the elbow becomes inflamed. This is because it’s trying to heal the multiple little tears or the one big tear caused usually by overuse.

With triceps tendonitis, the area becomes exquisitely tender because your body is trying to heal through inflammation. You may feel you have a sore triceps for no reason, as even the slightest use of the muscle can cause you a lot of pain.

As part of the healing process, the area will feel warm to the touch. It may even look red and be exquisitely tender, like a burn. Your elbow may become a little bit swollen. Every time you lean it on the table, it will hurt.

How to Treat Triceps Tendonitis

Under these circumstances, with an acutely inflamed tendon, the cleverest thing anybody can do is to rest it. This means putting your arm in a sling and really resting it as much as possible to let it settle.

Rest is a very powerful anti inflammatory – the best. However, to enhance this process, you can rub lots of an anti inflammatory gel into the area – something like Voltaren or ibuprofen gel. You could also take anti inflammatory tablets, or ice the area cool it down.

These measures help to quiet the inflammation down. The most important, though, is to stop using your elbow.

Now, this kind of rest you can only do that for a certain period of time. It may be that the inflammation settles (and it should settle quite quickly.)

But supposing you now you’ve got to go back to work as a builder, or a pitcher?

The Difference between Tendonitis and Tendonosis.

If you carry on using a damaged tendon, what will happen over time is that the tendon will change from an itis to an osis. In other words, the tendonitis turns into a tendonosis.

This means parts of the tendon will heal up. Other parts of the tendon will degenerate and end up with little areas of dead tissue in them. That’s the commonest way the tendons respond to repeated injury.

Under these circumstances, the tendon itself is sore when you use it or stress it, but is not acutely inflamed. This isn’t great though, because you’ll end up with a chronically sore tendon.

What you need to do to help the tendon to heal optimally.

This is different process from when the tendon was acutely inflamed. When it’s an tendonis, you have degeneration and healing together in the tendon. In this scenario, there’s a narrow path to healing.

If you to do too much – or too little, you drift away from optimal healing. 

Healing and Relative Rest

If you do too little, for instance keeping your elbow immobile in a sling for six weeks, then the tendon heals in a suboptimal way. This is because when you’re not using the tendon at all, new collagen and scar tissue is laid down in many different directions, which will create an essentially weaker and less functional tendon.

What the tendon responds well to is a (very) small amount of stress, just enough to stimulate healing and to allow the collagen and the scar tissue to be laid down in response to the lines of force. 

In this scenario, it’s important not to overdo anti-inflammatories, because you want to certain degree of inflammation to occur as part of healing.

Triceps Tendon Stretches

As you rehab from a triceps tendonitis, you want to be able to stretch the tendon very gently.

The most basic triceps tendon stretch involves dropping your hand down behind your back. Lift your elbow and tuck it next to your ear. As you pull back, letting the arm drop, you will feel the whole triceps muscle and tendon stretch.

You then very gently lift your elbow up and stretch. You can do this as often as you like through the day. It shouldn’t hurt, unless everything is still acutely inflamed (in which case wait until you can do the stretch comfortably.) 

Next, you can start to tension up your stretch. What tendons respond well to is what’s called eccentric contraction.

If the tendon is shortening and contracting, that’s concentric contraction. But if the tendon is being stretched, and the muscle is lengthening, then that’s eccentric contraction.

It’s the best type of loaded stretch for tendons. The tendon is being stretched, but the whole muscle is lengthening under tension.

The way you do this is to hold a weight and slowly let it drop. You hold the weight behind your head, and slowly let it drop down. Use your other hand to bring the weight holding hand back up again.

Use a small weight – about 500 grams (1-2 pounds.) This type of exercise is best done under care of a physiotherapist or physical therapist who can help you incrementally increase the weight and numbers of repetitions.

When you manage a tendonitis properly, it should settle, although it often takes a number of weeks.. Unfortunately, once you’ve damaged the tendon, it does remain vulnerable, but with proper management, it should settle and you should be able to get back to doing what you would like to do.

If you’re a baseball pitcher or a person using a hammer a lot, or someone doing something recurrently stressful to the tendon, you may find this does interfere with your ability to get back to a highly proficient level. 

Triceps Trigger Points

Lastly, look at trigger points to help relieve tension in the triceps tendon. Trigger points are micro-spasms in muscle, and can be set off by things like a damaged and sore tendon.

Active trigger points in your triceps muscle will keep the muscle tight, putting extra strain on the tendon. This can delay healing, or cause more damage.

The good news is the trigger points are simple and fast to treat. You can have a look at triceps trigger point here, or get started treating trigger points here.

In this article, we’ll look at:

• What causes Tennis Elbow
• Tendonitis vs Tendinosus
• How to Rest a Tendon
• Tennis Elbow Surgery
• Tennis Elbow Surgery Recovery Time
• Tendon Rehab Exercises
• How to Continue to Play Tennis
• Elbow Straps for Tennis Elbow
• Tennis Elbow Injection: Platelet Rich Plasma
• Tennis Elbow Injection: Cortisone
• Trigger Points & Tennis Elbow

What Causes Tennis Elbow?

The tendon that becomes damaged in tennis elbow is the tendon that joins extensor carpi radialis muscle to the humerus. This tendon joins into the the side of the elbow (lateral epicondyle,) and that’s where the tendon becomes damaged.

So whenever you use this muscle to grip and lift, this stresses the tendon and causes pain.

The majority of people who have tennis elbow don’t play tennis, they’re doing some other task which requires them to lift and rotate their wrist.

Tendonitis vs Tendinosus

The thing about treating tendons is that it’s difficult. When you look at them in anatomy studies, tendons are shiny white because they don’t have a good blood supply. (Unlike muscles, which are red and have a great blood supply.)

They do a lot of work, acting as restraining ropes for your joints and muscles. They have to stretch and load up again and again, with very little blood supply.

When they do become damaged, this is a real difficulty. This is especially true when you look at that process of moving from -itis, which is inflammation, into healing.

If you have a tear in your muscle, which has a great blood supply, you have a lot of inflammation and then the muscle heals. It heals beautifully and there’s no degeneration.

But tendons typically move from a tendinitis to a tendonosis (or degeneration.) This means that it hasn’t healed completely.

If you want to give your tendon the best chance of healing, you need to give it a large stretch of time when it’s no longer being stressed.

Relative Rest vs Absolute Rest

The best way to rest a tendon is first with absolute rest, then with relative rest. Every time the tendon is overstressed, it will form new little tears. If you don’t move the tendon at all in the beginning you have absolute rest. The tendon is then able to turn on its healing and all the little areas that have been torn will start laying new collagen fibres in those areas.

As time goes on, (and this is usually after a few weeks,) you then can start to stress the tendon but you need stay underneath the level of tension that would cause micro-tears. Over six to eight to 12 weeks of rest the tendon will improve dramatically.

Tennis Elbow Surgery

Surgery for tennis elbow is a controversial topic. The cynic in me says that the main reason tennis elbow surgery works is that it forces you to stop using the tendon and gives it time to heal.

There are many different types of surgery for tennis elbow, golfer’s elbow and tendinitis conditions.

For most of them, what the surgeon is essentially doing is stimulating healing in your tendon. The usual way to do this is by either scraping or roughing up the tendon to increase blood flow into the area.

Tendonitis Elbow Surgery: Recovery Time

Then, for weeks after this surgery, you rest. You have your arm in a sling, and you do not move your arm. After a few weeks, you slowly start to increase the movement and stress on the tendon.

This rest is a huge aid to your tendon healing. The evidence is still out as to whether the rest is the most important part.

It does mean people with surgery give their tendons the proper amount of rest. Also, the surgery is slightly destructive, and will make your arm more painful to move for quite some time, further promoting rest.

Rehab Exercises: Concentric and Eccentric Loading of Tendons

You can load a tendon in two ways. There is concentric loading. And example of this is doing a bicep curl – lifting the weight up towards your shoulder. The tendon is being loaded up while the muscle shortens. Concentric loading tends to be bad for tendons.

The other kind of loading is eccentric. This is what happens when the tendon is being loaded and the muscle is being lengthened. For example, letting a weight back down – your arm is straightening while you’re carrying a weight. It turns out that eccentric loading is helpful for tendons.

The Alfredson exercises are eccentric loading of the tendon. Alfredson exercises for this tendon are that you support your arm on the edge of a desk. This isolates the wrist. You put your hand around a small weight, just 500 grams. You lift your arm and the weight up with your other hand, to avoid doing any concentric contraction and causing pain and damage to your tendon.

Then you take your hand away and slowly drop your wrist down. When you do this, you’re stressing the tendon, but lengthening the muscle. You’re doing an eccentric contraction, which is known to help strengthen tendons.

You do a set of 10, then rest, then do another set of ten. Do 2-3 sets of ten twice a day, morning and night.

How to Continue to Play Tennis with a Tennis Elbow

Let’s look at tennis player with pain in their elbow, and see why tendonitis happens. Every time a player grips their racket and applies force, the tendon that causes tennis elbow is being stressed.

As you serve, and play backhand particularly, you’re gripping the tennis racket and rotating and lifting your wrist. These are all the movements that set off the pain of an overworked tendon.

There are several other workarounds that can help you continue to play tennis. They all involve changing the forces that act on your extensor carpi radialis tendon.

Here are some workarounds, and you can use some, or all of them:

1. Get a bigger grip on your racket. The larger the area to grip, the less this tendon gets stressed.
2. Change your tennis style so that you don’t have as much pulling up (extension) and rotation when you play your backhand. (Work with a coach on this one if possible.)
3. Move from a single to a double handed backhand, which will take a lot of the stress off the tendon
4. Use a tennis elbow splint (see below)

Elbow Strap for Tennis Elbow

An elbow strap or splint for tennis elbow is a fascinating and very clever thing. It acts as a counter-force brace.

Here’s how it works. As you squeeze, lift your arm and rotate very slightly, you create a very precise pattern of stress in the tendon, causing pain. The counter-force brace is a thick band which you tighten and wrap around your forearm, below the tendon.

You tighten it just enough to not cut off circulation. It should be tight enough so that when you do the movement causing pain, the force going through the strap changes the angle of the stress in your tendon.

It reduces the amount of stress on the tendon by spreading and transferring it into your forearm. This is a surprisingly effective way to reduce stress on the tendon with concentric contraction. This can also aid healing.

Tennis Elbow Injections: Platelet Rich Plasma

How else can you improve the ability of the tendon to heal?

When the surgeon does surgery and roughens up the tendon, essentially what’s happening is increased blood flow into the area.

When I was doing general practice, I would do something called an autologous blood injection. I would take blood out of somebody’s forearm, let it start to clot, then re-injected around the tendon.

This works because the main part of the healing came from the platelets in your blood. The platelets, as they start to activate, send a chemotactic message out.

This message says: “We’ve got major problems, send in the troops into heal this area.” This is what happens after you injure yourself.

If you cut yourself, you start bleeding, but quite quickly the blood forms a clot. Very soon after that, the whole area becomes red and swollen. This is because the platelets’ chemotactic message has turned on inflammation.

Because there’s a not much blood supply to tendons, you get a limited healing response. Therefore, if you take partially clotted blood and inject it around the tendon, this fills the little spaces where they are tendon tears. The partially clotted blood then speeds up healing.

This practice has now been refined. Doctors spin down the blood in a centrifuge. They inject just the platelets and the plasma and in and around the tendon. This centrifuged blood has a higher concentration of platelets.

This type of injection is called PRP – Platelet Rich Plasma. The reason this practice is so safe is that you’re using the person’s own blood, not a foreign substance.

The other reason why it’s often effective is that you’re increasing your body’s natural healing ability, so you get healing with very little risk of side effects.

Tennis Elbow Injection #2: Cortisone

Cortisone injections are now done more than autologous blood and platelet rich plasma. The reason to use cortisone is that it’s fast.

You can have somebody come in with an incredibly painful tendon, you do a cortisone injection around the tendon and a week later that person is your best friend. The cortisone has damped down the inflammation in the area very quickly.

However, cortisone injections are a symptomatic treatment. They’re a treatment that makes the elbow feel much better.

That’s the good news.

Pros and Cons of Cortisone Injections

The bad news is cortisone injections don’t do much for the underlying cause of pain. It’s important to understand that the way you heal is with inflammation. If you do an injection that’s going to damp down inflammation, you’re going to have less pain, but you’re also going to have less healing.

In the long run, if you use cortisone, this can help with extremely sore tendons. (And tendons can get really sore.) A little bit of cortisone in the beginning to quieten things down can be really helpful.

But the traditional use of a big doses of cortisone around inflamed tendons has issues. At the end of six weeks the cortisone effect is reducing. By eight weeks, the pain is back. And by 12 weeks you’re back to square one.

Except you’re worse. You’re back to minus square one because the tendon hasn’t healed, and there’s often more degeneration, because you’ve been using a tendon that really needed to rest.

Other Dangers of Cortisone Injections

The other concern is when you put a fine needle into the area around the tendon, you can easily penetrate the tendon itself. If you inject cortisone into a tendon, you weaken the tendon significantly.

There’ve been many, many stories about people who’ve had large amounts of cortisone injected around the Achilles tendon. Later on the Achilles tendon has ruptured, because too much cortisone reduces the structural integrity of the tendon itself.

Also, if the tendon is no longer hurting (but not healed) people will overuse the tendon. This further slows down healing and causes micro-tears in the tendon, and the degeneration will be more significant.

So, while small doses of cortisone can be useful for short term pain relief, they’re not your best option for long term healing.

Trigger Points and Tennis Elbow

When a tendon is damaged, it’s a long, slow process to heal. Because it’s painful for a long time, the nerves to that area often become sensitized.

This will then send a message to the muscles to protect the area. When you have a damaged tendon, the muscle that supplies that tendon will often go into a protective spasm. It will get very active and tender trigger points.

Trigger points are a neuromuscular response as part of sensitization. They’re small micro-spasms in the muscle which cause pain and stiffness.

It’s very, very common for trigger points to be turned on in muscles where there is a tendonitis. It’s your brain’s way of saying “use this less.”

The other factor is that when a tendon is damaged, you start to use the muscle in a an abnormal way to avoid pain. This changes mechanics of use and can also turn on trigger points. This means you have not only pain from the tendon, but you also have pain from the trigger points.

The pain zone arising from particular trigger points can extend other the tendon that is inflamed or damaged. Part of the pain that you get when you do specific movement (like gripping and twisting) is from the tendon.

But part of it is often from trigger points in the forearm and upper arm muscles.

Healing will occur with giving the tendon a chance to have a rest. Sometimes though, everything can heal, but the trigger points remain. So for full treatment, you need to to look for trigger points in the muscles and treat them as well.

If you have tennis elbow, there will be exquisite tenderness just where the elbow tendon comes in. But if you follow the muscle down, you’ll find trigger points in the muscles of the forearm. When you press on them, the pain goes up into the elbow.

Treating these trigger points will improve some of your pain, and the function of the muscle will improve. Finally, active trigger points cause tightness in the muscle. If the muscles are very tight this increases tension in the tendon, and causes more stress and pain. This is a another way treating triggers gives good pain relief when you have tennis elbow.

If you want to find out more on treating triggers, here’s where to get with a free trigger point manual >>>

Here’s the article with the original story.

And a link to a visual history of pandemics.

Any thoughts, comments, questions – please put them in the comments section below!

If you want to further into Stoic philosophy:

The Daily Stoic – Website

Meditations – Marcus Aurelius

Daily Stoic – Book

Letters from a Stoic – Seneca

Right now, there’s a lot of talk about vaccines. They are been spoken of as the silver bullet, the knight in shining armour that will come and rescue us all. 

So, with all the leading medical companies and educational institutes working on a Covid-19 vaccine, why are most estimates still sitting at 18 months? 

And why are the few companies promising a vaccine by September so controversial?

To get full picture, it’s important to first understand how viruses work, how vaccines are made, and the checks and balances needed for a safe, effective vaccine.

Because, unfortunately, anyone who’s been in the world for some time knows that silver bullets and knights in shining armour rarely work out to be quite so straight forward. 

Here’s the next Antipodes talk on Vaccines and Viruses:

Any thoughts, comments, questions? Please put them below in the comments.

The syndrome has the word functional because there is no underlying organic pathology, meaning there is no disease causing the pain. This is a malfunction of something in your body, causing you to feel this really significant abdominal pain.

This article with look at:

• Diagnosis
• The Four Types of Functional Abdominal Pain
• Treatment Options

How do you know if you have Functional Abdominal Pain Syndrome?

The classic definition is if you have more three episodes of three hours of pain over a period of three months.

Functional abdominal is a complex problem. It involves not only the person but their relationship with the world. There is a, a word that’s used in pain medicine to describe this: bio-psycho-social.

Bio what’s going on in the biology of your body. Psycho is what’s going on in your mind and social is your interaction with the world. Functional abdominal pain is caused by all three of these spheres interacting.

If all you do is focus just on what’s happening in your gut, you miss the bigger picture and are unlikely to get better.

Due to this complex interaction with us and our world, the treatments are complex and multilayered as is the actual assessment and management of the problem.

At the moment there is no agreement between all the experts as to the ‘perfect’ treatment. Instead, you’ll find that there are a lot of options.

In medicine, whenever there are a lot of options, it means each one doesn’t always work, therefore you have to try several before you hit on the one that will work for a particular person. This is the norm for complex problems.

“For every complex problem there is an answer that is clear, simple, and wrong.”

H. L. Mencken

The Four Types of Functional Abdominal Pain

There are four types of functional abdominal pain:

Functional dyspepsia.
Dyspepsia has an old English word, which means [inaudible] sort of discomfort in the upper abdomen, just above your belly button.

This is usually is related to problems with your stomach. Because it comes from your stomach, the pain is not improved or made worse by bowel motions.

Irritable Bowel Syndrome
Irritable bowel syndrome is when your gut become sensitized, and this is the most common type. It becomes irritated and the gut wall becomes more sensitive to changes in pressure.

Normally what happens in your gut is you have a long tube. Food is moved along this tube by a ring that contracts the tube. This ring moves along, pushing the food through the gut. As the pushes food along, the gut in front of the ring relaxes. This is called peristalisis.

The wall inside the gut itself is full of pressure sensors to manage this process. When there is a dysfunction or a malfunction in the gut, the contraction ring starts to move. What should happen is the gut relaxes.

But if somewhere along the gut there’s another contraction, the food is being pushed into an area that’s being stretched. The pressure goes right up there. The little pressure sensors sound the alarm.

And what you feel is this awful, cramping pain in your gut. It’s not due to a disease, it’s caused by a digestive malfunction. The movement of the gut has become disordered and therefore you have these pockets of high pressure. That’s the first part of irritable bowel syndrome.

The part second is that the little nerve endings become more sensitive to pressure over time. And then going up to your brain, you get what’s called visceral hypersensitivity. This is where the nerves start to amplify messages.

These three things work together to make digestion a very uncomfortable process. People with IBS have episodes of intense pain with which are relieved by a bowel motion but then come back.

Abdominal Migraines
Abdominal migraines are a very strange phenomenon that only occurs mainly in childhood. What happens is you get this intense abdominal pain of unknown cause. It’s thought to have nothing to do with the gut but instead is caused by a sensitivity amplification of messages from the gut.

This is sensitization of the nerves supplying the gut. You get this intense pain, which is much more common in children. And it’s often associated with awful vomiting. The child looks terribly ill. Occasionally in children it’s associated with horrible headaches.

What tends to happen is that these abdominal pains go away, and are replaced by migraines. That’s why it’s called abdominal migraine

Abdominal Wall Pain
The last is abdominal wall pain, which turns out to be a really common problem. This can be the primary cause of the person’s pain or may in fact be secondary to other things going on.

What happens in the abdominal wall pain is trigger points get turned on in the muscles of the abdominal wall.

Your abdominal wall is full of strong muscles and you have these tiny areas in the muscle which go into a protective spasm. These can be incredibly sore and refer pain into different areas depending on where the triggers are.

This is called myofascial pain and it is due to trigger points. What happens is that sometimes people have an initial incident like appendicitis or a bowel problem. That gets treated, but they’re left with ongoing pain, which is quite significant and sometimes almost as bad as the original cause.

Often, you’ll find trigger points in the abdominal wall, which can be simply treated for fast pain relief.

Functional abdominal pain is the perfect example of mind body interaction. What we know is that we have a mind, and the mind is billions of tiny little nerves that talk to each other.

As they talk to each other, they use what are called neuro-transmitters as messengers. One of the big messengers in the brain is something called serotonin. Over the last 20 or 30 years, researchers have found a massive, massive network of nerves right throughout the gut.

This is now being called the brian in your gut. And it produces far more seratonin than the brain. So this idea of the mind and body being separate is quite innacurate.

Once you start seeing this connection, it’s clear how things that affect your brain, like family life, academic pressure, life events, work stress, and social pressures will cause different messages to be sent down to your gut.

These messages that come to your gut can cause the movement of your gut to become wound up. Most people remember going for an exam and feeling a stomach cramp. Stress itself sends messages down to the motility in your gut and which can cause malfunction. You may get areas of pockets of high pressure and then the nerves that relay message between your mind and your gut will become sensitised.

All of this can come together to cause these episodes of significant abdominal pain, for which there is no organic cause.

Treating Functional Abdominal Pain

Remember I said before, there is no one treatment that works for everyone. Instead, there are many approaches that are tried.

The most important thing is to first identify any red flags. If you look at abdominal pain, there’ll be a small proportion where there is something significant going on.

From a medical point of view, you would be looking for blood in your bowel motion, weight loss, and other signs that there is inflammation in the gut. This is how you eliminate problems like cancer or an infection.

All of these things can be ruled out by fairly simple tests: blood tests, bowel motion tears, urine tests, a colonoscopy, or some very simple imaging, maybe ultrasound, uh, something like that.

Once these have been ruled out (and it’s only a small proportion of people who have them,) then you need to look at functional abdominal pain as the cause.

Understanding the complex bio-psychosocial picture that’s actually turned on the pain is vital, because then you can make the right treatment choices.

Cognitive Behavioural Therapy
The treatment that’s been shown more than any other to make a difference is what’s called CBT, or cognitive behavioral therapy treatment.

First, you need to understand your previous responses to the stresses of life, your beliefs, and the things that drive you. Next, you work to change your responses.

You have to let go of unhelpful and limiting beliefs, and learn how to cope with the stresses of life, without them affecting your gut. As you start to do that, the gut will start to become happier.

The FODMAP Diet
There are other treatments that have made a difference for irritable bowel syndrome. There’s the FODMAP diet. FODMAP is an acronym for a diet which eliminates short chain sugars. These increase the amount of gas that’s produced during digestions, and cutting them out makes your gut less irritable.

The FODMAP diet will exclude a whole lot of things from your gut which are surprising until you understand that they all have these little short chain sugars.

Other helpful treatments are taking probiotics and increasing fiber in your diet. There has been one study showing that peppermint oil as a soother was useful.

Simple painkillers like paracetamol can help a bit, as well as protein pump inhibitors, and powerful antacids can sometimes help.

How You Cope with Stress

The biggest thing is understanding the relationship between how you respond to the stresses in your life, and how your mind and your gut affect each other.

The majority of of children get grow out of functional abdominal pain. But about one third it can become a major life problem, which requires a lot of treatment.

People with functional abdominal pain have a higher risk of this changing at some stage into an inflammatory bowel disease. These are diseases like Crohn’s or ulcerative colitis.

Therefore, the other important thing is that if you learn to live with your chronic abdominal pain and then it becomes more severe, you need to have that investigated.