Sleep, Chronic Pain and Our Biological Clock

Sleep, Chronic Pain and Our Biological Clock


SleepDeprivation_0Pain and sleep are integrally connected. A person’s quality of life and health can be disrupted due to many different reasons; like diet, activity level, and stress. However, one important, yet underestimated cause of a person’s reduction in quality of life, can be contributed to sleep loss or not enough restorative recovery.

Over the course of the last several decades, the modern worlds working hours have been consistently increased, along with an emphasis on active leisure, and “more” is typically seen as being better.

Depending on your profession, in some designations, people face sleep restriction. Professions; such as health care, emergency response and security and transportation require working varied shifts and often rounds of night work. In these fields, the effect of acute total sleep deprivation (SD) on performance is crucial and possibly life threatening. Furthermore, on average, in almost every profession, people tend to stretch their capacity and compromise their nightly sleep, thus becoming chronically sleep deprived. On a neurological level, this changes a persons biochemical, biological and psychological health. Thus, increasing risk for mental illness, chronic pain and disease.

What The Stats Tell Us:

In the adult population, about 15% of those surveyed report experiencing chronic pain. Nearly 50% of older adults have insomnia, have difficulty in getting to sleep, early awakening, and/or feeling unrefreshed upon waking. As we age, several changes occur that can place one at risk for insomnia, and less than restorative sleep; including age-related changes in various circadian rhythms, environmental and lifestyle changes, and decreased nutrients intake, absorption, retention, and utilization.

In all age groups, those who suffer from insomnia and consistently achieve less than restorative sleep show memory weakness, increased reaction time, decreased fine motor skills, short-term memory problems, and lowered efficacy levels.

A lack of sleep and restorative recovery can be more problematic in elderly subjects, because it puts them at higher risk for falling, cognitive impairments, weak physical function, and mortality. Not to mention, not getting enough sleep takes time off our life span. There’s a reason, our body tells us when it needs a time out to re boot, filter and process daily existence.

Minerals Count:

In order to have a restorative sleep, we must have the right percentage of calcium and magnesium present in our system. This directly relates to cell formation and re generation, as well as key processes in our body.

Magnesium: Plays an essential role in ion channels conductivity, such as N-Methyl-D-aspartic acid (NMDA) receptor, and unilateral entrance of potassium channels. Therefore, magnesium as a natural antagonist of NMDA and agonist of GABA is critical in sleep regulation.

Magnesium is the fourth most abundant cation in the body and the second most abundant intracellular cation. It is involved in more than 300 biochemical reactions of the body.  Magnesium is an essential cofactor for many enzymatic reactions, especially those that are involved in energy metabolism and neurotransmitter synthesis. It contributes to teeth and bones as well as activating enzymes, contributing to energy production, and helps regulate calcium, copper, zinc, potassium, vitamin D, and other important nutrients.

Calcium: Does not work alone in your body. It requires vitamin D, parathyroid hormone and healthy saturated fat in order to be utilized for strong bones, teeth and muscles. Nerve cells have calcium channels that act like gates in their membranes, regulating calcium flow in and out, triggering each cell to take action.

Bone health not only requires calcium, but an array of other vitamins, minerals and hormones to complete that process.  Another notable amino acid in sleep regulation is Tryptophan; which your brain uses to make serotonin and melatonin. These two substances are neurotransmitters that slow down nerve transmissions, relaxing your brain and body and encouraging deep sleep.


Sleep & Chronic Pain

Pain triggers poor sleep; we shift around, can’t get comfortable, and thus can’t fall or stay asleep. For instance, someone experiencing lower back pain may experience several intense microarousals (a change in the sleep state to a lighter stage of sleep) per each hour of sleep, which lead to awakenings.

Pain is a serious intrusion to sleep. Charles Bae, MD, a neurologist in the Sleep Disorders Center at the Cleveland Clinic in Ohio, puts it this way: “Pain can be the main reason that someone wakes up multiple times a night, and this results in a decrease in sleep quantity and quality, and on the flip side, sleep deprivation can lower your pain threshold and pain tolerance and make existing pain feel worse.”

The body’s has a built-in circadian clock, which is located at the center in the hypothalamus in the brain. This is the main mechanism that controls the timing of sleep, and is independent of the amount of preceding sleep or wakefulness. Therefore, it is no wonder that people who experience chronic pain, adrenal fatigue or other auto immune diseases have trouble sleeping. The Hypothalamus is one of the most important organs related to regulation of body systems and re generation of cell formation.

Circadian Rhythm & Sleep:

When considering the effects of sleep loss, the distinction between total and partial SD is important. The need for sleep varies considerably between individuals; averaging sleep length is between 7 and 8.5 h per day. Sleep is regulated by a two-part process that adjusts to the body’s needs every day. This two-part process is known as the homeostatic debt and the phase of your circadian rhythm.

The homeostatic process depends on sleep and wakefulness; the need for sleep increases as wakefulness continues. This homeostatic debt increases as a function of how long you have been awake and decreases as you sleep.

The second process that greatly influences the onset, of sleep and the duration, and quality of your sleep is the phase of your circadian rhythm. This phase is governed by your biological clock, whose rhythm is endogenous but is reset regularly by daylight, but deeply affected with inadequate amount of sleep. Studies show, that the circadian rhythm dips and rises at different times of the day. In adults, the strongest sleep drive generally occurs between 2:00-4:00 am and in the afternoon between 1:00-3:00 pm

The interaction of these two processes determines the sleep/wake cycle of a person and can be used to describe fluctuations in alertness, performance, energy levels and cognitive functions.

To perform at your best, achieve your dreams and reach your goals, ensure sleep is restorative recovery is part of your daily optimal well being plan.

Chronic Pain Series Part 4: Bridging the Gap Between Childhood Abuse & Adult On Set of Chronic Pain

Chronic Pain Series Part 4: Bridging the Gap Between Childhood Abuse & Adult On Set of Chronic Pain

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Living with chronic pain can be a highly frustrating, confusing and stressful experience; which can ultimately to lead to psychological distress, a higher risk of mental health factors and lower quality of life overall. Although bio-medical factors set in motion initial pain diagnoses for treatment, it is clear that psychological factors, our mental state and our past experiences around pain can significantly contribute to the development, exacerbation, and process/ pathway pain takes in our mind and body. Thus it also goes without saying that the maintenance and potential treatment paths must also take into account the biochemical, bio-mechanical and bio psycho-social models as well  to adequately offer clients with chronic pain the availability for recovery from chronic pain.

Over the course of the last several weeks we have looked at chronic pain and the associated links with mental health. Looking at a broad scope of potential risk factors in an attempt to better understand how we diagnose, the metrics we currently use and where we might bridge gaps in our systems, and offer people in pain more availability to resources and community support.

Successful management of chronic pain depends on a multidimensional assessment, taking into account both the objective and subjective metrics of analyses. To increase the likelihood of successful treatment outcomes, it is important to understand, assess, and treat contributing factors to the development of chronic pain disorders, and potential barriers to recovery of function – all to improve their quality of life.

In today’s post we look at the 4th installment of this Chronic Pain Series which looks to briefly link chronic pain in adults and the linkage to childhood abuse and neglect.  While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature.

Child Abuse: It’s in the Stats

  • 1 in 3 females and 1 in 6 males in Canada experience some form of sexual abuse before the age of 18.
  • 80% of all child abusers are the father, foster father, stepfather or another relative or close family friend of the victim.
  • 35% of girls and 16% of boys between grades 7 – 12 had been sexually and/or physically abused
  • Among girls surveyed, 17-year-olds experienced the highest rate of sexual abuse at 20%

The impact of child abuse is often discussed in terms of physical, psychological, behavioural and societal consequences. However, in reality it is impossible to separate them completely. The impact of physical consequences can result in trauma or injury to the brain, and psychologically, abuse can result in cognitive delays or emotional difficulties. Our experiences as children shape our belief systems and how we start to understand our place in the world, When violence is a part of this belief system, it alters our growth and development – both from the point of view of the biopyschosocial model, but that of our internal representation in the world.

There are a number of pathways by which early life abuse, neglect and maltreatment could contribute to the development of pain disorders in adulthood. For instance, abusive childhood experiences can often manifest in high risk behaviors and can contribute to the development of negative psychosocial characteristics (depression, anxiety, anger, and social isolation). These in turn can lead to long term physical health problems like; cancer, diabetes, sexually transmitted disease, alcohol or drug abuse, eating disorders, mental illness – the list is endless.

Battered Women's Support Services Logo

Battered Women’s Support Services Logo

Surviving Child Abuse: My Long Road to Recovery

“I was 6 years old the first time my mother’s second husband hit me.  I had left an empty Popsicle wrapper on the table, and forgot to put it in the trash. The memory of how this event shaped is still a bit fuzzy, but what I do remember was my first real and raw understanding of what fear, anxiety and no longer feeling safe feels like – the only word that comes to mind is the word “shattered”. What I do remember is hearing screaming behind me, anger I had never known and as I ran up the stairs blindly grabbing at the carpet, he dragged my 6 year old body back down the stairs – kicking and screaming, my body flailing.  I remember being thrown into the spare bedroom.  It was dark, there was a chill in the air, I was hot, the salty taste of my tears and my body shaking uncontrollably.

I scrambled on the bed, the screaming was deafening, not sure if it was my screaming, or my mother’s as she knelt in the doorway pleading with him to stop, or it was the rage of my step father that was deafening. All time seemed to slow down and stop.  Then I felt something hit the side of my head, a hit hard enough to send me flying off the bed and into the side wall. I remember tucking myself into the fetal position, my face hot, on fire, sweaty, shaking, my head pounding, my heart beat in my ears – it’s too loud. I could taste iron – was that what blood tastes like? The screaming, it wouldn’t stop. Then he left; and told me, lights off and to not come out until I was ready to be “good,” he left. I was alone, I could hear my mom sobbing. I felt shattered. That day forever changed our lives and it was not the last of it’s kind. I felt alone. I became silent. The child in me was no longer present. I was split in half. 

Needless, to say, I no longer enjoy orange Popsicle’s. 

I stayed in that room for what seemed like hours, laying on the floor, trying to understand what had just happened. Trying to understand why someone who said they loved me and my mother would cause such pain and fear. At the age of 6 – nothing, none of this makes any sense and it re defines, it re shapes how you see the world and your place in it. From that moment on, I slept with a night light on, I had a backpack ready by my bedroom window, a crayoned route to my biological father’s house and I slept with that widow cracked open, even in the winter in case my cat and I had to escape. No child should ever have a mapped out escape route from their own home. 

After that day, the abuse, the anger would continue for 9 long years. I would witness him hit my mother, fight with her, knock her down; physically, psychologically and spiritually. Over the years she became less and less the strong, vibrant mother I knew – and more of a woman fighting for her life, running from her demons. He controlled her actions, she lost friends, she rarely went out, she drank, he made her do cocaine with him, watch porn. I was 12, these are not journal entries a 12 year old child should every write. I should be writing about boy crushes, girl guides or sleep overs with friends, but even though all those things happens, I would write about this f***ed up stuff. Because it is – my life’s diary of endless ramblings. He was a sexual predator. For 9 years, I was slapped, spanked, stripped naked, whipped with a belt. My mother screaming as he “disciplined” me. He would come into the bathroom, when I was showering or bathing. He let his friends hit on me and womanize my mother and I.  At the age of 14 when we lost our home to debt, I convinced my mom to leave him. Him or me. I became the parent. I got 2 jobs in high-school, she got a restraining order and when the divorce was finalized – the healing began. Humpty Dumpty sat on a wall, Humpty Dumpty had a great fall. All the kings horses and all the kings men, couldn’t put Humpty Dumpty back together again. Where does one find the strength to go on? to move forward? to have faith that yes, life can be better? These were my ramblings from a therapy session as a youth. I was 16.” – Sarah Jamieson

Triumph Over Tragedy:

I tell this story in detail because stories, like mine, need to be told. We cannot sugar coat them. They need to be heard and the silence needs to be broken. Abuse is what started the downward spiral of my mother’s mental illness – a two decade long battle with her demons, her manic depression – later turned- bi polar disorder and addiction. For me – I turned to running as a way to process and understand “what the F*** had happened to me.” In all our trauma, my mother never got angry with me, she was always loving and even at a young age, I knew I was the glue that had to hold it all together. This burden turned out to be my most valued lesson.  In my mother’s passing from accidental suicide; I have learned that in my own silence there can be no full healing. I choose to not only speak for myself, but to pay tribute and honor to my mother’s memory by telling her story of courage.

As an adult, I have had decades of therapy to better understand the long term effects of my childhood abuse and chronic pain has been one of them. I have suffered from back pain for nearly a decade. Most of my therapy has been a combination of therapeutic movement found in Yin Yoga, Fascial Stretch Therapy, SomaYoga, Osteopathy, IMS and my appreciation of both running and flow state martial arts and strength training. The real healing comes from the self discipline of re defining and re connecting with loving yourself, trusting yourself and the process and as Brene Brown called it “Gremlin – Ninja-Warrior-Training” to “Dare Greatly.” 

The reasons why some children experience long-term consequences of abuse while other’s emerge relatively unscathed are still not fully understood. The ability to cope, and even thrive, following a negative experience is what we call “resilience.” I feel fortunate that I had a number of protective and promotive factors that contributed to my ability to hold my sh*t together. My resilience – I can only say is part of my DNA. My father has always been instrumental in my life and my mother even at her worst, loved me unconditionally. My psychological body (for the most part) seems to be intact, but my physical body has always had pain (understanding that in essence these two are not separate at all). It is a continued journey I walk every day, there are good days and bad days, there are still nightmares, but also memories of love. It is a life long journey of understanding and acceptance and I find solitude in service to others.”

Study by Arizona State University: 

Evidence suggests that childhood abuse may be related to the experience of chronic pain in adulthood. In a study performed by Arizona State University, the group used meta-analytic procedures to evaluate the strength of existing evidence to showcase the association between self-reports of childhood abuse and chronic pain in adulthood. Analyses were designed to test the relationship across several relevant criteria with four separate meta-analyses.

Results of the analyses are as follows:

(1) Individuals who reported being abused or neglected in childhood also reported more pain symptoms and related conditions than those not abused or neglected in childhood. When a child has broken bones, fractures, are shaken (as in shaken baby syndrome) it changes the physiological nature of growth and development. Scar tissue can build up, resulting in altered biomechanics later in life etc.

(2) Patients with chronic pain were more likely to report having been abused or neglected in childhood than healthy controls. A variety of somatic symptoms are consistently found to be higher in adults with a history of physical or sexual abuse compared with those without an abuse history.

(3) Patients with chronic pain were more likely to report having been abused or neglected in childhood than non-patients with chronic pain identified from the community.

(4) Individuals from the community reporting pain were more likely to report having been abused or neglected than individuals from the community not reporting pain. Results provide evidence that individuals who report abusive or neglectful childhood experiences are at increased risk of experiencing chronic pain in adulthood relative to individuals not reporting abuse or neglect in childhood. (1)

Adult Onset of Chronic Pain Shows Links to Childhood Abuse:

How specific types of abuse alone or in conjunction with other variables may lead to any of these conditions is unknown, although measurable abnormalities in major physiological regulatory systems (hypothalamic-pituitary-adrenocortical axis and autonomic nervous system) have been found in some adults with a history of abuse.

Fight or flight; are our natural survival mechanics of the human species. Childhood abuse can showcase severe deficiencies in the ability to effectively self-regulate emotion resulting in inappropriate perceptions of threat and exaggerated fight-or-flight responses and this alarm can stay on from childhood to adulthood. Much like the alarm of chronic pain – the nervous system and pain receptors just won’t shut off.  Many studies have reported de-regulated neuroendocrine responses in abused children and adults with a history of childhood abuse. When these self-governing pathways are disrupted they can promote pathophysiology in the body; which increases the vulnerability to the development of a chronic pain disorder and potentially interfering with recovery, and/or prolonging the process.

Childhood abuse survivors reported more adult traumas, and demonstrated greater neuroendocrine stress reactivity, suggesting physiological sensitization to stress and higher risk of stress-related illnesses.

In a publication called “The Long-Term Health Outcomes of Childhood Abuse;” at “The National Center for Biotechnology Information” states childhood abuse has been associated with a plethora of psychological and somatic symptoms, as well as psychiatric and medical diagnoses including depression, anxiety disorders, eating disorders, posttraumatic stress disorder (PTSD), chronic pain syndromes, fibromyalgia, chronic fatigue syndrome, and irritable bowel. Compared with non-abused adults, those who experienced childhood abuse are more likely to engage in high-risk health behaviors including smoking, alcohol and drug use,and unsafe sex; to report an overall lower health status; and to use more health services. Viewing these various health conditions and behaviors as the outcome and abuse in childhood as the exposure, many of the criteria for a causal relationship are met.

This publication found that in at least 3 meta-analyses on the effects of childhood sexual abuse find clear and convincing evidence of a link between such abuse and a host of adult psychological symptoms. Retrospective studies also show that childhood abuse has consistent effects on first onset of early adult psychopathology. For example, performing structured interviews in a random community sample of 391 women, Saunders et al. found that 46% of those with a history of childhood sexual abuse, compared with 28% of those with no abuse, had experienced a major depressive episode. Women with such abuse also had significantly greater lifetime prevalence’s of agoraphobia, obsessive-compulsive disorder, social phobia, sexual disorders, PTSD, and suicide attempts than women without such abuse. MacMillan et al., in a community survey of 7016 men and women, examined lifetime psychopathology risk in adults who experienced either sexual or physical abuse as children and found anxiety disorders and depressive disorders to be significantly higher in both men and women with a history of either physical or sexual abuse.  (3)

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Our Healthcare System: Bridging the Gaps

The need for more visible research that will reach physicians who provide the bulk of front line health care is underscored by failure to give even passing mention to the well-documented link between adult depression and childhood abuse in a recent review on depression in the New England Journal of Medicine. (3)

In Canada, 18% of women over the age of 12 experience chronic pain, as compared with 14% of men.34 Chronic pain is one of many serious long-term health consequences of intimate partner violence (IPV). British Columbia plays a significant role in research and development outlining the current scope of these linkages from chronic pain, trauma and abuse (both childhood abuse and partner/ family violence).  A publication in the Journal of Pain, Vol 9, November 2008 in an article called “Chronic Pain in Women Survivors of Intimate Partner Violence “ found that according to the national prevalence survey of women’s experiences of specific acts of physical and sexual violence by a male partner,  30% of Canadian women are affected in their lifetime. These stats have not changed much in the last 5 years. Domestic violence and abuse still affects 1 in 4 women in North America and according to police statistics more than 60% of daily calls are domestic abuse related.

Chronic pain can affect people of all ages. In Canada, one in five people suffer daily from chronic pain. It is a ‘silent epidemic’. As a member of the board at Pain BC, a local non-profit organization based in Vancouver BC, our role in the community is to help bridge these gaps and to empower both patients and our health care providers and healthcare system to make chronic pain a higher priority on our national agenda. We do this through fostering an inclusive community and educating on the multi tiered scope of chronic pain. We have a shared passion for reducing the burden of pain and for making positive change in the health care system in British Columbia. If you’d like to be part of reducing the burden of pain in BC, get involved.

Learn More: Some of my Top Support Links

More information on how to recognize abuse and to report suspected abuse, and a range of child-welfare and child-protection resources can be found at:

Battered Women’s Support Services:

Kids Help Phone:



(1)    Are Reports of Childhood Abuse Related to the Experience of Chronic Pain in Adulthood? A Meta-analytic Review of the Literature  by Debra A. Davis MA, Linda J. Luecken Ph D*, and Alex J. Zautra Ph D at Arizona State University –

(2)    Preventing Childs Abuse is Everyone’s Responsibility:  BC Newsroom, April 5, 2013: Sheldon Johnson, Ministry of Children and Family Development

(3)    “The Long-Term Health Outcomes of Child Abuse;” by The National Center for Biotechnology Information:

(4)    “Chronic Pain in Women Survivors of Intimate Partner Violence;” The Journal of Pain, Vol 9, No 11 (November), 2008: pp 1049-1057

(5)    Canadian Children’s Rights Council –

(6)    Pain BC –

Chronic Pain Series Part 3: Disarming PTSD & Occupational Stress Injuries

Chronic Pain Series Part 3: Disarming PTSD & Occupational Stress Injuries



What is subjectivity? 

Subjectivity, is a term used to determine a person’s perception, experience, feelings and beliefs. Most often, when it comes to chronic pain and mental health screening the “subjectivity” and indicators of risk, are still a large grey area and can be “subject” to interpretation.  Why? Because the reality is – the only person who can truly know 100% how you feel, how an experience has affected you – is you, and you alone. The rest is objective; as health care providers we make the most appropriate call we can based on our assessment; and this is where the grey area resides.  As much as subjectivity is a process of individuation, it is equally a process of socialization, taking into context the cultural environment, and the experience of interaction with people, places, and events.  These things change a person, and the debate on the best way to form a SOP (standard operating system) for diagnosis, treatment, prevention and programs is one hot topic that continues to be an on going theme in my research.

Over the last several articles,  introducing chronic pain, we have used the term `biopsychosocial model;` (bio) means biological, psycho (means psychological) and social (means environment); all of which refers to the body`s physiological, adaptive response to fear, pain and our environment. This model is the cornerstone of my research and although some of us may be born with a biologically determined, heightened sensitivity to stress, this fact alone is insufficient to create an anxiety disorder or even a precautionary risk factor for occupational stress indicators. Yet, it can give us great insight into being more receptive to persons who many be at risk. For instance someone who has had a long standing degree of child abuse, may be greater risk for depression or PTSD if he or she takes on a role involved with law enforcement, social work or combat… or on the flip side, it could be a leading reason they excel at these professions if they have the right coping strategy and insight. Again… there’s that grey area again. There has not been enough data collection to support either side.

Let’s review that model again’ the psychological factors in the biopsychosocial model refer to our thoughts, beliefs, and perceptions about ourselves, our experiences, and our environment. These cognitive patterns affect our perceived sense of control over our environment, and affect the way we assess and interpret events as either threatening or non-threatening; which are highly subjective.

Chronic Pain & PTSD:

Chronic pain and mental health screening, diagnosis, and pathways to direct treatment, are not yet fully standardized in our medical system, but, we have made much progress over the last decade with more health care providers looking at the integrated approach towards programs and services for people living with pain and people with dual diagnosis with mental health or trauma.

In an article written at the United States Department of Veterans Affairs, titled “ The Experience of Chronic Pain and PTSD: A Guide for Health Care Providers,” states a current PTSD prevalence of 35% was seen in a sample of chronic pain patients, compared to 3.5% in the general population. Trauma is not just physical or mental, it is both; all encompassing.

The human body and brain are one of the most complex and quantifiable conundrums, because there is still so much we do not yet understand about why one person can experience chronic lasting pain and another does not. Or, for the purpose of our discussion topic day; why one person can experience a traumatic event and suffer from PTSD, while another does not. It is a question that remains unanswered.

What is PTSD & OSI?

PTSD (Post Traumatic Stress Disorder) is a serious potentially debilitating condition that can occur in people who have experienced or witnessed a natural disaster, serious accident, and sudden death of a loved one, war, violent personal assault such as rape, or other life-threatening event. It can leave the person feeling intense fear, anger, and hopelessness.

Operational Stress Injury (OSI) is best described as any persistent psychological difficulty resulting from operational duties performed while serving in the Canadian Forces or in law enforcement or any emergency response profession. Difficulties may occur during combat duties, after serving in a war zone, in peacekeeping missions, or following other traumatic or serious events not specific to combat.

While it is considered normal to experience some form of distress after being exposed to a traumatic event, for some individuals, the symptoms persist. The long-term consequences can include, but are not limited to problems with interpersonal functioning, cognitive and biopsychosocial functioning, mental health  disorders, as well as substance abuse disorders, affective disorders, anxiety disorders, eating disorders, and conduct disorders.

More importantly, for those in professions where high stress is part of the nature of the job, like in military or law enforcement, coming out and saying “I may have PTSD” can seem like a great blow to the ego. Much like mental illness or chronic pain… PTSD comes with a label and the stigmatization attached to that label.


The Multi-Method Model: Screening 101

Psychologists and Psychiatric doctors are taught early in their training that assessment of human behavior and emotion is best done within a “multi-trait, multi-method” model.  The bases for this model are (a) the human condition, and (b) statistical limitations on measurement. As care providers we have a difficult time ascertaining the accuracy of patients’ pain severity, because of the nature of subjectivity. This can include chronic pain or mental health indicators. The body’s pain receptors or neuroplasticty just feels pain… it cannot differentiate between physical or mental always.

How do we really know when someone has an occupational stress injury or PTSD? We know that chronic pain, mental health and possible disability that often comes with it can lead to a cognitive reevaluation and reintegration of one’s belief systems, values, emotions, and feelings of self-worth and self responsibility , more importantly,  how one feels about the capability of performing their job and living their life.

Assessing PTSD can be tricky and it takes time and patience.  Measures vary in their sensitivity, specificity, and clinical utility for different settings and populations. Time permitting, the use of both self-report and interview-based assessments is recommended.  Health care providers generally assess by administering cognitive and physical examinations, having patients perform various tasks, if chronic pain is an indicator they could include exercises that help the provider evaluate the patient’s strength, flexibility and reflexes. When it comes to assessing mental health or PTSD risk factors, these exercises can range from one on one interviews where the professional looks for behavioral markers, assesses mental acuity, emotional triggers and cognitive thought processes.

Despite all of our understanding thus far on both chronic pain and mental health, the relationship between traumatic event exposure and adverse emotional or mental triggers/ affects remains still a very large grey area. Despite efforts to fully understand the relationship between traumatic event exposure and adverse mental health outcomes, our ability to quantify why only some trauma-exposed individuals become emotionally affected remains challenged.

Canada Steps Up:

Canada has some of the top tiered standard operating systems in North America, yet as a whole we can only train our officers so much, we can only prepare them so much and it is only until they are placed in real life situations can we truly know if PTSD or mental health risks will be a factor. Over the course of the last half decade Canada has been recognized as a world leader in fighting stigmatization and raising awareness of mental health illnesses.

In fact, through the Canadian Armed Forces, we have the greatest ratio of mental health care workers to soldiers in NATO, however most of what we now know and have implemented has been post deployment and is still a work in progress

Historically, PTSD has been associated with military personnel and the traumatic experiences involving combat and warfare situations, as well as emergency responders such as law enforcement and fire and rescue, but this can occur in any individual who suffers some form of trauma. The prevalence of PTSD is substantially elevated in patients with chronic pain, which is no wonder, as we know the nervous system cannot differentiate stress from the mind or body, all it feels is pain and stress. Officers that are on the front lines, are injured in battle or have had to be deployed for long periods of time have a higher degree of risk for both PTSD and chronic pain. Combat changes people, and pain changes people.

Many officers in law enforcement who are involved in confrontation, who have to work long shifts, operate on little sleep and have to deal with the worst of people’s worst days, day in and day out, also have a higher risk because of the nature of the job. This is not rocket science; and even though it has been very slow, the government is finally recognizing the need for greater resources and prevention nationwide.

The Canadian Armed Forces: Standing at The Front Lines

The first Operational Traumatic Stress Support Centre (OTSSC) opened in 1999. “ Lessons learned about psychiatric casualties from World War I (shell shock) and World War II (combat exhaustion, which comprised up to 25 per cent of all casualties in the Italian campaign) had been forgotten by the Canadian Forces (CF) by the time they were engaged in the first Gulf War in 1991.” Wrote Greg Passey, MD, CD, FRCPC  (1)

Canada’s role in the Afghanistan War began in late 2001; where we sent first Canadian soldiers secretly in October 2001 from Joint Task Force 2, and then the first contingents of regular Canadian troops arrived in Afghanistan in January–February 2002.  At the height of the war, during 2006, the high level of casualties and injured troops was overwhelming. Since then, the Canadian Armed Forces has made leaps and bounds in providing officers with necessary resources; however, many say there are still not enough professionals to go around. Even though all recruits must undergo rigorous screening both physically and psychologically prior to and post deployment, there are not enough operational stress injury clinics outside of the main facilities.

In 2011, the Canadian Forces released a study noting that of 2,045 randomly chosen personnel who served in Afghanistan between 2001 and 2008, eight per cent were diagnosed with mission-related PTSD. An additional 5.2 per cent were diagnosed with Afghanistan-related mental health disorders other than PTSD, like depression. (1)

In an article written by CTV news, dated July 20th 2011; by Dr. Greg Passey, who is a trauma psychiatrist and a former military medical officer, says the situation (PTSD and suicide) is all too common.  He says despite all the progress that has been made in raising awareness of PTSD, the stigma is still there and is a huge obstacle to overcome for many people in and out of the military.

“There remains a lot of misperception and ignorance within the military in regards to issues like post-traumatic stress disorder. They’re often viewed as people who are disciplinary problems,” Passey told Canada AM in this article.

Even the term ‘mental health issues,’ is stigmatizing, because it doesn’t speak to the severity of the illness, nor does it produce metrics to use for treatment. The brain is a physical organ. It has physical abnormalities and diseases processes and injuries. And so we should be talking about brain disorders. While they’re in the military, the resources aren’t too bad. The difficulty is once they’re released. And the reservists who have to depend on civilian resources; they can get lost.” (2)

He goes on to say that even with the recent recognition of PTSD, there are still not enough psychiatric resources and professionals to go around. The situation can become worse once a soldier retires or is discharged because they leave the support system.

In 1991, the majority of military psychiatrists at that time were centralized at the National Defence Medical Centre in Ottawa. Members of the military requiring assessment or treatment had to travel to Ottawa, which added to the stigma of mental health diagnoses. However, since 2006, the CAF has structured operational stress injury clinics all over Canada, all of which provide assessment, treatment, prevention and support to serving CAF members and Veterans. Each OSI clinic operate on an outpatient basis only and include one-on-one therapy sessions and group sessions to address PTSD, and mental health indicators and other issues that are occurring as a result of experiencing one or more traumatic events. Even though the CAF has made many changes and additions to support their troops; there needs to be a higher political agenda pushed forward and pushed up the food chain at the health care systemic level. (1)

Law Enforcement:  In The Line of Duty

At the JIBC (Justice Institute of British Columbia), all new recruits undergo block training where they prepare for the stressors and are offered courses/materials to better understand the complexities they could encounter on the job. They offer classes like; critical incident and stress, acute reactions to trauma and grief, incident reduction, front line workers guide and a all supported by the Public Safety Library. This relates to both law enforcement and fire and rescue candidates.

All new recruits with the Vancouver Police Department (VPD) are offered a health and wellness workshop style day at Copeman Healthcare, one of Vancouver’s leading private healthcare facilities; and home to my employer with Fit to Train.

New recruits come to Copeman Healthcare center and are offered preventative tools to ensure their optimal physical and mental health are looked after. Speakers from the physiotherapy and Kinesiology department, as well as the medical and psychology fields speak on topics related to long term health and law enforcement. Dr. Mackoff; a Registered Psychologist consults to a number of police departments both in Canada and internationally. As a psychologist Dr. Mackoff treats individuals experiencing difficulties with anxiety, trauma, depression and relationships. Dr. Mackoff has an interest in providing psychological assistance to individuals who are coping with health related difficulties

The RCMP’s Occupational Health Services, have specialized health practitioners who screen and monitor all members to identify mental health risks, as well as OSI clinics all over Canada, close or within detachments. RCMP officers have direct access to Canadian medical and psychological practitioners of their choice; inclusive of general physicians, psychiatrists, and community-based psychologists; asll of which fall under the RCMP’s Health Care Entitlements and Benefits Programs.

In October 2012; the Ontario Ombudsman released a report, “In the Line of Duty” in which was an investigation into how the Ontario Provincial Police and the Ministry of Community Safety and Correctional Services have addressed operational stress injuries affecting police officers; where 34 recommendations were outlined.

Much like the RCMP the OPP found that one of the obstacles facing police is that the force has not done any significant research into the OSIs among its officers, that the periodic screening is voluntary and there is a high level of stigma associated with OSI.

In the BOLC “Badge of Life Canada” online blog; they featured 2 of those recommendations (3) :

Recommendation 1:

The Ontario Provincial Police should take additional steps to reduce the stigma associated with operational stress injuries existing within its organization, including:

  • conducting a comprehensive review of its education, training, peer support, employee assistance and other programming related to these injuries

Recommendation 2:

  • consulting with experts, police stakeholders, the Canadian Forces, Veterans Affairs Canada, and other police organizations
  • researching best practices relating to addressing operational stress injuries in policing; and
  • developing and implementing a comprehensive and co-ordinated program relating to operational stress injuries. Subsection 21(3)(g) Ombudsman Act

Furthermore, a study from Carleton University found that officers in Canada are facing greater pressures at work that may be taking a greater physical and mental toll on police than previously believed.


A PTSD Mobile Coach:

The use of technology has also been a great turning point in chronic pain and mental health. The new OSI mobile app is a new channel for Veterans and serving personnel in the Canadian Armed Forces and the RCMP to get information and resources on operational stress injuries.

The PTSD Coach Canada app is designed to help you learn about and manage symptoms that can occur after trauma. Features include; reliable information on PTSD and treatments that work, tools for screening and tracking your symptoms, easy-to-use tools to help you handle stress symptoms, direct links to support and help and is always with you when you need it. Form more information please visit this (link).


A Local Hero: Captain John Croucher, PPCLI officer working at 1CMBG

This is a story that deserves its own headliner, its own article. Captain John Croucher’ otherwise known as “The Sir,” to his men served in Afghanistan in 2006. The platoon captain of the 1st Battalion, Princess Patricia’s Canadian Light Infantry; who on May 25th, 2006 was severly injured after an he and his 20 officers, and their LAV was struck by an IED. The third to hit Alpha’s second platoon, or the 1-2 as it’s called; Capt. Croucher underwent eight surgeries at three different hospitals in three different countries, first in Afghanistan at the Canadian-led base hospital at Kandahar Air Field, then at the U.S. military hospital in Landstuhl, Germany, and finally in Canada at the U of A.

In 2006 Cpt. Croucher came to Vancouver to receive treatment for PTSD and further rehabilitation and I was the lucky Movement Coach who was given the privilege to work with Captain Croucher weekly for nearly 2 years. He remains one of my dearest friends and is one of my hero’s.

Next week hear Captain Croucher’s story and his first hand accounts of overcoming injury, breaking the stigma of PTSD and his role back in active duty, as well as some of the positive changes our government is making in OSI standardization, as well as some of the gaps that may still need bridging.

June is PTSD National Awareness Month, let’s support our troops!



Chronic Pain Series Part 2: Mental Health & Chronic Pain

Chronic Pain Series Part 2: Mental Health & Chronic Pain

Mental Health and Chronic Pain:

Mental health and physical health are fundamentally linked; there can be no denying that people in pain, feel stress and it is this cycle of stress that leads us to consider our mental health. People living with chronic physical health conditions experience depression and anxiety at twice the rate of the general population.

Living with chronic pain every day puts a strain on your psychological well-being. Keeping the mind healthy while the body struggles to finds ease is not always easy, but it plays a huge role in coping with day to day pain. It is a perpetual cycle that acts as a feedback loop in both the brain and the body.

On the flip side, it also goes without saying that people living with a serious mental illness are at higher risk of experiencing a wide range of chronic physical conditions.



It is no secret that there is a link between chronic pain and certain mental health concerns, like depression. This can be extremely frustrating during the diagnosis stage, because of the dual diagnosis of chronic pain. In fact, depression is often one of the first conditions that doctors try to rule out when diagnosing chronic pain. As many as 50% of people who suffer from chronic pain also have recurrent clinical depression. Billions have been spent on healthcare per year, yet chronic pain is still not high on the medical agenda.

So what is Clinical Depression? Clinical depression is more than a feeling of sadness or low, down and out mood. It is a psychological state that causes fatigue, lack of motivation, appetite changes, slowed response time and feelings of helplessness, inability to partake in the things you love, which is doubled by the pain of……pain. Depression has physical symptoms as well, including aches, pains and difficulty sleeping. Does this not sound familiar? Does this not sound a lot like many of the same symptoms of chronic pain? YES.

Depression is more than a side effect of chronic pain: the two diagnoses are often so interwoven, that they can be difficult to separate the two for proper treatment and resources. Chronic pain can keep people from doing the things they love. Pain changes how our body’s move, and how we relate to the world. It changes our mood; therefore, it’s safe to say that people who have chronic pain tend to be less active than those who are healthy, because their minds and bodies cause them to slow down and the anticipation of pain receptors leave little room for getting excited to move around and be merry. Again, we see this constant cycle of anxiety around pain.  Not feeling happy with your quality of life is often an emotional drain. With few outlets available for stress relief, it is easy to fall into a downward spiral that leads to depression.

In the Vancouver Sun on April 15, 2013 there was an article “Chronic pain: Managing it, living with it: Health system lags in chronic pain treatment,” outlining the need for chronic pain to be higher up on our medical systems agenda.

 “Depression can make people’s pain feel more intense as it can potentially stop them from feeling hopeful and they can lose motivation to do the work of recovery, which adds up to more pain, she says.

Diagnoses related to chronic pain are therefore difficult. Complex pain is a biopsychosocial issue as opposed to acute pain,” says Squire. “So that means we’re never just assessing the painful part, we’re assessing somebody’s mood, usually their sleep. It has cognitive effects, so they’re quite complicated assessments.”

We still do not have enough data metrics and research to support the proper pathways to treat people with chronic pain, but there are many organizations that are coming together to change this. Two of those organizations are PainBC and Change Pain Clinic, located right here in VancouverBC, but we will get to them in just a mere moment. Let’s look at the cycle of stress.


The Cycle of Stress:

Pain activates the areas of the brain that respond to stress; through pain receptors. This is one of the body’s coping strategies for dealing with acute pain and for protecting us from harm. It is a survival mechanism that’s been encoded in our DNA since the dawn of time. When the brain gets the signal, the brain reacts by sending the body into high sensory overload and overdrive, to prepare for fight or flight. When the pain goes away the signals are supposed to stop.

However, we see with chronic pain, the fight or flight signals don’t turn off, and the nervous system stays in a constant state of high alert, like an alarm in the morning that won’t shut off. You can imagine how annoying and frustrating that would sound like; at some point all you want to do is throw the freakin’ alarm clock against the wall and drop “F”bombs right, left and center.

Now imagine that constant alarm in your body 24/7. It can feel debilitating, maddening and deafening. The body does not get a break from the brain’s stress chemicals and too much stress without time off eventually wears the body down, which can leave you vulnerable to depression.

Stress management can be complicated and confusing because there are different types of stress,  each with its own characteristics, symptoms, duration, and treatment approaches.

Now, not all stress is bad, but when we do not know how to cope or adapt to the changing landscape, it can do more harm to us, then we realize. In most psychology journals, psychologists describe four types of stress – hyopstress, eustress, episodic acute/ hyerpsress and chronic/ distress:


  • Hypostress: insufficiently low stress
  • Eustress: sufficient, adaptable stress, positive stressors
  • Episodic Acute /Hyperstress: recoverable, high stress, “A” type stress
  • Distress: excessive, unadaptable stress, inability to recover or cope


The emotional trigger and response is critical in establishing greater levels of resilience, in hopes of instigating more positive coping strategies that can greatly improve ones ability to cope under stress.  These include options such as; gentle and restorative yoga, breathing classes, meditation, music therapy, light movement classes, even brain entrainment. All of which have shown to be successful when applied to their treatment and personal coping strategy. Of course, none of these alone will do the trick, but an integrated system designed for YOU  – can offer you renewed HOPE.


The Biopsychosocial Model:

The biopsychosocial model (abbreviated “BPS”) is a general model or approach positing that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors, all play a significant role in human functioning in the context of disease or illness. Indeed, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms The biological component of the biopsychosocial model seeks to understand how the cause of the illness stems from the functioning of the individual’s body. The psychological component of the biopsychosocial model looks for potential psychological causes for a health problem such as lack of self-control, emotional turmoil, and negative thinking.  (Wikipedia)

Rather than offer you a full synopsis on this model, it can be best viewed in this riveting presentation featured in April via Pain BC:

For those of you interested in the cross pollination of these fields, I highly recommend you take the time to view this presentation.


Renewed Hope

Our community mental health sector, as well as our community in chronnic pain management, is undergoing a province-wide transformation. Many organizations, including local branches of the Canadian Mental Health Association, grassroots organizations in pain specialties have received new funding for service enhancements over the past several years; however it is not enough. Policy making and governance are high on the agenda to support long term, sustainable change at the higher levels. With new policy and adequate funding this can offer those patients with pain who may not be able to afford services and programs new hope in optimizing their health and wellness.

PainBC and teams like Change Pain Clinic are two pioneers in the areas of chronic pain who are paving the way for a renewed sense of dignity and hope for those who live with chronic pain and dual diagnosis in mental illness.

Last week we looked at PainBC, but I wanted to draw your attention to the previous “Empowering Self Management of Pain” webinar series. A series of webinars that aired in May brought forth the power of how innovation and technology can bring people with pain together to better understand their conditions and the power they have to take charge and manage their own personal health and wellness. In case you missed them please watch them all here –

Change Pain Clinic:  

A passionate team about leading health care system change for everyone burdened by pain. Since it’s fruition in 2009, founders Brenda Lau, Greg Siren and Judy Pryce have been collaborating on ideas on how to improve the lives of pain patients and pain practitioners. An integrated team of clinicians and health practitioners brings together the necessary skill sets to truly revolutionize how we look at, deal with and treat people in pain.

More importantly, a team readily open to put themselves on the line to change agenda, governance and policy within our medical system. Word on the street is Fit to Train Human Performance Systems may just be combining forces and joining this revolution. I feel honored to be part of this team and part of this revolution.

Not Myself Today: Partners in Mental Health

In January, a major step forward was taken with the launch of a National Standard for Psychological Health and Safety, which promotes good mental health and prevents psychological harm in the workplace. This is an important start.

The Not Myself Today campaign was created to proactively deal with our mental health. Every one of us has had a day when we don’t feel like ourselves. Now, imagine living with those feelings not just one day, but many days – and the shame, discrimination and lack of treatment and support that goes with it. This is especially critical at work – where so many of us spend so many hours a day. This campaign is designed to better understand and break the stigma around mental illness. As we know much like chronic pain, the stigma is the same. If you can’t “see” it…how do we tell others about how we “feel.” This campaign aims to change that and to bring people who feel miss understood…together to join forces… so they CAN and WILL be understood.



The moral of this story, is that there are those of us who understand, who are here to help and offer support. There is hope and dignity in this struggle and as we continue to forge forward, more and more options are available to those who live with chronic pain and mental illness. I would like to close by offering you a fan-freakin-tastic quote, by one of my mentors, who has undergone his own transformation with chronic pain, injury, being stigmatized with labels; a man who is a fighter and has come out on the other side stronger and more resilient. This is quote from one of his blogs titled “Strive but do not Identify with the Struggle.” Enjoy….


 “What you fight for, and what you refuse to struggle against, defines who you are. Fight for your values, but do not live in strife. You can do a thing, without becoming a thing, just like you can face defeat, but not be defeated. Stop keeping track of the mistakes you’ve made, the fights you’ve faced and the defeats you’ve suffered. You will again, but you will not become them by doing do; only by thinking you are.

Focus your attention on the right decisions you’ve chosen, the flow you’ve facilitated and the triumphs you’ve allowed. Steel against the negative until you no longer need to direct your mind, and you have trained yourself to be free of judgment at all. Judging a person doesn’t define who they are, but who you are; judging yourself is the same. The process of judgment limits us by the boundaries of its definitions.

Do not identify with the discord, even when life surrounds you with a cacophony. Remain in harmony with the melody of your soul despite the noisy world, and you give everyone with whom you harmonize, a chance to tune in to their own melody as well.” 

– Scott Sonnon


Next week we look at chronic pain and PTSD in our military forces. Serving those who serve and protect.







“Chronic pain had been a part of her life for as long as she could remember. Pain that stemmed from her back, pain that seemed to turn on and off like a light switch, progressively worse during times of high stress and seemed to manifest for no reason at all. Some days it felt debilitating, burning deep inside, referring down her leg, up her entire back, into her digestive track, some days it seemed like too much energy to get out of bed. A deep dark abyss of unanswered questions, a chase for time, where the doubts, those shadowy parts of oneself that reside in all of us from time to time…lay  just behind your every step forward and seem to start catching up to you, and it is exhausting work; the continued work to bury them deep down inside. Why me? Why Now? Have I not lived through enough? What if it’s cancer?  Is it left over trauma for a decade of child abuse? Is it all in my head? Her mother had bi polar and suffered from chronic pain, could it be genetic? Where ARE the answers? The questions are exhausting.

 For years, she did not speak of it, she would say.. “oh it’s just an injury from running,” .. “it’s nothing major,”…. but then those deep dark questions would rise back up like a tidal wave.” – Sarah Jamieson

This was a passage from one of my journals when I turned 30, 2 years after the passing of my mother and the beginning of telling my personal story, my journey through chronic pain, mental health and surviving trauma. Spending the last 2 decades in silence on a personal path of recovery and meaning to better understand why and how “pain” exists in the body and mind, and to find out if there is a connection between onset of chronic pain and those who survive childhood trauma. The silence is no more. For those of us who have survived trauma, we each have a story to tell, and we must find strength in speaking out.

For today’s post I would like to limit my scope to an introduction to chronic pain to give you a better idea of some of the positive points of interest I am engaged in.

I share this with you because as a medical community, there is so much we still do not understand about the human psyche and about chronic pain overall, but many of us; patients and medical staff alike, are coming together to try to offer better diagnoses, treatment and services to those who suffer every day with chronic pain. More importantly, for people like me, I tell my story, so that we can build better awareness around chronic pain, break the stigma attached to it and provide a beacon of hope for those to stand tall and who can see a quality of life they wish to live and lead in the future.

What is chronic pain?

It seems like an easy question, yet in fact it is not. In medical terms the distinction between the terms “acute” pain and “chronic” has been by determining an arbitrary interval of time from onset, usually using markers for acute pain lasting 3 months and chronic pain lasting longer than 6 months.

According to WorkSafeBC policy, chronic pain exists when two conditions are met:

  • The pain is still present six months after an injury or an occupational disease;
  • The pain is present beyond the usual recovery time for the injury or disease.

WorkSafeBC identifies two types of chronic pain:

  • Specific pain — pain related to a physical or psychological cause.
  • Non-specific pain — pain that exists without a clear medical reason.

Answering the question “what is chronic pain” is difficult, because it manifests uniquely in each person, it is not easily diagnosed, and it is not easy understood by our medical community and for many who live with chronic pain. For many who live with this day in and day out there is a giant pink elephant in the room called – stigma.

Chronic pain is under-recognized and most often under-treated and it has reached epidemic proportions in this country, affecting almost six million Canadians.

Did you Know: “That means more than 1 in 5 British Columbians are living with chronic pain; which results in the daily suffering, the breakdown of family and other relationships, the potential for addiction as a way to cope, the loss of productivity and purpose, the risk of becoming impoverished.”   – Pain BC


Chronic pain needs more of an agenda in our medical and therapeutic communities and many are starting to come forward to ensure chronic pain is not just on our local agendas, but provincially and federal agendas as well.

One of these organizations is called Pain BC, a local non profit organization formed in 2008.

Who is Pain BC?

Pain BC is made up of patients, health care providers, and leaders from academia, members of relevant non-governmental organizations and others, who share a passion for reducing the burden of pain and for making positive change in the health care system in British Columbia. I joined this board only a couple months ago and over the next 2 years my plan is to be a strategic part in raising the awareness of chronic pain and changing current landscapes of how we diagnose, treat and offer services to patients with chronic pain.

A dedicated group of well-educated, compassionate and appropriately resourced health care providers are essential allies for people during their journey with pain. Equally important is providing people in pain themselves with the education they need to become actively involved in their pain management, and giving patients a renewed sense of control and ownership over their lives and health.

Pain BC aims to deliver practical education sessions, providing assessment and other tools to guide and streamline practice, and continue to build partnerships to help advance systemic improvements, are all key to ” helping the helpers” improve the lives of people living with pain.

 Did you Know: Despite its prevalence, a recent survey demonstrated the lack of public awareness and education around chronic pain. Twenty-one percent of respondents indicated they suffered from chronic pain while only 47 per cent of Canadians surveyed “fully believed that chronic pain is real.” Chronic pain is under-recognized and under-treated. Chronic pain affects people of all ages. In Canada, one in five people suffer daily from chronic pain. It is a ‘silent epidemic’



The Canadian health system is operating on an outdated understanding of pain. Growing awareness of the human and financial costs of chronic pain has catalyzed an international movement to address the needs of people living with pain. Pain BC is adding our voice to others around the world calling for improved pain management. It’s time for a change.


Pain BC’s Vision:

Pain BC works toward an inclusive society where all people living with pain are able to live, work, play, relate, and learn with confidence and hope, and without their experience of pain being a barrier to pursuing their lives, through:

  • Reducing their pain and mitigating the impacts of their pain on all aspects of their lives and their families’ lives
  • Accessing the pain management resources that they need, ranging from prevention to self management, and early identification and intervention to more complex and long term pain management programs.

Self Management Support:

One of the key components of Pain BC, is the opportunity to empower patients to become leaders in their own lives. Self management and strategies are key to any successful endeavor, it is a critical piece of the chronic pain management puzzle. Research has shown that self management of chronic pain can significantly improve people’s quality of life. We all want to be leaders in our own lives, do we not?

Self Management Programs are collaborative partnerships between those suffering from chronic pain and health care professionals.

For more information:


Resources for Health Care Providers:

Health care providers treating patients with chronic pain are presented with unique challenges. Pain BC’s mission includes educating those health care providers and providing them access to the best resources available so that they may help their patients as effectively as possible.

To that end, Pain BC has compiled information on Assessment Tools & Clinical Guidelines,  Clinical Resources, Conferences and Training, Program Design and Operation, a directory of Pain Clinics and Services, as well as a list of Links of Interest. As part of our continued work in supporting health care providers, we also provide unique memberships FOR healthcare providers to get more engaged in chronic pain; and this includes everyone from doctors and nurses, to physiotherapists, chiropractors and anyone offering skill sets in pain management and therapeutic modalities.

Pain BC provides brochures and information at your finger-tips to help better serve your community.


What Makes Pain BC Unique?

Apart from it’s partnerships and integral work behind the scenes, Pain BC offers innovative ways for patients and practitioners to get involved. The list below is just a snippet of what is offered and what is in the Pain BC pipeline for 2013/2014:

  • Pain Waves Radio: Pain Waves Radio is a call-in internet radio show created by non-profit society Pain BC, where listeners can listen to, and interact with, leading chronic pain experts as they discuss the latest pain management research, tools, and trends. For more information:
  • Salons: a workshop style evening, that explores the art of public conversation.  An enhanced dialogue where speakers are chosen to present on a theme, and the flow of the event is not dictated by a regimented set of parameters, but around organic dialogue. It is meant to be interactive in an atmosphere of free flowing idea generation that is goal oriented and builds awareness on the topic at hand.  
  • National Pain Awareness November 3-9th 2013 A national conference focused on addressing chronic pain across the country. For more information please visit :
  • Become a Member or a Volunteer: Pain BC needs you to get involved and take action on chronic pain. In order for us to break the cycle of pain and stigma, we as a community need to work together. Benefits of membership include a subscription to Pain BC’s e-newsletter, eligibility to attend education sessions and conferences for free or at reduced rates, and participation in networking events and discussion forums.
  • Be involved in Research: If you are over 15 years of age and would like to participate in a Chronic Pain Survey, the CIRPD is seeking input from people with chronic or persistent pain to better understand what types of information resources are being sought.

Chronic pain still has a long way to go to be understood, but the more we continue to bring interested parties together, the more impact we can make and the more we can shrink that pink pachyderm, in the room. There is hope for those living with pain, it does not have to be a way of life. Being a leader in your own life, starts here.


Pain BC:

Canadian Pain Coalition –


Pain Series Part 3: Top 7 Corrective and Restorative Therapies for Chronic Pain

Pain Series Part 3: Top 7 Corrective and Restorative Therapies for Chronic Pain

Movement-based therapies such as yoga, tai chi, qigong and more mainstream forms of exercise are gaining acceptance in the world of chronic pain management. Many pain clinics and integrative medicine centers now offer movement-based therapy for pain caused by (dis)eases; like cancer and cancer treatment, rheumatoid arthritis, fibromyalgia, multiple sclerosis, and other (dis)eases and conditions.

Here I offer you seven of my top therapies that I have used  on and off to manage injuries, back pain, IBS and intermittent colitis, as well as coached clients through or referred clients, which has resulted in better movement, overcoming pain and restoration of their well-being.

In my own practice I am able to pull from a gambit of tools; where , Yin Yoga, deep breathing, NLP guided brain wave work and corrective transitional movement are part of my weekly pain management regime. Apart from what I can guide myself through, we all know that a support system and integrated teach is key. You can’t do it all yourself. Therefore, many of the therapies listed below I cycle in every 4-6 weeks. The first step is to always remember to honor the process and have patience as you progress. The second step is to ensure you keep moving. Humans are made to move, we are not meant to be stagnant. The less you move the more you will “feel” pain, your fascia will stiffen and you will lose strength. Train smart, not hard and take time to re build the trust in your training. The third step is understanding that there will be obstacles, detours and pit stops along the way. Like all things in life – unpredictability is a constant, so be prepared to have feedback from your body. In the beginning, your pain may increase, but this is a natural response, a protective response. If you keep your pain as an observer and your goal of living pain free as your driver, your body will respond as such, just give it time. Every step you take makes you stronger and brings you that much closer to the well-being you wish to achieve.


Yin Yoga & Deep Diaphragmatic Breathing:

Yoga and the art of pranayama are ancient systems developed in India that address the physical, mental and spiritual aspects of the individual. Studies have shown its positive effect on stress through a decrease in serum cortisol levels and increase in brain alpha and theta waves. It may also be of benefit by increasing self-awareness, relaxation on physical and emotional levels, respiration, and self-understanding (Nespor, 1991). Decreased stress may positively influence the emotional component of pain. On this basis, it has been advocated as part of a multimodality program for back pain (Nespor, 1989). In clinical studies, yoga has reduced the pain of osteoarthritis and carpal tunnel syndrome (Garfinkel, 2000), and promoted stress reduction and positive mood (Kerr, 2000; Schell, 1994). These are just a few of the many studies that show Yoga as an instrumental benefit to anyone living with chronic pain.

Committing to a regular practice of deep breathing is the first place to start. Learning how to train the body and mind to move with breath will help, not only to break down that protective “turn on” of our auto stress response, which leads to contraction and “tightness,”  deep breathing will help release and relax tissue, as well as work to supplies every organ with necessary oxygen and blood to help restore function.


Scott Sonnon, Intu-Flow and Prasara Yoga: 

NLP Integration and Somatic Healing:

The power of language goes beyond words. Combining the methods of NLP and Yoga; two powerful schools of thought; you can experience the transformational tools that can lead you towards breaking down barriers that hold you back from greater potential. A private yoga setting is the perfect space to connect the body and mind through practiced, sequential postures; while utilizing the power behind guided meditation and language to encourage your consciousness to overcome obstacles, de stress, restore and rejuvenate.

Meditation is proven to have a huge influence on brain activity and physical response. Meditation produces significant increases in activity in the prefrontal cortex, the part of the brain responsible for positive characteristics like optimism and resilience, as well as “higher” executive functions. By tapping into the mindfulness of meditation and focused movement, you can reduce stress levels, by reducing the production of cortisol and regulate your adrenal glands (the organs designed for fight or flight). This in turn encourages your immune system to function in optimal levels.

Somatic education emerged during the twentieth century, but has been practiced in Eastern traditions for centuries. Western science classifys somatic healing and somatic education; a term used interchangeably, as an internalized learning process which is initiated by a teacher who guides the client or student through a sensory-motor process of physiological change.

When we speak of self-teaching, self-learning, self-healing, and self-regulation, we know that this is a somatic process, and as coaches and teachers we must guide our clients to the understanding that these are genetically-given capacities intrinsic to all human beings. When we combine guided meditation and yoga, the body can undergo a transformation.

NLP Integration:

Corrective Movement:

Repetition in movement and altered movement patterns through compensation can cause imbalances in the body and increase the high sensory stress response in clients with chronic pain. This can lead to changes in the elasticity of the tissue. And as most of us know when we feel pain, we tend to do less; which leads to the body getting weaker and the tissue getting tighter. This fear of movement is the number one cause that continues the viscous cycle of pain.

There is evidence that if you perform slow paced movements with regular breathing and slow the heart rate, you can calm or quiet the autonomic nervous system. Slow paced, corrective movement can ensure a client’s success towards moving away from pain and moving into a more stable and pain free existence. This tempo and focused intention can target the pathways by shutting off or diminishing the inflammatory response that causes chronic pain. Many of my clients who suffer from chronic pain show better movement and reduced tightness, tone and neuropathy after 12 weeks of consistent corrective movement 2 times per week.

Functional Movement Systems: Understanding Corrective Movement  Video:

Tai Chi  (Taiji) and Qigong:  

are gentle movement practices that have been used for centuries in China for health. As a form of exercise and relaxation they have been used to improve balance and stability, reduce pain and stress, improve cardiovascular health, and promote mental and emotional calm and balance. In the area of pain management, scientific studies have shown their benefit in reducing stress, as evidenced by alpha and theta brain wave increases, increases in B endorphin levels and drop in ACTH levels (Ryu, 1996). Effectiveness has also been shown for complex regional pain syndrome, fibromyalgia, and chronic low back pain when combined with education and relaxation training (Creamer, 2000; Berman, 1997). Studies continue to clarify the mechanisms of action, benefits and applications of these movement practices for health maintenance and disease management.

Shou-Yu Liang (SYL) Wushu Taiji Qigong Institute:

KMI Structural Integration

KMI is expressed in two parallel through awareness of movement and Structural Integration; which is a hands-on form of tactile, kinesthetic communication. This technique allows the client and practitioner engage in precisely structured movement explorations that involve sensing, moving, energy work and relaxation. The design of KMI is to unwind the strain patterns and compensations residing in your body’s locomotors system, restoring it to its natural balance, alignment, length, and ease. Common strain patterns come about from inefficient movement habits, poor posture habits, and our body’s response to our external environment. Individual strain patterns can come from imitation when we are young, from the invasions of injury or surgery or birth, and from our body’s response to traumatic episodes. Compensation begets compensation, and more symptoms. KMI is designed to unwind this process and reduce structural stress. The method depends on a unique property of the body’s connective tissue network.

Structural Integration attempts to make one aware of his/her habitual neuromuscular patterns and rigidities and to expand options for new ways of moving while increasing sensitivity and improving efficiency without increasing in pain.

Sherri Leigh Iwaschuk:


Millions of people worldwide use acupuncture to ease a variety of painful conditions. Ever since the 1970s, when this ancient Chinese tradition debuted in the U.S., Western researchers have sought to understand the phenomenon of acupuncture. Even though there is still some controversy surrounding the scope of this ancient treatment; many swear by it’s healing powers and how it can be an effective tool towards reducing pain. What happens when a needle is inserted into “Acu-points,” the needle stimulates pain-sensing nerves, which trigger the brain to release opium-like compounds called endorphins that circulate in the body. There are some who believe that acupuncture works through a placebo effect, in which the patient’s thinking releases endorphins.  As for myself, I have seen Mon Jef Peters, with Fit to Train and I can say that it has worked wonders for me.

Fit to Train Human Performance Systems:


Osteopathy is a well-established branch of complementary medicineIt is a gentle hands-on treatment that aims to adjust your body’s structure (the alignment of bones, joints and muscles) so that you can function at your best, physically and mentally. The osteopath uses physical manipulation, stretching and massage to correct imbalances in the joints and muscles. Osteopathic treatment can also help problems that seem to have nothing to do with joints. Chronic fatigue, asthma and Irritable Bowel Syndrome (IBS) have all been successfully treated.

Correcting joint imbalances and postural problems allows your body to heal itself, freeing blood circulation and trapped nerves.

Roderia Ostepathy Wellness Art:

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There has been a growing concern amongst the health and wellness community, and this concern is chronic pain. More and more clinicians and trainers are having clients come to them with pain they are struggling to diagnose. So, what is chronic pain, and why is it on the rise?

First of all what is pain?

Pain is an defined as an unpleasant feeling often caused by intense or damaging stimuli. Therefore, we know that pain is a signal that tells us there is damage or something is wrong. However, with some pain conditions, the systems (including the brain) are altered. The pain sensory feedback cycle gets turned on repetitively and does not turn off, this is when we go from normal “pain,” to “chronic pain.” While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury, chronic pain is different. Chronic pain occurs, when there is pain that persists over an extended period of time; where the nervous system signals continue to fire.  This altered sate is often referred to as Neuroplasticity (also called brain plasticity, cortical plasticity or cortical re-mapping).

What makes pain “chronic?”

Chronic pain may be divided into “nociceptive” (caused by activation ofnociceptors), and “neuropathic” (caused by damage to or malfunction of the nervous system).

  • Nociceptive pain may be divided into “superficial” and “deep”, and deep pain into “deep somatic” and “visceral”. Superficial pain is initiated by activation of nociceptors in the skin or superficial tissues. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fascia and muscles, and is dull, aching, poorly-localized pain.
  • Visceral pain originates in the viscera (organs). Visceral pain may be well-localized, but often it is extremely difficult to locate, and several visceral regions produce “referred” pain when damaged or inflamed, where the sensation is located in an area distant from the site of pathology or injury.
  • Neuropathic pain is divided into “peripheral” (originating in the peripheral nervous system) and “central” (originating in the brain or spinal cord). Peripheral neuropathic pain is often described as “burning,” “tingling,” “electrical,” “stabbing,” or “pins and needles.

Does this sound repetitive? There’s that word again – Neuroplasticity. In the case of chronic pain, the somatotoic representation of the body is inappropriately reorganized following peripheral and central sensitization, and thus causes the signal to remain active. In order to understand the finite complexities, we need to have a good understanding of what “neuroplasticity” is.

What the Stats Tell Us:

Back pain, migraines, un diagnosed digestive issues and other chronic pain affect at 1 in 10 Canadians between the ages of 12 – 44. In 2010, CBC News Health provided a report featuring a case study involving 57,660 respondents, representing 14.6 million Canadians in the younger age range, and about 1 in 10, an estimated 1.5 million answered “no” if they were usually free of pain or discomfort. Among those aged 12-44, chronic pain was associated with back pain. Part of this is due to our lifestyle. We spend more time sitting, at the computer or technological devices, spend more time in cars, constantly seated in school, more and more North Americans are over-weight and over-worked. And when pain occurs, are natural response is to do less, and by this I mean, exercise less, move less and this all contributes to the onset of what is known as chronic pain.

The next question is; what causes it and why? This is the conundrum of our age, it’s extremely hard to treat and prevent something if you cannot diagnose, right? Many people who have chronic pain undergo test after test and the result is NO structural damage, no medical reason? Because, pain can’t be seen, like bleeding, or something structural found on an x-ray; medical professionals are taught to diagnose based on “the level of pain (intensity) must correlate to a specific medical finding.” When it does not, the client’s request and complaint can be easily dismissed because pain is – subjective. Two people with same injury for instance, can subjectively experience that pain in different degrees of pain; which can be based on genetic factors, pain tolerance, stress levels etc. Care must be tailored to each client, but I am getting ahead of myself (hint – teaser for the end of this article on the stigma of chronic pain).   Let’s circle back to one of the bulleted points of chronic pain – neuroplasticity.


We looked at this in a previous article “Neuroplasticity: The Power of the Mind.”  Let’s break it down; the word (from neural – pertaining to the nerves and/or brain and plastic – moldable or changeable in structure) refers to changes in neural pathways and synapses which are due to changes in behavior, environment and neural processes, as well as changes resulting from bodily injury. Let us also remember that the brain; in how it determines pain, does not recognize “mental” pain, from “physical” pain – it just “feels” pain. Therefore, if test, after test, after test comes back “negative” for structural damage, then as the old saying goes… “It’s all in your head.” This is actually partly true, because the brain and nervous system are stuck in “pain,” and that pain is very real to the brain – thus to you.  Part of our journey towards optimal health and wellness and personal human potential is mastering, the mental, emotional and physical self. With every behavioural modification (physical and mental) there is a psychosomatic component; especially, when it comes to chronic pain, and this realm should be taken into account when screening or identifying indicators of chronic pain in a client.

And there is no wonder why so many people in the West are experiencing this phenomenon. In the Western world, we have created an external (and internal) environment of busy, busy, busy, go, go, go, start early-stay late, cram, cram cram, beta, beta, beta (brainwaves)….you get the picture. Brain activity in individuals suffering from chronic pain, measured via  (EEG), has been demonstrated to be altered, suggesting pain-induced neuroplastic changes. More specifically, the relativebeta activity (compared to the rest of the brain) is increased, the relative alpha activity is decreased, and the theta activity both absolutely and relatively is diminished.

Not only are we not getting enough rest (sleep and/or recovery), we usually sacrifice nutrition and exercise to meet a deadline. This all leads to increased stress (ding, ding, ding – auto stress response – beast mode on), increased cortisol levels, increased tension in the fascia and musculoskeletal lines, shallow breathing, decreased circulation and blood flow, decreased mental acuity, anxiety, increased rate of depression, feeling of hopelessness – the list goes on and on. It’s no wonder; our bodies cry out in….pain.  In the experience of pain, communication between body and brain goes both ways. Normally, the brain diverts signals of physical discomfort so that we can concentrate on the external world. When this shutoff mechanism is impaired, physical sensations, including pain, are more likely to become the center of attention.

The Stigma of Chronic Pain:

The human body is a marvelous adaptive organism. Our brains are designed to learn from our environment and adapt. Pain is very different for every person, and it is usually mis understood and undertreated, because our medical system is poorly prepared to treat it.  The stigma stems from mis communication and lack of understanding. Most often those who have chronic pain are prescribed medication to treat it.

In a study done in 2011 by CTV News called “Adults With Chronic Pain Face Stigma: Study,” CTV quoted Dr. Doris K. Cope, pain chief at the University of Pittsburgh Medical Center stating; “The population’s getting older and less fit, and more survivors of diseases like cancer live for many years with side-effects from treatments that saved them. Too many patients think a pill’s the answer, she said, when there are multiple different ways to address pain including physical therapy, stress reduction, weight loss and teaching coping skills. Patients who take control of their pain fare better, but too many have unrealistic expectations. Pain is not simple.”

Pain is primitive, but it is also complex and as we have just outlined, it’s highly subjective.

It’s All in The Head: The Psychosomatic Element

In my experience, many of the clients I see for corrective movement and/or somatic healing deal with chronic pain on a daily basis. The anticipation of pain brings about fear of movement, and movement brings about the fear-memory of pain. You see the cycle?

Learning how to trust movement, identify barriers (physical, mental and emotional) is the first step towards removing stressors that contribute to the building blocks of the pain cycle. If a client comes in with high anxiety and pain, these two usually go hand in hand, starting with breathing in a supine (position 1 in FMS) will most likely reduce the level of pain. Why? Because deep breathing triggers the brain to secrete hormones that relax tissue, it also slows heart rate and induced more delta and theta brain wave frequencies. The very brain waves associated with deep relaxation, sleep and recovery. For review take a quick peek at my last article; “meditation for the mind: theta brain waves & your fascia,” and “Ride your brain wave: neuro-synchronicity and your human potential.”

The psychosomatic (mind-body) element; takes into account that the physical pain is almost always notably influenced by the client’s mental and emotional factors; which directly relates to the continued cycle. We will look at this in more depth next week. As coaches, having a background is psychology, NLP or life coaching comes in handy for cases involving both chronic pain and athletes. We all have barriers, fears, past limiting beliefs structured around painful memories. The goal is understanding the intention, the thought and response process and more importantly, how to guide a client towards dis-associating from the pain and re-connecting (re-patterning) with pain free movement AND thinking.

If the psychosomatic element is outside your scope of practice, ensure you refer to a professional. It will make your job a lot easier.

Stay tuned for next week!

Part 2: It’s All In Your Head, will feature the mental and emotional aspects of chronic pain and how you can uncover the power of language behind behavioral change.

Part 3: Movement is the Key, will feature safe and effective movement based, corrective exercises/ drills for chronic pain and how to properly coach a client who has been cleared by a physiotherapist for movement, but still has “pain.”

Don’t forget to follow our facebook page (Fit to Train), here you will find weekly tips, vlogs and resources on all things movement based.


CTV News Study 2011:

Harvard Health Publications:





“Walk where there is no path, and leave footprints.” ~ Unknown

For ultra runners, our feet can literally be coined the “tools of our trade.”  Clocking on any given week, my mileage “runs” an average of 140km via commuting, walking and being active for my profession as a corrective movement coach, and then of course training –  frolicking in nature (urban and rural). My feet have surprisingly held up very well over the last 2 decades of “pounding the pavement.” I like to think that Yoga and my Karmatic piggybank are to thank for my good fortune. Some have called me “Gandhi with Sneakers” others have called “a pure nutter.’ I would say both equally apply.

Running has always been my greatest teacher, my salvation, and my savior. Every step can be a tool to build upon the framework of thought, reflection and exploration. A moment in tme to process some of our most internal challenges and our greatest fears. And since I also believe that “fear” is merely “love” masked by shadow – we can all overcome any adversity, with the right strategy.  I have running to thank for creating the space, from which my mind, body and spirit can co-habitate to work through some of those moments where we strive to find balance, truth and our purpose in life. I believe sports and movement are fundamental to this process, and our feet – our greatest asset.

From the Ground Up:

Getting to know the mechanics of your feet and the pivotal role they play in athletics, yoga, movement and grounding is the first step to establishing a solid foundation in your any daily practice. In the yoga tradition, the lowly foot paradoxically has an almost transcendent status. Students will touch or kiss the feet of teachers, mentors and gurus alike – as a means of reverence, appreciation and respect.

Just as the foundation of a home or any structure for that fact, it must be level to support all the structures above it.  This is a perfect metaphor for our feet, as it makes sense to strive for foundational balance and sturdiness to support the legs, spine, upper extremities and the weight of the head, as well as the gravitational compression of our environment.

If our foundation or base is tilted, unsteady or collapsed, it will be reflected up through the body as distortion or misalignment and can cause compensational breakdowns throughout the interconnected systems. Therefore, does it not make sense to consider your feet first, and start cultivating balance from the ground up?

The Foundation of Design:

The foot is the foundation of athletic movements, our root to the earth and often, it is the most neglected. The foot is an intricate structure of 26 bones (I count the  tiny sesamoid bone in the great toe, but this is usually not counted –  let’s honor him here) that form two crossing arches of the foot. The longitudinal arch runs the length of the foot, and the transverse arch runs the width. The muscles of the foot, along with a tough, sinewy tissue known as the plantar fascia, provide secondary support to the foot. The foot has internal muscles that originate and insert in the foot and external muscles that begin in the lower leg and attach in various places on the bones of the foot.

Unlike solid structures, our bodies are mobile temples, and thus our feet are required to be adaptable, flexible and adjust to varied terrain and environmental factors.

When there is pain, the body reacts by changing the way it moves or functions in an effort to reduce the pain. Biomechanical changes or (dis)ease may prevent the normal range of movement and cause further injury. For instance, if there is excessive wear on one side, the foot can shift off its central axis, which can put strain on the knee, hip or sacral areas.  Weakened or unbalanced mechanics found in the feet, often refer pain and discomfort elsewhere in the body and literally can change the way we move through the world.

Our feet also ground us to the earth. Yoga is an exceptional fragment in time to clearly focus on this connection, as well as the obvious summer time walk along the beach, barefoot walk in the park – or barefoot anywhere, as is all the craze with barefoot running (I will save this for another article) as this topic is growing on me.

Reach for the Peak in Mountain:

Take mountain pose for instance; a perfect time to enhance your connection with nature and the earth, and to create malleability in the foot. We do this by taking the time to feel every inch of our feet, where our weight distributes and be stretching it lengthwise and extending it out laterally. By making the foot more elastic, we build an effective trampoline that springs the weight of the body upward. In all standing postures in yoga, these complementary forces of descending weight and rebound are at work.

Also consider postures that allow your connect both your hands and feet to the earth; a few personal favorite of mine are (of course) the sun salutation series (modified to focus on more joint fluidity), forward fold variations (there is something about swaying in the wind and having my feet rooted, but hands grace the floor that is comforting to me), triangle pose (reaching one hand to the sky and the other firmly planted along with me feet to earth is empowering), and lastly a vinyasa of crow pose to teddy bear stand to modified head stand (for some silly reason I find this one inspiring and playful at the same – it reminds me of fooling around in grade 3 gym class). Find posture that resonate with you and re connect this Spring!

As Spring has finally sprung, take some time to walk barefoot and connect to your roots, and during your next yoga practice take time to re connect and give your feet a little more (much needed) TLC.




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