Guiding You on Your Journey to Wellness

• Helps reduce fear of movement and catastrophizing

• Helps patients understand that more pain does not equate to more
  damage.

• Patients understand that their nervous system is overprotective

• Improved self-efficacy. Patients understand why they hurt

• Targets the contributing maladaptive beliefs about pain and emotional
  responses

  Methods:

• Explain Pain Approach (NOI Group)
  
  Developed by David Butler and Lorimer Moseley. Focuses on educating patients about their pain using metaphors stories and neurobiology to create a shared language and understanding around their pain.
  
  

• Pain Neuroscience Education (PNE)
  
  Educating patients about how the nervous system processes pain.
  Explains the mechanisms by which a dysregulated or sensitized nervous system can create any symptom, validating the patients understanding and decreasing fear.
  
  

• Cognitive Functional Therapy (CFT)
  Developed by Peter O’Sullivan. Combines education with exposure to feared activities, creating a corrective experience and promoting pain free movement.
  
  

• Biopsychosocial Model Integration (BPS Model)
  Helps patients to understand to complex interplay between biological, psychological and social factors
  
  

• Acceptance and Commitment Therapy (ACT)
  Teaching psychological flexibility, acceptance and mindset changes along with PNE. This shift in perspective helps to change maladaptive beliefs, remove pressure and promote healing.
  
  

• Pain Reprocessing Therapy (PRT)
  Focusing on retraining the brains response to brain using pain somatic tracking, relaxation techniques and affirmations.
  
  

• Cognitive Behavioural Therapy (CBT)

  Helps to address unhelpful thought patterns, which may be impeding the recovery process, creating fear, guarding and contributing to physical pain and sensations
  
  

• Emotional Awareness and Expression Therapy (EAET)

  Focuses on the emotions associated with physical pain. Education around how changes in the bodies physiology from thoughts and
  emotions can change pain sensitivity and produce physical symptoms through nervous system changes.

• Desensitizes the nervous system by gradually confronting feared activities

• Reduces fear and catastrophizing by proving that movement can be safe

• Improved movement patterns. Less guarding and stiffness with movements

• Helps the nervous system adapt through neuroplasticity and re- wiring. Activities = safe

Methods:

• Patient Led Goal Setting
  
  Patient uses the Patient Specific Functional Scale outcome measure to set (3) meaningful goals they would like to work towards, this will be the focus of our graded exposure approach.
  
  

• Graded Motor Imagery
  For patients with severe fear, imagining feared movements (motor imagery) or using virtual reality (VR) environments can serve as the initial step before physical movement. Visualizing movements activates the same neural pathways as actually performing the movements themselves!
  
  

• Graded Exposure Therapy
  Identify feared activities using the Fear Avoidance Beliefs Questionnaire (FABQ). Graded Exposure Therapy involves gradually exposing patients to movements or activities they fear will cause pain, starting with less challenging tasks and progressing to more difficult ones. This exposure helps break the fear avoidance cycle.
  
  

• Graded Activity
  Focuses on time contingent rather than pain-contingent increases in activity levels. Unlike graded exposure, which targets fear, GA emphasizes functional restoration regardless of pain intensity. Helps restore conditioning and improve self efficacy.

• Modulate and downregulate the central nervous system, decreasing pain.

• Improved stress and emotional regulation. promotes a sense of safety in the nervous system, decreasing fear and anxiety and improving emotional state

• Improving autonomic nervous system balance by moving from sympathetic (fight or flight) to parasympathetic (rest and digest). Reduces inflammation and pain
  
  Methods
  
  

• Breathing techniques

  Helps to balance the autonomic nervous system, reduces heart rate, lowers cortisol levels, decreases anxiety and promotes relaxation.
  

• Mindfulness Meditation

  Increase prefrontal cortex activity, decreases the activity of the amygdala and limbic system. Leads to improved stress resilience and pain perception.
  
  

• Progressive Muscle Relaxation (PMR)

  Alternates between tension and relaxation of muscles, signaling safety to the brain and activating the pain inhibition pathway. Reduces physical tension and associated pain due to relaxation response
  
  

• Somatic Tracking

  Focuses on gradually exploring body sensations in a safe environment. This switches the association with the sensation from fear to indifferent. Over time the link between the sensation and fear response weakens and the sensation dissipates.
  
  

• Expressive Writing (Journaling)

  Pain is worsened by stress and negative emotions. Journaling allows for emotional expression, decrease limbic system overactivity.

• Regulates the HPA axis (stress pathway), reducing cortisol, adrenaline and other stress hormones, dampening pain sensitivity

• Downregulates the sympathetic nervous system, decreasing muscle
  tension, increasing blood flow and dampening the pain response

• Lowers systemic and neuroinflammation, decreasing sensitization of painful or injured tissues and dampening pain

• De-sensitizes the central nervous system, improving pain thresholds
  and sensitivity

• Improved cognitive-emotional brain circuits. Negative thought
  patterns can create loops (catastrophizing and rumination), which further sensitive the nervous system

• Increased sense of empowerment, energy and self-efficacy that
  patients can recover from their painful condition
  
  
  Methods
  
  

• Breathing techniques (Diaphragmatic, Box, 4-7-8)
  Helps to balance the autonomic nervous system, reduces heart rate, lowers cortisol levels, decreases anxiety and promotes relaxation.
  
  

• Mindfulness Meditation
  Increase prefrontal cortex activity, decreases the activity of the amygdala and limbic system. Leads to improved stress resilience and
  pain perception.
  
  

• Past, present, future stressor lists
  Gives patients a better idea of what their current stress load is, then choosing strategies and techniques to address these stressors.
  Stressors can either be managed or mitigated if modifiable, or reframed if unmodifiable.
  
  

• Journaling
  Journaling about past, present and current stressors (without overwhelm) and what emotions they invoke, while feeling the sensations can allow you to feel the stress response, watch it subside and move through the stressor, giving it less “charge”
  
  

• Multidisciplinary Collaboration
  If you experience severe depression, suicidal ideation, adverse childhood events, abuse or any other form of complex trauma, it is advised you speak with a mental health professional including a counsellor, psychologist, or psychiatrist. Complex trauma can dysregulate the nervous system, leading to a heightened and prolonged stress response and pain