Conférence donnée au département des sciences de l'exercice de l'Université Concordia

1. Ten principles to beat chronic pain !
Yvan Campbell
Kinésiologue
March 22nd 2017
Concordia University
Montreal, Qc, Canada

2. Stop telling them
they should learn to
live with their pain. # 10

3. • It is false.

4. Van der Velde and Mierau (2000) : réduction de 31 %Taimela S, et coll (2000): réduction de 50 %Leggett et coll (1999): réduction de 50 %
Rainville et coll (1992): réduction de 32 %Edwards, et coll (1992): réduction de 30 %
Witting et coll (2001): réduction de 23 %
Science is showing us that we can eradicate
chronic pain :

5. There is only one pain that is easy to endure,
it is that of the others

6. Martine, chronic pain for 3 years

7. Chronic pain
is complex
# 9

9. • So, there is no simple solution,
no simple method.

10. • Chronic pain is a multifactorial
problem
• It requires a biopsychosocial
approach

11. Use a
systematic
approach
# 8

12. • Build yourself a frame of
references based on evidence-
based exercise sciences
Scientific
literature
Clinical
experience
Client/patient
preferences
Decision

13. • With time and experience : build
your own method
• « Learn your stuff », in your
field and outside your field (5 %
law)

14. • The knowledge that is going to
put you in the top 5 % of your
profession is not related to your
field, but from other fields

15. First,
relationship
# 7

16. • Tell your client that you believe her

17. Educate
# 6

18. • If your patient wants to beat
pain, he must know the enemy

19. # 9

20. # 9

21. There are two
kinds of pain
# 5

22. • Nociceptive pain
• Chronic (persistant) pain
Teach that there are two kinds of
pain, and therefore two ways to
treat them.

23. Nociceptive Pain
1
2
3
pain

24. alarm immobilisation return to movement
Time
Nociceptive Pain

25. alarm immobilisation return to mouvement
Time
Chronic pain

26. Pain
Increase pain
+ -
Decrease pain
Chronic pain

27. • Chronic pain is caused by a
dysfunction related to those two
subsystems ;
• Chronic pain is now viewed as
a disease of the central nervous
system, mediated by
neuroplasticity.

28. Concept of neuroplasticity

29. Fear avoidance or
endurance related
responses
# 4

31. Daniel, construction worker, back sprain, 3 months after physio/ergo

32. Systematic desensitization
• Educate
• Graduated exposure to
movement

33. Roger, 4 back surgeries, chronic pain for 5 years

34. in 15-20 % of the
cases, there is no
kinesiophobia,
there is
endurance –
related response

35. • Patient will continue the
exercise or the physical task
even if the pain increases, until
the pain is intolerable
• The no pain no gain approach

36. Gerry, 3 amputated fingers, chronic pain for 1.5 years

37. • Posterior horn is oversensitized
by repetitive nociceptive signals
1
2
3
douleur

38. Concept of central sensitization
caused by neuroplasticity

39. • Inflexion point of pain intensity
• Re-adjusting the relation
between movement and pain
intensity
# 3

43. • Physical training
# 2
Importance of

44. • There is a direct relationship
between the relative effort of a
given task and pain intensity

45. • As your capacities decrease,
the relative effort will increase,
and consequently pain intensity

46. Hope
# 1