Introduction
Pain is unpleasant, it is the brains way of protecting you,
by getting you to stop what you are doing because you want the pain to stop.
Pain is used as an alerter to danger to stop you getting
injured.
Pain is the outcome when the brain thinks you being
threatened with injury.
If the brain thinks you are in danger, then you will have
pain, even if there is no danger.
Most commonly pain occurs when there is actual or potential
damage to the body, but this is only part of the story.
Pain is part of the body’s damage prevention systems, it is
the light on the top of the Xmas tree.
Chapter 1 Pain is normal
Descartes dualism provide the basis for most pain treatment
but there are better ways to look at it than this.
Many every day aches and pains are caused by tissue damage. Memory
of pain causes pain, to stop you making the same mistake twice, so you will
associate things with pain.
Thoughts and emotions can be the source of pain, so the loss
of a loved one can, quite literally hurt.
Pain says you are threatened and are in danger and need
protecting. The trick is finding out why the brain thinks you are threatened.
The amount of pain you experience does not correlate with
the amount of damage you are suffering.
Pain depends on context, which is what the brains
interpretation uses. So a violinist’s left hand will be more sensitive to pain
as this is the one that they use with the violin, as it is more valuable.
To distinguish between emotional and physical pain is
unhelpful as the way pain however caused is processed in the same way.
When you have difficult emotions there are physical
correlates, and difficult physical feelings, then you have emotional
correlates. Emotions can affect muscle tension and cellular process, an unjust
physical injury will have accompanying emotions.
Ignition cues=the things that combined, paper, petrol,
match, cause pain
Unexplained pain is worse than explained pain. Context
effects pain, males have higher thresholds if tested by women.
70% of people with prosthetics get pain where their limbs
used to be. This shows how we have a virtual map of our body, in our mind, to
know where it is. A schema in Merleau Ponty terms.
Chapter 2 Your remarkable danger alarm system
The brain reacts to inputs without us ever being conscious
of them. Our brain tells us the amount, nature and location of danger in the
body. When the alarm system doesn’t pick up on danger in diabetes and leprosy
then there is real danger. If you didn’t get pain when you got appendicitis you
would die, a pain system is very useful. The pain system is augmented by the 5 senses
which help us with self-preservation.
The brain is the alarm systems command centre. The brain is
the safest part of the body as it is encased in bone, in a hydraulic casing.
A closer look at alarm signals
There are millions of sensors throughout your nervous
system.
3 types of sensor
1.
Mechanical
2.
Heat
3.
Chemical
A neurone is an individual nerve cell, and sensors sit in
the outside of them. When the sensor is activated it opens to take positively charged
particles into the neurones in which it conducts to the next neurone. Theses
sensors as well as your eyes, nose and ears are your first protectors against
harm.
Some neurones transmit messages at 150 km per hour, and some
only at 1km per hour. The messages they send are of the type temperature
increase in my area, danger in my area. The burning, aching sensation is
produced by the brain on the basis of all the inputs.
Nerves are in your skin, muscle and bone.
A dentist anaesthetic closes the neurones sensors, so they can’t
transmit signals. The sting of a sting ray keeps the sensors open which makes
it a hugely painful experience.
Sensors only last for a few days then they are replaced.
Your sensitivity therefore is continually changing. Sensors are made in the
neurones under the direction of your DNA, which will produce a different number
of sensors depending on your needs at that time.
There are some special neurones that send danger signals in your
tissue to the spinal cord. These nerves are called nociception and fire for any
tissue danger.
When a neurones sensor is open it takes an electrical
charge, when there are enough charges an action potential is created, an
electrical spike that is transmitted to the brain. These signals are sent to
the top of your spinal cord.
There is a synapse, i.e. gap, between the incoming messages
from various neurones, to the one neurone which transmits these signals to the
brain. This neurone only accepts certain types of input. Theses inputs can be
memory reinforcer signals, day to day signals, and some reinforcing signals
which is controlled by the immune system.
At the top of the spine not all danger messages get sent to
the brain as the brain can also send out serotonin, morphine and other opioids
which cause the neurones to lose their charge which means they don’t pass the
signal on.
The message is processed throughout the brain
When the brain receives the danger message, then it needs
to create a story to understand it and uses other sensory information, memories
and beliefs to do this. When people are in pain hundreds of brain parts are
in use simultaneously.
There are many parts of the brain used to express pain can
be called the ignition nodes. These clusters of nodes are sensation, memory,
movement. If these nodes are repeatedly hijacked they get very sensitive,
neurotaggged. A pain neurotag is the pattern and system of pain expression, i.e.
the specific ignition nodes.
The neurotag for pain then is the lit up patter of clusters
of nodes that are being used in this pain experience. These parts are connected
electronically and chemically. Many of the ignition nodes are activated by a
wide range of stimulus that grab your immediate attention that is why some
people with chronic pain can have the pain activated by changes in temperature.
Thus pain experience is across a number of systems, movement, cognition,
sensation, concentration, fear…. And every experience of pain is unique,
although will follow certain patterns,
The brain is an orchestra and can produce pain like music in
many different ways. There is a stickiness and an n habitual aspect of this, in
that the orchestra if it plays the same tune all the time, doesn’t know
anything else, people involved in other tunes stop playing. There are more
possible connections in the brain than particles in the universe. Millions of
synapses link and unlink every second.
There are many human systems involved in pain
1.
Sympathetic\para sympathetic system
2.
Endocrine system (control metabolism, bp,
cortisol)
3.
Immune system
4.
Muscles
All these systems are like sprinters good to use in short
dosages but you get problems if they are used for a too long period.
The immune system can make you sleepy to promote healing.
Pain motivates you to escape, it seeks help and grabs
attention
Motor system can protect the damaged area
Chapter 3 the damaged and deconditioned body
Whenever you are injured in every day wear and tear the
healing processes of the body start to work. Pain is a good guide to the
healing process, sometimes rest helps, sometimes movement. Healing only happens
once, and it can happen imperfectly and leave scars.
The healing process
Tissues become inflamed, which brings the body’s immune and
rebuilding cells to the area. A scar is formed, the tissue is remodelled as
best as it can be. Two main things that determine healing speed are blood
supply and tissue requirement. Ligaments for instance have a poor blood supply
so take longer to heal. Pain should
diminish as tissues heal, sometimes it goes before the process is complete.
After the heal the tissue may not be as mobile but it is repaired.
Soft tissue takes 2-4 weeks, bone up to 12 weeks, then there’s
remodelling for bones which can take many months, even years.
Acid and inflammation in the tissues
Cells produce acidic by products, if you sit on a rock the by-products
cannot be removed so you get a build-up of acid and alarm bells to move
Any disease with itus at the end is an inflammatory
problem. Inflammation is the most primitive
form of defence.
When you’re damaged, there’s an inflammatory soup created of
histamine, white blood cells that fight infection, create scars and rebuild
tissues. Inflammation makes joints stiff. The swelling gets blood and healing
chemicals to the area. This is the case for acute inflammation, chronic is
different.
Muscles
Muscles are quite hard to damage, you can get micro tears
and they do have a lot of sensors, but to tear a muscle is really really
unlikely. Muscles have great blood supply and repair themselves quickly.
The body, the muscles are the conduit between brain and
world.
Spasm and limping are muscle protecting behaviour.
Discs
Discs in your back are not free floating, and can’t pop out,
they are surrounded by bone and cartilage. Discs degenerate naturally as part
of the aging process.
The most common disc injury is the straining of ligament
tissue
Skin
Skin is our biggest organ, but is rarely associated with
chronic pain. A lot of understanding about pain comes from the skin.
There is an area of the brain, that relates to each part of
your skin, and the more important it is, the more area it has. If you use a
part of your body more, therefore you will have a bigger part of the brain
allocated to it.
Skin slides as we move.
Bone and joints
Joints have a thin super sensitive layer that covers them
that is what hurts when you tap your shin.
If a change in the body is slow the body concludes it is
not in danger, so doesn’t put the pain alarm on.
The brain likes messages from joints so it can alter posture
and balance in relation to that information.
Smashed bones can heal within 6 weeks.
The peripheral nerves
There are hundreds of meters of peripheral nerves in your
body. Nerves are cords, 50% ligaments 50% neurones.. The nerves can be sensors
for the brain, or driving muscle activity or the sweat system.
The ligaments of a nerve have nerve endings in them. Nerve sensors can be activated by stress
chemicals! Nerves slide as you move.
Damage to nerves may not be apparent for days\weeks. No scans show nerve
damage up, but pressure or stretching they are very sensitive to.
Dorsal root ganglion (mini brain)
First place information from the nerves get modulated and evaluated.
The DRG has the DNA that produces neurones and sends them around the body. DRG
tunes into chemicals in blood, and produces changes in neurones accordingly
Backfiring nerves
Neurones can backfire, so the signal gets sent up from the
periphery to the brain, to say danger, before it reaches the brain, one of the
dominos falls back on itself and this can end up with the inflame message being
received by the initiating neurone, when actually it didn’t need to.
What you might notice with peripheral nerve
problems
Tennis elbow is a nerve problem.
Symptoms of nerve problems
Pins and needles
Sometimes burning pain
Pain at night especially in hands and feet
Movement makes it worse
Have small trigger points
Nerves can become sensitive to stress, to the cortisol in
the blood, which can set up a vicious cycle where the unexplained pain which
makes you stressed is interpreted by the nerve as a danger, then can produce
more pain in the nerves.
Peripheral nerves can produce some odd symptoms
Nothing for days or weeks after problem then big hit of
symptoms: itchiness of skin, water running in skin, ants on skin
Chapter 4 Altered central nervous system alarms
Pain nearly always involves something going on in the
tissue, it might be inflammation, underused, unfit, or slow healing.
The dorsal horn, responsible for sending messages from
Dorsal Root Ganglion to brain, gets quicker at sending signals of a certain
type the more of them it receives. The
neurones change so they stay open longer, to allow more positive charge to go
through them. This means that you become more sensitive to danger. What also
happens is that neurones are produces with sleeper sensors that are asleep
until they are needed that effectively produce memories of pain. I think the
previous all relates to the DSG’s processing of incoming messages in the dorsal
horn. So our increase of sensitivity to pain, our memory of pain is in the DSG.
The DSG can also produce neurones to go sprouting, so this is the creation of
supersensitive pain remembering neurones next to neurones which actually have pain,
so you get a spread of pain.
The spinal cord as a magnifier of tissue reality
So as soon as there is enough pain signals, then the dorsal
horn amplifies this, by reducing sensitivity, creating doormat pain memory
neurones.
What should happen is when the injury reduces so does the
sensitivity,
Brain
When the brain areas are light up, the pain neurotag, what
that does is to enhance information or activity from that area, so this will
also bring back related pain memories
There are also changes in the virtual body, where the pain
area smudges and now occupies surrounding parts as well.
When the brain is sensitised then it also makes you more
sensitive to pain, gets your other systems going. Sympathetic, endocrine,
motor,
Thoughts are nerve impulses
As we can predict situations we can avoid tissue damage, but
this prediction of tissue damage can produce pain. When you are highly sensitised to pain,
thinking about it, seeing someone else in pain, or doing what would produce
pain in you, can produce pain. If you imagine a movement then your mirror
neurones fire, and produce something of how it would feel if you did it
yourself.
Central sensitisation
This is when the brain or the spinal cord become highly
sensitised. Symptoms are:
1.
You are given multiple diagnostic labels
2.
The pain persists a long time after the tissue
has healed
3.
The pain spreads
4.
The pain worsens
5.
Lots of movements hurt
6.
Pain becomes less predictable
a.
Latency, dynamic triggers
7.
Pain more related to thoughts and feelings
8.
Pain linked to previous threat, or anticipated
threat
Chapter 4 Response systems the sympathetic and
parasympathetic nervous systems
The sympathetic nervous system is a rapid response system to
help you do things quickly for a short time.
In a fight or flight the adrenal gland on top of your kidney
releases adrenaline into your body (it is there already regulating y our
breathing, blood pressure and pupil size). The sympathetic nervous system, then
delivers adrenaline to all tissues. Its brain driven and responds to threat. Adrenalin
diverts energy to brain, muscles and heart. It also constricts the gut.
Adrenaline happens before the decision to fight, flight or freeze.
With chronic inflammation, nerve damage, and heightened
alarm sensitivity, then adrenaline in your system can amplify the danger
messages and cause pain.
Sympathetic liberates energy, and the para sympathetic
conserves it. When the para-sympathetic system is activated then you get tissue
repair, this will be the case during, rest, sleep and meditation.
Endocrine response system
The endocrine system works with the sympathetic nervous
system, is harder to get going but lasts longer when it does get going. Threatening inputs to the hypothalamus make
it release hormones which get converted into cortisol by the adrenal gland.
Cortisol is a protector it slows down the body processes
which are not used and enhances the ones that are. Healing, rest and digest are put on hold by
cortisol. It activates muscle, brain and endorphin support.
Long term high cortisol levels is associated slow and poor
healing, depression, loss of libido and loss of memory. Cortisol production peaks in the morning, and
is as its lowest in the early evening. People with maintained inflammation
often have higher levels of pain the evening when their cortisol levels are
down.
Oxytocin, is a pain reliever, helps lose weight and can be
got from cat pats and hugs.
The Immune system
You immune system knows who you are and attacks who you are not.
Cytokines form a mobile protection system in the body. Cytokines can enable
inflammation and when you have flu more are produced giving that lethargic and
feverish sense.
Our immune system has a memory, it’s why vaccinations
work. Long term pain leads to more pro
inflammatory cytokines. The immune system may underpin the spread of pain. Old
injuries can come back when there are more pro inflammatory cytokines.
The immune system can be fired by the interpretation of your
brain.
Immune boosting behaviour
1.
To have an influence on the quality of your life
2.
To be in control of your life and treatment
options
3.
To have family and medical support
4.
To have a strong belief system
5.
To have a sense of humour
6.
To exercise appropriately
Movements Strategies
The brain produces pain to motivate you to protect your
body, this is a good short term strategy and invokes the fight or flight
response. It tenses the big muscles trapezium and hamstrings. These are two
of the favourite ones turned on, but if they are turned on for too long you get
problems:
1.
Smaller muscles around them go to sleep
2.
They produce a lot of acid
3.
They get stiff
Back pain is associated with a change in trunk muscle
activity. Fear of pain can get a change in trunk muscle activity to the non/
“normal” activity.
You need, when rehabilitated to work out what threats you
are frightened of then see if you are changing the way you hold your body in
light of this. It may well be that this protective mechanism is exposing
some tissue to danger and preventing healing
Chapter 5 Modern Management tools
Different groups of professionals will offer different
opinions on your pain. Health professionals have frameworks on which they base
their work. The framework of this book
is neuromatrix i.e. the components involved in the sensation of pain, the
neurotag, pains unique relationship and virtual body, i.e. that there is a
representation of your body that is constructed on the basis of value, that
dictates how pain will be felt, i.e. the threshold for a highly valued part of
the body will be lower than other parts. It sees that there are various ignition cues
to pain:
1.
Tissue damage
2.
Fear
3.
Memories
4.
The wrong information
5.
Various circumstances
Thoughts, ideas, knowledge and fears are seen as having the
same electrochemical impulses as nerves.
The onion metaphor is how there are many different
components that can contribute to the pain experience. The onion causes the orchestra to play the
tune.
The Onion
1.
Nociception (The danger receptor neurones)
a.
This can be fired for actual tissue damage, or
from a tissue scar, as it doesn’t feel right, or from unfit or sensitive
tissues
2.
Beliefs and attitudes
a.
Remembering that it was my fault that I did
this, whilst I was sitting down, so avoid sitting down for too long. When you
sit it is the belief that can cause pain
3.
Suffering
a.
Wrestling against the pain, and how much you
shouldn’t have it, and how bad it is creates more pain
4.
Pain escape behaviour
a.
The escape behaviour may be associated with
previous pain incidents so remind you of pain and cause it. Trying and failing
to find a cure.
5.
Social Environment
a.
Perhaps people are angry with you due to your
pain. This in turn will be painful, and make you see the pain as worse.
Pleasure giving activity may be curtailed due to what society expects about
people with pain
Ideal health professional questions:
1.
What is happening in my body
a.
Is there any scientific backing
2.
How long will it take to get better
a.
Short and long term goals
3.
What are all the options for management
a.
From science what is likely to help
b.
What might help
c.
What wont
4.
What can I do for it
5.
What can you do for it
6.
Is there anything nasty that needs special
attention
7.
What do my physical findings, e.g. x-ray, mris etc.
really mean
The Onion cont.
Anything that adds to the brains sense that it needs to
protect itself could be part of your pain maintenance.
Pain:
1.
Your brain wants to protect yourself from
anything it concludes is dangerous
2.
In persistent pain, your pain alarm system is
sensitised, and even minor threats can encourage the orchestra to play the pain
tune, a tune it knows only so well
Fear of pain & avoidance
So I have pain I don’t know the cause, I don’t know when it’s
going to come exactly, so I reduce activity to avoid this pain, but then reduce
my quality of life and normal working of my body, which then gets unfit..
Coping with pain styles
The brain and body use the same systems to cope with threats
be they physical or non-physical.
Effective coping mechanisms for pain
1.
Problem solving
2.
Understanding pain
3.
Changing thoughts, beliefs and behaviours
Coping strategies are either active or passive.
Useful active coping strategies
1.
Nudging the edge of pain, neither avoiding it or
pushing through
2.
Making short term attainable goals and long term
goals
3.
Remaining positive
4.
Improving understanding
5.
Exploring different ways to move and do things
Dysfunctional coping strategies
1.
Boom\Bust
2.
Pain avoidance
Pain avoidance
Pain kicks in after trigger, stop trigger, other triggers,
stop those activities. Reduced activities increase the significance of pain and
its suffering, makes the body unfit and gives higher sensitivities
Boom\Bust
Pain comes on, tolerate it, pain chemicals build up then
knock you out for days. So here what the
sensation of pain is becomes bigger than it needs to be, pain is associated
with the pushed through build up, rather than the initial trigger. As the pain is seen as bigger activity starts
to be reduced, then you push through and repeat.
Chapter 6 Management Essentials
There is no single solution to all pains but there are three
tools that are shown to be helpful
1.
Education and understanding your pain
2.
Graded exposure
3.
Accessing the virtual body
The unknown is scarier than the known, so understanding your
pain reduces it.
Motion teaches the body how to work again, teaches the
orchestra how to play other tunes but the pain tune.
Tool 1 Education and Understanding
The best approach to pain, is to understand it and nudge it,
to not avoid it nor push through it.
For recurrent pain, it makes most sense to say the
recurrence has been provoked as there have been enough cues to the virtual
representation of the old injury.
Hurt does not always equal harm
The brain can do many things to stop you injuring yourself
1.
Pain
2.
Fainting
3.
Vomit
4.
Sleep
Practical Exercise
If you have pain then
1.
What activated the alarm
2.
Get to know your pain
Tool 2 Graded exposure and pacing
Movement is the major system that is affected by pain.
1.
Create a graded hierarchy that has the things
that you really want to do at the bottom, and do just a little of them. Or alternatively
something you really need to do more of.
2.
Create a baseline of level of activity you can
do without flare up
3.
Plan your progression
4.
Gradually increase and don’t flare up, but don’t
freak out if you do
5.
If you can put fun into the hierarchy then it’s
going to be more achievable
How graded exposure works is that it gradually increases the
flare up line and the protect by pain line and tissue tolerance line. The
graded exposure show the body that it doesn’t need to put on the pain alarm
system as it can do more without problem, as it does more so the tissues get
fitter and more robust and resilient.
Tool 3 accessing the virtual body
1.
Imagine performing exercises without pain
2.
Take a painful movement and alter its aspects,
have different gravitational aspects, do it in water.
3.
Do the exercise in a number of conditions and
contexts
4.
Add varying balance challenges
5.
Add varying sensory inputs music , close eyes
etc. if you can do a movement that is usually painful without pain, then do it
in the mirror so you can reinforce the idea in your brain
6.
Alter the environment of the activity
7.
Do the movement in different emotional states
8.
Add distractions which will disable the pain
neuro tag
9.
Plan functional activities which include your
feared movement
10.
People with persistent pain, move with
regimented movement. So break your movement down into section, and alter the sections,
lead with different legs, ensure your head is up etc.
11.
Use sliders so these are distractionary opposite
movements, so head back when leg out
12.
Perform movements in a neighbouring tissue
friendly way
13.
Playing with you glitches, when you notice some
compensatory pain related behaviour, try altering it. Keeping it can confirm I’ve
got pain.
14.
Let your mind go
Summary
Purpose of Pain
Pain is one of the bodies signals that there is danger, and
you need to stop what you are doing to protect yourself, fainting and vomiting
being two of the other. All pain is
created by the brain.
Cause of Pain
We establish that we are in danger, and that we need pain through
a number of ways.
1.
Tissue receptors
a.
There are mechanical, chemical and heat sensors
in tissues.
2.
Cognitions
a.
Our beliefs about the situation: if we are in
danger and if a pain response is the right one.
However feeling pain doesn’t always mean that you are in
danger, and should stop what you are doing.
Tissue damage heals with 4-6 weeks, bone damage heals within
6- 8 weeks.
Distinction pain and suffering
This distinction is between pain as the primary sensation,
when you strip away thoughts about pain and the reaction too pain, it is the pure
sensation (although If you dig into it its not this simple as mind and
body=pain).
Suffering is all the extra distress on top of the initial
pain, what you think about the pain, how unfair, how debilitating, the things
you don’t do because of it (which causes distress). Pain management techniques
are predominantly suffering management techniques and when you reduce the
suffering, many times the pain goes too.
What else can cause pain, when you are not being
harmed?
Our Pain system
An increase in sensitivity, the brain can produce more\less
tissue sensors, and can change its sensitivity levels to when it thinks there
is danger: it becomes over-protective.
Neurones can backfire so where the tissue receptors that
initiated the pain might be in your foot, it is conceivable that you have pain
in your hip.
The immune system, has a memory and old pains can reoccur
again when there isn’t tissue damage
When there is chronic pain from a body part, in the brain next
door areas can then be activated (smudging) and there can be sensitivity in nearby
areas to the problem area
Emotions
Stress: this can increase the sensitivity of neurones, and
then increase the experience of pain.
Beliefs
Our beliefs, that pain means we are being harmed and how bad
it is, the memories, associations of the situation.
How important the body part is to us that is in pain, a
violinists fingers will be more receptive to pain than a cyclist.
Its also the case that just because the body is “injured” it
doesn’t mean there should be pain. Over years the body gets wears and tears, if
these wears and tears are small enough they don’t offend the brains pain
alarms. The result can be when people
die and you looked at their spines, you couldn’t tell who was crippled with
pain and who wasn’t.
Behaviour
Avoidance
When people are in pain they can avoid doing things that increase
the hurt, which makes a lot of sense in the initial tissue damage phase of
pain. However there are two parts of
this, one if exercise is stopped because of a pain in one area, whilst its
healing up 8 weeks, if all exercise is stopped, the rest of the body grows
weak. Secondly when healing is done if there is still pain, and no exercise is
done on the painful area, then the body doesn’t get to realise it is ok again. Whilst it will be noted lower down how to do
this, slowly and gently is the approach so a strong pain response isn’t made by
the brain.
Adjustments
When there is pain, people will adjust how they move. A foot
pain can lead to a limp, or a problem in the left hip will change the gait.
There are a couple of problems here. Firstly another part of the body can get
overused, and cause pain, secondly doing this reinforce the brains idea that
there is a problem with original areas, and thirdly the exercise that is needed
to get the original area back and working isn’t being done.
Boom and Bust:
If when you feel good you do too much, you can make the pain
worse, the brain can get more sensitised, you can strengthen your beliefs that
there is something really wrong with your body. Then you will go into a bust
mode, where you don’t exercise, don’t stretch and strengthen your body which
again will weaken your body, strengthen your beliefs about the pain, increase
your sensitivity.
What can help?
Doctors
Ensure that you have no current acute tissue damage that
needs treatment.
Understand your pain
Read the explain pain book and write down your own understanding
of your pain. This will help you find out what is most helpful for you, and
reduce the pain as you will see that hurt doesn’t equal harm
Graded hierarchy
Create a graded hierarchy (with a physio) of exercises to stretch and strengthen, to
get your overall body back to its unified and glorious working unity. You may well want to do some imaginal
exercises in this hierarchy, which will help loosen your brain up too.
Ensure that the graded hierarchy is moving towards something
you care about.
Mindfulness
Firstly read either https://jonkabat-zinn.com/offerings/books/
the pain relief book or if you like a longer read the full catastrophe living
book
Follow the body scan meditation below
https://mbsrtraining.com/mindfulness-body-scan-by-jon-kabat-zinn/
or
https://www.betterlisten.com/products/series-1-guided-mindfulness-practices-with-jon-kabat-zinn
This body scan will reduce stress and tension (reducing
pain) and also give you a pain management tool, through breathing in and out of
the pain site. What you will also find is that it may in time reduce your
suffering, through just being with the pain sensation which changes moment to
moment
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