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Three posters of pain – 50x70cm

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Three educational cartoon posters in A3 format

  1. Pain physiology
  2. Pain psychology
  3. Physical activity as pain modulation
SKU: 1002 Category:


The three posters will be helpful in the mirroring process making your patient more aware what pain is, what causes pain, and what mechanisms can increase or decrease a pain experience.

Each poster is in the format of 50cm x 70cm. They should be framed and put on the wall either in your treatment room, in the waiting area, or in a hallway where it is quiet. The goal is not to explain the information on the poster, rather asking the patient: “What do you think about the information on this poster”, or “What does the pictures on this poster mean to you? What may happen, is that the patient recognizes him/herself in the pictures and start to talk about what the picture mean. Another patient may just look at the poster, nodd, and say nothing. Having the posters on the wall at your clinic you signal that this information is within “the walls” of this clinic and if you want to talk about any of this you are very welcome to do so. It is important not to push the patient into any of this, rather gently showing the patient that this knowledge is important and will be helpful in the treatment.


Physical activity as PAIN treatment

Don’t explain the poster to your patient. Instead, ask the patient “what thoughts do you have when you see the poster”. The patient is likely to know about endorphins and that training is a way to produce these endogenous opiates. To further support that correct dosage of training is good pain modulation, explain that training and the production of endogenous opiates inhibit nociceptive input. The hypothesis is that the exercise therapy has anti-sensitizing effect. The training allows for the patient to tolerate increased loading and that the nervous system reacts in a normal way to normal loading, suggesting that graded exercise therapy has an anti-allodynic effect. Communication develops when you the therapist are on-site in the training room. While the patient cycles is a good opportunity for the therapist to explain what is happening. “When you cycle, nerve impulses travel from your ankles, your knees, your hips and thigh muscles to your spinal cord. A chemical reaction block these nociceptor impulses from reaching your consciousness. At the same time, cells in the pituitary gland in your brain is activated. The cells produce endorphins that circulate out and bind to nerve cells in your brain and other parts of the central nervous system, just as morphine does. In this way, you get a further blocking of nociceptive impulses experiencing less pain.


Physiology of pain

Do not explain the poster to your patient. Instead, ask the patient “what thoughts do you have when you look at the different elements of the poster”.

The patient will recognize him or herself in the red devils and in the pain orchestra that plays pain tunes.

However, it is more difficult to understand that we do not have pain receptors but nociceptors. Nociceptors (mechanical, thermal and chemical) are designed to detect tissue injury and have high tresholds for activation, meaning that initially there must a certain intensity of a stimulus to activate nocicepetors. However, over time these nociceptors lower their treshold for activation so that a normal stimuli that should not cause pain causes pain. This is allodynia.

Pain equals stress. When pain and stress combine they activate the Hypothalamus – Pituitary – Adrenal gland axis (HPA axis), increasing the level of stress hormones in the body. Later, with long-term pain and stress, the HPA axis may be so overloaded that the descending pain inhibiting system become dysfunctional. The patient often recognizes themselves in the three different persons. One has gained a lot of weight, one is suffering from mood changes affects his/her relationships at home and at work, and the third person is suffering from increased anxiety and depression. This is an important factor for sensitization processes and the burn out syndrome.

It is now important that we explain something. As mentioned above, we do not have pain receptors, but nociceptors. The nocicpetors have high tresholds for depolarization and is primarily designed to detect tissue injury. The nerveimpulses from nociceptors are interpreted in various parts of the brain which again determines if you will experience pain, what type of pain, and how much pain. Thus, pain is an OUTPUT, not an INPUT. Most interesting of all, is that research show, that our thoughts and feelings are connected to the pain experience. Thoughts and feelings modulate the pain experience. Thus, psychological factors can either increase/activate or decrease/inhibit nociceptive input, controlling the physiologic reactions in the brain and spinal cord related to the pain experience.


Psychology of pain

This is the most important poster of the three posters. A rough estimate is that 70-90% of the patients find this poster most interesting. Is it because the drawings of the poster deal with feelings?

Again, do not explain the poster to your patient. Instead, ask the patient:

“what thoughts do you have when you see the poster”. Or “what do you see here”.

Many patients recognizes themselves in the poster and open up to what he/she sees. In this way, the patient avoids feeling stigmatized and can be relieved to understand that the commonly negative expressed idiom “it’s all in your head” is in fact backed by sound evidence that relates pain to our psychological reactions and feelings. If you the therapist had explained the poster for the patient, there is the risk that the patient will feel stigmatized and interpret negatively everything you say. When the patient begins to explain and open up about the pictures, you can then ask open-ended questions or give answers if there is anything the patient is wondering about. A journey now begins between you and your patient, working together towards understanding how psychological factors, thoughts and feelings control the pain experience. Finally, It's nice for them to discover the idea for themselves and it easier for you and me to guide them than trying to explain it.


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