FALL 2013


The CPMU Motivator



“Motion is Lotion




A different approach to
exercise is being
used at the
Chronic Pain Management

Unit (CPMU)



“Our first approach is to challenge the

 nervous system and make it less sensitive.

 Then we increase strength and endurance
with  an individualized exercise routine.”



Unfortunately, many clients arrive at the CPMU with negative experiences regarding exercise and physiotherapists. Frequently used phrases such as “no pain, no gain”, “push through the pain during exercise and get it done” and “how do I get stronger if I don’t work harder” are heard. Physiotherapists are known as “physioterrorists”.


Many graduating physiotherapists are starting to learn more about chronic pain during their graduate programs and are now aware that pushing through exercises is not a helpful approach with the chronic pain population. Unfortunately, it has been clinically noted that the swing to the other end of the continuum occurs and as a result the increased use of passive modalities such as Tens, Acupuncture and passive range of motion exercises appear to be primarily utilized. The two extremes of either pushing through exercises and ignoring the nervous system’s response or the opposite extreme of the increasing use of passive modalities are not helpful. Clients with chronic pain often become reliant on the passive modalities and further deconditioning of muscles occurs.


At the CPMU, we are educating patients about the nervous system and the consequences of over doing and under doing tasks. This type of education is known as Pain Neurophysiology Education (PNE). PNE is used to increase one’s understanding of the body’s nervous system as an “alarm” system. Patient’s who feel pain, often assume it’s a sign of tissue damage in progress. However, feelings of tingling, burning, warmth, inflammation, etc. can also be a result of a “wound up” nervous system. People living with chronic pain are taught that their nervous system has become over sensitive and that central and peripheral sensitization is occurring. Education focuses on the “alarm system/nervous system” and how not to push through exercise when the alarm system sounds. Rather, patient’s are encouraged to be aware of their nervous system and “challenge” it by way of a graduated, individualized exercise program.


Most recently chronic pain education had used a chronic disease management approach which teaches individuals how to cope and learn to live with a condition and, as a result, experience an improved quality of life and function. However, Pain Neurophysiology Education (PNE) is different because it teaches that change can actually occur at the cellular level and that pain can change. PNE utilizes brain science and brain plasticity to teach patients that new neural pathways can develop and thus change the physiology which causes persistent pain. Pain can change and quality of life and function can improve.


Researchers have investigated the effectiveness of PNE as an intervention. At present, reviews of Randomized Controlled Trials show mixed results. Some studies have shown that people with increased levels of fear with movement and chronic pain have found PNE helpful. Further research will need to determine the best treatment approach for this population.


Not all clients are open to the new concepts presented. Many become frustrated by the internal drive to want to push forward, work through the pain; as they have always done in the past. They are not ready to work at their baseline so their nervous system can become less sensitive. Other patients sometimes struggle with the concepts presented in PNE where English is not their first language. Although we have a better understanding of how an individual’s physiology changes with chronic pain, the question of how to effectively present material to this population continues to evolve.


In summary, PNE has provided more information to the client and given them the hope that they can change their nervous system and therefore their pain response. More quality research is required to determine the best approach to chronic pain management in order to improve the quality of life of individuals living with this persistent condition. To date, we have found that clients who are empowered to make changes to their nervous system, with the use of PNE, appear to have an increased control of their pain response and how to manage their flare-ups.




adria copy


Adria Fransson



CPMU Patient Testimonials


“This pain management program was a lifesaver for me, from start to finish. Having every one you need, daily and at your disposal, ensures that every aspect of your daily struggle with pain is met, not just physically but emotionally and spiritually. I would highly recommend this program as it will open your eyes to the pain-emotion connection.”


Steve Johnston

Windsor, Ontario

Completed 4-week Program March 28, 2013
Funder: Veteran Affairs Canada



An excerpt from a patient’s facebook status  “I'm back home from Hamilton and Chedoke Hospital Pain Management Programme (4 weeks). I made a ton of friends both at the Programme and at the Courtyard Marriott. The first week was intense, moving muscles I had forgotten I had but now at the end of the programme, I walk 3-4 km a day, eat three meals a day, stretch and relax as needed and have learned the valuable art of pacing ones self -- definitely needed by most of the people I know in our fast-paced world! My pain level, while still the same, is somehow easier to deal with, with the tools I've been given. It's like my life's toolbox had 3 or 4 things in it before and now I can't close the lid! Ten to Twenty percent of our population deals with Chronic Pain and if only 1 of you seeks the help through a programme like at Chedoke, then it was worth bothering the other 324 of my friends with this update! I love you all! Thank you for your kind words of encouragement. — feeling better.”


Paulette A. Miller

London, Ontario

Completed 4-week Program Sept 6, 2013
Funder: Veteran Affairs Canada



A BIG Thanks! goes out to our integral students and volunteers


Chitra LalooChitra Laloo, a Ph.D. student in the Medical Sciences program at McMaster University is collecting data for her Ph.D. dissertation research from our chronic pain patients this summer. Chitra's research is focused on development and testing of the Pain-QuILT, a web-based tool for the visual self-report of sensory pain. The Pain-QuILT uses a simple visual language to help patients to express the quality, intensity, and location of their pain. The current study aims to compare the Pain-QuILT with commonly used paper-based instruments, the McGill Pain Questionnaire and the Brief Pain Inventory.


Alena RussoAlena Russo, a fourth year Psychology student at McMaster University has just completed her 6 week summer course (independent study) PNB 4QQ3 at the Department of Psychology Neuroscience and Behaviour, McMaster University, which I have supervised. As part of the requirements for her course completion, she wrote a paper entitled “Interdisciplinary Pain Management Programs and their Effectiveness in Treating Patients with Chronic Pain.” Other than this, Alena also attended aspects of the Program, rounds and presentations and scored assessment and program evaluation measures.



Viola KacaViola Kaca, also completed a fourth year course (independent study) here last May to June. She presented on the Physiology of Pain to our Team, scored assessment and program evaluation measures as well as showed others how to score these measures.



Caroline Maschewski, a fourth year psychology student at the University of Victoria, British Columbia, was our sole volunteer for this summer. She began coming here once a week for about 2 hours in July and will end towards the end of August prior to her departure for BC to complete her psychology degree.


Our students and volunteers are an integral part
of our Program. Everyone benefits from their involvement here.





“Standing Together”

A Conference to Unite those Affected by PTSD

September 14, 2013,   London, ON

Dr. Eleni G. Hapidou, Psychologist, was a guest speaker on the topic of “Chronic Pain & PTSD.”  Sonya Altena represented the CPMU with a display booth at the conference.




Clinical Pain Management Skills Course, Canadian Academy of Pain Management (CAPM)

September 8, 2013, Hamilton, ON

Dr. Eleni G. Hapidou, Psychologist, presented “Whole Group Practice of Relaxation and Stress Control” and along with Dr. D. Rosenbloom “Understanding Meditation Approaches for Pain”.


A Practical Approach to
Drug Misuse and Diversion

April 14, 2013 and September 14, 2013, Hamilton, ON

Dr. Ramesh Zacharias, Medical Director, is one of the key organizers. The next meeting is scheduled for early 2014. Please see a summary of the meetings below.


20th Annual Conference on Innovative Strategies for Issues Complicating
Brain Injury

May 9 and 10, 2013, Hamilton,, ON

Hosted by Acquired Brain Injury Program,
Hamilton Health Sciences

Dr. Sean Curran, Anesthesiologist, was a guest speaker on the topic of “A Biopsychosocial Model for Pain Management in Patients with Cognitive Impairment” Sonya Altena represented the CPMU with a display booth at the conference. 




A Practical Approach to

Prescription Drug Misuse and Diversion



Dale Tomlinson
Michael G. DeGroote National Pain Centre


This spring, work began in Hamilton on developing a sustainable strategy around the use and abuse of opioids in Ontario. On April 25, 2013, organizers, Drs. Norm Buckley, Angela Carol and Ramesh Zacharias, held a very successful day-long meeting - A Practical Approach to Prescription Drug Misuse and Diversion. Stakeholders included patients, pain physicians, law enforcement, addiction experts and the coroner’s office. The key-note speaker at this meeting was Dr. Richard Dart, Executive Director of the RADARS System. RADARS was developed as a way to address risk management obligations, specifically the challenges faced with reports of abuse, misuse and diversion of prescription medications. It is an independent, nonprofit operation of the Rocky Mountain Poison and Drug Center (RMPDC), Denver, Colorado. A follow-up meeting was held on September 14.  Key-note speakers at the September meeting included leaders who have participated in developing successful strategies in their own communities (Inverness, Nova Scotia; Six Nations of the Grand River First Nations; and Wilkes County, North Carolina). Work began on developing a template for addressing the complex problem of prescription drug misuse and diversion which can be implemented not only in our own local community but also across the nation. A third meeting is planned for spring 2014 to refine a roadmap for moving forward.







For further information regarding the Chronic Pain Management Unit (CPMU)
please visit our
website or phone us at 905-521-7931 or email to pain@hhsc.ca

For further information regarding the referral process or to make a referral,
please complete the
referral form.

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