Need help with managing your pain?

Bethanie Trevenen, AHTA Accredited Hand Therapist

So, you have pain…

All of a sudden, your entire life is encompassed by pain.  The pain is persistent, never ending and all-consuming.  It may have started after a major injury, or it could be the result of a relatively minor injury – that now feels like a major injury!

Practitioners of hand therapy are well equipped to help you deal with this persistent pain that has seemingly taken over your life.  They will do this alongside your physical rehabilitation.  There may be several components that they will address: pain education, Graded Motor Imagery (GMI) programme, physical rehabilitation and general advice.

Pain education: It is helpful to understand persistent pain and how it impacts you, and as result will help you to be able to ‘turn down’ the pain.   They may even show you some YouTube clips to further explain plain.  You may like to view this one to get started:

Some important points to remember:

  • Pain is not an accurate measure of tissue health or damage
  • You can have pain without any physical stimuli- thoughts and places can activate pain
  •  Pain is very personal and always real

 (These points have been taken directly from the Tame the Beast YouTube clip from above)

Graded Motor Imagery programme:

This will include

1.       Left/Right discrimination – this will use either an app or cards to assist with body perception (ability to recognise your injured body part as part of you).


2.       Imagined movements – the next stage involves imagining moving your own body (part) without actually moving it (Decety & Jeannerod, 1996). This will activate special parts of your brain, like a golfer practicing his golf swing.

3.       Mirror box – the final stage is about ‘tricking’ the brain.  This involves use of a mirror so you think you are looking at your injured hand, but you are actually seeing the mirror image of your uninjured hand.

GMI is evidence based and research has shown that it can alter pain.  It may be a little difficult to understand at first, which is why you need a health professional to help you understand and use the GMI programme.

Physical rehabilitation – these are specific exercises given by your hand therapist to help with your upper limb injury.

General advice:

Activity – work up to 30 minutes of general cardiovascular exercise every day.  Ideally, you want to reach the point of being ‘puffed’

Sleep – aim for 8 hours of sleep every night.  This can be particularly difficult when you have persistent pain.  Sleep is necessary for your body to heal, so it is important to discuss this with your health professional if you have trouble getting your normal amount of sleep.

Breathing – persistent pain can result in shallow breathing all the time.  Try and use deeper, diaphragmatic breaths.  There are many apps to assist with this if you need additional help.

Pacing – spread out your activities over the day and week. This will help avoid overdoing it on some days and therefore causing a lot of pain the following day.

Vitamin C – 500-1000mg per day for 3 months.

Remember that pain is changeable.  You have the capacity to turn the pain up or turn it down.  Your practitioner of hand therapy will be assisting you in turning down the pain so you can return to your normal daily activities. Visit and your local practitioner of hand therapy for more information on how to change your pain.




Decety, J & Jeannerod, M (1996). “Mentally stimulate movements in virtual reality: does Fitt’s law hold in motor imagery?” Behav Brain Res, vol 72, pg 127-134.

Graded Motor Imagery Course and Explain Pain Course by NOI group

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