20Jul/15

My A to Z of pain

Photomarathon - Alphabet by Eva Van Ostade | https://flic.kr/p/i84n6g

Photomarathon – Alphabet by Eva Van Ostade | https://flic.kr/p/i84n6g

My A to Z of pain —

This is by no means exhaustive, but rather a brainstorm of some of the most salient features of the Pain Coach Programme to overcome chronic pain and injury.

I am sure that I will mould this and re-shape it in time, as you are also free to from this basic framework. At the heart of the thinking lies the person suffering persisting pain, whereby their sense of self and who they feel that they are has been compromised and affected by the pain. Pain often becomes all-encompassing, pervading into all corners of one’s existence. Except that this need not be the case as we understand our pain, develop our thinking to take the right action and focus, utterly focus upon the vision of how we want to be living. All too often the messages given and auto-suggested are negative and inaccurate and hence as soon as the thinking is right and based on what we really know about pain, the person will see the opportunity to move forward towards a meaningful life once more.

A to Z of pain:

Attitude to pain affects what you think and the action you take.

Behaviours are chosen based on your beliefs; work on your beliefs about pain by really understanding it.

Change happens in the wake of developing your thinking about pain.

Decide to focus on what you can do rather than what you can’t.

Energise yourself with movement, breathing, diet and engagement with people who nourish you and make you feel good.

Focus on your vision of who you want to be and what you want to be doing. Re-visit this focus often each day.

Galvanise your strengths and focus on them to develop and grow.

Habits of health created by you.

Intelligent emotionally to be aware of how you and others are feeling so that you can make positive changes by focusing on your strengths.

Jump for joy as often as you can; if not literally, then in your mind — imagine jumping!

Kick unhealthy habits by developing your strengths.

Laughter has great effects on health and you.

Meaning is key for engagement at work and in relationships, so create a meaning for all these situations.

Notice what is happening right now; be mindful and see how anxiety drops and you feel better. When you feel better, your pain feels better.

Observe your thoughts rather than being embroiled in them.

Persevere to achieve your vision.

Quiet time to re-charge.

Refresh often during the day with movement, breathing and creating calmness in your mind.

Success comes with perseverance, choosing to think positively, learning from mistakes and focusing upon your vision.

Tell yourself positive messages over and over and notive how you feel — also using your own body language: sit up, stand tall, be proud becasue you are worthy.

Understand your pain is undoubtedkly the fisrt step in overcoming pain.

Virtues and morals drive what we do because that’s what we believe. They should be in synch with those of our relationships and work.

Worthy of overcoming pain and living a meaningful life – you are!

X factor is something we all have. Use it to motivate yourself and change emotional gears.

Yes I can.

Zzzz’s are an absolute must for health. 8 hours.

* These thoughts derive from the Pain Coach Programme for overcoming chronic pain.

There is a programme for individuals suffering chronic pain and a mentoring programme for clinicians who work with people with chronic pain problems who want to develop their skills and strengths. Call us now: 07518 445493

13Jul/15

Pain and society

By Tess Watson | https://flic.kr/p/8W6Gkm

By Tess Watson | https://flic.kr/p/8W6Gkm

Pain and society — Pain is an issue in society, and for society. Why pain has become the number one global health burden is a question that we must consider and answer using on-going study of what pain really is, how it influences us, how we influence pain, how pain emerges from individuals who form society and how society views pain. No mean task, however we must envision where we want to be as a society and focus on getting there.

One of the biggest problems with pain is that it is misunderstood. The predominent thinking remains in the pathological and body structure camp as an explanation for pain. This thinking needs to develop across the whole of society, in fact begining in schools where I believe children should be taught about pain.

Fear is a huge factor in pain — what does this mean? Will it get better? Will this pain ever go away? Etc etc. Of course those who understand pain will know that these very thoughts are ample to fuel further protection and hence pain. We need people to understand that pain emerges in them as an individual, very much flavoured the situation in which the pain is noted, influenced by past experiences, beliefs about pain and immediate thoughts and emotions. There are reams of papers examining these factors. The early messages are vital when someone has injured themeselves or suffre an acute episode of pain. The right thinking from the outset creates a way forward with effective behaviours and actions to allow the body systems to co-ordinate healing and recovery. Unnecessary fear and worry simply divert resources away from these processes and hence affect the outcomes. We do not need to fear pain but rather, take action and deal with pain.

When someone has more persisting pain, and this is likely due to certain vulnerabilities that we are understanding more and more, again the mesages must be clear and accurate. The notions of management and coping are just not good enough. We can deliver much better care, advice, coaching and treatment than ‘management’ implies. This is beneficial for the individual, the funder and hence society as a whole. Society needs to be purporting the right messages about pain and therefore we need to develop thinking on a large scale.

When I studies the Pain MSc at Kings College London under Dr Mick Thacker, I used to wonder why it was called ‘Pain: science and society’. Whilst I do not know the exact reasons for KCL’s entitling of the course, now it is obvious to me that we have a huge societal problem that needs urgent attention. There is a responsibility for all of us to come together and develop so that change occurs in the wake of new thinking based on the huge amount of research into pain. We need the support of the policy makers, businesses and individuals. Why policy makers and business? Because we can change what is happening now including the vast cost of chronic pain — this huge pot of money could become available for many other areas of life. So let’s move forward together.

If you are a policy maker or a business recognising the effects of chronic pain on society or upon your business, contact me for information on shifting and devloping thinking to take big action. t 07518 445493

Pain and society by Richmond Stace

11Jul/15

Pain and the perfectionist

By LordEfan | https://flic.kr/p/kUfKKZ

By LordEfan | https://flic.kr/p/kUfKKZ

Pain and the perfectionist could be a title of a book in which the character suffers on-going pain, seeking to conquer himself using his perfectionist traits. I know of no such book, but I do know that a significant number of people who I see with chronic pain are perfectionists.

Like most things though, it is how you look at it that makes the difference. Most traits that we exhibit have a benefit and a purpose in our lives in one quarter but can be problematic in other arenas. Perfectionism is no different.

Whilst being a perfectionist would be highly adaptable when studying the detail of a document, arranging a bouquet or organising an event, when this spills over into being hard upon oneself, it can push the individual too far. Compassion must start with the self — being kind to yourself. It is all too common that people are self-critical, either overtly or more frequently via the inner dialogue. Continually telling yourself that you are not good enough or that you will never achieve is the exact opposite of believing in yourself. If there is one characteristic that is vital in overcoming pain, it is the belief that you can do it.

The sense of never being quite good enough is a safety mechanism of sorts. On the flip side it may drive the individual to practice or work harder, and this is acceptable if it does not cause angst and on-going stress that is incongruent with health and a feeling of wellness. Chronic stress is a significant issue in the modern world, having a huge role in many of the common problems that we see today — e.g. functional pain syndromes such as IBS, headache, migraine, functional abdominal complaints. Chronic stress causes the body to set itself in an inflammatory state, and there is a constant preparedness for action to fight or run away from a wild animal. Except there is no wild animal, just our thoughts and interpretations. These we can learn to observe rather than become embroiled within with techniques such as mindfulness.

Perfectionism is a strength that we can foster as part of the programme of overcoming pain. I base my treatment and training programmes upon your strengths as these are what we use in life to succeed, and succeed you will by nurturing these within an action plan that takes you back to a meaningful life. It is easy to say don’t be too hard on yourself, yet difficult to master. But it is possible to harness the strength of perfectionism and use it to overcome your pain.

For information about the Pain Coach Programme to overcome chronic pain, call 07518 445493. The Pain Coach Programme is also a learning programme for clinicians who want to develop their skills, either 1:1 mentoring or in small groups. Call us for details or email [email protected]

 

10Jul/15

Pain and guilt

You are beautiful by La Melodie https://flic.kr/p/99ACEa

You are beautiful by La Melodie https://flic.kr/p/99ACEa

Many people who I meet will describe their pain and guilt. Naturally they come to tell me about their lived experience of pain and how this impact upon their lives. They narrate a story in which they are the person who has lost their sense of self, who they think that they should be and how they think their life should be. In answer, I will seek to make sense of their story with explanations and a route forward (the coaching and treatment programme). Then we encounter the challenge to surmount feelings of guilt at the thought of dedicating time to ‘me’ in order to overcome the pain. How will I do these things when I have to…….? You can fill the gap with work, be a wife, be a husband, be a mother etc etc. Familiar feeling?

So here is the deal. You actually deserve to get better because you are worth it. One of the common themes in chronic pain is that the sense of self-worth diminishes, if it was not already ground down by life’s experiences over the years. This is certainly something that needs to be worked upon as part of the coaching programme, along with self-belief, self-efficacy, confidence, focus, resilience and motivation to name a few.

How can we do the things that we need to do in both thought and action, if we do not prioritise? It is your job to get better.

A clever programme will easily interlace into your life rather than be seen to be something separate. We have a lived experience and the development of self to change health and pain is moment to moment. It is as simple and as hard as developing new habits using the skills and strengths that you already possess. A clever programme will use your strengths to overcome your pain. And by overcome, I mean resume a meaningful life, and what this means to you — not the clinician or anyone else, you. When you feel like you, according to you, then all those around you will benefit as well. So as much as you may begin by viewing the prioritisation of the programme as being selfish (and I hope you do not now, or did not, but soon you won’t), to be you again requires that you do make this one of your top 3 priorities. You are not separate from your environment or the people in that environment, and hence you need to focus on you and those around you need to develop their thinking about this as well.

For this reason, I encourage partners and family to come to some sessions, or even come on their own to develop their thinking and to see their role in your recovery. You could even start by asking them to read this blog.

To be you is not to be selfish but a vision to be achieved.

For further information about the Pain Coach Programme to overcome pain, call now 07518 445493 — you deserve it!

09Jul/15

The habits of pain

When we have suffered pain for some time, the habits we create can become part of the problem, and part of the reason why we are not moving forward. Whilst certain actions that become habitual are useful in the early stages, they only have a role for a finite period of time. Subsequently, other strategies need to be used to develop, learn and move on to overcome pain. 

A simple example would be a limp that is useful after an ankle sprain, that is not helpful one year later. In different parts of the body we do different things according to the typical actions that body part would be actually used for as well as intended use. This latter point is relevant because we are continually predicting and planning actions mostly at a subconscious level. We are responding to ten environment we are in, the context of that environment and the tools within that environment that we may use, such as a cup or a pen that the brain plans to pick up on sight if relevant. We don’t always know about this, and interestingly, just the mere plan or intent of doing something can cause pain on the basis that we are in protect mode. The same is true for watching others actions that would be of a high threat value to us. Someone with pain in their back may experience a twinge on observing someone else bending. For clinicians, this offers clues as to the level of protection — bend in front of the patient to see how they feel. 

As well as movement based habits that are actually based upon our beliefs about pain, injury, ourselves and the world, we have habits of thought. We automatically think about a situation, someone’s comments and about something we may need to do. These thoughts, if identified with, will impact upon what we choose to do. If I believe that when I move it hurts because I am further injuring myself, I will either not move or will move in a guarded way. In part I will do this on purpose, in part my protective systems (nervous, immune, autonomic) will inlfuence my movement upstream by contacting the sensorimotor areas of my brain. Of course we are not just brain but whole person, so I say this for convenience of the description. We learn quickly at the outset that a particular movement hurts and we may then anticipate this and decide not to move to to tense up and move abnormally. Whilst this is again useful in the early stages when the tissues really need protecting (whilst healing), as time goes on we need to move to get fitter and back to normal life. 

These are just a few examples of what happens. In some cases there are cycles of inflammation that trigger an acute flare-up within a persisting problem. Initially it maybe useful to use some of these protective habits, but only in the short-term. Not allowing them to take hold and only using them wisely is key. I like the metaphor that describes a man who is walking through a forest and comes upon a fast moving river. To cross he builds a raft and successfully reaches the other side. Does he still have a need for the raft? Should he hoist the raft onto his shoulders and carry the cumbersome vessel thought the trees? I think not. At each moment we need to think clearly about what is the wisest action. 

As I said earlier, and often say, we must address the whole person including their habits of thought and action and how the two entwine. We must explore why protective habits are being used and then develop this thinking into a range of skills that take the person onwards to where it is they envision being. This vision is vital and I work hard with people to create a strong image of what it is they want and how it is they want to be. This becomes their steer and all their thinking, focus and actions are upon attaining this vision. We become what we focus upon and hence we must use our strengths. 

For further information about my Pain Coach Programme for overcoming persisting pain, please call 07518 445493

08Jul/15

Dystonia coaching programme

Lateral view of neck by Double-M https://flic.kr/p/9swvo6

Lateral view of neck by Double-M https://flic.kr/p/9swvo6

The dystonia coaching programme that I have developed over the past few years is based on similar thinking to that of persisting and complex pain. In fact, the reason why I started working with people experiencing dystonia is because of a conversation with Dr Marie-Helene Marion (the movement disorder specialist).

We were discussing biology, people and influences, thinking that we were talking about the same thing, but in fact I was talking about persisting pain and Dr Marion was talking about dystonia! From thereon it was clear that there are significant parallels in what we see and who we see, leading to an innovative approach based on the latest neurosciences. I was fortunate enough to talk about this at The Dystonia Society meeting and The British Neurotoxin Network conference.

Most cases of dystonia that I see are cervical. This is a troubling condition in many ways, including the social aspect that is commonly forgotten. By this I mean how dystonia impacts upon the person’s social interactions due to the way it can make them feel about themselves. This is such an important part of the problem, as the way we think and feel affects our sense of self and how we move. With a movement disorder, this is highly pertinent. Our thoughts and feelings can frequently be impacted upon by the way we think others see us, potentially driving behaviours such as avoidance and protective posturing, both of which affect quality of life.

There are several other notable consistent findings. An altered sense of body position that underpins the imprecision of knowing where your body is in space and the movement imprecision that is the classic sign. In fact, it is the sensorimotor function that is a problem as a whole, influenced by a range of factors such as thoughts, emotions, the environment. As with pain, dystonia is a whole person problem and as such requires whole person thinking behind the treatment and training programme.

Botox treatment often has good effects when used at the right dosages. Commonly people become engrained in thinking that they must have injections every 3 months, with this expectation influencing behaviours and outcomes. In my dystonia programme we immediately aim to develop this thinking into how we can gap out the need with specific training but also challenging unwarranted expectations. It is exciting to think that drugs are affected by the way we think as it opens the door to great possibilities.

Much like the Pain Coach Programme for persisting pain, the dystonia programme targets the person: their thinking, emotions, movements, sensations as a whole. There are specific training exercises that take advantage of our ability to develop (commonly called neuroplasticity) and learn, and a range of strategies that target the influences upon the way we move and face the world including stress, anxiety, thoughts, other people and the environment. Our understanding of ‘how we work’ is ever-growing and this is cause for great optimism as we see people overcome chronic pain and dystonia in theor own individual way.

For more details or to book an appointment, call now 07518 445493

29Jun/15

Overcoming neck pain

'neck' by JB | https://flic.kr/p/4VYHd1

‘neck’ by JB | https://flic.kr/p/4VYHd1

Overcoming neck pain is the aim of the many sufferers of this common persisting problem–it’s in the top 10 of global health burdens! What causes neck pain? Regular readers will be familiar with the notion that pain emerges in the person, located where protection is deemed necessary. The feeling of pain, (‘I am in pain’) exists as a motivator through its unpleasantness, demanding attention and action sufficient to reduce the threat and hence leading to pain relief.

The question to ponder upon is why is this person in pain? What has created such a threat value that there is benefit from a painful experience to drive some form of change in thought and action and vice versa, such that the threat diminishes. What can potentially pose a threat? We have to say potentially because these factors will not bring about a pain response in all people as we know. The existence of pain and intensity of pain do not rely upon these factors. Instead it is the meaning and the significance given to these factors that determines what happens next. Consciously I may not believe that sitting for an hour is ‘dangerous’, yet from my body, which of course is not separate from who I think ‘I’ am, emerges the feeling of pain. This is where the sense of self becomes confusing because how can my body be separate from ‘me’. We often use language, especially to do with pain, that distances ourselves from the feeling, except this is erroneous thinking as the pain is emerging in us, much like a thought emerges and becomes conscious. Consciousness is the background upon which a small amount of what is going on appears to us, including pain and other sensory experiences that can frequently evoke emotions.

Examples of factors that can be rated as dangerous:

  • Inflammation (tissue damage, neurogenic)
  • Infection
  • Contexts: e.g. sitting at a desk, driving, carrying a bag
  • Thoughts: the meaning that we give to the pain
  • Stress: this is a response to perceiving a situation as being threatening rather than the actual situation itself
  • Tiredness

In other words we must look beyond, well beyond the area that hurts and think about the person and their life, which includes environments in which they inhabit (home, work, play), people they spend time with, things that they do, past experiences, pain vulnerabilities. This is the same for pain in the neck as it is with any other persisting pain problem. Only with a comprehensive view can we think broadly enough to devise a programme of treatment, training and coaching to sustainably overcome the problem.

***

Pain Coach Programme to sustainably overcome persisting and complex pain. Call now: 07518 445493

21Jun/15

Caring for our elderly

Caring for our elderly is a society wide responsibility. On a micro level, individuals care for family members or friends. On a macro level, the government must create a framework that permits this to happen effectively as well as ensuring that supporting services for carers are accessible and fair. This blog is about the former, suggesting a way of thinking to help carers optimise their effectiveness. However, if a policy maker is reading, you should be considering how to best facilitate and support these straight forward strategies.

There are a multitude of problems associated with being older, but we must not forget that it is a person and not just a range of conditions. An individual is living the experience that we observe, and if this lived experience is painful, limiting, confusing or isolating, we can only imagine what this must be like. There is no better example than dementia, when that person’s reality is shifted brutally into a seeming groundhog day. We have no idea what this can be like, but we must empathise and realise that many of the behaviours are due to fear and anxiety re-lived over and over.

A simple example: an individual spending more time in bed than being up and about, also suffering dementia. The stiffness in the body ensues and often needs easing with gentle therapy. The passive movements when another person takes hold of your body to move the joints or massage the muscles can be painful as a norm. However, this can provoke a protective response as the person withdraws their limb for fear of pain or it actually hurts. The pain eases with the treatment and relief can be obvious. The next day, the same fear is evoked as there has been no memory laid down from the previous day, so the whole experience is repeated as if new, fears and all.

Remembering that the person is that, a person, is a guiding light in our thinking. Cultivating compassion through the practice of working with the vulnerable is a valuable skill to benefit both the recipient of the care and the giver. Seeing the experience for what it really is, rather than clouding it with thoughts, allows the carer to focus on the individual and their needs. These are simple practices that just need to become habits, and when they do, amazing things can happen. It is not for me to tell you what they are, but if you do practice, you will soon know.

Here are a handful of tips that I routinely give to carers:

  • Create calm in your own mind before every interaction, even if it is just a few moments of breathing and re-focusing.
  • Be present throughout the session, noticing all that is happening right now.
  • Use a calm voice and smooth movements — before changing someone’s position or encouraging them to move, explain calmly what you will be doing and why; even if you are not sure they will understand. It will put you in the right frame of mind and perhaps they will pick up on your tone and compassioned intention.
  • Use touch skillfully. Stroking has amazing effects on the body sense, sculpting the feel of the body for that person as you send signals into the brain maps as well as creating a soothing atmosphere and calming the person.
  • Position the individual so that they can be alert to all the stimuli around them. You know what it feels like to be slumped in bed or in a chair — stiff, lethargic etc. Change their position so that they can be part of what is happening whilst you talk to them and engage as much as possible in a positive tone. Remember that the position our body takes affects how we feel. Make someone feel good by giving them height and posture.

There are many more easy things that we can do to make a massive difference. Carers have a key role and if they know and understand all the influence that they can have, it changes everything for the better.

I encourage carers to come to sessions or to come alone to learn about what they can do. Feeling empowered as a carer is really important, and the Pain Coach programme incorporates the needs of the carer so that the relationship with the patient is bi-directionally healthy.

Call me for further details on the Pain Coach programme: 07518 445493

20Jun/15

The problem of migraine

migraine by r. nial bradshaw (2012)

migraine by r. nial bradshaw (2012)

The problem of migraine is bigger than most people realise. In fact, the problem of chronic pain is bigger than most people realise, this being apparent as I purposely ask people I know and meet if they know what is the number one global health burden. It is chronic pain by the way, and migraine and headache sit in the top 10 along with back pain, neck pain and osteoarthritis. Depression is at number 2.

Migraine is sometimes referred to as a functional pain syndrome. Not everyone likes this term, myself included, yet it’s use does mean that we can consider migraine as one of a number of conditions that hurt and cause great suffering. These conditions have a common biology known as central sensitisation, meaning that the individual’s systems that protect are more likely to do so, resulting in persisting pain in many cases.

The other well known functional pain syndromes include irritable bowel syndrome (IBS), temporomandibular disorder (or jaw pain, clicky jaw etc), pelvic pain, dysmennorhoea, vulvodynia, interstitial cystitis, chronic back pain and fibromyalgia. These are often co-morbid with anxiety, depression and hypermobility. As individuals, it is common to find perfectionist or obsessive traits that may be useful in certain arenas such as work, helping to achieve great success, yet in other areas of life cause problems. More women than men report these problems, although I am seeing increasing numbers of men who often describe groin pain as a starter but then we explore the history and discover one or more of the aforementioned list. A further frequent finding is difficulty conceiving, this primarily due to the body systems that protect being persistently fired up (by normal living and exposures as well as stressors), and whilst that person is in such a mode, having children is not on the body’s agenda whereas survival is.

As with most of the functional pains, the story highlights certain vulnerabilities that can increase the likelihood of persisting pain including genetics, epigenetics, early life stressors and prior infections/injuries. These factors sculpt the systems that protect as they learn how to respond as well as becoming increasingly vigilant. The combination therewith creates an individual who is more likely to respond to actual or potential threat with vigorous and prolonged action and behaviours. With anxiety in the mix, this person is then likely to over-worry, which in effect further raises the threat value and heighten the responses even more. And so it goes on.

Rarely are the conditions explained adequately to patients, and certainly knowledge of the link between the seemingly different problems has never been volunteered to me by a patient. Therein lies a problem that the individual is suffering one or more pains and other symptoms (e.g./ tiredness, poor concentration, disrupted sleep, lethargy, flu-like symptoms, brain fog), yet they have no understanding as to why, or how it comes on, or what they can and must do to change the situation and move forward. Explaining the condition(s), the links, what the patient needs to do and what we can do to help and support them over a period of time that we can estimate is a key start point.

Further to the common biology, we can observe in the clinic the posturing, movements, guarding, poor body sense, altered sensorimotor function and the overall manifestation of how that person is feeling through body language and the words they use. We can gather far more information about the person, the whole person, by talking to them, listening to them and their concerns. What is their lived experience? The structured interview does not allow for this conversation. Yes we need some specific questions, but creating an open environment gives the person a chance to talk, feel heard and validated. This sets the scene for specific training, techniques and strategies that need to be used throughout the day and the development of understanding, all of which are the knowledge and skill base that the patient needs to overcome their pain.

No matter how long you have had pain, it can and does change. We are designed to change, and this is happening all the time. We are on a continuum, and we can have a say in where we go. It is a challenge and requires dedication, motivation, resilience and practice, but with the right thinking, action and support, great things can be achieved. I am honoured to see this happen in the clinic every week as people overcome their pain and resume being who they think they should be.

If you are suffering or think that you could be suffering with functional pain syndromes, call me for a chat and we can decide what you need to do to start overcoming your pain: 07518 445493

Clinics in Harley Street, Chelsea and New Malden Diagnostic Centre

17Jun/15

Sticks and stones

Sticks and stones by Coloured Pencil Magazine (2014)

The old saying goes, “sticks and stones will break my bones, but words can never harm me”, however this is not exactly true when it comes to messages that are used to explain pain. Of course you could argue that words only cause harm if we interpret them as harmful rather than what they are per se, just words. Easier said than done!

Earlier this week I saw the word ‘instability’ written in reference to low back pain. This is a word that has been used frequently as a means to justify the use of something to create ‘stability’ and hence solve back pain. It has not worked.

The reason it has not worked is because there is no instability, and more importantly because pain is not a structure. I emboldened those words.

Pain is a whole person, emerging in that whole person in respect of a perceived threat. That is not a structure or a pathology. It is the whole person’s response to that pathology or injury that manifests as pain (in a bodily location), involving a number of systems that have a role in protecting us: e.g./ the nervous system, autonomic nervous system, immune system, sensorimotor system.

An injury or a pathology is not the same as pain. We cannot equate them as they are poorly related. An injury is an injury, and pain is pain, the latter being one of a number of responses to the former.

Back to instability. What does it suggest to the recipient of the message, “You have instability, which is why you have back pain”? How will this affect their pain, bearing in mind this is a pretty threatening thought? How will it affect their movement?

If there is true instability from a serious injury or a pathology that has affected the vertebrae to a significant degree, this calls for urgent surgical care. We are not talking about this scenario though, rather the number one global health burden that is low back pain. This pain is not explained by instability. If anything, the use of this word creates dependence rather than a proactive approach to restoring normal, confident movement and living life with less or no pain.

Pain is the vehicle that brings most people to the clinic. We need to give meaning to the individual’s meaning about their pain that they have already created, bringing their thinking into alignment with what we really know about pain. We must convey the right messages from the start to reduce the risk of chronicity. I just want to add that we need to tackle pain in the broadest way from the beginning, incorporating all dimensions–physical, emotional and cognitive–but importantly, how these interact as the whole person with prior experience, beliefs, genetics, gender, co-morbidities etc. The step-wise approach of trying medication, then physio, then interventions, then psychology etc (not always in that order!) does not work. It does not work. The whole-person needs to be addressed from word go. The whole climate and culture of health-caring for pain must change. And this includes the words we use, in reference to my earlier point.

When we understand pain, the actions that we take change for the better. When it makes sense and we know that we are safe to move and live, it takes us in the right direction. Each person has their own lived experience of pain that has been cultivated through the development of all the protective systems that have been subject to prior demands, and learned how to react in certain situations. This makes some people more vulnerable to chronic pain. Let’s help these people by asking the right questions at the start so that we can change the course that they are heading on.

We can and must do better. The science is there to be used and the thinking is there to be used. With the blending of neuroscience and philosophical thought, we are now in a time of great optimism. We can make lasting change for our generation and the next as we change our thinking and take big action across society and the globe, together.

********

Richmond Stace: Specialist Pain Physiotherapist

My overarching aim is to change the way that society thinks about pain so that we can tackle what is the number one global health burden, chronic pain. One to one with individual sufferers, via writing and talking, and the UP | Understand Pain campaign, I hope to shift thinking so that we can reduce the suffering that people feel across the globe.