Category Archives: Pain



VulvodyniaVulvodynia is a painful condition, often exquisitely so, located in the vulva, which is the skin surrounding the vagina. Usually unexplained, this troubling condition can arise seemingly from nowhere, interfere with intimate relations and hence attempts to conceive. Vulvodynia is also known as a functional pain syndrome–these are painful problems that lack a pathology of note that explains the extent of the pain and include irritable bowel syndrome, fibromyalgia, TMJ dysfunction, migraine and pelvic pain. Functional pain syndromes are often concurrent with hypermobility, anxiety and depression, a further common character trait being perfectionism and a tendency for the person to be hard on themselves thereby creating a cycle of chronic stress.

The pain of vulvodynia is often very localised and triggered by direct contact. Naturally this occurs during sex and touch, but sometimes sitting position can bring on the pain. As with any sensitisation, there is a primary location of pain but there can also be a secondary area surrounding that is due to central nervous system (and other systems) involvement. Suspected vulvodynia or other pains in the pelvis should be assessed and examined by a gynaecologist as a first step before beginning treatment, and by a consultant who knows and understands both the condition and the impact — Miss Deborah Boyle at 132 Harley Street.

With vulvodynia often being part of an overall picture of sensitivity, it means that there is a common biological adaptation that is upstream of the range of seemingly different conditions (the functional pain syndromes). As soon as the individual understands that pain is not an accurate indicator if tissue damage, but rather a reflection of the perceived threat and prioritisation by the body-person, there is a realisation that the pain can change. Pain can change because perceptions can change as we take on board new information and consequently think and act differently, creating new habits. The new habits set the conditions for on-going and sustained change that includes overcoming pain.

We have limited attention and hence can only be aware of certain amount of stimuli in any given moment. If pain is consuming much or all of your attention and consciousness, then this is all that is happening in that moment, with all other possible experiences being disregarded–it is a matter of prioritisation. When the perception of threat is reduced by a constructive thought or action, the pain moves out of our attention span and we become aware of other thoughts, feelings and experiences. How we respond to pain is unique and learned through our lifetime right up until that point; all those bumps and bruises as a child, how our parents reacted, more serious injuries or illnesses and the messages we received from doctors, teachers and other ‘big people’, then through adult life, moulding our beliefs about ourselves, the world, health and pain each time we feel it. The sum of all this activity, most of which we are unaware of, sets up how you respond to the next ache, pain or injury, blended of course with genetics. It seems that some people are genetically set up to be more inflammatory, meaning that responses to injury are potentially more vigorous and go on for longer. Understanding this means that the right messages and treatment can be given, thereby appropriately addressing the injury or pain. One of the big problems is that this does not happen, and the explanations are structural and based upon the body tissues. This ignores the fact that we have body systems that protect and these systems have sampling mechanisms in the tissues and organs but largely exist elsewhere–e.g./ nervous system, autonomic nervous system, endocrine system, sensorimotor system, immune system. We have to go upstream as well as improve the health and mobility of the local tissues.

Going upstream is vital in overcoming vulvodynia, and this is where the Pain Coach Programme works–this is my part of the treatment programme. You may also choose to work with a women’s health physiotherapist who will work more locally. So what is the Pain Coach Programme?

The Pain Coach Programme is a a blend of the latest neuroscience of pain with a strengths based coaching approach to success. Understanding your pain and that you have the biology and strengths to overcome your pain is a vital start point. You have been successful in the past using these strengths, and you can do so again by drawing on these characteristics and using them to develop your health in terms of how you think and act. Overcoming pain is all about resuming a meaningful life, engaging with activities and people as you want to, in a way that allows you to flourish. The Pain Coach Programme provides you with the knowledge and skills that you need to in effect become your own coach, moment to moment making clear decisions that take you towards your vision of how you want to live. This alongside treatment and specific training to develop normal movement and a healthy body-mind. The skills you learn also help you to fully engage in life, whether this be at home, at work or at play.

If you suffer vulvodynia or other painful problems, call us now to start your programme: 07518 445493

Licorice Medusa|

Neuroplasticity and impermanence

Licorice Medusa|

Licorice Medusa|

I was asking myself whether neuroplasticity and impermanence are related and how this dynamic would work on a practical level. Concluding that there is some usefulness in relating the scientific neuroplastic characteristics to the Buddhist philosophical construct of impermanence, I have briefly shared my thoughts here.

Neuroplasticity refers to brain cells’ (neurons) ability to change at synaptic and non-synaptic levels. The synapses are where neurons communicate and hence the communication can change, whereas non-synaptic changes occur in the axons and dendrites (structures of the neurons). Impermanence is a fundamental part of Buddhism whereby it is agreed that nothing is permanent. In other words, change is constantly afoot as each moment passes to the next and so on.

On the basis that we are continually learning and changing with each and every new experience, moulding our reality in that given moment, it is highly probable that neuroplastic changes are underpinning our lived experience. We are of course on a continuum, begining with a blank slate to be filled as we progress through our life, genes being appropriately sculpted through exposure and meaning and creating what is a rich, textured existence. The fact that no moment is the same and each is so fleeting, fundamentally means that change is a constant and a definite and hence nothing about existence can be permanent.

Whilst we like to attach ourselves to various things such as our partner, our body, our beliefs, all of these are constantly changing too, alongside the changes that we are making. This constant dynamism is what makes life so fascinating, piquing our curiosity at each and every turn with the unfolding of events. It is worth considering for a moment (that has just passed) that the past does not exist anymore, except in our unreliable memory, and that the future does not exist, except in our minds that attempt to anticipate and guess what may happen. You can argue the usefulness of predicting the future in order to make plans or indeed the recall of a past event to learn. Whilst this may have some use in certain situations, the large problem remains that when we ‘re-live’ a moment passed or project ourselves forward, the whole person responds as if actually there with all the same emotions, physiological responses and on-going thoughts–we feel it and live it. Through these lived experiences, which are invented and illusory, we then further sculpt our biological machinery, priming ourselves for what is to come.

Think about someone who bumps into you on the train. If this annoys you, do you carry on thinking about it or do you let it go? What mood were you in when it happened? In a tired, grumpy state, you may retort with anger; whereas a compassionate mood would see you forgive or even laugh. And what happens next when you arrive at work? How has that moment framed the next? With ever passing moments, impermanence at play, the realisation of this moving film in which you are the author, director and the star who can make choices moment-to-moment is a potent one.

So, let us enjoy being plastic and discovering the full impact of neuroplasticity (much is said about this nowadays, yet there is a great deal to learn about how changes in synaptic activity translate into real-time experience, learning and behaviour) and impermanence as these are characteristics we can use to grow and develop to take on challenges. Certainly in terms of pain and chronic pain, to understand that we are constantly changing creates realistic hope that pain can also change. Pain does change when you understand it fully and take healthy actions based on sound thinking.

Much of my time is spent with people suffering chronic pain, coaching them and treating them, harnessing their own ability to grow and change with new knowledge and skills that are employed to overcome their pain. Witnessing their change is an incredible priviledge as well as a wonderful example of neuroplasticity and impermanence.



I am in pain

We often say I am in pain but does this really describe what is happening. Knit-picking perhaps, but I think that what we say, the words we use and the way that we use them are fundamental to being human and who we are as individuals. The innumerable phrases that have been passed down the generations will have their origins in a time was very different. So how relevant are they now? And how useful?

Someone says to you, I am in pain and instinctvely you know what they mean. You cannot possibly know what they feel or how they are feeling it, but you know that they are feeling something unpleasant and want you to know about it. There is a point to telling others about your pain, perhaps to seek help or advice, to gain sympathy or to give reason for non-participation for example. These are all accepted reaons for sharing, and would typically be known as part of the social dimension of pain. 

However, we cannot really be ‘in’ pain. We can feel pain, pain can emerge from our very being (this includes our body) and pain can hurt, but you cannot be in pain. You can be in a house, a car or tent. Being in something suggests that you can get out. If you say that you are in pain, it suggests that you can get out of pain. Now, pain changes and is transformed (we are not in a constant state of anything, hence pain comes and goes like any other state–pain is part of a protective state), but you cannot get out of pain because you cannot be in pain. There is no entrance or doorway to pain that once you have entered requires you to find an exit. 

Should we change our terminology and what effect would that have? I don’t think it will really change anytime soon, however when clinicians are thinking about the pain being described by an individual, it is more accurate to  consider the whole person from where the pain emerges in a particular location, with the underpinning biology involving many systems upstream of the lived experience. A story book requires a reader, words on a page and the book to be bound together. The book is the body that is read yet the reader must take the words and create a meaning, a story that makes sense, lived in his or her whole person–a beautiful description is felt and lived through the whole person involving complex biology that is a blended mind-body; embodied cognition. Our body is a story book yet the story is our experience. Changing the terminology will occur with time and as the understanding of pain evolves. 

The growth of pain understanding is vital as a basis for informed choices and treatment choices–one of the biggest reasons for chronic pain being the number one global health burden is the lack of understanding, whereby the medical model continues to predominate treatment choices; i.e./ target treatment at the place where pain is felt in the body. This misses the point of pain as part of the way in which a whole person protects himself/herself, and indeed much of our common language contributes to an old belief system that our generation has been brought up upon. Evolution takes time and of course a new and more complex explanation to replace one that is simple, will be threatening. Nonetheless, this is where we will go as people experience failed treatments or do not reach the expected outcomes alongside developments in pain science that become increasingly known in the public domain. This knowledge will demand that things continue to change, and as a result so will our language. As is common though, this is a two way street and if we take opportunites to change our language, then we are using the social dimensions of pain to create learning opportunities that lay the foundation for perceptual shifts. And there’s one thing that changes pain, and that’s a perceptual shift.

Richmond with Georgie Standage co-founded UP | Understand Pain, a campaign to raise awareness of the problem of pain and what we can do to overcome pain — we are no longer managing pain, we are changing pain and coaching people back to a meaningful life. The next UP event is in October when more than 1000 singers will be performing; even more than last time! 

The Pain Coach Programme is a comprehensive strengths based approach to overcoming pain. Call us on 07518 445493 to start your programme.

Important Message by Patrick Denker |

Messages about pain

Important Message by Patrick Denker |

Important Message by Patrick Denker |

When someone seeks help for their pain and injury, they will be given messages about pain that are potent. They are told a, b and c, and hence often take these messages and become them via their own thinking and actions. This is the reason why the early messages about pain need to be accurately based on what we really know about pain and that they motivate people to focus on what they must do to recover. The way in which we think about and hence perceive our pain has tremendous impact on the extent of suffering and how we actually experience the pain itself. Put simply, a lack of understanding that can create concern, worry and anxiety, will raise the threat value of the whole situation, and therefore the body (you) protects further, including an increase in the intensity of the pain itself. All these experiences of thought and action are chemically based — depending on which chemicals are working with which receptors determines how the body systems are functioning and underpinning what we live out.

So what should the messages contain?

1. Facts about pain and the injury, including the poor relationship between the two, that pain is part of a protective response that includes other protective means such as altered movement (e.g. limping) and that the way we think and feel influence both the amount of suffering we endure as well as the actual intensity of the pain itself.

2. The person has an active role in overcoming pain — based on (new perhaps) understanding of pain and person, what is happening, why it is happening and what action needs to be taken.

3. Other relevant information to develop the person’s understanding, and in so doing, gain their trust, respect to follow a programme that motivates through positive thinking and experience towards their vision of how they want to be and live their life.

Undoubtedly, as with any problem we must understand it before we can deal with it. In the case of chronic pain, explanations incorporate the biological changes, behavioural changes and cognitive-emotional changes afoot and how to address these comprehensively–whole person.

The whole person approach recognises that there are many inter-related dimensions of that person, and that we must consider the individual as a whole rather than a back or a knee or any other structure or pathology. The experience of pain and other symptoms is a conscious leap from the underpinning biology, and no-one fully understands how our bodies, our ‘selves’, make that leap from biology to the lived experience. However, listening carefully and compassionately to the individual provides many clues as to why they are in protect and survive mode, emerging as pain and other symptoms, behaviours, thought processes and ultimate actions. This becomes the start point for designing a bespoke, proactive programme, beginning with the right messages.

Whilst the first meeting may identify where the actions taken by the individual are incongruent with recovery, it is worth remembering that this person is doing their very best with the knowledge and skills that they possess at that moment. Everyone has strengths with which they attained success in a range of arenas. Elucidating these strengths creates a start point and also allows that person to know and start feeling that they have the tools to overcome pain, but need guidance on how to best use them. That is our job.

This approach is part of The Pain Coach Programme for individuals to overcome their pain problem and for clinicians seeking to learn the Pain Coach approach for chronic pain. Contact us for more details if you are suffering chronic pain or a therapist wanting to advance yourself in the field of chronic pain: 07518 445493

Kitty Terwolbeck

Zen and the art of human maintenance

Kitty Terwolbeck |

Kitty Terwolbeck

Zen and the art of human maintenance is not a spiritual blog but rather a practical one that considers a way of approaching hands on treatment–this is whether you are a massage therapist, a physiotherapist, an osteopath or any other clinician who uses their hands for examination and treatment. Equally it could apply to a person comforting a loved one.

How you bring yourself to the act has a huge impact upon the act itself. Setting the scene both in terms of the environment and the focus of your intention will play out through the treatment in subtle ways that effect the overall experience. A moment’s preparation in that vain allows the therapist to focus and be present meaning that the full experience is had, allowing for a sensitivity (via the therapist’s hands yet experienced through their whole person) that enables gentle responsiveness to adapt the treatment to the recipient’s needs. A classic example is being aware of how the muscles react to different levels of touch. Being aware means that you can detect even gentle guarding that indicates protection and need for both nourishment (improved blood flow and oxygen delivery to over-working muscles that are being told to tighten in an attempt to protect–yet this comes at a cost, both of energy and a build up of acids) and a sense of safety so that the systems that are protecting the body can ease up.

Take a moment: before you begin the treatment, 3 easy breaths to become aware of what is happening now, how you are feeling, what you are thinking; continue to maintain awareness of the present moment, letting go of distracting thoughts that interfere with your focus.

Zen is a sense of oneness with the present experience, what is happening right now, free from distractions and letting life flow. There are many situations when this state of simply being is very useful–before exams, interviews, when negotiating, discussions with your employer, before performing etc. However, cultivating this skill on a moment to moment basis is hugely beneficial as it allows you to see and think clearly, even when thinking about the past or future, which can cloud what is really happening now. These are all just thoughts, but when we become embroiled, the body reacts and responds because we are our body as much as we are our mind, and all that this means. So, just thinking about being in an argument or giving a speech creates similar responses in the body as if you are there; but you are not.

In giving treatment to another person, being fully present means that you fully experience the moment. You will be completely engaged in all that is happening ‘now’, creating a potency that cannot be otherwise reached with a wandering mind that has no connection with the treatment. This is undoubtedly a practical skill that can be developed, some calling it ‘focused attention training’ and others ‘mindfulness’. Everyone has the ability to focus, even for short periods, and to enhance the skill with practice. There would be some benefit of simply taking a few breaths as described above, yet there is even greater advantages to be had from further practice with 5-10 minutes of mindful breathing each day; more if you are so inclined.

Not only does being present whilst treating enhance the treatment through a more responsive selection of pressures and movements, the clinician also benefits from the calm created, and the clarity of thoguht offered by being present and aware. In effect, the whole experiecne means that while you are treating, you are being treated. A good way to measure this is by noting how you feel at the end of the day. A mindful day will end with energy, and non-mindful day with fatigue. I know which I prefer.

* These are skills to be learned and developed in the Pain Coach Mentoring Programme for clinicians | call 07518 445493 for details

Photomarathon - Alphabet by Eva Van Ostade |

My A to Z of pain

Photomarathon - Alphabet by Eva Van Ostade |

Photomarathon – Alphabet by Eva Van Ostade |

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

By Tess Watson |

Pain and society

By Tess Watson |

By Tess Watson |

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

By LordEfan |

Pain and the perfectionist

By LordEfan |

By LordEfan |

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]


You are beautiful by La Melodie

Pain and guilt

You are beautiful by La Melodie

You are beautiful by La Melodie

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!


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.