Category Archives: understand pain

12Jun/17

What is pain?

What is pain?

Thoughts from the SIP 2017 Conference

Societal Impact of Pain

“Society needs to understand pain ~ what is pain?

Last week I attended the SIP 2017 Conference in Malta where a meeting of stakeholders deeply considered the issue of pain in society. Pain is a societal problem and the way forward will emerge from considering pain in this light. Significant and exciting steps were taken, which will be covered in a forthcoming article on this site and the UP | understand pain site.

Chronic pain is the number one global health burden. The approaches used for pain are not working. We are seeing the figures increasing over the years as more and more people suffer ~ 100 million people in Europe. Why? The main reason is the misunderstanding of pain that results in unnecessary investigations, treatments that don’t work and low expectations. The predominant thinking remains ‘biomedical’ both in terms of healthcare delivered and society’s expectations. Pain is not a medical problem. It is a public health, or societal issue. We are in it together, all of us. Even clinicians are patients!

Where do we start?

The UP enterprise has a purpose, and that is to change the way that society thinks about pain, hence Understand Pain. From the point of understanding comes new belief and commitment to reach one’s potential. The vision is a world where people understand pain so that the focus is upon the practices that foster a healthy, meaningful existence within the context of the person’s unique life. This emerges from co-operation between the person and the care-giver, working together to achieve results. This is the essence of Pain Coach, grounded in pain sciences, modern philosophy and strengths based coaching, delivering results based on what works.

Pain Coach not only gives individuals unique knowledge and skills according to their needs, but also the all-important know how. I may have the best drill in the world, but without the know-how I will still make big holes in the wall as I try to hang a picture. The Pain Coach coaches the person to coach themselves to overcome pain. Conversely, interventions and medicines are ways to circumnavigate the problem. This is not to say that they do not have a role, however, the person learns nothing about facing it and transforming the experience and therefore will continue the loop of suffering. Only by learning about one’s existing patterns and creating new patterns in line with a vision of success, can the person overcome their pain.

“What do you focus on?

What do you focus on? What language do you use to yourself over and over? What story do you tell yourself? You can make the decision to change your story. What can you control? Your attitudes, your thoughts, your day to day decisions are all yours. What do you do consistently? What do you think and embody consistently? That becomes the story of you. You can choose another script. That is the role of a coach, to help you realise and actualise your choices. To help you make decisions but ultimately you make them and commit to doing positive work to move in a desired direction. You decide the direction.

What is pain?

Pain is part of the whole person state of protect. Pain is poorly related to any stage of injury, tissue damage or indeed tissue state. This is the common misunderstanding, that somehow pain and injury are the same or related. This is not the case and indeed Pat Wall, the father of pain science and medicine, stated this in his 1979 paper. Why then, is this not practiced as mainstream? This is one of the key messages for all.

What are we protecting against? Initially there may be some kind of actual threat such as an injury or disease state, which is rightly interpreted by body systems as dangerous or potentially dangerous.  That’s the whole point of pain in a sense, to be so unpleasant that it compels us to take action. It is a vital survival mechanism without which we have no way to detect actual or potential danger. But, the pain itself remains part of a protect state in light of a perceived threat.

“Pain is a feature of a state of protection

When pain persists, aka chronic pain (not everyone likes this term or wishes to be labelled as such), it means that a state of protect is persistently emerging as the prediction of threat frequents each day. The range of cues or patterns interpreted as potentially dangerous seems to widen and widen so that normally innocuous situations are deemed to be dangerous. This does not mean it has always to be at a conscious level as most of our biology operates in the dark, ie/ there are hidden causes. However, expectation does play a role in as much as when we expect something to hurt it does and often more as we prime, raise the threat level, predict to ourselves that it will hurt and guess what?

Pain is not a constant state. There is no constant state, instead we are continuously ‘updating’, dynamically exploring the environment with the aim of meeting our predicted needs. When a person suffers chronic pain, they will experience a number of episodes in a given day, with a more challenging day featuring more frequent or longer episodes, and a better day featuring less or shorter episodes.

We are changing by design. No moment is the same. Like a foot placed in a river, it is never the same water that passes by. So change is not the question, rather which direction will you go? Which direction will you choose? To coach yourself towards a vision of success? To decide to commit to the practices of well-being? When people realise that they do have a choice it is empowering, inspiring and enabling.  We can decide to reach our potential.

Who suffers chronic pain?

Work is being done to discover more about who would be vulnerable to a chronic state of protect. Players include genetics, past experience (e.g. prior pain, early life events) and gender. One way to think about this is that we are on a timeline, so nothing happens in isolation. When I stub my toe, my existing health and sense of well-being will influence how I react both ‘myself’ and my biology. In other words, if I am very tired and stressed, my experience will be very different to if I were relaxed and happy. Getting the person’s story is key to understanding the context.

You can think of life’s events as priming. From day dot we are shaping ourselves and being shaped, right up until this moment. Every experience and everything learned sculpts us, our body manifest of the sum of all the things we have done and felt. The body systems that protect us evolve and become highly efficient, predicting that the causes of the sensory information mean that danger exists. Actively changing the sensory information with new practices, new habits and patterns of thought and action take us on different path. A path onward in a chosen direction. Our attitude to change and belief in our own abilities are both key factors — and both can change in themselves!

“Pain is whole person — it’s not my back in pain, I am in pain. Me

The perception or experience of pain is coloured by many factors in that person’s life, including past experience, beliefs, context, environment, actions (current and predicted), emotional state, attentional bias (what I am focusing upon), other people and more. Pain undoubtedly emerges in the person. In other words, it is the person who suffers pain, not the body region where it is felt. Much like it is the person who is thirsty, not their mouth.

In summary

  • It is the whole person who feels pain
  • Pain is part of the way we protect ourselves in the light of a perceived threat
  • Pain can and does change
  • Understand pain to change pain
04Jun/17
Teens suffering chronic pain

Headache

Headache is a leading cause of suffering

Headache and migraine are in the top 12 of the Global Health Burden of Disease Study (2011)

 

Headaches

If you watched Doctor in the House on BBC recently, you would have gained an insight into the terrible suffering caused by cluster headache. This is one of the many conditions characterised by chronic pain. In this case, there was significant improvement as the family made some important changes. More on this shortly.

Chronic pain is the number one global health burden, costing more that cancer, heart disease and diabetes put together. There are millions of people across the globe enduring chronic pain states. They have little or no understanding of why they continue to suffer and no knowledge of how to overcome their pain. This can and must change, and to do so means that society needs to understand pain ~ this is the reason for UP | understand pain. Pain is a public health problem of huge significance.

The programme hosted by Dr Rangan Chatterjee highlighted the impact not only upon the brave lady Gemma, but also upon the family. It was their shift in thinking that resulted in new habits, which create the right conditions to get better. That was a choice made based upon new understanding. Realising that we have a choice is a key first step. We can make the decision to commit to doing the things that will change our health, our relationships, our performance and our pain.

Pain always occurs in a context and involves life’s habits. On realising the range of influences upon pain, the person can instigate changes that make a huge difference. In the family setting, this involves all members, including children. There are huge numbers of children who suffer pain (1 in 5) and huge numbers who support a parent. This is a vast problem in itself.

A brief look at pain ~ what is it?

Pain is a whole person state of protect based on the existing and prior evidence that there is a threat or possible threat to the person. Much of the processing is subconscious, our biology in the dark (e.g./ you don’t know what your liver is doing right now), emerging as a lived experience or perception. Anything that poses a possible threat can result in pain. It is important to consider that something only becomes a threat when we think it so, and hence the meaning we choose to give a situation makes it what is it.

It is not only when we are thinking that something is a threat to us of course. Our biological systems interpret sensory information and predict that it indicates possible or actual danger. Working on a just in case basis means that we can get it wring. When we are sensitive,m this can happen more often than not, which is why pain can become so dominant. The range of contexts and situations widen and we notice the pain moments over and over. This does not have to continue. We can actively infer something else with new understanding, new actions, new habits and new patterns — that’s the programme.

Pain and injury are words often used synonymously, but they are simply not the same. Pain is part of a protect state, very similar to that of stress, and injury is something you can see. The former uniquely subjective and a perception constructed by the whole person

What can we do about pain?

The short answer: a lot!

The first step with any change is to make the decision to commit to practicing new habits that lead towards your desired outcome. This decision comes off the back of understanding pain because then you realise that there is plenty you can do to change and overcome your pain.

This always starts with developing a working knowledge of your pain so that you can coach yourself: the right thinking and the right actions to get the best outcome. Initially you are likely to need advice, treatment and coaching to ensure you remain on track.

When you understand pain, you do not fear it or try to avoid it, instead you face your pain, learn about your pain and overcome your pain. This is different to taking a pill or having an injection, which circumnavigate the issue. Only by facing the challenge can we transform the experience of pain. Many messages in modern society encourage us to avoid the difficult things in life but they are unavoidable. We are not typically taught skills to face the challenges that will come up, and so when we do have something to deal with, we suffer. This does not need to be the case, certainly when it comes to pain.

This is not to say that pain is not unpleasant. Of course it is, but we can learn how to minimise the impact and work to create a happy and meaningful life, by living and practicing the skills of well-being. By living I mean that you try to do the things that you want to as much as you can. More dated thinking about pain suggests that you have to get better in order to resume living, however I have turned this on its head and said that you get back to living by getting back to living. Getting back to living IS the way to get better.

In a sense there is a template of how your life and you should be, and there is no real separation between the two. When the template of what is actually happening is different to the expected one, this mismatch creates a drive to bring them together. Pain is one of those drivers. So, if we try to live as best we can, we are in fact bringing these two templates together. Of course there will be a certain tolerance, even perhaps a few moments in some cases, but this is the start point or the baseline. Working from your baseline, you can get ‘fitter’ and healthier with the practices you commit to, and thereby point yourself in a desired direction.

“what is your vision of success?

A treatment programme is therefore weaved into your life. You are in the driving seat. This is an important concept as healthcare often puts you in the passenger seat, or as one patient told me, ‘in the boot’. This is not right and will certainly not help the person to get better. The modern understanding of pain tells us a very different story, which is exciting, but must be told as far and as wide as is possible, which is the reason for UP | understand pain.

If you are suffering headaches, you should consult with your healthcare practitioner as a first port of call. You will want to know the possible reasons why you have headaches, but then you will want to know what you can do, what they will do to support you and roughly how long this will take. With an understanding and a direction, with a decision to commit to practices of well-being and determination, it can be transformative.

RS

 

 

 

 

04Apr/17
UP & CRPS UK London Marathon

Not long now

Not long now ~ with only a few weeks away before the London Marathon, I must admit that I am getting rather excited. It has been very worthwhile putting in all the miles with the aim of really enjoying the day.



One more long run to do this weekend and then I will be tailing off as advised by my team of trainers and co-runners. Yesterday a friend asked me about these 20+ milers and how you keep going. I never imagined that I would ever be running for 3-4 hours, and certainly never thought I would be popping out for a ‘quick 10 miles’. I have found that the time passes quickly once I get going but really focusing on what is going on around me, looking up, coaching myself to remain relaxed and feel inspired by the encouragement I receive.

Anyhow, the really important bit is raising money and awareness of two key projects tackling the number one global health burden: pain. The charity CRPS UK and the social enterprise UP | understand pain both envision a world of people understanding their own potential to live well and to overcome their pain.

THE PROBLEM OF PAIN

The costs of chronic pain to individuals and society are vast. Loss of earnings, loss of productivity, the expense of treatments that often don’t work and above all the immense suffering. This need not be the case if society really understood pain. By understanding pain, individuals would know where to put their efforts to get better from the outset of a pain problem, whatever the cause, and healthcare would deliver effective care.

The thinking on pain still largely resides in out-dated models. This means that individuals become reliant upon passive treatments, are subjected to endless unnecessary investigations and are exposed to the wrong messages about pain that keep expectations low and purport fears and worries that only increase suffering.

“Pain is poorly related to injury, tissue health, structures in the body, biomechanics or pathology

Our journey to understand pain began when two remarkable men created pain medicine. Pat Wall and Ron Melzack changed the landscape forever and have inspired a generation of scientists and clinicians to ask questions about pain and discover the answers: what is pain? What is pain for? What can we do about pain?

Our knowledge about pain has increased enormously but there is a long way to go before our current understanding is practiced day to day in society. This gap is a significant societal issue, and one that UP will bridge with the forthcoming education programmes and an online resource that is this very website. The UP site will be re-launched this year, packed with information that people can use to understand pain.

WE HAVE AMAZING POTENTIAL

Humans are incredible. We are designed to change, adapt and learn, so tapping into our natural resources is one of the most potent and enabling things we can do. Consider all the achievements of mankind, which largely boil down to a clear picture of success, an ability to focus upon a plan of action, taking action and learning along the way when facing challenges. Together with a dose of determination, courage and belief, we can achieve by always being the best that we can be: ‘I will be the best me today’ is not a bad mantra to have!

The challenge of pain is no different. The programmes that UP will run for people in pain and for clinicians are all based on how we can be successful, how we can chose the positive route, how we can achieve our best. This is by focusing on what we do well, how we do it and how we can do more of this whilst acknowledging and seeking to improve in other areas.

So this in my mind drives my desire to do my best in training and on the day on 23rd April. Having said that, I will be pleased to see some familiar faces in the crowd on the way round! Or even faces I don’t know who want to support our causes. Pain affects so many people across the globe for so many reasons. Together we can change this by changing the way society thinks about pain and our expectations. Let’s expect to do well and live well.

Please support us here by donating whatever you can and join us for a quiz night before the run on Thursday 20th April in Surbiton — see here.

Thanks!!

18Feb/17

Why am I running the London Marathon?

Why am I running the London Marathon?

We are 10 weeks away from the London Marathon and I am getting excited about the day. The training is going well, and I am using others experience and knowledge as a yardstick, reaching 16 miles so far. A bit more nudging in March and I’ll be set to join the thousands of other runners, coursing round the great city of London.

So why am I doing this? The answer is simple. To raise awareness and money to address the biggest global health burden, chronic pain. It costs us the most economically but of course the amount of suffering worldwide is immeasurable. This must change and we can change it by shifting our thinking to be in line with what we know about pain. With an understanding of pain, individuals realise their potential to overcome their pain and live meaningful lives. This is achievable, and in this day and age we have the means to reach across the globe to give people the knowledge and skills. This is the story of UP | understand pain, which was co-founded by myself and Georgie as a pain awareness campaign. Now we have big plans to take the project to another level to achieve our aim of changing the way society thinks about pain.

Complex Regional Pain Syndrome (CRPS) can be a terribly disabling condition, characterised by intense pain. Many people have not heard of CRPS and within healthcare diagnosis is often delayed. This is a problem because like most conditions, early identification allows for treatment to begin. The treatment must be based upon the person’s understanding of the signs and symptoms, for there is an understandable fear that drives on-going protection. Therefore, as with any injury or pain problem, the early messages must be right and make sense.A person’s belief drives their behaviours and subsequent thinking, so a good working knowledge of pain is vital ~ understand pain to change pain.

CRPS UK gained a place in this year’s London Marathon, and having spoken twice at their conferences and being in regular contact, I ‘volunteered’ to be the runner. I was very excited to be chosen and gratefully accepted, which is now why I am out in the Lycra every other day (I will not be posting a picture of that!). CRPS UK is a charity dedicated to advancing the understanding of the condition and supporting people with CRPS. The people involved are doing incredible work to raise the profile and have achieved so much through their dedication. Please visit their website here.

You may be someone suffering chronic pain or know someone who is regularly in pain. Most of us do know someone and can see the effects upon their life. This is not just pain from backs and joints but pain related to cancer, heart disease, arthritis, irritable bowel syndrome, headaches, migraines, rheumatological diseases, pelvic pain and many other conditions that hurt. The work being done by CRPS UK and UP aims to change this and provide resources and training that gives individuals and society a way forward, to overcome pain and live well.

Please show your support here and donate generously

Thankyou!!

30Jan/17

CRPS Diagnosis

CRPS Diagnosis

CRPSComplex Regional Pain Syndrome (CRPS) is a collection of signs and symptoms that define this particular condition. A syndrome according to the Oxford Dictionaries, is a ‘group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms’. Therefore, we can clump together any set of symptoms and give it a name, which is really what has happened over the years in medicine. The important point is that when we use the term, we should all know what we are talking about and know what we should look for to make a diagnosis. In other words, a set of guidelines.

The Budapest Criteria delivers guidelines for CRPS, which you can read about in this paper by Harden et al. (2013). The clinical criteria (see below) acknowledge the sensory, vasomotor, sudomotor/oedema and motor/trophic categories that really highlight the complexity of CRPS. Pain is often the primary concern, with people describing their incredible suffering in a range of graphic ways. However, it is not just the pain that causes suffering but the way in which the life of the person changes together with their sense of who they are and their sense of agency seemingly lost. One of the roles of the clinician is certainly to help restore that sense of who I am, a construct that is built from many of life’s ‘components’.

Budapest Criteria

1. Continuing pain, which is disproportionate to any inciting event

2. Must report at least one symptom in three of the four following categories

  • Sensory: Reports of hyperalgesia and/or allodynia
  • Vasomotor: Reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry
  • Sudomotor/Edema: Reports of edema and/or sweating changes and/or sweating asymmetry
  • Motor/Trophic: Reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

3. Must display at least one sign at time of evaluation in two or more of the following categories

  • Sensory: Evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement)
  • Vasomotor: Evidence of temperature asymmetry and/or skin color changes and/or asymmetry
  • Sudomotor/Edema: Evidence of edema and/or sweating changes and/or sweating asymmetry
  • Motor/Trophic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

4. There is no other diagnosis that better explains the signs and symptoms

Importance of diagnosis

A diagnosis made in the same way, based on the same criteria means that clinicians, researchers and patients alike are all discussing the same condition. This may seem pedantic but in fact it is vital for creating a way forward. Clinicians mus know what they are treating, patients must know what they are being treated for and researchers must know what they are researching. Sounds obvious but let’s not take it for granted. So the Budapest Criteria has pointed all those with an interest in the same direction. Consequently we can focus on creating better and better treatments.

As with any painful condition, the start point must be understanding the pain itself. The following questions arise that we must be try to answer:

  • why am I in pain?
  • why this much pain?
  • why is it persisting?
  • what influences my pain?
  • what do I, the bearer of the pain, need to do to get better?
  • what will you do, the clinician or therapist, to help me get better?
  • how long will it take?

New thinking, new science, new models of pain over the past 10 years has advanced our knowledge enormously. Understanding how we change, how our body systems update, how we can make choices as individuals, and the practices we can use to change our pain experience to name but a few, create great hope as we tap into our amazing strengths and resources as human beings. Detailing the treatment approaches is for another series of blogs, but here the key point is that the first step in overcoming pain is to understand it. It is the misunderstanding of pain that causes erroneous thinking and action, which we can and must address across society — pain is a public health issue. Chronic pain is one of the largest global health burdens (Vos et al. 2012). It costs us the most alongside depression, and I believe that this need not be the case if and when we change how we think about pain, based on current and emerging knowledge.

“The first step to overcoming pain is to understand it”

upandrunThis is the reason for UP | understand pain, which we started in 2015 with the aim of changing the way people think and then approach their pain, realising their potential and knowing what they can do. We are about to launch the new website that is packed with practical information for the globe to access online. Alongside this we have plans to create a social enterprise that will purport the same messages, coming from the great thinkers and clinicians who are shaping a new era in changing pain.

In April I will be running the London Marathon to raise awareness of the work of both UP and CRPS UK. You can support the work that both are doing to change pain by donating here

Thank you!

 

29Jan/17

Pills, injections & surgery don’t teach you how to live

Pills, injections & surgery don’t teach you how to live ~ pain is a public health and social issue
Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

Important Message by Patrick Denker | https://flic.kr/p/a9iUAG

In chronic pain, everything changes. The way you think, feel, move and body sense are all impacted by this on-going state of protection that keeps you in a defensive mode. Even the world looks different as perceptions of the environment are distorted (Ref). The changes that we live and experience have biological underpinnings that have and continue to be studied. Clarifying what is happening at this level aims to give rise to new clinical approaches, both pharmacological and non-pharamcological.

This short article is by no means anti-medicine or anti-surgery because these methods have their place. In that place they must remain, viewed as an option within an overall plan or programme that delivers the outcome of overcoming pain. My point is simply that understanding pain means that we realise that explanations relying upon tissue structure or pathology do not hold up. Pain is not a structure and pain cannot be seen on any scan or x-ray. Pain is a lived experience emerging in a person, which is a culmination of multilevel neuroimmune processing and consequent prediction of the existence of a possible threat. Pain exists within our perception of the current moment that is informed by context and past experience (priors): what we are thinking, what we are doing, who we are with, where we are.

Only I can experience my pain under these circumstances, with some ‘components’ being conscious and many being subconscious. For example, I know that I am anticipating pain in the form of a thought: ‘I expect my back to hurt when I put on those shoes’. Yet I do not know and cannot ‘feel’ the activity of my brain, instead living the biological processing as a conscious experience of what it is like to exist in this moment. Here if course we are contemplating consciousness and what it is like to be me, and we do not know how biology becomes this experience.

Pain emerging in the person makes it as complex as the person; and we are complex! Equally, pain relief or achieving a pain frePain Coach Programmee state is as complex. Neither are permanent states as we are continually changing as our body systems and models of the world update. Our ability to shape our body systems with experience creates such opportunity and with that hope. But it is the individual who shapes their systems by making choices based on understanding. This is why understanding pain is so important as a starter. By this I don’t mean knowing all the chemicals and receptors, instead a working knowledge of pain that can be used practically at any given moment so that the person knows what to think and do. In essence, they learn to coach themselves, which is the basis of my Pain Coach Programme.

There are many influences upon the pain experience itself as well as the likelihood that we will feel pain. Unsurprisingly these include stress, anxiety, thoughts, emotional state, environment, other people, fear, context, memory, tiredness and past experience. The person can understand these influences and develop practices that lessen and ease their impact, learning new habits that are pointed towards health and happiness. This is a significant part of the programme of getting and living well. Pills, injections and surgery do not provide such a learning opportunity. Indeed there maybe relief in the short term and there is a potential role here, yet we are interested in long term change in a desired direction.

Suffering chronic pain has many effects upon the person. Certainly their biology has adapted and changed meaning that they can be in a protect or vigilant state more often, and therefore more reactive with emotions and behaviours. Body sense often changes resulting in altered movement patterns, which in turn cause issues navigating the world as well as providing sensory information that can be continually interpreted as evidence of a threat. Recall that pain is in the face of a perceived threat: more threat = more likelihood of pain. Learning the skills of wellbeing together with specific training sculpts biology towards that underpinning lived experiences of health and wellbeing. Again, pills, injections and surgery do not provide such an opportunity.

Overcoming pain to live a meaningful life requires understanding, effort, practice, resilience, motivation and the right attitude. Everyone has the ability to use their strengths and values to motivate actions (thoughts and acts — remember that a thought is an action) that steer change in a positive direction. It is realising that we can choose. We can choose the attitude we take towards a challenge, and the challenge of chronic pain can be one of the greatest faced by an individual.

Rightly so, an argument has been put forward that pain should be considered an issue of public health. Pain is certainly a societal problem, and in looking at it in this way, we are more like to be able to address the issue that costs us an extraordinary amount of money each year. Financial cost is one thing, but the amount of suffering across the globe and in particular in poorer regions, is another. We are compelled to think differently and we can to do this with the knowledge that we have about pain emerging from science, social and philosophical fields. This is a desperate situation needing collaborations between countries and organisations. Fundamentally, the picture of the modern pain epidemic can be changed, beginning with changing society’s thinking about pain. This involves practical and engaged education projects.

Pain education has been trumpeted and righty so. However, there has been a focus on the neuroscience of pain, especially the role of the brain to the point that the brain is described as somehow being separate from the person. Very contemporary philosophical thinking together with neuroscience has nudged us towards the whole person and viewing pain as a lived experience emerging in the person. This allows us to consider a range of ways to educate the person about how they can change their pain, overcome their pain and live a meaningful life. Of course this is always work in progress and it continues with great gusto. The emphasis on chemicals and receptors has moved on. Whilst interesting to know the microbiology of pain, what the person on pain really needs are practical ways of changing their pain in that moment.

Reflecting on the points made, one can see that the biomedical approach to pain is limited by the fact that pain is a social and public health problem, not a medical problem. Some of the recent best thinking about pain has come from historians, public health experts, English scholars, philosophers, artists, and poets. People ask me how they can learn more about pain. The answer lies in listening and looking at society and people who live the experience. Pain and suffering are ubiquitous. They do not live in a book and certainly not a medical textbook!

So what next?

UP | Understanding PainAt UP | understand pain we are working on several projects that will deliver the latest information and thinking about pain to society. Very soon the new UP website will be launched, giving us an online reach across the globe, allowing people to access this information. UP is a social project, working to evolve the way societies think about pain so that suffering can be reduced. With pain being such an individual matter, when only I can feel my pain that is defined by my knowledge, beliefs and experiences to date, the projects must be culturally sensitive. This does not mean going about it carefully, indeed we need to be shouting the current understanding of pain from the rooftops, instead referring to the fact that there is a significant cultural dimension that blends with all other dimensions of the pain experience.

For example, one place that I intend to have an impact is Cambodia (I will explain my reasons in a later blog). The first steps have to include a deeper insight into the current thinking and what factors and beliefs underpin that thinking. We know that it is not simple to replace an existing model with another, even if the latter is more logical and accurate.

Delivering skills and knowledge to people suffering and to those providing the care in principle is straight forward. Much of what is delivered is straight forward, understandable and does not rely on expensive or complicated equipment. The Pain Coach Programme is easily taught and scaled for example, not only giving people what they need to point themselves towards being healthy but creating habits from which emerges healthy, meaningful living. In so doing, pain becomes less and less of a feature, simply because the person is engaged with their life, feeling that sense of being able to make a choice, having meaningful interactions with others, resulting in fulfilment.

Pain is a social issue, a public health issue. Pills, injections and surgery will not solve this problem and in fact can be the cause of increasing reliance on such measures, meaning the individuals have no understanding of what they need to do to get better. Medical interventions do not teach people how to live and whilst there maybe a place for this kind of relief, it must be within the bigger picture, a model of that person’s life that includes all dimensions: e.g./ social, psychological, cultural, gender, biological. The risks of using medication have been well publicised in terms of opioids and this remains a significant social issue.

It is the person who feels pain, the whole person, not the body part. Society’s thinking can evolve in line with what we really know about pain and make a huge impact upon the vast amount of suffering that comes at such great expense. This starts now.

27Aug/16

If pain

If painIf pain was understood, there would be less suffering.

If pain was understood, the right messages would be given from a young age, sculpting behaviours based on what needs to be done.

If pain was understood, there would be no fear about it.

If pain was understood, we would focus on what we can do to feel better.

If pain was understood, it would be known that listening deeply is the first step to help someone transform their pain.

If pain was understood, it would be known that understanding pain changes pain.

If pain was understood, there would be an enormous amount of money available for a better society.

If pain was understood, it would sit in the realm of public health and not medicine.

If pain was understood, there would not be the reliance on medication.

If pain was understood, what would the world be like?

— this is the mission of UP | understand pain; to globally change the understanding of pain, because put simply, the world would be a better place if pain were understood.

www.understandpain.com

06Jan/16

Onwards in 2016

UP | understand painOnwards in 2016 is my thinking. This is not a New Year’s resolution, but instead a commitment to developing the work thus far, upon raising awareness of the vast problem of pain across the globe. Whilst many organisations, governments and charities are focusing on particular conditions, and fine work many are doing, there is an overarching problem that needs addressing — the problem of pain: what it is? What it means to the individual? What is the impact? What can we do to overcome pain? This leads on to simple questions that we must answer swiftly: why am I in pain? What can I do? What are others going to do? How long will it take?

Pain appears in injury, in stress, in anxiety, in cancer, in heart disease, in diabetes, inUP | understand pain schools, in homes, in workplaces, on the playing field, in men, in women, in children, in the existence of disease, in the absence of disease, it comes in a moment and passes in a moment. Pain is everywhere, and whilst it plays a necessary role in our learning and survival, in many cases the pain is prolonged, amplified and causing on-going suffering when it need not. We have an obligation to change this situation because we can. We have the knowledge, we have the skills and we have know-how and it needs to be used across the board. This is a societal problem that we can tackle together, starting with understanding pain.

The UP campaign that we started last year has gathered great momentum, capturing our imagination and those who were touched by the events at T5 Heathrow, and creating a platform for our plans in 2016 and beyond. This year we will gain charity status and be taking our message as far and as wide as we can — each new person who knows about UP and that pain can change will be a messenger, and this way we can reach out across society. The facts that I give people each day, the knowledge and skills that we work upon together to create the conditions for change in a direction that the person desires, steers them towards sustained health and a life well lived. We are changing all the time, every moment is new and an opportunity, so we can learn to embrace this and keep moving onward!

Onward for me is continuing to develop the blend of pain sciences, philosophy and coaching to get the best out of each and every individual. We all have great potential that is to be realised, and this includes people overcoming their pain. There are too many negative messages given, wrong messages given and subsequent self-talk that predicts poor outcomes. This is not necessary at all and needs to be reversed. Let us talk of health and feeling good as much as we can! There are always challenging times, yet we can view these as difficult or as an opportunity to learn. We will not always be happy, but we can learn how to recognise thought viruses and old beliefs that we can update and change perspective upon in order to view things differently and hence feel differently as our embodied mind evolves.

So, with great gusto, onwards and UP!

03Nov/15

Georgie at T5 for Understand Pain

Georgie at T5 for upandsing

 

 

 

 

 

Georgie at T5 for Understand Pain (click image for video) for UP | understand pain awareness campaign with Rock Choir.

UP aims to change the way we think about pain, because to overcome pain we begin by understanding it. With this knowledge and a range of skills, you can successfully move forward and resume a meaningful life; Georgie being a prime example — read her story hereBec’s story here and read Jo’s blog here.

With the money we raise at our @upandsing events, we will be running Pain Coach workshops for people suffering pain and their carers, and workshops for clinicians who wish to develop their knowledge about persisting pain — keep an eye on the UP website for dates. We also aim to develop and mature the website into a high quality resource.

30Oct/15

What’s next for UP?

UP | understand painAfter last week’s huge success once again, we know that we are on the right path! The support from the members of Rock Choir and the public was incredible, demonstrating that people recognise the scale of the problem. They also acknowledged that the situation is changeable, and we will certainly be driving this change with both our messages at events and with the Pain Coach seminars. Pain Coach is an approach to persisting pain that incorporates the latest pain sciences, the latest thinking in pain and strengths based coaching for successfully overcoming pain and resuming a meaningful life — watch out for the dates. This is all about the individual understanding their pain and knowing what action to take at any given moment to take them towards the life they envision.

UP | understand painHere are our immediate objectives that we are now working upon:

  • Achieving charity status
  • Pain Coach seminars for people suffering persisting pain and their carers
  • Pain Coach seminars for clinicians and others who need to understand pain (e.g. lawyers, human resources, occupational health, managers within business)
  • Develop the website as a high quality resource for pain information
  • The next events that will always include music and song; simply because it makes us feel great!!

UP | understand painOur aim is to develop and mature UP, widening our net gradually as we support and educate society about pain and how we can go about changing and overcoming pain. If you would like to help us grow, please do get in touch: [email protected] and visit our website at www.understandpain.com and on Twitter @upandsing

UP | understand painWe will announce Pain Coach dates and the next event very soon. Please tell your friends and colleagues about us and ask them to join our journey — a fun way of delivering a serious message and taking definite action.

We look forward to seeing you at the next event!