I see more women in pain than men in pain. Naturally, it depends upon the individual as to whether they seek help or not, yet as a general observation it appears that women in pain are more likely to take some action.

The most common presentation is a female aged between 30 and 55 years, who has suffered pain for some time, months or even years, which is now impacting upon her life in a number of ways. Typically the pain is affecting homelife, particulalrly looking after young children,  and worklife, or both in some cases as the pain pervades out into every nook and cranny. Sometimes this happens over a few months but often it is a slow-burner that is suddenly realised. When we have a conversation about the pain, cafe style*, it becomes apparent that there have been painful incidents punctuating a consistent level of sensitivity, building or kindling. The pains emerging in the person include back pain, neck pain, wrist pain, knee pain, foot pain — any joint pain — muscular pain; and can be accompanied by a range of pains known as functional pain syndromes: pelvic pain (dysmennorhoea, period pain, endometriosis, vulvodynia), irritable bowel syndrome, migraine, headache, fibromyalgia, jaw pain. The person, whilst unique and has a unique story to tell, is often hard on themselves by nature, a perfectionist, anxious and a worrier.

There are many, many women suffering a number of these problems that appear to be unrelated, but this is not usually the case. Upstream changes, or biological adaptations, play a role in the symptoms emerging, yet of course the way a condition manifests is dependent upon the individual themselves, with the uniqueness of each person, their tale, beliefs and life experiences.

Nothing happens in isolation. In other words, there is a point in time when we experience a sensation that we label and communicate, but this is not in isolation to what has been before. The story that the person tells me is vital because it reveals both the unfolding of how the individual comes to be sat in the room and allows me to begin giving some meaning to the experience; i.e. helping the person understand their pain and how it sits within their lifestyle and their reality. I say within because pain should not define who we are, yet it often appears to and hence needs to be put into perspective; the first step to overcoming the problem.

So, there are priming events that often begin much earlier in life than the pain that eventually brings the person along to the clinic. These priming events are biological responses to injuries, infections and other situations that are also learning situations. Learning how to respond at time point A then ‘primes’ for time point B as a response kicks in based on how our brains predict the best hypothesis for what ‘this all means’–what we are experiencing now is the brain’s best guess about what all the sensory information means based upon what has happened before, probability playing a role. One of the reasons for a good conversation is to identify the pattern of pain over the years, how it has gradually become more intrusive as the episodes intensify and become more frequent. The pattern can then be explained, given meaning and then provide a platform to create a way forward.

We are designed to change and each moment is unique. This gives us unending opportunities to steer ourselves towards a healthier existence and leading a meaningful life. To get there though, we must have a belief that we ‘can’ and be able to hold that vision. This vision of the healthy me is one that allows us to ask ourselves the question ‘am I heading towards the healthy me with these thoughts and actions, or not?’. If we are not heading in that direction, then we are being distracted and need to resume the healthy course, actively choosing to do so. How are you choosing to feel today? This is an interesting question to ask oneself.

We still have a certain amount of energy each day and a need for sleep and recuperation. Exceeding our capacity means that we are not meeting our basic needs — security, nutrition, hydration, rest. There is only a certain amount of time that we can keep drawing on our energy before we must refresh. Failing to attend to the basic needs leeds to on-going stress responses that are meant only for short bursts. Prolonged activation begins to play havoc in our body systems as we are in survive mode, not thrive mode. In particular, systems that slow down include the digestive system and the reproductive system. Many, many of the women I see have issues with both — e.g./ poor digestion, bloating, sensitivity, intolerances, fertility problems. The biology that underpins behaviours of protection (fright or flight) are preparing you to fight or run away. Having a meal or trying to conceive are low on the biological agenda when you are surviving.

Too much to do, too little time. Modern day living urges us to be busy being busy. Demands flying in from all quarters, yet it is the way we perceive a situation, the way we think about it that triggers the way we respond, not the situation itself. This gives us a very handy buffer. By gaining insight into the way we automatically think and perceive, this being learned over years (i.e. habits), we can become increasingly skilled at choosing different ways of thinking, letting thoughts go, and focusing on what enables us to grow. This very quickly changes our reality, our body, our environment and the sum of all, which is the lived experience.

With on-going pain we develop habits of thought and action, including the way we move that is integral to the way we sense our bodies. Our body sense and sense of self changes in pain, as does our perception of the environment (things can look further away when we have chronic pain or steeper when we are tired), all of which add up to provide evidence that we are under threat. More threat = more pain because the amount of pain we suffer is down to the level of perception of threat and not the amount of tissue damage. We have known this for years, yet mainstream healthcare and thinking remains steadfastly into structures and pathology. It is no mystery then, as to why chronic pain is one of the main global health burdens when the thinking is wrong! So what can we do?

If you are a woman suffering widespread aches and pains, tiredness and frequent bouts of anxiety, there is good news! As I said earlier, we are designed to change, and change is happening all the time. We need to decide which way we wish to change and then follow a plan, or programme, that takes you towards your vision of the healthy you. Pain is a lived experience and hence the programme must fit your life and unique needs as the techniques, strategies of thought and action interweave your life, moment to moment, taking every opportunity to create the right conditions. The blend of movements, gradually building exercises, mindful practice, sensorimotor training, recuperation, resilience, focus, motivation and more, together form a healthy bunch of habits that are all about you getting healthy again, which is the best way to get rid of this pain. No threat, no pain.

* the cafe style conversation is my chosen way of unfolding the person’s story. How do we chat in a cafe? It is relaxed and open, allowing for the full flow of conversation.

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