The Pain Coach

Tip of the iceberg

A bit of my art…

What we feel is at the tip…

The same can be said for any perception. The pinnacle is our conscious experience emergent from the person. What makes the person? Who am I? Both are great questions pondered by many over the years.

To overcome pain requires understanding. That’s why I am so passionate about it, to the extent that we co-founded Understand Pain. What does overcome pain mean?

Overcome pain

This means different things according to the person and their circumstances. In essence it means that pain is no longer the dominant ‘force’ in the person’s life. We can all improve our lives in many ways. In practicing certain habits and skills we can move on and live a fulfilling life. Often we need guidance, encouragement and support. This is the role of the coach and hence why I pioneered Pain Coaching: pain science + strengths based coaching.

We can think about two broad categories for simplicity. Firstly, there are many people who can get better. The pain that they experience can improve and resolve. This does not mean that they will not feel pain ever again because pain is normal. Pain is a need state like hunger or thirst. They develop the ability to protect themselves and use the survival states appropriately instead of ‘just in case’ over and over as with persistent pain.

Some people have a condition that features pain. There are many of these. A number of conditions are modifiable by creating new healthy habits and with medical treatments. In fact, as we are always growing and developing, we have the ability to change the outcomes: i.e./ a better life. One of the main problems is that people are give the wrong messages and believe that however they are now, that is it. Typically the person feels helpless and gives up, resulting in things getting worse.

Overcoming pain means that you use certain tools and practices each day, like cleaning your teeth, to get better. When someone comes to see me to improve their life, we clarify what this means to them and their picture of success: what are the real results that the person wants to achieve?

My artwork…

Back to the iceberg. This is a mere schematic of course, yet it gives a sense of the reality and the importance of the whole person approach.

A person comes into the clinic room. They look like they don’t want to be there. ‘What can you do for me that all the others have not?’, is the question hanging in the air. Commonly people have seen multiple specialists and therapists before they arrive at my office.

At that point I just let them tell their story. The practiced one comes first. This is the script that has been iterated over and over, not only to doctors and physios, but also to self (if you believe in the ‘self’…). Here comes the art of deep listening together with gentle questions that offer the opportunity to go paint the real picture.

Creating the space and time for the person to open is invaluable. They may not at this point, but they can if they feel it is right. You learn to spot when it is coming. The posturing, the facial changes, the breathing and especially the eyes soften as a ‘barrier’ comes down — there maybe many layers to this narrative.

Now the sub-script emerges. The real story is being told as we go back in time before pinging into the present and back again. Keep the space and the freedom for this to be told. All the clues are in the narrative, and this is what sits beneath the waterline of the iceberg.

Usually the person reports feeling better although all you have seemingly done is listen. But you have done more. You have listened deeply and been present. You have give the most valuable resource, time. The person inherently knows that and the trust builds. We seek to reach the level of the trusted advisor as a Pain Coach. People with complex pain do not need physiotherapy per se. Certainly not in the traditional sense. They need coaching.

The whole person

It is a person who comes to see the doctor or therapist. Not a knee, a head, a mind or any other organ. A whole person.

Despite this reality, healthcare continues to be organised in silos. There are usually separate institutions for bodies and minds because of course we can drop our mind off at the front door and go and wait while it is treated. As ridiculous as it sounds, this is the system. And even though the person arrives as a whole, they are soon reduced.

At the ESSKA conference last year I spoke to some 400 people in the audience, mainly surgeons. There appeared to be surprise when I started by saying that we are more than a knee. There was even more surprise when I asked them to touch their neighbour’s knee and report what that was like; the quality. For most, it adequately demonstrated the concept of the whole person.

The complaint is the tip of the iceberg. What can I do for you? Or my opening sentence is: ‘Tell me about you’. They will share the bit that is ‘visible’ in iceberg terms, not bodily terms. Yet this emerges from all that is unseen, in particular our biology in the dark that we have no access to. All we have are our conscious perceptions that are inferences and based upon affordances in our world.

Changing outcomes

We cannot change a person but we can coach them so that they change their outcomes. Their existing strategies and ways of coping are not delivering what they want in their life. We expand their choices. We don’t tell them that their current ways do not work as this is what they have been reliant upon. Instead, new heathy habits are formed, lined up with a picture of success. This is the focus. The more you focus on treating the pain, the worse the outcome. The more you focus on the person and how they want their life to be, the better the outcome. Now our work begins.


Richmond provides 1:1 Pain Coach Mentoring for clinicians who work with people suffering chronic pain and health conditions. Contact us using the form below for more information or to start your own coaching to get the best of you.

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