For some time I have been eyeing up the idea of ultra running. Having spent the past few years training for and completing several marathons and half-marathons, the urge to take it onto another level overcame me. I booked myself a date with Race to the Stones.
An old friend completed the 100k run this year. I went down to collect him and watched the runners coming in. There was such a great vibe! Much like a mini-festival; relaxed, encouraging, inspirational and lots of smiles…in amongst some pain of course!
The course follows an ancient path. We will be running and walking in the footsteps of Vikings, Romans, dragons and Kings — not in fancy dress I hasten to add!
Journey from the Chilterns to the mystical North Wessex Downs past mighty iron age forts, ancient monuments and through some of Britain’s most stunning landscapes
There’s been a lot of work going on behind the scenes at UP. One project that I have been creating is a 6 week UP programme to be delivered to NHS patients. The beauty of the programme is that whilst the content is based upon the latest thinking in pain and associated scientific fields, the actual practices and tools are really simple.
The aim of the UP Workshop is to help people to understand (their) pain and to lead fulfilling lives. This is achieved by following certain principles during day to day living, towards a picture of success.
Currently we are towards the end of the design phase. This involves deciding upon the content and how it will be layered week by week. Whilst the aim is to deliver knowledge, skills and know-how, we will also be measuring the effects together with a cost analysis. Such data will be important for scaling the Workshops to address the huge problem of chronic pain that exists in society (€441bn per year, SIP).
A new app from Sam Harris offers a simple way to integrate mindful practice into daily living. Harris is a well-known neuroscientist, thinker and writer. Recently, he published a book, ‘Waking Up’, with the same name as the app and his excellent podcast.
There are many mindfulness and meditation apps, so what makes this one different?
There are a number of features that I like about this app. At first glance, it is easy to use with two primary interventions: the daily mindfulness practices together with a series of short lessons. Understanding the practice of meditation and mindfulness is important. With the rise of popularity, the true purpose has been lost within promises of what the practices deliver to sell them as a commodity.
Each day a meditation practice is encouraged to build momentum. The bite-sized sessions are appealing because we all have 10 minutes we can dedicate to ourselves (in a kindly way). The meditations are simply numbered: day one, day two, day three etc. The first 3 come with the app, and as you progress, further practices are unlocked. I think this is rather motivating.
Learn to use your mind instead of your mind using you
Ajahn Brahm speaks about greeting mindful practice like an old friend across the street who you have not seen for years — that feeling. The daily practices being unique and building on the last creates a sense of learning, growing and development. The user is learning and becoming familiar with the way that his or her mind work. That is the essence of mindfulness. To know one’s mind is a valuable life skill; if not the most valuable.
To gain full access a subscription is necessary. This can be monthly (£7.49) or yearly (£55.99).
Harris’s approach is non-spiritual. Some people are concerned that to practice mindfulness is to take an alternative spiritual path. Whilst indeed many do practice as part of a spiritual journey or dimension to their life, this is not necessary. And you do not need to wear anything special either.
In the Pain Coach sessions we typically practice mindfulness to become familiar with the way your (embodied) mind works. We know that focus and attention can improve along with emotional flexibility. To this I would add the notion of ‘seeing things for what they really are’, or being in touch with reality. It is certainly not about relaxing or thinking happy thoughts or trying to achieve or fix something. It is about being and seeing, letting go and being open, curiosity and noticing.
Usually I will send a recording of the session to the person so that they can practice at home. However, there is immense value on having different quality resources, alternative angles and voices to which to listen. The Waking Up app is most definitely that, so if you like, give it a go.
Sanjay came to see me about a persisting and most troubling painful problem that is common in cyclists, pudendal neuralgia. We worked together towards his picture of success, following the principles of the Pain Coach Programme. As ever, the focus was to understand pain and move onto live a fulfilling life.
The old tale ‘good, bad, who knows?’ illustrates the continuity of life, or impermanence, as we live life’s ups and downs. This is such a narrative here as you read about the joy of cycling, the suffering caused by the pain and the consequential limitations, the freedom of overcoming pain, the birth of an idea and the use of strengths to create something new, with purpose.
Here is Sanjay’s story in his own words.
Most keen cyclists have experienced the addictive nature of being on a bike, the sense of freedom, speed and the happy effects of serotonin. I always loved riding my metallic blue Raleigh Grifter as a kid and unfortunately didn’t have an opportunity to upgrade to a bigger bike once I out grew the Grifter.
Many years later I rediscovered cycling again when my arm was twisted by colleagues at work to take part in the London to Brighton charity ride. I loved the experience and fell back in love with cycling again. My time on the bike increased and the challenges got harder.
It took a few years to build up the confidence to join a cycling club, but when I did I never looked back. I met an amazing group of new friends and inspirational people.
I would generally ride a few sportives every year and managed to get a saddle sore after a sportive a few years ago. I’m not very good at staying off the bike and didn’t help the healing process by getting back on the bike before it healed properly. This led to a persistent saddle sore. After various antibiotics creams and tablets the sore still persisted. I had based most of my free time and social life around the bike so found it challenging mentally when I wasn’t able to ride.
One day at work I suddenly developed a pain around my sit bones that extended down my leg, it felt like a strange pain, almost electric and was worse when I was sat down. As if the saddle sore wasn’t enough I now had another issue to deal with.
Search for treatment
Over a period of a couple of months, I saw 5 different doctors and 4 different physios and still didn’t have any improvement or diagnosis. At times, it felt like the pain was getting worse and I was spending a lot of time on my feet to avoid sitting. Depression was starting to sink in as a result of the pain and inability to do the normal things that I enjoyed doing.
I decided to get an MRI scan done and this showed inflammation at the point of pain near the sit bone. This provided some hope so I then started treatment with a physio to treat this condition and after a couple of months the pain just got worse. Next stop was a pro-cycling team physio and doctor who both worked together to finally give me a diagnosis. It wasn’t the news I wanted to hear, a trapped pudendal nerve. Also known as Pudendal Nerve Entrapment (PNE).
I turned to Google for advice and struggled to find any good news about recovery from the condition. The doctor suggested cortisoid injections or a powerful antidepressant with the side affect of numbing the nerves. Knowing that these options were just masking the root cause I started working with a clinic that specialised in nerve injuries including the pudendal nerve. They had knowledge of the injury and I did have some progress however after months and months of treatment, I had only around 10% improvement and still couldn’t sit without pain.
I was very low during this time and began searching for answers again. I came across Richmond Stace’s pain physio website and something seemed different about Richmond’s treatment. I quickly booked an appointment. I walked into Richmond’s office very depressed and without hope and walked out with the belief that I could recover. Richmond had a different approach to anyone else that I had seen. He helped me understand the cause of the pain and that knowledge led to empowerment and therefore belief that I could overcome the pain. Richmond provided tools including visualisation techniques, motor pattern training and mindfulness practices.
Richmond provided a programme of treatment and adapted and progressed the plan based on my progress. I started sitting again very quickly after treatment and running again after only a few weeks. I was back on the saddle for short periods after a few more weeks and back on the road riding again after a couple of months. It felt amazing to ride again after 8 months off the bike and gradually over time the pain completely disappeared.
During the time I was having treatment with Richmond, my contract finished so I was no longer working. Richmond mentioned a book called ‘Screw Work Break Free’ by John Williams. I quickly bought and read the book and felt inspired to pursue something more meaningful. A few years earlier I had dreamt of creating my own natural and eco-friendly cycling nutrition brand and this felt like the perfect opportunity to start making the dream come to life.
As I was spending more time on my bike over the years I realised that most of the sports nutrition options on the market were highly processed, high in sugars and gave me stomach issues. I started making my own bars with real food ingredients and they tasted so much better plus my stomach was much happier.
The path to taking the products from my kitchen to a manufacturer was not an easy or quick one, there were many obstacles and the ability to adapt was key. I stuck to my values throughout the process and that included only using the best quality real food ingredients, sustainability and creating an inclusive brand that inspires people to ride and get involved in sports whilst eating well.
Pursu will be launching in March 2019 and the name has been inspired by the Pursuit cycling events and represents the Pursuit of better nutrition, the Pursuit of goals and ambitions. The launch bar packaging will be 100% home compostable and is made out of bio-based materials. In addition we have partnered with a great charity called Recycle (re-cycle.org) who supply unused bikes from the UK Africa to help improve lives through the power of bicycles.
It seems like a long time ago that I wasn’t able to see a way out of the constant pain. Not only did I recover completely, an opportunity to pursue a dream also came my way. Before I met Richmond, there was little hope for recovery from PNE. I know there are other cyclists with the same or similar conditions and I hope my story provides hope to them.
You can keep updated with progress and competitions on Instagram @pursunutrition and sign up for a launch discount at pursu.co.uk.
Some reflections on the day of the Beachy Head Marathon; the experience, running and what’s next for #upandrun.
What an incredible day it was yesterday. Everything came together on the south coast to create the perfect backdrop for #upandrun at the Beachy Head Marathon and Beachy Head 10k.
Hats off to my wife Jo, who volunteered to run the hilly 10k course, for UP. Jo would tell you that she doesn’t really like running, however, she certainly experienced the runner’s high yesterday, feeling that unique sense of joy as you pass under the finish line.
This is a beautiful part of the UK, and the marathon opens the opportunity to get out there and experience the rolling hills, steep climbs and hugely encouraging Sussex people. In a way I could say that I ate my way around the course. I certainly had about six Mars bars amongst other fare to keep us going. And then there was the band!
Trail running is different to the typical road race. Most people are there to ‘enjoy’ themselves, take in the views, feel that sense of camaraderie and complete the course. The fuelling stations were most welcome — the smiling faces, hands holding out drink and boxes of chocolate, biscuits, bananas and of course, jelly babies.
The run is the main event, yet the conversations and comparing of notes before and after are all part of the fun. The smiles and nods, the acknowledgements of fellow participants and others all make it special. Into the night you could still see the glint of the swinging gongs, the badges of courage and completion.
Many run for causes — you know why we were running. Reading other’s shirts, some printed and some scrawled, ‘mum’ for example, it all provides the narrative. So many stories that make for the rich, shared experience.
The last section of the marathon was the most scenic. The Seven Sisters provided the view and the journey, up and down (breaks on!!).
The day’s many high points remain vividly in the memory. They will provide great boosters for future runs. The basis of using strengths-based coaching is to clarify what went well and how one can build on this moving forward. Preparation and planning the day certainly form strong building blocks: the building of tolerance with months of training, taking it easy the week before the day, eating well the night before and looking after one’s energy during the run.
‘Me, my legs and I’ was a draft blog that I was writing during the training for this marathon. It’s a lengthy and involved process, much like life. There are many analogies that one can draw from distance running, for life is an endurance event in itself. How we prepare, the approach we choose to take, how we bounce back, how we roll with life’s challenges, how we remain present and see reality, how we let go and how open we are to whatever is or may happen are all important factors that determine the quality of our life, and the run. Or vice versa.
I have a number of mantras that I have used to keep going, whether it be the run or life. Yesterday I didn’t need too many. It was just one of those days that it all worked. The sun, the view, the vibe, the support, having loved ones around, the Mars bars. But sometimes we need more. At one point I stuck on ‘Nothing but a good time’ by Poison. I ‘rocked’ up the hill!
And so to the end. I had a text from Jo, who had completed her run and was ecstatic. I called her up and we shared her joy — what a massive motivator it is to hear someone buzzing with such excitement! Before I knew it, I was coming towards the final descent, a steep one. Watch the steps, people yell as you come down the hill. The final boost was hearing my kids singing happy birthday over the loud speaker as I came along the final straight. They had the microphone! Awesome!
As the sun was setting over Eastbourne and Beachy Head, I felt that I had somehow ‘done’ the hills. Then I thought about it and realised that you never can. They are always there, despite some cracks and crumbling. You never beat the hill, just your own fears and worries.
Until next time.
And the next #upandrun challenge. Look out for the logo! And the Understand Pain Workshops — next one in Preston on Nov 3rd >>> free tickets here. Please do share this so we can have as many people attend as possible. The more sharing, the better!
The sun is not up yet, but we are. As ever, you seem to be waiting for the day, and then it is upon you.
We arrived in Eastbourne last night, welcomed by the most enormous moon as we followed the coastal road, Beachy Head on the right in the dark. In places I had to drop down to third gear to climb the hill, thinking about how we would be running those very same hills in just over 12 hours.
I am fortunate that a old pal has done the Beachy Head Marathon before. He also introduced me to a fellow runner from his club who has done it ‘5 or 6 times’. Casual. I would definitely remember how many times I had done it! So it can’t be a big deal; right? I was invited to a 20k warm up, which I politely declined. 44 is enough today thanks. The next piece of advice was gold: at the start, walk until you hear the bagpipes and then start running. This was followed with, yes, the first hill is a bastard. Righty ho!
Time to climb into the kit and grab some brekkie. There’s always something special about putting on the shirt, and representing something far bigger than oneself. You remember that the run is representative of a huge need in society and is one more step forward in raising awareness.
Look out for the pics on the way round, and maybe some live footage.
Only a few days to go until the Beachy Head Marathon and 10K. Followers will know that we are running to raise awareness of the work of UP, Understand Pain. UP is the social enterprise dedicated to changing the way society thinks about pain to reduce the enormous burden of suffering.
There are a number of things to get right when running a marathon. Fortunately I have some solid advisors around me for training, kit and strategy. Then there is the question of fuel, both day to day, before and after longer runs and during the runs — I have just had to accept that those gels are vile to get down but serve a purpose…
I must admit, I have enjoyed the eating bit of the preparation as I did before the London Marathon in 2017. Flaxseed, porridge, nuts, greens, juices, beetroot (and beetroot shots), pasta, rice, cheese…. yum! Then there are the energy bars; and I really like these. So, I was delighted to accept sponsorship by Pursu Nutrition, and not just because I had sampled and loved the bars during the experimentation process.
There is a synergy between UP and Pursu that started with the creator, Sanjay, coming to see me about a common cycling pain problem (pudendal neuralgia) that is typically enduring and limiting — his story to follow. It was during our work together when he overcame his pain, that Pursu came into existence. We chatted a fair bit about the bars, but mainly about the purpose, the mission, the ‘why’, which always resonated with that of UP.
I was most excited to be given a box of bars by Sanjay. I am pleased to say that I have managed to keep enough for the day, for both Jo (my wife) and I (this time Jo volunteered to run the 10k whereas previously I persuaded her do run the Royal Parks 1/2 marathon, apparently…!). I admit that I did eat two on the way home.
The rolling hills of the South Downs await us. This week is a little like a phoney war as others who have tapered will know. The feeling that I should be doing something has to be overcome by simply resting, stretching, moving, a couple of light jogs and then stuffing our faces on Friday. Ha!
Look out for our posts. If I can take footage on the run I will, to share the experience! Please share and spread the word about our work. We have an UP Workshop on Nov 3rd in Preston that is free for people suffering pain (click here) and the UP Programme will be on the website very soon as a starter to be built upon — a range of tools and practices; knowledge, skills and know how to overcome pain.
What is to overcome pain? This means living your best life, considering your circumstances, building wellness and focusing on what you can do each day to achieve a picture of success. Pain is not permanent; we change. I want you to reach your potential and overcome pain by living, feeling inspired, enabled and in control.
Pete and I share a passion and a purpose. We discovered our shared purpose over a number of conversations at dinners and conferences. More recently Pete and I recorded our chats, ‘pain talking’ (see here, here and here) to share our thoughts. There will be more to come, much Moore!
Our purpose: to change the way people and society thinks about pain. Why? Read on…
Today Pete is giving the Sir Michael Bond lecture, an annual British Pain Society event. The talk is unsurprisingly titled: Pain self-management; first choice or last resort? Punchy and to the point, as is Pete. And this is what the pain world, which is in fact the whole world with pain being a ubiquitous experience owned by only the first person, needs to jolt the right actions.
Pete and I could be considered outspoken, disruptive and bringers of change. However, not everyone is comfortable with change. We meet resistance. Not so long ago I spoke to a large group of mainly doctors, presenting some of the latest thinking in pain. The feedback was a fascinating mix of love and hate. Clearly some were hankering after change, recognising that the current predominant model has failed. One who only had courage with his or her feedback form accused the thinking as snake oil. I would love that person to sit in front of the likes of Karl Friston, Andy Clark, Mick Thacker and try to run with that argument!
But this is the reality. We have clinicians practicing old ways that refuse to change their thinking. This is of great concern as the millions across the globe continue to suffer (needlessly) as a result of the misunderstandings of pain. The situation must change: this is the purpose of Pete and I.
Self-management and coaching
Pete has been working tirelessly to engage clinicians and pain sufferers. He shows them that self-management is the way forward using his own story and The Pain Toolkit. An important principle that we must all adhere to is that only the person can ease their own suffering.
Whilst there can be a role for medication and intervention when chosen with good reason and used wisely, the main thrust should always be the person’s understanding of pain and what they do themselves. As I say to each person I see, you are with you all the time so you must be able to coach yourself with clarity and calm to take the best actions.
To understand pain is always the start point. The true insight into the cause of one’s own suffering unlocks the door of potential. This is why Understand Pain exists as a means to deliver the knowledge, skills and know how to society. At UP we have the vision of a world that understands pain. This would mean a huge reduction in suffering, more money available for other social concerns, people would know what to think and do, and treatment would be about encouragement of wise actions by the person.
Getting the best of people
It is always the person who suffers pain (not the body part) and hence we must think about the person and their life. And this is why The Pain Toolkit and Pain Coaching are successful in encouraging and inspiring people to live as a means to managing and overcoming their pain. Waiting for the pain to go before getting back to living just does not work. There is only this moment to take action, right now. The future never comes, so if you are waiting, it will be a long one!
Coaching and specifically Pain Coaching seeks to get the best of the person by giving them practical and working knowledge of pain. The focus is upon the person’s picture of success and how we get there step by step. All too often people think that they must just cope, get by, live with it etc. Of course, if this is your best hope then this is all that will be achieved. This is not the fault of the people. It is the problem in society — pain is a social problem. When society changes its thinking, the actions will change. Pete and I: this is our work. And we will keep going, encouraging people to understand, to use tools and practices each day and to build momentum towards a better life.
Today Pete will speak frankly. He will be entertaining, because he is, but he will hit the mark with the fact that self-management is the key ingredient. Without this there is little chance of progress.
I am thrilled that Pete has this opportunity. He deserves the stage and will undoubtedly make an impact. I will try to get there early and get a front row seat! Pete, can I wear a Liverpool shirt?
This is a short blog about why keeping touch with your body is important
The body, your body, is always there. It is always changing and updating, but in essence a constant feature of the present moment.
The mind however, goes off. It travels forward and back at a whim so it seems. But reality is only here and now, the rest is just in thought. However, each thought, each feeling, each sensation and each movement are all embodied. They are also embedded within a context, an environment and a society. The mind simply cannot be considered in isolation.
This in mind so to speak, means that what we focus on governs how we feel. Our emotional state is a biological state, orientating us towards a particular experience, to meet a particular set of needs. What is interesting is that when we focus our attention on the feeling itself, if it is a state of pleasure or joy or any other positive feeling, it grows. When we focus on a negative feeling such as anxiety or anger, what happens? Well, you can either try it or wait until the end to discover the answer.
The whole person
Regular readers will be familiar with my writings on the whole person. In short, the premis is that it is always the person as a whole who has an experience. For example, I feel pain in my hand rather than my hand is in pain. The importance lies in the need to address the person to successfully address pain. As I tell people I see, the biology of pain (and there is nothing specific to pain) is largely not where you feel it.
To feel oneself then, requires a completeness. A wholeness that needs both body and mind to be in the same place at the same time. Only when the two are together as one are we truly present. In our world where we learn early to escape the body from horrible feelings, emotions and sensations, this can seem like the thing to do. We are encouraged to drink, smoke, take drugs, buy something new and distract. Except trying to avoid and escape results in on-going suffering instead of facing and transforming. We cannot escape suffering in life. It is part of life. But no-one teaches us how to suffer. To know how to suffer is to reduce the impact and overcome the cause(s) of one’s suffering.
A simple practice
One simple way to be whole, and to connect and re-engage with the body is with the body scan. This is where you pass your attention through your body from top to bottom. You notice without judgement, with acceptance of what is, and an openness to all experiences and sensations. In so doing, you are whole, which is the true person.
The awareness, or check-in as I sometimes call it, is a way to address our biological needs. Checking in, I am aware that I need to move, to stretch, to drink, to eat, to scratch, to go to the loo etc etc. Without this bodily awareness, I miss the cues and conscious feelings of need states. And to miss out on the basics can add up over time. Place stress on top and soon our bodily systems are in survive mode, increasingly interpreting sensory information as possibly dangerous. What do we feel then? Headaches, body wide pains, irritable bowel, fatigue, poor concentration, low mood, anxiety and more.
Make a commitment
So what can we do?
We can decide to commit to a route of wellness and practice certain skills each day to build. Without wellness life is even more of a challenge. Part of being well is being present and we can only do so with body and mind together. Each moment is made up of our perception, action and cognition. They are inseparable, yet each adding something distinct the the richness experience.
If you like, now, you can sit or lie and pass your attention through your body to see what is what. Remembering of course, impermanence. Things are always changing, otherwise life would not be possible. So notice the ever changing biology at work. You can spend a minute or a few minutes or an hour. That’s the beauty of checking in. It is easy, and you can do it anywhere, anytime.
A vital question is one that can make a significant difference to your understanding, your beliefs, your decisions and ultimately your actions. This affects your quality of life.
At the Understand Pain Workshop I encourage questions. The session is for the attendees to glean as much information and practical know-how as they can. So on being asked a classic pain question, the opportunity presented itself to nail one of the biggest misunderstandings.
Arguably the belief that pain is related to tissue state beyond any other association is the problem. On hearing about the latest knowledge about pain, the person can then find themselves in no man’s land. This is the intellectual point in time when you can be caught between two models, the old and the new. Which do you believe? The old often runs deep. It can feel really uncomfortable too. We are surrounded by the biomedical explanations in the media, with adverts, from those around us and healthcare providers.
So what was the vital question asked at the workshop? It was simply put: is this all in my head? The question came off the back of being presented with the latest thinking and science of pain — not that this is in, or should be considered to be exclusive. In other words, pain science is really a conglomeration of fields of study such as basic neuroscience, cognitive sciences, social psychology, consciousness science and perceptual studies to name but a few. As ever, for science to move forward, we need to ask great questions. This is where contemporary philosophy delivers with the likes of Andy Clarke and Jakob Hohwy amongst others.
To understand pain is to understand being human. Our strengths, our weaknesses, our biases, our attentional scatter, our changeable emotional states, our inability to suffer skilfully (due to society encouraging us to try to avoid something that is unavoidable) and our tendency to live by illusions of the mind instead of reality. Escaping from our bodies is something we learn early in life, as we climb into our minds to avoid turbulent emotions. Who ever gets taught how to face these challenging emotions? Society encourages the exact opposite. The short-term cover ups or fixes.
We will be sure to try to meet our needs for relief. We can do so in a healthy way or an unhealthy way. Lacking any tangible or obvious options, it is understandable why one would reach for something unhealthy: alcohol, cigarettes, drugs, sweet stuff, or another way of trying to feel better in that moment. The problem is that this does not last because the problem has not been addressed. Only by courageously facing and seeking to transform suffering do we experience sustained change in a desired direction.
There are a number of pain facts we can use to help people understand their experience. For example:
Pain and injury are poorly related
Pain is related to perception of threat
Several of the major influences upon a pain experience (and the actions you take) include emotional state and tiredness
Pain, as with any conscious experience, is the brain’s best guess
Pain is embodied
Pain is embedded in society
What you are focusing upon determines your quality of life
Looking at this list and more, and considering the position of the biomedical model that seeks damage or pathology to explain pain, the gap becomes apparent. Whilst the biomedical model plays a role in identifying such damage and pathology to determine whether a surgical or medical approach is necessary, it does not provide answers to why pain experiences vary so much.
How is it that a paper cut can be so painful? Why can we feel pain in fresh air in the case of phantom limb pain? How does someone run on a broken ankle? How can someone be impaled yet feel no pain? And so on. One simple way to consider pain and injury is by the fact that the former is subjective and cannot be seen, whereas the latter is objective and is usually identifiable. The way that the injury, pathology or lack of observable damage is experienced will depend on context, existing biological state, prior experience, the impact in terms of perceived limitations, expectations, and beliefs about pain and injury. There’s a lot more, but this covers a good amount of ground for now.
Pat Wall (one of the forefathers of modern pain medicine and science) in 1979 and John Loeser (the originator of the biopsychosocial model) in 1982 both described the lack of relationship between pain and injury, so this is not new thinking. It is simply that society has gone with another, simpler and if I am cynical, financially convenient explanation(for many stakeholders — those that treat using the biomedical model & pharmacological companies). Loeser said:
“Physicians and patients usually harbor a concept of pain that involves a linkage between body damage and the pain reported by the patient. This is an inadequate concept that leads both physicians and their patients into unnecessary difficulties in the management of chronic pain.”
On being presented with the seemingly new thinking about pain, some people then make the assumption that the clinician is suggesting it is somehow in their mind or their head. On doing so, they have missed a couple of key points: pain is always embodied and pain is whole person.
Pain is always embodied
Pain can only be experienced in the body, or where the body should exist (and a representation continues to exists in the nervous system) in the case of phantom limb pain. Pain involves the brain, our thinking, our emotions and hence our mind, but it is always felt in the body. It is never imaginary, and anyone who suggests that this is the case does not understand pain.
Pain is whole person
It is the whole person who feels pain, not the body part. If my knee hurts, my knee does not go off to seek help, I do. Much like if I am thirsty, my mouth does not go to get a drink, I do.
Considering that it is the whole person, it follows that how they are in any given moment will impact upon how they experience pain and the choices that they make to relieve their pain. This is why it is vital to treat the person, and not the body part or simply a condition. Oliver Sacks, the great neurologist and writer, said this from the outset. Many other great physicians and clinicians have agreed and achieved results as a consequence. I live by this notion, knowing that to focus on the person and their needs is the way forward. To focus on the pain leads to poor outcomes.
The definitive answer
The answer to the question, ‘is it in my head?’, or, ‘is it in my mind?’ is no. Pain involves many body systems (most of the biology of pain is not where you feel it) gathering information. The brain interprets this sensory data in the light of what has already been and is known before generating a prediction of the most likely causes of that data — a best guess (see a great talk here from Anil Seth). This is both whole person and embodied as explained briefly above. Understanding this is a key step in the right direction, and part of an overall understanding of pain that allows the person to engage fully with the necessary practices, training and actions that permit progression, living and overcoming pain.
On we go as ever.
Please do share this article with fellow clinicians, friends, and others who need to understand pain.