In a week’s time I head off to South Africa to deliver a series of Understand Pain talks. This is a great opportunity to connect with clinicians, therapists and others who work with people suffering pain. Invited by TensCare, we will be working together on this tour to educate, enable and empower people to provide best care for pain.
TensCare: We provide drug-free pain relief for the long-term treatment of chronic pain conditions and the relief of the acute pain during childbirth
One of the main issues and reasons why pain is such an enormous global health burden is the misunderstanding of what it is and how it arises. The predominant approach remains biomedical despite the fact that this model does not deliver solutions. Society needs us to build on our knowledge about pain and offer person-first care: it is the person who feels pain, not the body part.
In brief, I will be talking about the purpose of pain, why it persists and what we can do to help and encourage people to move on and live fulfilling lives in their own unique way. This is using strengths based coaching together with the latest pain and related sciences, focusing on meeting the person’s needs. This is the essence of Pain Coaching, which is a skillset and way of delivering care that sees a person first, not a patient or a list of problems. Instead, we see someone with strengths and the potential to improve their life. We guide and facilitate this growth in a positive way.
My hope and aim as ever, is to bring the latest understanding and thinking about pain to society in a practical way.
Towards the end of the trip I plan to run #upandrun 13 in and around Cape Town, taking in Table Mountain. This is the awareness raising part of the Understand Pain social enterprise work, as I continue with monthly ultramarathons.
It’s probably going to be a soggy #upandrun on tomorrow when I trot from Cheltenham to Bath along the Cotswold Way. The weather has hit the UK over the weekend, another sure sign of climate change and reason to look after our planet and ourselves — the two entwined.
#upandrun 12 is an unsupported, or solo run. Whilst I do enjoy the excitement of an event, there is something about doing it alone. Not seeing another person for miles or hours and simply connecting with nature has special qualities. For company you have the trail, the fields, the trees, animals, birds, sounds of the wind and silence.
Our experience of nature is embodied of course, so no matter what we perceive ‘out there’, the inner world informs what that is like. Running for long periods of time means inevitable connecting with the self, one’s body and how they are unified. Each step, each twinge, each ache and each pain tell a story. Your story.
Challenging moments arise. On a solo, there’s no-one there to encourage, no aid station and no medal at the end. There’s a purity to this; what’s the motivator? A purpose. Undoubtedly, having a strong sense of purpose is fuel. The ‘why’. So why?
My shared purpose with UP is simply to help people improve their lives, in particular those suffering chronic pain. And why? Because I believe that we can truly help others transform their lives and move on. This belief has strengthened over the years. We are designed to do better than just survive, which is what many people are doing day to day; surviving their lives.
Then there is the ‘why’ of running…
Recently I was considering the practice of curiosity, and it dawned on me that this is the reason I run. I am curious about what is over the next hill, how the day unfolds, the scene in front of me and how it emerges in my awareness and passes. I am curious about how far I can go and what it will feel like; the unknown.
Tapping into the natural explorer, these ultra-runs quench that thirst. We are born explorers, learning about the world and ourselves with every movement and experience from the outset. Picture a baby starting to move, crawl and then walk, building a lived experience of the world. We create that world by acting upon it, predicting what comes next based on what came before. Touching nature by stepping on the trail, I a perceiving that very trail by the act of running.
#upandrun is made complete by workshops and spending time coaching and encouraging people to reach their potential and achieve the results that they desire. The current project focuses upon people suffering pain from osteoarthritis. There are more free places available, so please share or do get in touch to sign up for your place (see the link below).
“I can see the world”, were the words of a person who learned to be upright. Early reflections on the UP OA Pain Coaching Project
I love hearing people’s realisations, uttered as they experience something new, with wonder, curiosity and excitement. This was someone participating in the UP OA Pain Coaching Project, who learned to be more upright and hence had a new view of the world.
It sounds so simple to be upright, yet it takes practice. We can train ourselves to use our body in a more efficient way seeking thoughtless, effortless movement, yet with awareness of having a body. Disconnection with the body for reasons of persistent pain or trauma are common. Reconnection with the body then, is an important part of moving forward, together with whatever is most important to us in our life.
The focus of osteoarthritis treatment is usually upon the area that hurts. This frame of reference needs widening as it is the person who feels pain (and other symptoms), not the body part. Further, the biology of the experience of pain and stiffness, and any other perception, exists far beyond the location of the actual feeling. To feel pain, we need a sense of the body area, a nervous system, an autonomic nervous system, a sensorimotor system, an immune system and more. What we don’t actually need is the body part. Confused?
Consider phantom limb pain. The limb is lost yet the person feels pain in that space. The simple fact is that pain and injury, or pain and pathology, are poorly related. This is why purely addressing the bit that hurts is not adequate.
You may think that in an acute injury this will be enough. I sprain my ankle so I treat and look after the ankle. Many do this. But the body (person) keeps not only the score of the injury and response, it will craft adaptations that can only be addressed by considering the whole person. Failing to do this means that protective responses and habits, formed at the outset, can persist and create further problems or on-going sensitivity. The idea of a quick fix is largely to blame. There is no quick fix. There is only complete treatment and rehabilitation of the person if you want the best outcome.
UP OA Pain Coaching Project
We are a month in, some nearing the end of their course of sessions. It’s been fascinating to look deeply at people’s experiences and beliefs. This project is an opportunity to reflect upon and study Pain Coaching, identifying key moments in conversations and themes that arise.
The purpose of UP is to improve the lives of those suffering chronic pain. Beyond building insights into the coaching process for pain, the UP OA project is a great way of reaching into the community and helping people understand their experience and learn new ways of moving forward.
I will be posting reflections each week.
If you suffer osteoarthritis pain or know someone who you think will benefit, please contact us here, putting OA in the subject bar. We have opened more free places.
UP moves into the 3rd week of the OA Pain Coaching Project. There are more places available if you suffer pain from osteoarthritis…
We started the UP Pain Coaching Project for osteoarthritis pain three weeks ago, and so far it has exceeded expectations. Motivation has been high amongst the participants, keen to learn different ways to improve their lives. Most have signed up for face-to-face sessions at the New Malden Diagnostics Centre, but we can also use Zoom/Skype if you live afar.
“I realised by the time I’ve got here this week my joints already feel better.” (A participant at their second session)
The free programme consists of 3 interrelated steps
Clarify your picture(s) of success
The types of questions you explore:
What are the real results you want to achieve? (This is your direction)
What is the ideal self you want to work towards?
What is really important to you in your life?
How committed are you to the programme?
How and why is it important to you to make some changes to improve your life?
Understand your pain
What you will understand…
What is pain?
Why does pain persist?
What causes and influences my pain?
What positive action can I take when I am in pain to feel better?
Positive action: exercises, strategies, practices and tools
On clarifying what you are working towards, we design a programme for you. The content will depend upon your picture(s) of success. There is a huge range to draw upon, some of which are daily proactive practices, and others that expand your choices for dealing with challenging moments. All are in line with the results you want to achieve.
Your toolbox can include: movement, mobilisation, sensorimotor training, breathing, relaxation, sleep strategies, periodising your activities, exercise, increasing activity levels, connecting with what is important to you (people, places, purpose), self-coaching and motivation, imagery, how to form better habits, prioritising, mindfulness practice and more.
After a few months of planning, the Pain Coaching Project started today. This is a really exciting time for Understand Pain (UP) and we are thrilled to be able to offer free sessions to people suffering the symptoms and pain of osteoarthritis (OA).
Pain Coaching focuses on the person, their strengths and their potential to improve their life. This comes in many forms as each person will have their own picture(s) of success. For some it will be an increase in walking, whilst for others it maybe to be able to socialise and feel more connected. We all have our ‘thing’. The aim of the programme is to give you knowledge, tools and practices to improve your life.
Starting with a conversation about you, your life and what you want to achieve, we then move into the practical sessions. There are many practices and tools to use, so we choose those most relevant to you. For example, we look at ways to mobilise your body and improve your quality of movement, breathing, planning your days, organising activities, relaxing deeply, building fitness, mindfulness, improving strength and confidence to be active.
If you would like to take advantage of the Pain Coaching Project and see how you can improve your life, book your place now by emailing here, and putting OA in the subject line.
When asked to write a ‘brief’ insight into my story, I questioned whether I could do this. I thought to myself ‘my story is far too complex to be able to sum it up in a short few paragraphs’. But then I realised how throughout my journey so far, when I have been faced with a challenge I step up to the mark, and I make it happen. So, here is my story:
Growing up I was a happy and healthy child who lived and breathed sport. And I was very successful with both my academic and sporting achievements. From the age of twelve I was playing cricket for Kent, representing Kent for Cross Country Running and Athletics as well as participating in any other sport where I could find the time. Life was good as a child, and I loved every moment.
However, in my teen years I developed anorexia nervosa which lead to a hospitalisation in my early twenties. I was in a critical state when admitted to hospital and there was little hope I would recover. However somehow, someway I managed to find some inner strength, determination and drive to want to recover from this illness. And so I began a long journey to restore my physical and mental health. I had a vision of leaving the hospital and being able to return to my sport, and continue working towards my goals of representing Great Britain at either cricket or running (I hadn’t quite decided at that point).
Someway into my recovery I began to experience pain in my back. To begin with this pain was leaving me in tears on any movements. And it soon began to spread, I started feeling pain in my feet, knees and hips. For me this was not only an immense source of suffering, but it was puzzling as previously I had only ever experienced pain through injury during sport. So, like most people we began to get tests, scans and multiple visits to countless health care professionals including physios, psychotherapists, doctors, hypnotherapists, movement specialists, nutritionists, the list was endless. I was in desperate search to see if anyone could shed some light on this unexplained pain. This went on for a good couple of years, all the while my hope gradually fading before my eyes as I struggle to walk for five minutes without breaking down or sit through a coffee date with a friend before becoming in terrible discomfort. This led to a desperate google search, which became a moment I will never forget. I vividly remember laying on my bed one evening, crying and typing in to google ‘success stories of overcoming chronic pain’. And this search led me to Richmond Stace. I instantly knew at that moment I wanted to work with Richmond, to try something different. And what an incredible decision that way.
My first appointment with Richmond was similar to many, myself walking in depressed and clearly rapidly loosing hope. Yet upon leaving my energy had changed completely, and my mind was fixed, pain can and will change, I can do this. Over the coming weeks Richmond taught me what pain was and I began to understand that I can influence this pain simply by choosing my thoughts, feelings and actions wisely, always keeping them inline with my vision, to be happy and healthy. Richmond provided me with tools such as mindfulness, visualisation, motor and sensory skills, the power of gentle touch and lastly he empowered me to know that I can and will live a fulfilling life.
We worked slowly, acknowledging that i had also been diagnosed with osteoporosis from my eating disorder so we were mindful of this when putting plans and programmes together for me. And the changes in my pain and happiness were incredible. Within a few weeks I was doing things I had longed to do for so long, I was back out walking pain free, I was in the gym, going to yoga, I could swim. Running and cricket were being held back for the time being until my bone density improved but they remain goals in sight. Richmond’s approach was one that was so different to any other practitioner I had seen before, but one that truly changed my outlook on pain.
Four years later, I now have a 1st Class honours degree in Sport and Exercise for Health, I have a distinction from my Masters degree in Clinical Nutrition and Eating Disorders, and I am now pursuing a PhD at Griffith university in Australia exploring the effects of low energy availability on injury risk and sporting performance in athletes. I now enjoy going to the gym most days of the week, I am a qualified yoga teacher who practices most days and I love nothing more than a long walk in nature. There is a famous quote that says ‘don’t look back you’re not going that way’, but I don’t like this quote because for me sometimes looking back is truly remarkable, as it allows me to really see how far I have come. From a place of suffering, from a place where all hope was lost, from a dark depression, to now being in a place where I moved on significantly, I am living a fulfilling life, living an adventure. I would be lying to say I am free from my issues with pain, I still get some periods where I experience pain like I previously did, and occasionally I find myself slipping back into old habits. However, I soon realise this does not benefit me in the slightest, so I turn back to all the tools in the toolbox I now have to overcome difficult times. If I experience an increased period of pain, my instant reaction used to be ‘this is a disaster’ and I would seek out physios, doctors, pills and potions to try to find a quick solution. But through my increased knowledge and understanding of pain I no longer react in such a way, instead I now view these experiences like this ‘ok, I feel you. What is the next best decision I can make that is going to help the situation (whether that be rest, movement, sleep, mindfulness, 3 deep breaths, laughter, food/ drink, meeting a friend) that is in line with my underlying vision of health and happiness’. Ultimately my next decisions always try to reduce the threat level, to reassure my body and mind that I am ok, I am safe. I have leant to observe my thoughts, feelings and actions and change them if they are not serving me well or if they contribute to suffering in any way.
I will never be able to thank Richmond enough for his ongoing help, support, guidance and encouragement during this stage of my life. Not only has he provided me with so many tools to overcome chronic pain, but also I have learnt so much about myself, who I am, what I want, my visions, goals and not to mention to wonderful books I have been guided too along the way. Richmond you are truly incredible and I thank you from the bottom of my heart.
So, for anyone out there who may be in that dark place right now, please trust me when I say, pain can and does change, when given the right environment to do so. Our experience of pain is influenced by our emotional state, fatigue, prior experience, our beliefs, our environment, our anticipation and expectation about pain. This can seem overwhelming however it is also truly empowering because having so many factors that influence pain means there is so much opportunity to change pain, because after all we are always changing. So, in this moment don’t be afraid to leave the shoreline, dive in and explore, along the way you will learn there is real depths to explore. There may be some darker patches, and inevitable challenges, and every now and again you may feel like the waves crash down on you. But trust me there is a shimmering horizon that calls you, and this is a journey that will ultimately take you towards that horizon. So, reach far, reach wide, take those meaningful steps, even if you need to tip toe forward to start, begin now and know there is a meaningful life out there for you too.
In a project supported by GSK, you will receive 4 Pain Coaching sessions with Richmond Stace, co-founder of Understand Pain (UP) and pioneer of Pain Coaching. This can be face to face if you are able to attend one of the clinics, or Skype/Zoom if you live afar (UK or abroad). There will also be some small group sessions with 4-5 people).
The aim of both Pain Coaching and this project is to help you understand your pain and give you tools and practices to improve your life.
We are also studying key moments in the coaching conversations and will be voice recording the sessions to create transcripts. These will be anonymous and securely saved according to GDPR regulations.
Pain Coaching is a blend of strengths-based coaching and pain neuroscience. Results-focused, we work together to clarify your picture of success and then design the steps in that direction. The steps consist of a range of ways to overcome pain and live your best life. This is a continuous process meaning that once you have the knowledge and skills, you are able to build momentum and seek sustained improvements.
Coaching is increasingly being used in the NHS as it is the primary way we can encourage effective self-care and independence. Strengths-based coaching has been pioneered by Mike Pegg. Mike sums up strengths-based coaching as a means of ‘…how we can encourage people during our time on the planet. It looks at how we can help people to build on their strengths and achieve their picture of success’. This approach is one of the predominant forms of coaching that we see in successful business organisations and sport.
Getting the best of you so you can live your best life
Free Pain Coaching sessions for OA pain
1:1 (in person or Skype/Zoom) or small group
Understand your pain and symptoms
Learn tools and practices to improve your life
Build momentum for sustained improvement
Start your Pain Coaching today by visiting the Project page and arrange your first session.
Yesterday morning I set off to conquer the 12 summits of London, inspired by The Guardian’s running blog by Jonny Muir. It was #upandrun number 11 kicking off 2020 with a run around the capital, which offers so much of interest, best seen on foot.
#upandrun is the running project from Understand Pain, raising awareness of the problem of pain in society, and what we can do to make a difference
We know that London is diverse. Yet it is only by passing through multiple boroughs that we can actually witness and feel this diversity. On the way round I encountered wailing ambulances, dogs, kids on bikes, a drone, pushchairs, cars, boats, cats and more. I ran along streets and paths bordered by terraced housing, mansions, premises boarded up, high rise blocks, walls, fences, the Thames, industrial units, skyscrapers, canals, woods, shops, and parks. Whilst much can seem unremarkable because we see it each day, it is in fact quite remarkable how this all works. A living city.
Putney Heath, Wandsworth
Westow Hill, Lambeth
Sydenham Hill, Lambeth
Sydenham Hill, Southwark
Shooters Hill, Greenwich (Eaglesfield Recreation Park)
Bethnal Green, Tower Hamlets
Seven Sisters Road, Hackney
Highgate Hill, Islington
Spaniards Road, Camden
Park Road, Westminster
Harrow Road, Kensington and Chelsea
Harrow Road, Hammersmith and Fulham
The route was 80k. Here are some of the highlights in pictures.
What is lined up for 2020?
#upandrun will continue with monthly ultramarathons — you are welcome to join me for a leg; get in touch.
Understand Pain has a new exciting project starting imminently. The focus is upon helping people suffering pain associated with osteoarthritis (OA), to improve their lives . Supported by GSK, I will be delivering Pain Coaching in small group workshops and 1:1 sessions (face to face and Skype). Information about how to sign up will be posted soon, so keep an eye out if you are interested. This is a free service delivered by myself, Richmond Stace, pioneer of Pain Coaching.
Undoubtedly, choosing the way of the vegan is gaining momentum. Each person will have their reasons. Here are mine.
There’s little doubt in my mind that I have chosen a vegan diet over the past couple of months to test the effects in me. It is likely I have been influenced by notable ultrarunners such as Scott Jurek and Capra Corbett.
(Being slightly philosophical for a moment, any decision that we make is the culmination of a range of beliefs, most of which are hidden away from our conscious awareness).
So how has it gone? It’s been interesting, that’s for sure, including other people’s responses. All in all, I can summarise by saying that I feel more energised, my running times appear to have improved (maybe I’m pushing harder?) and my digestive system seems to be working better (less bloating, discomfort, lighter). It is early days.
At the end of the blog are some of my favourite vegan things to eat
Initially being vegan meant a very different shopping experience. I had to really think about what I was going to eat and hence what I needed to buy. It has become easier with new habits of where to look, such as knowing where the oat milk is located.
Then there is the challenge of being vegan and eating a healthy diet. The two do not have to co-exist. It would be easy to go for processed vegan food, all neatly packed at the end of one aisle in my local supermarket. When you look, there are plenty of vegan options, replacing day to day foods: cheese, sweets, biscuits, chocolate, bacon, sausages etc. I have had some scrumptious vegan sausages!
A recent trip to Liverpool meant finding places to eat. I was pleasantly surprised to find that this was rather easy, with plenty of vegan options. I even saw a vegan chicken burger ad on a huge billboard from a well known fast food company — not my thing, but an interesting shift.
Beyond being curious and seeking to build wellness, there is also the positive effect upon the planet. Each person doing what they can adds up. This could be reducing plastic, easing back on animal products, or less travel.
From a scientific perspective much more research is needed. The recent film Game Changers provoked controversy with opponents claiming that the studies used were poor quality. However, if the reaction is to reduce the consumption of meat, this can only be a benefit. Many of the people who adjusted their diets subsequently were probably ready for change for different reasons. Whilst some of the quoted research may be inconclusive or lack certainty, it is pointing us in a particular direction.
Veganism is growing. And with the increasing numbers of people choosing this approach, there must be further research to understand the consequences. For instance, are there risks that need countering with vitamin supplements?
Only a couple of months in, I am unable to make any concrete claims about my case study of one. However, I will stick with it for now. Besides, much of the food is so delicious!
Some of may favourite dishes so far…
Vegan Indian food with jackfruit, soya, tofu and vegetables
Roasted vegetables with tofu
Coffee with oat milk
Avocado & green vegetables
Fruit smoothies with chia seeds
Granola with oat milk or soya
Vegan sausages for breakfast with beans and mushrooms
Bean burritos with home made guacamole and salsa, plus vegan cheese
76k along the Thames Path taking in Shepperton, Chertsey, Staines, Windsor, Maidenhead, Marlow and finally the home of one of the most famous regattas
The final ultra of the year for Understand Pain saw me running along the Thames, finishing at Henley-upon-Thames bridge. It’s a flat route meaning that most of the strides were similar, making for monotony as a challenge. The only variation was traversing fields, featuring uneven ground — tyre tracks, mole hills, divets etc. This was especially interesting in just the light of my head torch. Patches of fog provided additional fun.
Now it is time for some planning: monthly races and solos for 2020. There are so many to choose from! My thinking is to go for a 100-miler and another mountain race. I have some unfinished business on Snowdon, but perhaps Europe.
The UP workshops will have a different look in 2020. There are a couple of new projects afoot, which I will announce in more details once the details are finalised.
Exciting times ahead!
Meanwhile, here are some photos from #upandrun 10.