A vital question

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Chicago Downtown from The Willis (Sears) Tower 

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.

The question

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.

Teaching pain

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.

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The Pain Coach Workshop at Entropy in Chicago

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.

The next Pain Coach Workshops are in London and Preston

 

Chicago day 1

There’s no better way to shake off the travel tiredness than to head out for a run in a new city. Fortunately Chicago offers a beautiful route along the edge of Lake Michigan, which happened to unsettled this morning under the moody sky.

Having fiddled around with the workshop content this morning, I set off to explore some of the city. By foot and public transport are my favoured ways of both getting about and getting a feel of the place.

My first observation is the simple friendliness of Chicago. It has been easy to navigate my way around because people are delighted to help. Whether it be the direction, working out the ticket machine or simply reminding you to hold on as the bus pulls away, there’s feeling of, we’re in this together. I like that. I also like the local accent.

By the way, when the bus pulls off, it is so gentle! I don’t think you could fall over, even if you weren’t holding on.

Chicago is packed with great looking coffee shops. Places to hang out without pressure to finish up and move on. The pace feels slow. Maybe that’s because I’m in no hurry today, but I haven’t seen many people in a hurry. I have seen many people taking it at their own pace.

Rolling up to Lincoln Park then Wicker Park and onto Logan Square, there’s a hip, laid-back feel. I’m looking forward to a couple of nights up this way. No longer have I my beard and I didn’t bring a check shirt, so I may look out of place. Or maybe not. Perhaps that’s just the London hipster thing.

Of course the main purpose of coming to Chicago is to share an approach to overcoming pain. Tomorrow with clinicians and Monday with some people who are suffering. As I was running through my (many) slides, it reminded me of how pain is such a huge topic because it must draw upon so many fields. The reality is that pain and our brains don’t much care about this. And indeed the reason is that pain is as complex perhaps as consciousness itself, of which it is part at times.

I couldn’t help but notice the advertisements asking for participants in medical the bus there were at least two; post-shingles pain (neuralgia) and schizophrenia. I wonder how many people apply. The wording is rather persuasive and suggestive of ‘free treatment’. Have a look below and see what you make of it.

An easy night ahead before the Pain Coach Workshop tomorrow. I’ve warned the participants that they are just that, not attendees. The day is fully immersive as together we experience the practices from start to finish. If we are encouraging patients to do things, so should we. The point is that we are all patients really.

Pain Coach Workshop Chicago is being hosted by Entropy Physio — Sarah and Sandy it be precise.

There are 2 workshops coming up in the UK in London and Preston.

UP goes to Chicago

Next month UP goes to Chicago where I will be delivering an Understand Pain Workshop at Entropy. This is an exciting step for UP as we start our new chapter on changing pain in society.

UP was always supposed to be a global phenomena, and this is our first international event. The plan is for many more, both in terms of our reach via the web and in person at workshops.

Understand pain and understand your potential

The UP workshops are for people who suffer chronic and complex pain who need to understand their pain and their potential. Most people I meet have insight into neither as society continues to suffer the consequences of old thinking about pain. Still there is a the predominant search for a body structure or pathology to explain pain, both in healthcare and by the person. We have known for a long time that this is simply not true. The workshop reveals what we do know and how we can use this knowledge to ease our suffering in a practical way.

I like to talk about an individual’s MAP — mastery, autonomy and purpose. We use new knowledge, skills and practices to master ourselves, our thinking and actions, by deciding autonomously what we want in our lives. Following certain principles, we can implement and integrate daily rituals to build momentum towards our picture of success. Re-establishing the purpose(s) in our life gives us a reason and a motivating force to practice as we must if we want change. This is the basic model of success that I present in the workshop, offering a choice to each person who comes along to the workshop. A choice to create a better life.

The purpose of UP is to bring what we know about pain and suffering to society. But of course that is not enough. We must then go about alleviating pain and suffering. UP then has a two-pronged approach to both inform and then encourage positive change. I believe that we can build momentum through stories that we gather. Stories of how people have achieved success.

The workshop is based upon the Pain Coach Programme. This is a programme that seeks to educate, enable and encourage individuals to reach their potential to live their life. Why coaching? Simply because coaching is all about getting the best out of people. Based upon the latest thinking in pain, human performance, consciousness, perception, wellness, and other fields that are contributing to our understanding of being human, the Pain Coach Programme offers a way forward.

For more information about UP workshops, please contact us +447518445493 or click here 

UP and running — Beachy Head Marathon 2018

Following the Box Hill 20k trail run, I fancied something along the same lines. There’s definitely something about running out in nature, up and down hills, covering different terrains, and most of all the camaraderie.

So, on discovering that the Beachy Head Marathon takes place on my birthday in October, I felt compelled to sign up to give it a go. And then my wife Jo said she would do the 10K!

On the Beachy Head Marathon, my good friend and experienced marathoner said to me, its a completer, not a competer. I like that idea. Runners of distance get it. There’s a draw to discovering what you can achieve, how far you can go, what its like to be out there for hours and to find out where your strengths and weaknesses lie.

I have only been at this for a few years so would count myself as a novice in the endurance world. However, in this time I have learned a great deal about the rewards of perseverance and how they seamlessly spread into other arenas of life. No matter which step you are taking, there’s always another. But which direction do you choose?

At school we were made to run almost every day. At the time I resisted. Why Sir, I would ask (often). What’s the point of running? I used to think running was just about, well, running. I now have another perspective. My son asks me, why do you run, its boring, why don’t you cycle, its quicker. I understand his view. He is 13.

Running distances seems to suit the middle ages; see all the ultra runners birth dates. As someone said to me, why would you want to go running for hours when you are in your 20’s when you could be out with your friends doing __________ (fill in the gap).

Anyhow, October 27th it is, Beachy Head the place. A stunning backdrop, challenging hills (up and down — I’m not sure which I prefer; up I think!), and a purpose. The purpose as you know is to share a message in society: pain can and does change starting with understanding. Regular readers will be aware of the reasons why chronic pain is the number one global health burden. I am sure that most if not all of us can think of someone who suffers daily. Think about what that is like: the way pain seeps into every corner of someone’s life. It may be you.

There is a desperate need for change in thinking in society, which will underpin the demand for the right kind of approaches to pain. We are still blanketed by methods that do not offer a way forward. This only emerges from understanding and right action. UP is all about both understanding pain and using this knowledge for right and wise action to ease suffering by living.

I am very excited. I am excited about the BHM 2018 but also because UP is now registered and ready to go. The immediate plans include the website as an immediate place of contact for quality information about pain, booklets to order and distribute, a little book of pain and online courses. We have raised a good amount of money to fund these projects but of course we need to keep this going with future funding, donations and other opportunities that present themselves. Great times ahead as we pursue this purpose!

Understand Pain

New CRPS Adult guidelines ~ some thoughts

The 2nd edition of the ‘CRPS in adults’ guidelines have been released on the Royal College of Physicians website. You can click here for a direct link to the page where they are available for downloading.

This is important for several reasons. Firstly because CRPS (complex regional pain syndrome) is one of many painful conditions that is poorly understood by both society at large and the healthcare community. Secondly, updates should be regular because our understanding is always advancing, in particular when it comes to pain. One of the primary features of CRPS is the pain, which results in enormous suffering via the effects. The guidelines point out that even when limb signs (see Budapest Criteria) abate, if the pain persists, CRPS can still be considered active. In these cases, where the limb signs were previously existent, CRPS can be diagnosed in its NOS (not otherwise specified) form.

“Complex regional pain syndrome (CRPS) is a debilitating, painful condition in a limb, associated with sensory, motor, autonomic, skin and bone abnormalities” (Veldman et al., 1993)

The Budapest Criteria were an important step in classifying CRPS, when the condition can be diagnosed incorrectly on the basis of sensitivity and not the necessary signs and symptoms. A number of people will be told that they ‘have’ CRPS when in fact they do not, starting a quest for answers and treatment, but of course barking up the wrong tree. One of the major issues in this situation is that this often leads to an internet search, which highlights the many stories that would do nothing except heighten fear. Whilst fear is a normal emotion, it is also responsible for holding people back, as well as driving behaviours that are not in line with success. Overcoming and using fear, rather than fear using the person, is vital in the process of moving forward.

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Budapest Criteria (Harden et al. 2007)

The updated document is packed with the latest knowledge and statistics. There are algorithms to guide therapists and clinicians, and lists of therapeutic interventions and rehabilitation techniques. For all healthcare professionals working in ‘musculoskeletal care’, this is a must read. It forms a good foundation from where the CRPS literature can be explored.

Beyond this, it is necessary to look at the pain literature that includes the latest thinking, which is a blend of neuroscience and philosophy. At the peak of insight, it is common language to talk about the whole person, that the person experiences pain and that the brain is an inference machine making a best guess. All of these concepts are richly bound and grounded in science but are far from the mainstream. That is the problem. The mainstream remains bound tightly to the biomedical model, which has a role in eliminating disease and pathology for example, but must hand over to a comprehensive model that supports and encourages the necessary understanding, empowerment, independence and actions that get results.

It is for this reason that some years ago I began to blend practical strengths-based coaching with pain and perceptual science, simply aiming to get the best out of each individual. Most people do not reach their potential, largely held back by fear and misunderstanding. There is a very good reason why Understand Pain is called Understand Pain. The problem of any condition or pain exists when we have no understanding and no solutions. Whilst pain is always unpleasant, when understood together with a toolbox of practices and strategies, it is no longer a problem per se. This is a significant step forward as the person changes their approach and relationship with the condition and how it emerges in them. To achieve this requires ‘know-how’ and self-coaching, using new scripts or inner dialogues that drive new actions that are in line with a clear reference point: the person’s picture of success. Without a direction, we drift. Consider the announcement on an aeroplane when the captain speaks over the tannoy, saying that we will be taking off, but the destination is unknown. We need a picture, or a prize, and we need principles to follow to get results using our strengths and successful styles. We all have those.

CRPS remains a challenging condition for the sufferer and those close-by. However, there is massive optimism as we gather momentum behind approaches that get the best of people. It is not just about exercising. It is about a complete approach that addresses all the dimensions of pain and suffering in their unified form, all the influences and how we can actively infer something new and better in our thinking and actions. Gaining momentum is key, as practices are interwoven into each day, integrated and implemented by the individual who feels gathering control and empowerment towards their picture of success.

On we go, together.

RS — more here

Talking pain ~ video series

Together with Pete of The Pain Toolkit, I have been talking pain. This is a simple way of getting across the key messages about pain in bite-sized videos.

The first chat was based on the 5 question challenge when Pete asked me how I ‘got into pain’, my story in other words, and then what I say to people who are seeking the quick fix, the future of how we will deal with pain and the role of social media. Today we dug down deeper into dispelling the myth of the quick fix as an option.

In brief, overcoming pain is one of life’s challenges. Embracing this as a problem to solve by living one’s best life delivers many possibilities. This turns the traditional thinking, which has not worked (otherwise chronic pain would not be the No1 global health burden), on its head; i.e. we get back to living by living, not waiting for something to happen, or relying on hopes. Instead we follow a route of mastery, creating lasting and positive change, achieving results and maintaining a consistent course towards a desired outcome. This IS the model of success and we can apply this here, in addressing pain.

So, there is no quick fix, instead a route forwards where we fill our lives with the good stuff! We use our natural resources and strengths, and become resourceful. Everything you need is right there, and once you release yourself from the old, limiting beliefs and conditioned thinking (I can’t…I won’t….tomorrow etc etc.), you can start taking steps towards success. Is this a pain-free life? Does it mean being ‘happy’ all the time?

Pain is part of life. The pain you may be feeling has persisted and is not indicative of a tissue issue or pathology in many cases. Instead it is an on-going protect state as more and more contexts and situations generalise as being a threat — even though they are not. We have to actively re-train this, gain control over our mind rather than the mind controlling us, because once we decide to commit to consistent practices that build health, wellness and joy, they shift us into a different state, or chemistry. That is how we overcome pain. The more we focus on treating pain, the worse the outcomes. The more we focus on the person living well, the better the outcomes — for what we focus upon governs how we feel and where we put our energy. What do you want? Where are you going to pout your energy? Into a life full of joy? Or a life full of pain?

It sounds easy when you put it like that! Of course it is a challenge and there are many ups and downs. But you do not have to let that get in the way of you deciding to commit to a new path, one that you follow to gain wins and success in all areas of your life — again, because you decided to. How often do you feel happy, just because you can? Now you can use that as a daily practice!

So, onwards we go, as this is the only direction of travel. We build our ability to change state into that of excitement, determination, joy, love, compassion and all the many other states .We can get into such high energy states by moving, breathing, visualising, connecting and many other simple day to day practices. It merely takes the decision to do so, the development of a routine and practice, or repetitions, just like strengthening a . muscle.

More answered questions to come! You can email us your questions (painphysiolondon@gmail.com) or come to twitter and tweet @painphysio

In the meantime, enjoy!

For more information about the The Pain Coach Programme, click here

Talking pain with Pete

Pain Coach + Pain Toolkit getting together to deliver the RIGHT messages about chronic pain

This is the first of a series of conversations about pain. Pete’s 5 question challenge:

  • how did you get into pain?
  • what about people looking for a quick fix?
  • what questions should patients ask me?
  • is social media useful?
  • what is the future for pain management?

A series of chats coming soon. Enjoy!

Pain in Spain

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Keynote at the Congreso Fisio 2018

IX UMH Physiotherapy Congress 2018, Alicante

There were several remarkable things about the UMH Physiotherapy Congress in Alicante last week, which I will share below. Before though, I want to state that without doubt, the organisers created a meeting that universities around the globe should seek to emulate. This was a conference that was professionally co-ordinated, filled to the brim with great and varied content, smoothly run, and was attended by an enthusiastic, passionate, sizeable group of 420 professionals and students. The success emerged from the co-ordinated efforts of many individuals, in particular Sergio Hernández Sánchez, Ellana Mckerrell and Roser Bel-lan Roldán.

I was delighted to be asked to speak to over 400 people at the main conference and then run a Pain Coach Workshop for professionals. This was an opportunity to share some of the latest thinking about the global problem of pain, and ideas about how we can go about driving social change together. On reviewing the statistics, it appears that the chronic pain numbers are slightly lower in Spain compared to the rest of Europe (16.6% and 20% respectively). Despite the mild difference, this still represents a major public health issue that needs urgent attention, with the costs estimated at 1.5% of GDP.

“The pain in Spain is mainly on the plain”

This was a conference of the highest quality. The topics, the speakers, the logistics, and the atmosphere were second to none. And what is so remarkable is that the conference was planned, organised and run by the physiotherapy students from UMH. This was as professional as it could be, and therefore the Congreso was a great success as far as I was concerned.

The Pain Coach Workshop was an UP (Understand Pain Social Enterprise) offering, allowing me to work with twenty five professionals who were keen to build on their knowledge and skills for chronic pain. The participants kindly shared their experiences and insights about chronic pain in Spain, and together we worked through a ‘lite’ version of the Pain Coach day.

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Pain definitions from the 5 minute challenge

With a handful of English speakers, we had a fantastic translation team, who really made the workshop happen. They were brilliant as we got into the rhythm of exchanges. In the three hours we looked at the vehicle of coaching as a means to deliver skills and knowledge, together with always seeking to get the best from both the individual and the clinician. From there, we considered a range of practices including those that seek to build wellness, address sensorimotor adaptations, reduce threat and sensitivity and to encourage people to live their best lives, whatever their circumstances. The emphasis of the Pain Coach is upon realising the choices we have in life and how we make the best ones to achieve success and results. The philosophy that runs through the programme is based upon knowledge, wisdom, and compassion.

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Translation in action at The Pain Coach Workshop

This was an important trip for several reasons. Firstly to make new friends in Spain so that we can build upon the successes and create future events that benefit individuals and society. Secondly, we have identified a need that we can meet together with education, encouragement and enablement at both the undergraduate and professional levels. And thirdly, we can tap into the passion that was so clearly expressed in the opening ceremony by Roser and Sergio, to move forwards in a positive and productive way.

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For information about keynotes and Pain Coach Workshops, please contact us: painphysiolondon@gmail.com

The Shape of Pain ~ a show about the pain of CRPS and relationships

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“One woman attempts to articulate her experience of physical pain. Pain with no apparent cause. Also, she’s met someone, and they want to make this work. Words and an original sound score combine to create an explosive dialogue about love and perception. An experiment in how we talk about pain – and if we ever do that in a way someone else can understand.” China Plate

To briefly set the scene, this is a one-woman show that attempts the most challenging of tasks, to communicate pain. For many years, I have listened to people as they try to describe their pain, providing an open forum for them to use their own words, descriptions and illustrations. Of course, none fully capture the lived experience and so we must acknowledge this limitation whilst absolutely validating what the person says. Carefully documenting the language, phrases and comparisons, we must treat the narrative with care and compassion, listening deeply and equally observing how the words are delivered—gestures, facial expressions and subtle posturing.

And so, The Shape of Pain seeks, in an experiential manner, to get over to the audience what it is like to be in pain of a chronic nature as a feature of complex regional pain syndrome (CRPS). For those who are unsure, CRPS can be a painful condition of an extreme nature. There are other signs and symptom as well, which out of necessity define it. There are many painful problems and we must be able to differentiate to deepen our understanding through enquiry. The Budapest Criteria set out to do just that.

For me, it was a remarkable performance by Hannah McPake, delivering the narrative with authentic emotion, seeking to engage the people in the room. I am not a theatre critic so I can only comment on the technical aspects as an amateur, so I will stop there. However, as a clinician with a purpose to drive social change with regards chronic pain, and as a member of the audience, I was somewhat torn between the two. Flitting in my (embodied) mind, just as when we were invited to explore our perception of the Necker cube, I was critically appraising the way pain was being described, then drawn to the sensory experience of being present and back again.

In a conversation afterwards with some of the people who had watched the play, there was a feeling that we had definitely had an experience. You are not simply sitting and watching. You are absorbed by force—the sounds, the stage, the lights, the performance, and the projection of the script on the panels, which to me represented the imprisonment that some perceive and describe as their sense of agency is seemingly squeezed from them. In the discussion group, we all appeared to subscribe to the idea of pain having a shape. Job done!

Knowing that people suffering with particular sensitivity, and that is not just those with CRPS, will react protectively as their brain predicts a possible danger, means that the play would likely be provocative of pain. This point is made clearly in the script, which you can purchase, and a reason for an actor playing the part because of the effects of the words. Many people have told me, usually when prompted, that watching someone move, thinking about movement, certain smells, sounds and other ‘stimuli’ bring on the pain. When you understand pain, you know why this happens and how very real it is, together with changes in the sense of size of the limb, perception of the world and the sense of self.

Chronic pain is the number one global health burden. There are huge financial costs for society to bear, and immeasurable suffering for individuals. With the numbers of people affected by what we can safely say is a public health issue of major concern, you would expect a play such as The Shape of Pain to be sold out in a sizeable theatre as society tries to gain a grip on the problem. The question at large is why, with the costs in the billions each year and the impact on social function, is there so little accurate and impacting coverage? Most articles describe pain in the wrong way, the ‘old way’, which is distinctly unhelpful at best, and at worst keeps people thinking the wrong way. At the moment I have no answer to that, but instead focus energies upon delivering the right messages and the latest understanding to those in need.

The Shape of Pain is a significant contributor to the narrative of the most impacting of pains. A main feature of the tale is relationships. That of the person embodying the pain with the pain, the person in pain with a loved partner, the person in pain with the audience, and all of these vice versa. Undoubtedly, with pain lurking and then dominating ‘me’, there is impact on relationships. We are social creatures and relationships are important for our health, whilst also being the source of great suffering if we are not careful and nurturing. It can be more challenging to nourish a relationship if you are suffering pain persistently, as the Shape demonstrates frankly, but equally one can gain strength.

I will not capture all the angles within this short blog. Yet I hope to transmit several key messages of hope whilst fully applauding the team behind this play. They have created a brilliant piece of intimate theatre in which you cannot fail to feel deeply engaged as you run from emotion to emotion until the rather disquieting, darkened end, which is wholly appropriate. However, in a selfish way, I am pleased that the venue is smallish and intimate, because you feel so much more ‘in the room’ with the character.

On hope, there has been great advance in our understanding of pain, primarily from the getting together of neuroscientists and philosophers. This has resulted in better questions, with new insights for answers that are most helpful in describing pain to people so that they can give meaning to their lived experience. From there, this understanding informs many practices and tools that can be used to manage the painful moments, and overall seek to improve one’s life with a clear direction and steps to take. We are designed to change, impermanence making life viable, with each moment unfolding as fresh and new. This in mind, we can choose an approach, establish our purpose and pursue it in the best way that we can.

Here are 5 facts about pain (there are many more):

  1. Pain (a subjective feeling state) and injury (objectively observable and measurable) are not the same and they are not well related
  2. Pain is part of the way we protect ourselves
  3. There is no pain centre in the brain. And there are no pain signals or pain chemicals. We have systems that have a role in protection and survival — e.g./ nervous system, sensorimotor system, immune system
  4. Pain is an inferred state that motivates us to take action to address a need in our body or our world
  5. Chronic pain does not ‘start’ at 3 months. The reasons why someone experiences on-going pain are more to do with prior life experiences of protection, genetics, early uncontrolled pain at the time of the incident and perhaps gender. There are and will be many more factors.

A brief summary of the modern approach to chronic pain

As I have said, the first step to successfully managing pain moments and carving a new way forward, is to understand your pain. This is how any programme should begin, with practical knowledge and ‘know-how’. To get results, we have to shift our thinking and approach as much as using the new and necessary practical tools and actions each day. This does not mean ‘you’ have to change as a person. Instead, you are encouraged to use your existing strengths and successful styles (you will have had many successes in life, overcoming challenges) to focus on your desired outcome and the steps to take.

There are specific exercises that need to be practiced in a dedicated manner, just like learning a musical instrument, general principles to follow to gradually engage with chosen and loved activities (getting into flow), and thinking tools to focus, create calm and build wellness, our greatest buffer to life’s ups and downs. The Pain Coach Programme contains all of these components together with many other tools and practices to draw upon to embody and live a meaningful life. There is not any single practice, instead an approach that embraces what we know about being a conscious human being.

Managing the painful moments with increasing skill transforms these episodes into opportunities to head in the chosen direction. Like learning to sail a boat, we learn a great deal when the waters get choppy, and we may even capsize! But then we can focus upon rolling the boat over again and setting sail towards that desired outcome. This may happen over and over, but we can choose an approach steeped in doing our very best as we seek to master ourselves. The principles of mastery certainly apply here. In facing these challenging moments as they arise, we create new habits, replacing those that do not work, but always in line with what we want to achieve. Stringing these together with the skills of being well and specific training, we can build a foundation of understanding, compassion (especially self), and know-how that can be built upon.

This is truly an exciting time as our learning gathers pace. My role and purpose is to be a conduit and distill the great work being done by many across the globe, into tangible and practical tools that each and every one of us can use to get the best results.

The Shape of Pain is on now at The Battersea Arts Centre (where I had some delicious potato wedges in the cafe!) until 10th March. If you are interested in pain or dramatic theatre or both, this is definitely worthwhile seeing. Note though, if you are a pain sufferer, it may be evocative for some of the reasons outlined above. In knowing this though, you may choose to go along for the ride.


For further information, contact me at painphysiolondon@gmail.com

A story of learning

Funny colorful signpost to different countries around the world

This patient wanted to share her story to inspire others. She travelled to London from her country in Africa to find answers to her pain problem.

Overcoming a pain problem requires understanding that informs practices you use each day, through the day, whilst living life the best way you can. In other words, you may have parameters to work to right now, but these will grow as you develop and build wellness, together with the specific exercises and strategies you use to get better. It is a learning process. Nothing happens in isolation as we are all on a timeline with what is happening now impacting upon the next moment and so on.

Many people do not realise or actualise their potential. We have much more ‘say’ in what happens than is commonly thought. Understanding, awareness, patience and compassion are all key ingredients for gathering insight into what is really happening now, the best actions to take and how to carve out a way onwards that is meaningful.

This is the work of overcoming pain by addressing the needs in ourselves and our lives concurrent with building wellness (resilience, outlook, attention and generosity).

Here are her words:

Hi everyone, my story begun in October 2016. I woke up one morning partially ready to go to work and I noticed a slight pain in my butt, I thought nothing of it and went to work. The next day I was limping but I still ignored the pain because I had a lot of things to take care of at work. What would they do without me in the office? duh… absolutely nothing. The pain kept increasing and within a week I was paralyzed by pain and completely immobile. The pain was so severe in my left leg that moving any other part of my body (eyes and mouth excluded) caused excruciating pain, so I had to lie still. I still get emotional thinking about the day I was taken to the hospital, because the pain was so bad I had several blank moments I fought against because I didn’t want to faint and cause more injury. It was tough but we made it to the hospital eventually.

At first the doctors thought I was suffering sciatica but after a couple of days they saw that the medication did absolutely nothing for me except put me to sleep for long hours. So, I started a series of tests, blood tests, scans, x-rays and MRI all of which were very traumatizing because of the pain and the village it took to help me from one point to the other. Eventually I was diagnosed with transverse myelitis. It was a probable diagnosis, they still weren’t sure.

In the beginning of this whole situation I thought it was something that a pill and a day of rest would cure but as time went by and the pain kept increasing I thought death had come for me. yes, I did feel as if I was going to die but I wasn’t ready so I found myself soliloquizing continuously about my dreams and how I was looking forward to the future. I even remember getting upset for a moment at God for giving me all these dreams and then letting death stand in my doorway before I achieved any of those dreams. A whole day of both internal and external positive speech got me to the point of utter believe that no matter what happened I was going to live.

Weeks passed, the pain was more manageable but I was still bed ridden. For someone who is independent and very private; it was quite devastating to lean on people for every single thing. I mean I am extremely grateful for my mother, she was there from the beginning to the end but it was gut wrenching when I couldn’t sit on my own because my back muscles couldn’t hold me up, so I had to be held like a child or when I couldn’t even brush my teeth or feed myself or lay on the bed myself or bathe myself.  Like I said before, I am extremely grateful for everyone that took care of me but it did not change the fact that it was extremely difficult to see myself in that position; but as time went on I learned to see all the little things we all take for granted when we have complete health and accepting help became easier for me but not without the overflow of gratitude for all other things good. Indeed I learnt to be grateful for everything no matter how little, which was very important in my recovery journey.

Four months passed, I was better and using a walker to get around. I was discharged from the hospital but things did not progress further. I almost panicked wondering if I was ever going to walk on my own again but I didn’t allow myself enter that rabbit hole. Eventually my parents brought me to London for further medical treatment, to see if there was anything the doctors back home missed and after another round of tests and scans I was directed to a Rheumatologist and a Physiotherapists (Richmond Stace).

During my first meeting with Richmond Stace I quickly understood that this was not a physical fight; it was more mental than physical. “The fact that there is pain doesn’t mean that there is injury” he said, these words changed my life because from then on I started to try myself. I developed the courage to believe I could not just walk again but run and dance and do everything I loved to do before I became ill. Some days where extremely harder than others but my self- speech helped me through those days. If I had an emotional issue I could not overcome on my own, I spoke to Richmond about it and he would tell me what to do; it made me understand that I didn’t always have to internalize everything but since I’m the kind of person who doesn’t really like talking to others about my innermost thoughts I found a way that always helps and that is journaling. I don’t write every day but I write when I am battling something that won’t just go away; and it helps every single time.

The days went by, I kept doing my exercises and mental imaging, some days I would think I was getting better and others made it look as if I was going back to square one. I read a lot, everything I read was kind of like an expansion of the things that Richmond was teaching me and it was a wonderful blend. The time for us to go back home was near and I was able to take at most five painful steps a day. I remember the day my mother booked our tickets back home, she requested for assistance and it upset me so much because it made me feel as if I was not going to get better before we go back. I was going to go back home still using the walker and nothing was going to change but things did change. Two weeks before we went home, I got up one morning, looked at my walker which was always beside my bed and ignored it without realizing that I was ignoring the thing that helped me get around; I got up with very minimal pains, I walked to the sitting room and never looked back. I screamed for my mum and the moment she saw me walking with only two legs, she fell on the floor and began to cry. It was a very emotional day but all was not over.

I was walking by myself, every one including my doctors where very happy for me but what I did not realize was that I couldn’t jump back into my usual life. Richmond gave me exercises to do but I decided to take the exercises further and I tried to run a short distance. Guess what? I couldn’t run at all. I tried to jump and it was painful as hell. Walking around for more than an hour was so painful I felt like using a walker again. I got very upset because I felt that I was going to look healthy and not be completely healthy. I was still going to need a wheelchair at the airport, look for the elevator or escalator wherever I went. I was so upset that I cried for a whole hour in the bathroom and when I was done I cleaned my tears and did the exercises Richmond told me to do in the first place and I haven’t stopped since.

So, I have come to the end of this long story and these are the lessons I have learnt so far.

1) In all things give thanks

2) Help is good, no man is an island. Accept help and be grateful for it

3) Read, knowledge is power

4) Meditate, it is the best medicine

5) Visualize your health goal

6) Persevere

7) Do what your doctor says especially if your doctor is Richmond Stace

8) Laugh, laugh as hard as you can. It’s better to laugh than to cry

9) Never ask. “Why me?” and if you do, your answer should always be “because I am special and highly favoured”.

Am I able to run now? Nope, am I able to dance? Just a little but I can jump without pain and I can walk for three hours straight without pain. I am not there yet but is anyone ever “there”? and besides what is “there”? Where is “there” anyway? I have come to believe that this life is a journey and as long as I am happy in each moment and doing the things that will improve me then “there” for me is actually now. I hope this encourages you to keep pushing for something better.  Your life is your life, only you can do the things it takes to be better.

Signing out! Anonymous.