Author: Richmond Stace | The Pain Coach

Not long now…

Richmond Stace | The Pain CoachLeave a comment

With only a few weeks away before the London Marathon, I must admit that I am getting rather excited. It has been very worthwhile putting in all the miles with the aim of really enjoying the day.

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One more long run to do this weekend and then I will be tailing off as advised by my team of trainers and co-runners. Yesterday a friend asked me about these 20+ milers and how you keep going. I never imagined that I would ever be running for 3-4 hours, and certainly never thought I would be popping out for a ‘quick 10 miles’. I have found that the time passes quickly once I get going but really focusing on what is going on around me, looking up, coaching myself to remain relaxed and feel inspired by the encouragement I receive.

Anyhow, the really important bit is raising money and awareness of two key projects tackling the number one global health burden: pain. The charity CRPS UK and the social enterprise UP | understand pain both envision a world of people understanding their own potential to live well and to overcome their pain.

The problem of pain

The costs of chronic pain to individuals and society are vast. Loss of earnings, loss of productivity, the expense of treatments that often don’t work and above all the immense suffering. This need not be the case if society really understood pain. By understanding pain, individuals would know where to put their efforts to get better from the outset of a pain problem, whatever the cause, and healthcare would deliver effective care.

The thinking on pain still largely resides in out-dated models. This means that individuals become reliant upon passive treatments, are subjected to endless unnecessary investigations and are exposed to the wrong messages about pain that keep expectations low and purport fears and worries that only increase suffering.

“Pain is poorly related to injury, tissue health, structures in the body, biomechanics or pathology

Our journey to understand pain began when two remarkable men created pain medicine. Pat Wall and Ron Melzack changed the landscape forever and have inspired a generation of scientists and clinicians to ask questions about pain and discover the answers: what is pain? What is pain for? What can we do about pain?

Our knowledge about pain has increased enormously but there is a long way to go before our current understanding is practiced day to day in society. This gap is a significant societal issue, and one that UP will bridge with the forthcoming education programmes and an online resource that is this very website. The UP site will be re-launched this year, packed with information that people can use to understand pain.

We have amazing potential

Humans are incredible. We are designed to change, adapt and learn, so tapping into our natural resources is one of the most potent and enabling things we can do. Consider all the achievements of mankind, which largely boil down to a clear picture of success, an ability to focus upon a plan of action, taking action and learning along the way when facing challenges. Together with a dose of determination, courage and belief, we can achieve by always being the best that we can be: ‘I will be the best me today’ is not a bad mantra to have!

The challenge of pain is no different. The programmes that UP will run for people in pain and for clinicians are all based on how we can be successful, how we can chose the positive route, how we can achieve our best. This is by focusing on what we do well, how we do it and how we can do more of this whilst acknowledging and seeking to improve in other areas.

So this in my mind drives my desire to do my best in training and on the day on 23rd April. Having said that, I will be pleased to see some familiar faces in the crowd on the way round! Or even faces I don’t know who want to support our causes. Pain affects so many people across the globe for so many reasons. Together we can change this by changing the way society thinks about pain and our expectations. Let’s expect to do well and live well.

Please support us here by donating whatever you can and join us for a quiz night before the run on Thursday 20th April in Surbiton — see here.

Thanks!!

Pain and choice

Richmond Stace | The Pain CoachLeave a comment

There is one thing that pain does and that is narrow down our choices. A sense of choice has a major role in the sense of ‘me’ and who I am. Losing choice impacts upon us significantly as we feel less and less like ourselves and who we are meant to be. This is a very common description of the impact factor that I hear when listening to people enduring states of chronic pain.

Talking to people with pain as we seek to gain insight into the causes of their suffering. This provides a way to offer support, guidance and a way forward. Of course we can only move forward, but sometimes it does not feel like that! Groundhog day.

Enabling one to see their choices then, becomes a valuable and important exercise. We have many, but sometimes we just need a little help to realise and then actualise. I believe that the greatest steps are taken when this happens as the person feels empowered to steer their ship once more.

We need to know where we are going of course, a direction created by clarifying what we want as opposed to what we do not want ~ “I don’t want pain” versus “I want to live well”. Focusing upon living well motivates actions and behaviours in line with this whereas thinking about getting rid of pain keeps our attention on pain. We will only be successful, and we can be, if we have the right approach, mindset and attitude that we may have to cultivate and practice. Most I see do need to work upon these skills of attention, resilience, self-belief and determination. That is the first choice.

We can choose our approach. We can choose to engage in healthy activities. We can choose to take every opportunity to live well. We can choose to create the conditions to feel better. We can choose to have meaningful interactions. We can choose to leave some thoughts alone if they make us feel bad. We can choose to move and gradually move more as we adapt. We can choose to learn about our pain and our responses to pain, and then change them if need be. There are many choices we can make.

Of course it sounds easy when written and the doing is different. It is an experience. However, it is perfectly do-able. We are designed to change and do so every moment that passes. We can harness our potential and opportunities with simple measures, practices and skills based on new knowledge. Achieving success is with everybody’s reach although sometimes we need some help and guidance. But we can do it. This is the ethos of UP. Let us make choices to live well, create joy and face challenges with a sense of ‘I can’.

Choose ‘I can’.

 

Why am I running the London Marathon?

Richmond Stace | The Pain CoachLeave a comment
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16.3 miles

We are 10 weeks away from the London Marathon and I am getting excited about the day. The training is going well, and I am using others experience and knowledge as a yardstick, reaching 16 miles so far. A bit more nudging in March and I’ll be set to join the thousands of other runners, coursing round the great city of London.

So why am I doing this? The answer is simple. To raise awareness and money to address the biggest global health burden, chronic pain. It costs us the most economically but of course the amount of suffering worldwide is immeasurable. This must change and we can change it by shifting our thinking to be in line with what we know about pain. With an understanding of pain, individuals realise their potential to overcome their pain and live meaningful lives. This is achievable, and in this day and age we have the means to reach across the globe to give people the knowledge and skills. This is the story of UP | understand pain, which was co-founded by myself and Georgie as a pain awareness campaign. Now we have big plans to take the project to another level to achieve our aim of changing the way society thinks about pain.

Complex Regional Pain Syndrome (CRPS) can be a terribly disabling condition, characterised by intense pain. Many people have not heard of CRPS and within healthcare diagnosis is often delayed. This is a problem because like most conditions, early identification allows for treatment to begin. The treatment must be based upon the person’s understanding of the signs and symptoms, for there is an understandable fear that drives on-going protection. Therefore, as with any injury or pain problem, the early messages must be right and make sense.A person’s belief drives their behaviours and subsequent thinking, so a good working knowledge of pain is vital ~ understand pain to change pain.

CRPS UK gained a place in this year’s London Marathon, and having spoken twice at their conferences and being in regular contact, I ‘volunteered’ to be the runner. I was very excited to be chosen and gratefully accepted, which is now why I am out in the Lycra every other day (I will not be posting a picture of that!). CRPS UK is a charity dedicated to advancing the understanding of the condition and supporting people with CRPS. The people involved are doing incredible work to raise the profile and have achieved so much through their dedication. Please visit their website here.

You may be someone suffering chronic pain or know someone who is regularly in pain. Most of us do know someone and can see the effects upon their life. This is not just pain from backs and joints but pain related to cancer, heart disease, arthritis, irritable bowel syndrome, headaches, migraines, rheumatological diseases, pelvic pain and many other conditions that hurt. The work being done by CRPS UK and UP aims to change this and provide resources and training that gives individuals and society a way forward, to overcome pain and live well.

Please show your support here and donate generously

Thankyou!!

CRPS Diagnosis

Richmond Stace | The Pain CoachLeave a comment
CRPS Diagnosis

Complex Regional Pain Syndrome (CRPS) is a collection of signs and symptoms that define this particular condition. A syndrome according to the Oxford Dictionaries, is a ‘group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms’. Therefore, we can clump together any set of symptoms and give it a name, which is really what has happened over the years in medicine. The important point is that when we use the term, we should all know what we are talking about and know what we should look for to make a diagnosis. In other words, a set of guidelines.

The Budapest Criteria delivers guidelines for CRPS, which you can read about in this paper by Harden et al. (2013). The clinical criteria (see below) acknowledge the sensory, vasomotor, sudomotor/oedema and motor/trophic categories that really highlight the complexity of CRPS. Pain is often the primary concern, with people describing their incredible suffering in a range of graphic ways. However, it is not just the pain that causes suffering but the way in which the life of the person changes together with their sense of who they are and their sense of agency seemingly lost. One of the roles of the clinician is certainly to help restore that sense of who I am, a construct that is built from many of life’s ‘components’.

Budapest Criteria

1. Continuing pain, which is disproportionate to any inciting event

2. Must report at least one symptom in three of the four following categories

  • Sensory: Reports of hyperalgesia and/or allodynia
  • Vasomotor: Reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry
  • Sudomotor/Edema: Reports of edema and/or sweating changes and/or sweating asymmetry
  • Motor/Trophic: Reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

3. Must display at least one sign at time of evaluation in two or more of the following categories

  • Sensory: Evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or deep somatic pressure and/or joint movement)
  • Vasomotor: Evidence of temperature asymmetry and/or skin color changes and/or asymmetry
  • Sudomotor/Edema: Evidence of edema and/or sweating changes and/or sweating asymmetry
  • Motor/Trophic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin)

4. There is no other diagnosis that better explains the signs and symptoms

Importance of diagnosis

A diagnosis made in the same way, based on the same criteria means that clinicians, researchers and patients alike are all discussing the same condition. This may seem pedantic but in fact it is vital for creating a way forward. Clinicians mus know what they are treating, patients must know what they are being treated for and researchers must know what they are researching. Sounds obvious but let’s not take it for granted. So the Budapest Criteria has pointed all those with an interest in the same direction. Consequently we can focus on creating better and better treatments.

As with any painful condition, the start point must be understanding the pain itself. The following questions arise that we must be try to answer:

  • why am I in pain?
  • why this much pain?
  • why is it persisting?
  • what influences my pain?
  • what do I, the bearer of the pain, need to do to get better?
  • what will you do, the clinician or therapist, to help me get better?
  • how long will it take?

New thinking, new science, new models of pain over the past 10 years has advanced our knowledge enormously. Understanding how we change, how our body systems update, how we can make choices as individuals, and the practices we can use to change our pain experience to name but a few, create great hope as we tap into our amazing strengths and resources as human beings. Detailing the treatment approaches is for another series of blogs, but here the key point is that the first step in overcoming pain is to understand it. It is the misunderstanding of pain that causes erroneous thinking and action, which we can and must address across society — pain is a public health issue. Chronic pain is one of the largest global health burdens (Vos et al. 2012). It costs us the most alongside depression, and I believe that this need not be the case if and when we change how we think about pain, based on current and emerging knowledge.

“The first step to overcoming pain is to understand it”

upandrunThis is the reason for UP | understand pain, which we started in 2015 with the aim of changing the way people think and then approach their pain, realising their potential and knowing what they can do. We are about to launch the new website that is packed with practical information for the globe to access online. Alongside this we have plans to create a social enterprise that will purport the same messages, coming from the great thinkers and clinicians who are shaping a new era in changing pain.

In April I will be running the London Marathon to raise awareness of the work of both UP and CRPS UK. You can support the work that both are doing to change pain by donating here

Thank you!

Richmond to run London Marathon 2017 for UP and CRPS UK

Richmond Stace | The Pain CoachLeave a comment

I am very excited to announce that I will be running the London Marathon this year jointly supporting UP and CRPS UK.

Please support us here by donating whatever you can spare to help reduce suffering

CRPS UK is a registered charity that is focused upon supporting people with complex regional pain syndrome (what is CRPS?). CRPS is often a terribly impacting condition characterised by intense pain and accompanying symptoms that reach into every aspect of the person’s life. Having received little attention, CRPS is gradually becoming more recognised, thanks in great part to the on-going work of the team at CRPS UK.

Georgie, my co-founder at UP, came to see me several years ago with CRPS and therefore at UP we were thrilled to team up with CRPS UK. CRPS has been a condition that I have studied for many years, and having worked with many people living the condition, personally I am honoured to represent CRPS UK and UP in this way, hoping to make a contribution by raising money to allow the work to go on.

Chronic pain is the number one global health burden. Think about all the conditions that hurt and cause pain. This is not just musculoskeletal pain, but all pain — cancer, gastrointestinal disorders, headaches, migraines, pelvic pain, heart disease, post-surgical pain, infections, inflammatory disorders! If pain was understood globally, by society, by individuals, we would know what we can focus upon to overcome the problems and live as best we can in a meaningful way. At the moment this is not the case. There is still a focus on the tissues and pathology as an explanation, but this is not the case. We have known for years that pain and injury are poorly related, and that there is much more to pain to know and work with to create the conditions for change.

This is what we aim to do at UP and CRPS UK. Pain is a public health problem affecting millions in many different ways: home life, relationships, social activities, work to name a few. People need to know the ways in which they can navigate these issues and move onward. The money you give will directly support projects and initiatives to reach this end where we hope to influence the policy makers and healthcare providers, but in essence to help the individual ease his or her suffering.

Thank you.

Richmond

 

parkrun

Richmond Stace | The Pain CoachLeave a comment

Keeping #upandrun going after The Royal Parks 1/2 marathon, I joined 1000-odd runners in Bushy Park yesterday in the parkrun. For those who have not heard of the parkrun, there are hundreds of these each week across the country and around the world. I for one am hugely impressed by the size of this phenomena. What a brilliant idea to get people enjoying being active each week.unnamed

There is no cost, except your own energy! You simply register here, follow the instructions, get to your local parkrun destination and go for it! Easy! With your barcode, you are timed so you can chart your progress, chasing the PB! Get the lingo! (It means personal best but you HAVE to say ‘PB’ in the running fraternity).

Naturally I was sporting the #upandrun kit as I always will when out running. Raising awareness is a key part of our work at UP as we inform society about the scale of the problem of pain in terms of personal suffering and economic cost. Most people don’t realise that pain is such a global health burden.

Viewing chronic pain as a public health issue, at UP we are seeking to develop society’s understanding and hence shift thinking to drive actions that change this problem individually and globally. This means that people understand their pain and know what they can do, and that healthcare and policy makers understand pain so that the right processes can be put into place.

So, if you fancy running for UP, wherever you are in the UK or abroad, let us know and we can arrange a running shirt. Within reason we will also pay for your running place. In return we aim to gain maximum exposure and to fundraise to support our work, website and research. Contact us for more information: upandsing@gmail.com

RS

We have done the run!

Richmond Stace | The Pain CoachLeave a comment

up-maraThe Royal Parks 1/2 marathon today (9th October 2016) ~ we have done the run!

Team UP completed the run around the Parks and London today to raise awareness for UP and money to launch our campaign. It was a great success!

The Team: Richmond Stace, Jonathan Vickers, Peter Brown, Chris Mutch & Ann Dunmall

On a beautiful morning, we completed the course in good time. Ann even sang in the Rock Choir performance on the main stage!! Awesome!

We were very well supported by Jo, Lucy, Lucy H, Georgie, Mark and of course the volunteers and staff. A big thanks to Sally!

This success means that we will do it again. And again. The #upandrun will now be one of the ways in which we continue to raise awareness through exposure and conversations with people and other charities. UP will support runners in the UK and beyond by funding their place and supplying a running shirt while the runner raises money for UP. So if you want to run for us, get in touch ~ upandsing@gmail.com

You can still support us here: upandrun

And now for the feet to go up!

The day before the run

Richmond Stace | The Pain CoachLeave a comment

I am excited about the run now. I have never run a 1/2 marathon before and so it is a step into the unknown. Having said that, each day is a step into the unknown as we can only ever try and predict the future based upon what we know. In that sense, why worry?

It is tempting to have a little run today to keep the legs moving. I have been told that having run for over an hour and now used to plodding along for this time, the last 45 minutes to an hour will be fuelled by the event atoms sphere created by the people and the place. I’ll let you know.

The UP team have had incredible support in many ways including the very generous donations that continue to be made. You can give here to contribute to our mission of changing the number one global health burden  that is chronic pain ~ click here 

The aim was £5000 and we have already achieved over £7000 demonstrating how people feel about the scale of this problem. It is around 1:5 people, 20% of children, that experience and live with persistent pain. This is an enormous number of people and of course the reasons for the pain are far and wide as are the contributing factors. Many people do not realise that tiredness, stress and emotional state play a significant role in an individual’s pain.

~ Pain is not well related to injury. Consider phantom limb pain for a moment. There is no limb yet there is pain in that limb; in that space. We don’t need a physical presence to suffer pain and this is because most of the biology of pain does not exists where we actually feel it. You don’t need to hear a joke laugh, you may just think of something funny. When you are at the cinema and the film appears on the screen, where are all the components that make this possible? Most are not on or involving the screen. There is a the projector, the software, the power source etc etc. In understanding pain, we think more widely and hence develop therapies and ways forwards ~ this is the essence of UP and the research we are supporting.

The money that has been raised so far will allow us to set up a strong foundation. We will apply to become a charity, which will enable us to grow and develop. We hope to link with other charities who are in aid of conditions where pain is a problem. The website can now be transformed into a great resource for all to access and learn about pain ~ understand pain to change pain has always been our motto. Like any problem, when we understand it, we know what to do.

The understanding of pain has moved on enormously over the past 10 years and this will continue. In particular my optimism comes from the incredible research that is being undertaken, which we will be reporting upon and supporting. Interestingly, the main thrust comes now from a blend of disciplines drawing upon their knowledge to create a fresh and testable model that is by far the most exciting model that exists. It would not surprise me if this model were to explain many of life’s conundrums.

So now it’s back to the run. The people have supported us and our job at the UP team is to put one foot in front of the other and have fun tomorrow at the Royal Parks 1/2 marathon. Look out for the logo and come and say hello!

What else can you do to help UP?

Follow us on twitter here @upandsing and use #upandrun for the hashtag of the day and on Facebook; retweet our tweets, tweet your own, tweet a picture of the UP logo, grab a picture with one of the UP team!

RS

UP supports research into pain

Richmond Stace | The Pain CoachLeave a comment

cropped-screen-shot-2015-10-21-at-08-20-53.pngOne of our main objectives is to raise money to support vital research that will make a significant difference to the way in which pain is understood and treated. Such research is underway here in the UK. This is both exciting and necessary in moving forward our thinking so that we can have a significant impact on the global problem of pain.

Mick Thacker has been an enormous influence upon my work and beyond, and in fact I blame him entirely for my obsession with understanding pain! I still recall the lecture he gave when I had my ‘aha’ moment, realising that there was a way forward. Not looking back since, there have been incredible steps forward to where we are now. Mick has had a huge impact upon so many people over the years and this continues. We have a lot to be thankful for and I am grateful for the opportunity to support the work he describes below. I believe that this research is by far our best opportunity to truly understand pain.

‘We propose an interdisciplinary programme of research that focuses on a new approach to pain based on the Predictive Processing Framework (PP) set out by Profs Andy Clark, Jakob Hohwy, Anil Seth and Karl Friston. The main feature of this proposition is that pain arises from circular influences that link the body (including a brain) with the world. This approach sees pain as an action-orientated perception that attempts to both identify and alleviate/limit the potential causes of actual, potential or ‘imagined’ danger to the self. We believe that this approach will extend well beyond the current bio-psychosocial model.

Working closely with philosophers and neuroscientists we will reframe our current understanding of pain using models of PP and will marry empirical based experiments into nociception with current philosophical perspectives. We plan to use these newly acquired perspectives to propose and plan a series of empirical studies that examine pain from the perspective of PP. The direction of these studies are likely to employ many different approaches across the (cognitive) neurosciences including human psychophysics and neuroimaging as well as the development of modelling paradigms involving artificial neural networks and related techniques allowing us to fully understand and evaluate pain and it’s impact on the person.’

Mick Thacker PhD. MSc. Grad Dip Phys. Grad Dip MNMSD. HPC. FCSP.
Senior Consultant AHP (Pain) Guy’s & St Thomas’ NHS Foundation Trust &
Centre for Human and Aerospace Physiological Sciences. King’s College London.
Pain Section, Neuroimaging. Institute of Psychiatry. Kings College London.
Adjunct Senior Research Fellow, School of Health Sciences. University of South Australia.

Some strong words about pain

Richmond Stace | The Pain CoachLeave a comment

Here are some strong words about pain because this is what drives the UP | understand pain campaign. Chronic pain is the number one global health burden — it costs us the most and then consider the personal cost and suffering endured by each individual. We are not just talking about musculoskeletal pain (e.g., back pain, neck pain, osteoarthritis etc.) but all pain: headaches, migraines, pelvic pain, irritable bowel syndrome, cancer related pain, pain related to conditions such as diabetes, heart disease, lung disease and all the other situations in which we hurt and can continue to suffer.

Traditionally the search for the reasons for pain consisted of looking for a pathology, an injury or other structural explanation in the body. The biomedical model needs something to find, something to see with the naked eye or on a scan. Pain can never be seen.

Pain is the ultimate example of a conscious experience, and conscious experiences are built by the individual based on a number of factors that are biological, psychological and sociological. Typically it is the biology that is focused upon with some psychology, which means that the biopsychosocial model purported for some years now, is not really used except in name.

The reality is that you cannot separate these dimensions. How is psychology not biological or sociological? How is biology not psychological? It makes no sense to divide what is a lived experience, a first person experience that embraces the unification of thoughts, perceptions and actions. Fortunately for society, there is a model that is most likely to be able to reflect this unification and the research needed to test the model is going to be supported by the UP campaign (charity-to-be).

As society has evolved so has our pain. Chronic pain is a societal phenomenon — on certain parts of the world, back pain did not exist until the concept was introduced by modern healthcare. That is a societal issue, not a medical issue. And by this regard, society needs a shift to support a new understanding of pain to relieve that very society of this on-going pain problem. This is not a medical problem. As time moves away from the initiation of the pain experience, it shifts rapidly towards the need for a sociopsychological model — what does the person in pain need to understand? What do they need to do? How do they engage with their family? How do they engage with their work? How do they communicate their pain? What actions do they need to take day to day to get better?

This is a public health problem that needs addressing as such. It is not dramatic to say that world leaders and policy makers need to be having conversations about the health problem that costs the globe the most and taking action now. It is absurd that the main reason for seeking help, the vehicle taking people to healthcare is frequently pain. How much formal training do healthcare professionals receive?

The passion behind UP | understand pain emerges from the absolute need for an enforced change from the bottom up. Society needs to be instrumental in the change for its own good and so this is where UP is taking the campaign. To the people. The voice of the people to enforce the necessary change.

This weekend UP has a team at The Royal Parks 1/2 Marathon, raising funds that will be the foundation for all that is described above. So join us and spread the word as we raise the profile of this problem into the consciousness of society for action to be taken now.

Join us on Twitter @upandsing using #upandrun