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.
Here’s the plan. Hampton Court to Reading; just over 50 miles along the Thames Path heading west.
Never has the need to understand pain been greater. Undoubtedly we are in times of great suffering for many reasons — mainly driven by our choices as humans on this planet. Whilst suffering is undoubtedly part of the lived experience for all of us, we can do so much better at being there for each other, regardless of background. At the end of the day, we all have the the same needs and desire for a fulfilling life.
Understand Pain plays its part by bringing practical knowledge into society so that people can improve their lives. My preference is face to face at the workshops: UP for people suffering persistent pain, for GPs and for healthcare professionals. The latter includes student physiotherapists who are the next generation and can make a huge difference. Last week I was enormously enthused by a sizeable group of MSc and BSc physio students at Leeds Beckett University where I ran an impromptu session (read here); a kind of surprise gig….
My hope and dream is much more of this as the story gathers momentum — so please share far and wide!
Look out for the next blog and the pics of #upandrun 10 on the day >> @painphysio on Twitter and @paincoach on Insta.
On Friday night Strava told me that I had reached 3000k for the year so far. Undoubtedly, the cause Understand Pain (UP) has been a massive motivator together with a sense of purpose, echoing the thoughts of Dean Karnazes: ‘…ultrarunning is a noble pursuit and has brought purpose to many people’s lives, as it has mine.’
However, there’s a long way to go. Society needs to develop its understanding of pain: what it is really and why it can persist. That’s one of the main purposes of UP.
My intention is to continue with the ultrarunning to raise awareness of the problem of pain. There is no end goal; just to keep going as in the style of shuffling mile after mile. Along the way, I hope to gain partners who want to share the story of making a positive impact in society (do get in touch here if you are interested). For example, UP recently has teamed up with a large healthcare company to work on a really exciting Pain Coaching project — more on this soon.
But, none of this would have been possible without the support and encouragement of a number of people. Therefore, I dedicate this blog and the #upandrun 3000 to them with massive gratitude. Some I know well and some I know of; all have helped in their own unique ways and many won’t have realised!
We gathered near Totnes in Devon at a holiday house on the Sharpham Estate, with dual hot tubs outside on the deck. The taxi driver who dropped me was most surprised to see a full, steaming circular bath full of people as we pulled up. He quickly reversed, and I don’t think he believed me when I said that it was a running and writing retreat.
It was a super weekend. The group gelled as we shared our stories, reasons for signing up and our dreams. Adharanand and Richard set a tone of openness, humility and clarity that enabled authenticity. Naturally I cannot speak for the others, but this is how it felt. Through this we were treated to passionate, amusing, hilarious, ridiculous, descriptive writing, some in the form of a game and some in prose. People we had left at home may have thought we were on a jolly, but this was hard work. It just so happens that both the running and writing are passions.
We wound our way up and down trails, through woods, along paths, hopping from rock to rock, through gates, over stiles, under the sun, through the rain, in the shadows, in wide open spaces, along the river, skipping through streams, sliding down narrow muddy routes, sploshing and squelching, flying and skipping, trudging and striding we went. Most of all though, we were together, sharing our own experiences as one.
The running was fun. However, it was the writing workshops that created the opportunity for openness and vulnerability. That’s when you get to know someone at a deeper level. Each person brought themselves, cultivating a unique blend of thoughts feelings, emotions, insights; all embodied.
The next UP Workshop is on November 20th at The Groves Medical Centre; free tickets here.
If you would like to hots an UP workshop for clinicians who want an introduction to Pain Coaching or for people suffering persistent pain to learn how they can improve their life, please contact me: firstname.lastname@example.org
Look out for #upandrun 10 in December — it could be in your area!
I wholeheartedly believe in people’s ability to change their pain. Why? Because I have seen it so often and heard how individuals have improved their lives. We also see the effects of changing people’s perceptions in the research settings.
Many scientific studies have shown how we can alter experiences in many different ways. My role as a clinician is to translate this into something practical for people to use day to day to get better. This is why I spend time with scientists, researchers and philosophers on a regular basis, but also draw upon many fields to create programmes for people to get the best of themselves.
Here is a story about a person’s experience of changing their pain. In this case, chronic headache. I act as an encourager, a supporter and a coach, but it is always the person who must do the work to get better.
I suffered from Chronic Daily Headaches for twelve years, before I was eventually referred to Richmond by my neurologist, Dr Marie-Helene Marion, to whom I am eternally grateful for doing so.
Before visiting Richmond, the only option I had to relieve my headaches was medication and, when the drugs stopped working, I would feel completely hopeless in their wake. But, in just a few short sessions, Richmond completely reconfigured my relationship with my headaches – giving me tools to manage the pain and, more importantly, feel in control.
Very soon the hopeless despair was gone because now, when I was faced with a headache, I had options. Whether it was as simple as a full body meditation, going for a run, or turning to my daily journal, there were things I could do that had a direct impact on the pain and therefore my state of mind. I no longer felt crushed by the onset of a headache because I could take action. If the drugs didn’t work, it wasn’t the end of the road, there was something I could do to better the situation.
As a result of my treatment, I am slowly coming off my medication (something I would never have imagined possible, having been on them for so long) and feel better than ever about my headaches. It has honestly changed my life.
And there’s one other thing – until I saw Dr. Marion and Richmond about my headaches, no one had ever told me that I would ‘get better’. It was always about managing the symptoms with medication. It’s a simple thing to say , that you might ‘get better’ but, for the first time, I had been given permission to believe that I didn’t have to live with my headaches forever – from the outset this was a huge psychological boost. And, I am pleased to say, they were right. I am getting better.
It is time to think about the October #upandrun ultramarathon now that I have recovered from the Snowdonia adventure and am back to running around locally.
There are several choices, both of which are solos. That is when the runner heads off on his or her own, unsupported, making their way from A to B.
The one I shall go for is Richmond to Oxford along the Thames Path. Previously I ran from Hampton Court to the Thames Barrier, so this will be going the other way; out of town so to speak.
The route is 100 miles. I will chunk this into two days, finding somewhere to stop overnight. Any suggestions are welcome. Preferably somewhere quiet, with nourishing food where I can dry out and put my feet up for a few hours before setting off again. All I will carry is what I can fit in my backpack.
So that’s the plan. I will confirm the dates soon.
For the 7th ultra I am hitting the hills, or rather mounting the mountains….
Most of the races so far have included some steep hills. Over the South Downs near Ditchling Beacon on my way to Brighton from London, traversing the Seven Sisters from Eastbourne towards Brighton and along The Ridgeway on Race to the Stones, have all challenged my thighs. Running and walking uphill is one thing, coming down is another. There’s an art to the latter. A balance between controlling one’s descent so you don’t fall and saving your quads! The Maverick inov-8 ultra has an elevation of 3020 over 60-odd k.
Traditionally I am not great with heights. So this ultra presents an additional element and feature for me to cope with whilst climbing, descending, walking trotting, hopping, shuffling and running. Don’t look down! Having said that, I have been on mountains plenty of times before and usually enjoyed the views, fresh air and freedom.
Recently I was thinking that #upandrun would continue for 12 months, #12in12. But then I thought about afterwards and what I would do. I can’t see that I will stop, so this will continue indefinitely with a blend of races and solos that accompany the monthly UP workshops (next one on 18th Sept >> tickets here).
You can support Understand Pain here, helping us to run the workshops each month so that they are free for those most in need, to increase the number of workshops and the reach. Meanwhile, I’ll keep running to raise awareness and bring the tools to people so that they can improve their lives.
#upandrun is an Understand Pain project raising awareness of the problem of pain — the No1 global health burden. We are working to reduce the enormous suffering caused by chronic pain that affects millions and costs billions.
Are you a GP who sees people suffering chronic pain?
The answer is most likely yes considering 20% of the population suffer chronic pain. There are many presentations (in no particular order): back pain, neck pain, irritable bowel syndrome, fibromyalgia, arthritis, post-injury, headaches, migraines, pelvic pain, endometriosis, menstrual pain, tendonitis, as a feature of a particular condition, cancer, heart disease and more.
Chronic pain is the No1 global health burden. Pain is the main reason why people seek help. Yet it remains poorly understood, meaning that people’s expectations are out of step with what they need to get better, and the treatment offered can take them down the wrong path. Together these contribute to the on-going problem that is showing no signs of change in the right direction: less suffering and less cost. We must and can make this happen. The ‘we’ being society.
GPs are in a prime position to help drive this change with the right support and systems in place. As a GP or healthcare clinician, how do you feel when a patient (person) suffering chronic pain comes into your room? Be honest. Does the challenge excite you, or is it the so-called ‘heart-sink’ time? For me, I have always loved the challenge and the fact that we can always do something to help the person improve their life. But this is because I have always felt that I can work in this specialist field and make a difference, building knowledge and experience over 20 years. Without the practical knowledge and the coaching approach, I am certain I would feel lost and overwhelmed.
Now, I do not believe that you need 20 years in the world of pain to be able to have a positive impact. But I do know that understanding pain is vital, as is having confidence in your approach. Both are transmitted to the person in front of you whether you are aware or not.
Steps to take
The first step is to be aware of your own beliefs, biases and behaviours in these situations. These will frame your approach. What is your approach? Establishing the way you ‘treat’ is the next step. Do you treat chronic pain? Do you treat the person? Do you coach the person? What do you do, how and why?
On knowing your start point, you can then build your knowledge of pain: what is pain really? For example, understanding that pain and injury are poorly related, that pain and tissue state bear little relation to each other, that pain is a need state, and that pain is the brain’s best guess to explain the current state. Further, you learn that pain is related to the perception of threat and the state of the person. It is of course the person who suffers pain, not the body part. And, most of the biology in the dark when we are in pain, is not actually where we feel it. The pain experience itself is just the tip of the iceberg.
You have a choice. You can continue using the same approach, and indeed there may well be some ways that you find to be effective. Or you can add to your repertoire of tools and design a system or process. This I can help you create.
One of the biggest challenges is always the time factor. Perhaps you have 7 minutes, 10 minutes or the ‘luxury’ or more. It is tight. This is a complex situation that requires time and the human touch. How can effective care be achieved? How can we really help this person improve their life? The primary choice remains medication. There is a role for medication and it is often expected by the person and hence a pressure to prescribe exists. However, whether you do or not is your choice as the clinician. But of course medication does not teach someone how to improve their life and will mean that the natural systems of (biological) protection become lazy together with a limitation upon the person’s responses. People commonly rely upon and hope for the quick fix option when there is none. Instead there is a way forward that eases suffering and improves life, but it takes longer and is more effort. That is the reality, the uncomfortable and inconvenient truth about chronic pain.
To address pain you have to address your needs in life, build wellness, create new heathy habits, take a new perspective, expect and know that life can get better and practice day to day to day, much like cleaning your teeth — you know this is true when you truly understand pain.
The questions are: what does this person really need? What are they telling you in the narrative? And then, how good are my deep listening skills?
So, with limited time and the desire to make a positive impact, we need a plan. One that we can roll out in an individual way. We need a set of options and resources that can meet the needs of the person step by step. When you know that you have a plan, the pressure eases because you know that you can make a positive impact. You outline the plan to the patient, start the wheels turning as you help them understand their pain (always the key), and focus on what they CAN do to improve their life.
The Pain Coach approach focuses upon what the person wants in their life and how they want their life to be: focus on what you want, not what you don’t want. See how often we do the latter, and sure enough…. . This is why coaching offers so much because we tap into the person’s strengths to move on towards their picture of success. We have a clear direction and steps to take each day. It is a challenge, but coaching encourages and supports the person to live their best life, to show up in the best version of themselves, and to reach their potential.
What would it be like if you had a process?
How would you feel about supporting, encouraging and coaching people suffering chronic pain if you knew that you had a process in place? Would this have a positive impact upon their lives? Your practice? Your stress levels? Costs?
Your process includes a range of ways that you address particular problems that arise together with resources to call upon. Within each session you have 1-2 key points to cover. Sessions are scheduled according to the priorities for that person. This removes some of the time pressure because instead of trying to cram in as much as possible, or prescribing as the first port of call, you know that you have a number of appointments set up for particular issues to be discussed and acted upon.
In essence, when a person has an idea about what is happening, why, what they must do, what the clinician will do and over a rough time period, they will be satisfied and engage. The trusted advisor status is vital when working with someone suffering chronic pain. This takes time and follows reliable, compassionate care, i.e./ positive actions in line with the person’s needs.
There are many pressures upon GPs. From society, patients, and themselves to deliver the best care. Resources are always limited in some shape or form, in particular the most valuable one: time. This being the case, we must work out the best ways of moving forward. For chronic pain, currently the greatest health burden, creating a process within your practice that enables you to listen (deeply) to the patient, and step by step meet their needs will increase efficiency and improve outcomes. Within this process, pain coaching is a means of working with the person so that they can reach their potential.