Chronic pain

Probably the best meeting in the World

Richmond Stace | The Pain CoachLeave a comment

More reflections on SIP 2017

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You know what it’s like. You realise at the time that you are involved with something important. Then you get home and start thinking ‘wow’, that really was probably the best and most important meeting in the World when it comes to the problem of pain: SIP 2017.

The problem of pain is undoubtedly one of the greatest challenges facing society, and most people don’t even realise. Up to 441 billion Euros is the cost of chronic pain each year. That is an enormous financial burden that does nothing to describe the suffering endured. This can and must change. Attitudes and beliefs in society need a drastic update in line with what we really know about our potential as human beings for fostering change. Out with the old messages, out with interventions and medicines as the way to solely ‘manage’ pain, out with the notion that pain equates to tissue damage. Out, out, out!

“out with the old messages and in with the real understanding of pain. Then society knows that this suffering can ease

It was fascinating and enlightening to hear so many European clinicians and stakeholders talking about people (patients), the importance of healthcare professional education, and even the word coaching was used. In the room were people looking at pain from all angles, a unique blend in the first place. This set the scene for deep discussion, learning and results.

The openness to ideas and modern thinking about pain was refreshing. The people at SIP 2017 want to understand, want to learn and above all want to make a difference. And we can make a difference by persevering and looking at every possible way to change the way society thinks about pain ~ understand pain to change pain.

No single group dominated the meeting. Instead the forum was truly free for each person to contribute and put forward their thinking and experiences. We heard people talk about their pain, and they were able to discuss this with scientists, clinicians and policy makers in an environment created purposefully. It seems that clinicians ‘worry’ about conferences or meeting where people with pain and suffering can speak about their lives. Instead, this should be encouraged and embraced as we get to the bottom of the problem and take real steps forward. How useful is a conference where academics or clinicians speak about cases and research without ant real stories in the room?

“the openness to ideas and modern thinking about pain was refreshing

My intention is to build and cement relationships with other stakeholders across Europe, be involved with the new EU platform, contribute with UP and Pain Coach workshops and take action in line with the vision of UP: a society that understands pain.

SIP statement

‘The European Commission is following SIP’s lead and has launched the EU Health Policy Platform to build a bridge between health systems and policy makers. Among other health policy areas, the societal impact of pain is included as well and will have a dedicated expert group.’

In the UK we must take this example of how we can move forward. Pain is a societal issue and hence we need to hear from all stakeholders, in particular patient representative groups. The lived experience of the person is the basis of what we are working with to overcome pain. We are seeking to change the story so that the person can say: I feel like myself. Change is what people want, defined in their own terms by things that they want to do in their life. We can and must work on a number of levels to achieve this and we can and must be optimistic. Why? Because we are changing every moment, we are designed to change and need to know how.

Our quality of life is determined by how we feel. How we feel is determined by what we are thinking (consciously and subconsciously). What we are thinking is based on our beliefs about the world, and these stem from all the influences in our life. The moment to moment decisions and actions we take through the day shape our life and the ‘rating’ we give to our life. However, there is constant change afoot and we can harness the opportunity this creates by making decisions to commit to a particular pathway. The pathway is determined by the practices chosen in line with a desired outcome. Being determined to be the best you, with a clear vision and being coached to achieve success and long-term results transforms the experience. This is the essence of Pain Coaching.

With 100 million people suffering pain in Europe, 100 million Americans suffering and the rest of the World following the same theme, we must create the conditions for change. This starts with the understanding of pain because when people truly understand their pain, they realise their potential and a way forward. There can be a role for medication and interventions on occasion, but with this being a societal problem, there are many other actions that empower and enable people to overcome their pain. Together we can do this as a modern society. We have the means and with the costs so high, we have the impetus.

RS

Positive work at the Societal Impact of Pain Symposium 2017

Richmond Stace | The Pain CoachLeave a comment

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SIP 2017 drives change

The problems

The title of the interest group itself, ‘Societal Impact of Pain’ or SIP, drew me to the 2017 conference. I firmly believe pain to be a societal issue that has enormous consequences for individuals and the world in which we live. Whilst there are many meetings dedicated to pain, most focus on a scientific programme. This is only part of a much bigger picture that includes socioeconomic factors, culture, beliefs, gender, access to healthcare, understanding of pain and lifestyle, to name but a few. SIP, as far as addressing pain as it needs to be addressed is ‘on the money’. And speaking of money….

Chronic pain is a huge economic burden. The cost of pain to the EU each year is up to €441 bn — today that is £387 bn.

Wake up policy makers, yes that is £387 billion.

Back pain alone costs €12 bn per year in Europe although the most staggering figure is the €441 bn think about all the other conditions that hurt) and the source of immeasurable suffering for millions. It is estimated that 100 million people suffer in Europe.

“Pain causes a problem for individuals as well as a challenge for healthcare systems, economies and society (SIP 2017)

Clearly, what we are doing at the moment does not work. There are reasons for this, including the fact that pain is misunderstood in society: healthcare professionals and people (patients). This results in the wrong messages being purported, low expectations and poor outcomes. This must change and the SIP 2017 meeting was a perfect breeding ground for positive work in the right direction. There were some significant steps forward, emerging from the synergy of different groups gathered together.

What was my purpose?

Representing UP | understand pain, I was attending SIP 2017 to gain insight into the current thinking about pain from a societal perspective. In particular I was interested in the language being used, the messages being given about pain, and the plans for positive work to drive change. Listening to the talks, being at the meetings and talking to different stakeholders, I was inspired. My passion has been strengthened by what I heard. I know that UP is absolutely on track and my aim now is to contribute to the on-going work, primarily by changing the way society thinks about pain — see workshops here.

The message that I deliver, and that of UP, is that pain can and does change when it is understood thereby empowering, enabling and inspiring the individual to realise his or her potential. The individual is part of society and hence with so many people suffering, this means society is suffering. Drawing together the necessary people to create the conditions for change was the purpose of SIP 2017. From the outcomes (see below), this is what has been achieved.

See the SIP 2017 Impressions here: videos and photos

Who was there?

One of the features of the meeting was the range of people in attendance. For fruitful discussion and action it is essential that stakeholders from the different sectors get together. This is exactly what SIP 2017 created. In no particular order, there were clinicians, academics, scientists, policy makers, MEPs, patient groups and organisations, patient representatives and others who have an interest in the advancement of how society thinks about and addresses pain.

Valletta panorama, Malta
Valletta panorama, Malta

The right language

The focus was upon the person and their individual experiences of pain within the context of modern society. We all need to understand pain for different reasons, although we are all potential patients!

  • People suffering need to understand pain so that they can realise their potential for change and live a purposeful life
  • Clinicians need to understand pain so that they can deliver the treatments and coaching to people in need
  • Policy makers need to understand pain so that they can create platforms that enable best care

I was pleased to hear and see recommendations for coaching, although the term was not defined. Having used a coaching model for some years, I have seen this bring results, as it is always a means to getting the very best out of the individual ~ see The Pain Coach Programme.

Within the biomedical model, which does not work for persistent pain, the person is reliant upon the clinician providing treatment. We know that this approach is ineffective and in turn, ineffective treatments result in greater costs as the loop of suffering continues. Giving the person the skills, knowledge and know-how enables and inspires people to make the decision to commit to the practices that free them from this loop. People do not need to be dependent upon healthcare to get better. With a clear vision of success and a way to go about it, people can get results and live a meaningful life. This is the philosophy of UP and I was delighted to hear these messages at the meeting.

An issue raised by many was the measurement of pain. The way that pain improvements are captured and the desired outcomes differed between people (patients) and policy makers. The Numerical Rating Score (NRS) is often used, but what does this tell us about the lived experience of the person? Pain is not a score and a person is not a number. If I rate my pain 6/10 right now, that is a mere snapshot. It could be different 10 minutes later and was probably different 10 minutes before. The chosen number tells the clinician nothing about the suffering or the impact. It is when the impact lessens, when suffering eases does the person acknowledge change. No-one would naturally be telling themselves that they have a score for pain unless they have been told to keep a tally. We need to understand what is meaningful for the person, for example, going to work, playing with the kids, going to the shop.

SIP 2017 ~ chronic pain is a societal issue

Steps forward

SIP have issued this press release following the symposium:

‘MARTIN SEYCHELL, DEPUTY DIRECTOR GENERAL DG SANTE, FORMALLY ANNOUNCES LAUNCH OF PAIN EXPERT AND STAKEHOLDER GROUP ON THE EU HEALTH POLICY PLATFORM AT THE SOCIETAL IMPACT OF PAIN SYMPOSIUM’

Mr Seychell gave an excellent talk, absolutely nailing down the key issues and a way forward. This has been followed by with positive action. The SIP statement reads:

‘The European Commission is following SIP’s lead and has launched the EU Health Policy Platform to build a bridge between health systems and policy makers. Among other health policy areas, the societal impact of pain is included as well and will have a dedicated expert group.’

From the workshops the following recommendations emerged:

  1. Establish an EU platform on the societal impact of pain
  2. Develop instruments to assess the societal impact of pain
  3. Initiate policies addressing the impact of pain on employment
  4. Prioritise pain within education for health care professionals, patients and the general public
  5. Increase investment in research on the Societal Impact of Pain

A further success has been the classification of pain

Building momentum

Following this inspiring meeting where so much positive work was done, we now need to take action individually and collectively to get results. I see no reason why we cannot achieve the aims by continuing to drive the right messages about pain. This is a very exciting time from the perspective of EU policy but also in terms of our understanding of pain. The pinnacle of that knowledge must filter down through society, which is the purpose of UP.

To do this we (UP) are very open to creating partnerships with stakeholders who share our desire for change. UP provides the knowledge and the know-how that is needed for results, because without understanding pain, there can be no success. Conversely, understanding pain means that we can create a vision of a healthier society that we enable with simple practices available for all. Society can work together to ease the enormous suffering that currently exists. We all have a stake in that and a responsibility to drive change in that direction.

~ A huge thanks to the organisers and Norbert van Rooij

Please do get in touch if you would like to organise a meeting or a workshop: +447518445493 or email painphysiolondon@gmail.com

 

Who should you see for chronic pain?

Richmond Stace | The Pain CoachLeave a comment

You have a choice but which is the right one?

The short answer to this question is a clinician who truly understands pain. Such a clinician will work together with the person in a way that is solution focused and inspires change in a desired direction.

Many people will go to their doctor, so they immediately enter the medical model. Informed doctors will help the person understand their pain from the outset and initiate self-coaching practices. Others prescribe pain killers or anti-inflammatories, they may refer for investigations and could provide a tissue based explanation, thereby entrenching the biomedical thinking from the outset. Most of us have been brought up with this model so it is implicit. Our deepest beliefs about pain and injury tap into this because it is what we ‘know’ despite the fact it is actually wrong. Pain and injury are neither the same nor are they synonymous.

“Pain and injury are not the same and they are poorly related

Of course the same can be said for other clinicians and therapists who base their thinking on the biomedical model. Even those who claim to be ‘biopsychosocial’ will maintain a focus on the bio, perhaps with some psycho and rarely any socio. Pain as a public health issue necessitates that this be turned on its head. When a person is in pain, they don’t need to think about chemicals in their body or what their brain is doing. Instead they need a practice that they can use then and there to change their current course.

Is there an ideal clinician or therapist?

You may be surprised to know (or maybe not!) that pain education for healthcare professionals is minimal and falls short of the need. Those interested in pain may follow a further course of study such as the syllabus described by the International Association for the Study of Pain. Others may be examined upon the dimensions of pain, how they interrelate and their emergence in the person as a lived experience. Modern pain education requires input from the fields of neuroscience, cognitive science, studies of consciousness and philosophy as a bare minimum.

Briggs et al. (2015) looked at undergraduate pain education and concluded:

‘Documented pain teaching in many European medical schools falls far short of what might be expected given the prevalence and public health burden of pain’. 

understand pain to change pain

What do we need?

Society needs dedicated clinicians for pain who can incorporate all dimensions of pain and how they blend in the context of the person and his or her life. Each moment is made up of cognition, action and perception within a sociocultural background and on the end of a lifetime of prior experience and learning. The clinician must understand that pain is part of such a moment and be able to lever the opportunity and potential that each person holds. In understanding pain, they know that the person can be successful in changing their life.

In essence when a person seeks help with their pain, they want change. No longer are they satisfied to maintain their current existence. They have decided to change and want to know how. Existing disempowering beliefs have thus far been in the way of successful change — e.g./ pain = damage; fear of pain; fear of change; fear of failure. These beliefs can be far reaching and deep, having existed since childhood. Each person also has empowering beliefs that can be used with their individual strengths, building their potency with practices, much like building muscle. We change by design, but often need the know-how. This is where coaching is a powerful approach. The person with chronic pain needs coaching to reach their potential.

“let’s focus on what you want and what you CAN do

The Pain Coach Programme focuses on the individual achieving results and success. With the foundation of understanding pain in place, the person can learn and develop practices that foster health and well-being whilst other practices maintain the course towards a desired outcome: what do I want in life?

When we need help in life we turn to a trusted advisor who can give us what we need to change our circumstances. The challenge of pain is no different. Only the individual can decide to take action, and it is the action that leads to results. However, he or she needs a clear vision of what they want, new understanding, actions to take and the know-how or practical knowledge of how to apply new thinking and skills. This is why coaching is ideal because it provides just that.

For more information on workshops and Pain Coaching:

UP | understand pain workshops

Pain Coach Programme for complex and chronic pain

Pain Coach 1:1 Mentoring for Clinicians

 

 

We need a new pain definition

Richmond Stace | The Pain CoachLeave a comment

What should the definition consider?

Marsaxlokk market with traditional Luzzu fishing boats

Tomorrow I head off to Malta for the Societal Impact of Pain Conference 2017. The areas that will be discussed include:

  1. Pain as a quality indicator for health systems
  2. Building platforms to address the societal impact of pain
  3. Impact of pain on labour and employment
  4. Challenges, models and lighthouses in pain policy
  5. Evolving concepts in the definition of chronic pain: a dynamic process

Overarching the meeting is the multi-stakeholder platform (SiP) that is described on the website as:

The “Societal Impact of Pain” (SIP) is an international platform created in 2009 as a joint initiative of European Pain Federation EFIC® and the pharmaceutical Grünenthal GmbH and aims for

  • raising awareness of the relevance of the impact that pain has on our societies, health and economic systems
  • exchanging information and sharing best-practices across all member states of the European Union
  • developing and fostering European-wide policy strategies & activities for an improved pain care in Europe (Pain Policy).

The platform provides opportunities for discussion for health care professionals, pain advocacy groups, politicians, insurances, representatives of health authorities, regulators and budget holders.

The scientific framework of the SIP platform is under the responsibility of the European Pain Federation EFIC®. Co-operation partners for SIP 2017 are Pain Alliance Europe and Active Citizenship Network. The SIP 2017 symposium is co-hosted by the Malta Health Network and the No Pain Foundation. The pharmaceutical company Grünenthal GmbH is responsible for funding and non-financial support. SIP 2017 is made possible with the financial support of the Ministry for Finance in Malta.

There are some very important conversations that need to be had, and these must then be translated into positive work. I am absolutely focused on the positive work aspect because we need change, society needs change and we need results. I believe that this is achievable. Of course with all this talk of pain, the question is whether we are talking about the same thing?

The IASP definition of pain:

“an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

This was published in 1979 and based on work from 1964 by Harold Merskey. Perhaps it is time for an update! The IASP definition certainly captures some of the features but there is one major bit missing as far as I am concerned. The person.

Pain is a whole person experience. Regular readers will have an understanding of pain now, and the fact that pain is not grounded in any structure or pathology (the biomedical model). Instead, pain is part of a whole person state of protection when there is a perceived threat. The key word is perception and much of perception involves biology in the dark and the hidden causes of sensory events; i.e./ we are aware of certain expectations with regards to pain, but most of the biology is going on without our conscious knowing.

A person suffering chronic pain spends a significant amount of time in a state of protect, much by habit. The range of contexts within which the experience emerges in the person widens as threatening situations are increasingly interpreted (biologically and consciously via habits of thought) as threatening.

I would encourage people to think about a definition of pain encompassing these key features:

  • the whole person
  • perception
  • threat

This would be a good start point. From there we can consider the sense of self and how our understanding of this contributes to the experience of pain. I love the notion of ‘expecting yourself’ as put forward by Prof Andy Clark, a leading philosopher who’s work I think will impact enormously on our thinking about pain, together with Dr Mick Thacker and others who are leading the way.

Exciting times and exciting times ahead. There is MUCH hope now and so there should be. This thinking needs to pervade society and this is the purpose of UP, to deliver the right messages and to deliver solutions with results. Positive work to be done!

RS

Pain Coach Workshop for GPs

Richmond Stace | The Pain CoachLeave a comment

Why should GPs understand pain?

Audience Applaud Clapping Happines Appreciation Training Concept

Sat 3rd June Education Morning at New Malden Diagnostics Centre

~ Do you understand pain?

Can you confidently answer these questions:

  • what is pain?
  • what do we currently know about the causes of pain?
  • what can the person in pain do to overcome their pain?

Pain is one of the commonest reasons to seek help. And we are not only talking about back pain or neck pain, instead thinking about all the circumstances and conditions that feature pain. Digging deeper, whilst the pain is unpleasant by its very nature, it is the suffering that drives the act of going to the doctor. We can even take this a stage further and suggest that the causes of suffering result in consulting with the GP. For example, the person who cannot work, cannot play with their children, cannot play sports etc. It appears as if life’s choices have disappeared. By definition, suffering refers to the loss of sense of self, and indeed the person with persistent or chronic pain can feel such loss.

The existing understanding of pain has taken us a long way away from the biomedical model. The biopsychosocial model has gained some traction but the predominant approach continues to be driven by the search for an injury, a pathology or a structural explanation. For many years it has been known that pain and injury are not synonymous ~ the famous paper by Pat Wall was published in 1979:

“The period after injury is divided into the immediate, acute and chronic stages. In each stage it is shown that pain has only a weak connection to injury but a strong connection to the body state.”

Pain features when we are in a state of protect in the face of a perceived threat. The intensity of the pain relates to this state and not to the extent of tissue damage. Pain and injury are fundamentally different and hence any explanation or treatment for pain based upon the thinking that a ‘structure’ or biomechanics is to blame is at odds with our understanding of pain. In fact, it is this misunderstanding that contributes significantly to chronic pain being the number one global health burden. This can and must change, which is the raison d’être for UP | understand pain.

~ understand pain to change pain

This being the case, this workshop will be a brief look at this enormous societal issue, a public health concern of vast importance considering the massive costs and immeasurable suffering. Not only will we review current thinking and understanding, we will consider the role of the GP and practices that can be readily used.

  • understand pain yourself
  • know your role
  • how can you help the person understand their pain?
  • setting the person on the right course: what is their vision of success?
  • practices you can choose to use in clinic

This overview is based on the Pain Coach Programme. The programme delivers results for people who make the decision to commit to practices that bring about change in a desired direction. They understand that we are designed to change and that we have great potential to be harnessed and used to overcome pain and live a meaningful life.

1:1 Pain Coach Mentoring: for clinicians who choose to pursue understanding pain to a greater level together with the practice of Pain Coaching.

RS

Sense of self Conference

Richmond Stace | The Pain CoachLeave a comment

Who am I? 


For the next couple of days I will be immersed in conversations about the sense of self and consciousness ~ see here. This is becoming a bit of a ‘buzz’ area, and rightly so. This is something we need to really understand and draw into healthcare. We are, or should be, treating people and their unique lived experiences. The predominant thinking remains dualist and is condition-focused rather than viewing a whole person, their life, their prior experiences, their beliefs and how this informs ‘now’. 

Two of the best examples of conscious experiences are love and pain. In the moment of the phenomena, both absolutely dominate the ‘self’, the ‘me’. But what is the self? Some argue that the self does not exist. It is an illusion. I have some sympathy with this view because to answer the question of self, we must know where it exist ~ where is my ‘self’? And with different ‘selfs’, to which are we referring: physical self? Narrative self? Where is the ‘I’? It encompasses the whole person, but is this ‘I’ the same one that other’s experience? Whatever I consider to be my ‘self’ may not be the same that others perceive. 

“Where is your ‘self’?

For some years I have supported an approach that addresses the person as much, if not more, than the condition. This means that together we consider the continuous story that results in the present moment and the context within which the person’s pain exists. The person describes their pain but digging deeper reveals the suffering they endure, and the two are different. Suffering emerges from a loss of sense of self. We even use the phrase ‘I don’t feel myself’ to describe this loss and then ‘I feel myself again’ when we are complete once more. Therefore I maintain that in treating the whole person, we are seeking to restore their sense of self according to their definition of ‘me’. 

Treating a person so that they may feel a sense of complete self requires us to look at their unique causes of suffering. We can then design a bespoke programme that addresses the existing patterns by creating a new pathway, carving a way onward with new habits. A focus on what the person wants, their clarified vision of success, is vital as this provides a direction and reference point: am I thinking and acting in line with this picture? The decision to commit to this journey then becomes the day to day, moment to moment practices. 

The ‘I’ reference in a particular context is what we are treating. Gaining greater insight into this sense of self will help us to sharpen our messages (explanations) and tools. Together with our ever-increasing knowledge of pain, this becomes a potent force. We seek to deliver results by providing the means to carve that new pathway forward: both the tools and the know-how. This is the essence of Pain Coaching that taps into an individual’s vast potential to get better and live meaningfully, leaving behind concept of coping and management. This is about living well because we can by making certain choices. Pain Coach presents these choices to the person. 

The Sense of Self conference will enlighten this whole person approach. I look forward to bringing you cutting edge thinking and how we can use it to continue our pioneering work to change the way society thinks about and addresses pain. 

RS

UP and running again

Richmond Stace | The Pain CoachLeave a comment

A journey of courage

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The London Marathon now in the past, we are focusing on the next run, The Royal Parks 1/2 Marathon in October. The details of the projects being co-supported with UP will be released soon, however we have two participants bravely embarking on the training journey. This is very exciting, but above all, full of meaning as they face the challenge of getting fit to run 13.1 miles. I know that they will do their best and we will be fully supporting them with a training programme and lots of positive encouragement.

Having just done the marathon for the first time, I know what it feels like to be thinking about running for long periods. However, the reality is never as bad as the thought, like most things. The actual run on the day is the icing on the cake, whereas doing one’s best along the way is success. This is a test. A test of oneself. And this is why it is such an incredible learning opportunity and a way to boost self-belief whilst improving physical health.

I will be documenting these two runners’ journeys and hopefully they will be writing their own blog entries. Sharing stories like this is inspiring to us all. We love to hear about and feel motivated by others’ achievements. They have achieved already by signing up. Now they can clarify their picture of success and think about what that looks like as they begin their experience!

RS

 

Compassionate abiding

Richmond Stace | The Pain Coach1 Comment

A way to approach unwanted feelings by Pema Chödrön

Man and woman holding hands at a table

Pema Chödrön writes with deep compassion about the challenges we face in the modern world. Pema and Thich Nhat Hanh are two of my favourite reads, as they bring the philosophy of Buddhism to the people in a practical way. The practices do not need to be considered spiritual, instead ways to gain insight, patience and build compassion toward ourselves and the world. They offer a great deal more than that too!

My Pain Coach Programme is a range of simple and practical skills that you use to overcome your pain and live your life meaningfully. These skills are based on understanding your pain, the key foundation from where new healthy habits emerge. Here is a wonderful practice from Pema, compassionate abiding, which is a way to bring warmness to your feelings of discomfort. We all experience uncomfortable emotions and feelings, yet we are rarely trained how to face them, instead encouraged to avoid them. These feelings are a NORMAL part of life and hence unavoidable. Therefore, having the skill to be open to these feelings is a way to ease suffering.

In relation to pain, we have many associated feelings and emotions that increase suffering. There is the pain itself and then the suffering we live from the way we think about it. When you realise that you have a choice, it is hugely empowering. ‘How am I choosing to think about this pain?’ is the question to pose to self. As you step back from being embroiled, you gain insight and actualise the opportunity to make a choice to think differently and feel better. This is why it is so important to understand pain. To understand pain is to know that you are safe and free to make choices, and to live.

The practice

When you realise that you are hooked, which is that familiar feeling you have when a habit is about to arise, you use this practice. We all have many hooks that lead to the unpleasant or unwanted emotions and feelings, from seeing that the loo seat is up to the way a partner says something, from Monday morning blues to the craving for a cigarette. Other examples include addictions, phobias, fears, prejudice, shame, and rage

The embodied feeling emerges often with a familiar inner dialogue. However, we can choose to write a new script, a positive script. Interestingly, our self-confidence is determined by what we are telling ourselves and listening to (these are different) in this moment ~ watch here. Remember though, it is normal to feel the range of emotions. We need them all, even if we don’t enjoy some of them. No-one ever said life was wholly enjoyable!

In 2 parts

Breathing in

Being in touch with and open to the feeling of being hooked, breathe in deeply, allowing the feeling to really be there. Allow the feeling to exist. We can be tempted or in the habit of pushing away. You will be aware of the urges and discomfort, and that is normal. You can be ok, you can be comfortable with being uncomfortable. You abide with the feeling.

Breathing out

As you breathe out, you ease the tension that is part of and surrounding the discomfort. The out-breathe frees us from this tension as the space in which the embodied feeling exists becomes apparent.

When to practice

There is no limit to how much you can practice. I think a useful start point is to sit somewhere familiar and practice for a few moments and over time gradually increase the length, or blend with other mindful practices. Of course, drip-feeding our selves through the day, so little and often, has a really beneficial effect because we form a healthy habit. We can also practice as we become aware of the feelings of discomfort as they arise, touching the experience with our own natural warmth and compassion. You will notice how your typical reaction softens.

We are not pushing the feeling away. Instead we are fully there and present as the feelings transform, as all feelings, thoughts and emotions do. Nothing is permanent. No matter how ‘bad’ you are feeling right now, it will change because we change, every moment, like the water of a river that continues to pass by. This fact and the science of pain that gives us a new understanding of our potential, gives great hope and reason to be optimistic. Be inspired to live well, because we can.

A life of appointments

Richmond Stace | The Pain CoachLeave a comment

When life is dominated by the next appointment


Most people I see have a long story of pain. Frequently there has been years of suffering that has and does impact upon their life.  For some their days are strung together by appointment after appointment as they search for an answer to their pain. The key that unlocks that door is understanding pain. To understand pain is to know what you can do to move onward in a chosen direction. Undoubtedly, we can be successful in overcoming pain because it can and does change. We are constantly changing, like the water of a river, there is constant movement in one direction. Embracing and harnessing our potential enables us to live a meaningful life.

Whilst seeking an answer, there are always boundless doctors and therapists who offer solutions. Skipping the understanding bit and hastening to a remedy or treatment is often the way, yet the foundation is not in place. We must understand our pain to gain a sense of meaning, to know that we need not fear pain and instead to focus on certain practices and skills to enable change.

Expectations are typically low in chronic pain, which affect outcomes. The promise of success followed by yet another failure hits hard. Some people even blame themselves as the self-critic chips in. Developing self-compassion is a key skill as we learn to be patient with ourselves, let go of blame and focus on living well. To be harsh towards oneself is to provoke the same biological protection as when we feel pain. Of course our expectations are based on what we know, past experience and in the moment adjudication of the likelihood the treatment will work (based on what we already know again). In essence it is a prediction as is our current perception. The wonderful thing about being human is that we can change the prediction and infer something else. It is time to expect to get better. To expect that life will be full of challenges, but to expect to face them, learn and move on in a meaningful way. This starts with understanding pain.

One of the issues with on-going appointments is that the person maintains their focus on pain in their life. There is plenty more to define the person than their pain. What we focus upon we get more of, is a loose rule. If pain becomes dominant and rents much space in our conscious capacity, then there is little room for anything else. We must make space and while we are attending appointment after appointment, no space is being carved out. But I need the appointment because I must check and see if I have…….. etc, you may say. It is true that we must elimate any serious pathology or injury that necessitates repair, but beyond that, if the focus is upon living well and practicing such skills, then getting better is possible. The roundabout of consulting rooms is not.

~ pain and injury are not synonymous 

Regular readers know that pain and injury are not synonymous. They are different. And they are poorly related. We have known that for years yet the modern approach persists in a search for a structure or pathology to explain pain. There is no such thing as pain is a body, or whole person state. Like fear, like love, like hunger. You can see none of these because they are lived phenomena, experienced by a person and embodied by a person. A herniated disc, a disc bulge, an inflamed tendon, none are pain. Pain is a state of protect that emerges in the person in the face of perceived threat. Yes, these visible changes can co-exist with pain, of course. But they are not pain and not the cause of pain. The cause of pain is a perceived threat. It is how we and our body systems (they are not separate) interpret what is going on in our body but within the context of this moment (emotional state, environment, who we are with, what we are doing, prior events etc) that determines whether we feel pain or not. You will note from this description all the opportunities we have to change pain, because pain is part of me as much as my ears or my hair so it is mine to change. The change begins with understanding pain.

So, once you have seen the relevant specialists and determined that there is no serious pathology or injury that needs repair, and it has been confirmed that this is a problem of pain, then you can focus on getting better. This is through the practice of the skills of well-being whilst maintaining a course towards your picture of success, the healthy you with purpose.

Open space in your life to live well and be inspired to reach your potential, because you can.

RS ~

We are more than a brain

Richmond Stace | The Pain CoachLeave a comment

Brain On The Wall

Have we gone brain mad!

There was a great step forward when the brain was considered to be part of the pain experience. The recent popularisation was in part due to the work of Lorimer Moseley who has been researching pain and delivering insights that have definitely caused a shift in thinking. However, it was Pat Wall and Ron Melzack who were the original thinkers, inspiring work in the field of pain science and medicine, with their Gate Theory of Pain (1965).

Brain explanations have captured the popular media as the ‘neuro’ tag is shunted onto the front of words to add scientific validation. We must always check to see if the claims are truly grounded in neuroscience of course. As much as we have people writing and blogging about how science pans out in real life, there are those who sift through the literature and comment critically. We are thankful for the latter as society is regularly hit with breakthrough claims that are sensationalised. How often do we then find out that these claims are unsubstantiated or they quietly go away?

When discussing pain, and this is a complex area, the brain is rightly included. The brain is certainly involved in any conscious experience as best we know, but we are more than a brain. Pain illustrates this well. However, we commonly hear experts talk about pain in the brain, or that we feel pain in the brain. This is not true.

If I am hammering and I accidentally rap the end of my finger instead of the nail, it is very likely to hurt. The pain that I feel will depend upon context. If there is someone else present and watching me, I will have a different experience compared to if I were alone. I may wish to show that I am ‘hard’ and brush it off whilst feeling the intense pain localised deep in my digit. Being alone, I may shout out and wave my hand around, grip the finger with my other hand and ask myself why I am doing this job anyway. There are many possibilities and many different influences upon that pain experience in that moment. This involves the brain, and if I happened to be wearing a portable functional brain scanner (that does not yet exist), you would be able to see activity in certain parts of the brain. These areas are not specific to pain.

There are no pain signals, pain centres in the brain, pain messages, pain nerves or anything else specific to pain. Pain is a ‘body state’ according to Wall (1979), and one that sets us up to heal and get better through motivation. We are motivated or compelled to take action. The relationship between pain and injury is poor and often non-existent, especially in chronic pain states. Pain is about protection and survival.

~ pain and injury are poorly related

Back to my finger. The message that the pain is in my brain is still out there in society. I have just hit my finger. Where do I feel it? Where is my brain? Can I feel the pain there, in my brain? Or do I feel it in my finger?

Pain emerges in the person (Thacker, personal communication) and we feel it in an area of the body deemed in need of protection. Even just in case, which is likely to be the reason for much chronic pain. The body systems that protect continue to do so in accordance with a range of influences and situations, in particular contexts. This is predicted to be ‘dangerous’ or threatening to the (whole) person and hence we experience the phenomena of protection, i.e. pain. Pain is allocated a location in the body where we feel it. The brain is involved in this projection and hence strategies and practices that target known brain mechanisms are to be encouraged. But we also need to address where it hurts and the local tissues and associated areas that adapt to the protect state.

It is the person who suffers pain, not the brain. It is a body area where we feel pain, not in the brain. The brain is involved but we do not feel things in there. Even in phantom limb pain when there is no body part, the sensation and experience of pain is felt in that space. Tissue state and existence has a minimal role, and less so as pain persists. It is about the interpretation and prediction of what the sensory information means based upon prior knowledge that determines our conscious experience.

In our drive to change the way society thinks about pain, this is one of our messages:

Pain is about the person. Let’s treat the person because when the person feels better, the pain feels better. We can change pain. We can live a meaningful life.

RS