The end of a successful roadshow: Neil Wright (TensCare), Juan Schaerer (Adcock Ingram), me, Nick
I was very pleased to be asked to speak at the Adcock Ingram Sports Science & Rehabilitation division launch roadshow — a whistle-stop tour of South Africa.
Innovative TensCare CEO Neil Wright asked me whether I would give a series of talks in South Africa (Johannesburg, Durban and Cape Town). He had heard that I bring an ‘edge’ to the topic of pain. I like to think so, but only in terms of challenging out-dated thinking that holds us back. What a great opportunity, I thought. A chance to spread important messages via Understand Pain (UP) and to learn about how chronic and complex pain is addressed in South Africa.
The new Adcock Ingram division was being launched to local physiotherapists, chiropractors and biokineticists, and the theme of the events was pain. How could I resist? Adcock Ingram are engaging with therapists and clinicians in a new way that is generating a great deal of excitement. This is based on creating great relationships and distributing high quality products that compliment rehabilitation, including the range of devices from TensCare.
Both the team putting on the roadshow and the attendees were buzzing! The feedback from the people in the audience was very positive. There was a thirst for quality pain education, and it would be great to follow up with full Pain Coach workshops.
Johannesburg audience
TensCare and TENS
TensCare is an employee owned company, distributing TENS and electrotherapy machines all over the world. One of the main reasons to use TENS is for pain relief, in both acute and chronic pain. It is probably best known and most used in maternity care.
In my experience, TENS is under-used for chronic pain. Whilst TENS will not solve the problem, it can offer relief that helps the journey forwards. As an inexpensive and simple form of self-treatment, it is a good option. The key is that the user understands how it works and how to best use the unit. This can take some time and practice, but with instruction, discovering the right parameters can be found more swiftly.
Nick & Richmond selfie in Durban
I shared the stage with Nick Martichenko from Canada. Nick spoke about the use of tape and the understood mechanisms, whilst I focused on pain and pain coaching. I entitled the session ‘The Challenge of Pain’ as a doff of the hat to Pat Wall, the founder of modern pain biology, who wrote a book of that name. It was Wall’s work that resulted in the development of the TENS machine.
Three days, three events
On the road…
The roadshow put on by Adcock Ingram was very high quality from start to finish. They really wanted to make sure that every detail was covered. This was appreciated by the attendees who were most enthusiastic about the event. There was a new precedent being set, and the beginning of a new engagement between Adcock Ingram and therapists/clinicians.
I was particularly impressed by the way that the sales team approached their work. Selected and led by Juan Schaerer and Sheila Keshav, this group has come together in a short period of time. There was a great deal of positivity within the team, supporting each other, and getting jobs done from start to finish. I was privileged to be able to hear some the individual stories about how they came to join the team.
Cape Town Team
From a pain education perspective the roadshow was a great opportunity to talk about ways in which we can help people understand their pain and move on to improve their lives. That’s the purpose of UP. I hope that everyone else enjoyed their time as much I did. This was a super start and I will be very interested to learn how this story unfolds.
After a few months of planning, the Pain Coaching Project started today. This is a really exciting time for Understand Pain (UP) and we are thrilled to be able to offer free sessions to people suffering the symptoms and pain of osteoarthritis (OA).
Pain Coaching focuses on the person, their strengths and their potential to improve their life. This comes in many forms as each person will have their own picture(s) of success. For some it will be an increase in walking, whilst for others it maybe to be able to socialise and feel more connected. We all have our ‘thing’. The aim of the programme is to give you knowledge, tools and practices to improve your life.
Starting with a conversation about you, your life and what you want to achieve, we then move into the practical sessions. There are many practices and tools to use, so we choose those most relevant to you. For example, we look at ways to mobilise your body and improve your quality of movement, breathing, planning your days, organising activities, relaxing deeply, building fitness, mindfulness, improving strength and confidence to be active.
If you would like to take advantage of the Pain Coaching Project and see how you can improve your life, book your place now by emailing here, and putting OA in the subject line.
A new project for UP: FREE Pain Coaching for people suffering pain from osteoarthritis
Osteoarthritis is a leading cause of pain and disability, estimated to affect 8.5 million people in the UK. This being the case, UP is offering a free Pain Coaching programme for sufferers.
In a project supported by GSK, you will receive 4 Pain Coaching sessions with Richmond Stace, co-founder of Understand Pain (UP) and pioneer of Pain Coaching. This can be face to face if you are able to attend one of the clinics, or Skype/Zoom if you live afar (UK or abroad). There will also be some small group sessions with 4-5 people).
The aim of both Pain Coaching and this project is to help you understand your pain and give you tools and practices to improve your life.
We are also studying key moments in the coaching conversations and will be voice recording the sessions to create transcripts. These will be anonymous and securely saved according to GDPR regulations.
Pain Coaching is a blend of strengths-based coaching and pain neuroscience. Results-focused, we work together to clarify your picture of success and then design the steps in that direction. The steps consist of a range of ways to overcome pain and live your best life. This is a continuous process meaning that once you have the knowledge and skills, you are able to build momentum and seek sustained improvements.
Coaching is increasingly being used in the NHS as it is the primary way we can encourage effective self-care and independence. Strengths-based coaching has been pioneered by Mike Pegg. Mike sums up strengths-based coaching as a means of ‘…how we can encourage people during our time on the planet. It looks at how we can help people to build on their strengths and achieve their picture of success’. This approach is one of the predominant forms of coaching that we see in successful business organisations and sport.
Getting the best of you so you can live your best life
Key features
Free Pain Coaching sessions for OA pain
1:1 (in person or Skype/Zoom) or small group
Understand your pain and symptoms
Learn tools and practices to improve your life
Build momentum for sustained improvement
Next steps…
Start your Pain Coaching today by visiting the Project page and arrange your first session.
Yesterday morning I set off to conquer the 12 summits of London, inspired by The Guardian’s running blog by Jonny Muir. It was #upandrun number 11 kicking off 2020 with a run around the capital, which offers so much of interest, best seen on foot.
#upandrun is the running project from Understand Pain, raising awareness of the problem of pain in society, and what we can do to make a difference
We know that London is diverse. Yet it is only by passing through multiple boroughs that we can actually witness and feel this diversity. On the way round I encountered wailing ambulances, dogs, kids on bikes, a drone, pushchairs, cars, boats, cats and more. I ran along streets and paths bordered by terraced housing, mansions, premises boarded up, high rise blocks, walls, fences, the Thames, industrial units, skyscrapers, canals, woods, shops, and parks. Whilst much can seem unremarkable because we see it each day, it is in fact quite remarkable how this all works. A living city.
The summits:
Putney Heath, Wandsworth
Westow Hill, Lambeth
Sydenham Hill, Lambeth
Sydenham Hill, Southwark
Shooters Hill, Greenwich (Eaglesfield Recreation Park)
Bethnal Green, Tower Hamlets
Seven Sisters Road, Hackney
Highgate Hill, Islington
Spaniards Road, Camden
Park Road, Westminster
Harrow Road, Kensington and Chelsea
Harrow Road, Hammersmith and Fulham
The route was 80k. Here are some of the highlights in pictures.
Greenwich foot tunnelThe City from Greenwich ParkThe City from Sydenham HillStephen Lawrence memorialLondon lights from Hampstead
What is lined up for 2020?
#upandrun will continue with monthly ultramarathons — you are welcome to join me for a leg; get in touch.
Understand Pain has a new exciting project starting imminently. The focus is upon helping people suffering pain associated with osteoarthritis (OA), to improve their lives . Supported by GSK, I will be delivering Pain Coaching in small group workshops and 1:1 sessions (face to face and Skype). Information about how to sign up will be posted soon, so keep an eye out if you are interested. This is a free service delivered by myself, Richmond Stace, pioneer of Pain Coaching.
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.
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.
Your process
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.
#upandrun project >> ultrarunning + UP workshops to help people understand pain and move on to a fulfilling 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.
Summing up
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.
For more information about Pain Coach Mentoring for you or your practice and Understand Pain Workshops for people suffering pain, contact us here >> richmond@specialistpainphysio.com
As the UP story gathers momentum, in particular the #upandrun project (ultrarunning, marathon running and the UP education programme), we are delighted to welcome two new UP ambassadors: Chris and Jeff. Both will be running for #upandrun so keep an eye out for blogs, pictures and always the hashtag!
If you see #upandrun hashtag, give us a shout out! Take a pic and post it on Twitter or Instagram.
Chronic pain affects so many people for so many reasons. The measure of our success will be how many people we can inspire to move on to live their best lives.
This week look out for…
Richmond running along the Thames Path tomorrow (Thursday) from Hampton Court to the Thames Barrier
Next week look out for…
The UP talk and workshop on Weds 3rd July at 2pm at The Groves Medical Centre. Get your place here >> tickets
It’s been a great weekend in Brighton, but now it’s straight back into training to be ready for the Isle of Wight Challenge at the start of May. That means a 20k trot today.
The route yesterday was lined with supporters giving enthusiastic encouragement. Some of the stretches were long and straight, meaning that as you were running, you could see the sea of bobbing heads stretched out in front for some distance. Coming back from the power station to Madeira Drive, the 360 and the pier were landmarks. With the wind blowing at you, they seemed so far away!
The final stretch to the finish line is an incredible moment. The crowd are going absolutely crazy and because you are stretched out, it feels like you are the only runner. Suddenly you’re filled with energy and find yourself sprinting (it feels like sprinting…) to the line. Awesome!
So now onto a longer run that is a totally different experience. My preference is off road, trailing running so although this is 53k x 2 (Sat/Sun), for me there’s no sense of needing to hit a pace. Instead it is about enjoying the ride, meeting others who are in for the long haul and marvelling at the scenery of the island’s coastal path.
As ever, this is for UP, so do follow us with the #upandrun as we seek to raise the awareness of the problem of pain, especially chronic pain, and what we can do as a society to ease suffering.
There is no quick fix for persistent (chronic) pain, but you can understand your pain and move on to a fulfilling life
In a world where we have become accustomed to immediate gratification, the really important things take time and effort. For example, relationships, work satisfaction and wellness. There’s no quick fix for any of these, and the same goes for pain. All require understanding, a picture of success that you work towards each day by taking positive steps. This is normal.
People often ask if they can get better. I say yes. We can always improve and get better. What does this mean? It’s individual of course, but in essence it means that the person feels liberated from their suffering and is able to live a fulfilling life. Do they still experience pain? Probably. But there’s a big difference.
A suffering society ~ time for change
Pain is part of the way we protect ourselves and survive. It is normal and necessary. Yet why do so many people continue to experience pain when there is no immediate threat or danger? Similarly, why do people who suffer PTSD continue to suffer repeated episodes? Why do people with anxiety disorders feel anxious when nothing is actually happening? Why do people feel depressed when there is joy all around? Hopefully you can see the similarity in the patterns here. The words are interchangeable and the suffering immense. This can and must change, and driving this change is the purpose of Understand Pain.
The answers to these questions lie in the way we live and the way society has evolved and is working. This is why a social shift is necessary as we develop a new level of consciousness, understanding the causes of suffering so that we can focus on building wellness.
The difference is the impact factor. The inner disturbance lessens, life fills with meaning and great states more often as the person pursues a purpose and reconnects with people and the planet. We only have a limited capacity for awareness, so when we fill this with people who inspire us, support and love us, when we share and give, when we get outside into nature and feel that we are contributing to something greater than ourselves, life transforms.
There is no super-highway. To achieve a better life requires us to know what that life would look like and take steps in that direction each day. We need a clear direction and tools and practices to use to keep us motivated, orientated and an awareness of the achievements along the way.
We are designed to change — life would not be possible without change. Embracing this natural development, we can learn to create the conditions for moving on, whatever our start point. We continually ask questions of ourselves and the answers determine the quality of our lives via the answers and what we focus upon and decide to do. So asking the right questions is key. Here are some examples >> What CAN I do? How can I build my energy? How can I best look after myself? What steps can I take today towards my picture of success? What can we do together to move forwards? What is the best decision now? And now? Whatever you ask, you will answer.
Suffering chronic pain, you are likely to need support, help and encouragement with practical advice about what you must do each day. Pills do not provide this, nor any other form of quick fix. We are encouraged to push down emotions, distract and turn away yet it is by facing our ‘stuff’ and all the reasons in our life why we continue to suffer. This takes courage but it is the way to transform our lives. And we all want the best life we can create.
Sanjay is a superb example of someone who did exactly this, moving on to a meaningful, fulfilling, challenging, scary, exciting project, Pursu. I would encourage you to read his story on the Pursu website as he has created both an incredible product but more so is the meaning behind it and what he is doing to contribute to society. And this from a story of pain: Sanjay’s story
On May 22nd I will be talking about this and more, giving practical tips and knowledge about pain to help people gain insight and move on. This is free and you can get tickets here
Pain can be thought of as a need state like hunger or thirst. Similarly, emotions are considered to be indicative of our inner physiology that guide as towards a range of actions to make sure that we maintain healthy parameters.
Pain is an experience unique to the person. It cannot be seen, it has no shape, colour or form. Pain is typically hard to describe although we have a large number of words that attempt to capture the feeling. Using the word itself tells us that the person is having or has had an experience of the sensation, yet it tells us nothing of the type of sensation. The particular qualities are always private and part of the inner world. Much like thirst. Try and describe the sensation of thirst…
What is a need state? This is when we become aware of a feeling, often closely associated with thoughts (the brain basis of thoughts and feelings co-exist, which makes sense), which has the purpose to motivate action. Our brains and its body systems need each other, and this is part of how we obtain what we need to survive. Our brains are only interested in survival, which is why many people suffer as a consequence of the lives we lead within the current society.
We are designed to look out for danger, and together with the ability to think back and ahead, we can perceive threat very easily. As we keep practicing this, we get very good at it! The consequences of worrying about things that usually don’t happen, or replaying past unpleasant events include all sorts of common ills. For example, chronic pain, IBS, headache, migraine, functional movement disorders, anxiety, depression, pelvic pain, skin disorders and autoimmune diseases. The reason is because we become ‘inflamed’ by the way we live, spend much time in a protect state and hence the healthy mode is quashed. We can change this as soon as we decide to improve our lives in a number of ways.
All of these feelings mentioned above are all signs. They create the opportunity to make changes, create new habits and build a better life. This makes sense because there are many ways we can now satisfy our wants, and indeed society encourages this everyday. You may want to buy things, accumulate stuff, eat junk food, drink alcohol, smoke cigarettes and more. Yet we do not need these things, which only bring very short term relief before the next urge.
Pain as a need state to be transformed requires facing the reasons why the person remains in pain. This can be challenging because we don’t usually like to deal with our ‘stuff’. Instead, it appears easier to take a pill or have an injection or something else that appears to be quick fix. However, none of these things truly transform suffering and liberate the individual. Medical care can contribute a little, but it is the work of the individual to understand their true needs and meet them each day that makes the difference. Pills do not teach you how to live well moment to moment. You must learn the skills of being well in your own way.
This is the purpose of The Pain Coach Programme. To deliver the insight to people so that they can understand their pain and move on to a fulfilling life. This is whether they are a struggling athlete who feels on-going pain, someone with a condition that features pain, a person who feels life has got on top of them and they hurt (and feel exhausted all the time), right across the ages and certainly spanning our society.
We must revise our thinking in society so that the suffering eases. That’s the purpose of Understand Pain (UP and why I am running (follow #upandrun on Twitter) many miles, writing these blogs and giving talks. We can do this together, so please share! All of what I write is based on the latest research and understanding of pain, so whilst it may sound different (and I hope it does), this is because we have been conditioned to believe something more simple. But the more simple version is not solving the problem. It is likely making out worse because people are continuing to rely on drugs and other means to get better, when they do not provide the answers. You do.
understand pain 