A new app from Sam Harris offers a simple way to integrate mindful practice into daily living. Harris is a well-known neuroscientist, thinker and writer. Recently, he published a book, ‘Waking Up’, with the same name as the app and his excellent podcast.
There are many mindfulness and meditation apps, so what makes this one different?
There are a number of features that I like about this app. At first glance, it is easy to use with two primary interventions: the daily mindfulness practices together with a series of short lessons. Understanding the practice of meditation and mindfulness is important. With the rise of popularity, the true purpose has been lost within promises of what the practices deliver to sell them as a commodity.
Each day a meditation practice is encouraged to build momentum. The bite-sized sessions are appealing because we all have 10 minutes we can dedicate to ourselves (in a kindly way). The meditations are simply numbered: day one, day two, day three etc. The first 3 come with the app, and as you progress, further practices are unlocked. I think this is rather motivating.
Learn to use your mind instead of your mind using you
Ajahn Brahm speaks about greeting mindful practice like an old friend across the street who you have not seen for years — that feeling. The daily practices being unique and building on the last creates a sense of learning, growing and development. The user is learning and becoming familiar with the way that his or her mind work. That is the essence of mindfulness. To know one’s mind is a valuable life skill; if not the most valuable.
To gain full access a subscription is necessary. This can be monthly (£7.49) or yearly (£55.99).
Harris’s approach is non-spiritual. Some people are concerned that to practice mindfulness is to take an alternative spiritual path. Whilst indeed many do practice as part of a spiritual journey or dimension to their life, this is not necessary. And you do not need to wear anything special either.
In the Pain Coach sessions we typically practice mindfulness to become familiar with the way your (embodied) mind works. We know that focus and attention can improve along with emotional flexibility. To this I would add the notion of ‘seeing things for what they really are’, or being in touch with reality. It is certainly not about relaxing or thinking happy thoughts or trying to achieve or fix something. It is about being and seeing, letting go and being open, curiosity and noticing.
Usually I will send a recording of the session to the person so that they can practice at home. However, there is immense value on having different quality resources, alternative angles and voices to which to listen. The Waking Up app is most definitely that, so if you like, give it a go.
Some reflections on the day of the Beachy Head Marathon; the experience, running and what’s next for #upandrun.
What an incredible day it was yesterday. Everything came together on the south coast to create the perfect backdrop for #upandrun at the Beachy Head Marathon and Beachy Head 10k.
Hats off to my wife Jo, who volunteered to run the hilly 10k course, for UP. Jo would tell you that she doesn’t really like running, however, she certainly experienced the runner’s high yesterday, feeling that unique sense of joy as you pass under the finish line.
This is a beautiful part of the UK, and the marathon opens the opportunity to get out there and experience the rolling hills, steep climbs and hugely encouraging Sussex people. In a way I could say that I ate my way around the course. I certainly had about six Mars bars amongst other fare to keep us going. And then there was the band!
Trail running is different to the typical road race. Most people are there to ‘enjoy’ themselves, take in the views, feel that sense of camaraderie and complete the course. The fuelling stations were most welcome — the smiling faces, hands holding out drink and boxes of chocolate, biscuits, bananas and of course, jelly babies.
The run is the main event, yet the conversations and comparing of notes before and after are all part of the fun. The smiles and nods, the acknowledgements of fellow participants and others all make it special. Into the night you could still see the glint of the swinging gongs, the badges of courage and completion.
Many run for causes — you know why we were running. Reading other’s shirts, some printed and some scrawled, ‘mum’ for example, it all provides the narrative. So many stories that make for the rich, shared experience.
The last section of the marathon was the most scenic. The Seven Sisters provided the view and the journey, up and down (breaks on!!).
The day’s many high points remain vividly in the memory. They will provide great boosters for future runs. The basis of using strengths-based coaching is to clarify what went well and how one can build on this moving forward. Preparation and planning the day certainly form strong building blocks: the building of tolerance with months of training, taking it easy the week before the day, eating well the night before and looking after one’s energy during the run.
‘Me, my legs and I’ was a draft blog that I was writing during the training for this marathon. It’s a lengthy and involved process, much like life. There are many analogies that one can draw from distance running, for life is an endurance event in itself. How we prepare, the approach we choose to take, how we bounce back, how we roll with life’s challenges, how we remain present and see reality, how we let go and how open we are to whatever is or may happen are all important factors that determine the quality of our life, and the run. Or vice versa.
I have a number of mantras that I have used to keep going, whether it be the run or life. Yesterday I didn’t need too many. It was just one of those days that it all worked. The sun, the view, the vibe, the support, having loved ones around, the Mars bars. But sometimes we need more. At one point I stuck on ‘Nothing but a good time’ by Poison. I ‘rocked’ up the hill!
And so to the end. I had a text from Jo, who had completed her run and was ecstatic. I called her up and we shared her joy — what a massive motivator it is to hear someone buzzing with such excitement! Before I knew it, I was coming towards the final descent, a steep one. Watch the steps, people yell as you come down the hill. The final boost was hearing my kids singing happy birthday over the loud speaker as I came along the final straight. They had the microphone! Awesome!
As the sun was setting over Eastbourne and Beachy Head, I felt that I had somehow ‘done’ the hills. Then I thought about it and realised that you never can. They are always there, despite some cracks and crumbling. You never beat the hill, just your own fears and worries.
Until next time.
And the next #upandrun challenge. Look out for the logo! And the Understand Pain Workshops — next one in Preston on Nov 3rd >>> free tickets here. Please do share this so we can have as many people attend as possible. The more sharing, the better!
Only a few days to go until the Beachy Head Marathon and 10K. Followers will know that we are running to raise awareness of the work of UP, Understand Pain. UP is the social enterprise dedicated to changing the way society thinks about pain to reduce the enormous burden of suffering.
There are a number of things to get right when running a marathon. Fortunately I have some solid advisors around me for training, kit and strategy. Then there is the question of fuel, both day to day, before and after longer runs and during the runs — I have just had to accept that those gels are vile to get down but serve a purpose…
I must admit, I have enjoyed the eating bit of the preparation as I did before the London Marathon in 2017. Flaxseed, porridge, nuts, greens, juices, beetroot (and beetroot shots), pasta, rice, cheese…. yum! Then there are the energy bars; and I really like these. So, I was delighted to accept sponsorship by Pursu Nutrition, and not just because I had sampled and loved the bars during the experimentation process.
There is a synergy between UP and Pursu that started with the creator, Sanjay, coming to see me about a common cycling pain problem (pudendal neuralgia) that is typically enduring and limiting — his story to follow. It was during our work together when he overcame his pain, that Pursu came into existence. We chatted a fair bit about the bars, but mainly about the purpose, the mission, the ‘why’, which always resonated with that of UP.
I was most excited to be given a box of bars by Sanjay. I am pleased to say that I have managed to keep enough for the day, for both Jo (my wife) and I (this time Jo volunteered to run the 10k whereas previously I persuaded her do run the Royal Parks 1/2 marathon, apparently…!). I admit that I did eat two on the way home.
The rolling hills of the South Downs await us. This week is a little like a phoney war as others who have tapered will know. The feeling that I should be doing something has to be overcome by simply resting, stretching, moving, a couple of light jogs and then stuffing our faces on Friday. Ha!
Look out for our posts. If I can take footage on the run I will, to share the experience! Please share and spread the word about our work. We have an UP Workshop on Nov 3rd in Preston that is free for people suffering pain (click here) and the UP Programme will be on the website very soon as a starter to be built upon — a range of tools and practices; knowledge, skills and know how to overcome pain.
What is to overcome pain? This means living your best life, considering your circumstances, building wellness and focusing on what you can do each day to achieve a picture of success. Pain is not permanent; we change. I want you to reach your potential and overcome pain by living, feeling inspired, enabled and in control.
A vital question is one that can make a significant difference to your understanding, your beliefs, your decisions and ultimately your actions. This affects your quality of life.
At the Understand Pain Workshop I encourage questions. The session is for the attendees to glean as much information and practical know-how as they can. So on being asked a classic pain question, the opportunity presented itself to nail one of the biggest misunderstandings.
Arguably the belief that pain is related to tissue state beyond any other association is the problem. On hearing about the latest knowledge about pain, the person can then find themselves in no man’s land. This is the intellectual point in time when you can be caught between two models, the old and the new. Which do you believe? The old often runs deep. It can feel really uncomfortable too. We are surrounded by the biomedical explanations in the media, with adverts, from those around us and healthcare providers.
So what was the vital question asked at the workshop? It was simply put: is this all in my head? The question came off the back of being presented with the latest thinking and science of pain — not that this is in, or should be considered to be exclusive. In other words, pain science is really a conglomeration of fields of study such as basic neuroscience, cognitive sciences, social psychology, consciousness science and perceptual studies to name but a few. As ever, for science to move forward, we need to ask great questions. This is where contemporary philosophy delivers with the likes of Andy Clarke and Jakob Hohwy amongst others.
To understand pain is to understand being human. Our strengths, our weaknesses, our biases, our attentional scatter, our changeable emotional states, our inability to suffer skilfully (due to society encouraging us to try to avoid something that is unavoidable) and our tendency to live by illusions of the mind instead of reality. Escaping from our bodies is something we learn early in life, as we climb into our minds to avoid turbulent emotions. Who ever gets taught how to face these challenging emotions? Society encourages the exact opposite. The short-term cover ups or fixes.
We will be sure to try to meet our needs for relief. We can do so in a healthy way or an unhealthy way. Lacking any tangible or obvious options, it is understandable why one would reach for something unhealthy: alcohol, cigarettes, drugs, sweet stuff, or another way of trying to feel better in that moment. The problem is that this does not last because the problem has not been addressed. Only by courageously facing and seeking to transform suffering do we experience sustained change in a desired direction.
There are a number of pain facts we can use to help people understand their experience. For example:
Pain and injury are poorly related
Pain is related to perception of threat
Several of the major influences upon a pain experience (and the actions you take) include emotional state and tiredness
Pain, as with any conscious experience, is the brain’s best guess
Pain is embodied
Pain is embedded in society
What you are focusing upon determines your quality of life
Looking at this list and more, and considering the position of the biomedical model that seeks damage or pathology to explain pain, the gap becomes apparent. Whilst the biomedical model plays a role in identifying such damage and pathology to determine whether a surgical or medical approach is necessary, it does not provide answers to why pain experiences vary so much.
How is it that a paper cut can be so painful? Why can we feel pain in fresh air in the case of phantom limb pain? How does someone run on a broken ankle? How can someone be impaled yet feel no pain? And so on. One simple way to consider pain and injury is by the fact that the former is subjective and cannot be seen, whereas the latter is objective and is usually identifiable. The way that the injury, pathology or lack of observable damage is experienced will depend on context, existing biological state, prior experience, the impact in terms of perceived limitations, expectations, and beliefs about pain and injury. There’s a lot more, but this covers a good amount of ground for now.
Pat Wall (one of the forefathers of modern pain medicine and science) in 1979 and John Loeser (the originator of the biopsychosocial model) in 1982 both described the lack of relationship between pain and injury, so this is not new thinking. It is simply that society has gone with another, simpler and if I am cynical, financially convenient explanation(for many stakeholders — those that treat using the biomedical model & pharmacological companies). Loeser said:
“Physicians and patients usually harbor a concept of pain that involves a linkage between body damage and the pain reported by the patient. This is an inadequate concept that leads both physicians and their patients into unnecessary difficulties in the management of chronic pain.”
On being presented with the seemingly new thinking about pain, some people then make the assumption that the clinician is suggesting it is somehow in their mind or their head. On doing so, they have missed a couple of key points: pain is always embodied and pain is whole person.
Pain is always embodied
Pain can only be experienced in the body, or where the body should exist (and a representation continues to exists in the nervous system) in the case of phantom limb pain. Pain involves the brain, our thinking, our emotions and hence our mind, but it is always felt in the body. It is never imaginary, and anyone who suggests that this is the case does not understand pain.
Pain is whole person
It is the whole person who feels pain, not the body part. If my knee hurts, my knee does not go off to seek help, I do. Much like if I am thirsty, my mouth does not go to get a drink, I do.
Considering that it is the whole person, it follows that how they are in any given moment will impact upon how they experience pain and the choices that they make to relieve their pain. This is why it is vital to treat the person, and not the body part or simply a condition. Oliver Sacks, the great neurologist and writer, said this from the outset. Many other great physicians and clinicians have agreed and achieved results as a consequence. I live by this notion, knowing that to focus on the person and their needs is the way forward. To focus on the pain leads to poor outcomes.
The definitive answer
The answer to the question, ‘is it in my head?’, or, ‘is it in my mind?’ is no. Pain involves many body systems (most of the biology of pain is not where you feel it) gathering information. The brain interprets this sensory data in the light of what has already been and is known before generating a prediction of the most likely causes of that data — a best guess (see a great talk here from Anil Seth). This is both whole person and embodied as explained briefly above. Understanding this is a key step in the right direction, and part of an overall understanding of pain that allows the person to engage fully with the necessary practices, training and actions that permit progression, living and overcoming pain.
On we go as ever.
Please do share this article with fellow clinicians, friends, and others who need to understand pain.
There’s no better way to shake off the travel tiredness than to head out for a run in a new city. Fortunately Chicago offers a beautiful route along the edge of Lake Michigan, which happened to unsettled this morning under the moody sky.
Having fiddled around with the workshop content this morning, I set off to explore some of the city. By foot and public transport are my favoured ways of both getting about and getting a feel of the place.
My first observation is the simple friendliness of Chicago. It has been easy to navigate my way around because people are delighted to help. Whether it be the direction, working out the ticket machine or simply reminding you to hold on as the bus pulls away, there’s feeling of, we’re in this together. I like that. I also like the local accent.
By the way, when the bus pulls off, it is so gentle! I don’t think you could fall over, even if you weren’t holding on.
Chicago is packed with great looking coffee shops. Places to hang out without pressure to finish up and move on. The pace feels slow. Maybe that’s because I’m in no hurry today, but I haven’t seen many people in a hurry. I have seen many people taking it at their own pace.
Rolling up to Lincoln Park then Wicker Park and onto Logan Square, there’s a hip, laid-back feel. I’m looking forward to a couple of nights up this way. No longer have I my beard and I didn’t bring a check shirt, so I may look out of place. Or maybe not. Perhaps that’s just the London hipster thing.
Of course the main purpose of coming to Chicago is to share an approach to overcoming pain. Tomorrow with clinicians and Monday with some people who are suffering. As I was running through my (many) slides, it reminded me of how pain is such a huge topic because it must draw upon so many fields. The reality is that pain and our brains don’t much care about this. And indeed the reason is that pain is as complex perhaps as consciousness itself, of which it is part at times.
I couldn’t help but notice the advertisements asking for participants in medical the bus there were at least two; post-shingles pain (neuralgia) and schizophrenia. I wonder how many people apply. The wording is rather persuasive and suggestive of ‘free treatment’. Have a look below and see what you make of it.
An easy night ahead before the Pain Coach Workshop tomorrow. I’ve warned the participants that they are just that, not attendees. The day is fully immersive as together we experience the practices from start to finish. If we are encouraging patients to do things, so should we. The point is that we are all patients really.
Pain Coach Workshop Chicago is being hosted by Entropy Physio — Sarah and Sandy it be precise.
Next month UP goes to Chicago where I will be delivering an Understand Pain Workshop at Entropy. This is an exciting step for UP as we start our new chapter on changing pain in society.
UP was always supposed to be a global phenomena, and this is our first international event. The plan is for many more, both in terms of our reach via the web and in person at workshops.
Understand pain and understand your potential
The UP workshops are for people who suffer chronic and complex pain who need to understand their pain and their potential. Most people I meet have insight into neither as society continues to suffer the consequences of old thinking about pain. Still there is a the predominant search for a body structure or pathology to explain pain, both in healthcare and by the person. We have known for a long time that this is simply not true. The workshop reveals what we do know and how we can use this knowledge to ease our suffering in a practical way.
I like to talk about an individual’s MAP — mastery, autonomy and purpose. We use new knowledge, skills and practices to master ourselves, our thinking and actions, by deciding autonomously what we want in our lives. Following certain principles, we can implement and integrate daily rituals to build momentum towards our picture of success. Re-establishing the purpose(s) in our life gives us a reason and a motivating force to practice as we must if we want change. This is the basic model of success that I present in the workshop, offering a choice to each person who comes along to the workshop. A choice to create a better life.
The purpose of UP is to bring what we know about pain and suffering to society. But of course that is not enough. We must then go about alleviating pain and suffering. UP then has a two-pronged approach to both inform and then encourage positive change. I believe that we can build momentum through stories that we gather. Stories of how people have achieved success.
The workshop is based upon the Pain Coach Programme. This is a programme that seeks to educate, enable and encourage individuals to reach their potential to live their life. Why coaching? Simply because coaching is all about getting the best out of people. Based upon the latest thinking in pain, human performance, consciousness, perception, wellness, and other fields that are contributing to our understanding of being human, the Pain Coach Programme offers a way forward.
For more information about UP workshops, please contact us +447518445493 or click here
This is important for several reasons. Firstly because CRPS (complex regional pain syndrome) is one of many painful conditions that is poorly understood by both society at large and the healthcare community. Secondly, updates should be regular because our understanding is always advancing, in particular when it comes to pain. One of the primary features of CRPS is the pain, which results in enormous suffering via the effects. The guidelines point out that even when limb signs (see Budapest Criteria) abate, if the pain persists, CRPS can still be considered active. In these cases, where the limb signs were previously existent, CRPS can be diagnosed in its NOS (not otherwise specified) form.
“Complex regional pain syndrome (CRPS) is a debilitating, painful condition in a limb, associated with sensory, motor, autonomic, skin and bone abnormalities” (Veldman et al., 1993)
The Budapest Criteria were an important step in classifying CRPS, when the condition can be diagnosed incorrectly on the basis of sensitivity and not the necessary signs and symptoms. A number of people will be told that they ‘have’ CRPS when in fact they do not, starting a quest for answers and treatment, but of course barking up the wrong tree. One of the major issues in this situation is that this often leads to an internet search, which highlights the many stories that would do nothing except heighten fear. Whilst fear is a normal emotion, it is also responsible for holding people back, as well as driving behaviours that are not in line with success. Overcoming and using fear, rather than fear using the person, is vital in the process of moving forward.
The updated document is packed with the latest knowledge and statistics. There are algorithms to guide therapists and clinicians, and lists of therapeutic interventions and rehabilitation techniques. For all healthcare professionals working in ‘musculoskeletal care’, this is a must read. It forms a good foundation from where the CRPS literature can be explored.
Beyond this, it is necessary to look at the pain literature that includes the latest thinking, which is a blend of neuroscience and philosophy. At the peak of insight, it is common language to talk about the whole person, that the person experiences pain and that the brain is an inference machine making a best guess. All of these concepts are richly bound and grounded in science but are far from the mainstream. That is the problem. The mainstream remains bound tightly to the biomedical model, which has a role in eliminating disease and pathology for example, but must hand over to a comprehensive model that supports and encourages the necessary understanding, empowerment, independence and actions that get results.
It is for this reason that some years ago I began to blend practical strengths-based coaching with pain and perceptual science, simply aiming to get the best out of each individual. Most people do not reach their potential, largely held back by fear and misunderstanding. There is a very good reason why Understand Pain is called Understand Pain. The problem of any condition or pain exists when we have no understanding and no solutions. Whilst pain is always unpleasant, when understood together with a toolbox of practices and strategies, it is no longer a problem per se. This is a significant step forward as the person changes their approach and relationship with the condition and how it emerges in them. To achieve this requires ‘know-how’ and self-coaching, using new scripts or inner dialogues that drive new actions that are in line with a clear reference point: the person’s picture of success. Without a direction, we drift. Consider the announcement on an aeroplane when the captain speaks over the tannoy, saying that we will be taking off, but the destination is unknown. We need a picture, or a prize, and we need principles to follow to get results using our strengths and successful styles. We all have those.
CRPS remains a challenging condition for the sufferer and those close-by. However, there is massive optimism as we gather momentum behind approaches that get the best of people. It is not just about exercising. It is about a complete approach that addresses all the dimensions of pain and suffering in their unified form, all the influences and how we can actively infer something new and better in our thinking and actions. Gaining momentum is key, as practices are interwoven into each day, integrated and implemented by the individual who feels gathering control and empowerment towards their picture of success.
Together with Pete of The Pain Toolkit, I have been talking pain. This is a simple way of getting across the key messages about pain in bite-sized videos.
The first chat was based on the 5 question challenge when Pete asked me how I ‘got into pain’, my story in other words, and then what I say to people who are seeking the quick fix, the future of how we will deal with pain and the role of social media. Today we dug down deeper into dispelling the myth of the quick fix as an option.
In brief, overcoming pain is one of life’s challenges. Embracing this as a problem to solve by living one’s best life delivers many possibilities. This turns the traditional thinking, which has not worked (otherwise chronic pain would not be the No1 global health burden), on its head; i.e. we get back to living by living, not waiting for something to happen, or relying on hopes. Instead we follow a route of mastery, creating lasting and positive change, achieving results and maintaining a consistent course towards a desired outcome. This IS the model of success and we can apply this here, in addressing pain.
So, there is no quick fix, instead a route forwards where we fill our lives with the good stuff! We use our natural resources and strengths, and become resourceful. Everything you need is right there, and once you release yourself from the old, limiting beliefs and conditioned thinking (I can’t…I won’t….tomorrow etc etc.), you can start taking steps towards success. Is this a pain-free life? Does it mean being ‘happy’ all the time?
Pain is part of life. The pain you may be feeling has persisted and is not indicative of a tissue issue or pathology in many cases. Instead it is an on-going protect state as more and more contexts and situations generalise as being a threat — even though they are not. We have to actively re-train this, gain control over our mind rather than the mind controlling us, because once we decide to commit to consistent practices that build health, wellness and joy, they shift us into a different state, or chemistry. That is how we overcome pain. The more we focus on treating pain, the worse the outcomes. The more we focus on the person living well, the better the outcomes — for what we focus upon governs how we feel and where we put our energy. What do you want? Where are you going to pout your energy? Into a life full of joy? Or a life full of pain?
It sounds easy when you put it like that! Of course it is a challenge and there are many ups and downs. But you do not have to let that get in the way of you deciding to commit to a new path, one that you follow to gain wins and success in all areas of your life — again, because you decided to. How often do you feel happy, just because you can? Now you can use that as a daily practice!
So, onwards we go, as this is the only direction of travel. We build our ability to change state into that of excitement, determination, joy, love, compassion and all the many other states .We can get into such high energy states by moving, breathing, visualising, connecting and many other simple day to day practices. It merely takes the decision to do so, the development of a routine and practice, or repetitions, just like strengthening a . muscle.
More answered questions to come! You can email us your questions (email@example.com) or come to twitter and tweet @painphysio
A week ago we had another Pain Coach Workshop. This time in Wilmslow, near Manchester. A great spot with some excellent local cafes. I do love a cafe.
Regular readers will be familiar with the UP story, the UP vision and how we are supporting the next generation of clinicians and therapists by providing two sponsored places for local undergraduates.
Everyone who attends the Pain Coach Workshop brings immense value to the day. Purposely a small group to create a positive dynamic, the team all add their experience and views. In particular I enjoy hearing from the current undergraduates–the openness, freshness and the beginner’s mind that I encourage is evident.
Sam and Emma from Salford University came to the Wilmslow workshop, and here is what Sam had to say:
Here’s what Sam had to say:
I have recently completed the Understanding Pain & Pain Coach Workshop lead by Richmond Stace. I am a physiotherapy student, and was lucky enough to receive a free place that Richmond provides to support local undergraduate development.
I became interested in this workshop due to my time out on placement, in which I was challenged with chronic pain patients. Many patients had been seen by numerous health professions prior to myself, and suffering with pain for many years. I did not feel equipped to deal with this patient group who had deeply established pain belief systems and pain embedded within their lives. I believe as a student, it is important to develop the ability and confidence in which you can challenge a patient’s understanding of pain.
I understood the approach of ‘Making Every Contact Count’ was vital to encourage physical activity and promote behaviour changes that lead to a healthier lifestyle. However, I now feel that the approach of ‘Making Every Contact Count’ needs to extend to pain coaching. The course has provided me with the tools to encourage patients to understand pain and most importantly, gain control over it. This is a skill that will need to be practiced, and as a student it is the perfect time to develop and create change in ourselves, in-order to create change for our patients.
I thoroughly enjoyed this workshop, it was great to share the day with experienced physiotherapists and it was a fun learning experience. Richmond’s passion, values and drive is infectious and I cannot wait to graduate to develop my abilities to encourage, educate and enable change. A big thank you to Richmond for this great learning opportunity and I would encourage all physiotherapy students to attend!
The next Pain Coach Workshop is in Newport on Sat November ~ see here