Today I will be at the Walthamstow Garden Party, which is a little more than just a garden party! Take a look at all the events. It’s an incredible day of great entertainment and delicious food!
Come and find me in the Health Zone if you have questions about pain or the work I am doing to tackle the global pain crisis with UP.
I am there all day to talk and talk and talk! So, if you suffer pain, treat pain, have to decide upon policy, want to know about the latest thinking in pain science, are interested to partner with UP, set up workshops at your practice, come and see me.
When you come along, take pics and use the hashtag #UPparty so that we can gain even more momentum with our work to change pain.
In Europe alone, chronic pain costs up to €441 billion each year, affecting at least 100 million people. This can and must change, this being our purpose at UP.
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.
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.
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
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.
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:
Establish an EU platform on the societal impact of pain
Develop instruments to assess the societal impact of pain
Initiate policies addressing the impact of pain on employment
Prioritise pain within education for health care professionals, patients and the general public
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.
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’.
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:
Building platforms to address the societal impact of pain
Impact of pain on labour and employment
Challenges, models and lighthouses in pain policy
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!
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.
Liverpool footballer Jordan Henderson is suffering plantar fasciitis. His manager, Jurgen Klopp, is monitoring his progress but cannot confirm whether Henderson will be able to play again this season ~ report here. Lower limb injuries and pain are an occupational hazard for footballers, particularly those who make a career from the game. Here are some important considerations.
Pain and injury
Pain and injury are not the same. Are you injured? Or does it just hurt? An injury can be from an inciting event such as a twist or contact with another player. Or it can a ‘slow burner’ when there is a gradual breakdown of tissue. The point that this is detected by the body systems that protect us and interpreted as dangerous is the pain moment. It can take a long time for this to brew into something conscious. You will note from this that there are at least a few layers of activity before we actually feel pain.
Pain and injury are poorly related. We have known this for many years both scientifically and anecdotally. Yet the predominate message in society through implicit thinking is that pain must be due to an injury. Then the search for a structure begins. Pain is a body state of protection, compelling us to take action. A motivator if you like. Pain is poorly related to the state of the tissues. Consider phantom limb pain when there is no limb yet there is pain in a space. The body systems and our brain, which has a significant role in all conscious experiences including pain, work on a just in case basis. Recognising patterns, drawing on past experiences and predicting what the sensory information currently suggests are all part of the processing that underlies our lived experience. Pain does not have a simple physical basis.
The injury moment
At the point when an actual injury occurs, the context plays a big role in what happens next, as does past experience. In this moment there is a rapid assessment of threat. If the weight of evidence suggests danger, then it will hurt. If something else is more important, such as escape or wanting to win the final, it is quite possible for the pain to be minimal or non-existent.
There are other factors that play a role in the processing: where am I? What am I doing? How am I feeling? Who am I with? Have I been here before? What does this mean?
The meaning of foot pain to Henderson is very different to the meaning for me. For me it would be unpleasant, inconvenient and prevent me from being as active as I might otherwise be. For Henderson, it means he cannot work, therefore impacting upon his career. This then, would be far more threatening and hence create a context for more protection. It would be similar if a violinist injured his or her left hand compared to the right. Meaning is key and must be considered.
Persistent pain
Problems that involve tendons, and we can include plantar fasciitis here, typically go on for months. There has been huge amounts of research and work undertaken to look at this problem, most of which has focused upon the tissues themselves. Whilst tissue health and tolerance for force is important, a much wider approach is needed starting with recognition that it is the person who feels pain. This being a fact, it points us towards addressing the person as much as the condition, and even more so thinking about how that person uniquely interacts with the condition. There is a key interface.
Most of the biology of pain is not where the pain is actually felt. Much like the film you watch in the cinema involves much more than the screen. The adaptations that occur in chronic pain are in the emotional centres of the brain, the connectivity between the thinking and planning areas and emotional centres, and in the sensory areas. We are more than a brain of course and all the habitual changes we observe and those that occur in the dark (e.g. neuroimmune) somehow emerge as a lived experience. This delves into questions of consciousness and self.
To address plantar fasciitis then, we need to think about a range of factors, beginning with the person’s understanding of their pain. This understanding sets the scene, reduces fear and promotes engagement in the training and practices needed to overcome the problem. We have to create the conditions for this to happen, which is why the person needs to focus on a clear direction and the means to achieve this. Fears, worries and anxieties will of course intervene, but the more quickly this energy can be transformed into the practices of well-being and specific training, the more efficient will be the recovery. Just as an insight, practices would include body sense training, proprioceptive training, nourishing movements and mobilisations, sensorimotor training, mindful practice, graded exercise (strength, endurance etc). But this is all based upon a mindset focused on success, so the practices of resilience and attention come into play. The aim is sustained learning and change to overcome the problem by facing it and transforming it, not trying to get around it by just using pills, injections and other means of avoidance.
Looking back through the story and knowing the person creates the opportunity to understand how the problem emerged in the case of a slow burner. An acute injury can also be analysed to discover if there were any factors increasing the vulnerability to injury and indeed vulnerability to develop a more persistent problem.
In summary, the bigger picture is always important. Considering the person as much as the condition and ensuring that pain is understood. Understanding pain is the key.
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.
Building platforms to address the societal impact of pain
Impact of pain on labour and employment
Challenges, models and lighthouses in pain policy
Evolving concepts in the definition of chronic pain: a dynamic process
I will be attending this symposium to take the opportunity to meet and talk to clinicians, policy makers and others who want to address the social issue that is chronic pain.
Regular readers will be aware that one of the first steps for UP as a social enterprise is to relaunch this website as a practical resource. This work is well under way. UP will the reach across the globe, connecting with people and clinicians who are seeking to be involved. There is great urgency in the need to tackle the problem of pain, not just for the current times but the next generations. We simply have to create new thinking that permeates across society. At UP we will be supporting the next generation of clinicians and healthcare professionals in various ways including sponsoring attendance at Pain Coach Workshops. UP also has plans afoot for the youth who we feel need to understand pain as a simple skill of well-being.
My hope is that I will connect and have discussions with like-minded and determined individuals who seek to drive change. If you are attending SIP and would like to meet for a conversation, please contact me here or via the form below.
Updates and news will be posted here, including during the SIP symposium.
The London Marathon is next Sunday, 23rd April. This means a week of relaxing, putting my feet up, being fed grapes and generally letting everybody run around after me. Well, that’s the dream….
It’s an interesting time during the tapering. I feel that I should be doing more. My body behaves like a dog waiting at the door with lead in mouth, yet I know (from some excellent advice) that the opposite is what is needed right now. A few easy, short runs will be just fine, I keep telling myself.
It has been hard work but a thoroughly enjoyable test of one’s ability to keep going and maintain a training routine of 40+ miles a week. That’s a lot of time. Some may say ‘me time’. I am grateful for those close around me for allowing me to spend a good chunk of time out there and then putting up with my stretching, moving, twitching and generally fidgeting to ease the aches and pains. I have also probably become a bit ‘boring’ as I talk about the times I have run….
It is hard to avoid thinking about a time. Initially I was just aiming to finish but now I am eyeing four and a half hours. But who knows! I have never done this before so it is a leap into the unknown!
I doff my hat to all my fellow runners and wish them all well on their individual quests. By all accounts the London Marathon day is a great one and I am thankful for the chance to experience the crowds, the buzz and the bobbing heads of the sea of runners.
If you can come and support CRPS UK and UP, you’ll be a welcome voice from the crowd! You can also support our work by coming to our quiz on Thursday (20th April) (click here) or donate here
understand pain 