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.
When asked to write a ‘brief’ insight into my story, I questioned whether I could do this. I thought to myself ‘my story is far too complex to be able to sum it up in a short few paragraphs’. But then I realised how throughout my journey so far, when I have been faced with a challenge I step up to the mark, and I make it happen. So, here is my story:
Growing up I was a happy and healthy child who lived and breathed sport. And I was very successful with both my academic and sporting achievements. From the age of twelve I was playing cricket for Kent, representing Kent for Cross Country Running and Athletics as well as participating in any other sport where I could find the time. Life was good as a child, and I loved every moment.
However, in my teen years I developed anorexia nervosa which lead to a hospitalisation in my early twenties. I was in a critical state when admitted to hospital and there was little hope I would recover. However somehow, someway I managed to find some inner strength, determination and drive to want to recover from this illness. And so I began a long journey to restore my physical and mental health. I had a vision of leaving the hospital and being able to return to my sport, and continue working towards my goals of representing Great Britain at either cricket or running (I hadn’t quite decided at that point).
Someway into my recovery I began to experience pain in my back. To begin with this pain was leaving me in tears on any movements. And it soon began to spread, I started feeling pain in my feet, knees and hips. For me this was not only an immense source of suffering, but it was puzzling as previously I had only ever experienced pain through injury during sport. So, like most people we began to get tests, scans and multiple visits to countless health care professionals including physios, psychotherapists, doctors, hypnotherapists, movement specialists, nutritionists, the list was endless. I was in desperate search to see if anyone could shed some light on this unexplained pain. This went on for a good couple of years, all the while my hope gradually fading before my eyes as I struggle to walk for five minutes without breaking down or sit through a coffee date with a friend before becoming in terrible discomfort. This led to a desperate google search, which became a moment I will never forget. I vividly remember laying on my bed one evening, crying and typing in to google ‘success stories of overcoming chronic pain’. And this search led me to Richmond Stace. I instantly knew at that moment I wanted to work with Richmond, to try something different. And what an incredible decision that way.
My first appointment with Richmond was similar to many, myself walking in depressed and clearly rapidly loosing hope. Yet upon leaving my energy had changed completely, and my mind was fixed, pain can and will change, I can do this. Over the coming weeks Richmond taught me what pain was and I began to understand that I can influence this pain simply by choosing my thoughts, feelings and actions wisely, always keeping them inline with my vision, to be happy and healthy. Richmond provided me with tools such as mindfulness, visualisation, motor and sensory skills, the power of gentle touch and lastly he empowered me to know that I can and will live a fulfilling life.
We worked slowly, acknowledging that i had also been diagnosed with osteoporosis from my eating disorder so we were mindful of this when putting plans and programmes together for me. And the changes in my pain and happiness were incredible. Within a few weeks I was doing things I had longed to do for so long, I was back out walking pain free, I was in the gym, going to yoga, I could swim. Running and cricket were being held back for the time being until my bone density improved but they remain goals in sight. Richmond’s approach was one that was so different to any other practitioner I had seen before, but one that truly changed my outlook on pain.
Four years later, I now have a 1st Class honours degree in Sport and Exercise for Health, I have a distinction from my Masters degree in Clinical Nutrition and Eating Disorders, and I am now pursuing a PhD at Griffith university in Australia exploring the effects of low energy availability on injury risk and sporting performance in athletes. I now enjoy going to the gym most days of the week, I am a qualified yoga teacher who practices most days and I love nothing more than a long walk in nature. There is a famous quote that says ‘don’t look back you’re not going that way’, but I don’t like this quote because for me sometimes looking back is truly remarkable, as it allows me to really see how far I have come. From a place of suffering, from a place where all hope was lost, from a dark depression, to now being in a place where I moved on significantly, I am living a fulfilling life, living an adventure. I would be lying to say I am free from my issues with pain, I still get some periods where I experience pain like I previously did, and occasionally I find myself slipping back into old habits. However, I soon realise this does not benefit me in the slightest, so I turn back to all the tools in the toolbox I now have to overcome difficult times. If I experience an increased period of pain, my instant reaction used to be ‘this is a disaster’ and I would seek out physios, doctors, pills and potions to try to find a quick solution. But through my increased knowledge and understanding of pain I no longer react in such a way, instead I now view these experiences like this ‘ok, I feel you. What is the next best decision I can make that is going to help the situation (whether that be rest, movement, sleep, mindfulness, 3 deep breaths, laughter, food/ drink, meeting a friend) that is in line with my underlying vision of health and happiness’. Ultimately my next decisions always try to reduce the threat level, to reassure my body and mind that I am ok, I am safe. I have leant to observe my thoughts, feelings and actions and change them if they are not serving me well or if they contribute to suffering in any way.
I will never be able to thank Richmond enough for his ongoing help, support, guidance and encouragement during this stage of my life. Not only has he provided me with so many tools to overcome chronic pain, but also I have learnt so much about myself, who I am, what I want, my visions, goals and not to mention to wonderful books I have been guided too along the way. Richmond you are truly incredible and I thank you from the bottom of my heart.
So, for anyone out there who may be in that dark place right now, please trust me when I say, pain can and does change, when given the right environment to do so. Our experience of pain is influenced by our emotional state, fatigue, prior experience, our beliefs, our environment, our anticipation and expectation about pain. This can seem overwhelming however it is also truly empowering because having so many factors that influence pain means there is so much opportunity to change pain, because after all we are always changing. So, in this moment don’t be afraid to leave the shoreline, dive in and explore, along the way you will learn there is real depths to explore. There may be some darker patches, and inevitable challenges, and every now and again you may feel like the waves crash down on you. But trust me there is a shimmering horizon that calls you, and this is a journey that will ultimately take you towards that horizon. So, reach far, reach wide, take those meaningful steps, even if you need to tip toe forward to start, begin now and know there is a meaningful life out there for you too.
On Friday night Strava told me that I had reached 3000k for the year so far. Undoubtedly, the cause Understand Pain (UP) has been a massive motivator together with a sense of purpose, echoing the thoughts of Dean Karnazes: ‘…ultrarunning is a noble pursuit and has brought purpose to many people’s lives, as it has mine.’
However, there’s a long way to go. Society needs to develop its understanding of pain: what it is really and why it can persist. That’s one of the main purposes of UP.
My intention is to continue with the ultrarunning to raise awareness of the problem of pain. There is no end goal; just to keep going as in the style of shuffling mile after mile. Along the way, I hope to gain partners who want to share the story of making a positive impact in society (do get in touch here if you are interested). For example, UP recently has teamed up with a large healthcare company to work on a really exciting Pain Coaching project — more on this soon.
But, none of this would have been possible without the support and encouragement of a number of people. Therefore, I dedicate this blog and the #upandrun 3000 to them with massive gratitude. Some I know well and some I know of; all have helped in their own unique ways and many won’t have realised!
I wholeheartedly believe in people’s ability to change their pain. Why? Because I have seen it so often and heard how individuals have improved their lives. We also see the effects of changing people’s perceptions in the research settings.
Many scientific studies have shown how we can alter experiences in many different ways. My role as a clinician is to translate this into something practical for people to use day to day to get better. This is why I spend time with scientists, researchers and philosophers on a regular basis, but also draw upon many fields to create programmes for people to get the best of themselves.
Here is a story about a person’s experience of changing their pain. In this case, chronic headache. I act as an encourager, a supporter and a coach, but it is always the person who must do the work to get better.
I suffered from Chronic Daily Headaches for twelve years, before I was eventually referred to Richmond by my neurologist, Dr Marie-Helene Marion, to whom I am eternally grateful for doing so.
Before visiting Richmond, the only option I had to relieve my headaches was medication and, when the drugs stopped working, I would feel completely hopeless in their wake. But, in just a few short sessions, Richmond completely reconfigured my relationship with my headaches – giving me tools to manage the pain and, more importantly, feel in control.
Very soon the hopeless despair was gone because now, when I was faced with a headache, I had options. Whether it was as simple as a full body meditation, going for a run, or turning to my daily journal, there were things I could do that had a direct impact on the pain and therefore my state of mind. I no longer felt crushed by the onset of a headache because I could take action. If the drugs didn’t work, it wasn’t the end of the road, there was something I could do to better the situation.
As a result of my treatment, I am slowly coming off my medication (something I would never have imagined possible, having been on them for so long) and feel better than ever about my headaches. It has honestly changed my life.
And there’s one other thing – until I saw Dr. Marion and Richmond about my headaches, no one had ever told me that I would ‘get better’. It was always about managing the symptoms with medication. It’s a simple thing to say , that you might ‘get better’ but, for the first time, I had been given permission to believe that I didn’t have to live with my headaches forever – from the outset this was a huge psychological boost. And, I am pleased to say, they were right. I am getting better.
For the 7th ultra I am hitting the hills, or rather mounting the mountains….
Most of the races so far have included some steep hills. Over the South Downs near Ditchling Beacon on my way to Brighton from London, traversing the Seven Sisters from Eastbourne towards Brighton and along The Ridgeway on Race to the Stones, have all challenged my thighs. Running and walking uphill is one thing, coming down is another. There’s an art to the latter. A balance between controlling one’s descent so you don’t fall and saving your quads! The Maverick inov-8 ultra has an elevation of 3020 over 60-odd k.
Traditionally I am not great with heights. So this ultra presents an additional element and feature for me to cope with whilst climbing, descending, walking trotting, hopping, shuffling and running. Don’t look down! Having said that, I have been on mountains plenty of times before and usually enjoyed the views, fresh air and freedom.
Recently I was thinking that #upandrun would continue for 12 months, #12in12. But then I thought about afterwards and what I would do. I can’t see that I will stop, so this will continue indefinitely with a blend of races and solos that accompany the monthly UP workshops (next one on 18th Sept >> tickets here).
You can support Understand Pain here, helping us to run the workshops each month so that they are free for those most in need, to increase the number of workshops and the reach. Meanwhile, I’ll keep running to raise awareness and bring the tools to people so that they can improve their lives.
#upandrun is an Understand Pain project raising awareness of the problem of pain — the No1 global health burden. We are working to reduce the enormous suffering caused by chronic pain that affects millions and costs billions.
Are you a GP who sees people suffering chronic pain?
The answer is most likely yes considering 20% of the population suffer chronic pain. There are many presentations (in no particular order): back pain, neck pain, irritable bowel syndrome, fibromyalgia, arthritis, post-injury, headaches, migraines, pelvic pain, endometriosis, menstrual pain, tendonitis, as a feature of a particular condition, cancer, heart disease and more.
Chronic pain is the No1 global health burden. Pain is the main reason why people seek help. Yet it remains poorly understood, meaning that people’s expectations are out of step with what they need to get better, and the treatment offered can take them down the wrong path. Together these contribute to the on-going problem that is showing no signs of change in the right direction: less suffering and less cost. We must and can make this happen. The ‘we’ being society.
GPs are in a prime position to help drive this change with the right support and systems in place. As a GP or healthcare clinician, how do you feel when a patient (person) suffering chronic pain comes into your room? Be honest. Does the challenge excite you, or is it the so-called ‘heart-sink’ time? For me, I have always loved the challenge and the fact that we can always do something to help the person improve their life. But this is because I have always felt that I can work in this specialist field and make a difference, building knowledge and experience over 20 years. Without the practical knowledge and the coaching approach, I am certain I would feel lost and overwhelmed.
Now, I do not believe that you need 20 years in the world of pain to be able to have a positive impact. But I do know that understanding pain is vital, as is having confidence in your approach. Both are transmitted to the person in front of you whether you are aware or not.
Steps to take
The first step is to be aware of your own beliefs, biases and behaviours in these situations. These will frame your approach. What is your approach? Establishing the way you ‘treat’ is the next step. Do you treat chronic pain? Do you treat the person? Do you coach the person? What do you do, how and why?
On knowing your start point, you can then build your knowledge of pain: what is pain really? For example, understanding that pain and injury are poorly related, that pain and tissue state bear little relation to each other, that pain is a need state, and that pain is the brain’s best guess to explain the current state. Further, you learn that pain is related to the perception of threat and the state of the person. It is of course the person who suffers pain, not the body part. And, most of the biology in the dark when we are in pain, is not actually where we feel it. The pain experience itself is just the tip of the iceberg.
You have a choice. You can continue using the same approach, and indeed there may well be some ways that you find to be effective. Or you can add to your repertoire of tools and design a system or process. This I can help you create.
One of the biggest challenges is always the time factor. Perhaps you have 7 minutes, 10 minutes or the ‘luxury’ or more. It is tight. This is a complex situation that requires time and the human touch. How can effective care be achieved? How can we really help this person improve their life? The primary choice remains medication. There is a role for medication and it is often expected by the person and hence a pressure to prescribe exists. However, whether you do or not is your choice as the clinician. But of course medication does not teach someone how to improve their life and will mean that the natural systems of (biological) protection become lazy together with a limitation upon the person’s responses. People commonly rely upon and hope for the quick fix option when there is none. Instead there is a way forward that eases suffering and improves life, but it takes longer and is more effort. That is the reality, the uncomfortable and inconvenient truth about chronic pain.
To address pain you have to address your needs in life, build wellness, create new heathy habits, take a new perspective, expect and know that life can get better and practice day to day to day, much like cleaning your teeth — you know this is true when you truly understand pain.
The questions are: what does this person really need? What are they telling you in the narrative? And then, how good are my deep listening skills?
So, with limited time and the desire to make a positive impact, we need a plan. One that we can roll out in an individual way. We need a set of options and resources that can meet the needs of the person step by step. When you know that you have a plan, the pressure eases because you know that you can make a positive impact. You outline the plan to the patient, start the wheels turning as you help them understand their pain (always the key), and focus on what they CAN do to improve their life.
The Pain Coach approach focuses upon what the person wants in their life and how they want their life to be: focus on what you want, not what you don’t want. See how often we do the latter, and sure enough…. . This is why coaching offers so much because we tap into the person’s strengths to move on towards their picture of success. We have a clear direction and steps to take each day. It is a challenge, but coaching encourages and supports the person to live their best life, to show up in the best version of themselves, and to reach their potential.
What would it be like if you had a process?
How would you feel about supporting, encouraging and coaching people suffering chronic pain if you knew that you had a process in place? Would this have a positive impact upon their lives? Your practice? Your stress levels? Costs?
Your process includes a range of ways that you address particular problems that arise together with resources to call upon. Within each session you have 1-2 key points to cover. Sessions are scheduled according to the priorities for that person. This removes some of the time pressure because instead of trying to cram in as much as possible, or prescribing as the first port of call, you know that you have a number of appointments set up for particular issues to be discussed and acted upon.
In essence, when a person has an idea about what is happening, why, what they must do, what the clinician will do and over a rough time period, they will be satisfied and engage. The trusted advisor status is vital when working with someone suffering chronic pain. This takes time and follows reliable, compassionate care, i.e./ positive actions in line with the person’s needs.
There are many pressures upon GPs. From society, patients, and themselves to deliver the best care. Resources are always limited in some shape or form, in particular the most valuable one: time. This being the case, we must work out the best ways of moving forward. For chronic pain, currently the greatest health burden, creating a process within your practice that enables you to listen (deeply) to the patient, and step by step meet their needs will increase efficiency and improve outcomes. Within this process, pain coaching is a means of working with the person so that they can reach their potential.
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
The next stage of #upandrun for Understand Pain is the London (Richmond upon Thames) to Brighton. 100k from city to coast. I lived in Brighton for some years, so it feels a little like running home.
This time I will be doing it in one day; the full 100k. Of course I am expecting and preparing for challenging moments along the way. That’s why we do it! To face, overcome and complete.
Running can be a great metaphor for life. Inevitably life is full of ups and downs. These are unavoidable. However, our approach and attitude define them as opportunities or obstacles. Whilst these moments maybe hard and unpleasant, the way we view them determines whether we learn and move on or suffer more than is necessary.
The tougher moments when running include fatigue and heaviness in the legs, knowing that despite going for hours, there are still hours remaining, and various aches and pains. I’ll share a few strategies that I use to re-focus and keep going.
1. Re-focus on what you want and keep going
Everything comes through the mind. The mind is embodied. These are both important considerations. There is no separation between body and mind. Instead we have a (whole) person. The way we think is embodied, the decisions we make are affected by our body state, and our bodies keep the score of all our thoughts and emotions. Skilfully appreciating this and using it to our advantage is one of the habits of peak performers. We can all be peak performers in our own way.
In that tougher moment, you learn to take a perspective and re-focus on what you want to achieve as an outcome. What is my picture of success, or dream? When you focus on what you want, you feel your energy lift. In one way, this is how you know you are focusing on your picture of success rather than something else. For instance, paying attention to the feeling of heavy legs and any on-going thoughts brings on further sensations of heaviness — it gets worse.
2. Remember your purpose
Knowing one’s purpose is healthy according to research to date. Since Viktor Frankl wrote Man’s Search for Meaning, there has been interest in purpose as something that spurs us on, gets us up in the morning and drives persistence in the face of adversity.
Many people run with purpose. Often this is for a cause such as a charity, chosen in the name of a loved one who suffers or has passed on. I believe that is why events such as the London Marathon are so emotive.
In that moment when it is ‘sticky’, you recall your purpose, the person or people you are representing and drive on. You know that no matter how much it hurts right now, it is nothing compared to the suffering of others.
3. Fuelling skilfully
On longer runs, your fuelling is essential. It is also personal and unique in as much as each person must find out what they need. The experimentation should take place on training runs so that you know and can prepare fully for the actual event.
The night before I always have a (big) bowl of spaghetti bolognese. In the morning, I am up early having porridge with blueberries and honey. At least one shot of coffee is also essential for me, together with two shots of beetroot juice. Until the start, I will nibble: a banana, a Pursu nutrition bar, cashew nuts; and sips of water.
During ultra runs, I re-fuel around the first 10-12k mark and then at the rest points. On the Ultra Challenges, the rest points are every 10-15k ish, offering a range of fruit, pastries, cookies, flapjacks, sweets, coffee, water, sports drinks, pick n mix, hot meals (at lunch) and more. Typically I will have a banana, salt and vinegar crisps, a cookie, water, a shot of coffee, pick n mix (yum!), watery fruit (e.g./ melon), sports drink and refill my bottles. I carry gels and use them as needed, but typically towards the end when I need a little booster.
The principle I follow is to keep hydrated and fuelled rather than wait. I used thirst as a guide, but only very mild thirst, sipping regularly, especially if it is hot. When I notice a particular type of heaviness and I know that there is a way to go before the next stop, I will use a gel.
Marathons are different because the are no rest points; the run is non-stop. Fuelling and drinking are on the go. It can be messy!
Whichever way you find works, it is a key strategy to use in order to keep going.