A life of appointments

When life is dominated by the next appointment

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

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

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

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

~ pain and injury are not synonymous 

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

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

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

RS ~

A brief guide to pain – what is it?

Welcome to my brief guide to pain. Pain is an enormous topic, drawing upon many disciplines and fields, similar to the study of consciousness. Whilst putting together my thoughts to answer the question ‘what is pain?’ I soon realised that it was going to be a lengthy piece, and only for those who had the time and inclination to bear with me. Regular readers of my blog at Specialist Pain Physio will be familiar with the importance of understanding pain (hence UP!! and @upandsing) as the start of changing and overcoming pain, particularly persistent pain. Now it is obvious why we called our campaign UP | understand pain — because when you do, you’ll realise that it can change when you take action, and that is what Pain Coach is all about.

So here’s my brief guide to pain in bullet points:

What is pain?

Here are some facts but not all (we will always discover new facts, and I will update accordingly):

  • This is my recent thinking on pain: “Pain is the conscious experience of a need state, others being hunger and thirst, felt by a person in a particular area of the body in respect of a perceived threat (that may be conscious or subconscious, or both), not separate from the context of the moment, the environment, prior experience, predicted experience, the social circumstance, current biological state, health, thoughts, feelings & emotions”.
  • Pain is a vital survival device, without it we do not live as long or as healthily.
  • Pain is part of the way we protect ourselves alongside changes in movement, body sense, thinking, emotions, perceptions of the environment, planning, anticipation, attention.
  • Pain is how we protect ourselves in the face of a perceived threat. When our body systems detect danger, actual or potential, there is a need to protect and this includes pain in the area that is perceived to need such protection — consider that the sum of sampling our body tissues, organs, systems (they sample themselves as well), plus the sum of the environment, plus the results of sampling the brain (what do I know, where am I, what are my beliefs, what have I done here before, what has worked, how am I feeling etc) leads to what we experience in any given moment; and if the sum of all of these inseparable characteristics of being alive represents some kind of threat, then we will change our behaviours and experience pain. For the mathematicians:
    • (what is happening in my body + what is happening in the environment + what I know + what I do not know I know) right now = (my reality in this moment) that is always passing
  • It is poorly related to the extent of the injury or tissue damage.
  • It hurts and ‘I’ feel it in my body (or where my body used to be or should have been, in the case of phantom limb pain).
  • It is ‘I’ who feels pain, not my body; I hurt, much like I am thirsty and not my mouth
  • When I feel better, my pain feels better (because I feel pain).
  • Pain involves many body systems — always the nervous system, often the immune system, plus the autonomic nervous system, the endocrine system and the sensorimotor system.
  • There is no pain system, there are no pain signals. There are systems that detect changes and presume threat that requires attention and action; pain compels us to do something to make it go away, both in how we think and what we do.
  • Pain is influenced by how we are feeling, how we think about it, where we are, who we are with, what we have been doing, what we are doing, what we may do, how tired we are, how much attention we put on the pain and our expectations to name but a few.
  • We can only feel pain now, in the present moment. Our memory of the pain experience is unreliable, and whilst we may recall that we were in pain several days or weeks ago, we cannot remember that actual feel of the pain with any accuracy. Like any experience, pain happens in the moment but is hugely flavoured by the way we think about it. For example, if we are anticipating that something will hurt, such as getting up from a chair, then it usually does and more due to the expectation priming our systems that protect. If we have pain under certain circumstances, an association can develop so that the next time the context arises, protection kicks in, including pain.

Next time….what sorts of things can we do to overcome pain?

Richmond Stace | Pain Coach & Specialist Pain Physiotherapist

2nd UP event 24th October 2015

UP HeathrowAt UP | Understand Pain we are really excited to have our second event following the enormous success of the launch in March. We had hundreds of choir members from Rock Choir, singing out for UP at Heathrow where passengers and staff enjoyed the entertainment at Terminal 5. This time we are going bigger and better with more choirs and a non-stop sing-a-thon, the only breaks being brief talks about UP, what we are doing and why.

UP was formed by Georgie and Richmond earlier this year to raise the awareness of the huge problem of pain (back pain is the number one global health burden; in the top 10 of global health burdens we have back pain, neck pain, osteoarthritis and headaches), and that there is plenty that we can do to change and overcome pain, this to resume a meaningful life as exemplified by Georgie herself and many others.

One of the biggest problems regarding pain that we face as a society, is the misunderstanding of pain itself. It is still thought of and treated as if the body structures are to blame, i.e. where the pain resides is where the issue exists and where treatment must be directed. Pain science has been telling us for years, since Pat Wall and Ron Melzack shifted our thinking, that there is much more to consider as the biology exists elsewhere in the main. The latest thinking blends science and philosophy to consider pain as a whole person, lived experience — e.g. in the case of back pain, it is the person who feels pain, not the back; much like hunger, it is the person who feels hungry and not their stomach.

Our current priorities are:

  1. To achieve charity status — this will afford us opportunities for fundraising and other benefits of being a charity. We have had numerous offers from people who wish to run to raise money. We will support people who wish to fundraise with information and t-shirts
  2. To develop the website and social media presence
  3. Start the Pain Coach workshops* with the monies raised so far and from the next event.

* more information to follow on Pain Coach workshops.

If you are travelling through Terminal 5 or work at the Terminal, come and see us and show your support!! If not, don’t worry as we are filming the event so that the World can see the performances and hear our messages.

Onwards and UPwards….. please spread the word and ‘like us’ on Facebook and follow us on Twitter @upandsing

Gillian’s Story

Huge thanks to Gillian for sharing her story here:


I am always a busy person; I play short mat bowls several times a week and have represented my County and England, I run a Junior session for bowls, I love to swim and I am a member of Horsham Rock Choir. I use a computer as the main part of my job of Practice Manager for a charity.

My problems began in 2010 when I slipped on some ice and inadvertently tried to break my fall with my left arm. I had restricted movement and upper arm nerve pain but after some physio my situation improved.

In Dec 2012 I developed pain in both arms after lifting a heavy object at work. I was referred for physio in Jan 2013 when I was diagnosed with tennis elbow in my right arm and shoulder impingement/tennis elbow in the left. After some exercises my right arm improved but I had further physio in the following months for my left arm. During this time the worst aspect was the nerve pain from my elbow to my hand – no painkillers relieved it, and I was in constant pain with or without movement, even scratching my face or lifting a kettle were agony!

In September 2013 when I was still in a lot of pain and had a further condition added – ulnar nerve entrapment – I was given 2 steroid injections. There was an improvement but of course the underlying problems were still there and in January 2014 there was a return of my intense pain. A further course of steroids followed, but the actual injection was excruciatingly painful and I was left with numbness in my ring finger. I was pain free until Nov 2014 when I moved a pot in the garden and experienced a twinge in my elbow, the problem was exacerbated when I used a simple screwdriver in Dec at work and I ended up in the worst pain I had had for some time.

By Jan 2015 I was at the end of my tether and rather than go the NHS route saw a physio who I knew privately. She felt that my neck was also the cause of my problem plus bad posture. Her approach was more holistic and she gave me some acupressure to try and calm me down from my very distressed state. She even suggested counselling as she was concerned about my mental health as a direct result. I was at various times loaned a TENS machine, given ultrasound and massaged. She helped me address by posture and gave discussed calming techniques. She discussed with me how my mental state was affecting my pain but I was sceptical about this at the time and more or less dismissed it. There was a degree of improvement in my condition over the following month thanks to the new physiotherapist but I was still struggling day to day.

During all these periods in and out of pain I have had to stop playing bowls and going swimming, use my right hand more – particularly with the mouse at work, been unable to sleep on my left side, been restricted doing the dance moves at choir, and not been able to do many day to day things that I used to take for granted.

In March 2015 I attended Heathrow Airport with Horsham Rock Choir where Georgie Standage my choir leader and Richmond Stace were hosting an event for UP. I took one of the flyers and did my research via the UP website. I found the videos very interesting – in particular the one explaining how “all pain comes from the brain” (Lorimer Moseley). I took particular interest too in the mindfulness videos. But I also found the written information really useful too. Over the following weeks I used mindfulness apps and also ‘talked’ myself out of pain. When I felt pain I closed my eyes and tried to focus on other parts of my body; if I hit my weakened elbow (as I do frequently!) I told myself that it was fine, it would hurt for a while and then I’d be OK. I used Mindfulness to keep me calm and I found that my nerve pain lessened in the weeks that followed.

By May I was able to resume my bowls for short periods to use my mouse at work left handed, do my Rock Choir moves without pain and return to swimming. Significantly I can sleep for periods on my left side without pain – which I haven’t done for a long time!

It is now July 2015 and I have been pain free for just over 3 months–other than the odd elbow bash! I do get the occasional twinge, and very interestingly if I am stressed about anything I get a bit of nerve pain in my arm! Looking back some of the worst pain ties in with significant stressful times in my life. I am still wary and careful about exacerbating things, but importantly I feel that “yes I do have pain sometimes, but pain doesn’t have me”. I am indebted to UP for giving me my life back, and I continue to use the techniques I have learnt – in particular the Mindfulness Breathing – to keep me calm and in control.