I was very pleased to be asked to speak at the Adcock Ingram Sports Science & Rehabilitation division launch roadshow — a whistle-stop tour of South Africa.
Innovative TensCare CEO Neil Wright asked me whether I would give a series of talks in South Africa (Johannesburg, Durban and Cape Town). He had heard that I bring an ‘edge’ to the topic of pain. I like to think so, but only in terms of challenging out-dated thinking that holds us back. What a great opportunity, I thought. A chance to spread important messages via Understand Pain (UP) and to learn about how chronic and complex pain is addressed in South Africa.
The new Adcock Ingram division was being launched to local physiotherapists, chiropractors and biokineticists, and the theme of the events was pain. How could I resist? Adcock Ingram are engaging with therapists and clinicians in a new way that is generating a great deal of excitement. This is based on creating great relationships and distributing high quality products that compliment rehabilitation, including the range of devices from TensCare.
Both the team putting on the roadshow and the attendees were buzzing! The feedback from the people in the audience was very positive. There was a thirst for quality pain education, and it would be great to follow up with full Pain Coach workshops.
In my experience, TENS is under-used for chronic pain. Whilst TENS will not solve the problem, it can offer relief that helps the journey forwards. As an inexpensive and simple form of self-treatment, it is a good option. The key is that the user understands how it works and how to best use the unit. This can take some time and practice, but with instruction, discovering the right parameters can be found more swiftly.
I shared the stage with Nick Martichenko from Canada. Nick spoke about the use of tape and the understood mechanisms, whilst I focused on pain and pain coaching. I entitled the session ‘The Challenge of Pain’ as a doff of the hat to Pat Wall, the founder of modern pain biology, who wrote a book of that name. It was Wall’s work that resulted in the development of the TENS machine.
Three days, three events
On the road…
The roadshow put on by Adcock Ingram was very high quality from start to finish. They really wanted to make sure that every detail was covered. This was appreciated by the attendees who were most enthusiastic about the event. There was a new precedent being set, and the beginning of a new engagement between Adcock Ingram and therapists/clinicians.
I was particularly impressed by the way that the sales team approached their work. Selected and led by Juan Schaerer and Sheila Keshav, this group has come together in a short period of time. There was a great deal of positivity within the team, supporting each other, and getting jobs done from start to finish. I was privileged to be able to hear some the individual stories about how they came to join the team.
From a pain education perspective the roadshow was a great opportunity to talk about ways in which we can help people understand their pain and move on to improve their lives. That’s the purpose of UP. I hope that everyone else enjoyed their time as much I did. This was a super start and I will be very interested to learn how this story unfolds.
After a few months of planning, the Pain Coaching Project started today. This is a really exciting time for Understand Pain (UP) and we are thrilled to be able to offer free sessions to people suffering the symptoms and pain of osteoarthritis (OA).
Pain Coaching focuses on the person, their strengths and their potential to improve their life. This comes in many forms as each person will have their own picture(s) of success. For some it will be an increase in walking, whilst for others it maybe to be able to socialise and feel more connected. We all have our ‘thing’. The aim of the programme is to give you knowledge, tools and practices to improve your life.
Starting with a conversation about you, your life and what you want to achieve, we then move into the practical sessions. There are many practices and tools to use, so we choose those most relevant to you. For example, we look at ways to mobilise your body and improve your quality of movement, breathing, planning your days, organising activities, relaxing deeply, building fitness, mindfulness, improving strength and confidence to be active.
If you would like to take advantage of the Pain Coaching Project and see how you can improve your life, book your place now by emailing here, and putting OA in the subject line.
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.
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.
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.
It’s been a great weekend in Brighton, but now it’s straight back into training to be ready for the Isle of Wight Challenge at the start of May. That means a 20k trot today.
The route yesterday was lined with supporters giving enthusiastic encouragement. Some of the stretches were long and straight, meaning that as you were running, you could see the sea of bobbing heads stretched out in front for some distance. Coming back from the power station to Madeira Drive, the 360 and the pier were landmarks. With the wind blowing at you, they seemed so far away!
The final stretch to the finish line is an incredible moment. The crowd are going absolutely crazy and because you are stretched out, it feels like you are the only runner. Suddenly you’re filled with energy and find yourself sprinting (it feels like sprinting…) to the line. Awesome!
So now onto a longer run that is a totally different experience. My preference is off road, trailing running so although this is 53k x 2 (Sat/Sun), for me there’s no sense of needing to hit a pace. Instead it is about enjoying the ride, meeting others who are in for the long haul and marvelling at the scenery of the island’s coastal path.
As ever, this is for UP, so do follow us with the #upandrun as we seek to raise the awareness of the problem of pain, especially chronic pain, and what we can do as a society to ease suffering.
There is no quick fix for persistent (chronic) pain, but you can understand your pain and move on to a fulfilling life
In a world where we have become accustomed to immediate gratification, the really important things take time and effort. For example, relationships, work satisfaction and wellness. There’s no quick fix for any of these, and the same goes for pain. All require understanding, a picture of success that you work towards each day by taking positive steps. This is normal.
People often ask if they can get better. I say yes. We can always improve and get better. What does this mean? It’s individual of course, but in essence it means that the person feels liberated from their suffering and is able to live a fulfilling life. Do they still experience pain? Probably. But there’s a big difference.
A suffering society ~ time for change
Pain is part of the way we protect ourselves and survive. It is normal and necessary. Yet why do so many people continue to experience pain when there is no immediate threat or danger? Similarly, why do people who suffer PTSD continue to suffer repeated episodes? Why do people with anxiety disorders feel anxious when nothing is actually happening? Why do people feel depressed when there is joy all around? Hopefully you can see the similarity in the patterns here. The words are interchangeable and the suffering immense. This can and must change, and driving this change is the purpose of Understand Pain.
The answers to these questions lie in the way we live and the way society has evolved and is working. This is why a social shift is necessary as we develop a new level of consciousness, understanding the causes of suffering so that we can focus on building wellness.
The difference is the impact factor. The inner disturbance lessens, life fills with meaning and great states more often as the person pursues a purpose and reconnects with people and the planet. We only have a limited capacity for awareness, so when we fill this with people who inspire us, support and love us, when we share and give, when we get outside into nature and feel that we are contributing to something greater than ourselves, life transforms.
There is no super-highway. To achieve a better life requires us to know what that life would look like and take steps in that direction each day. We need a clear direction and tools and practices to use to keep us motivated, orientated and an awareness of the achievements along the way.
We are designed to change — life would not be possible without change. Embracing this natural development, we can learn to create the conditions for moving on, whatever our start point. We continually ask questions of ourselves and the answers determine the quality of our lives via the answers and what we focus upon and decide to do. So asking the right questions is key. Here are some examples >> What CAN I do? How can I build my energy? How can I best look after myself? What steps can I take today towards my picture of success? What can we do together to move forwards? What is the best decision now? And now? Whatever you ask, you will answer.
Suffering chronic pain, you are likely to need support, help and encouragement with practical advice about what you must do each day. Pills do not provide this, nor any other form of quick fix. We are encouraged to push down emotions, distract and turn away yet it is by facing our ‘stuff’ and all the reasons in our life why we continue to suffer. This takes courage but it is the way to transform our lives. And we all want the best life we can create.
Sanjay is a superb example of someone who did exactly this, moving on to a meaningful, fulfilling, challenging, scary, exciting project, Pursu. I would encourage you to read his story on the Pursu website as he has created both an incredible product but more so is the meaning behind it and what he is doing to contribute to society. And this from a story of pain: Sanjay’s story
On May 22nd I will be talking about this and more, giving practical tips and knowledge about pain to help people gain insight and move on. This is free and you can get tickets here
Look out for the orange shirt and share pics >> #upandrun
I am pretty excited now. As usual I woke early, so we will get on the road to the South Coast. I’ve not done a road marathon since the London in 2017, and that brings back great memories.
This week has been a coaster, or tapering, which has its own challenges that are more mental than physical. Although it all comes as one experience of course — I don’t want to disappoint regular readers into thinking I have become a dualist!
I have noticed that the really short, easy paced runs of between 3 and 8 km to be more tough than the long ones! Although important to keep moving and the feel of the stride, I find them heavy, rather boring and puffy (I puff). There you go.
Anyway, it’s off to Brighton, one of my favourite places, to pick up the running pack, take in the sea air, meander through the lanes, end up with a big bowl of pasta and an early night.
If you are supporting or coming to watch the Brighton Marathon, give me a shout and a wave, take a pic and share with #upandrun so we can spread the word and gain momentum. Understand Pain is all about a better world that we can create together.