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.
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.
This is a strong message and one that must be realised.
Life is only possible because of change and impermanence. Each moment unfolding is new, and fresh. Bodily sensations such as pain appear in our awareness as the objects and contents of consciousness, just as thoughts, sounds and what we see appear to us. This is our lived experience. When we stop and watch our own experience, this can be realised.
What often stays the same and recurs is what we tell ourselves about the pain we are feeling. Of course this can be reinforced by the fact that the same things are challenging each day. We attach to our stories. The inner dialogue can be so influential despite the fact that much of what we tell ourselves is untrue, self-critical or pure nonsense at times. What we need is a self-encourager that comes from self-compassion.
A problem that we can all have is the remnants of, or continuation of coping strategies that we once learned to shut off from stress, avoid pain and protect ourselves in the short term. However, in the longer term, the coping strategies cause dysfunction and prevent us from getting better and improving our lives. These are not set in stone and we can create new habits that build wellness and resilience, which support us create a better life.
Mindful practice and meditation is one way of realising this experience, gaining insight into the difference between the sensations of pain and the thoughts that we have about the pain. Learning how to observe our thoughts, feelings and experiences enables us to cut through the sense of self, be in touch with reality (the present and only moment), let go and liberate ourselves from on-going suffering.
Buddhism talks about the two arrows. The first arrow is the pain that you feel. The second arrow is the suffering caused by the way you are thinking about your pain. Learning about the knowing the difference is important.
There is much to be hopeful for. For some years I have focused on helping people gain insight into their suffering and what they can do to move onward. Compared to 10 years ago, people are much more open to what we know about pain rather than being dominated by limited beliefs and social conditioning that we are all subject to in unique ways from childhood through. The research and study of pain continues to reveal much that we can distill into practical tools for day to day use. Improving lives is a learning process, taking on new habits to build momentum. Some of the skills initially surprise people, but soon enough they realise their potency in changing our experiences sustainably.
Pain can be thought of as a need state like hunger or thirst. Similarly, emotions are considered to be indicative of our inner physiology that guide as towards a range of actions to make sure that we maintain healthy parameters.
Pain is an experience unique to the person. It cannot be seen, it has no shape, colour or form. Pain is typically hard to describe although we have a large number of words that attempt to capture the feeling. Using the word itself tells us that the person is having or has had an experience of the sensation, yet it tells us nothing of the type of sensation. The particular qualities are always private and part of the inner world. Much like thirst. Try and describe the sensation of thirst…
What is a need state? This is when we become aware of a feeling, often closely associated with thoughts (the brain basis of thoughts and feelings co-exist, which makes sense), which has the purpose to motivate action. Our brains and its body systems need each other, and this is part of how we obtain what we need to survive. Our brains are only interested in survival, which is why many people suffer as a consequence of the lives we lead within the current society.
We are designed to look out for danger, and together with the ability to think back and ahead, we can perceive threat very easily. As we keep practicing this, we get very good at it! The consequences of worrying about things that usually don’t happen, or replaying past unpleasant events include all sorts of common ills. For example, chronic pain, IBS, headache, migraine, functional movement disorders, anxiety, depression, pelvic pain, skin disorders and autoimmune diseases. The reason is because we become ‘inflamed’ by the way we live, spend much time in a protect state and hence the healthy mode is quashed. We can change this as soon as we decide to improve our lives in a number of ways.
All of these feelings mentioned above are all signs. They create the opportunity to make changes, create new habits and build a better life. This makes sense because there are many ways we can now satisfy our wants, and indeed society encourages this everyday. You may want to buy things, accumulate stuff, eat junk food, drink alcohol, smoke cigarettes and more. Yet we do not need these things, which only bring very short term relief before the next urge.
Pain as a need state to be transformed requires facing the reasons why the person remains in pain. This can be challenging because we don’t usually like to deal with our ‘stuff’. Instead, it appears easier to take a pill or have an injection or something else that appears to be quick fix. However, none of these things truly transform suffering and liberate the individual. Medical care can contribute a little, but it is the work of the individual to understand their true needs and meet them each day that makes the difference. Pills do not teach you how to live well moment to moment. You must learn the skills of being well in your own way.
This is the purpose of The Pain Coach Programme. To deliver the insight to people so that they can understand their pain and move on to a fulfilling life. This is whether they are a struggling athlete who feels on-going pain, someone with a condition that features pain, a person who feels life has got on top of them and they hurt (and feel exhausted all the time), right across the ages and certainly spanning our society.
We must revise our thinking in society so that the suffering eases. That’s the purpose of Understand Pain (UP and why I am running (follow #upandrun on Twitter) many miles, writing these blogs and giving talks. We can do this together, so please share! All of what I write is based on the latest research and understanding of pain, so whilst it may sound different (and I hope it does), this is because we have been conditioned to believe something more simple. But the more simple version is not solving the problem. It is likely making out worse because people are continuing to rely on drugs and other means to get better, when they do not provide the answers. You do.
What does this mean? Put simply, pain is experienced by the person and not by the bodily location or part. In the case of back pain for example, it is not the back that is in pain. Instead it is the person who experiences back pain. This is no different to thirst in as much as the mouth does not experience thirst and head off to get a drink. The person does.
Now, what does ‘whole’ refer to? Again this is a key point of understanding. There are no separations. We are whole. The lived experience, what it is like to be ‘you’ in any given moment, emerges from the meeting of thoughts, perceptions and actions (enactivism).
One of the reasons why considering the whole person is so important is because it is the person that we treat. Pain is poorly related to tissue state, but it is well related to the state of the person. It was Oliver Sacks, the famous neurologist and writer, who stated that it is as much about the person as the condition. He was a man of great compassion and insight.
Conditions in name are lists of signs and symptoms. They are brought to life by the whole person in a unique way with all his or her thoughts, feelings, emotions, expectations, hopes, priors and beliefs, each in a different environment and context. A huge number of variables exist within every unfolding moment. Listening to the narrative illustrates this, which is why deep listening is important.
The model that best represents the whole is the biopsychosocial (BPS) model. Truly using this approach means that the biology, psychology and sociology of pain are considered, in relation to each other. It is in the middle of these overlapping dimensions that the person’s experience sits. This is what we seek to improve, the lived experience.
When we focus on the person and what they want to achieve in their life, we can design a programme that encourages and supports them to take steps in that direction each day. This can only be achieved by thinking about the whole person.
There is a straightforward difference between pain and injury. Pain is subjective and injury is objective. Pain is a lived experienced. An injury is a disruption of the body tissues. You cannot see pain. Usually, you can see an injury.
Unfortunately the words are often used interchangeably. Further, there is the belief that pain and injury are well related. However, we have known that this is not the case for many years. Pat Wall, one of the forefathers of modern pain medicine and science, spoke about this in his famous 1979 lecture. Since then there have been countless studies showing that pain is part of how we protect ourselves and related to the state of the person within a particular context.
We have many stories of varied pain responses to different injuries. Sports people continuing to play with sprains and fractures, soldiers sustaining severe physical trauma reporting no pain, and the large proportion of people suffering the symptoms of IBS without any notable pathology. More-so, there are no investigations that show pain. Pain cannot be seen on an X-ray or an MRI scan.
We must be clear. People suffering pain must understand why they feel pain, why and how it can persist, and then focus on the steps that they can actively take to move on and get better. Misunderstanding pain is one of the main stumbling blocks. Erroneous thinking results in wrong decisions about treatment and self-care, but also impacts upon the sense of empowerment, belief in oneself to improve and hope.
Truly understanding pain helps the person to let go of unhelpful and fearful thoughts and to build confidence (in moving for example). It creates a strong foundation from where the person can build and gather momentum towards their picture of success.