#upandrun moves on to the Isle of Wight

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.

RS

#upandrun Pain Points (6): there is no quick fix for persistent pain but you can understand your pain and move on to a fulfilling life

Me with Sanjay who created Pursu nutrition bars

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

Together we move on.

RS

#upandrun >> the day before the Brighton Marathon

The day before the Brighton Marathon

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.

RS

#upandrun Pain Points (5): Pain can and does change

Pain can and does change

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.

RS

#upandrun Pain Points (4) Pain is a need state

Somewhere I was running

Pain is a need state

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.

RS

#upandrun Pain Points (3) ‘Pain is whole person’

One of the final tapering runs, in the sun #upandrun

Pain is whole person

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.

RS

#upandrun Pain Points (2): pain and injury are not the same

CRPS UK running vest for the Brighton Marathon

Pain and injury are not the same

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.

RS

Pain Points (1) with #upandrun

Pain Point (1)

Pain is what the person says it is

This may sound obvious but I think that we need this to be loud and clear. There are still too many people who say that they feel that they are not believed when they describe their experience.

I started my career in healthcare in ’93 training to be a registered general nurse. My fascination with pain began in the theatre recovery rooms when I noticed how propel responded so differently. The ‘size’ of the operation did not seem to matter. How the person was, in other words their state, really did.

Studying pain, I inevitably came across the quote from McCaffery (1968) on pain: “whatever the experiencing person says it is, existing whenever the experiencing person says it does“.

This has ever-stuck with me. Everyone behaves in such a way as to meet their needs. When a person describes their pain experience, these are not merely words. It is an expression of need. In chronic pain, we must ask why is pain a predominant feature of this person’s life? What are the needs that must be met for the suffering to ease?

To understand this, the person must be free to express their lived experience from the first person perspective. As clinicians and therapists, we can only gain insight through deep listening within a supportive, encouraging and compassionate environment.

Deep listening involves being present and paying full attention to the person. Not only do we hear their words but we see how they are embodied and delivered. Getting to know our own biases and beliefs allows us to let these go so that there is no ‘filter’, just pure awareness. This begins the therapeutic process.

See the latest #upandrun post here >> Brighton Marathon to raise awareness of the problem of pain and what we are doing to drive social change

RS

Understand Pain Talk & Workshop 22nd May

Richmond at The Understand Pain Workshop

The Understand Pain Talks and Workshops are our way of getting out into communities and listening to people: the voices of society. A suffering society. At UP, our purpose is to contribute to society by showing people practical ways of reducing their suffering by living their best lives.

Understand pain and move on to live a fulfilling life

On Wednesday 22nd May, Richmond will be talking and running an UP workshop in New Malden.

This event is free, although we always welcome donations to fund our going work.

Click here to get your place

 

Getting the best of Christmas

5 top tips if you suffer chronic pain

If you are suffering chronic pain, here are 5 tips to maximise your festive spirits and joy. You can decide upon your approach and give it your best by following some simple principles.

1. Make a plan

What is your picture of success? How do you want Christmas to be? What can you focus on that would make it memorable for the right reasons?

The questions we ask ourselves, we will always answer. So, make sure you come up with ones that self-encourage, helping you to focus on what you want, rather than what you do not want.

Think and act like the person you want to be

Make a plan each day, prioritising the key moments, punctuating them with rest and recovery time. You can share your plan with those you’ll be sharing the day with so that everyone is on board. Of course, the best plans do not always turn out the way we want, so we need to be flexible. However, if we try to stick to it in the best way that we can, often made easier by writing it down, then we are doing all that we can to be successful.

2. Motion is lotion

This is a way of nourishing your body (tissues — muscles, joints, tendons etc.). The key is to be consistent through the day. In essence, the movement is ‘pumping’ blood and hence oxygen into the tissues as well as removing the build up of toxins (that cause sensitivity).

The brain is embodied, and needs movement to survive — the brain needs a body. Pretty much everything that we do requires movement. Anything that gets in the way of the movements necessary to meet our needs will raise the perceived threat value. As many readers will know, pain is well-related to perception of threat and the state of the person, and poorly related to the tissue state.

Move to groove >>> any movement is a good movement!

A simple way of using ‘motion is lotion’ is to move and change position every 15-20 minutes, and then stand up and move around every 40-60 minutes. These are ball-park figures and it is important to work out your own need for movement. Further, you may like to use prompts and reminders until this becomes a habit.

3. 3 breaths

As often as you can remember (use reminders for this as well), stop and pay attention to three full breaths. Notice the moment when you first breathe in, the sensations in your body, and as you breathe out, the sense of letting go.

Attention is one of the skills of being well. A famous study was entitled, ‘the wandering mind is an unhappy mind’; in other words, the more we can pay attention to what is really happening, the happier we feel. Paying attention to your breath is a simple way to develop this skill.

Notice how you relax and muscles ‘let go’ as you breathe out. This is because on the out-breath, the parasympathetic nervous system is more active. This branch of the autonomic nervous system is responsible for all the important healthy functions behind the scenes: digestion, sleep, energy, anti-inflammatory activity and more.

5/5 breathing >>> count slowly to 5 as you breathe in, and count slowly to 5 as you breathe out. Continue for a minute or two, or longer

We have no direct access to our biology. It is in the dark, so to speak. However, there are one or two things we can choose to take control over to an extent. Breathing is one, with all the benefits that come with the innumerable practices that have been ‘breathed’ over the centuries.

A further use of the 3 breaths is when you feel tense, pain, frustrated, angry, upset or any other emotional state. Notice how when you pay attention to the breath, those feelings ease. This is because you have stopped fuelling them with the thoughts.

4. Meaningful connections

We need each other. We are design to connect and share and be generous. Have you noticed how your feelings change when you do something for someone else, no matter how small or insignificant that it may be? In fact, it is the little things, consistently, that make the difference, especially in a relationship.

How great does it feel to be with people who care about you, and you care about? Notice how that feeling builds when you pay attention to it (re-read the bit on attention above if necessary). Become aware of those great feelings and sensations in your body when you merely think about a special person.

Even when you don’t know the person you are encountering, can you make the connection meaningful by passing the time of day, and smiling? Of course you can! This can become the way you do it; your style.

Watch other people interact, share and be kind to each other. You will change state and feel it. Pay extension.

One way of connecting is by touch. Again, by design we have a system dedicated to light touch that is a direct way of soothing another, showing care and concern and evoking a healthy biological response. This is also a simple way for a partner to share a moment with you.

The key to feeling the effects, is to be present. This is the only moment, right now…it’s gone, and here is another…gone, and so on. Being present means that you can pay attention to what is actually happening, rather than being embroiled in the mind’s wanderings. To be present is also a skill to practice.

5. Smile. Just because you can

Notice what happens when you bring on a gentle smile. A soft upturn of the corners of your mouth. You can choose to tie this in with the now well-known practice of gratitude. The (biological) state of gratitude is one of the healthiest and an ‘antidote’ to suffering states.

Before the practice, it is important to acknowledge that all states are normal and part of the spectrum of feeling states. We need all of these states of course, as they communicate a need.

What are my needs right now? This is a great thinking tool, as you step back from being caught up in it all, and realise what it is that you need to do in this moment: move, breathe, eat, re-frame a thought etc.

What are my needs right now?

To practice gratitude is to become aware of something in your life that you are grateful for. There are many things that we can chose. Of course, whether they become apparent depends on your mood. A handy mantra here is: for a good mood be grateful, in a bad mood be graceful.

Practice: think of a moment in your life when you felt truly grateful for something. Focus your full attention on this memory, re-living it using all your senses, noticing which senses amplify the feelings. Is it the sights, the sounds, the feel? As you continue to focus on the feelings as they arise in your body, notice how they build.

Moment to moment noticing of things to be grateful for and those that bring you joy is a practice; a skill. For instance, you can decide to approach the day by looking out for things that make you laugh or smile. Then you practice.

The fact of the matter is simple in principle. The challenge is to keep focused and pay attention to what is really happening in the face of the many distractions. It is to realise that we live out a story that can appear to have been written for us. There’s some truth here in as much as we are fed beliefs from a young age, many of which are wrong, yet can limit us as we grow. Realising that you do not have to continue with the same story if it is full of suffering, is the first step to moving onward. Many don’t realise their potential, feeling that somehow, this is it. Not true. Is it time for a new story for you?

What will be your story from now?

And so, what will be your approach? How are you going to do Christmas? How are you going to do life? What is your picture of success? What principles must you follow each day to get those little wins on the way forward? Make a plan, get the right support and encouragement around you, and go for it. Each person is a miracle when you think about how we came into existence and how we are designed to grow and serve a purpose.

Merry Christmas.