General Articles

You have a background in physiotherapy, how did you come to specialise in ongoing pain issues specifically?

I was first interested in pain experiences and chronic pain when I was training to be a nurse.. I picked this up again during my physiotherapy degree when Professor Mick Thacker gave a couple of lectures on pain science. I went on to study pain neuroscience with Mick with the intent of specialising in the early-mid 2000s and I haven’t looked back!

Lots of people think of pain as a normal part of life - particularly when living with chronic conditions - when should people seek help for ongoing pain? 

Pain is a normal part of life – everybody experiences aches and pains. Unfortunately, with the biomedical model continuing to predominate, many people do not realise all the things they can do to improve their life and ease their suffering. 

The main ways of dealing with chronic pain continue to be pills, medical interventions, sometimes exercise and then some people attend a pain management programme. The problem is that pills and interventions do not offer sustained transformation of pain, and do not teach the person how to live themselves into a better life. They are passive whereas understanding and overcoming chronic pain is an active process of learning and living. When the person truly understands their pain, they realise this truth. 

What is the best way to manage chronic pain? And, does this differ for different people? 

There is no one way or single therapy. Instead we must meet the person where they are, clarify their needs, then agree on the way forward and create a practice.

When creating a practice, you have to consider four main interrelated themes:

(1) Specific skills and exercises to achieve particular goals such as improving mobility, better quality movement, increasing strength and capacity (e.g./ walking).

(2) Day-to-day skills – this is the bulk of a person’s time; their waking hours. How to live in such a way (thinking and acting) that they are following a path of getting better. This includes planning, prioritising, periodising activities, engaging and re-engaging with meaningful activities, self-care and recharge time. This theme is key and is based on the philosophy of living better.

(3) The skills of being well – this includes day-to-day skills and how to take this further, including gratitude, paying attention, awe, self-compassion, sleep, and diet. 

(4) Skills and strategies to relate and respond to challenging moments. Suffering is inevitable so we need ways to relate to it with skill and care for ourselves, knowing that things are always changing. 

What are the long-term effects of chronic pain?

The ongoing suffering and pain can affect all aspects of a person’s life, especially if they believe they cannot improve it. Many people are just told to cope with pain, but this is very limiting. 

When the person understands their pain, they know this to be true and can act upon it in specific ways to improve their life. There are many ways to improve your life, even from the most difficult start point.

How have clinical approaches to pain changed throughout your career? 

There have been some positive changes in the clinical world and society, but nowhere near enough. There is a long way to go because the biomedical model still predominates, despite it failing to offer explanations for chronic pain and effective ways forward. 

Despite this, the progress in understanding chronic pain with science and philosophy coming together has been enormous. Seeing the person first and as a whole person in their lived world helps us to explain people’s experiences and offer practical ways forward. 

 What are current perceptions/stigmas surrounding pain that you want to bust?

Many! Here are just some of the wrong messages:

• Chronic pain does not change
• Chronic pain can’t get better
• Pain is the same
• The person has gone backwards
• Injury and pain are well related
• Pain is in the brain
• Pain is a process
• Medication and interventions are the main treatment options
• There are particular therapies for pain

 If someone is living with pain, what are your top tips for managing it?

Firstly, understand your pain. You will probably need help and guidance on this because most of the information out there is outdated or wrong and you won’t know where to look.

When you understand your pain, more possibilities and opportunities become available, partly because your beliefs have updated, beliefs play a role in shaping pain.

Then have a clear picture of success – what are you working towards? Clarify why this matters and the strengths that you will use.

Work with a healthcare professional who truly specialises in chronic pain. It’s important to ask about their training and experience. They will guide and encourage you, helping you understand your experiences and create a practice.