It is at this time of year that I reflect upon what I know about pain. In particular, persisting or chronic pain. This is the combination of knowledge, experiences and thoughts that I have gathered on my journey so far. Most of this comes from spending time with people and listening to what they say about their experiences.

Who are those people? They are members of one of the biggest clubs in the world, which no-one wants to be a part of — chronic pain, also known as persisting pain. Perhaps 20% of the population suffers, including children. Pain is one of the major health burdens, affecting millions and costing billions.

On an individual basis, people have their own story of how the pain emerged and continues. Each describes the impact in the form of disconnection with what matters in their life. In one sense, my role is to help them reconnect with the important things: people, purpose, the planet (nature) and their bodies.

It starts with understanding pain — what is it? Why and how does it persist? And importantly, how is it happening in this person’s life? To help someone understand their pain and move on, you have to get to know them, their life and their style. By style I mean their unique approach to life based on their beliefs. All of this starts very early on in life with our formative experiences and learning. 

My approach

In brief, it is person-first. This means that I focus on the person, their potential to get better and build wellness. All efforts are put into helping, guiding and encouraging the person to design and follow a way forward to achieve a picture of success using practical tools and strategies that deliver results.

Pain Coaching is the concept that I continue to pioneer, drawing on the ways we can work with individuals to achieve success. It is a blend of the latest understanding of pain together with strengths-based coaching. We draw on the person’s positive history, clarify their picture(s) of success and then design a way forward using practical tools and strategies. The overarching aim is to improve lives, and I believe that we can.

This is mind, the common complaints that people arrive to describe include back pain, neck pain, arthritis pain, fibromyalgia, complex regional pain syndrome, recurring sports injuries, headaches, migraines, abdominal pain and pelvic pain. In essence, my role is to help people who are struggling with their pain, wherever this is felt in the body.

So, onto pain itself, recognising that it is a unique perception of the person. There are several key questions that I will lightly explore.

What is pain?

This is the ultimate question. Well, one of them. For me, this sits alongside classics such as who am I? But then I am biased.

It starts with a vision.

My vision is a world that understands pain and knows what to do about it. For this to be realised, what must we know? For starters, to answer: what is pain?

There is plenty that we do know. Unfortunately, much of this is not yet in the day to day public realm despite the original thinking emerging in the 60’s from Ron Melzack and Pat Wall. We can consider them as the fathers of pain medicine and science.

Melzack and Wall realised that the brain played a role in pain. They also understood that signals from the body were modulated in the spinal cord and brain, meaning that pain and injury were not well related. This is a key message: the perception of pain is individual and variable depending upon a range of factors.

From there onwards, bands of scientists have run with the baton, cheered on by a relatively small number of clinicians and interested parties. Consequently, our knowledge base has increased enormously, creating much hope. We can say with certainty now that pain can and does change. Now we need society to catch up so that we can reduce the burden of suffering. In one sense, I see this as my calling.

What is the purpose of pain?

This short article can only provide an introduction. Pain is a vast topic that draws upon biology, psychology, philosophy and sociology. Most revealing in recent times has been the study of consciousness, in my opinion. Therefore, we will necessarily just scratch the surface.

Pain delivers a message. It highlights needs in one’s life with compulsion, immediacy and a special type of urgency. The noise pain creates is difficult to ignore. But then perhaps we should not be ignoring or distracting as there is a purpose, or a need. This is similar to hunger and thirst, also need states.

Often people will describe how they ignore their pain or distract themselves. This maybe an important strategy under certain circumstances, but only ever meeting a short-term need. Understandable in the modern world of short-termism, instant gratification, and ‘now-ism’. This is part of our normalised thinking within the sociocultural setting.

Yet pain is a call to action. You know what it is like to be repeatedly asked to do something, which you ignore and become increasingly irritated by the request. If you took note and then did something about it, the requests would cease. Fine, except what do I do about persisting pain? This also has a message. I do not believe that it is somehow erroneous or maladaptive.

What can I do?

This is the question that everyone asks me in different ways. They also ask how they can gain control. The answer is that there are plenty of things you can do. But most will only make sense when you understand pain as a need state that is perceived as part of the way we protect ourselves.

In short, we can seek to meet our needs and build wellness. If, however, the person is focused on a disc or joint or pathology at the expense of all else, they will miss the many opportunities to move in a desirable direction. Readers will recall that pain and injury, pain and tissue state are not well related. Especially as time progresses.

What are my needs? There are plenty of these. Some may be familiar with Maslow’s hierarchy of needs. We certainly need to feel safe, to be nourished and to feel heard and wanted. We also need to self-care. Many struggle with these due to social conditioning that has taught them otherwise.

Often with some guidance and encouragement, the person makes discoveries about their needs. They uncover the message that the body is communicating. Common examples include reconnecting with what matters (people, purpose, the planet) and their body, processing trauma, focusing on what they want to achieve instead of why they are not, a good diet, movement, to reframe things that create stress and breathing.

Building wellness and meeting needs overlap. Both require day to day habits, so we are seeking to form new and healthy ones that shape a positive future. In other words, the choices we make today and everyday thereafter play a role in the quality of our future life. How I am now is a culmination of the decisions I have made to date – the body (person) keeps the score (also the title of an excellent book that explores the embodied impact of trauma). So, how do I want to be? What do I want my future self and life to look like? It begins now.

There is always a risk that some take this as blaming, which it is not. Instead, it is a positive approach, which is seeing things as they are (positive realism), working towards a picture of success and taking steps each day.

No-one chooses to be in pain. But by developing understanding, we can begin to take control and build a better life from wherever the start point. My role is to encourage, educate and empower when invited to do so, and support the person on their journey.

This is the start point for 2021.

Want to keep learning?  Find out more about the author, Richmond Stace - Specialist Pain Physio