My learning journey through pain

When I came out of uni in 2003, I came out with a very biomedical framework. It was amazing that we would be “fixing people in pain”, but were taught very little about pain . Over the next 10 years, I was helping many people, my “magic hands” were casting their spells and people were feeling better. But there was always a percentage of patients I couldn’t help.  Truth was, a lot of the techniques I was using were not magic and didn’t do most things I thought they did, but people were getting better. There was still big gaps in my knowledge and understanding.

In 2010 I had chronic pain, depression and anxiety. When I reflect on the years before my pain, I was probably sitting on the edge of depression and anxiety for many years, I didn’t even know I was struggling. I had the full catastrophe going on – kids, mortgage, one income – and my way of making more money was to work harder. My sense of self and self-coherence was slowly being eroded and I had stopped doing what made me, me.  I stopped fishing, exercising, gardening and learning and I was just surviving. Then I started to get an ache in my right shoulder………..

“The vulnerable organism is more prone to pain states, when you are low you hurt more easily” (Louis Gifford 2014).

When the pain didn’t go away, I started catastrophizing about the meaning of the pain and what it meant for my family and for my future – how would I do my job and pay the bills? I was using a lot of avoidance behaviours in an effort to stop me from hurting myself further. I couldn’t see a clear path forward and I couldn’t make sense of what was happening to me.  Over the next year and half I saw Myo’s, Physio’s, Osteo’s, Acupuncturists and my GP.  None of this treatment was very helpful for the pain and I spiralled into depression and anxiety.  My danger detection’ systems were in overdrive, I was perceiving dangers everywhere and was a feed forward mechanism, where I was rapidly going downhill. Looking back the pain was not a 10 out of 10, it was more a 5 out of 10, but if you listened to what I was saying (I mean really listened) the word “pain” was like a code word,  I was saying I was in trouble and needed help. Not one of those therapists asked me about my mental health and how what the pain meant to me.  They were just focusing on the pain and looking at it as being a tissue-based problem.  Back then most practitioners (including myself) were working within a mainly biomedical framework.

I remember waking up one morning and thinking if I died at that moment I would not care.  Death would have been a relief, and this was the catalyst for me to take control and do something about my depression. For a lot of people there is a clear turning point and for me it was this day when I started changing from “being a patient, to being a person again” (Thompson 2019). I went to my doctor and I started treatment for my depression. In the weeks that followed I started moving again in spite of my pain (realizing pain did not equal damage) and I enrolled in an 8-week mindfulness course (MBSR – Mindfulness based stress reduction).  Mindfulness was probably the hardest and most rewarding skill I have learnt in my life, and the course was hugely influential in cultivating a change in my relationship with pain, mental health and my sense of self. I developed coping strategies that moved me towards what I valued and loved, and I looked at ways of decreasing the dangers (real and/or perceived?) in my world (or at least giving them less power).  Gradually I got my depression under control and my pain went away. Could there be a link?

This experience is behind my drive for helping others in chronic pain or in vulnerable state. It was a catalyst for me to fully embrace the biopsychosocial framework and delve deep into pain science. You need to be able to pick up on when a client is struggling or has deteriorating mental health because early intervention is vital for stopping or slowing the progression. We are not Psychologists, but we need to be psychologically aware, so we can make appropriate referrals when needed. I have developed a networking group in the hills of different health professionals to give us a wide referral network to help manage and treat this interplay between chronic pain and mental health more effectively.

In 2014, I felt like I needed more knowledge and didn’t know where to look. I remembered an author of a book that I read at university many years before. I decided to google this guy David Butler, to see if he had written anything else. I nearly fell over when I realised, I had missed a whole new world. David had written a lot more books since Mobilisation of the nervous system. Like a lot in the group reading explain pain was a game changer, it helped me to make sense of the BPS model. I went deep into the Explain pain journey and was getting some great results, but there was still a percentage of people I was not helping, what was I missing?

Reading Explain Pain for the first time many years ago, triggered a seismic shift in my understanding of the pain. The reconceptualization from a more biomedical, linear understanding of pain, to a more biopsychosocial, emergent understanding of pain, made so much sense to me. Explain Pain utilises storytelling and metaphor to bridge the gap between what the patient knows and what they don’t; knowledge can have a powerful at changing the persons relationship to pain and how they interact with their world. My understanding now is that we are not trying to replace pre-existing knowledge but give the patient a greater repertoire on how to respond to their pain, challenging pre-existing beliefs.  A lot of the time education alone won’t change a person, but it’s what they do with this knowledge that’s important and challenging embodied behaviours and creating more flexibility in how they respond to their changing world.

In my local area back in 2016 I set up a health practitioner networking group where we can build connections and learn together. When people come into our clinics do they just come in with just a sore shoulder or back? Well NO, they come in with all the complexities that make us humans. One practitioner won’t have all the skills to help a patient with all facets of their health. But when a network of practitioners brings their different skill sets and work together, we can give our patients the best quality of care and get them onto the road to better health. As practitioners we are working with people every day, but it can be a lonely job and you can feel isolated. A big part of the group is supporting and helping each other with the challenges of running a practice and with how life interacts with it.  A lot of this is driven through my own personal experience many years ago where I felt isolated, and I was struggling with life. Some of the talks have been aimed about self-care for the practitioner to make sure we have coping strategies to keep us at our best. The practitioners in the group have become close friends and people I can now rely on for support and for this I am very thankful.

In 2017 a wonderful human called Bronnie was a speaker at my associations conference in Melbourne. This was the next catalyst of change for me. Bronnie didn’t mention ACT in this presentation, but a lot of what she was talking about resonated with me. The following year I did another workshop with Bronnie and Alison Sim around ACT and motivational interviewing. This workshop helped me to make sense of what I did to help myself many years ago when I was in chronic pain. I essentially did ACT and now I have a name for it. I spent many years reading the books by the wonderful Russ Harris but it was a lonely journey as no one around me in Allied health was thinking the same as me.

In 2020, I stumbled on the ACT in the clinic course with Laura. This course is exactly what I was looking for! A community of people passionate about learning and helping people is wonderful. Over the next few years, I spent time working with Laura on ACT, predictive processing and pain geek. This has challenged me on many levels, from a practitioner and personal perspectives. This last year I have stepped away from study for a while and was concentrating on integrating this knowledge into the clinic, working with chronic pain support groups in my local area and running health networking events. Now its time to start learning again.