I have had the privilege of being trusted to relieve other people’s musculoskeletal pain for 2 decades now. It’s been a wild and interesting ride. Much of what I have seen and experienced wouldn’t surprise you at all. Parts of the experience I wouldn’t even bother retelling because you would think I was either insane or dishonest, the human body is a deep and mysterious place. Any any case it has been a constant and unending learning curve.
The most important learnings for me have and will always be those that help me do a better job. Practical learnings can take many forms for a pain clinician. Some learnings are purely ‘hands on’ and skill based in nature, other learnings can be around correct decision making and mindset, and others learnings relate to the all important patient psychology. Here are some of my most fundamental learnings, I share them in the hope that they may help you to better understand how to resolve your own pain.
Whether you are getting treatment for back pain, heel pain, headaches, plantar fasciitis, hip pain or sciatic pain on thing remains a constant… the need for trust. Trust is so important in healthcare interactions that it almost trumps any other ingredient.
Imagine if you required the most simplistic of all healthcare interventions, removing a splinter, now try and get that done without any trust. There is no way you would let me dig a splinter out of your finger with a pin if you didn’t trust that I had your best interests at heart. Therefore the splinter will remain in your finger until you find someone you do trust to do the job, at which point it becomes a very easy matter. If that doesn’t happen eventually that splinter could get infected, leading you to a great lesson in the value of trust. This simple example illustrates for me how important of a factor trust really is.
Managing chronic pains like back pain and headaches requires a far more sustained form of trust than the removal of a splinter. This greater need for trust is further inflated by the fact that we often don’t fully grasp the processes involved in treating our pain the same way we do that splinter. Without a good understanding of the topic we seek help with greater trust is required when we hand over control to our chosen professionals.
As a practitioner there is nothing more disconcerting than working on the stubborn sciatic pain, neck pain or foot pain of someone who you can sense isn’t really ‘feeling the trust’. Over the years I have become highly atuned to the non-verbal signals that patients put out when they aren’t willing to trust the process. Experience has taught me to be pretty pessimistic about the chances of success in such cases.
Having seen how hard pain management is when trust is lacking I have developed a deep sense of gratitude for the massive amounts of trust so many of my patients put in me. Their trust is something I might have taken for granted early in my career, I most certainly don’t any more. I think many people would be surprised by how easily managed even the most stubborn pains are when there is a high level of trust sustained over time.
Degeneration & Injuries
Over the years I have become more and more aware of the connections between the injuries we sustain when we are younger, and the wear and the degeneration we suffer with later in life.
I had 2 eighty year olds in my office recently, a husband and wife who have a very similar lifestyle and health history. The husband lives with chronic pain in his ankle and the wife has no chronic pain whatsoever and is far more mobile. I had them both show me how well they can stand on 1 leg. The husbands balance standing on 1 leg is so bad you would think he had a neurological disorder, whereas the wife can balance quite nicely.
The cause of the massive difference between the 2 was a series of badly sprained ankles that the husband had sustained as a younger man. When informed him that the reason for his pain and his lack of balance was the fact that those sprains had never recovered properly he told me that he “already knew that and had been able to feel it”. Those un-rehabilitated injuries have left him with chronic pain, chronic muscle weakness and a chronic loss of mobility.
Many of the injuries we suffer with early in life are caused by subtle weakness and herald the onset of early degeneration later in life. Other injuries that we suffer are the precise cause of those degenerative changes later on. Joints that are ‘unstable’ tend to wear out much faster than joints that are strong and well aligned.
There is great news for those of you who are willing and able to work with the strength, alignment and wellbeing of your joints. Much can be done to slow down or even stop problems from developing later on.
Pain is not nice, that’s kind of the whole point of it. If the pain of touching a hot stove wasn’t so motivating it wouldn’t serve its biological purpose. If the pain of a broken leg wasn’t so intensely unpleasant, you would keep running on it. This very nature of pain is what makes living with stubborn pain so horrible, it’s like we get stuck with something that was only ever supposed to offer temporary guidance.
The fact that pain is so frustrating can make surrendering to the process of relieving and rehabilitating it very challenging. This difficulty is exacerbated a thousand-fold when we add the ‘time’ ingredient. If you are sick to the back teeth of your pain and I tell you it isn’t going away within 3-6 months it can be pretty depressing news.
Where this natural frustration becomes a big issue when it erodes our resolve to follow a course of action. This aspect of human psychology is not unique to pain obviously. When we are in a rehab process that is taking way longer than we want it to there is a clear and present temptation to start considering other options, or even worse quitting all together.
The frustrating truth is that turning up to a clinic like ours with chronic pain can be like turning up at a gym with chronic obesity. Good things take time. I meet many people each year who prematurely discontinue care simple because it isn’t progressing as quickly as they told themselves it should.
To this day I still feel real frustration for people every time I see them allow frustration to erode their resolve and commitment to processes that are merely time dependent. I sincerely hope that each of them find solutions that work for them, but that isn’t always easy with chronic pain; especially when you are imposing your own schedule on what is fundamentally part of nature’s realm.
Persistence is king if you want to get rid of chronic pain.
Over the years I have instinctively sought to simplify everything that I do. I try to keep treatments as simple possible. I try to limit exercise prescription to a small handful of the most important movements. I try to keep my explanations as simplistic and waffle free as possible… with variable success.
For the longest time I felt a bit self conscious about how simple my processes have become. We live in a world that values ever more complex and sophisticated solutions and technologies after all. Increasingly though I have learned from far more accomplished people than myself that simplicity is often a symptom of mastery… so here’s hoping that’s the form I have taken.
The value of simplicity in the world of pain management can sometimes be powerfully demonstrated to patients. I meet people on a weekly basis who have had north of 20k worth of medical treatments and investigations for their pain with no success. These same people then experience rapid resolution of their pain over a handful of visits where they are scraped with a $1.50 porcelain spoon. Hard to think of a better advertisement for simplicity than that.
The value of simplicity in rehabilitation processes is vast. Any exercise program that is going to reliably bring lasting outcomes for chronic pain sufferers needs to be executed long term. If I hand you a bulky complex solution and ask you to execute it long term the chances of you doing so are very close to zero.
Open mindedness doesn’t really sound like the most practical of things, it is usually more just a sort of dispositional choice that we intermittently make in life, as we hop from one topic to another. Over the years though I have come to view open mindedness as being as important as intelligence or hard work in terms of its practical application. The reason for this is that open mindedness often facilitates a more flexible approach to problem solving.
I can remember even as a child that I would often be willing to take the devils advocate position on many topics. Subjects that my friends and family were pretty settled on (usually based on whatever the most common narrative is on that topic) I would often be more open minded about, it caused a lot of lively debates.
Without any conscious intention on my part my open mindedness has been a major help to me over the last 2 decades of managing pain. It has lead me to a series of breakthroughs in understanding of how to manage pain that would not have been possible had I taken what I learned at University and called it the gospel. Over time it has massively expanded the number of people and complaints that I am able to help.
Even at the most fundamental level open mindedness is an essential building block in the healthcare process. When we seek the help of a doctor we are looking for someone who was open minded enough to undertake great learnings. We are also looking for someone who is open minded about the possibility of our own healing and the likelihood of solutions to our physical suffering. Without these ingredients the train doesn’t even get out of the station!
Given how complex the body is and how little we still understand about pain, it isn’t surprising that I am still learning after 20 years of pain management. I still have a lot to learn and ‘we’ still have a lot to learn, the statistics on chronic pain in western culture are grim and getting worse all the time.
The great news from my perspective is that what I have learned above all else are 2 key things. Firstly, that chronic pain is totally figure-outable in the VAST majority of cases. Secondly, that the solutions are generally way more simple and cost effective than most of what we currently do medically about chronic pain. This is the best possible news!