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The Strengths-Based Shift: Why Pain Researchers Are Asking "What's Right With You?" Instead of "What's Wrong?" | Prof. Niamh Moloney & Barry Moore
122 Plays16 days ago
For decades, pain care has run on a simple question: what's wrong with you? Risk factors, deficits, pathology, problems. It's well-intentioned but could the deficits focus being making things worse?
In this episode of Pain Coach, Lachlan sits down with Dr Niamh Moloney and PhD candidate Barry Moore from Curtin University to unpack a quietly radical reframe in persistent pain research: stop leading with what's wrong, and start asking what's right.
Niamh shares the the beachside journaling session that flipped her thinking. Barry walks through his newly published scoping review in the European Journal of Pain, surfacing 79 studies on protective factors like self-efficacy, optimism, resilience and social connection, that help people live well with pain.
Crucially, this isn't toxic positivity. It's not about ignoring pathology or dismissing what hurts. It's about refusing to reduce a person to a list of their risk factors and building care around the resources they already carry.
If you've ever walked out of an appointment feeling smaller than when you walked in (or unintentionally sent a patient home that way) this conversation will change how you think about pain care.
One problem in, a couple of solutions out. That's the goal.
RESOURCES:
- Free trial of Pain Coach: https://paincoach.co?utm_src=podB&N
- Dr Niamh Moloney on X: https://x.com/drniamhmoloney
- Barry E. Moore LinkedIn: https://www.linkedin.com/in/barry-moore-006a24145/
- 📄 Moore, B. E., Schleidgen, L., Hang, C. P., et al. (2026). "Protection from Chronic Musculoskeletal Pain: A Scoping Review." European Journal of Pain, 30(4): e70273. → https://doi.org/10.1002/ejp.70273
- 📄 Rabey, M. & Moloney, N. (2022). "I Don't Know Why I've Got this Pain!" Allostasis as a Possible Explanatory Model. Physical Therapy, 102(5), pzac017. → https://doi.org/10.1093/ptj/pzac017
KEY TOPICS
00:00 — Intro
00:43 — Disclaimer & welcome
01:22 — Meet Dr Niamh Moloney & Barry — paths crossing at Curtin
03:05 — What is chronic / persistent pain?
05:18 — Why pain persists: the multifactorial picture
09:35 — Central sensitisation in lay terms
12:47 — Why "central sensitisation" grinds Niamh's gears
15:36 — How to know if your nervous system is involved
18:43 — Niamh's lived experience of persistent pain
20:34 — The "why" behind the wider project
24:46 — The allostatic load paper: "I don't know why I've got this pain"
26:14 — Confronting her own risk factors
27:55 — The beach notebook: writing down what kept her well
29:44 — CliftonStrengths and the leadership lightbulb
31:39 — From deficits to strengths: a research pivot
33:09 — Antonovsky, Holocaust survivors & the salutogenic model
36:16 — Barry's scoping review (European Journal of Pain) — 79 studies
38:25 — Strengths aren't just the opposite of risk factors
40:04 — What surprised the researchers
43:30 — Lived experience: how people actually use their strengths
46:13 — Strengths ≠ toxic positivity: validating patients first
48:56 — Why disability (not pain) was the chosen outcome
51:22 — Pain intensity work is coming next
52:43 — The decade-long wider project & future studies
56:58 — Building hope, not despair
58:18 — Advice for someone at their low point
1:04:04 — Where to follow Niamh and Barry
Recommended
Transcript
Introduction to Risk Factors in Healthcare
00:00:00
Speaker
You can come in with a knee problem and then I can send you home with a knee problem, a sleep problem, a stress problem, a weight problem, a physical activity problem. And that's very demoralizing. Like, that is not how I want you to leave my clinic. I think in healthcare, we automatically focus on the risk factors, as we say. My interest in the PhD is, first of all, like what are these strengths?
00:00:20
Speaker
where We call them strengths or we can call them protective factors and in people in people with pain and how do we go about looking for them or identifying them and then subsequently using them in management? yeah Because it can be very, very, very demoralizing and overwhelming if you go in, as Niamh said earlier, you go in with one problem and you leave with four problems rather than going in with one problem and leaving with a couple of solutions.
00:00:43
Speaker
This podcast is not personalised medical advice. Consult a health professional before acting on anything discussed. Just give me 30 seconds before we start. Whether you're a clinician, wanting better outcomes for your patients, someone living with chronic pain, or supporting someone who is, thank you for being a loyal listener.
00:01:03
Speaker
Most regular listeners haven't hit follow yet. If that's you, please tap it now. It tells the algorithm to show this to more people it can help. And that's the single biggest thing you can do to help me and my guests on our mission to create a world with a little less pain.
00:01:22
Speaker
Very nice. Thank you for coming on
Barry's Research Journey
00:01:24
Speaker
Pain Coach. um I just want to give listeners a little bit of an idea of how your paths crossed. Thanks, Lachlan. Thanks for having us. and We're really excited to be here. um So I was ah really fortunate that Barry signed up to do um a research master's project a couple of years ago. So Barry was undertaking the clinical masters in musculoskeletal physiotherapy at Curtin University, where I work. And we had put forward this project as part of a bigger body of work. And Barry took the lead on the project. I think you took the lead on it pretty early on and across the Masters. um So that was our first kind of introduction, I think. Yeah. Yeah. So I did my Masters in Perth. in I'm originally from Ireland.
00:02:16
Speaker
moved here six years ago, did my masters and i I did my masters to try and develop as a clinician and then, you know, interacted with this project. And, you know, two years later now I'm, you know, very much into a PhD. So yeah. And I was lucky enough to have Niamh and the other supervisors as my supervisors, because that's really, know, developed a great interest for me for research. And yeah, very, very happy that I have made that, made that connection.
00:02:43
Speaker
Yeah, awesome. We'll ah we'll discuss the PhD later on in the in the podcast.
Understanding Chronic Pain
00:02:51
Speaker
But i want to give I want you guys to give listeners a bit of an understanding of chronic pain because that's your area of research. Can you give it just a layperson's understanding of of chronic pain?
00:03:05
Speaker
Well, I suppose from a, you know, we we often define things in practice and in research and, you know, by definition, persistent pain is pain that lasts for longer than three months. That's, um in my view, fairly lame um in terms of it's, when we think about pain, it's very much a lived experience. And so for me, persistent pain, that um is the,
00:03:31
Speaker
that carries the burden is the one that really impacts people's lives. and um And when pain persists and interrupts the things that you value, um causes you a lot of discomfort, um stops you from, you know, participating in your your work or your sport or engaging with your family in the way that you'd like to um i think then that it started to become a bit of a problem and we're into that that that space and then there's lots of ways that we break persistent pain down into different pain types and but that's a bit more academic i think and but it's it's helpful sometimes for us to understand that so we can start to
00:04:12
Speaker
to look after it and in a more individualized way. Yeah. Yeah. I agree with that sentence. I think it's just always very individual to the person. Like chronic pain means different things to lots of different people. And I think It's you know most important that you understand what it means to the person that's in front of you. So like, you know, understanding what, you know, as Niamh says, what it's taken away from them and you know how it's affecting them, yeah know, all the different things that could contribute. I know that's something that you're interested in.
00:04:43
Speaker
and lock in Lachlan with your app, like figuring out all the different contributors. And we know that that can be very, very complicated, but also I think it's on us to try and simplify that for people and and help them understand those things.
00:04:55
Speaker
And that's kind of what we're interested in with research as well from you know, we'll probably get into this from a more strengths-based approach rather than deficit-based approach. Yeah, um I'm excited to get into that and the the wider project.
Factors Contributing to Persistent Pain
00:05:10
Speaker
um what Why does pain persist? Like often pain, you know, you get an injury and you recover.
00:05:18
Speaker
why Why does pain persist, which is, you know, that the term chronic pain is pain that persists really? That's a hard question, I think. Yeah, well... It's all the things that talked about in terms of there are multiple factors that can drive can can drive that, can can cause it to persist. And so it might be that you have an injury that is slower to heal.
00:05:44
Speaker
that that that has a more persistent inflammatory profile to it. So at a tissue level, there might be things that cause that to persist. um There might be things, we know that, again, when we look at the research on this, we know that there are many risk factors um that can contribute to and pain persisting. So um whether it's you're quite stressed and life is quite stressful for you, um whether it might be early life stressors, which you might have had no control over, um but that make your nervous system, your your body a little bit more sensitive. um And I think it's really important with some of those things to recognize that they might be risk factors for persistent pain. But actually, they were probably helpful for you in those instances. And we can talk a bit more about that, about how we look at some of these stressors, because actually some of them are probably really sensible in a certain context. um
00:06:40
Speaker
We know things like the things that clinicians say to patients can really influence that. So only yesterday we were at one of our meetings, our research meetings, and we've a mix of clinicians and academics across the the team. And one of the um ah researchers who's in clinical practice just reflected on a patient he'd seen who um had talked about information they were given a year ago from a healthcare care practitioner, which probably stopped them using their strengths. So they had lots of healthy healthy lifestyle factors. They were strong. They were engaged in family activities, you know high engagement. And the advice that they were given actually stopped them from using those healthy behaviors, says help lifestyle factors, um and took them away from those strengths. And so the information was some of the influenced their thinking, their understanding of what was going on, and then that influenced them avoiding things that actually could have been helpful. So there's lots of physical factors, psychological, how we think about how we make sense of our problem, stressors. um We know environmental factors are playing. There's more information, I think, about environmental factors that might be playing out pro-inf...
00:08:02
Speaker
ah promoting more inflammation or pain sensitivity. So it really is a multitude of factors that can influence persistent pain. Is there anything else? Yeah. Well, I think Niamh touched on the environmental factors, but, you know, social factors as well.
00:08:16
Speaker
You know, someone's social circumstances, if they're, you know, it's easy for someone to go out and exercise if they're in a nice, safe neighborhood. Whereas, you know people you know who don't quite have that privilege, it might be harder for them to to try and get out of the pain. and And those kind of things can be really hard to shift.
00:08:33
Speaker
And. and Yeah. Like, i don't know. Yeah. We, we, we really like, and as clinicians it's, it's, it's recommended that we try and pick out all these things, you know, pick out, um, risk factors and if we can try and identify them early and stop people from progressing down that, um, down that path, that would be ideal. But we know that that's not always very helpful or effective, you know, I think we might need to try and broaden our, our, our approach to that, which is kind of what we're interested in as well.
00:09:03
Speaker
and Yeah, so pain is obviously very multifactorial. And when we met Barry, it was around Pain Coach, the app that I developed and trying to simplify that into actionable solutions for people because ah my own lived experience, it's been kind of complex to try to work out well what is actually triggering it, what causes contributing factors are there. And so it can get it can be a bit daunty daunting knowing that it's multifactorial when you're expecting that there's going to be this this one thing that they could fix.
00:09:35
Speaker
um And we'll talk more about that. But if in clinics, so I work at Managing Pain, which is a persistent pain clinic.
Central Sensitization in Pain Clinics
00:09:43
Speaker
um The word thrown around is always central sensitisation as a mechanism, I guess, that underlines some of these factors that you're you're discussing. And Niamh, I know that you've done a bit of work on this. um So what are some thoughts, like what's what's a basic understanding of this idea of central sensitisation and what are some signs that people can look out for? Yeah.
00:10:08
Speaker
you've You've kind of hit on like a little um trigger point for me in ah in the sense that um it's interesting that that's kind of something that's talked about a lot and in in your clinic. and Because central sensitization is is a mechanism, is a mechanism within our nervous system. um And so it's only one, you know, it's only one of those mechanisms. And I guess we've I i guess why is that trigger? I think we've kind of overemphasized this these two words. But however, this kind of idea of if we think about it in lay terms, it's um a more sensitive of nervous system. And so what that means is that you're
00:10:51
Speaker
um your nerves will detect detect information and respond to it more easily. um When there might be some tissue input like touch or some pressure, your nervous system might ramp that up and um and increase the volume on that um and even more so. And probably importantly, it also links a bit to another concept, which is our natural, our endogenous pain relieving system, our natural pain relieving system. and the dial on that can get turned down. So we're not as effective at internally and dialing down our own pain. So normally there's this kind of nice equilibrium of input into our nervous system and our nervous system can control that quite well. It can dial the turn the dial down on it appropriately. um and when And that gets out of kilter when we have ah persistent pain. So that's, um I don't know if that answers that question, but i hope that's a kind of a like more lay version of it. um And there are lots of things that can drive, again, all the things that we were talking about can also influence your nervous system becoming a bit more sensitive, responsive, and and kind of resulting in more nociception, this danger detection in your body. Yeah.
00:12:19
Speaker
Yeah, and there can be anything from the peripheral things we talked about to your thoughts and beliefs or the stressors and so on. I want to push on the trigger point. I'm a physio, right? So because it'll be it it'll also be quite interesting for people um to to hear. what What is it about the idea of central sensitisation that grinds your gears? Yeah.
00:12:47
Speaker
Ah, I love the term grind your gears. and I think, and and look, so I've done loads of research in this space. So my PhD, you know, which is 14 or 15 years ago now and that I completed my PhD, looked specifically at and sensory testing and heightened sensitivity in people with neck and arm pain.
00:13:10
Speaker
And I did lots of work in the early days, like after that, um looking, we did a big systematic review looking at sensitivity and its relationship with people's reports of pain. And we also, um you know, did lots of work around that. So I've been very invested in that in that space. um I was involved in some papers that were looking at how we um how we identify that in clinical practice. And people, some of the the clinic clinical audience will know that we've kind of landed on this term nociplastic pain as reflective as that maybe more reflects this kind of more persistent pain type where there's heightened nervous system sensitivity.
00:13:53
Speaker
I think what grinds my gears about it is that it's a very mechanistic term so it describes mechanisms within the nervous system and then that's kind of gotten extrapolated out to
Debate on Overemphasis of Central Sensitization
00:14:10
Speaker
describe all factors um and i think that's the piece that that grinds my gears i think that That's why some of the papers when we talked about central sensitization pain got criticized rightly because they went, well, that's not the right term because it's a mechanism and you can't have a whole pain type that's kind of predicated on a mechanism.
00:14:34
Speaker
So that's my that's my my gears on it. And even the nociplastic pain and so on, like we... we don't have what good, well-evolved criteria yet. Like it's an early stage that we're at with that. There's a lot of work to do in that space. And it is only one part of the overall lived experience for people. So it's just the the part. It's just the one part thing. Yeah, I guess from a clinic perspective, it's more, it's probably not language we'd use with
00:15:09
Speaker
clients that much, but I think it's more just to understand like the different drivers and and yeah yeah potential sources for the person's pain. do you do you um How would someone know? let' Let's just stick on the central sensitization thing for a second. How would someone how would someone know that they're they might have a nervous system component to their pain?
00:15:36
Speaker
there is um There's ah quite a good, there's been more for the clinicians, there's quite a good time article, I think you might be on this one, with Darren and Tim Mitchell. It's like a masterclass for for pain sensitivity, I think. yeah And that gives some really good examples of when ah of when a clinician might know, or when, if we can probably extrapolate that to to clients as well, certain signs and symptoms that might make you think, okay, maybe there's ah there's an element of that in it. And I think one that I find that...
00:16:05
Speaker
is really can be quite easy for people to understand is pain with light touch. So we know normally that if i if I lightly stroke my hand here, that's not that's not a painful, that's not a painful stimulus that isn't causing me pain. But then when we think that as a nervous system driver in it, those kind of things can can become painful. And that usually makes absolutely no sense to somebody.
00:16:28
Speaker
Then if we can frame it in that way, okay, well, maybe we think that there's nervous system element here that can start to make sense to people. So that would be one example or, you know, heightened, you know a heightened response to to cold.
00:16:41
Speaker
Or I think it's even been suggested, you know, like light and certain smells and that kind of stuff can kind of can kind of trigger pain for people. So when we're looking at those kind of symptoms, when they're not really quite making sense to what we would normally think about just, you know, your usual response to injury, then that's when we might start thinking that there's a nervous system element to it.
00:17:03
Speaker
And I think the the light touch part, that's a really kind of classic sign. But I don't think we see it like, so my clinical experience is mostly in primary care. And I would have seen a lot of people with persistent pain, but I wasn't working in the tertiary care.
00:17:20
Speaker
pain management services. and And so what I would see is people where um this component of nervous system sensitivity um certainly at play, but not necessarily that more extreme version where you see aladinia, for example. um But where I would go what I would see a lot of is pain that's more regional, more widespread. um And ah that might be one, you know, you've got like the right side of my body seems to be more affected or it's your knees and then it's your hips and then it's your back. And um and so the pain either moves around or has multiple sites that doesn't really make sense from an injury point of views, but but that might be one. um
00:18:03
Speaker
By virtue of the fact that it persists, there's got to be some component because so again, come back to the the bugbear around central sensitization is that that's a normal phenomenon. And so it's on a spectrum, right? So it's a normal phenomenon. I can reverse and and to some degree, you know, we see that with post total knee replacements. And then it's when it's become more pronounced, we're more considerate of it.
00:18:27
Speaker
and So I go to like, how would a person know? There might be those extremes of like, I don't tolerate wearing a necklace or a scarf. I get paying down the cold aisle of the supermarket. So there might be those ones, but it might just be that This moves around.
00:18:43
Speaker
I don't know why I'm sore today. And then maybe this is the bit where I don't know why I'm
Niamh's Experience with Stress-Induced Pain
00:18:50
Speaker
sore today. And we start to step back and go, well, what were the last few days like? And so for me, I have a lived experience of persistent pain. And I pained from my kind of my teens to my early mid-30s fairly consistently. I wasn't disabled by my pain, um so it didn't influence what I did in my life that much, but I was really regularly uncomfortable in my body.
00:19:13
Speaker
and um And certainly for me, stress is a trigger. So I will, it took me a while to couple these things together, um but I will have a really stressful day, not sleep very well. And the next day, then I would be sore. And it took a while for me to kind of step back and go, oh, OK, these things are kind of linking up together. um And it wasn't anything I had done or yet. And so that would be a sign, I think, that there might be some nervous system sensitivity at play.
00:19:45
Speaker
Yeah, no, that's ah they're all very, very helpful things, I think, for people to understand and know what to look for, because like we talk about it as clinicians. um And as a patient, it can be very confusing ah if they don't sort of understand the different signs and and what we're looking for and why we're looking for that and how that changes the treatment direction and how they can then engage in life again with those with those different signs, which I guess we' we'll probably touch on later.
00:20:19
Speaker
when we discuss a little bit more around your PhD, Barry, in terms of treatment ideas around it. And you've kind of already alluded to it with the, you know, multifactorial whole person kind of approach.
00:20:34
Speaker
But before we we go there, Niamh, I'd like to... um understand the why behind the wider project that you guys are embarking on, what the project is and and why while you're yeah setting out to sort of tackle this area.
00:20:53
Speaker
um Have you got a few minutes? It's a bit of a story and it's got a few after
Strength-Based Approach to Pain Management
00:20:58
Speaker
years in it. Now, I am Irish, so we do like to tell quite ah a long story, as my partner is always reminding me. um but um so I've kind of set the scene a little bit in that I've been working in clinical practice for quite some time. I've i've mixed academic life and and, you know, working in academia and medicine. and working in clinic and I'm somebody with a lived experience of pain and I've been doing pain research um for quite some time and I think one kind of some of this is coming to the fore maybe about eight
00:21:35
Speaker
seven or eight years ago um and part of it is I'm in clinical practice um <unk> doing lots of assessments that are around this kind of multiple dimensions multiple contributions and like you say they're like you know this thing about why are you asking me about x y and zed you know people would come in I'd get them to fill in an Erebro sleep quite a short sleep questionnaire and a short physical act activity questionnaire as part of the intake And then we'd start these conversations. So we started looking at things broadly. um And I was saying, you know, like, I'm really interested in whether you sleep. And they're like, that's got nothing to do with my pain. And I'm like, oh, I'm still interested because of and it can really influence healing. And it's important in you know pain. And that's why we ask those questions.
00:22:22
Speaker
But I was increasingly conscious that as we're starting to ask these questions and have conversations around different contributors, that that can become really overwhelming. And so I was really realizing in in in very lived experience terms, like of having to pull back a little bit and be careful not to overwhelm because you can come in with a knee problem and then I can send you home with a knee problem, a sleep problem, a stress problem, a weight problem, a physical activity problem. And that's very demoralizing. Like that is not how I want you to leave my clinic.
00:22:54
Speaker
um And so the the flip of that, of course, is that if we look at these things, there are options. and I was had really tuned into Julie Redfern had done this study in cardiovascular health about pick one thing so you can there's all these risk factors for you have a heart attack for all these risk factors for you having another heart attack and and she's done this study of looking at what if you try and change everything or if you change one thing and that piece around changing one thing people have better outcomes So I was it's having that narrative around with people going, okay, there's a lot here, but let's let's think about one thing.
00:23:32
Speaker
And I was conscious about the overwhelm. I was using some of that persistent pain training that I'd had in terms of, like I'd done a lot of work around acceptance and commitment therapy. And that's about like living, tuning into your values and committing to action around that. Some motivational interviewing. What have you done in the past that's got you over this? You know, that that time sounds like that was quite hard, you know, tuning into what people, their own strengths. um Lots of things had, I guess I was, had knowledge around um some of the work that...
00:24:09
Speaker
David Butler and Laura Mamosley were bringing to play around danger in me and safety in me. You know, they were talking about that. So it's bringing that into conversations around like what's good here too, as well as what's, and what are the dangers in me? And I'm not sure I use those terms, but that was the the flavoring in the clinic.
00:24:28
Speaker
So that's one thing that's going on in my brain. Around that time, and this how I know this was in 2020 because we wrote this paper in lockdown. and Martin Raby, who's one of the researchers on this team, and we had a clinic and together, and we talked about this paper and around allostasis.
00:24:46
Speaker
And we wrote this paper called, I don't know why I've got this pain, it was the first title. And it was anastatic load as an explanatory model. And we had talked about this for ages. um Lots of people come into clinic and they've got they can tell you what happened and what the kind of sequence of events was. Lots of people come into clinic.
00:25:08
Speaker
And they go, I don't know why I've got this pain. that There's no specific mechanism of injury. It's not anything, one thing in particular. And allostatic load, so relates to stress load.
00:25:23
Speaker
It's so the accumulation of stressors in your body and how that can lead to um physiological changes in your body that are more sensitive, so that sensitive nervous system piece, and more pro-inflammatory, so you're more likely to have a kind of a low level of inflammation in your body in response to all of these stresses that come together.
00:25:46
Speaker
And it's linked to, it can reach a point where it's overload. And then that can link to lots of chronic illnesses. It's not just persistent pain, but that can lead into lots of chronic inflammatory disorders or metabolic disorders like diabetes and um yeah know things like rheumatoid arthritis often has a stress component to its onset. So there there are lots of conditions where this can be the effect.
00:26:14
Speaker
So we, one of the pieces in that paper was about framing that. And then we looked at lots of literature that pulled together the risk factors. So why does this happen? um And much of that conversation was around psychological stressors and early life stressors so adverse childhood events in particular and then there was physical stressors as well so you know if you're time zoned if you're working across different time zones jet lag high physical stress either in your work or maybe it's a performance thing and I had a moment when we were towards the end of the paper we wrote where I went oh my goodness like that's me and it was really confronting
00:26:58
Speaker
um And I got felt really quite low for probably a week or two because I was like, I have like not all of these risk factors, but I have quite a lot of these risk factors, and particularly around early childhood and stressful life. And feeling like, you know, I felt like the injustice of it, like I didn't have control of that. Like that's just, the you know, stuff that happened. um And then it was like I started catastrophizing and predicting forwards and going like, oh, I'm going to be terrible. I'm not going to be able to go out and do my hill walking in my 60s and whatever that I want to do. um
00:27:35
Speaker
And it took me a week or two to come back to hang on, Niamh, you're healthy. And actually you've recovered from having persistent pain to really not having much pain at all. Not more than I would say I have the normal ebbs and flows of life now. um And so I started writing.
00:27:55
Speaker
I remember sitting on a beach. I was living in Guernsey. remember sitting on a beach with a piece. I used to do bit of journaling sitting there and which and started writing what the things that kept me healthy were. And um it was interesting because i didn't go mental fortitude and whatever. And I'm really fit. And I wrote, I love my feet in the sand.
00:28:16
Speaker
I like running in woods. um You know, it was really, it was really simple things. i have really good friends. I have people who love me. i have people I love. um And it was, and and it started growing and then it did get back to some physio things and, you know, being a bit, I guess, that being a physio was a strength and um that put me in ah a healthcare care context. It gave me a stable income. It allowed me to go and get um therapy for the things that I had to deal with. and But having a stable income allowed me to do that. um
00:28:50
Speaker
I worked in persistent pains. I worked closely with psychologists, so de-stigmatized me being able to go and get care. um i had friends who talked openly about their feelings, which 20 years ago, you know, might not have been. ah but I was really lucky because not everybody did. I think we're more open now. um So those see lots of those things were there.
00:29:11
Speaker
i don't think I ever got disabled with my pain and I think physio helped that and because of, you know, like I understood that, um you know, that me experiencing pain didn't mean I was doing damage, for example. I understood that very early on um and I had great reference points. So that was kind of a ah piece. And then I went to, shortly after I went to Auckland. This is chapter three, sorry. This is definitely the Irish piece where I'm intended into verse three of the ballot.
00:29:44
Speaker
I moved to Auckland to help set up ah um a new physiotherapy program over there. And um as part of that, I did a leadership course. And in the leadership course, the first thing they got us to do was a CliftonStrengths assessment.
00:29:58
Speaker
And I just had this light moment of going, oh wow, okay, um this is interesting. and And so I reframed how I thought about myself because I always was focusing on the bits that were my weaknesses and trying to correct those.
00:30:13
Speaker
And actually they go, well, you need to know about those and you need to attend to those in your team perhaps, but actually you need to think about using your strengths more. So that was a really pivotal moment of going, ah, like,
00:30:27
Speaker
To be a good leader, you actually have to use your strengths. And I started talking um to Martin and others about this around, okay, well, like we don't, we're not that explicit about this in pain care. Maybe we should be.
00:30:41
Speaker
which shorter chapter, we're coming to the end, but which brought us into looking at the literature more broadly and going, oh, well, they do this in OT and they do it in mental health.
00:30:52
Speaker
and um And there are other disciplines that are more explicit about this and do it more intentionally. And actually there is bits of this in acceptance and commitment therapy and in chronic pain management and in positive psychology and in cognitive functional therapy. And in pain education, there are definitely elements of that in there that are threaded.
00:31:15
Speaker
Even person-centered care is in there and is threaded. But we could be more explicit about it. Let's start and look at the literature and see what's out there. Over to Barry's paper. That, you know, was that first paper of going, OK, let's look look at what's out there in the literature. And then let's talk to people and see what are the strengths they've used.
00:31:39
Speaker
Yes. Thank you so much for sharing. sorry Sorry, Barry. well i will I will come to the PhD, I promise. ah that's what The initial reason for the podcast was a PhD.
00:31:52
Speaker
um But thank you for sharing, Niamh. I have my own lived experience with persistent pain and I I've shared a similar journey actually in, ah in, in many ways, you know, not very disabling, high high functioning, able to, you know, I played master's footy on the weekend, but I, I still struggle from day to day. um And,
00:32:17
Speaker
Yeah, just I actually came to this point where I was like, was it helpful to learn about pain science for me? Was it actually that protective or was it problematic? um And i'm probably I'm sure there's other people, clinicians out there that, you know, might might share that story as well but um thank you for being vulnerable because it's it adds so much to the work that you do honestly um that clinical experience you're not just a researcher but also the lived experience so um i love the direction and uh now over to you barry tell us about the phd
00:32:50
Speaker
Yeah. So, um, my interest in the PhD is first of all, like what are these strengths where we call them strengths or we can call them protective factors, um, in people, in people with pain and how do we go about looking for them or identifying them and then subsequently using them in management.
00:33:09
Speaker
And I find the, where this idea for me comes from about protective factors, i I find quite interesting. There's, there's quite an interesting story behind it for me.
Salutogenic Model and Resilience Studies
00:33:19
Speaker
Um, and early on, when I started engaging with this, with this project, and I was looking into strengths and protective factors. I came across this.
00:33:28
Speaker
and a medical socio sociologist called Aaron Antonovsky. and And back in the seventies, he was, he was doing, or probably even earlier than that, he was doing research into the effect that stress has, has on people.
00:33:43
Speaker
And a really interesting story for me was he was looking at and women who were young, young adults during world war two Um, and there was, there was a group of women and there, there, were there were Jewish women and there was a group of women who hadn't been in a concentration camp and had, and a group of women who had been in a concentration camp.
00:34:04
Speaker
And they looked at the proportion of people who were in reasonable health, emotionally and physically in each group. And 51% of the people who hadn't been in a concentration camp were in reasonable physical and emotional health.
00:34:18
Speaker
And 29% of those people who had been in a concentration camp where were in reasonable physical, emotional health. Obviously, we normally would look at, okay, wow, 71% of these people are not doing very well. And that kind of reflects, you know, us as a society, but also healthcare, we kind of do focus on those things.
00:34:40
Speaker
But if you actually step back and look and think about, that's astonishing that 29% of people, nearly one third, nearly one-third of people who had been through unimaginable horror in a concentration camp and then were displaced and then ended up settling in a country where there's there's been repeated wars. They're actually and kind of thriving emotionally and physically.
00:35:03
Speaker
And that kind of led him down this path of, okay, what it is it what is it about these people? There must be something about these people that's helping them you know get get through that hardship and and and be thriving.
00:35:14
Speaker
So he kind of started looking and and and developed this model called the salutogenic model of health. and And that basically means like, and what are the origins of health or wash what makes people healthy?
00:35:28
Speaker
And he coined this term generalized resistance resources. And and what what those are is what are the factors about somebody that helps them to combat stressors and actually come out the other side of it and move towards move towards full health?
00:35:43
Speaker
And if we, if we kind of apply that to pain, musculoskeletal pain, you've you've probably seen these these people in practice, Lachlan, and they're out there in the community that have significant, maybe pathology or significant pain problems, but they're actually functioning mean extremely well. they're they're you know They're thriving physically, they're engaged, they're they could rest they dig might self-define as living well with pain. And that's something that's been, yeah I've seen a lot in the research about people who, despite having these problems are living well. so if we
00:36:16
Speaker
What I'm interested in then is looking at what it is about these people. And in so the first publication of my PhD, it's been published in the European Journal of Pain.
Research on Protective Factors in Pain Management
00:36:26
Speaker
just last week. And I think first of all, I'd like to acknowledge that it it it was a team effort. it was It wasn't just me writing this. you know I had support from my supervisors and co-authors, particularly Leon Schleiden over in Germany and then some other collaborators across the country.
00:36:41
Speaker
and So we what I was interested in is what are the kind of factors that might be, we'll say the term protective or might help people you know, live live well with pain. And the outcome we we were looking at was specifically disability or or someone's ability to function.
00:36:59
Speaker
And, you know, we looked at a whole load of studies dating back. I think the earliest one was in the 80s, looking at different factors that were associated with either lower disability or or better function in people and people with them with chronic musculoskeletal pain. And that includes things like back pain, neck pain, rheumatoid arthritis, osteoarthritis, those kind of things.
00:37:23
Speaker
and And we identified 79 studies. So there was a lot of... them data to look at and go through ends and amalgamate. And the kind of the results that came out were, like, if we we haven't really mentioned yet the biopsychosocial model. I'm not sure if people listening, I'm sure clinicians will be familiar with that, but maybe clients listening to this may not be familiar with that term. But really what that means is, you know, when we speak of pain, we we recognize that there's biological factors that can
00:37:55
Speaker
that can contribute to it. There can be psychological factors like Niamh mentioned before, like low mood, stress, those kinds of things. And then social factors like your social support or your socioeconomic status can contribute to pain. And the the results that we we found kind of broadly mapped to that idea that there are biopsychosocial factors, but we were more interested in the things that are inherently positive rather than, i think in healthcare, we automatically focus on the risk factors, as we say.
00:38:25
Speaker
And when we think about protective factors, I must admit that when I interacted with this project, first of all, when I thought about protective factors, I was like, oh, well, that's just going to be the opposite of risk factors.
00:38:38
Speaker
And that, I think, just reflects that, you know, that diet that deficit's bias in healthcare, that we are very, very focused on that. And obviously that's important. But obviously my understanding now has changed to change a lot, that protective factors can be inherently positive by themselves.
00:38:53
Speaker
They might exist on a continuum between, yes, low levels or risk factor might be protective. Or, you know, things could have U-shaped relationships where, you know, a high level of a protective factor might might eventually become...
00:39:06
Speaker
become not helpful. But um so we identified things, you know, there was psychological factors such as things like self-efficacy. That was a key one.
00:39:16
Speaker
um And what self-efficacy means, you know, in kind of simple terms is your confidence to carry on despite despite having, we're talking about pain in this specific circumstance. so despite having pain, that was a key key factor that came up most frequently.
00:39:35
Speaker
Other things that came up were things like optimism and resilience, a positive, and you know, positive expectations of recovery. What else now? Like some biological factors, things like your, your, your strength, your exercise capacity, your, your, your flexibility, those kinds of things. And then social factors such as, you know, positive social support, good relationship, cohesion, socioeconomic status, education, and those kinds of things.
00:40:04
Speaker
So like that, so for for me, while, you know, there there's obviously needs to be more research into these specific factors to see how protective they are over time, or if, you know, if we look at them more detailed, it might get whittled down to some more just some more important things. But for me, it really just... um brought maybe just opens up our my curiosity anyway to start considering that there is more to look for than just risk factors. Because I think the danger is, and I've experienced this myself with engaging in we're engaging with them you know engaging with them the healthcare system, that people can very easily be reduced to just their risk factors and their pathology.
00:40:47
Speaker
And the risk of that is we don't see someone as their you know, as the in terms of their strengths or their abilities or what they're able to do. you know, if you're looking at a someone's past medical history and it says something like, um, degenerative lumbar spine, you get this automatic negative bias about that person without realizing actually they're extremely hardworking.
00:41:08
Speaker
They're engaging in exercise all the time. They're, you know, they're really engaged in their community there. They have all these strengths. So yeah, for me, it's just that with this, we just start thinking about these things in a little bit more detail and a little bit more explicitly.
00:41:25
Speaker
Was there any surprises when you went through the the research project that of things have popped up or were you like, oh, that's you know what what I expected to see?
00:41:36
Speaker
like I certainly expected there for most of these factors to be in the psychological domain. and I think that pub that probably reflects you know we're just where the research is. and And I wasn't surprised that things like self-efficacy comes up over time, because i think I don't think it's controversial to say that we know that self-efficacy is an important thing.
00:41:59
Speaker
um There was, I was potentially expecting some more physical things to come up. Like, you know, muscle strength came up maybe once, once or twice. was surprised that that hadn't been, you know, and but maybe that just reflects, you know, me as a physio, that's what I can, that's what, that's what seems obvious to me. There was some, if I try to think now, there was some, maybe some Like so in terms of the lifestyle things, and like adherence to a Mediterranean diet came up. I thought that was interesting. Um,
00:42:33
Speaker
You know things like physical activity came up, which I wasn't surprised about. We know that physical activity is helpful, but I think just the, the, yeah, the, the kind of overwhelming focus on psychological factors was probably, was probably important or yeah. Noticeable for me.
00:42:49
Speaker
Can I, can I add something to that as well? I think what I was surprised about was, um, how much literature was actually out there. So one of our problems when we did the scoping review was actually and the number of hits we got. and weed we had to We had to get like research screener, which is this way of kind of semi-automating the screening process. um And we wanted to be broad and expansive in our thinking, but we actually ended up with a lot of literature. So that was one surprise for me was like, actually, again, you know, as as kind of ah and working into a newish space, it was quite a bit out there. um
00:43:30
Speaker
we don't We can't say for sure it's a scoping review, so that's really inclusive. It doesn't whittle things down to go, this is the most important factor, because we didn't look at the balance of what's contributing and what's negative. Like, we didn't look at that. We just looked at anything that had a positive association.
00:43:46
Speaker
um I think the other part to me that that's been really interesting is probably a second study that's come out of this, or is part of this broader work, and that's about, we've we were just about to publish a ah paper on um ah lived experiences of people who who have recovered or live well with pain, where we specifically asked them about their strengths and what they used in their journey. And I think what um what was really lovely about that project was it was very broad.
00:44:19
Speaker
One person was saying, I'm an athlete, I'm very disciplined. um I'm very process driven. Give me a process and I'll follow the process. um Like I would never have asked that about that in clinical practice.
00:44:33
Speaker
But I think going, hang on, what are those things that like you do well or how could we kind of optimize your care knowing that like maybe you're quite process driven or we might see hints of that.
00:44:44
Speaker
There were some people who really use their social networks really well. So i remember this one lady who talked about, um how she she was really mindful herself so she had practiced a lot of mindfulness and she was very she was very connected to different people she's a really big community and she would go if I need a boost and a push I'll go and talk to this person So she, one of her friends or, you know, that she would read our family members that she would reach out to whenever she needed a bit of a push in the right direction. She's like, when I need some TLC, I'm going to go and reach out to this person for a little bit of love and a hug and a cuppa. And, you know, and so she was like, she was very um ah intentional about how she's using her social network, which I thought was really cool. um So I think though there was a really broad richness of things that, the people with lived experience were telling us that reflects this bit like when Barry talked about we can be very reductive in in our clinical practice to what again it says what's the problem what are the risk factors and then we lose sight of actually the resilience and resources that live within people
00:45:57
Speaker
the 29% of people that have been through horrors and can come out the other side and be live really well. And I, I, I find that really inspiring to know that they like people can really thrive through all of this.
00:46:13
Speaker
I think just an um important show point on, on that, you know, with, with the strengths based approach, we're obviously explicitly, we want to look at these, people's people's strengths, but it's really important that we like, we're not ignoring someone's, someone's risk factors or somebody's, somebody's deficits. You know, we still need to be very safe clinicians. We need to do our screening. We need to understand these things. And if, if someone needs very specific and important, yeah important care that we are providing that if we can, or we're referring onwards, if, if it's outside of our,
00:46:44
Speaker
our scope or, you know, if we can do things to help address those, but maybe we're, maybe when appropriate, we're not emphasizing those, those risks and we're just trying to use what's, what's available to somebody already to try and, you move them in the right direction.
00:46:58
Speaker
Cause I think just like, sorry, I'm going to jump in on that one. is that It's so important, isn't it? Like if someone comes into you in clinic, um, They want to talk to you about a problem that they're having.
00:47:09
Speaker
So how invalidating would that be if we just go to, oh yeah, but this is great and this is great and this is great. Like that is not something that we are advocating at all, but we still need to engage in really good clinical care that listens to what the person's telling us, understands their problems, understands their concerns, triages them properly, assesses them properly so we're safe in our clinical practice and appropriate. And can we enrich this by understanding there's a whole person that sitsby sits with it?
00:47:39
Speaker
very Yeah, I'm glad you addressed that. I was actually about to just raise that as like one of my, I love the project. I think it's amazing. And I think like I love the, the,
00:47:51
Speaker
the wider project and I'll be watching this space as they come through. But my concern was exactly that because like patients that come and see you, they want validation because many times they feel like they've been invalidated by, you know, healthcare professionals. And I just wondered whether this would lean into sort of like that toxic positivity where they're coming in like there's something wrong with me and you're like, no, everything's, you know, you're like,
00:48:22
Speaker
Yeah, definitely don't want to do that. It's it's really, and and in fact, the people with lived experience told us that as well. So we had this one piece that was the allure of the deficits model. and And it's just a fundamental, I need to understand what's going on with me. And that's fundamental to anything in terms of making sense of pain and where that kind of balances and making sense of pain and whether there's a bit of pain neuroscience in there, who knows, you know, that might be part of that. um But it's um that' that that's actually really important. But it's also also we have to be safe as clinicians.
00:48:56
Speaker
Totally. Barry, why did you choose disability? I'm disappointed, ah to be honest. ah The reason being is because, know, I feel like And fortunately, and I'm very grateful for this, like function's not a problem for me, right? You know, I can do a lot of things. um But my...
00:49:18
Speaker
I would love to feel less pain. and And I actually, I have these conversations a lot because kind of every now and then on LinkedIn, someone, so a clinician will say like, oh, we need to move away from a pain focus and we need to ah worry about function.
00:49:35
Speaker
and i And I go, well why Why don't we just let the patient decipher what their goal is, whether it's function or pain? Because for me, function's not important. It's ah it's about pain. Anyway, why did you why did you choose to look at disability and not um pain?
00:49:53
Speaker
Yeah, well, as Niamh alluded initially when we were doing this, like our our search strategies, we wanted to include multiple multiple outcomes.
00:50:04
Speaker
And pain intensity was was one of them, you know, disability, physical function, and then maybe even some mem kind of health-related quality of life. But... As Niamh said, the we we were surprised by the amount of literature out there.
00:50:17
Speaker
So it was like a reasonably from a feas feasibility point of view, we did have to kind of narrow the focus focused down a little bit. and that was on to to pain intensity and, that's sorry, not pain intensity, ah disability and physical function. And I suppose it kind of does, like, I i completely understand what you're saying. There is that narrative around about...
00:50:35
Speaker
you know, what do people, you know, people want to get their lives back rather than, you know, reduce pain. But that's, i you know, as you've just said, people often do want to just reduce their pain and and and they're already functioning very well.
00:50:50
Speaker
So yeah, it was kind of a feasibility point and kind of kind of thing. and and But it's coming. Spoiler alert. It's coming. Spoiler alert. Yeah. So watch this space because there is more work.
00:51:00
Speaker
Yes. Yeah. So yeah, it's in process. The pain intensity part is in process. yeah so Because I'm with you. I have that same experience where disability wasn't the factor, but yeah, the pain pain was. And I think... For a long time we've gone to, in research anyway, we've gone to, well, disability seems to be where we can change.
00:51:22
Speaker
So that's probably part of that driver, right? That seems to be more accessible to change than pain intensity itself is. And so, but I also would encourage your audience to understand that while we can't promise you can change pain, it is possible because I'm somebody who's gone from having regular pain and to not having much pain at all in the last kind of 10, 15 years. So yeah, it is possible as well. Yeah, it's awesome. Yeah. I feel like I need to get you back on, Niamh, for part two, just hearing your story and your sort of personal journey through it all. I think that would be very, very helpful.
00:52:03
Speaker
um And selfishly, I don't do this for anyone, to be quite honest. um Hopefully people will start to tune in and listen. But really, i just it's an excuse to sit down with people that potentially wouldn't sit down with me if that if it wasn't for the podcast. and um Tell me a little bit more about like the wider project and like what your' your vision of where you want to go with it, some of the projects that potentially might come out of this or some that are already underway and how how people sort of stay stay in tune with what's going on.
00:52:43
Speaker
Do you want to talk about your PhD part first then I'll talk about the broader project? So like yeah with with my PhD, as I mentioned, I'm interested in how we assess someone's someone's strengths. So that's kind of where I'll be going with it. And obviously this the scoping review is the first part of that to just kind of figure out what are the strengths or what are the potential strengths.
00:53:09
Speaker
And then, you know, moving on to, you know, discussing with clinicians how they might use strengths or assess strengths or what what a strengths based approach means to clinicians there or, you know, how they go about using strengths, assessing strengths if they do assess strengths or whether it may be what are their perceived barriers or or and or facilitators of of implementing strengths based approaches.
00:53:32
Speaker
And then hopefully leading on to developing some sort of assessment methods that, you know, clinicians can try and can, can try and use to actually try and pick out, okay, this like Lachlan comes in to see, he's coming in to see me.
00:53:46
Speaker
What are the strengths that I can maybe, maybe, um, kind of well hop onto or, or leverage, um, in, in, in, in the management. And then, that kind of will probably lead on or leads onto the kind of the wider project as to how, you know, you've identified someone's strengths.
00:54:03
Speaker
Great. Then what are you going to do? Like what do you what do actually do with those, with those, with those strengths? So that kind of leads onto, I suppose, and Dr. Martin Raby's work and, and, and Neve's work.
00:54:15
Speaker
So the broader project, I guess, this we've we've already alluded to a couple of the other studies that are in it. Um, Barry's work and the other part of that scoping review on the pain intensity, they're they're really in that information gathering phase. So we kind of go through these different phases in research where we go information gathering, let's pull together what we know today. So we've done that from the literature and then we've got the lived experience of people with pain.
Positive Pain Trajectories and Thriving
00:54:42
Speaker
um And then we're working on um looking at people
00:54:47
Speaker
who've got positive pain trajectories. So those people who um really haven't had much pain at all um or have recovered. um And so we've got some lived experience and qualitative studies. We've interviewed those people.
00:55:02
Speaker
and Martin's um got working on the positive pain trajectories from large cohorts. So these are, um there's a cohort study here in Perth. and So,
00:55:15
Speaker
for kind of a general audience, a cohort study is basically taking a large population of people and studying them over time. And so the RAIN study is one of those studies here in WA and people come in, they were on gen two, so they would have, ah they've been hit they've been with the RAIN study their whole lives and we're taking their data from age 17 to 27 and going okay we've we've mapped their trajectory so there's a group of people who have pain and you can see this kind of inflection in there where they start to increase in their pain and there's a group who've had pretty mode mild moderate pain and then those who've had low pain um across this 10-year period and
00:55:59
Speaker
like with that risk focus for decades and decades, we've really focused on what is it about the people who don't do well um and all the risk factors. And we've used these people who are, who do well as the reference group, kind of assuming the absence of risk. And so what we're doing is then going, okay, let's look at these people who have, that are on that mild pain trajectory and What are the factors that are associated with that? So we've we've kind of moved through analysis. um um That's been a big piece of work this year where we're kind of at that stage of having some preliminary data and we can see the factors that might be associated, profiles of things that might be associated with that. um And there are lots of things that we've already talked about, but there's more physical data. So so we're going to do that. And we're doing that again in the Hunt study and the 1958 study, which are big, big cohorts that span decades. So we can have like really robust data around this. and
00:56:58
Speaker
We want to build... we' We're doing some work with clinicians going, what do you understand about um strengths and how do you do it? So there's some work with clinicians um developing a framework for assessment. And then, yeah, what does care look like? So we'll need to move into a phase of looking at what does care look like? um and and how are people doing that so there's work around that in terms of kind of building that that that piece and so that's a there's a decade of work but you know that's a might be following us for a while lot because it takes quite a long time to do all of these phases and and and so people say oh it takes 10 years for it to get into clinical practice well it takes quite while to do to do that work right away
00:57:48
Speaker
No, it's exciting though. And I um wish you guys Godspeed on it so that we can get better outcomes for people um with persistent pain. um Yeah, lastly, I just want to i always close with this. um What, do you have some advice for someone that's listening to this and they're, guess, need maybe at your low point, um what would your advice be to them?
00:58:18
Speaker
So I think in my low point, the best thing I did was sit down on that beach that day with an open pad and just started a stream of consciousness writing about all the things that were actually really positive that I had used or was using.
00:58:35
Speaker
in life to keep me well and to get better. And we've often talked about this in terms of like, I said to you, what are your strengths, Lachlan? You might go, oh, but if you start going, okay, well, if that's hard, that might be something people do because that might anchor them into that. And and then, um but you might go, well well, you've overcome X, been through bereavement or you've worked hard at that exam and you got through it what is it about you that got you through that so you kind of lean into your own mastery um you know not in an egotistical i'm amazing kind of way but just in a like you know what i do do some good stuff here like i do have some skills knowledge resources inside of me and so i think the first thing i would say to a listener would be maybe that's a good place to connect and then go am i using that
00:59:28
Speaker
Am I using that to the best of my ability? Could I, is there more here I could use? um And sometimes we talk about de-stress, like I, for me, de-stressing parts. So stress sensitivity was something that's really big for me. And um I can, there's but there's, and you can go, well, I need to take things out of my life to de-stress. Actually, what I need to do is go for a bike ride with one of my girlfriends. Like that is one of my best things or sit on a beach and go for a swim or, you know, those kinds of things were the things I need to put something in that helps me de-stress.
01:00:00
Speaker
um So I would big pad stream of consciousness. Are you using, are you using some of that stuff? Is there, is there more good stuff, more more gold here that you can tap into? Awesome advice. What about you, Barry? Yeah.
01:00:17
Speaker
Um, my advice would be that you are more than just your w risk, your weaknesses and your, your pathology and, you know, find, find someone who's going to help you, help you realize that really try and understand you and, you know, try and get you to do more of the things that make you feel, you know, that fill, fill your cup, as they say, and, and like, you know, really understand what, what motivates you, what's, you know, what your meaningful activities are and what your goals are and that kind of stuff.
01:00:45
Speaker
And, you know, because it can be very, very, very demoralizing and overwhelming if you go in, as Niamh said earlier, you go in with one problem and you leave with four problems rather than going in with one problem and leaving with a couple of solutions. So that would be my my advice from a clinician point of view. I don't have the same lived experience as but, you know, from a clinical perspective, i think it's I think it might be nicer as a clinician as well.
01:01:10
Speaker
to, you know, to kind of practice in a bit more of a positive way, you know, it can be maybe a little bit more, make you feel maybe a little bit better as a clinician because it can be, it can be hard when you're you're dealing with, them you know, lots and lots of negative you know risk factors and narratives and that.
01:01:26
Speaker
And clinicians say that. So we used to teach a lot of pain. I teach a lot of pain education, pain courses. I do that university level, but i used to do a lot more CPD courses for clinicians and clinicians would always say that they find it really hard when we get into the psychological factors, physios in particular, because we don't have, we have a much stronger grounding in the physical part.
01:01:49
Speaker
um And they're often ah nervous about opening that can of worms and, um you know, maybe feeling like that that that's a hard space to be in. And I think that's true, that what you said is really good. Like, um you know, being able to tackle that, but from a place of being able to have those conversations and growing your skills around having hard conversations and, you know, tricky conversations, but from a place of, but there's more here too. This is here and also, and this too, like there's these good, there's these positive things. um I like that phrase. I'm going to steal that, that one around you go, instead of coming out with four problems, you go in with a problem, you come out with four
Building Hope in Pain Management
01:02:27
Speaker
solutions. I like that. That's a, that's going to become a catchphrase. You heard it here first. Yeah.
01:02:35
Speaker
Yeah, that's awesome. I just want to zoom out a little bit and say like when it comes to pain as a, you know pain is a protective mechanism. It's trying to tell us something, whether that be like, you know, take your hand off the hot plate or you know, some of these other more broadly lifestyle changes that that we've touched on.
01:02:55
Speaker
it's It is fascinating to sort of see your project in that pain protective kind of view and and the role that fear sort of plays in on that. Because, yeah, like if you go in with one problem and come out with five, how's that how is that helpful for ah a system that's already under immense stress? yeah So I think i think there's heaps in this and I'm excited to see it evolve over the, I guess, decades by the sounds. But um hopefully they'll you you can group feed it for us.
01:03:28
Speaker
yeah yeah yeah sure yeah on that point we really will want to get like you know we really want to try and build hope in people rather than rather than you know despair of leaving the leaving the clinical encounter with with problems so yeah it really is kind of anchored in hoping a positive outlook that's awesome so many people are looking for that so that's that's epic if people want to follow along What are they, where do they go? What do they look at? Is there links? Is there like, how do, how do they keep track of what you guys are doing?
01:04:04
Speaker
Yeah. Well, I'm, I'm, I deleted my Instagram recently because it you know, wasn't one of those things that was filling, filling my cup, but I'm on, I'm on LinkedIn. I know that's not very. you know patients probably aren't on linkedin looking for these stuff or from a clinician point of view i try and post some strengths based stuff every now and again and and post some research and neve i know you're on linkedin as well yeah i'm on linkedin and x so um dr neve maloney on x you'll find some i'll start sharing some more there i've withdrawn a little bit but i can re-engage i think it's important to share this and maybe we'll look at that as a way of trying to um share a little bit more as the journey goes.
01:04:47
Speaker
Yeah, awesome. Awesome. Well, thank you guys so much for for coming on and I'm keen to get you back when some of these things develop. Yeah. Thanks so much for having us. It's been really fun to chat to you about it. um Yeah, really excited about the project. And yeah, thanks for sharing our story to other people as well. Yeah, appreciate it thanks for Thanks for taking the time.