Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Why We Should Teach Every Child About Pain | Joshua Pate
73 Plays1 month ago
In this episode of Pain Coach, physiotherapist, researcher, and TEDx speaker Joshua Pate joins us to unpack the complexity of pain - especially how children and adults make sense of it and why our beliefs matter so much for recovery. Josh shares powerful metaphors, practical strategies, and inspiring patient stories that highlight the balance between short-term relief and long-term change.
We discuss how pain science can transform healthcare, everyday coping strategies, and even prevention - starting as early as schools. Whether you’re living with pain, supporting someone who is, or simply curious about how the brain and body work together, this conversation offers hope, validation, and tools to help you move from the backseat to the driver’s seat of your healing journey.
Resources
- Pain Coach: Helping Clinicians Take The Guesswork Out Of Pain Treatment
- Connect with Lachlan on LinkedIn
- Book an appointment with Lachlan
- Joshua Pate’s website & resources
- Zoe and Zac’s Pain Hacks children’s book series
- Josh’s TEDx: The mysterious science of pain
- The “One Thing” Project
Key Topics & Timestamps - 00:00 – Introduction
- 06:38 – Josh’s journey: From physiotherapy clinics to pain research and children’s books
- 10:48 – Myths about pain: Why pain isn’t just about “damage”
- 23:42 – Turning down the pain “volume”: The Lego Experiment
- 40:47 – Validating pain: Why “hurt ≠ harm” isn’t always helpful
- 46:15 – Practical Tip #1: Making sense of your own pain and how others see it
- 49:26 – Practical Tip #2: Multidisciplinary support and short vs. long-term strategies
- 52:11 – The ladder analogy: Small wins build toward big change
- 55:25 – Inspiring patient story: From toilet-seat struggles to the Great Wall of China
- 58:47 – Driver’s seat vs. backseat: Balancing agency and support
- 01:03:08 – The “One Thing” project: Messages of hope for people in pain
- 01:05:00 – Closing reflections: The importance of curiosity, validation, and prevention
Recommended
Transcript
The Transformative Potential of Pain Education in Schools
00:00:00
Speaker
And if we spend even like 1% of the time learning about pain at schools, like it could be totally transformative. The same way that I learned about sun safety and recycling and and not smoking and all that stuff when I was a kid. And now that's a normal behavior for me because I think it has like a, um like we call it a protective effect. The chances of someone developing pain-related disability could be less. And that's my hunch.
00:00:24
Speaker
It might not be, like I might be wrong, But like we need to at least test it. Like the latest science seems so compelling that we should at least be doing a study on it, right?
Joshua Pate's Role in Pain Education
00:00:34
Speaker
Today on Pain Coach, we sit down with Joshua Pate, physiotherapist, pain researcher, and senior lecturer at University of Technology, Sydney.
00:00:45
Speaker
Josh studies how kids think about pain and how those beliefs shape their recovery. He's the author of the children's book series, Zoe and Zach's Pain Hacks, and a TEDx speaker reaching millions worldwide.
00:00:58
Speaker
Josh's mission is to reduce the time gap between discoveries in pain science and adoption by kids, parents, teachers, and the general public. This podcast is for educational purposes only.
00:01:12
Speaker
The views expressed in this podcast do not constitute medical advice and are general in nature. You should obtain specific advice from a qualified health professional before acting on any of the information within this podcast.
00:01:27
Speaker
Josh, this morning I used an AI perplexity to ah to explain to me um who you are If you could have um tailored that, what would the what would you say in like a
Journey into Pain Research
00:01:40
Speaker
paragraph? Who is Joshua Pate?
00:01:43
Speaker
Oh, I think I've done a similar thing, actually. I had to check it say to see if it was um factually accurate. But so i like my job title is a senior lecturer in physiotherapy at UTS. And so the way that that gets broken up is like 40% of my job is teaching in a master of physio program. And so I previously worked clinically in a um and pain clinic, a couple different ones throughout Sydney um in major tertiary hospitals.
00:02:09
Speaker
And the ah the next 40% is research. And so my PhD was in kids' pain and how kids think about pain and then how that affects the way that they move their bodies and get back to doing stuff that they love.
00:02:21
Speaker
um And then the last 20% is called like service. It's like often the boring part. But for me, it's my favorite bit, which is doing stuff like this and um being on like the radio or making TEDx videos and all sorts of different stuff where trying to like get reduce that gap between a scientific discovery and like the general public agreeing.
00:02:42
Speaker
um like For instance, like if we rewind a long way back when people thought um that the Earth was the centre of... um where we are and the sun went around the earth like i think it was galileo or someone he like got him put in jail and then like within a few generations everyone agreed with him and there's kind of this like uh one's going to put someone in jail for for making a pain discovery but there's this element of we have learned so much in the last couple of decades as researchers but the general public kind of still thinks that
00:03:14
Speaker
Pain is very simple and straightforward and and kind of like a really bad thing all the time. And I guess there's just nuance to all of those things that I just said. And um yeah, I think that's kind of my job, I suppose.
Simplifying Pain Concepts for Children
00:03:27
Speaker
um in In like the side hustle world, I guess it's like by night, I say, i like writing kids books. I have young kids myself. And um so a bunch of those are about pain and physiotherapy stuff. So ah like I'm really fascinated by this idea that ah People don't need to be to become a neuroscientist to get better. And like it can be simple. And that's a really hard thing to do is to make a complex idea clear and simple. So hopefully, um you kind of we'll see some of that in action today. I'll try my best.
00:04:02
Speaker
Yeah, amazing. Yeah, I i ah um i read it was an Albert Einstein quote, I think, where where he says, basically, if you can't explain it simply, um you don't understand it well.
00:04:15
Speaker
yeah So, you know, and I think what's cool about what you do is you are explaining some very complex problems to um to kids um and in children books. So I'm really keen to pick you pick your brain. And if there's adults listening, um I still think that they can get a lot out of it because it will be within reach of them to understand and comprehend some of the complex things that you're going to be explaining.
The Lag in Pain Science Adoption
00:04:41
Speaker
I love what you said about the the the gap between research and then translating that even into clinical practice we know is about 15 17 years and then to the general public it must be longer than that so you know any i'm just guessing maybe 30 30 years the gap is and i i share that passion with you and that's one of the reasons that i do the podcast is to sort of translate what's happening in the in the research research research world into, okay, clinical practice, but also this podcast for the general public and someone suffering with pain. What what have we learned and how can that help them?
00:05:22
Speaker
So that is, yeah, that's epic. Tell me, how did you get into pain research and in particularly ah pain research for kids?
00:05:33
Speaker
Yeah. So I was ah like when I first graduated as a physio, I worked in the children's hospital and like was rotating in different positions there. And I knew the pain clinic physio there um and ah then got offered. One of my bosses said, would I like to kind of get a taste test of research? And that wasn't in pain.
00:05:55
Speaker
um And it was like a couple of days a week. And if I could get ah a job The other three days, that it had worked well rather than having a full-time job and adding two days on top. And so anyway, i ended up, I kind of didn't like overly, it wasn't like overly interested in pain. I was just fascinated by the idea that like I kind of graduated thinking had magic hands and like passive treatments would just fix pain. like I'm doing inverted commas. know it's a podcast, but but like I had this pretty simplistic idea of pain. And if someone didn't get better, it was kind of their fault.
00:06:27
Speaker
um And I just thought, well, like I did everything that the textbook said and they didn't get better. That's their problem. And like I wouldn't ever say that to them, but there was this element of like, oh, well,
00:06:38
Speaker
it doesn't always work or something like that. And then, um yeah, started this job in the pain clinic and also started doing research in like kids congenital limb deficiency, just a different topic, but I was getting to work with really clever people and that was fun.
00:06:51
Speaker
And so I had this balance, but like the pain clinic work, I just couldn't believe that they were not doing like hands-on stuff primarily. Like they were doing it when needed, but like as an adjunct to the main treatment, which was like active self-supported management. So,
00:07:07
Speaker
um yeah, just couldn't believe that. And then the first time I saw someone like at the one year follow up who was just doing so, so much better, like had gotten back to work and doing all this great stuff without having anyone push on the sore bit, I just couldn't believe it.
00:07:20
Speaker
um And so then I was really fascinated by that. And then it was, i went kind of all in and probably too far down the path of like anti hands on. But like, and I think there's a middle ground there.
00:07:32
Speaker
um So when I say hands-on, I mean like yeah manual therapy, massage, like dry needling, all these kind of treatments where you're kind of pushing on the bit that's hurting.
00:07:43
Speaker
um Whereas this educational approach and this exercise approach was much more like global. And it's like, oh, your whole nervous system's trying to keep you really safe. And and so maybe it's doing that too much. Like, can we turn that overdrive down?
00:07:55
Speaker
um Those kind
Clarifying Complex Pain Science
00:07:56
Speaker
of ideas. And I just... like I was so fascinated by that. And so while I was doing this Masters of Research on this other topic, I was thinking about all these research questions I had. And we were using this book. um It's called Explain Pain and um really fascinated. And for adults, like a lot of them like kind of got it, but a lot of them were like, why are you making me read a book?
00:08:16
Speaker
um And I was just fascinated by like how simple could we make this? And so I started writing like simple anecdotal versions of different stories in my life and different stories just generally.
00:08:26
Speaker
um And then it was like, oh, maybe we could do this like based on scientific journal findings. and We could simplify them. And then like, so I was an uncle, like got married and they had nieces and nephews who were young.
00:08:39
Speaker
And I just got really fascinated about like, a kid's book is such a cool platform for like repetitive learning and and everyone in the household's kind of reading it because mom and dad are reading it too lots of times.
00:08:51
Speaker
um And so I was like, maybe we could combine all of these things. And then, yeah, by the time I started my PhD, we had to step back a lot because it was like, what are we even trying to change, right? Like, um Like if we can't assess someone's pain beliefs and knowledge, we call it the concept of pain. Like if we're trying to reconceptualize pain, we need to kind of assess that and measure that variable so that then we can see if it changed afterwards.
00:09:17
Speaker
Otherwise, it's a little bit like you're just in the dark hoping and thinking that maybe what you did works. And that's what happened for me with my hands-on approach. i Someone would come in who was hurting.
00:09:28
Speaker
I'd push on it. They felt better. And I attributed the feeling better to my physical um touch, I suppose. And then once I saw the opposite true, I was like, well, maybe it's the education that's fixing them. And and then I like, now I have this nuanced idea that like everything is so much more like, um we call it multifactorial. It's like a really big word, but the idea is there's like so many different things influencing so many different things all the time.
00:09:56
Speaker
And like, So it's not like I'm saying, oh, the weather's causing pain or anything like that. But it's like, if you feel differently, that's going to have an impact. and And yeah, i anyway, i just I guess I would just became really, really curious. And that led me to go, hang on, we should develop some way of assessing how people think about pain.
00:10:14
Speaker
And that applies across the board. It's not just for kids. um And yeah, we've been like working with schools and doing all sorts of stuff since then in the the years that have followed. And it's a really exciting journey, I must say, like highly recommend it to you, Lucky, if you if you're interested in research.
00:10:28
Speaker
um but But this idea of being curious and and it's not like I now know everything there is about pain. Like if anything, I feel like I know proportionally less um of all there is to possibly know about pain. And that's exciting. Like i love that idea that we just have still so much to try and grapple with and understand.
00:10:48
Speaker
um Like say most recently, probably stuff about the immune system is fascinating. Like, yeah how does our immune system predict if something's going to be bad in the future and and how does that affect pain and yeah so there's always cool questions and so if people are listening and have great questions lean into them and start trying to find the answers i think um it's a really cool journey to go on yeah for sure i i love what you said there about um you know the more you learn the more you realize you don't know and the more questions that come up that is the pursuit of knowledge like the world is uh
00:11:23
Speaker
a very mysterious place and there's lots to learn. And, um, that curiosity leads to a lot of progress. And I find it fascinating because not everyone has that mindset. You know, you have, I have clinically people that come in not many, but people that come in and they feel like they know everything there is to know about pain. So it's like, why, why you, why are we speaking about pain? I sort of, you know, know it. And in, from an experiential level, they absolutely, um, do. And that's there's, there's, there's, um,
00:11:52
Speaker
some expertise that comes only through experience. um But there is so much to know about these topics and and when you start to dabble into it, you realise how much you don't know.
Common Misconceptions about Pain
00:12:05
Speaker
um but ah What I'd like to ask you as a pain researcher is what are the and a clinician, what are the most common myths that you hear about pain?
00:12:17
Speaker
like The way that I've been thinking about this the most, I'm working on um this kind of book or blog post idea about how we view pain. like And if we have a certain lens of seeing pain in a certain way, then we kind of keep doing this thing where we try and confirm that we're right.
00:12:35
Speaker
um And so I think like I teach in the the physio program and a lot of them have learned like biomechanics and how the body works and the physics of movement and all that stuff. And it's great, cool knowledge to have.
00:12:48
Speaker
But often then we start attributing like with that lens on, we see pain as a very structural, like it's it's like it's because that bit is broken. um so the the kind of myth I think is that maybe we think about our bodies, particularly in Western cultures,
00:13:05
Speaker
um like a machine or or a computer or like this structural kind of thing. Like we go, oh, well, if my car's broken, I'll go the mechanic. So if my body's broken, I'll go to the ah physio, whoever it is.
00:13:18
Speaker
um And just that mindset of like but feeling fragile and and broken rather than like resilient and adaptable, um which is probably more accurate. and And so- Like I think a lot about the kind of what metaphor should we kind of live by. There's a book called Metaphors We Live By that's super interesting. Not about pain, but it's just interesting.
00:13:38
Speaker
And um I did a ah TEDx talk recently and I talked about this lens called the Park Ranger lens. And if you think about your body like it's like a national park, right?
00:13:49
Speaker
as we call it in Australia, um and like there's seasons and there's so much to it and there's so much complexity and there's so many things that influence whether something grows and and things get pruned. and like There's just lots of elements to it rather than it being like a mechanic. And and so I just think flipping that is probably the... like I don't know if it's a myth, but it's just kind of this cultural expectation of like you watch those infomercials on TV or something and it's like you can fix your pain in three easy payments or whatever.
00:14:21
Speaker
Like it's just like that's just missing the whole point of this. Like our, yeah, like the point of pain is that it's keeping us safe. um It's not about saying there's damage and and that's a huge shift to make. And I think once someone goes, someone shifts that focus from damage onto like threat or danger or whatever the other word is, warnings,
00:14:41
Speaker
um Then suddenly you become curious rather than afraid, you become curious and you're like, oh, maybe I could try different stuff.
Shifting Perspectives on Pain Management
00:14:48
Speaker
And so there's lots of great treatments over the last decade or so that are kind of built on that idea of gradually exposing yourself to the thing that was triggering the pain. um So like cognitive functional therapy is an example of that. But even like in a pain clinic, we called it pacing, like lots of strategies where when you exercise, it's like you're doing the thing that originally caused the pain in your mind. If you're thinking structurally, it's like it kind of doesn't make sense.
00:15:13
Speaker
um But if you think about your body like that kind of national park vibe, like a forest, you what you're doing is you're allowing it to to regrow again. And like, it's not going to grow unless you kind of do the hard work again. And and I think what that does is it gives people slightly longer term perspective.
00:15:32
Speaker
So rather than it be about like minutes and hours of relief or pain, and those those moments are really important and pain freaking sucks in those times. But at the same time, if we can zoom out and and kind of value the longer term better,
00:15:48
Speaker
I think that's when people, like that's probably the myth is that is that paint you're going to be stuck. like Like you will be stuck unless you go and get a quick fix. um and that Because that's just not true. Like there's just so much fluctuation in pain ah for like almost every single person. There are some exceptions to this. But like just hopefully what I'm saying is just like provoking people to be curious rather than it being annoying.
00:16:11
Speaker
It's like this idea of like, awe and wonder of wow my body is so capable of of adapting like if you go on a holiday why does your pain feel different or whatever it is like uh and i just love that kind of starting that aha moment but it often can take months and even sometimes a year um yeah does that answer your question yeah absolutely it brings brings a lot of hope to to know that we can change and we're capable of change i think there probably is a camp that doesn't believe that but we won't
00:16:41
Speaker
We won't probably go there too much. um What what i want to I want to dive into that park ranger idea a little bit
Park Ranger Metaphor for Pain
00:16:51
Speaker
more. So in this analogy, is the park ranger, that say, the mind or the brain or your like conscious awareness and the the national park is is the body and the physiology and what's happening, I guess, underneath the ice iceberg?
00:17:09
Speaker
Sure. um It's hard to merge lots of metaphors. I just say like you as a whole person is the park ranger. And then like your context and your environment and everything that's going on and your and your pain and like all your feelings. So like things like fatigue and worry and all these different invisible protective feelings is like just part of the ecosystem of of what's going on.
00:17:33
Speaker
um And like if you think about, say, like rain, people could go, ah rain is so terrible and it's inconvenient. um So maybe, like yeah, yeah you could there's just lots of things you could compare it to. But like rain is what can bring the growth. And like that's what long-term could be useful.
00:17:51
Speaker
um And I'm not saying like, i don't know. It's funny. I actually joke with my kids sometimes. ah like, oh, we don't need umbrellas. Like we're we've got skin, we're waterproof. And like I'm trying to build this resilience constantly, probably a little bit over the top. but um But it's like this idea of like, hang on, we don't we don't need to worry about that thing necessarily. And I guess it's that idea of,
00:18:12
Speaker
what like your eyes on the prize kind of idea. Like if your goal is to kind of maximize quality of life, that's a very different goal than trying to avoid pain. And it might sound similar, but if you can separate those two goals as very different things, like one is you're trying to get rid of a bad thing. And the other is you're trying to maximize a good thing.
00:18:32
Speaker
And that shift in mindset is really, really um useful like for a clinician particularly because suddenly you're turning up to appointments, ready to try stuff, keen to change, seeing if things are possible um versus that old mindset like that we used to have, which is like, maybe I should rest. It's pretty bad. I probably should just stop going to work or school or whatever it is.
00:18:53
Speaker
um and And to me, like, yeah, I'm not saying like, just to be clear, I'm not saying pain's all in people's head or it's all their mindset, but I just think we we have surprising amounts of agency, which is a long a technical word, but like surprising amounts of like,
00:19:09
Speaker
kind of um potential power over these different feelings um and and it it doesn't just apply to pain which is a cool another experiment that people can play with is like thinking what other protective feelings do i have and how can i change those um and for instance like say like worrying or yeah or pain like for me like going out for a run or getting outside is really useful um when I have those feelings and you just go, oh, wow, that was a temporary feeling and and you start noticing things that you wouldn't notice if you just doubled down with the rest and the freaking out.
00:19:42
Speaker
um Yeah, yeah, yeah. Yeah. Yeah, i think I think what your National park Park Ranger analogy sort of brings out is the multifactorial nature of pain, which is like, you know, against, you know, the the common mechanistic,
00:19:58
Speaker
mechanical, ah like we're a machine way of thinking and that, you know, all of these parts affect one another. So like, you know, in an ecosystem, obviously, if one if one species dies out, that has downstream effects. And so like our our body's systems work to work together to produce and they change and they can produce pain or they can reduce pain depending on some of those changes. Is that like,
00:20:26
Speaker
Yeah, yeah like ah maybe I'll give a really simple example, not chronic pain, just something relatable.
Context and Expectation in Pain Perception
00:20:31
Speaker
And we we've set a study up. One of my master's students is doing this. It's called the Lego study and people are stepping on Lego. I won't kind of – we're recruiting at the moment, so I can't give you all the the the results.
00:20:42
Speaker
um But when I do author visits in schools and read the the Zoe and Zach's books and stuff, um I get three kids up as one of the little activities, up on the stage in front of their whole school,
00:20:53
Speaker
And I say to them, let's imagine there's a pile of Lego there and you've got no shoes on it and you're going to step on it. Like I don't want them to actually step on Lego in front of everyone. um But inevitably one kid like rolls around on the ground screaming in pain and they're just pretending.
00:21:08
Speaker
and And then the second kid will just kind of like stoically push through. And then the third kid does something in between or often they're even tougher and they're like, I'm fine or it didn't even hurt me. um And you just see these different responses. And often like as young as a five-year-old can can acknowledge that the same Lego, same stimulus, um but a very different kind of... What they would probably use the word is like reaction or a different amount of pain.
00:21:33
Speaker
And so I think about like even if we just... focus on a couple of variables and it's so much more complex than this. But like what what we're demonstrating in that little experiment um is the expectation, the role of expectation. So like one kid is expecting that it would be terrible and so that's why they act that out.
00:21:51
Speaker
And so expectations is a big thing. And in this study, for instance, we're using different um creams and And these creams don't do anything, but we we tell people that they do and they're in a scary container and and all this stuff. and And that alone is changing the way that someone rates not only their pain, but the amount of damage that they think the Lego has caused.
00:22:11
Speaker
um And it's not like everyone feels a five out of 10 or everyone feels whatever. Like it's it's just so variable at an individual level. And one of the cool things about doing research is there's different methods to explain stuff.
00:22:23
Speaker
And so we're setting up this study where you kind of become your own control group. and And like, so whatever happens at the baseline, we get it so that it's stable and then we can introduce changes and then see how things have changed.
00:22:35
Speaker
um And so it's, yeah, for me, it's really exciting. So not only we changing expectations, but like, for instance, we're covering up um the Lego in in earlier trials of it. um And people don't know what it is. And for some people that makes it worse um because they're like, oh, maybe there's something like metal or whatever, something really, really bad.
00:22:54
Speaker
um And for other people, they go, oh, that's softening it. And so it's better. um And like, so That's our eyesight combined with expectations. um and Those two things seemingly are like silly, like irrelevant almost. When you fall over and scrape your knee, you're not thinking, oh, geez, my vision contributed 10% to this experience.
00:23:15
Speaker
like That's not our gut feeling. But once you start learning this neuroscience, it sort of becomes it's like, geez, I had a bad sleep and that and that. and My memories are of a vaccine were bad and this was bad and blah, blah, blah. And like all of those little things are adding up. and i And I think that's a cool way of viewing like exactly what you were saying is like there's so many variables, so many different little things that are like 1% or 2% or 5% or 10% rather than it being one thing.
00:23:42
Speaker
Because for sure, if someone steps on a really big sharp Lego, those danger messages are louder and the person typically ah may feel more pain. We're still early days in the study.
00:23:53
Speaker
But like... The crazier thing to me, the more mind-blowing thing is that all these other things are influencing the volume of pain. And so in the kate kids' pain clinic where we do research, um in that kind of setting, the the yeah the metaphor that we talk about is imagining having like ah volume buttons like on the side of a phone or an iPad.
00:24:12
Speaker
And it's like... does that thing like expectations or or the weather or your memories or whatever, is that turning the volume of your pain up or down? And so all of these different things are jumping on either the plus button or the minus button.
00:24:26
Speaker
And then overall you end up having more or less pain, but it's hard to pinpoint that one little tiny thing. um And so, yeah, like in the kids books, And the way that we address that, so we bring that up based on ah a study where ah ah the color of a light changes someone's pain.
00:24:41
Speaker
um But later in the at the end of the book series, um Zoe Zoppens has this plan and I think she has something like 53 strategies. And like people, if someone listening to this has never heard about the the latest neuroscience, they might be like, why on earth would you need 53 strategies? Like just do one thing that fixes the pain.
00:24:58
Speaker
um But once you start realizing that all these things add up, like having 50 strategies is so much better and and it gives you so much more confidence to move forward. um And so I guess, yeah, it comes back to what you're saying about hope of like learning this isn't just like a fun fact.
00:25:14
Speaker
And for me, that's what motivates me to get to work every day and like pump to teach people about this stuff and like build resources and all that is that it's not like learning algebra at school and i i nothing against algebra. It's interesting. But like this, if this was learnt at school and if we spend even like 1% of the time learning about pain at schools,
00:25:36
Speaker
Like it could be totally transformative. And I'm i'm currently writing a grant to to get funding to do this stuff in schools. And we are a little bit already, um but I just think there's so much potential that if people could learn about this complexity earlier and it just became, that's what they know. Like in the same way that I learned about sun safety and recycling and and not smoking and all that stuff when I was a kid. And now that's a normal behavior for me.
00:26:01
Speaker
I reckon it's like, it could be transformative. And It might not be. Like I might be wrong, but like we need to at least test it. Like the latest science seems so compelling that we should at least be doing a study on it, right?
00:26:15
Speaker
Anyway, that's that's my little rant on that. Many things can change the volume of our pain. Yeah, it's so cool. My brain is going, which way do I go? Which way do I lead this conversation now? Because so many things have popped up. But i want I want to go, what I find interesting is that you're doing some of these studies that have been done and tested on adults in different contexts, the red and the blue light.
00:26:39
Speaker
um There's been different studies around how the context of what's going on influences the experience of pain and it's so cool that you're able to do that with um in that population um of kids because it's it hasn't obviously been done or at least not to i don't know it might be done you'd know better but No, yeah, it hasn't really been replicated much. And I think, um yeah, that's just another cool thing about science is just feels like such early days. Like we just don't know what we don't know yet And so even doing the same study as another lab overseas or something is probably worth doing because there's just so many so much complexity all the time, right?
00:27:23
Speaker
Yeah, for sure, for sure. I want to go back to a thing that you said because you were quick to say, i don't want you to think that I'm saying that it's all in your head.
Is Pain Solely a Mental Construct?
00:27:32
Speaker
And this is a common pushback to pain science and pain science education is that are you telling me it's all in your head? And when it's when it's done poorly, especially, um this is the sort of idea that people get and they can feel very invalidated because,
00:27:50
Speaker
there is something really validating about um the biomedical model of pain, meaning, you know, you see a structure, it's damaged. Oh, that's the reason I have pain. I now feel validated and believed and all of those things.
00:28:06
Speaker
um Tell me, because I think that it's a myth that it's all in your head. Can you speak to that? Yeah. Yeah, yeah. Oh, it's like, yeah, when you were asking before about the number one myth, it's it's probably up there, right? Like a lot of people go...
00:28:21
Speaker
like they they hear about this complexity of like, say I've mentioned like expectations, memories, all these things that happen up inside your head. um And it's kind of like, oh, but I'm not saying that. And I guess that, yeah, that's a bit, it could be a bit confusing.
00:28:35
Speaker
So I teach at university like 14 weeks of neuroscience about about pain. And I reckon the first four or five weeks at least, and these are in like students who have already been to uni for several years,
00:28:47
Speaker
um they would hold to that. They'd be like, Josh is saying that it's all in my head. i I know he's not saying that, but I still can't grapple with it. And then there's this tipping point where they've spent enough time wrestling with it, where they go, it is just like so much more complex. And like, they kind of start embracing that. And there's a real like moment of of change in in most people.
00:29:10
Speaker
um I surveyed the students at the end of this semester for the first time. So I've been teaching this for like five years. And um And I said, did this apply to you personally? And I just couldn't believe how many students, like more than half, like endorse that the the knowledge that they have from learning this would like change their own personal life.
00:29:32
Speaker
And that's crazy. Like, I just think that's amazing. And then, so for me, the question is how little could we have taught um for them to have that benefit? Because I think it has like a um like we call it a protective effect. It's like, it's it's like,
00:29:48
Speaker
the chances of someone developing pain-related disability could be less. And that's my hunch. So when I say that, like, um yeah, so we need to get back to this all-in-your-head thing from there. So one when someone thinks pain is all in my head,
00:30:04
Speaker
The reason that they think that that's the case is they've heard, okay, my brain has a map or whatever. They've heard some sort of analogy um explaining what's going on and they've gone, oh, that's happening up in my head.
00:30:18
Speaker
And the body part, like pain's not coming from my body part. It's a feeling that my brain creates. um And I just think in the the neuroscience, like once I get to in yeah week six of the lectures, we start talking about all the different mechanisms by which pain can last a long time.
00:30:33
Speaker
And there's several of them that are happening in the spinal cord. um And say if you have like ankle pain, like there's several things that are happening in the ankle. um that are turning up the volume, like we call it ah like inflammatory soup and like this idea of sensitization. There's lots of long words there.
00:30:50
Speaker
um But basically like more danger messages than necessary are being sent. And the messages that are going from that body part are being more sent more efficiently. Like it's like there's more lanes on the highway being developed.
00:31:03
Speaker
Yeah. And then it gets to the spinal cord and then there's even more receptors. Like there's more catchment points to get those messages. And then they get passed on to even more lanes. like and And so like at every level of the body, things can be turned up. And so like I guess an immediate comeback to that to that objection would be um like it's definitely – partially in your head and your spinal cord and your body. Um, because I don't think we want to dismiss and say it's all in one place.
00:31:35
Speaker
Like in the same way, if someone said to me or my ankle pain, it's all due to my ankle. Like, I think that's technically wrong. Um, but coming across about a technicality when someone is struggling, yeah, as you say, like it can feel dismissing. And um,
00:31:52
Speaker
um For me, like the way that I kind of navigate that lately anyway, has been this lens idea of going, hey, like, how do you make sense of your ankle pain?
00:32:03
Speaker
um And what's going on? Like, how does your mouth say ow? Like, when that hurts in your ankle, how does it, like, how does it get to your mouth? Like, you You were saying it's in your ankle. Like, why is your mouth involved?
00:32:15
Speaker
and And that starts kind of bringing someone into this idea that they're a like it's a whole person approach to chronic pain. um So it's not just the brain or just the spinal cord or just the body part.
00:32:28
Speaker
Like, it's a combination of all of those things. um Because our body parts, even like in our fingers and stuff, they're making... there's a sense that the senses in those body parts at the nerve endings, they're making their best guess about what's going on. And if you get stung by a bee or you cut your finger or whatever happens, then suddenly there's this mismatch of what you expect and then what's actually happening and there's poison from the bee or whatever it is.
00:32:54
Speaker
And then there's a mismatch at the spinal cord level and then there's a mismatch at the brain level and and like your whole body has to keep calibrating and working out that balance. um And so I guess like I'm trying to get to that bottom line of going, it isn't all in your head. like It's just so, so, so much more complex than that.
00:33:13
Speaker
And I think like i I have family members who joke and go, oh, your whole research is just saying that pain, they're faking it. I'm like, that is like totally opposite to the goal of what I'm after.
00:33:24
Speaker
And like they're just stirring me and and joking and stuff. but But there is this real sense that our thoughts do matter. Like, and people who have depression alongside pain have worse pain and have worse outcomes.
00:33:36
Speaker
And so there is an element of your thoughts are important. And I'm not like, so we don't want to get away from that either. And like, it then you start feeling like you're digging a hole and it's like, oh man, I don't want make it worse. um But yeah, for me, it's this, it like, I think just reframing the whole conversation of going, like, if you didn't have a brain,
00:33:56
Speaker
then you wouldn't have pain. But if you didn't have a spinal cord, you wouldn't have pain. And if you didn't have that body part, maybe you still could have pain because there's like phantom limb pain and stuff. But like, For you, you have all three things. You have the body part that's sore, you have the spinal cord, and you have your brain. And all of those body parts work together.
00:34:14
Speaker
um And yeah, like and until, like I don't think the research is going to change rapidly in this space of just grappling with pain as a whole person, a feeling makes a lot more sense to me.
00:34:28
Speaker
And so... Yeah. I don't know. what what's your What's your take? Like, how would you answer the question? Like, I have a couple of one-line answers to that, but I've tried to just unravel some of the, like, current ways I think about the answer.
00:34:41
Speaker
Yeah. I mean, I think you're spot on in that. Like I don't think pain is all in your head. The word all just takes the nuance out of it, right? So pain's not all in your head, but your head matters. Your feelings, your thoughts, your expectations, your past experiences, and and also your non-thinking brain in terms of like, you know, your stress levels and that flight or flight response. They all matter and contribute to pain.
00:35:08
Speaker
um But I think what people hear us say is that you're manufacturing this. You're making it up. And so that's where the pushback comes comes clinically. I've actually moved a lot away from using the terminology brain when I talk about pain science education because of that and yeah more talking about the nervous system as a whole. Because when I talk about the nervous system, people don't think that I'm telling them that they're manufacturing it or that they're making it up.
00:35:39
Speaker
um So I've sort of shifted and obviously the brain is part of that nervous system. um But I've sort of... The tricky thing is like for me, i have been down that path of going, oh, it's the nervous system.
00:35:51
Speaker
The tricky thing is that's an oversimplification. And like even kids can understand that the immune system is involved too and like and your endocrine system and all these different systems are also involved in pain and...
00:36:03
Speaker
And like, yeah, I struggle with that a bit as well. Like I think um when we talk about having a cold or a disease or something, everyone's very happy to say, oh yeah, the immune system's keeping you safe and it's protecting you at many different levels and all of that stuff.
00:36:19
Speaker
But when it comes to a feeling, it's like, oh, I need a scan. I want to see where the damage is. um But like what we're seeing in all these studies is actually the amount of damage is like a part of the puzzle, but it's not the main part.
00:36:31
Speaker
But like what you think of the damage is a really really important variable. And so for like if there's clinicians listening – If someone brings in their bag of scans to the appointment and you don't even look at them, that's kind of dismissive because they're coming in going, hey, like all the previous health professionals have shown me my problem, my damage.
00:36:54
Speaker
And I have damage and you don't even believe my damage. You think it's all in my head. And so that can like subconsciously kind of share this myth. And whereas I think what we need to do and the reason that I developed the the concept of pain inventory, the questionnaire, is to try and start those healthy conversations about this stuff so that it's on the table and it's not so confrontational. Yeah.
00:37:17
Speaker
And because if someone comes in with lots of scans and they think that the scans are the most important part of the assessment, that's very different to coming in because they were forced to have lots of scans and they think, no, no, hang on. I already know that my anger is contributing here or whatever it is.
00:37:32
Speaker
um Yeah. Like, I don't know. Like to me, it's just, there's so much nuance or like little like um variables at play in that conversation. And, and so I think like,
00:37:45
Speaker
what What I say to the students is like, you've got two ears and one mouth, like just just do way more listening early on. Like don't get into teacher mode, um be in learner mode or listener mode.
00:37:58
Speaker
um And I think that alone is really useful. And so things like really practical stuff, like getting with a kid, like getting at their like eye level or below their eye level, sitting next to them,
00:38:10
Speaker
shutting up. um Like all of these things I reckon have pretty good therapeutic value um because the messages aren't going to go in. Like if someone's suffering and they're listening to this podcast right now, they'd be just like, he's full of it. Doesn't make sense.
00:38:24
Speaker
um But when someone, what we call is like ready to change in the, in the literature, i don't love that phrase, but like when someone is kind of ready to is curious and in experimenting with stuff it's just such a different conversation and I don't think people can become curious until they feel heard um yeah so maybe that is the solution to this myth is just going hey we need to make sure people feel heard and um yeah yeah Yeah, from, um I remember something that Lorimer said to this, because obviously this is ah an area of discussion in the Professional Certificate of Pain Science that I did at UniSA. And
00:39:05
Speaker
you it's really stuck with me because, so the the question is, are you saying it's all in my head? and And the question that you ask back is, well, where are you feeling the pain?
00:39:17
Speaker
And they go, oh, it's my foot. And then you go, well, the pain's in your foot, right? Like that's experientially, that's where they're feeling it. Where they're telling you they're feeling the pain is is where they're feeling it. Now, does that mean that all of these other factors are contributing to it?
00:39:35
Speaker
Absolutely. Of course, they're they're contributing to it. um It's not to to um take away that, but it sort of emphasizes that the human experience and and where you're telling me you're feeling it is where the pain is.
00:39:49
Speaker
Yeah, yeah. But these are the factors that we think are in our control to to be able to change this or modify this. um yeah And I think that conversation was really cool to me is because obviously...
00:40:04
Speaker
Loz has probably had copped the most flack around this. It's are you saying it's all in our head question? um And so just some ways that he's, he's learned to deal with that over the, over the time is it was really cool. And I've used that one quite a bit.
00:40:19
Speaker
um And I think it really is very validating. That's great. I often think about like what, when we think about the minimal amount of learning needed, it's like, what's the best message to start with in terms of, so if someone's hearing this and it's like, imagine you go to a doctor and they go, oh pain doesn't mean damage. And like, it can be quite offensive, I think. And like, there's so much potential for misunderstanding. Whereas a ah learning outcome, like many things can change the volume of pain.
00:40:47
Speaker
Everyone kind of gets on board with that. Like you do a silly Lego story or you explain a study, like every single pain study is like that. Like there's so many variables changing how much pain you feel. um And people can get on board with that.
00:40:59
Speaker
And so maybe... Yeah, maybe part of the solution here is thinking about where do we navigate and start these conversations. So I love what you just shared. Like of going if someone asks, is it all in my head? You say, well, where do you feel it? and And like that just kind of reframes the conversation.
00:41:13
Speaker
But like if you're then going to go straight into saying, oh, it doesn't mean your ankle's damaged, like then it's kind of confusing for the person. Yeah. Whereas if you start with this idea that like your body's so resilient and changeable and and so are your feelings, like so many of your feelings can change as well.
00:41:31
Speaker
um Then suddenly like that opens up the curiosity kind of department of your body. And I love that. Like I think, yeah, so- Like in the the kids books that I've written, like I would mostly clinically, I would start with the second book. And if I'm thinking about prevention, I'd start with the third book because it's about virtual reality and like the complexity of of like nociception and stuff, but like in a really simple way for for young kids.
00:41:54
Speaker
um Because I don't know if that idea of like, it's almost like I'm saying without validation, people aren't ready to hear that pain doesn't mean damage. um yeah And I've seen this like time and time and time again. And I just think,
00:42:08
Speaker
Like if we could put a ah billboard up of the latest neuroscience, I don't think that like pain not equal sign damage is the best message or hurt doesn't equal harm. Like I don't think it's that useful, but geez, new clinicians love spouting that message because it's so revolutionary from a clinical point of view.
00:42:28
Speaker
But I just don't think it's that helpful for the average person to hear straight away. Yeah. and yeah Anyway, like i love I love this idea of like if we could work out what order, like on average, everyone goes on their own journey, but like where's a really good place to start for most people? um And I think historically, we've just been so captivated by like the craziness of pain doesn't mean damage that we start there. But I think it's actually better to start in a more validating and like and kind of build rapport messaging approach. Yeah.
00:42:57
Speaker
And I think, to be honest, the pain doesn't always, ah doesn't mean damage. Pain doesn't mean damage. I don't think is a completely true statement. i Like, i I sort of ruined it, but I put in the phrase always.
00:43:11
Speaker
Pain doesn't always mean, because just sometimes it does. Sometimes you need to offload that structure. And sometimes you need to be in a cast for six weeks. And so i think sometimes,
00:43:23
Speaker
I just don't think billboard's going to capture the nuance that surrounds what pain is. um But we we could get way down into the weeds, Josh, and I would love that conversation. But many listeners...
00:43:37
Speaker
might not love it as much because they're kind of, they're here they're here thinking, okay, well, what practice, you're telling me it's all complex and, you know, I'm sort of drowning in the complexity already. I'm telling coming to terms with that fact because no one's been able to help me and I've seen specialists and they've told me that there's nothing I can do.
00:43:55
Speaker
And so I've seen the best and the best. i already know it's complex, but what the hell do I do? Like what what can I practically do? And so, I want to shift gears into some practical applications of from what you've learned about
Strategies for Pain Management
00:44:10
Speaker
pain. How can someone that's suffering, ah yeah, make some changes in their life to have a better outcome?
00:44:18
Speaker
Love that. i Like a lot of the research we're working on is seeing how, um say like AI chatbots, for instance, like chat GPT, like it's getting more and more accurate and aligned with the guidelines and and it's validating. Like if you say, hey, I've got chronic pain or my my son has chronic pain, um it goes, wow, that's horrible. And it has all these like things that it now says at the start, which I think is just awesome.
00:44:41
Speaker
Because that would be the first practical thing is like, has someone truly heard what's going on? And the reason I say that is in this StuVac break, so StuVac is like halfway through the semester. So like week nine, there was ah there's a student this year.
00:44:57
Speaker
And she came and said to me about her ankle and and she's like, ah we're not I'm not a clinician. I'm a teacher. And she just started going, but like, I know this is true for patients, but I don't know for me, like I've got, I sprained my ankle and like I have like real damage. and And like there was this real, like you could see the kickback, like internally she was like, but I'm stuck.
00:45:21
Speaker
And I just said like, what do you think is going on? And has anyone ever asked you that? And she's like, oh well, no, my physio that I see like as a sports physio and they explain what's going on.
00:45:32
Speaker
i said, well, but do you think what they think? Like where what do you think about your pain? And like it was so like first went red in the face, but then there was like this real like element of, hang on, I've never even paused to think about what I think is going on.
00:45:47
Speaker
um And so what I'm alluding to is this idea of making sense of what's happening. Because you are making sense of everything that's happening all the time. Like I've got young kids and when you have a baby, they're looking around trying to make sense of stuff.
00:46:00
Speaker
And like say, I find it funny that like a toddler boy versus a toddler girl seems to make sense of the world physically very differently. Like a girl, like out my daughters anyway, very cautious and like, oh, I better check if that staircase is safe.
00:46:15
Speaker
Whereas my son just like literally just launches himself off the stairs and he'll learn that it's dangerous by like bleeding and and and hurting. um And there's this idea they're both making sense of the world around them and and of their feelings and stuff. so So I guess like practical tip number one in my head is how are you making sense of it? And has someone actually heard what's going on?
00:46:38
Speaker
i'm And it's funny, like I'll often get emails after something like this, like a podcast or whatever going like, wow, I feel like you heard what was going on. I didn't even tell you. And in the the TEDx talk I did, I said, there is no way that I could truly understand what is happening for you in this moment.
00:46:57
Speaker
And I had all this queue of people afterwards going, I feel like you heard my 20-year journey when you said that you'd never understood it. um And I'm like, But I was saying the opposite thing.
00:47:09
Speaker
but it was like this validation of like, finally, someone has admitted that they don't understand the complexity of what's going on. And so there's this element of me saying pain is complex.
00:47:21
Speaker
But I'm also saying, I don't understand it all for you yet. And as a like health professional, as an educator, as a researcher, I need to make sense of your pain too. So, Step two is, so like there's you make sense of your own thing and are you how are you making sense of it Because you are to some extent.
00:47:37
Speaker
And then the people around you, like how's your mom and your dad and your siblings and whoever else is around you at home, how are they making sense of your pain? And you might have your soccer coach saying, come on, push through. And this other person, set like your teacher's like sending you to sickbay all the time, whatever it is.
00:47:52
Speaker
and And they're all making sense of it differently too. So the way that you make sense of your pain matters and the way that the people around you make sense of your pain matters. And it's not just the way that they make sense of like the fun facts about pain, but it's like truly your experience. like And so...
00:48:10
Speaker
yeah these might Some people might hear this and go, oh, that's not that practical. um But like once you do that, all of a sudden, there's all these practical strategies and things you can try and do.
00:48:21
Speaker
And so that questionnaire I mentioned earlier, people can go and just Google my name, joshuawpate.com slash copy is that you can do a questionnaire online if you want to start making sense of it yourself.
00:48:32
Speaker
um And it's the like there's lots of just little probing questions to start thinking about. How do you think about your own pain? And how do the people around you think about your pain and you can get them to fill out the questions and compare your responses and all that stuff um those conversations are probably going to be more useful when you look back in like a year's time if you have a good trajectory like what we hear anecdotally anyway is that that kind of matters and and so once that process has happened then we can talk about all the practical like the the really like physically practical things. um
00:49:04
Speaker
And I guess it depends on the person's scenario. like For some people, sleep is when they have relief and it's great. And for other people, the pain is interrupting their sleep. or or like And you could break that down, right? it could help them It could make it hard for them to fall asleep or it could make it hard for them to stay asleep. and And those are different different kind of influences of pain. and And that's where I would say the next practical thing...
00:49:26
Speaker
would be to make sure you've had a multidisciplinary assessment. So not just you haven't had just someone tell you to take Panadol, um but you also haven't had someone just to tell you to get on with it and exercise.
00:49:38
Speaker
And you haven't just had someone think about your thoughts a little bit. Like i would i would really, really value the perspectives, particularly of a medical doctor, a psychologist and a physio. Like that's in my bias. That's what I think.
00:49:50
Speaker
um But like in a hospital setting, we have like social workers and OTs and there's just like a list of maybe 15 health professionals who could all help and they all have a different lens to use that earlier word.
00:50:01
Speaker
um And it's helpful. Like, and I think doing one at a time is probably less successful than trying multiple strategies. um But yeah, so like that's that would be some first initial steps that I would do or for my family members, like that would be what I would recommend um because you want to have someone around that you trust and who has actually heard what's going on.
00:50:23
Speaker
Yeah. Yeah. And then in terms of like practical strategies, like there's so much, so, so, so many different things you can try. um And I guess it depends on the pain. Like if I think about pain when ah like pain related to movement or or it's worse if I do something heavy, um that's a different, like there's different treatment strategies for that.
00:50:42
Speaker
Yeah. and And then in terms of like strategies, like there's some strategies that help in the short term. So maybe you go, oh if I put a heat pack on, that lets me, I can then do the dishwasher or whatever it is.
00:50:54
Speaker
i Like that might be great in the short term, like build up what we call like flare up strategy. So some strategies that help in the moments and the the minutes and the hours. um But try not to become too reliant on them is the is the real battle there versus the long-term strategies, which are things like exercise and getting back to school and to work and all of that stuff.
00:51:15
Speaker
it It can be really hard to get to that point if you don't first have those short-term strategies. um But I think if you only focus on the short-term or only focus on the long-term, it's hard to succeed.
00:51:27
Speaker
And so you want to see someone who can do both at the same time, that builds you up in the moment, but also builds you up for the long-term. um And and the the graph, like I think visually a fair bit of the time about this kind of stuff.
00:51:41
Speaker
If you're graphing someone's pain over time, like so on the on the left is like now and on the right of the graph is say one year's time. And if you were to graph how much pain out of 10 you were feeling, it would probably look like a roller coaster, right? Like every time you you sleep, you're probably not feeling it or or whatever it is. And it and it would fluctuate or heaps.
00:52:00
Speaker
um And there's certain conditions that fluctuate more than others and all of that stuff. But what we want to do is like flatten that roller coaster out and then gradually kind of tilt it so that you're improving over time.
00:52:11
Speaker
and and it And it's like tiny gradual steps. um There's this awesome an image that comes to mind and it's a ladder and the person trying to climb a ladder And there's two two images like two panels in the comic.
00:52:23
Speaker
And on the first one, the first rung of the ladder is up too high and they're jumping trying to reach that first rung of the ladder. And on the second one, the rungs of the ladder at the start are like five centimeters apart and then they gradually get bigger and bigger gaps to being a normal ladder.
00:52:38
Speaker
And and the the point of it, like when you think about that, it's like, If I make um small successes possible in the short term, then the biggest successes can come down the track.
00:52:51
Speaker
And so for someone like returning to school or returning back to work or getting back into sport or whatever it is, those early changes, you need to find out ways for it to feel like a win.
00:53:03
Speaker
um And that's like, for me, I don't think that should be on the individual. I think that should be on the support people, like on the network of family and and the health professionals. Um, Yeah. Like, I don't know. Like if you reflect back to when you were toilet trained as a toddler, just again, like a simple analogy, like some kids want an M&M or a lolly or whatever. And some kids want a sticker and some kids want a tick and some kids want a pat on the back or like an encouraging phrase or whatever it is.
00:53:29
Speaker
And like you think about what motivates you and what what gets you going. And on average, like what we see in the research is things like tracking your activity and your progress in a really positive way and rewarding that.
00:53:43
Speaker
um And like smart watches and all that sort of stuff kind of do this a little bit already. um But like tracking that and and genuinely doing stuff that you'll feel proud of. Like if I am able to go up three stairs at the end of this week without flaring up my pain, like that's awesome. And I'm going to get like a Magnum in for Australians. Everyone knows what that is, but everyone else, it's this delicious ice cream.
00:54:06
Speaker
And like I would get an ego, a caramel ego. Like I'm just being silly. But like there's this idea of like what truly like will make this journey feel worthwhile. And you need to be realistic because some people are going, nah, I'm not going to feel good about any sort of success until I'm whatever, like climbing the harbor bridge or something, some really far-fetched goal.
00:54:28
Speaker
and because what we see in a pain clinic, the practicalities here, it's like we say we did a six-week, the moderate intensity program. It's not until about week four that people start acknowledging that they're improving. The health professional can see improvement within the first two weeks, but the person typically it takes another couple of weeks before they acknowledge that they're actually changing.
00:54:49
Speaker
And so we film before and after and all sorts of stuff. And it's not until that moment. And for some people, it's at six weeks. where they can even set a long-term goal. And so if you're stuck in the darkness and cloud of chronic pain right now, what I would encourage you to do is get a support network and set some tiny but meaningful goals that you can hopefully achieve with support.
00:55:12
Speaker
um And then once you've broken through that barrier, then suddenly the fog starts clearing and you can set the long-term goals. And my favorite anecdote of that is is this lady. She was like a pretty old lady um in a pain clinic setting.
00:55:25
Speaker
And she got to week four and she's like, by the follow-up, like there's a three-month follow-up. By that date, I'm going to go to China and climb on the Great Wall of China because I've always wanted to do it. And I thought it was impossible, but now I know that things are possible. And I just remember like kind of giggling internally because I'm like, that is a crazy ambitious goal.
00:55:44
Speaker
And this lady's goal was to be able to sit on the toilet seat in week one. Like ah like the goals had just transformed in in such a short time. And I just was like, if that... is possible. That is awesome. Like I was kind of thinking that's not realistic.
00:55:58
Speaker
um Like there was a part of me, but I was like, no, let's back up. Like, let's see how we can do it. And she's seeing the change. And so we made a plan. We worked back from that 12 week goal of going, okay, this is where you're up to. What will it take? And how much of the wall, like, obviously you're not going to walk on the whole wall um How much do you want to do? And how do you get there? And and like, what are your strategies on the flight for flare ups? And, and she made this plan.
00:56:19
Speaker
came to the follow-up and it was like the coolest celebration ever. She like did a slideshow and it was just this real sense of like, these strategies aren't just talk. Like it's not like this podcast is a waste of time. Like this is so, so valuable.
00:56:37
Speaker
Um, And so, yeah, i like I guess I could list off the Zoe's 53 strategies, but there's almost this sense of like, just once you get behind this this principle of like the the kind of concept that things can change, then you'll find out what works for you.
00:56:54
Speaker
um And what we typically see is the more active approach, the the approach where you are doing stuff, like you're in the driver's seat. those things work in the longterm way better than when you're in the passenger seat or the backseat or the boot. Like often people feel like they're in the the trunk or the boot of the car. Like they're they're so out of control.
00:57:12
Speaker
And so the psychologists we work with, they say, learn to control the controllable stuff. Like what are you in the driver's seat for? And, Yeah, anyway, so I guess I hope I've kind of answered some of these practicality stuff, but like I really do want to shift from the neuroscience to these practical strategies pretty early on because that's what when people get that moment of going, oh, yeah, okay.
00:57:33
Speaker
All right, things can change. um I don't know if that's what you see
Active Patient Participation in Pain Management
00:57:37
Speaker
clinically as well. Like once someone observes their own improvement, then they believe you. But it's really hard, right? Yeah, absolutely. I guess they they live with themselves day to day. So it's harder to sort of zoom out and see the bigger picture sometimes. But I love what you said about get out of the backseat or sometimes even the boot into the driver's seat. That's the whole reason behind my name, Physio Pain Coach.
00:58:02
Speaker
is because that's that's where I see myself. I don't know if you know much about cycling, but the Tour de France is coming up and there's a whole bunch of riders that literally just protect their main rider.
00:58:15
Speaker
So they ride out in front, they break the wind for them. They're called domestiques. And that's how I see myself as a physiotherapist. Like I'm doing all the hard work, but in terms of like breaking the wind and trying to give we give guidance and and going back and getting the food and bringing it up to you. But like you're that you're the you're the one in the driver's seat. You've got to cycle. You've got to keep going. And you've got to, at the end, you're the one that we're celebrating because you cross the finish line with your hands up and, you know, it's, you know,
00:58:47
Speaker
to To get to that analogy, like i I see myself as a guide, as a support network. um But the reality is, is that they have to step into the driver's seat and they have to change some of these things that they can change um yeah to have the success that they want.
00:59:04
Speaker
Yeah. Yeah. i want not And and so just one comment on that is that someone might hear that. And we' because we're talking about misunderstandings before people might hear that as a blame thing again of going, Oh, you're saying I'm not in the driver's seat. You're saying I'm not doing enough myself and and all of that. And I think that's why it's like, I love this idea of a coach or a support crew. um Like,
00:59:28
Speaker
It won't come across like blame if you truly are, if you do have a support crew around you. um And so that just be one other thing I'd really want to make clear is if people do feel blamed that it's their fault or it's their brain's fault or whatever um um for overprotecting them, these kinds of ideas, when you read some of these resources,
00:59:46
Speaker
it It's not. And the the health professionals around you want to support you. And I think just to make that like explicitly clear, because otherwise some people can start going, oh, like, I don't know if they believe my pain.
00:59:58
Speaker
Like, make sure you are surrounding yourself by people who believe your pain. And that's really important to start. Yeah, totally. No, I i would reiterate exactly what you've just said. And I think um yeah it's it's super super important for them to feel believed but also there's this balance between blame versus agency and i've spoken about it on this podcast a lot because you don't want to say you know you're a victim there's nothing you can do and everything's helpless and i'm sorry but you're just going to have to live with this that's not what what people want to hear
01:00:31
Speaker
But when you go too far the other way, they they feel like, okay, so you're saying it's all my fault because there are things I can do to change. um And I think there's this balance there of no, like there's plenty of things that people have done and You know, the ah research around adverse childhood events and how that changes our nervous systems and how that can lead to oftentimes people are victims. They've been in a car crash or they've, you know, they've had this traumatic event in childhood. And there's lots of things going on that, that you know, make it not your fault.
01:01:07
Speaker
But there are what we're trying to give is a message of hope that there are some practical things that they can do to to change their lives and to be on a trajectory of of healing ultimately. yeah um And yeah, there is a balance there. And it's it's easier to do one-on-one because we don't know who's listening. um But yeah, one-on-one, you can sort of bring that out.
01:01:28
Speaker
Yeah, yeah. Yeah, totally. I think if we can somehow zoom out to that kind of decades view, it like and it can take months to even get to that perspective, but it's really, really cool. Like it moves away the, I had a paper come out yesterday about these these lenses and stuff. And it's like moving away from like the lawyer's lens where you're going like, I need justice and I want revenge or I need a payment or whatever it is from that accident or something.
01:01:53
Speaker
towards this idea of going, hang on, like there are so many ingredients in my pain recipe or or whatever it is. And ah like, and and there's just so many ways you can think about how your pain works. And so my, like ah what I'd love to leave people with is just to reflect on like, how are you currently thinking about pain? And, and like, does that, do you think that actually matters? Or do you think what I'm saying is a waste of time? And like, I want you to be honest about that.
01:02:18
Speaker
um Yeah, it's just a hard question to reflect on. and And like this is what health professionals should do as well. like I think we all have our own ways of viewing it. and And what the data recently is showing is people can have two opinions that kind of oppose at the same time.
01:02:34
Speaker
like So they can think this A and B, and it's really like in some situations, they'll think A, and in other situations, they'll think B. And and that's hard to wrestle with. like we're just It's just tricky.
01:02:45
Speaker
Yeah. Yeah, I hope that's helpful rather than disheartening. But yeah, yeah it's been really cool. um i want to just give one more question. and And I think you're a part of this resource. But what is the one thing you would like people to know that are struggling at the moment? They're feeling in a dark place because pain is sort of overwhelming.
01:03:08
Speaker
And they're listening along to this. What is the one thing that you would like them to know? I love that. at At the Australian Pain Society Conference, I i ask this and we have a not-for-profit called One Thing and like there's a Canadian season coming out for season five this year. um I ask lots of people this question all the time and and one of my favorite answers, I think ah ah you mentioned you've had Mark Hutchinson on this podcast.
01:03:31
Speaker
um He said that biology is non-linear and it's like such a nerdy answer and he would he would be fine with me saying that, I think. um But like I think about that a lot is like we often have this expectation that things will go in a straight line. Like they'll either get better or they'll get worse.
01:03:48
Speaker
And it's and you you're kind of not open to the idea of it being a bit of a roller coaster. um And so I guess one thing I'd want people to know is that the pain is real even when it fluctuates. Like for a lot of people, they have really good days and really bad days.
01:04:02
Speaker
And that doesn't mean that on the good days they don't have damage and on the bad days their damage is really bad. It just means that pain is complex, right? like And so like the one thing I would encourage people to do is to have that curiosity um because I think, yeah, like if we if I jump too many steps ahead towards recovery stuff, it's almost unhelpful. like It's better if we just start back at that idea of like, hang on, how are you viewing your pain? like What do you think? like How are you making sense of it?
01:04:30
Speaker
Yeah. Yeah. Like the other the other one thing message I love is Gilletta Belton. And if people haven't seen her one, she said, um your pain is real and you are believed. and And coming from her and hearing her whole story is just awesome. She's someone totally would be awesome on your podcast.
01:04:47
Speaker
um But yeah, she she has a really cool story. And so, yeah, hopefully those things resonate rather than me being kind of the know-it-all or the hero or whatever. i'd I'd love to just borrow from some of the genius um from around the world in those videos.
01:05:00
Speaker
Yeah, that's awesome. i really appreciate that. i I might link it if you can send me the link through. we can link some of these resources for people and how people can get in touch touch or contact with you um if they'd like to ask questions or learn more about what you do.
01:05:16
Speaker
So thanks heaps, Josh. I really appreciate you coming on and I love the work you do. Thank you for making pain science really accessible to people. um It's so important. We didn't touch on this, but I think our hunch both is that you know, some of this could be very preventative for chronic pain. And um yeah, our beliefs do matter. So thanks heaps for what you do.
01:05:39
Speaker
And thanks for coming on the show. Let's chat about the prevention stuff next time. That'd be awesome. Awesome. Maybe there'll be a part two coming. in Thanks, Josh. ah right. Thanks. If you enjoyed this podcast, can you please hit follow?
01:05:52
Speaker
This simple action will help us reach more people in pain.