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The Real Reason Your Back Still Hurts (It’s Not What You Think) | Professor Peter O'Sullivan
175 Plays24 days ago
In this episode, Lachlan Townend sits down with world-renowned pain researcher and clinician Professor Peter O’Sullivan - a man whose work has completely reshaped how we understand and treat back pain.
If you’ve ever been told your spine is fragile, your core is weak, or your pain always means damage - this episode will change the way you see back pain forever.
Peter’s research and clinical leadership led to the creation of Cognitive Functional Therapy (CFT) - a revolutionary approach that helps people break free from fear, overprotection, and the belief that pain always equals damage.
Together, Lachlan and Peter explore:
- Why so many of us have been taught to fear movement and “protect” our backs
- How Peter’s own experience with pain changed the way he treats patients
- The science behind CFT and how it helps people reclaim confidence in their bodies
- The role of stress, sleep, exercise, social connection and nutrition
- Why posture, scans, and “core stability” might not be what really matters
Resources:
- Free trial of Pain Coach
- Book a consultation with Lachlan
- Evoolve Pain Care Academy
- Cognitive Function Therapy (3 year follow-up) paper
- Body Logic
Recommended
Transcript
Personal Experience with Chronic Pain
00:00:00
Speaker
I'm climbing these mountains, you know, facing imminent death. And then I'm going back into the clinic telling people, you know, lift with a straight back and be careful that they didn't round it because they might do damage to themselves. And it didn't really sit very well. I was skiing and had an injury come off a ledge and landed flat on my back. And it was like horrendously painful. And that kind of cascaded into this chronic pain problem. I started holding myself more rigid, being more aware of my posture and keeping it tense and everything got worse. And the penny dropped one day when someone said to me, why are you holding yourself so awkwardly?
00:00:33
Speaker
Once that penny dropped, I went, whoa, actually, I'm not damaged. i'm like I don't have a broken bone. And I started to relax my body and I started to move naturally. And I could feel I just slowly got better. There is very little evidence that holding good posture, bracing your core, or lifting with a straight back has got any benefits for us at all. In fact, it's tiring and it may even be provocative.
Introduction to Professor Peter O'Sullivan
00:00:56
Speaker
Today on PainCoach, I am thrilled to sit down with Professor Peter O'Sullivan. Pete is internationally recognized for his research and clinical work in persistent musculoskeletal pain, publishing over 350 peer-reviewed papers, speaking at more than 150 conferences worldwide, and pioneering what I believe is one of the best, if not the best, approaches to chronic lower back pain, cognitive functional therapy.
00:01:26
Speaker
I hope you enjoy the conversation as much as I did. This podcast is for educational purposes only. The views expressed in this podcast do not constitute medical advice and are general in nature.
00:01:39
Speaker
You should obtain specific advice from a qualified health professional before acting on any of the information within this podcast.
Collaborative Research in Pain Management
00:01:48
Speaker
Professor Peter O'Sullivan, I thank you so much for taking some time out of your busy schedule to to come on the Pain Coach podcast.
00:01:57
Speaker
It's an absolute honor to have you. As many may know that are listening and some may not know, you're a world-renowned researcher in low back pain. As you mentioned, you work clinically three days a week.
00:02:10
Speaker
And it's yeah what you've done in terms of research has really impacted me personally as a clinician and and the way that i I treat people and also even my business name. So my business name is Physio Pain Coach.
00:02:25
Speaker
yeah notice And I think that there was an editorial that you were a part of. that you know you pointed out that we should treat chronic pain like a guide and like a coach. And so that's that's definitely influenced my practice even to the point of my business name. So thank you so much.
00:02:45
Speaker
It's a pleasure to um meet you and be part of this. You know, Lachlan, like I'm part of a lot of, are a lot of people involved in the work. It's not just me. So, you know, I'm i'm often the face behind a whole team of people, ah but there are a lot of amazing people who kind of do a lot a huge amount of work that's behind, you know, yeah the the work we do Yeah, no, thank you for pointing that out. And I knew you would be a little bit embarrassed about me pumping your ego but i i made it I need to do it
00:03:18
Speaker
And the reason being is because listeners need need to know that you know you're not you know coming at this as just some...
Evolving Understanding of Pain
00:03:27
Speaker
ah random guy you've done a whole bunch of work in this area and I think you know we'll challenge them a little bit today and so this challenge that they're going to have in terms of some of the the ideas and beliefs and yeah misconceptions that are out there and they need to sort of be aware that there's there's a lot of research and a lot of backing behind this
00:03:49
Speaker
Yeah, 100%. And, you know, that's been part of the privilege of the journey I've walked, I think, is as a clinician, I've had to, and as a person, I've had to change my whole understanding and beliefs around pain, personally, from my own experience, but also as a clinician, and as a researcher. So I kind of like those three hats had to change across my own personal journey, research journey and clinical journey.
00:04:13
Speaker
Yeah, I'm looking forward to, we'll hopefully delve into that, but I love someone that can sort of change their mind. I often ask a question, what do we what have you changed your mind on in the last five years? And I think it's kind of a red flag if someone says nothing.
00:04:28
Speaker
yeah Yeah. Because we're always learning. 100%. And I think that's the beautiful thing about life is that we have this amazing ability to learn and be sculpted through our own experiences and interactions with people and stuff
Rethinking Pain Management Strategies
00:04:44
Speaker
that we learn. And, you know, as a as a researcher, fundamentally, you know, my research hat is we test hypotheses. So we we might have a belief and and I can give you heaps of examples around this. If we have a belief that this is something how it is and you look at the evidence, you go, actually, there's not much evidence for that.
00:05:02
Speaker
If we look at it and then we go, oh, let's do some research on it. And then you go, oh, wow, that is not what I thought. And then you kind of force to update your belief system and go, how does that fit? And then that forces you to kind of rejig your mindset.
00:05:17
Speaker
And I think that's it a lot of the journey that I've walked on. ah walk down. And it's often the journey of the people that I see who live with pain as well as they come in with a kind of mindset around pain, that stuff they've been told or stuff they've learned across their life. and And then it's like, whoa, that is not what I thought.
00:05:37
Speaker
but then Let's go there. I wasn't going to lead with this, but I would love you to just sort of give us a snapshot of the story of how you ended up where you are now. Yeah. So, it's a boy, it's a long journey.
00:05:50
Speaker
So, I grew up in New Zealand and went to uni in New Zealand and Dunedin. And so, I went, this is many years ago, and very little research around at all for pain.
00:06:02
Speaker
amazing lack of research. And so, you know, we got taught stuff, but there was really no evidence base behind it. There was kind of like, you know, a lot of beliefs around pain means there's something damaged in your back or pathology or something wrong with the way you move or your posture or this kind of stuff. That was a paradigm that I kind of grew up in.
00:06:21
Speaker
And then as an individual, I was into doing, you know, outdoor nature sports, climbing, rock climbing, kayaking, alpine climbing, actually doing really dangerous things.
00:06:34
Speaker
with my spare time, which loved. And then I was coming back to the clinic, telling people to be careful with their back watch
Personal Journey of Pain Recovery
00:06:41
Speaker
out how they moved. And there was this kind of dissonance in my head of like, hang on a second, I'm climbing these mountains, you know, facing imminent death. And then I'm going back into the clinic, telling people you know, lift with a straight back and be careful that they didn't round it because they might do damage to themselves. And it didn't really sit very well.
00:07:00
Speaker
and And then I'd had this, I had this injury, um i'd been I was skiing and had an injury where I'd like come off a ledge and landed flat on my back and it was like horrendously painful and that kind of cascaded into this chronic pain problem and i didn't think I don't think consciously I realized what I'd done, but I'd become really protective of my body.
00:07:24
Speaker
I started abnormally tensing my body. I started holding myself more rigid, being more aware of my posture and keeping it tense and everything got worse. and I was like, oh my goodness. I remember going home and at the end of the day.
00:07:39
Speaker
from my clinical work, just exhausted and in pain and going, I don't know if I can keep doing this. And then I started you know restricting my physical activity and stuff. And I was like, whoa, what is happening here?
00:07:52
Speaker
Now, I didn't have a broken back, so I got it scanned. It wasn't broken. So I knew ah wasn't damaged as such, but I just got myself into a real difficult situation. And the penny dropped one day when someone said to me, why are you holding yourself so awkwardly?
00:08:08
Speaker
And I'm like, this is a friend of mine. i'm like um that's And I realized that I was, I'd kind of gone into all the things that we've been taught at physio school around, you know, keep yourself tense, brace your core, keep, live for the straight back. I was bending over my patients, keeping myself rigid and it was exhausting and it hurt.
00:08:28
Speaker
And my pain was spreading and I could feel myself becoming distressed. And once that penny dropped, I went, whoa, actually I'm not damaged. I'm like, I don't have a broken bone.
00:08:41
Speaker
And I started to relax my body and I started to move naturally and started not to protect my body. And I could feel, I just slowly got better. Now that was a really interesting, pivotal insight personally what,
00:08:54
Speaker
what I think we see all the time in daily practice, that I'd kind of got myself stuck down this path that I've been taught, that I was teaching people to do, that didn't work for me.
00:09:07
Speaker
Now, that's not saying that holding certain postures or whatever doesn't work for someone else, but for me, it didn't work and it got me into a real trap. So that kind of led me and the team that I work with down a whole journey of like kind of in research of testing our beliefs around the body. And one of them was around body posture and around movement and and lifting.
00:09:30
Speaker
And we've done a lot of work in that space basically to show that that there is very little evidence that holding good posture, bracing your core, or lifting with a straight back
Impact of Beliefs on Pain
00:09:40
Speaker
has got any benefits for us at all. In fact, it's tiring i and and it's and it's probably inefficient and it may even be provocative.
00:09:49
Speaker
and And hurting you. And actually what we're perpetuating a lot of the time is these myths that actually can make people worse and make them think that they've got to overprotect their body, which actually we know is not helpful for them.
00:10:04
Speaker
That's a long answer to a question. No, that's a great. What's the threads that go through it, I suppose? Yeah, no, that's that's a great answer. i How long did the back pain last for you? Like how, what sort of duration was it?
00:10:18
Speaker
Months, like a number of months, probably across a year, i would say. Yeah, yeah. And, you know, it's interesting. We look at pain that most back pain episodes usually rib resolve within within three months. And there's a small group that go on to develop more persistent pain, which is, you know, we can be very distressing, disabling pain.
00:10:40
Speaker
limiting and and i was probably heading into that group well i was heading into that group um yeah it was and i really really had to teach myself to unlearn yeah yeah that and you're subliminally i was subliminally doing i don't think i was even consciously doing it it was like i kind of kicked in these protective mechanisms without really knowing what i was doing yeah yeah you're You're reflecting on a journey of sort of the the beliefs and the misconceptions that are out there widespread. you held on to hold on those beliefs for a period of time and you even put them into practice when you and had your own issues. Also from a research perspective, I believe you started off in this sort of in this field. do you Do you mind just talking about your shift from that style of research to where you are now?
00:11:33
Speaker
Yeah. So when I was like, when I first, oh, this is yeah many years ago now, this is like in the mid nineties. ah Like I was, I've got a brain that I like to know. I like to know things. I hate not knowing something. It drives me crazy.
00:11:47
Speaker
So I'm like, I'm going to do a PhD. So I kind of went down this path of like doing a PhD. And part of that process was ah in my head, back pain was linked to something structurally wrong in the back.
00:11:59
Speaker
And, And fundamentally, what we what my belief was back then is if there's something unstable in the back, we need to train the muscles around it to do a better job to support it. That was my mindset, which is a really common belief out there in our communities and perpetuated in gyms and like, you know, you name it, physiotherapy practices all over the world.
00:12:24
Speaker
And that was what I was believing. And so part of this research was to kind of look at um doing what was commonly known as stabilization training of like training people to work their core muscles and their back muscles to stabilize their back.
00:12:38
Speaker
But part of this was also looking at the muscles, the way the muscles were working around the back. And we realized that actually the muscles around the back weren't underworking. If anything, they were overworking.
00:12:50
Speaker
and they weren't relaxing. So we were like going, hang on a second here. And it's kind of weird looking back now, it was so obvious, right? Because if you think about when you're in pain, like if you have pain in your body, what do you do? What's your body's response? It's to tense up.
00:13:06
Speaker
it's It's not like we go, oh, I'm hurting, I think I'll relax. We don't do that as humans. It's kind of this inbuilt protective mechanism around pain, particularly if it's threatening, is our body tenses up. So if you've got back pain, typically, we tense the muscles around the pain, like around the back and across our core. We kind of generate pressure in our core, makes us stiff.
00:13:28
Speaker
So if you look at the research around people with pain and without pain, and anyone who's listening with pain would know this, like often the report of people with pain is that they move slower and stiffer, and they're more guarded, they find it harder to relax their body.
00:13:45
Speaker
That's a really common signature for having pain. And you know, like I've had some numerous times in my life when I'm like, oh, you're sore. It's like, it's really hard to move and your body stiffens up. That's literally the body's muscle system clenching up. And we kind of describe it a bit like the clenched fist. If your fist is clenched, it makes your wrist stiff.
00:14:07
Speaker
And it creates a lot of compression across those structures. Now, there's nothing wrong with the c clenching your fist, but you're walking around all day clenching, and it's going to get it you're gonna get a sore arm. In the same way, we saw that this was happening around the back.
00:14:19
Speaker
And we were looking at the what we call EMG, which is literally just measuring muscle activity of the muscles around the trunk. And we're like, hang on a second. These people
Challenging Traditional Pain Management Methods
00:14:29
Speaker
are overworking these muscles.
00:14:32
Speaker
What are we doing training them to do it more? And it was kind of like this penny drop moment of actually they can't relax them. And then we were listening to stories of these people going, my back feels stiff. It feels compressed.
00:14:45
Speaker
I'm constantly trying to, you know, crack it or loosen it. I'm looking for massage or heat or stretches to get relief. And it just keeps coming back. And I was like, and I was like, Whoa, what are we doing here?
00:15:00
Speaker
And it was kind of like this moment of realization that these people are already overguarded and over tense. A lot of these people were over tense already. And all we were doing is creating more tension. Now, there's nothing, this it's good to be strong, right?
00:15:16
Speaker
But it's not normal to be tense when you don't need to be. And we often use the analogy of writer's cramp. Like if you if you're writing and you clench the pen, you can't write for long because you just get too much pain in your body. And and that idea of over-contracting muscles is not efficient and actually can be painful.
00:15:36
Speaker
It's a really common thing we see with pain in the body. Now, particularly around the neck and the back and the upper back, like the trunk is a really common pattern because you can't unload it easily. And the body's response is guard it.
00:15:50
Speaker
So that was kind of like a light bulb moment for me, kind of realizing from our research and then kind of reflecting back on the stories and watching how people move going, ha, what was I thinking?
00:16:04
Speaker
Yeah. Yeah. Yeah, and there's obviously like there's a belief under the belief. The belief under the belief is that the spine is fragile and that it may it needs this protection. And, and you know, if could you touch on why this belief of fragility is yeah it's not helpful based around some of the science around pain that we now know?
00:16:30
Speaker
yeah Yeah, sure. It's a really common view. We know that that view emerges really early in life. So we've done studies looking at young people around 13 to 16, as well as people in their 50s. And it's a really common view that, you know, backs are fragile and need protecting. And I think i think that's partly emerged because...
00:16:51
Speaker
you know, back pain is so common, it's really debilitating and it's often triggered by very minor things. And so, you know, it's like you hear stories like I went to pick up a pen and my back seized up or I went to get out of bed or I just twisted to reach across and my back seized up. And so you can see when, and I used to believe this as well, ah you can see why you would think, wow, to do something that small can cause so much pain That means that the back must be super fragile that it could be so easily triggered.
00:17:27
Speaker
So it kind of makes sense that that's a common view, I reckon. Now, what we know, though, is that it's actually really hard to damage a back. So i've headed I've broken some bones in my back, and that was through mountain biking and flipping over the my bars and landing across a log.
00:17:45
Speaker
Massive force that went crack. that's you can You can break your back, and we know that from traumatic injuries. You can have other pathologies like dysprolapse. I think you mentioned you might had one. I've had one.
00:18:00
Speaker
but you know that's where there is you know some kind of force within the body that exceeds the the structural strength of the system and it can result in some kind of pathological process.
00:18:14
Speaker
But the majority of people, that means like 95% of people are back pain. there's and There's nothing identifiable once you when you scan them that kind of makes sense.
00:18:25
Speaker
that's predictive of their pain experience. And we often describe this as a headache. you know
Beliefs and Pain Behavior
00:18:31
Speaker
i think as as people, we we understand that you can get a terrible headache, like a 10 out 10 headache or a migraine with no head injur injury.
00:18:40
Speaker
and no damage to the head and no pathology because you're tired and you're stressed and you run down and you might be tense and stuff's happening in your life. Your health's not good and you maybe not be exercising.
00:18:53
Speaker
I don't think we understand that in the back. But its we know from the evidence we see a very similar kind of phenomena when our susceptibility to back pain is often when other stuff's happening in our life that leaves us vulnerable to mechanical loading.
00:19:10
Speaker
And that's not that's more about the sensitivity of the structures that of the body, not about the structural vulnerability of the structures. And that's a really important point to differentiate between tissue is super sensitive, but it's not damaged. And that's really hard, I think, for people to understand. It's hard for clinicians to understand, but it's a truth. Yeah.
00:19:36
Speaker
Yeah, it's it is it is super tricky. And obviously, you would have experienced some pushback to that. And I can think um yeah about the the listeners and there there'll be someone out there going, I don't i don't get it, what's going on here?
00:19:50
Speaker
Because they've always connected pain to damaged structures. And I guess as we grow up, we kind of learn it that way because you know we do fall over, scrape our knee and and pain is is
Differentiating Types of Pain
00:20:02
Speaker
around. And that Pain sometimes can mean damage, but but what you're saying is not not always.
00:20:08
Speaker
I've had yeah both pains. I've had you know a number of injuries in my life that have caused tissue damage and they were excruciating in pain. But I've also had pain in my life when there's no tissue damage that's caused exactly in similar excruciating pain.
00:20:24
Speaker
And for me as a clinician, that's super helpful because our job, as clinicians is to help differentiate the two. Because the last thing we want to do with someone where there is pain linked to tissue damage is to tell them that there isn't any.
00:20:39
Speaker
Because that's true. And like, you know, we know with a, like you can have a broken leg. It's not, you want to offload that leg to let it heal. So if you've got tissue damage, there's a period where the natural healing needs to take place. But that's why the history is taking so important Because we know about a third of people with back pain can't even report a trigger for it.
00:21:01
Speaker
Like there's no mechanical trigger. And usually it's stuff around high levels of stress, you know, um other stuff happening in their
Non-Mechanical Triggers of Pain
00:21:11
Speaker
life. and And usually there's a mixed bag that goes with it. You know, invariably if people are listening and they reflect back on when they've had a pain flare up, you know, I'd say to them, how were you sleeping?
00:21:22
Speaker
Yeah. you know, what was happening in your life? What were your stress levels? How was your mood? Were you engaged in physical activity? You know, how was your general health? And when you kind of look at those factors, often they'll go, you know what?
00:21:36
Speaker
I was under a heap of pressure at that time. yeah I was pretty tense and that's when I did something and then I got i got the flare up. and yeah And it makes sense when you see pain through that lens yeah that it could be linked to tissue damage, but it's often linked, often, not always, to other factors that we know can sensitize your system, make your system more sensitive.
00:22:00
Speaker
Yeah, yeah. Why are beliefs so important to you? Because I think that's a major... Major contribution of you is trying to dispel some of these myths and also replace them with more positive beliefs.
00:22:17
Speaker
Why is belief so important when it comes to pain? Yeah, so we know that beliefs will influence. So, you know, if you have a belief, for example, let's say we take the example of someone who is told, I'll give you an example of that a chap where I saw who's a firefighter, and he'd been told that he had a back of a 60-year-old.
00:22:39
Speaker
right He's 32 and he needs his back for his job. right So when I said to him, so what did what did that information mean to you? He said, that means I'm old before my time.
00:22:52
Speaker
That means I'm fragile. That means I need to start protecting my back more. That means I need to stop doing stuff like physical activity or things that load my back to preserve my time because I need to keep working.
00:23:09
Speaker
That's scary as well. ah That information scarier makes me worried. So a belief can influence our emotional responses to whatever it is. If particularly it's in the body and it's a threatening belief, but it also influences our behavior. So we know this, for example, that if someone holds a belief about the pain, it means is a sign of damage that it may not get better.
00:23:34
Speaker
that I need to protect my back. So I'm more likely to take time off work, avoid physical activity, protect their body more. It affects their confidence, you know, make make them my more frightened. So we know those are potent things drivers of pain persistence, for example.
00:23:53
Speaker
Now, if you had a belief, an alternate belief, so let's say I said to this guy, which I did, look, mate, those findings on your scan are normal in someone of your age. We know that at the age of 30, about 60% or 70% of people will have a so-called degenerate disc and 60% have disc bulges and 30% of protrusions. That is completely normal.
00:24:16
Speaker
And we know that even if you have those findings, it's safe for you to move and to use your body and to load it in a normal way. And I can help coach you to do it.
00:24:26
Speaker
Now, that was a pathway to that guy's recovery. So ah first message said, he said, impacted both his physical and mental health.
00:24:38
Speaker
And we know this from the from the research that if you're to if you tell someone that damage, that Not all, but a lot of people, it starts affecting their confidence, starts making them fearful, it starts making them avoid stuff because they want to, and it makes sense, you will protect your body.
00:24:56
Speaker
so So the beliefs are so important around giving honest, accurate information to people, but that's not enough because you've then got to give them a pathway. And that's the coaching bit to because often it's not enough to just say, hey,
00:25:12
Speaker
yeah these things are happening and it's like, well, I need some help to kind of take a journey to get back to the stuff that I value. Yeah, yeah. so you're you're obviously outlining that the beliefs change some of the like psychological aspects, also some of the functional aspects.
00:25:31
Speaker
But what about pain itself? how does belief How do the beliefs that we have in influence our pain?
Mind-Body Connection in Pain
00:25:39
Speaker
Yeah, so there's a really interesting study done A while back ah where they got this, ah what kind of it's called a thermode.
00:25:50
Speaker
It's like a hot or like a very, it's like a hot electrode. Put it on someone's skin. And they had two groups. And one group, they were like, look, this is really, really painful. And it's like, it could give you a bit of a burn.
00:26:04
Speaker
And they kind of ramped it up made people a bit frightened. And the other group, it's not a big deal, you know, it's a bit warm, but there's no harm to you whatsoever. They looked at the difference between those two groups and the group that was much more stressed around it showed a much bigger inflammatory response ah to exactly the same input.
00:26:28
Speaker
Now, what that tells us is that our beliefs, if it, our beliefs in itself wouldn't do it, but if you start making someone worried or stressed or frightened, so those emotions are potent drivers of our biology, essentially.
00:26:46
Speaker
That can change the sensitivity of a body and it change can change our chemistry. and Now, we we also know this from other research that when we look at people recover, often it's linked to people developing a more positive belief system around their body, becoming less fearful, becoming less protective, but and developing healthy lifestyle behaviors actually facilitates recovery. That means they have less pain and activity limitation.
00:27:18
Speaker
So there is a close relationship between how much pain we feel in our body and and how much we can protect our body ah related to our thoughts, amazingly.
00:27:31
Speaker
yeah So our thoughts influence our biology. And I think a lot of people misunderstand this by going, are you telling me it's in my head? um I always say to them, no way. Like, no way. Your thoughts and emotions will drive your biology. And, you know, let's give you an example of it. Like, yeah.
00:27:48
Speaker
you know, you can feel like if someone tells you something that's quite stressful, you feel your heart race. You can feel your breathing change. You can feel your body tense up.
00:27:59
Speaker
Every human being knows what that feels like. That's a thought. Someone just told you something that then triggers, and ah and but the emotions are the potent part of it. it if it triggers The thought is just a thought. If it triggers an emotion and that emotion might be stressful or threatening, what does that affect? Your gut, your heart, your tension in your muscles, your level of alertness.
00:28:25
Speaker
It changes your biology. Yeah, I think that's huge the way you put it there because
Placebo Effect in Pain Relief
00:28:31
Speaker
that is the common pushback to some of the pain science education around around um your thoughts and your feelings and your emotions and how they influence pain. But it it it influences it on a biological level. yeah And we we even see that in the placebo studies as well. You know, there are literally more endogenous opioids or yeah the opioids that are inherent within us floating around that are producing some of these pain relieving responses with with a pill that doesn't have the active ingredient.
00:29:04
Speaker
So that's that's awesome. i want to I want to touch on, so you did the, you have an editorial based on some of the research that you've done back to basics, 10 facts every person should know about pain. Yeah. Yeah.
00:29:20
Speaker
and And you list a bunch of myths. What are the most common myths that you hear clinically? Yeah. Can I tell you where that came from? So that we were involved in the, like the, the restore trial, which was this big clinical trial that we were involved in part of the training and the clinicians involved,
00:29:40
Speaker
them working with 80 different, about 80 people who had really disabling and distressing back pain. And part of that journey was to ask them, so what do you think's going on? Look, we do that anyway as clinicians because they're like, we want to know what you're thinking to go, what what do you think's going on?
00:29:57
Speaker
And we heard these recurrent themes come up all the time. And often people held a number of different beliefs. And then we asked them, where did you get that from?
00:30:09
Speaker
And almost invariably, it came from other healthcare practitioners. Now, that really concerned me because it made me realise that actually within healthcare, we are perpetuating and promoting healthcare.
00:30:24
Speaker
untruth about the back. So the kinds of things that often come up are, you know, back pain is means there's some serious medical condition going on. Well, we know that's about for 1%. That's not for the majority.
00:30:39
Speaker
like Back pain means, you know, there's something damaging you back and you need a scan. Well, we know scanning is really important in certain conditions. If you have a fracture, a trauma, infection, a history of malignancy, nerve compression, can't pee, that kind of stuff, really important, like really important.
00:30:59
Speaker
But again, 95% of people don't fit in that category. And the the other problem we've got is that we you know we wait kind of often within our health system, we get scanned thinking that that's the cause your pain. when We know that the majority of people with no pain have stuff on a scan, but it's scary language. So we use languages and scans like degeneration and fissures and arthritis and stuff that really worry people.
00:31:27
Speaker
We saw a lot of people worried about their scans. And these are scans that are normal, actually, age-related changes that anyone with no pain would have.
00:31:37
Speaker
But we're frightening people. We're telling them that was another belief. There's another one around pain flare-ups. It's like, oh, my God, I keep injuring my back. Well, we know that your susceptibility to a pain flare-ups is really common in back pain.
00:31:50
Speaker
And it can be really debilitating and really painful. The common triggers of it are if you're down, if you're under more stress, if you're less active, if you're not sleeping well, not if you're injured.
00:32:04
Speaker
And so that's a massive misconception because it makes you think, oh, better protect my back. God, I've got to, you know, like you treat it like an injury and actually it shouldn't be. There are lots of beliefs around the body itself, like you know the belief around if I engage in physical activity. So if i if if I'm doing a physical activity or a movement and it hurts, it means I should avoid it.
00:32:29
Speaker
Well, we know that when your body where your back is is really sensitive, lots of things hurt. But actually, as you relax and re-engage with those movements, they hurt less.
00:32:41
Speaker
if you If your response to pain is thinking, oh, gee, I'm doing that, it hurts, I won't do it, it gets us into a pattern of overprotection and avoidance, which actually makes the condition worse. So that's another really common belief that's perpetuated in health.
00:32:57
Speaker
There's another belief around the body, around posture. You know, it means, and I hear this all the time, people go, oh, I've got a really bad posture. My posture is really bad. And I've got a weak core, a really common belief.
00:33:10
Speaker
Now we know sitting up straight, it's not dangerous, but it's pretty tense and it won't protect you from back pain. So we know that at a population level, we also know this idea of lifting with a straight back,
00:33:25
Speaker
there's actually no evidence that it protects you from back pain. So, and it's less efficient. So actually relaxing and moving in a more natural way is what people without back pain do.
00:33:38
Speaker
And as people with back pain get better, they tend to do that more. So we, so it's a massive misconception. And we sell that through pretty much any manual handling training of like, yeah you've got to keep your back straight. You've got to brace your core. and and be careful not to bend your back or lift with a step lift. Well, there's just no evidence for it.
00:33:58
Speaker
The core thing, the core one's really interesting as well, right? Because I used to be part of that as well. This idea that somehow when you brace your core, you take load off your back, that is absolute not true.
00:34:10
Speaker
So when you brace your core, you tense your back. Now, that's appropriate if you're lifting something really heavy, you're doing a plank, if you're pushing something hard, of course you engage your core.
00:34:23
Speaker
But we see people with pain doing it, bending over, picking up something off the ground, rolling out of bed, getting off a chair. over contract your core makes you super stiff and very tense and it can cause more pain so that's another misconception and then i think if i haven't got them in front of me but i'm pretty much i'm running through them there's a really strong view in our community that if you if your pain's not getting better that means like you know there's this view that you will just get worse with time well we know that it's absolutely not true we know that even if you've had pain i see this in my practice
00:35:01
Speaker
Paying for 30 years, it's you still have the capacity for managing it effectively. And we have this view that it will just get worse with time. but We know that's not true, but it's a really common worry for people.
00:35:15
Speaker
And probably the final one is around You know, I need stronger medication or I need surgery or I need more invasive treatment. And sadly, you know, we we've see lots of examples of people with really heavy medication that just doesn't work. And no no better example of that than the opioid epidemic, which has actually had a really devastating effect on people and communities all around the world.
00:35:42
Speaker
it it The body actually starts accommodating to the medication after a period of time. It inhibits your body's natural opioid system in a lot of people, and it can actually you know lead to all kinds of other health problems.
00:35:56
Speaker
In terms of surgery, there are indications for surgery. Like if you've got a nerve that's compressed, that's limiting your ability to pee or it's it's affecting your power in a muscle or, ah you know, those are the or you've got an unstable fracture or something like that.
00:36:14
Speaker
Absolutely an indication for surgery. Mm-hmm. But for a lot of people,
Limitations of Surgery and Medication
00:36:20
Speaker
surgery for back pain, which might be a disc replacement or a fusion, the evidence for it, you know, looking at long-term outcomes is just not what people hope for.
00:36:31
Speaker
You know, around 30% are not doing well at, it's up to 40% in some cases, not doing well at all. There are complications with it and the outcomes are no better than if you don't have surgery. So,
00:36:43
Speaker
It's the fix isn't a fix in a lot of cases. And that's really hard for people if they've tried everything and then this is the last resort. It's hard because people in pain are wanting to get out of pain. It's totally normal. I would be the same.
00:37:00
Speaker
But we have to be honest with people to go, actually, at the moment, this is what we understand to be true. and And for a lot of patients, it's like, whoa, what are you telling me?
00:37:11
Speaker
Like, this is just common belief, isn't it? But we realize that when we look at the evidence, it's not supported by evidence. Yeah, I see it all the time, the despair and helplessness that happens when the last resort doesn't help, ah which is which is surgery for for a lot of people. That's there sort of like, okay, now I must just get this because it's it's not it's not working or it's not yeah it's not recovering and it's it's a disaster sometimes. yeah It's really sad.
00:37:40
Speaker
I had a man I saw just a fortnight like ago who had 30 years, or probably 40 years of back pain, And he'd had multiple, multiple treatments and interventions and ended up having his whole lower back fused.
00:37:55
Speaker
And his pain was worse, not better. And I was like, what are my options? And he'd kind of resigned himself to the fact that that was just his loss. And that's yeah so sad for me as ah as a human, let alone as a care practitioner, let alone as a researcher to go, got to stop doing that stuff when it's not indicated.
00:38:17
Speaker
Totally. A hundred percent. I think the most common that are two that I hear are the posture and the core. So I want to delve a little bit deeper on that. Where did this myth come from from that we must yeah pick up our things with a straight back?
00:38:33
Speaker
Yeah. So there are two different things here, I reckon. One is um if you look at kind of historically, ah look at, you know, the, you know, a Victorian era, In the United Kingdom, what were women doing? They were wearing corsets, right?
00:38:48
Speaker
They were wearing corsets and they were given education about how how to hold their bodies. Now, I've got a daughter and I've watched her with interest go through her, you know, dance and ballet and all this stuff and all the attention.
00:39:03
Speaker
Pull your belly and keep your shoulders back. we We tell people really early on in life to hold their bodies in certain ways, and women get it more than men.
00:39:15
Speaker
And we've seen that with population research, looking at 13-year-olds, body posture, how you sit and how you stand is probably best what is best predicted by your sex.
00:39:27
Speaker
If you're female, you tend to sit more upright. If you're male, you're more slouchy. Who gets those messages? So there is kind of like what we would say is social desirability.
00:39:38
Speaker
You know, we have this view of, oh, that's nice posture. We hear it all the time. Oh, that's nice posture. Like it looks socially desirable. You don't have to look far on social media to see what desirable posture looks like, desirable bodies look like.
00:39:54
Speaker
They look like a flat core, straight back. That looks desirable. You see someone with a you know relaxed core, louchy posture. People don't like it. It's not socially desirable. So I think there's a cultural component around body posture that is longstanding, that we have kind of kind of connected with back pain but because we're like, oh, you got to stand with a neutral spine. We hear it all the time. I was taught it literally my first day in physio school in Otago was stripped to my undies.
00:40:32
Speaker
And I had a posture photo taken and someone criticized it for not being good posture. That was literally day one. And I was this young boy. I hadn't even thought about my posture up until that time. And I just hear someone dismantling me.
00:40:51
Speaker
So it's so embarrassing. You're humiliated. Oh, 100%. It was terrible. and They'd never be allowed to do it now. It was like New Zealand back in the dark ages. But that that view is still around. and You don't have to look far around, you know, this this, you know, I'm not against Pilates, but my goodness, this idea you've got to, you know, brace your core to keep your back good, it's just not true.
00:41:17
Speaker
You know, being strong, great. Being active, great. Like, you know, moving, great. But, this idea that sitting upright and bracing yourself is good for you.
00:41:28
Speaker
So that's around the core and body position. And then that got kind of hooked into the lifting space. Probably not so much for looking good, but there was an earliest really early study by a surgeon called Alf Nackamson back in the, I think it was the sixties. might've even before that where he, they've stuck they had people with no pain and they stuck these little pressure sensors in their back.
00:41:54
Speaker
And they looked at where the pressure was the most, what postures cause more pressure. And they found that if you bend forward, if you're upright, there's less pressure, you bend forward, there's more pressure.
00:42:04
Speaker
And then they kind of extrapolated that to say, oh, right, so bending forward puts more pressure on your back. That must be a cause of back pain. There was never a link between the two. It just evolved. And then this whole thing came out around lift with a straight back.
00:42:22
Speaker
And that has perpetuated. Now, there are some other studies that have been done, like with um pig spines, where they get literally get a pig or knock it off, and they take its spine and they stick it in ah ah like a vice, and they repetitively bend the pig spine until it breaks.
00:42:41
Speaker
and And then they go, oh, repeated bending can break your back. Like that's like 20,000 bends. twenty thousand wins on a dead pig's back, right? That was never designed to be upright.
00:42:56
Speaker
And then it's extrapolated. That means if you do lots of repeated bending, you can break your back. It's like, oh my Lord. so It's like yeah your back ah has a lifetime amount of bends in it and then you your cactus is stuffed. And so that makes people think, oh, gee, I better be careful not to do too many bends because i've only got a lifetime of X.
00:43:16
Speaker
Now, that's so unhelpful because what we know about the human spine, it's organic. So actually, we get stronger with repeated load. We get stronger as we move and load our backs. And that's the other myth around loading.
00:43:31
Speaker
Loading makes your back stronger. And yet we often tell people not to load their backs. And so there have been a number of studies that we've been involved in around lifting. Nick Saraceni did a study called To Flex or Not To Flex, and that was to look at the evidence around whether rounding your back is a risk factor for back pain or for future back pain.
00:43:53
Speaker
There is not a single study out there that supports that view, but that's all through the ergonomic and manual handling industry.
00:44:03
Speaker
There's not a single study to support it. That's amazing if you think about it. There was a study in New Zealand that looked at, in fact, there was another what's called a systematic review, which looks at all the evidence in the literature.
00:44:17
Speaker
And it looked at how people with back pain lift versus how people without back pain lift. And it fundamentally showed that people with back pain tend to lift with a straight back. People with that but without back pain don't.
00:44:30
Speaker
Right. with that So one of my PhD students, Ivan Al, has just published a couple of papers showing that as people with chronic back pain get better, when there's a relationship between their movement and their pain, they actually start going from a squat lift towards a semi squat or stoop lift.
00:44:50
Speaker
So actually, and that's been followed up with other research showing that actually protecting your back less hurts less. ironically just so counterintuitive so we should definitely lift with a stoop posture if we're in pain would you say no what we would say is that don't be governed by rules i think rules are really unhelpful if they're not founded you know in terms of rules like you know we would say how did you used to lift before you had back pain and often people go oh i just over i'm like
00:45:29
Speaker
Let's try that because it didn't sound like that was a problem for you before. Let's check that out. And a great example of this was, and again, Nick Sarasini did this, one of his PhD studies, looked at people who'd been lifting and manual work for 10 years.
00:45:44
Speaker
Like people who'd survived the industry, hadn't had back pain. They were tending to just bend over. They were not lifting with a straight back. So they're doing something that's allowed them to survive that industry.
00:45:59
Speaker
the other The other study, which is super interesting, is look comparing lifting with us like a straight back versus a round back. Round back lifting is actually more efficient. You can generate more force for less effort.
00:46:11
Speaker
So if you're if you're in a gym, you're doing 10 lifts, it doesn't matter how you lift, right? But if you're a manual worker trying to lift with a straight back, that could be really fatiguing because it's not efficient.
00:46:22
Speaker
And often you talk to manual workers, they'll absolutely tell you that's the case. So lots of research is kind of heading down the path of like, we don't say there's one way to lift. We would say you need to be fit and strong and efficient to lift a variety of ways because that shows you've got a back that can adapt to a variety of conditions.
00:46:45
Speaker
Yeah, no, it's awesome research. It's really, really cool to see. And that's evolving and still happening and and we'll be better off we' be better off in five to ten years than we are now in terms of our knowledge around this.
00:47:00
Speaker
Yeah, go. Sorry, I want to delve into the your RESTORE trial. Yeah. Can you tell us just what happened in that trial and and what it what sort of implications it has for people with back pain?
Introduction to Cognitive Functional Therapy (CFT)
00:47:15
Speaker
Yeah. So the RESTORE trial was probably a lot. this is So cognitive functional therapy is kind of an approach that our team's been involved in developing. And it's really an integration of a whole lot of things.
00:47:27
Speaker
But fundamentally, there are three components to it. one The first is just helping people to understand what's going on. So it's not about lecturing them. It's not about telling them it's in their head. It's about saying, hey, tell me your story.
00:47:41
Speaker
Let's listen to your story and let's examine you and let's sit down and try and help make sense of your experience in your life. It's always like put the pieces together so it makes sense for you. That's the making sense bit.
00:47:53
Speaker
The second bit is building confidence. So we know that people with back pain, when pain is really disabling or limiting, lose confidence in their body. And so that part is really about just building confidence back in the body to re-engage in normal activities and movement without protecting your back.
00:48:14
Speaker
keeping it, you know, getting it strong, getting it active, but coaching them through that journey back to things in life they love. So it's entirely person-centered. So it might be, know, a person says, I can't sit for a period of time. So we would coach you to learn to sit in a more comfortable, relaxed position so you can do it.
00:48:33
Speaker
It might be, I can't play with my kids. So we'd work out what it was about playing with your kids and that you were struggling with and we coach you back to do it. It might be, I can't like Joe, I can't do my job as a firefighter.
00:48:44
Speaker
So we're going to go, right, what are the things that you're getting, what are the barriers for you working as a firefighter? So that's a longer journey because you need to be really fit and strong and lift heavy loads. And, you know, like that's a, you have to get super strong and fit for that.
00:48:59
Speaker
It might be, I can't go for a walk or ride my bike or go to work or whatever it is. It's like, so we, it's very person centered around, okay, let's create a program that's specific to you and your needs and your personal, you know, the way your body has responded to pain and build your confidence back to do that stuff.
00:49:23
Speaker
And then the third pillar is around lifestyle factors. So, and it's again, individual. So we would say physical activity is really important for human beings. And the best activity is the one that you like and you keep doing forever.
00:49:37
Speaker
So we don't say, you've got to do Pilates, you've got to do Summa, you've got to do this. We'd say, hey, what do you enjoy? And it's like, we dance, it's great. Could be Tai Chi, yoga. I don't care what it is.
00:49:48
Speaker
As long as you're doing it, we will coach you back to do it. Then addressing other things around sleep. We know sleep is super important. Stress coping is another really important thing. It might be relaxation techniques.
00:50:02
Speaker
as well as advice around healthy diets, we know is really important as well. So that's the lifestyle bit. So that is a model of care is really aligned to what the evidence tells us is good care for back pain.
00:50:14
Speaker
But it hadn't really been tested in a big trial. So what we did, it was a two-centred trial. There was a group in Sydney and a group in Perth. ah We trained up 18 clinicians, physios, to deliver this kind of care. And that was kind of hard for them because I think a lot of physios used to, you know, lie down and will do something to you. This was quite a shift in terms of you your role being as a coach rather than try and fix the person, if that makes sense. But a lot of these people had already kind of given up on those fixes anyway. They hadn't worked for them.
00:50:47
Speaker
So it wasn't a big shift, I think, for the patient. I've had tried that. It didn't work. So we compared what we call CFT, cognitive functional therapy, to usual care. That means you you were randomized at one of those two groups.
00:51:02
Speaker
There were about 500 people in the trial. We were really inclusive. The only think people we excluded were things like you know fractures, and yeah pathology, cancers, infections, compressed nerves and stuff. Everyone else went in.
00:51:17
Speaker
You could have had failed back surgery, you name it. And we didn't have an age limit. And we kept people up into their 80s because a lot of clinical trials just don't include older people, which is crazy.
00:51:30
Speaker
So we included all those
Long-term Benefits of CFT
00:51:32
Speaker
people. And then we followed them up. So there was a three-month intervention period where the people were seen about eight times at that time frame. And then we followed them up six months later, one off, just to check in with them and what we would call a booster session to kind of check in, make sure they're on track,
00:51:49
Speaker
doing well, answering any questions, off they go. yeah So what do we find? we We found that people who went through that approach compared to usual care had less pain, they were less disabled, they were less fearful, they were more confident, and they had more positive beliefs about the body.
00:52:09
Speaker
And they told us that they told us that actually building trust, having and someone to coach them that they trusted was really important for them building confidence back in the body, being showed they could do things.
00:52:22
Speaker
um Having those misconceptions kind of ah kind of help understanding those misconceptions and and developing a new confidence in the body was really important for them. Yeah.
00:52:33
Speaker
and interestingly just like next week we expect um to be released the three-year follow-up data as well that shows that those effects so those are treatment effects that we saw at 12 months look like that well we know they have lasted out to three years so that means something yeah fundamentally has changed for these people and when we've asked them it's so and it's really exciting because it gives and a lot of these people had literally given up on treatment i kind of just in our communities just going well this is my lot they kind of accepted it which is so sad i think so the other thing that we found is that it actually saved a lot of money so there was an economic analysis to kind of go does the economics of this stack up you know if you train up clinicians and you spend this time with patients does it actually you know economically for patients and for the health systems does that stack up
00:53:31
Speaker
And it showed that there was a cost saving of over $5,000 per person in the CFT arm. And that was because people were getting back to stuff. They're getting back to work. They're getting back to stuff that's, you know, like work at home and and and employment.
00:53:45
Speaker
So yeah actually, there's an economic and a clinical benefit for this model of care. The amazing thing about that study for me was not just that because it's a 12-week program with the booster, like you said, and oftentimes what we see in back pain studies is, you know, while the treatment is going on, there is an effect and then it just sort of revers reverts back to baseline. And the fact that, you know, ongoing and you've done a year out, it sounds like you're continuing that on to hopefully get some data around three years.
00:54:20
Speaker
It seems to... The effect size is maintained, which is phenomenal. What do you think? That is the key, I reckon, Lachlan, to this trial, that surprised people.
00:54:32
Speaker
And the reason there's almost no three year follow up trials is because you, there's almost no, there's very few trials that show a difference at a year. So there's no point following someone up for three years. The fact we got a difference in a year was why we followed people up for three. Cause we're like, wow, that's actually, and actually they improved more at 12 months than at six months. So wasn't just a maintainer, they actually gained over that time.
00:54:59
Speaker
Yeah. That's crazy. I've heard Lorimer speak about this and the his trial, the RESOLVE trial, and he he believes that that the reason for the effect was around this changing our beliefs around what's actually going on.
00:55:17
Speaker
Would you agree with that? What what do you think was the mediator to the effect that the people in the CFT group had? yes We actually know it because there's a paper that's under review at the moment that's looked at this.
00:55:29
Speaker
So when we looked at what underpinned the the effect ah for someone having less disability, which is ah what is our primary outcome measure, um a reduction in pain was one thing.
00:55:44
Speaker
So they had less pain, which kind of makes sense. If you're in lots of pain, it's really hard to engage in stuff, but actually they had less pain. So it was easier for them to engage in stuff. Less The word's not nice. Like there's this ah term called pain catastrophizing, which is not a nice thing, but it's actually just a reflection of your belief. So if you're believing that, you know, this is a terrible, this will never get better.
00:56:08
Speaker
um You know, I could, I never made it go back to work. There's nothing I can do about it. Those kinds of beliefs and thoughts were another thing. Confidence was the other one.
00:56:20
Speaker
So when people were, people were more confident, they're more likely to engage in stuff. and then less frightened. so So actually it's not a single thing. it's It's a change in what we call whole system change, a change in your beliefs, a less fear, more confidence. And the other thing that's super interesting is we were able to track how people moved.
00:56:44
Speaker
Because we had these movement sensors on people, we were looked at the things like forward bending or lifting, for example, And we found that as people got better, they started moving faster and often further.
00:56:57
Speaker
That makes so much sense. Like if you if you think of anything in your life, if you're not confident to ride a bike, how do you ride a bike? You ride slower and you're stepper. If you're not confident to, you know,
00:57:10
Speaker
ski or walk on a narrow bridge or whatever, you're slower, you're more guarded. out And we saw this that there's this body thing that goes on that as people get better, their body frees up essentially. They're freer to move, them more confident to move, they're not thinking so much about it.
00:57:30
Speaker
And so it's not just these thoughts, it's actually a body response as well. And that's so important because I think often we hear this and go, oh, if I just believe differently, I'm going to get better. We know that's not enough.
00:57:43
Speaker
It's a much more complex process than that around confidence building to do the things that you might have avoided or scary or in pain to be coached through that journey. And that's the doing bit.
00:57:57
Speaker
It's not about being told something. It's about learn experiential learning through a supported journey. There's no surprises there that there was multiple things that contributed to the effect because pain, of course, is multifactorial. I want to go back to the the lifestyle stuff.
00:58:16
Speaker
For those that have listened along and followed my journey, they know how passionate I am about lifestyle interventions for pain.
Lifestyle Factors in Pain Relief
00:58:24
Speaker
I've actually... Pete, you might not know this, but I've released an app um that I use with my clients.
00:58:31
Speaker
Yeah, cool. Pain Coach helps clinicians take the guesswork out of pain relief by tracking pain alongside key lifestyle factors, psychological distress, sleep, nutrition, exercise, and social connection.
00:58:49
Speaker
Pain Coach analyzes this patient data to uncover lifestyle scores, relationships, and trends, helping clinicians guide their patients towards the habits most likely to bring pain relief.
00:59:02
Speaker
If you're a clinician, head to paincoach.online for a free trial. If you're a person suffering with pain, let us connect you with a pain coach clinician at paincoach.online.
00:59:15
Speaker
But I'd just love to hear your thoughts on lifestyle and pain. yeah Look, i think you know I think what you touched on is correct. We know that everybody, the the the factors that drive pain are different for different people.
00:59:32
Speaker
you know I can tell you examples of people who you know are literally going to bed at two o'clock in the morning and you know, getting four or five hours sleep at night. That's just disaster for pain. Like it's a really, we know that's a driver of pain.
00:59:48
Speaker
We know there other people have insomnia and, and, you know, that's a sleep problem. Other people, pain itself keeps waking them up all night every time they move.
00:59:59
Speaker
So there are lots of reasons why sleep might become disrupted, but we know sleep's really important for some people, not for all, ah For some people, they sleep fine. it's They just can't function through the day.
01:00:10
Speaker
so that's yeah So then sleep becomes an issue and we would go, what is it about your sleep that we can help you target to get you sleeping better? the Physical activity, we just know is so protective.
01:00:22
Speaker
But there are lots of people where they can't do physical activity because it hurts them so much that they've stopped. And so part of what we do would be to coach them with strategies to get back to it.
01:00:35
Speaker
And then the maintaining it, we would say, is really important. So it's, you know, for whole health and forget about the back. It's important for your mental health, physical health, every aspect of your health.
01:00:48
Speaker
It is like brushing your teeth. It's just something every human being should be doing. Yeah. So that's that's kind of like an absolute that we really, really try and coach people towards, but often it's overcoming the barriers that we would take them through.
01:01:04
Speaker
And then it's kind of getting them to try and maintain those healthy habits over time. Yeah. Yeah. The stress things are the other one. That's, I think, really, really important. We see this more and more in the pain literature, and we certainly hear it with people.
01:01:18
Speaker
And we would try and give people stress strategies to manage their stress. That might be effective breathing techniques. It might be engaging socially. It might be because often when we're stressed, we do all the the things that actually reinforce our stress. It doesn't often not make it better.
01:01:35
Speaker
You know, we might drink more. We might sleep less. We might be on our phone more. We might socially isolate ourselves. And it's like a dopamine hit that gives us short-term relief. But on the long run, it can actually be detrimental.
01:01:48
Speaker
Yeah. And so, again, that would be a coaching process of like trying to help them through that. And then, of course, we've got some really interesting and emerging research, not us.
01:01:58
Speaker
ah There is emerging research around, you know, the whole microbiome, which is your gut health.
Emerging Research Areas
01:02:04
Speaker
That seems to be really impacted by things like stress as well as, you know, like ultra processed foods and stuff like that.
01:02:11
Speaker
Now that's quite an early emergent area in terms of say back pain, for example, that we research, but we do see certainly evidence around, you know, things like someone's metabolic health and their other health issues.
01:02:27
Speaker
So those things, again, are important, but they're really hard things to change. If you're, you know, a single mom, you've got three kids and you're short on time and you're working a job but you haven't got time to go to the shop and buy fresh food or maybe you can't even afford it.
01:02:43
Speaker
It is yeah so hard to to make those kinds of changes. So, yeah you know, we we come to our clinical encounters with a lot of empathy and not judgment because, you know, i think,
01:02:57
Speaker
living with pain really tough. I've had my own pain journey and I know how incredibly exhausting it is yeah to live with it.
01:03:09
Speaker
100%. Yeah. And so, you know, I think one of the things that we really come with is to go, hey, how can I support your journey rather than coming to someone and saying, hey, you need to sort all this stuff out in your life. And they're like, come and sit in my shoes for a week and see how that feels.
01:03:26
Speaker
ah know Exactly. A child who's sick or a parent with Alzheimer's or yeah whatever it is, you know, yeah people carry a lot of load in our communities. who That has big impact on them and it's hard.
01:03:40
Speaker
Yeah. Yeah. One of the reason that I developed the app was for my own clinical work. And also my own personal pain and trying to work out, well, how can I how can i help that?
01:03:53
Speaker
and And you're so spot on in that. What we're trying to do is for people to change habits. And we know habit change is so, so hard. And sometimes I feel like we just chuck the kitchen sink at them and say, hey, do all of this.
01:04:07
Speaker
And so the app sort of like the goal of it is to sort of reverse engineer that and go, okay, well, what are the things that seem to be related, have this relationship to your personal pain?
01:04:18
Speaker
And what comes the top is the most important. Let's just focus there because if we just chuck everything at you, good luck. It's it's tough to change one habit, never alone five at the same time. so that's kind of the the goal it's not perfect but it i think it's a little bit better than what we do clinical clinically where we sort of just kind of guess and and we kind of have to get them to relay a month's worth of of information in a session and it's uh yeah it's pretty hard so yeah it is and i think you know wearables are interesting because that's where a lot of research is going at the moment and some people
01:04:55
Speaker
they really value them and others hate them. So, you know, it's, it's really interesting around like some people love diaries, some people hate diaries, some people yeah love ah activity monitors, others like hate them.
01:05:06
Speaker
So there's a kind of personal preference that comes in here around, you know, what, what can we do that works for you to support your journey? And I presume that's sort of where you're placing that, but you know, I can think people who have gone, you know what, let's just get you to monitor these things over a period of a week or two and let's see what it's telling us about your pain. And that sounds pretty much what your app does. So would be interesting to collect some data on that to go, know, what are the patterns that you're seeing and and does that help
01:05:41
Speaker
someone nudge a behavior change process. ah So, you know, my research takes on at that point and go, that's interesting. That'd be cool to kind of explore. For sure. Well, if you want to if you want to take it up, Pete, I'd be more than happy to. I actually spoke to, I don't know if you know Joshua Pate, but he got me connected to, and for those that aren't that aware, um he's a pain researcher, particularly in pediatric pain, so for children.
01:06:09
Speaker
ah He got me in contact with Mark Overton that's actually done research around these lifestyle things with knee OA. And it's interesting, his research is very much aligned with surgery.
01:06:21
Speaker
yeah right unaware we sort of came at this from a different angle but um I've been in contact with him and he's also thinking oh maybe you know we could do something together here and see what the data looks like yeah so I would love that yeah cool yeah um I have a bit of a tradition on the show where I I ask you to to speak to someone that's feeling helpless feeling yeah a lot of despair because of their their
Hope and Improvement in Pain Management
01:06:48
Speaker
pain. and And in this case, let's just talk about low back pain.
01:06:52
Speaker
Can you speak to them? What should they do? And and is there hope for them? Yeah. so look, i that that's a group of people I see every week in my work.
01:07:04
Speaker
And I see people who carry a huge burden, pain and distress and kind of hopelessness or failed hope. And I'm so sorry. I'm so sorry that that's been your experience because it has it's that it's like a hidden burden that people carry. it you know You can't see it. If you had broken leg and your head sticks, it'd be so much easier.
01:07:28
Speaker
You know, it's like you could see it. It's measurable. And it's so hard, I think, to live with something that is not so measurable. That doesn't mean it's not exact. It's real. It's absolutely real. And I was invited on a podcast with a guy called Rangan Chatterjee.
01:07:47
Speaker
And he asked me straight up, he said, what's the best? Most important message you would give to someone, I'd say hope. Now, hope is an interesting thing because it's hope for what?
01:08:00
Speaker
We would never, ever presume a cure because we just don't have it at the moment for any chronic pain problem. But hope for some kind of recovery, hope to make sense, hope for some controllability of pain, hope that you could have less pain and distress and could engage in things of value in your life and get stuff back that you've lost.
01:08:25
Speaker
That's absolutely something that we know the majority of people can get back, even if you've had pain for many years. Now, that's not said lightly, but it's what our research has shown. Now, that's not everybody's journey, but it's a lot of people's journey. And so if you're someone who's kind of given up,
01:08:46
Speaker
And I suppose my question is what kind of care have you had? Have you had someone who's really spent the time to listen to your story, kind of understand the pattern to your pain, explored, you know, how your your relationship with your body, how you use your body?
01:09:03
Speaker
and reconnect you with your body, build your trust back in your body. Cause that's the journey that we take people through and it can have an extraordinary effect for a number. Not everybody. We just don't have a panacea, but it brings hope to many who've given up at the moment. And so, you know, I say it with great humility because you know, I'm not in the camp that's going to go, we've got the
Need for Comprehensive Healthcare Support
01:09:29
Speaker
cure of back pain. We absolutely don't.
01:09:31
Speaker
But we do know that these kinds of, that therapeutic journey can be life-changing for many people. And that's why we've, you know, the Evolve Pain Care Academy website we've set up as a social enterprise. So it's to create a kind of resource for people living with pain.
01:09:51
Speaker
Go to that website and and look for the resources for people with pain. And you'll see stories of people whose whose journey whose life journey's completely changed.
01:10:02
Speaker
You'll see information there around dispelling some of these unhelpful misconceptions. You'll you'll see co-designed pathway of what the components or the changes and what had to happen in their journey for for them to recover.
01:10:18
Speaker
So that's the that's probably where i would I would speak to those people. And, you know, i
01:10:27
Speaker
I've been so privileged, I think, to work in a job that I actually have, I love to do And I have so much hope, I think, that we could be doing something better and different.
01:10:42
Speaker
But we need health systems to support it because, you know, the problem we've got at the moment is we we have these short consultations that really don't give the patient or the clinician time to deeply understand what's happening and to take that journey.
01:10:57
Speaker
And that's a huge area, I think, that we have as a profession. And a lot of healthcare care is like really crammed into short consults that you don't even have time for a conversation, let alone a partnership.
01:11:11
Speaker
Hmm. Oh, thank you so much for that message. I'll put the link in the show notes so people can check that out, that resource out. It's feedback as well. Like we we really value feedback.
01:11:22
Speaker
If there's stuff that's there that you're going, you know, that's not helpful or that's confusing or that doesn't make sense, we really value it. So, you know, we're constantly, it's about that growth mindset.
01:11:32
Speaker
We're constantly changing what we do. how we do it because we learn from the people who give us that. And and we look at this as a partnership with people. Everything we've done is co-designed with people who live with pain.
01:11:46
Speaker
So they get to teach us because they they their teaching of us is just as important as the you know partnership we have with them. Yeah, awesome. Fantastic rec resource. I'll definitely put it in the show notes and people should go and check it out.
01:12:01
Speaker
Thank you so much for coming on the show and carving out a bit of time to speak with the listeners. yes I'm sure it's going to be a valuable resource for them. So thank you so much. Yeah, cool.
01:12:12
Speaker
Lovely chat. Quick reminder, clinicians head to paincoach.online for a free trial and people suffering with pain, head to paincoach.online to help us connect you with a pain coach clinician.