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Anjelo Ratnachandra: Hit by a molotov cocktail due to mistaken identity led to a journey with chronic pain
45 Plays4 months ago
In this episode, we’re joined by Anjelo Ratnachandra, who turned personal tragedy into a mission to help others overcome chronic pain.
Anjelo’s journey began when he was innocently hit by a Molotov cocktail due to mistaken identity in gang wars, leading to severe burns and chronic pain. This traumatic experience sparked his deep determination to reclaim his life and to lead others beyond pain.
Anjelo shares his personal story of living with chronic pain, the emotional and physical challenges of dealing with an invisible illness, and what he has learned from his own struggle, as well as from working with many others dealing with chronic pain.
He is the founder of Beyond Pain Clinic, Physiotherapist of the Year (2018) at the Australian Allied Health Awards, and author of the self-guiding book Beyond Pain.
If you’ve ever struggled with chronic pain or felt like it controls your life, this episode is for you.
DISCLAIMER - This podcast is for educational purposes only. 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.
RESOURCES:
Beyond Pain: Conquer Your Pain, Reclaim Your Life
Recommended
Transcript
00:00:00
Speaker
Someone broke the of the share house I was living in, in London, in East London, pulled the blind out and threw a bottle of cocktails straight out of my head. Like the pain itself was bad and you're trying to manage you know your medication with the side effects and constipation and lack of sleep and and so on and so forth. But I guess to show people that you're in pain, it wasn't so hard because I had all the burns and you know I could show all the bandages, et cetera. But once everything heals up,
00:00:31
Speaker
and the pain continues. There's no scan or x-ray that I could show anyone or I had some scarring, of course, but aside from that, you know people would just said, oh, you look all right, you look normal. yeah And it's this invisible struggle, I guess, where you're you're so having a struggling day, where you put a smile on your face to so that you can get on with life and continue in the community and society. Yeah, I think pretty much everyone with chronic pain sort of wrestles with that or struggles with that to some degree, that feeling of being dismissed or invalidated. If you think about it, naturally, the medical model and the model that we often taught at university or university or in training is that, oh, if there's something wrong with the knee, go get a scan done. Or if there's something wrong with the back, go get a scan done. But I often say to people, like, if you have a headache, what scan do you take?
00:01:27
Speaker
yeah There is no scan, but we just believe you. One of my childhood goals was to trick the Himalayas. And although my specialists are saying, oh, you'll never be able to do that, i'm one I'm a really firm believer as a therapist that we should never put ceilings on people's goals and aspirations. And so for me, I was adamant to say, well, this is um my lifelong dream as as a kid and growing up.
00:01:55
Speaker
I wanna see if I could do it. What would your advice be to someone that's feeling pretty helpless at the moment, feeling like they're in a bit of a dark place when it comes to pain? I think, you first of all, recognizing that it is a struggle, but recognizing that, you know, and being in a dark place means the pain's got control of you. You gotta take back control, and you don't have to do it alone. You're not alone. That's the most important thing. Reach out to your networks.
00:02:26
Speaker
Welcome to the Pain Coach podcast. Today we're joined by Angelo Ratnachandra, founder of the Beyond Pain Clinic, international speaker, physiotherapist of the year at the Australian Allied Health Awards, and author of the popular self-guiding book Beyond Pain.
00:02:45
Speaker
This podcast is for educational purposes only. 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. Thanks for coming on the show Angelo. um I appreciate you coming on and and I feel like you're going to have a unique perspective on chronic pain and and treatment and how to live you know, an abundant life with pain, because you have a unique experience in that you are a clinician, ah you're a physiotherapist, but you also have real life experience with pain. And I think that I always say to some people that have pain that in in a and a particular way they have, they are experts because of their lived experience. And then you also have the physiotherapy background as well. So it's a great combination. And I feel like
00:03:44
Speaker
There'll be a lot of insights that you will have for us and for the listeners. But I just want to take it back first and and just learn a little bit about your story. um And like every good story, I want you to start back prior to developing chronic pain. Just tell us a little bit about yourself and and where you're at in life. Sure. Thanks for having me, Lachlan. I really appreciate the opportunity. yeah ah Look, I think in terms of my story, look ah I grew up in Australia, in Melbourne. and um yeah qualified here in Melbourne and decided, like most young physios after a year or so of work, that you want to do the backpack travel overseas to the UK, which is exactly what I did back in 2003. And I think early on in my period, I was healthy, i was um I had no medical issues or anything like that at that point in time. And um and I think for me it was more about exploring
00:04:41
Speaker
What are the areas of physiotherapy? you know There's got to be more than just sports, physio, et cetera. There's nothing wrong with that. but i just And really working in prior practice, you know it really interested me that you know two people with the same injury, yeah same similar very similar mechanisms can have two very different outcomes. And why is that? And so really at an early sort of stage in my career, I was really fascinated about the psychology behind physical injuries.
00:05:10
Speaker
And so when I went overseas ah to the UK, I was very fortunate initially to work in a neurological sort of unit, rehab unit, and then worked in mental health. I reckon I was probably one of the earlier physios to work in mental health in a rehab facility and and then worked in pain management, which really working with psychologists, working mental health, the neurology aspects really gave me some insights into the link between the mind and the body.
00:05:39
Speaker
um that's That's how it came to be, yeah. Yeah, awesome. Yeah, we share that passion for the mind and the body and the integration between the two and how that brings about different outcomes and different pain experiences. um And i I never really wanted to get into the sports stuff because I quickly realised, you know, I didn't find as much meaning, and this isn't having a crack at the sports physios, but I didn't find it as fulfilling to sort of make someone run a little faster or jump a little higher.
00:06:09
Speaker
Um, so yeah, I went down into that, the pathway that you have, um, as well. So you were working in chronic pain, um, prior to developing it. Is that correct? That's correct. Yes. It was just the already. Yeah. Yeah. So tell us, tell us about your story about how you developed chronic pain. Well, yeah. So it's a pretty interesting story. I look, I was, um, one day I was sitting at home watching TV on a On a Friday night, it was the 23rd of June, 2006, and someone broke the of the share house I was living in, in London, in East London, pulled the b blind out and threw a bottle of cocktail straight out of my head. um So I put my hands up to protect my face. It deflected on my arms, hit the back wall, and it shattered. I guess the petrol just showered me, and then next thing I knew, I was set alight.
00:07:05
Speaker
so um I then had to subsequently use my hands and as a physiologist to put the flames out, I was wearing a t-shirt at the time and and sort of ran out the lounge room, closed the door and told my housemates to get out while I went into the shower and stayed in the shower until the ambulance and the fire brigade and the police came. Wow. Wow. And so you were caught in the crossfire, I believe, of of a gang sort of violence, gang war going on.
00:07:36
Speaker
That's correct, it was a case of mistaken identity, they got the wrong house. Oh wow. It was something to do with some turf war, teenagers, yep, yep. Oh wow, that's full on, that's full on. And so what, tell us a little bit about your journey after that. So like obviously you were a physio, but until you had some ideas around treatment and those kind of things, but what was your sort of journey through the healthcare system and how did you seek help?
00:08:06
Speaker
Yeah, look, it was a very interesting journey. You've become the patient very, very quickly, obviously, in these sort of situations. But look, ah in terms of me, I was in a burns unit, a cute burn unit for about a week, and then I had about six months of outpatients three times a week. I had, you know, your morphine injections and things like that. I had to have a skin graft, so on and so forth. You get pumped with medication and you go through the rigmarole of side effects, but also, you know, really,
00:08:36
Speaker
showed or demonstrated the importance of getting counseling early and support early and to complement the physical rehab. And I don't think, and really it set home to me that the message that you can't separate the two rehabs, you need to put it together because you're a person, you're not just an injured body part. So yeah, so that was predominantly what happened what happened. Yeah, and I guess you probably had not my I don't know much about Burns. My wife's actually a pediatric nurse and she did some some some work in the Burns unit. So she knows a little bit more about the challenges that you would have faced. But with when it comes to the pain aspect, tell us tell us some of the struggles that you had personally with your journey with pain. Yeah, um that's a good question. Look, I think predominantly
00:09:30
Speaker
One, it was at the at the beginning, it wasn't so bad. The pain itself was bad and you're trying to manage you know your medication with the side effects and constipation and lack of sleep and and so on and so forth. But I guess to show people that you're in pain, it wasn't so hard because I had all the burns and you know I could show all the bandages, et cetera. But once everything heals up and the pain continues,
00:09:57
Speaker
There's no scan or x-ray that I could show anyone or and I had some scarring, of course, but aside from that, you know, people would just said, oh, you look all right, you look normal. yeah And it's this invisible struggle, I guess, um where you're you're so having a struggling day where you put a smile on your face to so that you can get on with life and continue in the community and society. yeah And I think that is probably one of the biggest issues aside from dealing with the pain itself in that subacute phase. Yeah, I think um pretty much everyone with chronic pain sort of wrestles with that or struggles with that to some degree, that feeling of being dismissed or invalidated. Did you experience that from obviously friends, colleagues, but did you experience that also with the the health system? Oh, yeah, absolutely. Because again, it's a lack of understanding.
00:10:53
Speaker
um And it's not not pointing fingers at anyone. It's just their lack of knowledge on how pain works, et etc. Because if you think about it, naturally, the medical model and the model that we often taught at university or university or in training is that, oh, if there's something wrong with the knee, go get a scan done. Or if there's something wrong with the back, go get a scan done. But I often say to people, like, if you have a headache, what scan do you take?
00:11:20
Speaker
yeah There is no scan, but we just believe you. So yeah maybe we just need to believe the person in pain kind and show them that there is a life despite pain. It doesn't have to be that they don't have to that can't live a fulfilling life or a abundant life as you say. Yeah, 100%. I had ah a client of mine that she there was a missed coccyx fracture. This was like a year down the track and she was Within a session, she felt validated. And then the following session with the specialist, he said, but it's all healed and you shouldn't still be in pain. And like in an instant, she went from being validated and and happy that there was something there that they could sort of point towards to all of a sudden feeling that invalidated. And obviously that took us on a journey of unpacking you know what why you don't need to see something or visualize something or have any sort of proof to to have have
00:12:17
Speaker
pain um and for it to be real? Oh, absolutely. I think, um, ultimately, you know, you could have scans that look really bad, but have no pain and you could have scans that look really good, but have a lot of pain. So the actual physical deformity is not necessarily, and I'm saying obviously there's fractures and thumbs. It's obvious, but yeah, yeah, yeah.
00:12:40
Speaker
in In cases of most chronic pain conditions, there's no physical deformity or whatever that correlates to pain. you know yeah he can't this At the moment, you get functional and MRIs, but really we can't see pain.
00:12:53
Speaker
yes i you know viscent yeah 100%. I think a lot of people then jump to thinking that we don't think the body's important and it's just that we can't hold those two things um in intention, I guess, that that both the mind body and the mind ah play a role in the outcome, which is pain. ah yeah that's it i mean it Was it easy for you to to sort of wrestle with that when it was a personal journey? Yeah, no, yeah, look, it was easier because I already had exposed to working in pain management. So I had the principles and I was taught, but I think it still wasn't easy though, um because, you know, sometimes when you have to walk the talk, it's a lot harder, yeah but certainly gave me insights and appreciation of what my clients go through and what they go through. So it was certainly,
00:13:52
Speaker
um ah it was it was an eye-opening experience for me and certainly made me a better therapist for i believe anyway for me oh for sure yeah yeah and i can relate to that with some of my own personal experience as well um tell me you So my mission is basically to help people reclaim what pain has taken from them. And what what did what did pain, firstly, what did pain sort of take from you, at least for a period of time? um And then I'd love to for you to unpack a bit of ah your journey towards recovering those things. Yeah. Oh, look, mate, I was young. you know like I was ah in my mid 20s when all this happened.
00:14:37
Speaker
um I wanted to do whole heap of travel, I wanted to check, I wanted to work in different areas and all of a sudden these things happen, I've had burns. um Eight months prior to my burns, I had a collapsed lung and I had to have life-saving lung surgery for that. you know And so trauma after trauma within the space of 12 months, two significant traumas. um All of a sudden the specialist said, you know, you'll never do high altitude tracking, things like that, forget it because of your lung collapse and your chronic pain from your burns, et cetera. you know don't i
00:15:08
Speaker
do anything crazy, you need to protect yourself. So I felt as a young, independent guy who loves travel that my life is just struggling. And from a physiotherapy perspective, I couldn't use my hands as much anymore. you know Sure, I was working in pain management, which was less hands-on, more about education, empowering people, but I still wanted to do some hands-on work or have the opportunity if I wanted to go work somewhere else.
00:15:35
Speaker
And now all of a sudden I felt my career was maybe also restricted. So, you know, the different areas of my life was all of a sudden impacted. I often talk about the three pillars in one slide. That's your personal life, your social life, your vocational work life. And all three are all of a sudden got significantly impacted and my my world was just shrinking. So yeah, that's that's what sort of what pain did to me.
00:16:03
Speaker
And you were previously interested, like you were, like one of your hobbies was hiking. Is that correct? Yeah. Yeah. I love outdoor stuff. So, um, outdoor work and motorbike riding. So, uh, yeah. Okay. Yeah. Yeah. So. And were those things difficult at the time, like while you were on this sort of journey?
00:16:24
Speaker
Oh, absolutely. But I think for me, another thing I learned out of all of this is to make sure you set your personal goals or you set some goals um for yourself and work towards them. Okay. And, you know, that don't need to be unrealistic, but one of my childhood goals was to check the Himalayas. And although my specialists are saying, oh, you'll never be able to do that. i'm one I'm a really firm believer as a therapist that we should never put ceilings on people's goals and aspirations. ah sure We should be realistic but about what they can and can't achieve perhaps or what they can work towards, but we should never say you could never do that. yeah the um And so for me, I was adamant to say, well, this is um my lifelong dream as as a kid and growing up.
00:17:14
Speaker
I wanted to see if I could do it, so I wanted to work towards it. and I was very fortunate. you know um In 2010, I did Deborah's Basecamp. It took me but four years to to recover with life, getting in the way, work, etc. but you know um I did the training, the best I could, whatever, and then, and did it, it was quite gratifying. Now, I'm not saying people need to go to those extremes. It could be as simple as being able to have a meal sitting down or being able to play with their kids at the park. But I think it's important to set some meaningful goals because then you can work towards those goals, you know? For sure. Did you send a cheeky email to the specialist or?
00:18:00
Speaker
I'd love to, but um it was one of those outpatient clinics, you know, so um um there was plenty of photos I could send us. But yeah, it's possible, you know, like it's possible. Yeah, for sure. What I find um interesting is that they at times and I like the intentions there and I think the defensive way that people approach medicine is probably one of the reasons behind it. But I think you know if you outline and inform the person of the risks and the rewards and the benefits, it's really up to them to make the decisions of of what they do with that information. And I think you're right about you know putting
00:18:41
Speaker
unnecessary limitations on people. And really it just comes down to the fact that they don't see the ah full person. um They see the injury and and and maybe they don't have time or they work in a system where they don't have time to to see the full person, but they don't see what the trade-off is. um i have yeah I've experienced this many times where I had a client recently that netball was her thing and and Look, it I don't think it needed to be taken away from her. but And she understood the risks and the rewards of of doing that. But yeah, she had the same sort of experience with a specialist saying, that sorry, I don't think you should do that. um and i and And they take it as like, OK, well, if it's coming from a specialist, well, then I definitely shouldn't do that.
00:19:36
Speaker
um And look, it's it's sometimes it just gets lost in translation and then I'm not having having a go at the specialists as well. But yeah, I 100% agree with this. The idea that you say don't put limiting ideas on people and rather inform them. Like you said, Lachlan, I think specialist have best intentions. But sometimes our own fears and anxieties can be translated, yeah transferred to the client. And we need to be mindful of that. um That said, you know, someone's being unrealistic, you got to say, well, at this point in time, that's probably not realistic. But what would be a more realistic goal that works towards that? I think that that's fine. um Yeah, as opposed to just, and I guess it's a time thing to with appointments, etc. That could be a reason. But yeah,
00:20:25
Speaker
So yeah, goal setting was really key and and not losing hope was something I also learned out of that. Yeah. Yeah. So that was a, that was a one takeaway that you learned through the experience that you probably wouldn't have had if you didn't go through that experience, or at least it wouldn't have been emphasized the same way. Was there any other things, takeaways that you had from living with pain that you didn't have as a clinician?
00:20:51
Speaker
Yeah, like it's not necessarily a quick fix. you know yeah um It's something to work towards. and And even if you're doing everything you're meant to do, sometimes things do fall over and it's okay. not Don't be so hard on yourself um because that that is difficult. I mean, you're you're trying to live with a chronic condition for the rest of your life. um So sometimes you're going to get flare ups and setbacks and things like that. And that doesn't mean you've done something wrong or, and that's what I found. Like you you often try and be really hard on yourself. And then you think, well,
00:21:25
Speaker
If one of my patients or one of my friends are in this situation, what would I tell them? You know, so yeah to encourage them and completely not what you're telling yourself. So I think sometimes ah taking a step back and saying, okay, objectively, like you might be really hard on yourself, but realistically, what will be more appropriate? You know, I think that's really important. The other thing I would say is that not to let your pain be your identity.
00:21:53
Speaker
Because sometimes it can be all-consuming and everything's about pain. I can't do this because of my pain. I can't do that because of my pain. Or my pain stops me from doing this. Or it depends on my pain if I can know, you know, that might feel that way now. But you've got to work with your therapist and your team to find a way so you could, like you mentioned, reclaim. In my book I say, concrete dreams reclaim your life, you know? So yeah, I think it's really important to look at it in that context because it's about taking back control. Don't let the pain control you. You take control and find control and contain the pain so that you could live a fulfilling life. Yeah.
00:22:44
Speaker
That's what I would say, I often use the analogy to say, if you use the palms of your hands as your pain and you put it right in front of your eyes, you can't see anything beyond. It's just the pain. The future, your life, your friends, you can't see it, but if you can take it to the side, you're not trying to get rid of the pain, you're not trying to cure the pain, but you're trying to move it to the side. So you've got a bit of hope and vision of the future. I think that's, despite the pain, that's the concept here.
00:23:11
Speaker
Yeah, for sure. I have a similar one in that like, you know, pain can stay the same. But if your life expands around that, you still have it becomes less um less impacting the pain itself because your life is expanding and growing around that. And and and and what we know is that usually when that occurs is the pain starts to reduce actually in intensity and in size as well. Because it's a perception of the actual, I mean, the research shows, and in fact, my personal experience working in pain programs and things like that is when someone finishes a pain program, the pain level is actually higher.
00:23:52
Speaker
Not lower, but because their function is so much higher, they increase in pain because they're doing more. is not noticed, and in fact, it may feel like the pain is less, but if you if there's a way of objectively measuring, you probably see it's the same level or higher, but because their function is so much more, it's not, doesn't feel as, but but that function, greater function leads to greater sense of control. you know and And that's what we need to look at from a pain management perspective, is giving back the control, giving back the locus of control to the client.
00:24:25
Speaker
yeah When we're talking about before limiting beliefs, I do wonder, like there are definitely people with with chronic pain that do need to live with it.
00:24:36
Speaker
for the rest of their lives and they are going to live with it. But I also think that recovery is possible and and complete recovery is possible in in some situations and I don't like putting ceilings on it. Even though I know there's this balance isn't there with with accepting but also striving. um And ah I don't know what that is but I definitely like don't like to dictate to my clients around what the possibility could be. Well, you don't know that's that's just ah you're looking through a crystal wall then aren't you? So um I always the way I said to my clients, you always have the hope that you cure your pain. But the um in the meantime, what are you going to do about it? Yeah, 100%. That's a perfect way to look at it. Yeah, I'm glad that you said that because ah you know, there's I actually really hate the term
00:25:30
Speaker
pain management because it gives this a gives this idea that it can't be treated or it can't reduce or or even resolve in some cases. And although I think that that you know there are cases where it won't, um like you say, we don't have the crystal ball and I think it's it's good to sort of give the, I mean, we know that that expectations and beliefs around recovery ah change outcomes And then and then there's a group of people, I guess, a group of clinicians that will say, you know, you just got to live with it and manage it and change your expectations. And I wonder what effect that has. It's a yeah, it's a fine line. It's a balance there. It certainly is a balance. Look, I think it's more about the fact that
00:26:19
Speaker
Pain management really should be around. It is an interpretation of the term, isn't it? I think that management should really is around learning to manage your pain. Chronic pain is no different to having like diabetes or asthma. It's a chronic condition. right but and People hope you can cure diabetes and we hope you can cure asthma.
00:26:39
Speaker
but But what do you do in the meantime? You have an asthma plan, you have a diabetic plan, dietary plan, et cetera. Same with pain, and you have a pain management plan. yeah I could asthma management plan or diabetic management plan, and that's what you do. But yeah, of course, you don't lose sight and hope that one day there could be a cure, but in the meantime, what can we do to improve your quality of life?
00:27:05
Speaker
because For me, pain is that diagnosis, right? The struggle isn't the pain, the struggle is what you want to achieve, but you can't because the pain's impacting. So the struggle really needs to be about the goals you want to achieve and the things you want to do, and the pain is the pain. So how do we now work towards the things you want to do, yeah despite the pain? Yeah, for sure. That's how I'll be looking at it.
00:27:34
Speaker
you You love the quote from Aristotle. I saw it on LinkedIn and I'm gonna read it. um Treatment of the part should never be attempted without the treatment of the whole. That is the error of our ways, the separation of the body from the soul. I personally believe this is still one of the errors of our ways. And I think when- We're still learning. Yeah, yeah. When pain treatment or management does sort of,
00:28:01
Speaker
misses that aspect, I feel like it it's limited in its ability. what Explain why youre why you like this quote so much. Oh, look, just from personal experience. you know um We know ah exercise is good for your mind, but we also know a good mindset gets you to exercise. you know um Any injury, I believe, has a psychological component.
00:28:30
Speaker
And any psychological condition, I believe, has a physical component. It's it's linked. Like, we're born with a hard gut and a brain. yeah So how could you say that?
00:28:42
Speaker
you know, psychological conditions have physical manifestations and physical conditions can have psychological impact or psychological manifestations. So, um I love the quote because, quote because again, it teaches us to treat the person, not the injured part. And let's face it, like,
00:29:02
Speaker
you know, the medical model is based on René Descartes back in I think it was 1774 or something like that, right? Yeah. And so we're 1664. So we're we're looking at a model that's about 400 years in the making versus the biopsychosocial model, which is from since World War Two. Yeah. So yes, we are evolving and it will take time.
00:29:26
Speaker
but more and more we're understanding that yeah pain is more than the injured body part because, especially because when you look at amputees and stuff, they get phantom limb pain, there's no limb. So the traditional model doesn't add up. And so that's why I think having Aristotle's quote is really at home for me with the counseling and the physical therapy, because that's what I needed to get back on my feet. So yeah. yeah Yep, 300 BC and we're still trying to, we're still wrapping our head around it. That's when he, that's when he quoted that, I believe around that sort of. I think it's 1664 was when Aristotle quoted that was 1774. I think about 300 years, 400 years. Yeah, right. I swear I read on your LinkedIn that it was late. It was early. I'm sorry, I'm sorry, I'm not Aristotle. Rene Descartes. Aristotle said that. Sorry. Yeah. Yeah. Yeah. Yeah. I thought you were talking about Rene Descartes. Yeah.
00:30:25
Speaker
No, no, no, I'm going back to the pain. aristotle point Yeah, exactly. Yeah, yeah. yeah that's right minute ah Treatment of the part should never be attempted without the treatment of the whole. Yeah. Yeah. Yeah. Yeah. always yeah I always say to people like my my simplest explanation of pain is that it's an embodied experience that comes about by the interaction between the the brain or the mind and the body. And yeah can you can't separate the two. What do you do, because this happens often and I think even someone listening to this will get the sense that like maybe they feel that we're saying that they're fabricating it or they're they're thinking it into existence or that it's not it's not real because because of their experiences. What do you say to someone that
00:31:18
Speaker
that says that? Are you saying that it's all in my head or are you saying I'm making it up when you've when you unpack that? Definitely not making it up. No, absolutely not. I mean, pain is real. No one wants to be in pain. Some people might have alternative agendas and for whatever reason, they might act like they're in pain and they're not, but most people are genuine. It's hey it's impacting your lifestyle. Why would you go and impact your lifestyle to the level if you didn't have it? Just because you can't see in scans. And that's why I used the analogy with the headache. yeah like We can have pain and not have a scan to show it. um We can have phantom limb pain.
00:31:56
Speaker
Yeah, so how are you going to demonstrate it? It's very real. It's just that we don't have the the instruments or the technology to show the pain. It's in your nervous system. um That is really the nervous system is a hardware of pain. And unfortunately, we don't have like a blood test to show um diabetes or lung function tests to show asthma.
00:32:18
Speaker
yeah for for pain. So we we haven't got that technology yet. There is functional MRIs and things like that. That shows areas of the brain that lights up when you have pain. But then again, majority of those areas light up when you have anxiety, depression and other mental health conditions. That's why it's so intertwined, yeah the the mind and the body. So I would say my message is, yes, you do have pain and I'll believe you, but that doesn't mean that you your life needs to Yeah, your life's over and you can't do this or you can't do that. We can still find a meaningful life despite the pain and have the hope that one day your pain might resolve. But in the meantime, let's just work on what you need to do to achieve your goals despite the pain. Yeah, for sure. I think the headache one is a is a good one. um No one rushes to get a scan.
00:33:10
Speaker
Rarely do you rush to get a scan when you have ah a mild headache, but um not the same when you have, say, back pain or something like that. I i use the example of um love because because at at the end of the day, pain is a feeling. It's an it's a it's an experience that that really is a feeling just like love is. And and yeah you can't really point to anything and say that someone's in love. You just say, you just believe it because of the way because they tell you. And yeah, you can see the outcome of that, which you can also see the outcome of pain through certain behaviours and things like that that change. um But yeah, it's it's similar in that regard. And I think it is a tricky one, though, um because no matter even if you sort of nail it, you'll understand your depiction of that and the mind and the body, people do sort of tend to feel dismissed for some
00:34:08
Speaker
Well, sometimes. um I don't know. Do you find that tricky? Yeah, absolutely. yeah i think I think they feel dismissed because the practitioners that they're working with may have a limited understanding of they're not listening. Yeah. You know, um I think We've got to listen. We've got two years for a reason and only one, one mouth, you know, um, we've got to listen more than we talk as they say. So, um, so I think listening to the struggle, listening to the struggle and then helping them to help overcome that struggle is the most important and giving people hope is really important too. Yeah. For sure.
00:34:56
Speaker
Patients with pain often sort of go on this endless hunt for one single cause to their their pain that they can sort of get a quick fix from. um and And you can understand why because that would be amazing, right? If you could find one thing to just that just hits the nail on the head and and fixes it forever, that would be amazing. But oftentimes it's a bit of a mirage and they never really find it. Did you did you go down some paths of of trying to sort of find a ah solution that's sort of like one thing intervention that could be done?
00:35:39
Speaker
um I was fortunate I didn't know and again it comes back to because I was working in pain management in an international renowned pain clinic before my experiences but I can certainly see how that is. I know as a junior physio I used to say okay well let's try this or let's try that or let's try this and let's try that you know try all this merit of treatment to see if we can fix someone's pain that they've had for 10 years.
00:36:04
Speaker
And you're like, wow, this is not working. Have I failed as a therapist? You know, like yeah what's going on here? How can we cut? So yeah, of course in that context, and I can certainly understand why someone in with chronic pain would want to explore. Um, to, to that end, I would say that I'm not against people exploring all weird and wonderful options, but I think the most important thing is they, they test it out. And if it doesn't work, stop, don't keep going back.
00:36:33
Speaker
You know, it's so, and I think that's the biggest risk. Sometimes you need your own peace of mind to move forward. Someone else telling you back of your mind, you think, oh, buddy, if I just did that a little bit more, if I did this a little bit more, it impacts you. So.
00:36:51
Speaker
I'm not against, it's like people say, oh, should I try acupuncture or I can I, should I try this herbal medicine or I really think medicine or maybe yoga or Pilates might help. I said, well, it doesn't matter. Try whatever you want to do, but be sensible about it. Like don't try too many things all at once because then you don't know which one's working, which one's not or how they interact. But at the same token, don't spend thousands of dollars on one treatment. If you've tried it for months and it hasn't worked.
00:37:20
Speaker
Like it's not gonna work for you. It might work for your mate, but it hasn't worked for you. And that's okay because we're all individuals. Yeah, for sure. Or it may be that it's part of a solution, but it's multi-factorial. And so there's other aspects. It's one tool. Yeah. It could be one tool in your toolkit. I think that's definitely true, Angelo, when it comes to some of those things that you mentioned, which are very low risk.
00:37:47
Speaker
What about the sort of like the the more, the higher risk type, you know, I'm thinking surgeries and more, um yeahp those kinds of things. And again, with surgery and things like that, there is a higher risk and there's limited evidence of benefits of surgery, right? Whether it's spinal cord stimulators or ketamine infusions or fusions or etc. microgra etc um Again, I'm not against surgery, but what I always tell my clients is that if you do a non-surgical approach beforehand with exercise, pacing, all these other strategies, your gu your body and your mind is going to be fitter for surgery, which means you're likely to recover faster following surgery. So before you jump into surgery, get a few opinions.
00:38:39
Speaker
and try and get just yourself mentally and physically prepared for the surgery, then have it. Because jumping into surgery with an unconditioned or deconditioned body is not going to help you post-surgery, which is what you need. right yeah um And yes, if you have a look at the literature, um people everything's a bell-shaped curve for me, right I think.
00:39:01
Speaker
You know, the majority of the people sit here and there's always outliers, which could be great outcomes, really awesome outcomes and really, really poor outcomes. So surgery isn't bad. It just needs to be appropriately utilized and not jumped at. So I always say, while you have to wait, often you have to wait anyway, yeah for a while, get yourself fit both mentally and physically.
00:39:24
Speaker
yeah in preparation for surgery before you have it. And if you improve, then that's great. Like for example, when I was at the pain clinic in London, we used we actually implemented, I think it was a two week pre spinal cord stimulator program. And we had two or three people out of say 15 drop out of having surgery because they found the program helpful. Now for those people,
00:39:47
Speaker
It was great because they avoided surgery. So I'm not saying they're, and these were all people who are already signed up to have the surgery done. We just offered a two week program of pain education, pacing, exercise. like And they said, look, at this point in time, when i' neat I don't want to take the surgery. I think I can manage this a bit longer and see how I go. So I think it's that that we need to work towards.
00:40:10
Speaker
For sure, for sure. And it needs to be informed by, obviously, the body of research. And and and if they're informed again, they they people need to make their own decision once they have some information around it. No health professional should be dictating this the the outcome or the decision that they decide. um It's really in their hands once they're informed. um And I i like that decision.
00:40:38
Speaker
Yeah. 100%. And I like your idea. why not agree with the but Yeah. I like your idea about a second opinion. I say to people, you know, Chades measure twice and cut once, but so why don't we do that with our bodies, you know? Um, and I think, yeah, there's some wisdom to that as well.
00:40:56
Speaker
Yeah, I think that's a really balanced approach. It's not it's not a, because there are some surgeries as as well that are amazing for chronic pain. Like you think of knee osteoarthritis and you think of hip replacements, like oftentimes they have really good outcomes. um It just, yeah, and it depends on your unique situation as to what way to go. Yeah. What um what role do you think, so like,
00:41:27
Speaker
you How do you see the the role of a physio in someone's rehab?
00:41:35
Speaker
I know it's a very broad question, but... Yeah. um In the context of chronic pain, I think there's an element of physical conditioning, a traditional physio's role, but also there's a there's a huge part in education and reducing fear yeah towards activity and movement.
00:41:57
Speaker
And I think that the second and the third, we don't do too well as physiotherapists, and I think we need to get better at it. Because you could tell someone what to do, but unless you explain why they need to do it, they're less likely to do it. yeah And if you can be there and support them, so so say someone had their back lifting a box, right? You can give them the best exercise program in the world, but if you haven't told them why you want them to do it, they'll probably do it for a little while,
00:42:26
Speaker
And if you don't then teach them and support them to lift those boxes again, they'll always have a fear towards lifting that box because that's how they hurt themselves. So I think we also have a role to play in.
00:42:39
Speaker
managing or assisting to overcome fear avoidance behaviors. yeah um But also education, like education is huge. If you can give someone, in this instance, knowledge is power, you know? yeah It's coming from you as a reputable source, not just Dr. Google. um yeah But, you know, and it can be a real, it could be a real great driver. I know in the programs where you're on Beyond Pain, a lot of people, they say,
00:43:07
Speaker
The fact that someone sat with me and explained to me what the hell was going on was one of the single biggest changes in my mindset yeah towards my recovery. Yeah. havet And we don't even put our hands on and just going through because no one's really, they've had to listen, listen, listen, listen, listen, but no one's really explained to them and answered their questions. Yeah.
00:43:29
Speaker
Do you ever get the feedback like um from certain people that you you didn't do anything, you didn't treat me when yeah when you have the education or the conversation? Yeah, look, um we I think nowadays we sort of explain what we do and what our program contains. Yeah, yeah. um Because yes, it still is. They they often leave, like when I have my clients in the clinic, they're like,
00:43:54
Speaker
That was a different physio session to my normal physio sessions that I'm um'm used to. yeah um But nevertheless, they're grateful for it you know because I can see that. it was an important part to cover. Again, it's coming back to the mind and the body concept. yeah Why separate the two? And I'm certainly not saying I'm a psychologist or a counselor. I'm not saying that at all, um nor should we try and be. We've got to stick to our land and what we're good at, but I think providing education and some reassurance based on clinical knowledge, et cetera, on activity, I think it's really, really meaningful and helpful.
00:44:30
Speaker
Yeah, yeah, for sure. I think education is definitely treatment, but you can understand where they're coming from because they, you know, they they see what a physio is by watching the football on a Sunday. And so, like, you can't really blame them from then coming into the clinic and expecting a certain not an all intervention. So yeah, but it's it's surprising how many people are very thankful actually. And they've they've been, you know, when when you sit down and take the time to to hear them out, hear their story, have a conversation, give them some education. Some people are
00:45:07
Speaker
are very blown away by that because I haven't experienced that in the past but then yeah there's others that are like hey you didn't you didn't treat me which I can understand too. And I think for those people you need to sit down and spend some time exploring what they think they need something or yeah what treatment do they think they need, et cetera. Because again, it's about your own experiences and biases and you you want, if you're gonna treat someone, you want them to be on board with what you're gonna do.
00:45:37
Speaker
yeah not have doubts about what you're gonna do. So I think, again, spending a session going through, okay, what's your expectation? What do you think it's gonna achieve by me doing this this to you? Okay, well, maybe we need to give that a go so you can see what the outcome is and then we'll move. So it could be a ah slower than anticipated process, but nevertheless, no disrespect to the client. It's their yeah expectation experience and we're just trying to work through it with them to to help them see what they actually need.
00:46:05
Speaker
Yeah, for sure. I think it's cool because this is I mean, this podcast is for people that that are suffering with pain and, that you know, want some tools, advice, education that they can take to their health care providers and and unpack. But it's I think it's nice for them to have a little bit of an insight of, um yeah, the what we deal with from a day to day, but also like your perspective on on what's best for them.
00:46:32
Speaker
um in those scenarios. Tell me like empowerment, I think is a super important aspect, especially when it comes to to chronic pain. Tell me um why that's so important or tell the listeners why that's so important to to not just be a passive player in your treatment, um but to to actively participate and yeah, just try to unpack that for them Yeah, look, there's different different parts to that. One, if you have confidence in your own ability to manage your pain, then you're not going to be as fearful of it. Okay, if you feel you have a sense of control, then your anxiety and fear will reduce. And so which means that then you can start planning for stuff with that fear without saying, Oh, I got to see how I go on the day, yeah because then you can't plan.
00:47:28
Speaker
and your lifestyle is just going to be all over the place. So I think that's the first thing. I think the second thing is that at the end of the day, this could be a lifelong, as we discussed, while we hope there's a cure, this could be a lifelong thing. So how many times a week are you planning on going to your physio or your treater? If you're not willing to take control of that, and it's going to be a very, very costly and time consuming, and in fact,
00:47:56
Speaker
Your life is going to be more about pain and treatment rather than everything else that you want to do. Yeah. So it is really important. Nothing good is ever easy. It's true. It's a cliche, but it's true. um But once but that said, it doesn't have to be hard. You just need to take time and take on what you need to take on.
00:48:17
Speaker
yeah and work with a practitioner who's not there to just tell you to keep coming back, but actually there to teach you, educate you, build on your experience and knowledge, and then be there when you need them, not all the time, or be there when they want when you want them to help you out a little bit more, um as that support. yeah um And I think that's sort of the reasons why I think it's really important for and for you to take on, because then also,
00:48:47
Speaker
I mean, this is um slow sort of in a tangent, but if you as say a parent or an adult can demonstrate you can manage this struggle despite all this adversity, despite everything and move on, that's actually good for your kids to see. yeah Okay, because we know from research that For example, parents who are on welfare following an injury, et cetera, long-term, their kids actually grow up to emulate not necessarily those symptoms, but injury, illness, et cetera, more than parents who have a condition but move forward.
00:49:28
Speaker
and live a fulfilling life. So if nothing else, it's important from your family dynamic perspective that you do take control and show control that you are able to do it. Because as kids and family members, you're going to feel helpless if you can't help your family member who's struggling with pain. so But to see that they're taking the initiative and they're taking it on board, they're going to be more willing to help. Yeah, that's powerful. Love's a loves a pretty powerful motivator. so Yeah, shifting it to to some like others centered focus where, you know, you're doing it for your child, you're doing it for your family. um I think that's really powerful. i And that's the truth because that's what the research tells us, you know? Yeah, yeah, 100%. I can't help but um go back to sort of this idea of being over treated.
00:50:22
Speaker
Look, I would love to, I think most people have good intentions that work in this space, but but I can't help but see people sometimes get a little bit exploited um for the sake of money. And what would be some tips?
00:50:38
Speaker
and tricks for people or clients that are going to see practitioners to sort of spot these signs. I know this sounds really dark and gloomy, but I think the reality is is that it does happen just because, and and it might not even be, they might not they might have good intentions, but there is this um sort of bias ringing in the back of their mind. How do how do they pick up on this?
00:51:05
Speaker
Yeah, look, I think first of all, you need to be comfortable with whatever they're suggesting. And I think the way to feel comfortable is that you shouldn't necessarily be signed up for anything long-term. they And if they say, look, this is if someone says, look, this is a four-week, five-week program, fair enough, and this is the cost, fair enough, but they should be at some point to get out a jail-free card or get our card so that if someone's not finding it beneficial, they can either stop, especially your
00:51:38
Speaker
privately paid sort of clients. I understand when you have paid management programs, stuff that's hard because you're looking at staff numbers to patients and things like that. You've got to pay the staff. But if you're going to your prior practitioner, you know, your sole providers, things like that, I think it's important for you to test and judge whether, hang on, is this person really making a difference? Like, yeah, I'm seeing them. I've seen them for X number of weeks.
00:52:06
Speaker
Am I any better? I might be better when I see them, but what do I have to keep going back? Yeah, that's what you got. So they're giving you a temporary relief. And is that worth for the cost, time, etc? And what? yeah how And are they teaching me things to do when they gave me the relief after the recession? Have I been taught things to maintain that? Because if you can then self manage, then you don't have to go as often.
00:52:35
Speaker
Yeah, think they're the kind of things that I'll be looking at. ah I think, yeah, and I think, you know, with programs and things like that, you need, that's how they're, that's how they're budgeted. And that's fair enough, you know, to say, ah look, this is a $2,000 program and it's six weeks. or And then if you give all the information and you sign up for it, well, fine. Yeah. But if you're going to a therapist down the road in in a clinic and they say, look, I need you to come back weekly for the next two years or Yeah, twice a week and then three times. Well, why can't I just see how I'm going? Yeah. Yeah. that option Yeah. I think that's, that's, yeah, some good points there for, for clients. Now some people have unlimited resources financially and they're, they're happy to go into a provider and get short term relief over and over again. And that's, you know, that's fine. That's good entirely up to them. But I think it's important to, for people to be aware of, um,
00:53:33
Speaker
Yeah, what what is good service and what is good physio? Because it's it's it's not easy to spot. I mean, if I go to dentists, I have no idea what's a good dentist and what's a bad average dentist. Do you know what I mean? Really? I mean, yeah the outcome obviously paints a picture. But I think what you said about the outcome is this actually making a long term impact is super important. I think it's it's good to be transparent with your provider and just say, I would love to see some evidence of of me improving that's beyond just sort of like, oh, am I, aren't I? And I think some outcome measures and those kinds of things are really good to put in place of like, okay, day one, you were here. And and in week 12, we're now here, um you know,
00:54:26
Speaker
It's gotta be meaningful. It's like, you know, it's not about, oh, I can ride an exercise bike for five minutes if you don't want to ride an exercise. It's gotta be about, am I able to play with my kids? Or am I able to walk down on the beach, on the sand? Am I able to go back to work, et cetera? And it needs to be meaningful goals. And with the timeframe, that's where the smart goals sort of are helpful. And Lachman, I'll use your analogy of you don't take your car to a mechanic only for your mechanics. say Bring the car in every month because I'll just keep mixing this bit up.
00:54:56
Speaker
No, you're not going to pay to fix your car every month. You want it fixed. Yeah. Yeah. Yeah. So. Yeah. Transparency is key, I think. Oh, absolutely. And confidence in the therapist. Like you should, as a therapist, be confident. i Listen, I've tried work everything I could. You might need to go to so-and-so or someone else yeah because I don't think I'm really helping you because that those people with those finances you were mentioning,
00:55:25
Speaker
In fact, while it's fine for them to use the money is actually reinforcing their disability because they're having to go that many times. you know yeah So sometimes it actually works in the opposite way. Yeah, definitely. yeah come into What role do you do you think lifestyle interventions have for people with chronic pain? I'm thinking... Me first. What do you mean by lifestyle interventions?
00:55:51
Speaker
Yeah, lifestyle interventions like diet, sleep, stress management, social connection, those kind of key pillars of health. That's exactly what they are, key pillars of health. So absolutely important, paramount for our function. um You know, it's not just about the intervention on the pain, but it's about how our body then becomes healthy and active. And so a balance in all those things is what's required. We need to look at sleep. We know that if you have poor sleep,
00:56:20
Speaker
Your pain levels generally tend to be higher the next day. We know that lifestyle activities and things like that, that's better to do than exercise program because you're more likely to stick to it because it's things you enjoy doing. We know that high sugar, wheat content sometimes can negatively impact chronic pain. Inflammatory foods can impact chronic pain. So we know you need to have a decent diet. That doesn't mean you have to be strict. It just means that monitor. Don't just constantly be on junk food.
00:56:50
Speaker
alcohol, etc. um Yeah, mindfulness, relaxation, you know, that everyone, when you say mindfulness, people think, Oh, this yogi sitting down, you know, in a yoga, Matt, it doesn't have to be that mindfulness is about filling the mind with one thing, not many things, you can do something enjoy, you can look at paintings, you can read or I enjoy motorbike riding. So I go to a motorbike and go for a ride because I have to focus on the road and traffic around me and focus on my writing because otherwise I could have an accident. I can't think about it my kids or work or anything like that. So that's mindfulness for me. Relaxation meditation, really good if you can do it and work on it. It's a work in progress. No one ever really masters it. Yeah, awesome. Awesome. Now you had ah ah you had a unique experience in that you're working with chronic pain and some but some people didn't have their education and
00:57:50
Speaker
awareness of pain and and how it how it can impact and how how it works and how to treat it and manage it. What would your advice be to someone that's feeling pretty helpless at the moment, feeling like they're in a bit of a dark place when it comes to pain? What would your advice be for them?
00:58:13
Speaker
um Are you talking about ah um a client rather than a person? Yes, yeah, yeah, a client. yes So someone listening um it's that's in a dark place because of the pain and what it's taking from them. yeah I think you're first of all recognizing that it is a struggle, but recognizing that, you know, being in the dark place means the pain's got control of you. You've got to take back control and you don't have to do it alone. You're not a alone. That's the most important thing. Reach out to your networks.
00:58:42
Speaker
Yeah, think about things that's gonna make you happy or or at least distracted from the pain as a start, because if you release your endorphins, adrenaline, et cetera, et cetera, they're natural painkillers. Let's start with that. and So don't, you know yes, it's a clear, don't give up. Don't give up. Pain itself doesn't necessarily, heart or harm will kill you in most cases of chronic pain.
00:59:08
Speaker
You know, it's, it's about you taking back control and, um, and working towards something. And, you know, it's the cycle yeah a times will end and you'll move forward. And, but you, you just want to work and find out what's going to work for you and, and get the necessary supports in place for you to at least get through. And then once you feel in a better place, then putting the next steps and, and really then reflect.
00:59:38
Speaker
I'm very big on telling my clients when they're when they're doing well, of reflect on the bad times and think about, okay, what else do I need to get through this much easier? Because that'll help them in the future. Because and at the time of the darkness or flare up or setback, it's hard to think about what else can I do or whatever. You're just scrambling for any option to get relief. yeah Once you've got it and you're in the path to recovery or managing it, then do a loop back and say, okay, what else could I have done in that instance? Who could I have called someone? Could I have been somewhere? Could I have done something else in addition to what I was doing to try and help more? That way you'll have a plan in place for next time if this happens. Yeah. Yeah. Don't fear. That's what I'm saying. Don't fear it. That's amazing. Amazing advice. Thanks for that. I think that'll be very valuable to many people and thanks for coming on the show. Been a part of the episode. I think it's,
01:00:36
Speaker
You have a very unique experience in that you're both a clinician and someone with chronic pain. And so I think there's going to be a immense value for people listening. So I appreciate you. Thanks, mate. Thanks for having me on board. Can you do me a quick favor that will help me reach more people with chronic pain? Please hit the follow button and leave a review. It will only take you a few seconds, but it could change your life. Thanks.