Here are some words of encouragement after a call with a client. The themes might be relevant to others, so I'm sharing.......

You've had a tough time over the past 18 months and even before that, but what shines through is your ability to recover. You need to create the opportunity for that to happen again, and although you still have some current family stressors, if you could carve out some calmer moments for yourself, you'll see that recovery appears again.

Here’s an example of a frequently asked question about restarting movement when pain is still or has been strongly associated with that movement.

With persistent pain, an understandable but irrational fear can develop, as well as a predictable frustration in the person who has difficulty accessing what should be enjoyable, fun and healthy stress-relieving activities involving movement.

Returning to those activities is achievable but must be approached through a calm, conscious filter of rational safety.

As a patient started to recognise triggers to painful situations in her life, she was both fascinated and fearful about approaching this opportunity to address them. The opportunity itself can feel overwhelming when, for so long, there’s been no other option other than to live in the fearful unconscious reactions and the resultant pain that behaviour brings.

When seeking ways to recover from persistent pain, it is easy to forget how practical and straightforward it is to feel a sense of ease. For so long, the norm has been one of discomfort, pain, and doing something to relieve it, and if there are moments of relief, they become filled with nervous anticipation or fear of when that pain may return.

A patient’s question - Many somatic tracking exercises, meditations, etc., seem to ask you to be comfortable, relax, breathe deeply, focus on the pain, describe it, give it a colour, a shape - breathe into the pain, and show it a white light.

All good EXCEPT, what if you have no pain in a relaxed, non-weight-bearing state, and pain only happens when you’re moving and exercising? It's hard to do the breathing, relaxing thing then. So, are there things you can do when you’re on the move? Apologies if this has been asked a hundred times!

So, I’ve been improving steadily over the last year and slowly recovering from fourteen years of chronic and severe back pain. I totally ‘get’ the mind-body concepts, and while my improvement is slower than I would like, I have a lot of hope that all will be well one day.

This is how a patient described herself in terms of her intent to push through all things pain. For many, it is a shared perspective in persistent pain that can keep people stuck in a painful pattern. Discerning pain and understanding that having healthy alternatives to our default patterns can be a real game changer. Here are some suggestions presented in this case.

Someone described how the pattern of their persistent pain changed during a period of grief. Here is a breakdown of how I explained how to interpret the variation in pain they experienced.  

Pain is a concept that many people attempt to describe. Behavioural, philosophical and neuroscientific theories about pain arise, but one spiritual viewpoint of note comes from teacher Eckhart Tolle - Author of The Power of Now and A New Earth.

Here’s a question that symbolises the common frustration of those who suffer from persistent pain.

Does anyone else get pain flares after but not during physical exertion?

Here is a conversation between a couple of people following a podcast with Dr Rangan Chatterjee and Dr Howard Schubiner, discussing the relationship between persistent pain and the neural circuits driving it.

Overloading themes mirror many situations; grief represents the trauma experienced in this persistent pain cycle. Navigating recovery when you’re last in your queue means exposure to the risk of such pain is high. Here are some words of encouragement from a recent email which may help push you further up that list. 

I answered a patient with fibromyalgia regarding starting to move when ‘everything hurts’. It may be helpful to others. “I’ve got a question about the movement routine, please. Because I have fibromyalgia, most parts of my body ache/hurt when I move (or don’t move) to varying degrees - do I need to do a movement for every part!?”

When I walk, and it is painful, how do I push through without pushing through? You don’t push. You start to notice when you get the urge to push and ask what emotion drives that. It may be frustrating. It may be because you believe you should. It may be because you judge yourself for not being able to do what you expect of yourself. It could also be because you crave that walk, a stress-reducing activity, and it maddens you that you can’t do it comfortably.

When someone receives an injection for cancer treatment, and someone close to them observes that, where is the pain of that moment? Is the pain in the person with the pain-defining problem or the person observing them?

Here’s is an illustration of how one small event can trigger a considerable reaction. For example, seventy thousand fans watch a football match in a stadium. The game has ended in a draw after ninety minutes of normal time and another half hour of extra time, so they are playing out a penalty shootout. The winner takes all. Watch what happens after the following penalty. Pain or pleasure?

When seeking ways to recover from persistent pain, it is easy to forget how practical and straightforward it is to feel a sense of ease. For so long, the norm has been one of discomfort, pain, and doing something to relieve it, and if there are moments of relief, they become filled with nervous anticipation or fear of when that pain may return.

Here is a little puzzle for you. See if you can work out why someone would have pain on the way somewhere but not on the way back. I’ll describe this patient's situation and see if you can see why this phenomenon may occur.

Here’s a frequently asked question about a technique called somatic tracking:

‘I’ve just listened to a “Tell Me About Your Pain” podcast in which Alan Gordon does somatic tracking with Emily. Because her pain doesn’t move or change with the somatic tracking exercise, he says that’s a sign that she’s too fearful and then he uses another tactic of leaning into positive sensations.’

Being a medical professional means putting others first in your daily work is the default. It does, however, make some vulnerable to overload when they continue that intent at times when they should be making more time for themselves. This creates the environment where pain or symptoms start to appear and where the perfect storm for persistent pain can arise.

Here’s a follow-up message for a medical professional who experienced persistent low back pain and started seeing the truth about the pain.