Episode 4
The Power of Movement in Chronic Pain
Join us as we sit down with Lee Vaughan, a movement coach with lived experience of chronic pain, and Professor Blair Smith, a leading expert in pain medicine—and someone who understands firsthand the challenges of living with persistent pain. Together, they explore what it really means to stay active when your body says otherwise. From battling daily discomfort to finding ways to move that feel safe and empowering, Lee and Blair share candid reflections on their own journeys. They discuss the science of chronic pain, the emotional toll it can take, and—most importantly—the hope and benefits that movement can offer.
Produced with support from the British Society of Lifestyle Medicine.
Find us at https://themovementprescription.co.uk/ and join the conversation!
Transcript
Callum: Hello and welcome to the Movement Prescription Podcast. Pain is the commonest
Speaker:Callum: barrier to people being more active and yet it's extremely common with over
Speaker:Callum: a third of the UK population suffering chronic pain.
Speaker:Callum: This week it's a delight to have Lee Vaughan and Blair Smith on the podcast.
Speaker:Callum: Lee has lived with persistent pain for 33 years and has become a lived experienced
Speaker:Callum: patient advocate, describes it as giving back as part of his recovery.
Speaker:Callum: He's founded Partnering Pain and he now teaches on the peak health coaching
Speaker:Callum: course for pain management.
Speaker:Callum: Blair is a qualified GP and professor of epidemiology at the University of Dundee.
Speaker:Callum: For many years he's worked as a consultant in pain medicine and as a world-leading
Speaker:Callum: researcher into chronic pain.
Speaker:Callum: In this episode both lee
Speaker:Callum: and blair share their personal experiences of pain and
Speaker:Callum: we discuss the science of chronic pain the emotional toll it can have and the
Speaker:Callum: hopes and benefits that movement can provide i hope you enjoy uh lee blair thanks
Speaker:Callum: so much for joining today it's great to have you on the podcast pleasure thank.
Speaker:Lee: You thank you for having me.
Speaker:Callum: We could maybe just start by by asking or blair if you could define what chronic
Speaker:Callum: pain is and how it differs from acute pain.
Speaker:Blair: Okay, well, I mean, pain's one of these things. We all know what pain is.
Speaker:Blair: Everyone experiences pain almost, but it's difficult to put into words.
Speaker:Blair: But there is a good definition of it, which the International Association for
Speaker:Blair: the Study of Pain have developed, which is along the lines of it's a physical
Speaker:Blair: and emotional experience,
Speaker:Blair: associated with tissue damage or defined in terms of such damage,
Speaker:Blair: so it isn't necessarily that underlying damage that's evident.
Speaker:Blair: But pain is a useful, life-saving experience because it takes us away from danger
Speaker:Blair: or it makes us take actions which promote healing and return to health.
Speaker:Blair: Unfortunately, sometimes it lasts beyond that natural, normal tissue healing
Speaker:Blair: time, and then the pain itself becomes a problem. and that's when it's chronic or persistent pain.
Speaker:Blair: And it's not a useful thing. It overrides everything else.
Speaker:Blair: So that's effectively what we mean by chronic pain. It's when the pain is no longer a useful thing.
Speaker:Blair: Uh symptom.
Speaker:Callum: Thanks Blair. I know kind of arbitrarily we kind of use three months.
Speaker:Blair: Three months is taken as the cut-off point that's not, it is arbitrary as you say,
Speaker:Blair: but it's now written in kind of stone with the international classification of diseases,
Speaker:Blair: the World Health Organization's ICD version 11 which has been running for a
Speaker:Blair: few years and it formally defines chronic pain as pain which has lasted beyond three months.
Speaker:Callum: I find that interesting because when I'm referring patients with pain to physio,
Speaker:Callum: for example, the wait is now three months.
Speaker:Callum: So by the time they get there, they officially have chronic pain.
Speaker:Blair: Or the pain's got better.
Speaker:Callum: Yeah. Lee, I was wondering if to start us off, if you'd be willing to share
Speaker:Callum: a bit about your personal journey with chronic pain.
Speaker:Lee: Yeah, absolutely. So I sort of sit here today, 50, 51 years old now.
Speaker:Lee: Um but i've i've lived with pain for over
Speaker:Lee: three decades um so pain fatigue
Speaker:Lee: that all sort of originated mid to late teens um
Speaker:Lee: but i can only really say that on reflection because i
Speaker:Lee: didn't really know that that's what it was when it was um and i went through
Speaker:Lee: my life noticing just a lot of pain um pain when there really shouldn't have
Speaker:Lee: been pain minimal injuries that felt like i'd i'd broken a leg or broken an arm,
Speaker:Lee: my pain on reflection was highly exaggerated as an experience.
Speaker:Lee: I had a hip replacement when I was 28 years old.
Speaker:Lee: So I went through quite a major surgery with that as well, with the promise
Speaker:Lee: that it would alleviate the lower back pain I was suffering. And it didn't.
Speaker:Lee: And I often refer to the journey with chronic pain as a game of stakes and ladders.
Speaker:Lee: I think sometimes there are there are ladders of hope and i think there are
Speaker:Lee: snakes of despair and and i think sometimes that's where the health care system
Speaker:Lee: sits at the moment and that's not been too discriminant too too disparaging
Speaker:Lee: against health care professionals i know we try you do your best,
Speaker:Lee: but i got to january 2022 and i
Speaker:Lee: was physically and mentally broken i
Speaker:Lee: was signed off work um they looked like
Speaker:Lee: there was no no view of me going back i'd
Speaker:Lee: tended my resignation and i was staring down the
Speaker:Lee: barrel of ill health retirement at 47 years old i
Speaker:Lee: was in the worst pain of my life with that
Speaker:Lee: pain came anxiety came depression it came a complete loss in quality of life
Speaker:Lee: i was no i wasn't recognizable to me let alone recognizable to my family i just
Speaker:Lee: wasn't recognizable as the person they knew and all that and I was taking 28
Speaker:Lee: tablets every single day,
Speaker:Lee: I had the whole, if we remember Woolworths, I had the whole pick and mix.
Speaker:Lee: I had gabapentin, naproxen, nephepam, codeine, sertraline, omeprazole,
Speaker:Lee: and I was dangerously topping up with paracetamol as well.
Speaker:Lee: And, you know, we have to give attention to that kind of medication to people
Speaker:Lee: that are in such a low period of their life.
Speaker:Lee: You know, it's almost a load of gun at times. You know, I knew there was an easy way out.
Speaker:Lee: But I found my way to a pain management program, and I was fortunate because
Speaker:Lee: the Sheffield pain management program that I got on was great.
Speaker:Lee: It was a really good one. I was dragged there kicking and screaming.
Speaker:Lee: I had both arms tied behind my back. You know, my pain's that real stuff.
Speaker:Lee: I don't need none of this tree-hugging, flowery, whatever it is they're going to do stuff to me.
Speaker:Lee: But you know what? I got to the point where I just, enough was enough.
Speaker:Lee: What had I got to lose to try it?
Speaker:Lee: And it changed everything. And they didn't give me a new pill,
Speaker:Lee: didn't give me a new surgery. They just made me curious.
Speaker:Lee: They started to pique that curiosity around what pain was. For the first time,
Speaker:Lee: I had pain explained to me.
Speaker:Lee: I started to get an understanding of my pain as being a protector,
Speaker:Lee: as Blair says, about that protection system, these pain signals being a message,
Speaker:Lee: and messages that were born through a lifetime of trauma because my pain was never there to be seen,
Speaker:Lee: mris were clear x-rays are clear bloods were always clear you know you were
Speaker:Lee: never going to see it but if we'd have maybe shown a psychosocial mri on me
Speaker:Lee: you'd have seen it you'd have heard it you'd have heard the pain because there's
Speaker:Lee: that my life's been littered with numerous trauma which i I won't deep dive
Speaker:Lee: on, but, you know, terrible at times.
Speaker:Lee: And I started to make the link between emotions and trauma.
Speaker:Lee: I heard the podcast between Howard Schubiner and Rangan Chatterjee,
Speaker:Lee: which was game-changing for me.
Speaker:Lee: You know, physical trauma and emotional trauma share the same neural pathways
Speaker:Lee: in the brain. And when I heard that line.
Speaker:Lee: It was, that's me. That makes sense. For the first time in 30 years, that makes sense.
Speaker:Lee: And it makes sense because I know my story, but nobody else did because nobody
Speaker:Lee: else had taken the time to sit and listen and hear that story.
Speaker:Lee: And I sort of sit here today. I've set up my website with Partner in Pain, a Facebook group.
Speaker:Lee: And I did that purely selfishly because I started to understand the value of
Speaker:Lee: community and peer support and being around people simply took my pain levels
Speaker:Lee: down. And it was like, this is weird stuff, but they get me.
Speaker:Lee: They understand me. They don't judge me. They walk my shoes.
Speaker:Lee: And now I take one tablet a day. I haven't seen my GP for three years.
Speaker:Lee: And I am now working within the NHS as a health coach.
Speaker:Lee: I work with Peak Health and Olly Hart. I deliver pain education to healthcare
Speaker:Lee: professionals as part of a national program.
Speaker:Lee: So highly activated now, but I still live with pain.
Speaker:Lee: I'm in pain right now. but pain just pain is still in my life it's just no longer
Speaker:Lee: my life if that makes sense.
Speaker:Callum: Oh lee that's yeah it's really eloquent uh
Speaker:Callum: exploration or explanation of your pain
Speaker:Callum: i think you you kind of really touched on the complexity of of what chronic
Speaker:Callum: pain is and and how it kind of becomes all-encompassing you talked about some
Speaker:Callum: of the barriers that going to the the the pain clinic in Sheffield and hopefully
Speaker:Callum: we can kind of unpack some of those later.
Speaker:Callum: And you also talked about trauma and I think that's a really interesting thing,
Speaker:Callum: emotional trauma and the impact on pain and I know Blair,
Speaker:Callum: as lead of the team here, there's been some research done within our department
Speaker:Callum: looking at adverse childhood experiences and the association with chronic pain.
Speaker:Callum: As we move on and look to unpack that, just before, Blair, I know that you're
Speaker:Callum: more than just a professor in chronic pain.
Speaker:Callum: I know that you also have a personal journey of experience with pain.
Speaker:Callum: I wonder if you're willing to share a bit about that yourself.
Speaker:Blair: Okay. I mean, yes, it came much later in my life than Lee's story has just highlighted.
Speaker:Blair: And it was, I suppose, about 10 years ago I first developed cancer,
Speaker:Blair: bowel cancer for which I had major surgery and follow-up surgery and then it
Speaker:Blair: returned in bowel and liver cancer and even more major surgery.
Speaker:Blair: And as a result of the latter surgery in particular, I have ongoing neuropathic
Speaker:Blair: pain because of nerve damage during the surgery and that affects my leg and
Speaker:Blair: my foot in particular and has other functional restrictions.
Speaker:Blair: And it's interesting because neuropathic pain especially was an area in which
Speaker:Blair: I had done a lot of research,
Speaker:Blair: including the research around the experience of it and the mechanisms and factors
Speaker:Blair: that increased and mitigated risk for neuropathic pain. But of course,
Speaker:Blair: I'd never experienced it myself.
Speaker:Blair: And I think at an intellectual level, It's interesting then to experience what
Speaker:Blair: you've spent 20, 30 years researching academically to experience it personally.
Speaker:Blair: It's interesting, very unpleasant as well. Of course, it's a lot better now than it was.
Speaker:Blair: But I think going back to what Lee's story has just told us,
Speaker:Blair: I came from a different point of view, which was that I had spent many years
Speaker:Blair: trying with patients that came to our clinic, either as a GP or as a pain specialist,
Speaker:Blair: trying to achieve a shared understanding of some of the things that Lee's talking
Speaker:Blair: about, the relationship between
Speaker:Blair: social and psychological background and experiences and physical pain.
Speaker:Blair: And it's a difficult thing to get over and often to get people to accept,
Speaker:Blair: as I think Lee has also said in the first place.
Speaker:Blair: But I came to my experience of pain knowing that,
Speaker:Blair: first of all knowing something a lot about the biological mechanisms that were
Speaker:Blair: going on and also knowing the relationship between stress and trauma and I think
Speaker:Blair: I also knew about how to manage it and I think that,
Speaker:Blair: Starting with that understanding has actually made my journey a lot easier than
Speaker:Blair: it otherwise would have been.
Speaker:Blair: Otherwise, with the pain I was experiencing, particularly at the worst,
Speaker:Blair: it would have been really frightening.
Speaker:Blair: You spoke about staring down the abyss or down the barrel, I think you said.
Speaker:Blair: I would have called it an abyss if I was standing in that cliff experiencing
Speaker:Blair: those terrible shooting electric shock pains that were hitting me out of the
Speaker:Blair: blue and not knowing why. that would have been really difficult so.
Speaker:Callum: This is uh it's a podcast primarily
Speaker:Callum: about physical activity and movement it's it's
Speaker:Callum: for everyone uh although it is uh intentionally
Speaker:Callum: aimed at health professionals and with that in mind i kind of lead the conversation
Speaker:Callum: uh on on to kind of our remit and and maybe start with you lee and ask what
Speaker:Callum: role physical activity particularly has played within your experience of pain,
Speaker:Callum: both positively and negatively,
Speaker:Callum: and kind of within the context of you and everything else that's going on?
Speaker:Lee: Yeah, I mean, I was probably a typical young Sheffield lad that was physically
Speaker:Lee: active. I played lots of football.
Speaker:Lee: I was a good sprinter as a young man.
Speaker:Lee: And, you know, I was very often doing something. I was lucky that my family,
Speaker:Lee: my mum, you know, saw value in keeping us active and keeping us moving.
Speaker:Lee: But, you know...
Speaker:Lee: That slowly got took away from me and and
Speaker:Lee: i can only see on reflection but looking back as an
Speaker:Lee: 18 year old lad that would play a game of football on a on a
Speaker:Lee: saturday or a sunday but but would take five days
Speaker:Lee: to recover from it you know five days of pain
Speaker:Lee: and i mean it was everywhere the groin the
Speaker:Lee: hips the legs the arms and it was wow and
Speaker:Lee: you know i there was a joke within the local football clubs that i had my own
Speaker:Lee: parking bay at the sheffield hospitals you know i was there all the time and
Speaker:Lee: and it got to a point where my employer eventually threatened me and said you
Speaker:Lee: you're having too much time off work with injuries and things like that you got to make a choice,
Speaker:Lee: so I had to make a choice and that choice was well I have to give up playing
Speaker:Lee: the football which you think well well surely the pain would go away but no
Speaker:Lee: it didn't but I didn't just give up on that you know I tried other things I
Speaker:Lee: actually played baseball um I actually played nationally as well So another
Speaker:Lee: sport that can probably, you know, rough you up a little bit.
Speaker:Lee: But again, that had to stop due to constraints on knees and arms and things like that.
Speaker:Lee: So I was noticing that the more active I became as I hit my teens,
Speaker:Lee: the more pain I was experiencing, and particularly fatigue.
Speaker:Lee: I remember coming back off a holiday when I was about 18, and it had been a typical lads holiday.
Speaker:Lee: And without doing sort of a deep dive on that, the hows and whys of what happened,
Speaker:Lee: I now understand that, I think. But I came back chronically fatigued and I was tested for ME.
Speaker:Lee: I was tested for all sorts. My mum thought I'd got some sort of tropical disease
Speaker:Lee: from being out in Greece or something like that.
Speaker:Lee: Um, and I lost that job because of my time off due to, to fatigue in that particular
Speaker:Lee: job. So it was pain and fatigue all the time.
Speaker:Lee: And I, I, I suppose I gradually just, I let, I let activity go. Um, yeah.
Speaker:Lee: Obviously, I had hip surgery at 28, so that wasn't helping.
Speaker:Lee: I'd got an awful lot of pain in my right hip, and by the time that was looked
Speaker:Lee: into, the whole hip was shot and it was fully osteophytes and things,
Speaker:Lee: and I had to have it resurfaced.
Speaker:Lee: So you can just see this natural decline in how active I was,
Speaker:Lee: but the spikes in how the pain and fatigue were coming, I suppose,
Speaker:Lee: the natural boom and bust cycle, if you like.
Speaker:Lee: It was mirrored out in how I was moving less.
Speaker:Lee: I put on weight and then I started to experience
Speaker:Lee: more in terms of medication so I think the the
Speaker:Lee: less I moved the more I hurt but that's on reflection I thought
Speaker:Lee: I was doing the right thing because we conditioned that rest and
Speaker:Lee: recovery you know if you're hurting you rest you know
Speaker:Lee: pain is a protector as Blair says and we're sort of taught that if you're hurting
Speaker:Lee: don't move it you know don't touch it let it be you know when actually it's
Speaker:Lee: it's really it's safe to work at those soft edges of pain as I try to talk to
Speaker:Lee: people about that's a safe place to be,
Speaker:Lee: um and it wasn't it wasn't until
Speaker:Lee: a few years ago sort of speaking and again trying to say too much about healthcare
Speaker:Lee: professionals but I had an MRI done on my spine and I had a loaded list of numbers
Speaker:Lee: and words like compressions and bulges and all kinds of scary stuff that all
Speaker:Lee: I heard was were you're going to be in a wheelchair in five years.
Speaker:Lee: And then I remember also being told, don't ride a bike. That'll be no good for
Speaker:Lee: you. Not with that spine.
Speaker:Lee: Okay, so didn't ride a bike. I think Rudyard Kipling once said,
Speaker:Lee: you know, words are, of course, the most powerful drug known to mankind.
Speaker:Lee: And you have to be very careful how we talk to people. I recently ruptured my Achilles.
Speaker:Lee: And when I asked for the diagnosis, they said to me, well, that's as bad as it gets.
Speaker:Lee: But as Blair's just alluded to, I now have that knowledge and education to really let that go.
Speaker:Lee: I think that's not a great thing to say, but I know where I'm
Speaker:Lee: going with this instead um but what sort
Speaker:Lee: of transcended into the positives was as a very
Speaker:Lee: rash decision back in february 2020 22
Speaker:Lee: i think it was um i'm assuming you guys have probably heard of flipping pain
Speaker:Lee: up in the northeast i know that they do work up in scotland too um and i got
Speaker:Lee: talking to them and i ended up on their um i ended up on their tees valley peloton
Speaker:Lee: um in may 2023 and my wife said to me when I signed up for it, are you mad?
Speaker:Lee: You're laid on the settee rolling around in pain and you're signing up for a
Speaker:Lee: bike ride, but something just felt right.
Speaker:Lee: I don't know. I don't know what it was. And I went with it. And this was post
Speaker:Lee: pain management, me starting to understand messages of pain.
Speaker:Lee: And I got to spend five days riding around the North of England with the likes of Laura Mamosley.
Speaker:Lee: Deepak Ravinder, Cormac Ryan, and a peloton of 30 to 40 healthcare care professionals
Speaker:Lee: and a few living with pain too, totally invested in biopsychosocial care.
Speaker:Lee: It was one of the best weeks of my life. I felt like I'd found my tribe.
Speaker:Lee: I felt like I was amongst people that understand me, that knew me.
Speaker:Lee: Everything I was learning was being validated in that peloton.
Speaker:Lee: Riding through North Yorkshire with Lorimer Moseley, having a chat about this, that, and the other.
Speaker:Lee: I mean, I tell that to physios and a lot of them are a bit fanboy on me,
Speaker:Lee: But, you know, Lorim is a great guy and he's such a humble guy to be with as well. Plus Deepak too.
Speaker:Lee: But I didn't stop there. I learned
Speaker:Lee: that being on the bike was one of the very few places I had no pain.
Speaker:Lee: That thing about my degenerative spine was poor advice
Speaker:Lee: at best and and i went on to ride london to
Speaker:Lee: brighton later that year i then went on a peloton of the north of northumbria
Speaker:Lee: and then later that year in october 23 i rode across britain i did the uk coast
Speaker:Lee: to coast with four friends all of whom lived with persistent pain and we did
Speaker:Lee: it for pain concern and the charity up in scotland we raised nearly three thousand
Speaker:Lee: pound and we're not we didn't do it to say that everybody should ride a bike
Speaker:Lee: and everybody should ride across Britain.
Speaker:Lee: But what we should say, it was about hope, is we all need a little bit of a
Speaker:Lee: hope. We all need to value our values and our goals.
Speaker:Lee: And I very often can sit in terms of how active we are or how much we move and
Speaker:Lee: getting out into nature.
Speaker:Lee: So very much aware that, you know, one person's UK coast to coast is the next
Speaker:Lee: person's front door or their gate or their garden.
Speaker:Lee: And that is fine. That is okay.
Speaker:Lee: So now movement has just become this part of my life.
Speaker:Lee: Yoga qigong stretch if i've experienced pain my first reaction isn't to go for
Speaker:Lee: a medic for a tablet it's to have a stretch it's to move maybe have a walk and
Speaker:Lee: see what happens if i try that so it's now movement is a huge part of my life
Speaker:Lee: movement for me is medicine.
Speaker:Callum: Sounds like it's become a bit of a process as well lee it.
Speaker:Lee: Didn't happen.
Speaker:Callum: Overnight One of the things that I pick out from what you said is that it sounds
Speaker:Callum: like a lot of your physical activity, especially initially, was in the context
Speaker:Callum: of other people and supporting and supportive friends,
Speaker:Callum: family and professionals, which I'm sure is key.
Speaker:Callum: Uh blair how about you uh how uh how do you find movement helps with your pain
Speaker:Callum: and and maybe you can offer a bit bit of insight into maybe how movement influences chronic pain yeah.
Speaker:Blair: Um yeah sure i i was always reasonably active and one of the things i did before
Speaker:Blair: my surgery was to increase that activity so that i was going into surgery with
Speaker:Blair: um better physical fitness and running's my I think I don't enjoy cycling.
Speaker:Blair: But one of the sadnesses was with the nerve damage.
Speaker:Blair: After my surgery, I couldn't run.
Speaker:Blair: So I was having to find other forms of activity, mainly gym-based,
Speaker:Blair: which is equally unpleasant. But I guess you're moving.
Speaker:Blair: Actually, it's one of the benefits of COVID because then the gym shut down and
Speaker:Blair: I thought I'm going to have to just do power walking.
Speaker:Blair: And I had AIDS and physio and all sorts of things to help me even walk.
Speaker:Blair: But I'd managed to get rid of the AIDS and.
Speaker:Blair: Trying this power walking during COVID. And I thought, this is really quite
Speaker:Blair: boring. I'm just going to try running.
Speaker:Blair: I ended up actually having rediscovered, rediscovering the ability to run.
Speaker:Blair: And I've never looked back. Obviously, I couldn't run very far,
Speaker:Blair: not having done so for a while.
Speaker:Blair: But now I've done half marathons since then. And it's part of my life.
Speaker:Blair: And that very much keeps me going.
Speaker:Blair: And, you know, you're kind of asking, what is the role of physical activity?
Speaker:Blair: Why is physical activity good for chronic pain? And there's a number of reasonably
Speaker:Blair: well-evidence-based reasons for that.
Speaker:Blair: And some of them have been illustrated really nicely, actually, by Lee's talk.
Speaker:Blair: And probably the first and most obvious of these is that when we are physically
Speaker:Blair: active, we release endorphins, which are natural painkillers and make us feel good.
Speaker:Blair: And that's, I think, a lot of what has happened with you, Lee,
Speaker:Blair: when you've been cycling.
Speaker:Blair: So there's a natural feel-good factor that just comes with physical activity,
Speaker:Blair: which counters the feel-bad factor that you get with chronic pain.
Speaker:Blair: But also, when you're physically active, when you move, you build up your muscles,
Speaker:Blair: your muscles strengthen, and that is often the opposite has happened.
Speaker:Blair: If you've been thinking you've been enforced into physical inactivity because
Speaker:Blair: of pain, your muscles grow weak, and that probably makes pain worse.
Speaker:Blair: So building up the strength supports weak joints, for example,
Speaker:Blair: or gets you a stronger...
Speaker:Blair: There is good evidence that physical fitness is associated with reduced inflammatory
Speaker:Blair: processes and improved immune processes, which are important in pain mechanisms.
Speaker:Blair: So there's probably a good biological basis underpinning improvements in pain
Speaker:Blair: as a result of physical activity and psychological benefits of improved mood,
Speaker:Blair: reduced stress, better well-being, better sleep.
Speaker:Blair: And then, of course, improved circulation, improved blood circulation,
Speaker:Blair: which improves or brings all these chemicals to the places that they're needed
Speaker:Blair: to promote improvement in pain or whatever the underlying mechanisms are.
Speaker:Blair: And along with all of these, and again, Lee has illustrated those,
Speaker:Blair: comes the social benefits.
Speaker:Blair: You know, one of the things that we experience with chronic pain is often in
Speaker:Blair: the form of isolation. We're not going out, we're not feeling understood or
Speaker:Blair: valued, and we retreat into our own world.
Speaker:Blair: But if we're getting together with people, whether it's to cycle,
Speaker:Blair: I know running's probably a more isolating sport than our activity than others.
Speaker:Blair: But I also play football now, which I couldn't do before.
Speaker:Blair: Not very well, but it's a great bunch of guys that we play football with, so that's a benefit.
Speaker:Blair: And of course, chronic pain doesn't come by itself. there's a lot of comorbidities.
Speaker:Blair: Usually most people who have pain have at least one other long-term chronic medical condition.
Speaker:Blair: And the more sites at which we have pain, epidemiologically speaking,
Speaker:Blair: the more comorbid conditions we have.
Speaker:Blair: And physical activity is associated with improvements in those,
Speaker:Blair: for example, cardiovascular disease or respiratory health.
Speaker:Blair: And we showed in some of our research that people with chronic pain are much
Speaker:Blair: more likely to die early and the commonest
Speaker:Blair: causes of that early death are cardiovascular respiratory causes.
Speaker:Blair: So a wide ranging list of evidence-based benefits of physical activity associated with chronic pain.
Speaker:Blair: I would say it's difficult in randomized controlled trials to demonstrate specific
Speaker:Blair: physical activities associated with specific pain improvements.
Speaker:Blair: But one of the things we're involved with just now is an update of SINE guidelines.
Speaker:Blair: SINE is the Scottish Intercollegiate Guideline Network, and it's the Scottish
Speaker:Blair: equivalent of the NICE guideline that many people may be more familiar with.
Speaker:Blair: And SINE in 2013 published the first comprehensive evidence-based guidance for managing chronic pain.
Speaker:Blair: That's quite out of date now, so we're updating it just now.
Speaker:Blair: And that includes a section on the evidence for physical activity and the evidence is.
Speaker:Blair: Not necessarily there. It doesn't mean it's not good evidence. It doesn't work.
Speaker:Blair: It means the trials haven't necessarily been done. But despite that,
Speaker:Blair: there is good evidence for physical activity, improving pain intensity,
Speaker:Blair: physical function, and psychological function, particularly in chronic back
Speaker:Blair: pain, because that's where the trials have been done, but also in neck pain and fibromyalgia.
Speaker:Blair: And physical activity is wide-ranging in its types, That includes yoga and Tai
Speaker:Blair: Chi, Qigong that you've mentioned as well as just more general physical activity.
Speaker:Blair: So I'm a big fan of it. And we need better treatments than the medicines that
Speaker:Blair: are available because they are dangerous, have side effects.
Speaker:Blair: They can work for some people and they do work for many, but probably only as
Speaker:Blair: part of an overall program.
Speaker:Blair: And this should be a big part of the other part of the management program.
Speaker:Callum: It's in that context of an acknowledgement
Speaker:Callum: of many of the benefits of physical activity for chronic pain that is kind of
Speaker:Callum: helpful to I suppose reflect on both of your personal stories but Lee you talked
Speaker:Callum: about in your late teens and 20s the giving up physical activity almost because
Speaker:Callum: of that fear of making it worse.
Speaker:Callum: Claire you mentioned comorbidities and obviously or And naturally,
Speaker:Callum: they can be huge barriers to people participating in and of their own.
Speaker:Callum: Have there been any other barriers that either of you two have faced personally
Speaker:Callum: to engaging in physical activity?
Speaker:Callum: Lee, maybe we can start with you.
Speaker:Lee: I think you've quite rightly highlighted the primary barrier is pain.
Speaker:Lee: That's going to hurt. I'm not going to do it.
Speaker:Lee: We wouldn't say to someone with a broken leg, come on, you need to move more.
Speaker:Lee: We wouldn't have that conversation, but it's a visible acute injury,
Speaker:Lee: isn't it? So we have empathy and we don't say that.
Speaker:Lee: And I'd elaborate a little more on that and then to the fear of more pain.
Speaker:Lee: I'm already in pain. I don't want more pain.
Speaker:Lee: But secondary to it for me, and I know I actually polled my Facebook group on
Speaker:Lee: this particular question because I was doing a presentation last year in Sheffield
Speaker:Lee: to find out what we thought were the barriers. And secondary came fatigue.
Speaker:Lee: And you know i think that's often misinterpreted as
Speaker:Lee: to what that is is it a case of
Speaker:Lee: motivation you're not or you're not motivated i think until you've experienced
Speaker:Lee: chronic fatigue you've never experienced fatigue like it um and i often have
Speaker:Lee: this image in my mind that someone's stuck a syringe in me and just sucked all
Speaker:Lee: the energy out of my body and there's just this withering limp.
Speaker:Lee: Thing left behind um so for me chronic fatigue
Speaker:Lee: is huge in this as well it's it plays
Speaker:Lee: a part one day might be pain the next day might be fatigue and
Speaker:Lee: i think they both work with the same motivation it's just as i think pain can
Speaker:Lee: be a protector i think fatigue is a secondary way of doing that as well it certainly
Speaker:Lee: is with me and other barriers and it's not necessarily just for me um and i
Speaker:Lee: heard blair sort of allude to it a minute ago about gyms well that's not nice is it.
Speaker:Lee: Um but actually social anxiety is a
Speaker:Lee: huge thing you know people don't want
Speaker:Lee: to go to a gym they don't want to go and take part in a circuits class
Speaker:Lee: they they feel that i'm gonna have to explain that
Speaker:Lee: i can't do this and i can't do that and i may have to sit that out
Speaker:Lee: i may have to go for a rest or i might get a bit upset and
Speaker:Lee: all these people look fit and healthy and i
Speaker:Lee: don't want to be that's that's not me and there's a lot of
Speaker:Lee: anxiety around that um and i
Speaker:Lee: think another one that came out was education but it's the
Speaker:Lee: education around the people living with pain about us not understanding you
Speaker:Lee: know principles like you know push to it not through it
Speaker:Lee: or you know just working at those soft edges
Speaker:Lee: but also education i think of the leisure industry the pts and
Speaker:Lee: people like that the people who are actually delivering the classes don't
Speaker:Lee: fully understand well don't understand persistent pain or chronic
Speaker:Lee: pain it's not and that's coming from someone who's worked in
Speaker:Lee: leisure for the past eight years at the managerial level
Speaker:Lee: so i know there is negligent negligible
Speaker:Lee: understanding of chronic pain in
Speaker:Lee: terms of pt instructors and gym instructors group
Speaker:Lee: exercise instructors so it's that education there's very little empathy there
Speaker:Lee: and one really probably quite i'll try not go too political sorry callum but
Speaker:Lee: at the moment you know i have i have spoke to people who have said to me because
Speaker:Lee: i run movement programs in sheffield we run four a week and they're all free to access.
Speaker:Lee: And we get over 50 people a week coming to them and they're brilliant but i
Speaker:Lee: have people saying to me i can't because if the dwp find out i'm moving they'll take away my benefits,
Speaker:Lee: would we do that to people if they started taking tablets well you're taking
Speaker:Lee: tablets now so you know that's your medication you're all right well you know
Speaker:Lee: movement if movement is medicine,
Speaker:Lee: then that is a really backwards way of looking at things but that is a real
Speaker:Lee: real fear amongst people I mustn't do that because I can't lose the only money I have coming in.
Speaker:Callum: Yeah, it's kind of worrying to hear, isn't it? I wasn't quite aware that was the case.
Speaker:Callum: Blair, have you any other barriers to add?
Speaker:Blair: I mean, those are all really important ones, not necessarily a great deal to
Speaker:Blair: add, but from a personal point of view, it's often just, can I be arsed?
Speaker:Blair: Do I really want to go out there?
Speaker:Blair: And this is where the more you do it, the more it's helpful,
Speaker:Blair: because I have an adage which I read years ago, actually in Runner's World magazine,
Speaker:Blair: which was in any run, the most difficult step is the one that takes you out the front door.
Speaker:Blair: And once you've got past that one, everything else is better.
Speaker:Blair: And just the memory of that experience means that you can push yourself out the door.
Speaker:Blair: A colleague of mine in Arbroath, which is just up the road from here,
Speaker:Blair: She was very enthusiastic about movement and physical activity as an approach
Speaker:Blair: to managing chronic pain.
Speaker:Blair: And again, back to this gym business, there was a gym next door to the health
Speaker:Blair: center where she worked.
Speaker:Blair: And what she used to do was to take her patients to the gym.
Speaker:Blair: Just, you know, at the end of an appointment, come to the gym,
Speaker:Blair: look at the gym, and they can see that the people that are using the gym are
Speaker:Blair: not all super fit, lycra-clad muscle men, bodybuilders.
Speaker:Blair: They're people like them, the people who are all shapes and sizes who are just
Speaker:Blair: doing their best to achieve some kind of improvement in their fitness.
Speaker:Blair: And so I think it's getting over that perception that physical activity doesn't
Speaker:Blair: mean elite sports and high-level training. It just means walking out your front door or putting on.
Speaker:Blair: Sweatshirt and walking on a treadmill or down the path.
Speaker:Callum: Yeah, I think it's really interesting that the corporate world often skews our
Speaker:Callum: view of what physical activity is.
Speaker:Callum: They make it about kind of an elite exclusive activity and I think a lot of
Speaker:Callum: what you've both said is often and possibly in chronic pain,
Speaker:Callum: I'm putting words in your mouth, but it's all about finding a movement form that works for you.
Speaker:Callum: And there's such a huge spectrum, which is often limited by our imagination
Speaker:Callum: because there's so much more. There's Tai Chi, yoga.
Speaker:Callum: It's vastly beyond just gym running or going for a ride.
Speaker:Callum: As a segue into moving into overcoming barriers and tying up,
Speaker:Callum: I'd just maybe ask you both from your personal experience if you were to give
Speaker:Callum: one piece of advice to someone who was afraid of moving because of pain,
Speaker:Callum: what piece of advice would it be say you're in an elevator you've only got you've
Speaker:Callum: only got a number of seconds what advice would you give I don't know who to
Speaker:Callum: put on the spot here first Blair how about I would.
Speaker:Blair: Say try it and see.
Speaker:Callum: Thank you. How about you, Lee?
Speaker:Lee: Oh, wow. I'd completely agree. Try and see is one of those things.
Speaker:Lee: You know, fear is one of the biggest fuels for the fire, which is pain, if you like.
Speaker:Lee: You know, and the fact of the matter is, you know, yeah, moving with pain is scary.
Speaker:Lee: And it's okay to feel that way, you know. And I think it's okay to normalize that.
Speaker:Lee: It's okay to be scared to do this. It's the way we're programmed.
Speaker:Lee: But I would say start with something that is of value to you.
Speaker:Lee: What has value to you what would need the most to you to
Speaker:Lee: try and have back in your life and take blair's
Speaker:Lee: example if it was running that somebody wanted back
Speaker:Lee: in the life break that wasn't practical well how practical is walking
Speaker:Lee: because i i dare say without putting words
Speaker:Lee: in mouth here it's probably the outdoors where the
Speaker:Lee: benefit comes that being in nature the fresh air and
Speaker:Lee: just just being out of the house there's like like blair alluded
Speaker:Lee: to the endorphins the doping everything that starts the
Speaker:Lee: flow so you know can we see where people want to want
Speaker:Lee: to try to get back to what are the barriers and you know
Speaker:Lee: how can we work with that and explore those perception of
Speaker:Lee: those barriers that we've just said about the gyms aren't all
Speaker:Lee: lycra clad you know muscle muscle building
Speaker:Lee: guys that it isn't that isn't the reality of it but i
Speaker:Lee: think also start start where you are today you know cs lewis
Speaker:Lee: sort of said you can't go back and change the beginning but you
Speaker:Lee: can start where you are and you can change the ending you
Speaker:Lee: know don't look for the summer that i held just just the next step
Speaker:Lee: and for me one of the biggest things i try to say to people
Speaker:Lee: is about these soft edges of pain we're safe
Speaker:Lee: you know it's normal to have a little bit of response
Speaker:Lee: towards doing something you might get a little bit of something but that's normal
Speaker:Lee: that's your body's way of saying oh i'm not used to you moving like that or
Speaker:Lee: doing that kind of thing just have a bit of a rest for a day you know it's not
Speaker:Lee: a bad thing But if you do something and that pain really does not you for six,
Speaker:Lee: then you've pushed right through those barriers. Yeah.
Speaker:Lee: An analogy or a metaphor I like to use is to sort of say, see your pain.
Speaker:Lee: If it's a messaging system, see it as parking sensors on your car.
Speaker:Lee: You know, nobody would buy a parking sensor system, a parking sensor system
Speaker:Lee: on a car if it only bleeped when we hit the wall.
Speaker:Lee: And that's what we do in chronic pain. But if you start to listen at that first
Speaker:Lee: bleep or those first couple of bleeps, it helped it raise your awareness,
Speaker:Lee: bring your attention to what's going on.
Speaker:Lee: And that's where we start to be mindful of pulling back. am i doing too much
Speaker:Lee: am i going too far and just remember we don't make mistakes they're just opportunities to learn.
Speaker:Callum: I think blair's stories are really nice example of of your point lee in that
Speaker:Callum: you started post-op walking with a stick and and then progressed gradually to
Speaker:Callum: to running and i imagine that involved pushing as lee describes those kind of
Speaker:Callum: soft edges of pain yeah that's right.
Speaker:Blair: I remember when i first was able to walk around the field ringing my friend
Speaker:Blair: to tell him and it had taken me, you know, 45 minutes.
Speaker:Blair: But there was a sense of achievement and that's right. It was just that baby steps at first.
Speaker:Blair: And, you know, I'm not breaking any ground speed records with my running,
Speaker:Blair: but I'm enjoying it. And that's the more I'm doing.
Speaker:Callum: Just to close for the last couple of minutes, one thing which would be really
Speaker:Callum: helpful is kind of to look at what health professionals can do to support people with chronic pain.
Speaker:Callum: To become more active and maybe starting with you Lee what what support or encouragement
Speaker:Callum: from from health professionals or wider made a difference in your journey and
Speaker:Callum: and what what could people or what what what would you recommend people do or
Speaker:Callum: health professionals do to to support people with with chronic pain become more active?
Speaker:Lee: Wow. I think this one's a whole other podcast, Callum. And I think something
Speaker:Lee: I say, and I said it in a recent talk, is you will never finally answer until
Speaker:Lee: you understand the question.
Speaker:Lee: And we have to meet every person where they are at, because pain is complex, incredibly complex.
Speaker:Lee: We know there's psychological influences. We know your social determinants are
Speaker:Lee: driving your pain as well.
Speaker:Lee: But it isn't a one shoe fits all.
Speaker:Lee: So I think sometimes it's, and it's hard within the system we have right now
Speaker:Lee: to just allow someone time and space to explain their story.
Speaker:Lee: Explain their journey, and explore their goals.
Speaker:Lee: You know, only then, when we've understood the question, will we have any chance
Speaker:Lee: of working out what the answer is?
Speaker:Lee: And I know We Are Undefeatable did some work recently, and they asked that question,
Speaker:Lee: what are the barriers to physical activity?
Speaker:Lee: And they asked people living with long-term health conditions,
Speaker:Lee: and they also asked healthcare professionals in the leisure sector and
Speaker:Lee: people living with the conditions confirmed what we said today well
Speaker:Lee: the top two are pain and fatigue but sadly
Speaker:Lee: from the healthcare side of things and the leisure side of things the
Speaker:Lee: barriers their perception of the barriers were mindset
Speaker:Lee: and motivation so i think there's
Speaker:Lee: a there's what flipping painted in the moment in northeast there's an
Speaker:Lee: empathy gap and i just think that's that's born by
Speaker:Lee: the health literacy the education that's out there on both sides of it is we
Speaker:Lee: need to treat everybody as who they are that person sat in front of you understand
Speaker:Lee: them understand the story work out what their goals work out what their values
Speaker:Lee: are and then we can start to try and help shape the future but that kind of work is
Speaker:Lee: coaching it's not leading them it's just walking alongside them and just just
Speaker:Lee: being there for support i guess.
Speaker:Callum: Uh a really interesting kind of well two
Speaker:Callum: points one is is more empathy is required and
Speaker:Callum: the second and again maybe i'm i'm kind
Speaker:Callum: of drawing some dots between lines is that you know time and getting to know
Speaker:Callum: people is important and often you know that can be challenging in the current
Speaker:Callum: health situation but it's using our resources imaginatively and whether that's
Speaker:Callum: using health coaches or or physios or yeah the wider kind of primary care and
Speaker:Callum: health care resources blair sorry you were no.
Speaker:Blair: I was just going to say i've maybe got two different responses to that issue.
Speaker:Blair: One is my experience when I moved from working as a GP to working as a consultant in pain service.
Speaker:Blair: And I approached that job with a sense of apprehension because,
Speaker:Blair: you know, who was I that didn't have particularly specialist training in pain management?
Speaker:Blair: How was I going to be able to function at that level?
Speaker:Blair: But I quickly realized that the big difference I had was that As a GP,
Speaker:Blair: we have whatever it is, seven and a half, ten minutes, and that's not nearly
Speaker:Blair: enough to begin to explore these stories.
Speaker:Blair: For a new patient in the pain service, we had an hour, and so I...
Speaker:Blair: Did what all GPs would love to have done, and that is spent the hour listening to their stories.
Speaker:Blair: And even if we'd changed nothing by the end of that hour, invariably,
Speaker:Blair: the person would leave saying, thank you very much.
Speaker:Blair: That's the first time anyone's asked me my story, and that itself was therapeutic.
Speaker:Blair: The other side of the story is that when I was experiencing this post-surgical
Speaker:Blair: pain at its worst level, So I had to take the initiative, broadly speaking.
Speaker:Blair: If I hadn't stopped the pregabalin and duloxetine and lidocaine plasters on
Speaker:Blair: my own behalf, I would still be being prescribed them because nobody came in and suggested it.
Speaker:Blair: And I had to refer myself to physiotherapy after hospital because nobody was doing it.
Speaker:Blair: And that, I suppose, means two things. First of all, I knew what I was doing
Speaker:Blair: to an extent there, so I could take the initiative. But it also means that,
Speaker:Blair: shows me that to the extent that we can, we have to take responsibility for
Speaker:Blair: our own management, our own self-management.
Speaker:Blair: And in the context of this discussion, that includes physical activity.
Speaker:Blair: And ideally working in partnership with informed healthcare professionals.
Speaker:Blair: And I fully take on board everything that Lee has said about those.
Speaker:Blair: We've got a lot to learn as a profession, as a group of professionals, but we can do it as a team.
Speaker:Callum: And to be informed, or to become informed, there's some great resources out there.
Speaker:Callum: Flipping Pain, you mentioned earlier, Lee, and something I often advise to patients,
Speaker:Callum: your website, Partnering Pain, is another place to check out.
Speaker:Blair: Another one that I would highlight is the Pain Toolkit. Yeah.
Speaker:Blair: People's resource, which is fantastic.
Speaker:Blair: A reasonably similar story, actually, to some of Lee's that was behind the creation of that.
Speaker:Callum: We at dundee uni are doing research
Speaker:Callum: into physical activity and chronic pain and and hoping to
Speaker:Callum: to take it further and develop a toolkit for for
Speaker:Callum: health professionals and patients alike to become more active so uh so i'll
Speaker:Callum: put a link to to that as well in the show notes as long as everything else we've
Speaker:Callum: talked about aware of time thanks so much lee blair for for your time and and
Speaker:Callum: for for your expertise we could have talked for a lot longer i'm sure and there's
Speaker:Callum: a lot more things to discuss,
Speaker:Callum: but yeah, we'll pause there. And yeah, thank you so much again.
