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As you know, I write a small nugget of information each week for our pain relaxation class at 6.15pm on a Monday night. This will be the 30th nugget, which is pretty amazing – where have those 30 weeks gone? I had another topic in mind for this week, but a blog by another physio – Sports Physio Adam Meakins– prompted me to go back to my own Change blog (which I wrote in 2012 and has become a part of the final chapters in my books) and re-visit it and make some changes and use it for this week’s nugget at the pain class.
Embracing change (of your thinking, behaviour and your beliefs) is important, because if you won’t embrace change, then you probably won’t move forward with your chronic pain management. A comment on Adam’s thought-provoking blog by Pete Moore, who is himself a pain advocate who has created the Paintool Kit, also validated what Adam said. Why this is so crucial, is that Pete himself is a chronic pain sufferer, and he was giving the stamp of approval to the point that Adam was making in his blog was that “he  (Adam) will not waste his time and energy on any patient who thinks he should be more interested and invested in their progress and outcome than they are..”. Adam was directing his comments to his physio profession and other health professionals who risk (empathy) burn-out – listening to everyone’s pain stories can be exhausting and debilitating – and he was advocating for us to keep doing what we preach- exercising, taking a good break, socializing with friends and generally being mindful of self-care. I have to say that after 40 years of being a physio, I can relate to that and I am careful to keep leaving the desk looking untidy and heading to the gym and dance class as often as I can every day.
As usual, when I write these nuggets, then sometimes I decide it may be useful to post as a blog and so here it is.
‘Change is as inexorable as time, yet nothing meets with more resistance.’ Benjamin Disraeli
Change in our lives is an important concept to embrace. Whilst physios need to be skilled at encouraging, enabling and facilitating change in their patients, you as the patient / client need to understand that the biggest barrier to enacting better health outcomes, can often relate to inflexible thoughts about wanting to change how you do things, how you’ve always done things and what your belief is about what the right thing to do is.
Without an ability to embrace change in behaviour, beliefs and what are almost rituals – not much is going to improve with your condition, whether it be persistent pain, anxiety management and for that matter, things like sexual dysfunction and bladder / bowel issues (such as frequency, urgency, incontinence, constipation).
Rather than wishing for change, you first must be prepared to change.’ Catherine Pulsifer
Some of our thoughts, beliefs and behaviours are almost etched in stone, sometimes because our mothers have taught us these and handed them down from one generation to another; our church and religion has espoused some things; our girlfriends have told us; or because of what we read on social media or Dr Google. This makes them hard to let them go.
I think an important part of the change process is to:

  • Recognise there’s a problem
  • Acknowledge there’s a problem
  • Respect the process and seek help (with a health professional who will empower you with self-management skills)

‘Everyone can think of the one thing that would make life better for them. But people are not so quick to answer the second question: ‘What are you doing to make that change come true.’ Catherine Pulsifer
Life is busy and there seems no time for airy-fairy things like breathing training (tummy breaths, awareness of where your breathing is occurring, mindfully slowing it down, being aware of the rise and fall of your chest wall); like learning about mindfulness; like just switching off and listening to a playlist of calming music like a yoga playlist, or your other favourite artist and going for a walk in the fresh air. It may feel like it’s a waste of time or pointless, but these simple strategies can be life-changing for those with chronic pain and anxiety.
‘Never stop learning, like never stop changing and growing in your life – learning helps you adapt to change more easily.’
Pain science has itself changed – Ronald Melzack and Patrick Wall back in 1965 refuted the claim that there are specific pain pathways – how amazing that this work was way back then and yet this pain science is still being called new…..This has been elegantly explained in 2003 and updated in 2013 by Lorimer Moseley and Dave Butler in their book Explain Pain and expanded on in 2017 in their latest book Explain Pain Supercharged

Explain Pain Supercharged
Even 80 year olds can implement change – if you have the mindset that you can still learn new things and improve your situation. If you are fixed in your mindset and attitude then it will be hard to be inspired. Often what you will be taught is very simple – not rocket science.
‘You cannot change your destination overnight, but you can change your direction overnight.’ Jim Rohn
Sometimes the hardest thing to do is to open your mind. Your physiotherapist will open dialogue with some questions and listen (assess), empathise, educate, empower, nurture, cajole, encourage, console, praise – to help you on this journey, in a new direction, to a new destination, but if your mindset is fixed then it is almost impossible to change.
‘If you resist change, you will face challenges on a daily basis. If you consciously refocus your attitude to see the benefits of change, your outlook becomes positive and life becomes easier.’ Catherine Pulsifer

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And most importantly:
‘No action, no change. Limited action, limited change. Lots of action – Change occurs.’ Catherine Pulsifer
This is the crux of all this change talk. What you put in will be reflected in your result, even if the pain is not entirely gone. Hopefully you have learnt new strategies to decrease the intensity/ severity of the pain; you have learnt to decrease the impact of the stress hormones of cortisol and adrenaline which up-regulate the intensity and increase the fear and catastrophizing that can accompany pain and anxiety conditions. Most importantly you have learnt the concept of self-management and empowerment – and decreased the reliance on some-one external to yourself. This will be liberating.
And now to finish, just because amongst all those change quotes I really like this as a good piece of life advice for all of us – to help us deal with the complexities of modern work and life:
‘To focus on the people who do not like you and the things you cannot change is like climbing an infinite mountain; instead focus on the people who love you and the things you can change and you will find you can move mountains’ 
Michelle Ghislaine Ambler.

Meme sourced from (2) 
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(2) Meme sourced from