- Talking the patient better
- 1989 Emigration to New Zealand
- 1999 A switch to Australia
- EBM Guidelines for management of Acute Low Back Pain
6:20. Psychososcial factors – as things that may prevent patients recovering from low back pain
- PhD using BPS approach to pain – at University of Queensland (completed in 2009).
8:04. Dr Nick’s Outline of Working with a Persistent Pain Patient
- In the pain medicine world, patients are referred.
- The telling question… “what’s going on?”
- Pain & Depression are two sides of the same coin
11:46. What do Sir William Osler, A.T. Still and Hippocrates have in common?
- Increases breadth
12:55. Hypothetical Persistent Low Back Pain with Depression
- Figure out how much pain is interfering with their life
- Impact on enjoyment, on sleep, on ability to sleep, on emotions, on physical activities…
- How much does it bother you?
- Depression / Anxiety / Diabetes etc are all part of the patient’s life experience
15:30. Neck Pain in Women in the Workplace
- Biggest predictive factor – unsupportive management style at work
16:58. Dr Nick Penney’s 6 A’s Approach:
- Apprenticeship – learning about pain education pain as a sign of threat, not damage.
- Learning the ropes
- One of the big factors in inhibiting recovery is fear of pain, movement or re-injury
- Shifting beliefs – a challenge when there are mixed opinions among medical professionals
- Nocebo / nocebic effect
- George Institute, Sydney: recommendation to be very careful who you offer a scan to.
- Scans… NOT so reassuring
21:17. Migrating from Biomechanics to Pain Science
- Boos et al 1995 – 76% of asymptomatic people have disc bulges
- Pain Neuroscience suggests “this is normal – and therefore not a problem”
- Mind viruses & Memes
- Pain catastrophising scale
- Doesn’t respond to simple education and reassurance
- Mindfulness based cognitive therapy
- Mindfulness based stress reduction
- Actual experience as opposed to story (or negative emotion which comes from it)
25:11. Simple take-home mindfulness technique:
- Take a single thought like “My back is damaged”… let it percolate for 10 cycles of breath
- Prefix the thought “My back is damaged” with “I’m having the thought my back is damaged.
- Prefix the thought “I’m having the thought my back is damaged” with “I notice I’m having the thought my back is damaged”.
27:40. CHEK Training: Beliefs
- Getting up from the front row and walking to the back – Diffusion technique
- Identify a painful thought or emotion and sing it to yourself to the tune of “Happy Birthday”
- Working within the limits
- The body saying “this is enough”, rather than “this is damaged”
- The Salience Network (The pain neuromatrix)
- Is paying attention to the pain helpful?
- Threat to survival can àthe pain being dropped to zero
36:09. “Pain is designed to grab our attention”
- Facilitating pain pathways…
- Toe tapping
- Distr-Action Techniques
- Beware of avoidance!
- Acceptance can mean we stop struggling with it, which can then mean it starts to dissipate
40:44. EPOCC Collaboration.
- Acceptance vs clinical improvement
- Living well with pain, versus living well without pain
- Rewiring occurs in both directions
- Socioeconomic disadvantage – pain positively discriminates toward lower socioeconomic advantage.
- Results of Dr Nick Penney’s Integrative Pain Care
47:24. What do you put your success down to?
- Effective Application of the BioPsychoSocial Model
- Engel: getting too caught up in the data
- BPS is intertwined with other clinical tools
49:57. Socioeconomic Disadvantage
- Trend toward increased pain in lower socioeconomic status
- … Or may just be that chronic pain is under-reported
- Chronic back pain among aboriginal people… saw it as being part of life – accepted the situation… but didn’t have the belief that it would last
- Over medicalising back pain
- UK Mindfulness in Schools Program
- Living in our heads – in our stories…
- Non-judgemental awareness
54:18. Reconciling the clinical with the New Age or the Spiritual
- “Your biography becomes your biology” – Caroline Myss
- Lisa Feldman Barret – How Emotions Are Made – “If we change our experience today, we can change who we are tomorrow”.
- Brain as a predictive organ
56:26. Pain as an emotion
- A sensory and emotional experience
- Emotional experience of pain may be “suffering”… but suffering is optional
- Pain generates emotion, but it’s not a primary emotion
- Life experience tells us to feel certain things in certain situations
- It takes work, time, patience, persistence to change that
- Avoiding avoidance!
- Doesn’t mean being hopeless and helpless
- Accepting current reality
- Open to change
- Working towards acceptance, but have to remember “there’s no negotiation with terrorists”
- Concerns with acceptance: nutrition, lifestyle, sleep, mindset, breathing pattern
- Anxiety leads to breathing pattern disorder, which switches autonomic system sympathetic
- Slow deep breathing in the face of acute pain (in experimental conditions) is more effective than a single dose of morphine
- We have an in-built capacity to deal with pain than we’ve been led to believe
- Mindfulness, sleeping, breathing, moving… are free!
- Resistance from patients? Happy when they’re healthily sceptical
- Ultimately people have to experience
- Relatively small amount of training can be enough to capture patient’s interest
- Virtual bodies – phantom limb pain and cognitive reorganization
- Guided narrations for daily practice (20 mins / day of focused practice)
- Overtraining? … Striving for change ASAP… focus is key
- Tiger Woods
- Repetition is the mother of skill, so long as there’s skill in the repetition (P Chek)
1:08:21. Mindfulness-based Cognitive Therapy
- Derivation of mindfulness based stress reduction (for relapsing depression)
- Nearly 50% of those trained do not relapse – because it’s a life-skill
- Avoiding the cues that make you abuse a substance
1:10:47. Unconscious Cognitive Function – versus Conscious Cognitive Function
- Choosing to pay attention gives glimpse into unconscious / subconscious
- Rummaging through the garbage!
- “Alright XXXX, what are you thinking?” …
- “Is it helpful?” …
- Drop attention to feet for ~30 seconds
- Default Mode Network (the “me” network) goes quiet when we practice formally
- Default Mode Network does not come back online as much as it did before formal practice
- Safety / Security, Sustenance, Sex
1:16:09. Action – committed action
- Putting what we learned into play
- Values more than Goals (things that bring meaning)
- Sense of purpose
1:18:22. Dan Siegel
- Ascending Information = Beginner’s Mind
- Integration is more about choosing & observing to understand “what is”
- Stephen Porges’ Neuroception
- Gut sensation
- The brain is the one organ that can grow itself by thinking about itself.
- Dawson Church – Mind to Matter… 14 minutes meditation over 8 weeks for demonstrable improvement in sense of wellbeing and happiness and brain growth.
- Black Cab Drivers in London – doing “the knowledge”
- Plasticity – be careful of what you pay attention to
- If you blindfold someone, within 24 hours the visual cortex begins to become recruited by other parts of the brain.
1:24:45. Where Dr Penney’s work overlaps with Spirituality
- May enhance it, but not at odds with it
- Problems with beliefs as external locus as power
- Pain science was seen for many years through the lens of Christianity
- Meet patients where they are
- Beware of invalidating experience / ostracising people from their tribe
- People seeing pain as a judgement on them
1:30:57. Preventive Work / Prehabilitation
- Modifying beliefs when headed toward an orthopaedic procedure
- Easier to teach these skills BEFORE pain or stress is experienced
- Myriad Study in UK 3500 kids, 11-14year olds. Funded by Wellcome Foundation… following for 7 years… can this set kids up for different experiences
- Pilot Study: British Journal of Psychiatry
- Decreased anxiety & stress
1:34:54. To find Nick or learn more about his work, head to www.drnickpenney.com
In March 2020, I’m heading out to Nick’s home-turf – Auckland – to put on a 2-day Seminar to help health & fitness professionals better understand how to facilitate a return to optimal function for people experiencing persistent pain.
I will be showing how Nick’s amazing work can be applied clinically using evolutionary modelling to help prioritise; while expanding on the information presented in the “Ghost in the Machine” papers* I wrote with Paul Chek. If you’re local, I hope our paths will cross there!
To find out more or to book your place, head to this link.
*NOTE: this paper is usually behind a $31.50 pay-wall, but has been made available for free by Elsevier at this moment in time.