I have treated thousands of people over many years suffering from pains that have lasted well beyond the expected time a pain might be expected to be present for.Any pain that lasts more than 3 months is termed “chronic” although the fashion now is to term it “persistent” as this sounds a bit less fear inducing and perhaps something that might change positively in time.

Many of those that I have seen have tried other osteopaths, acupuncturists, physiotherapists, dieticians, surgeons (and may well have had bits cut away, or things squirted into them, to see it it helped the pain),psychotherapists, counsellors,healers, read books, joined support groups, taken every possible combination of medication, in the hope that they will at some point hit the jackpot and someone finds the solution to their problem.

Along this journey many will be frightened, frustrated, angry (at themselves, the medical system, their workplace- colleagues and bosses,family and friends and maybe even their God), spend time ruminating about the past and future and suffer with low mood and perhaps depression.

Having worked as an osteopath in the NHS for 17 years, I often see clients several years in their journey with pain. Very often the introduction is one of some suspicion on the clients part.They may have become quite cynical (and perhaps rightly so) about medics and their claims and often approach the consultation with very low expectations. Also as an experienced practitioner I know there is a known limited time frame in which you have to gain trust and set out your stall as to how you are different and why your method maybe one that will help them.

With this in mind it is easy to fall into the trap of forcing lots of information on them, in order to show them your knowledge and credentials. This was probably something that I was guilty of in my first 10+ years as an osteopath.

My eureka moment came when I attended a conference about 5 years ago run by Professor Peter O’ Sullivan, a New Zealand born physiotherapist and a leading researcher and authority on spinal pain (especially low back and pelvic pain).I had already started to change my thinking about pain from a simple “damage” model (known as a biomedical model), whereby what is seen on the scan is what your pain is, to a more nuanced understanding that many elements come in to play when dealing with what is a complex individual. We have all had different experiences and are all unique and therefore to understand someone’s pain you have to an extent understand them as much as is possible.It is like trying to fit together a very complicated jigsaw puzzle. It is what makes my work so interesting and when it goes well, so rewarding.On the flip side,I still take it personally when things don’t go well, but as I often say if everyone got better that you treat, you would probably end up with a religious following!.Interestingly being in a caring profession can be addictive as caring releases opiates in your brain, which make you feel good and therefore make you want to do it more.

What Peter O’Sullivan showed me was his brilliance as a master communicator of which, I realised, the most important part was the ability to listen well to the clients story.People often complain that they haven’t felt heard by medics of all types and often this is because we tend to feel that we are specialists who need to impart our knowledge. This forgets that the client is the expert about themselves. Therefore their story and what they see as the relevant points need to be taken into consideration, as even if, as the specialist, you may not see certain details as important themselves.Often, in what can be seen as superficial detail, there lies the heart of the problem.For example someone might say that their mother ended up in a wheelchair, or that their father died of cancer. Although no-one can predict the future, to inform someone that their is no indication that they would end in a wheelchair, or that their condition does not have any signs or symptoms that would draw you towards a possibility of cancer, may remove a massive roadblock in their life. This might then allow them to ruminate less, to sleep better, to restart doing things that give them meaning and pleasure. People with persistent pain often report that they feel their life is on hold, or that they are stuck.

We have very strong needs to explore our world, releasing a brain chemical called dopamine in order to keep this drive going. We need this evolutionarily so that we can find shelter, food and a mate.We learn to skillfully move in our environment. When things are going well it can be likened to riding a bike. When we are on a bike and things are going well, we become unaware of the bike, instead we are focussed on the road ahead, our aching muscles, our thirst, or perhaps thinking about arriving at our destination. If however our gears start slipping, or we get a puncture, our thoughts then have to return to the bike. And so it is when we get pain.We need to start thinking more about our movement, which can become awkward and defensive.Instead of moving with skill, ease and freedom, we start moving with deliberation, pain and perhaps fear.We might start to withdraw as a defence and this can ultimately lead to depression.

A good practitioner will be able to help you chart a way forward, to help you reengage with the world. Remember that this will be challenging, perhaps both mentally and physically. This is why a strong “alliance” (something I have talked about in previous posts and on my website) is so vital.It is often vital to have someone who can join you on this journey. Family and friends can be encouraged to join in, but a skilled, thoughtful therapist has seen problems before, knows the roadblocks and has tools to help overcome them.

As a mild rebuke to patients I would like to say this is a marathon not a sprint. Very often people with persistent pain give a practitioner 1 or 2 treatments and then say “oh well that didn’t work”, which can be a great disservice to the practitioner.If you have experienced pain for a long time, then it is unlikely you will be feeling big changes in that time. It is about building layers of healing, slowly regaining confidence, learning not to think about the body, but to learn to become skilful again.

As well as my standard 45 minute treatment, I offer a complex initial assessment lasting about 90 minutes, so that I can understand you as well as possible and to identify both roadblocks, but also to see what you are doing well and to build on that. There can be no promises of cure, indeed you may have 8 treatments and feel no difference. However in my experience someones pain can often reduce, say from a constant 7-8/10 to perhaps a 4/10 more intermittently. This may sound little but can make a massive positive impact on someone’s life.

The use of osteopathy, exercise advice and emailed programmes, sleep hygiene, hypnotherapy, acupuncture and mindfulness, can create not just a reduction in pain, but as importantly reduce significantly “suffering” from that pain.

So why not invest in yourself and get yourself back on that bike.