When it comes to working with pain, I believe the core of our clinical work is finding creative ways to help people find agency, strength and choice. 

In my early work, I used to believe there was a stretch or a manipulation for every health challenge. Over time I became unsatisfied with the structural models and learned that pain is much more complex. 

So I took a deep dive into pain, pain science and complex human systems. By appreciating our complexity, I actually found a new freedom and an array of new tools to work with the human condition, and especially with pain. My book, Pain is Really Strange was my first attempt to express very complex ideas about pain in simple ways. 

In this blog I explore creative ways to work with pain that embrace our complexity. I hope these ideas support you to help your clients find more agency, strength and choice when it comes to pain. 

1 We can use better metaphors

When it comes to pain, the most limiting metaphors tend to be that we’re broken machines, and that the damage is permanent. Permanence and broken structure don’t work well, it’s better to focus on sensitivity, adaptability and journeys rather than battles. 

‘Motion is lotion, every time you move, you inject a bit of synovial fluid into the joint.’

‘Movement is nature’s best lubricant.’

‘You’re an organic garden, not a broken machine’.

These kind of metaphors help to turn down sensitivity and promote more adaptation, more health, less pain, and more flexibility in our responses. 

2 We can create safety

Human beings need safety. The first, most fundamental act we’re doing is exploring, “am I safe?” We code the world, looking for signs of danger, to a degree that we’re incredibly sensitive to anything that’s perceived as a threat. 

Our sense of safety is intimately connected to our environment. For example, factors like social status, performance, and doing well are actually life and death issues for us. To be accepted and validated by your peers is as important as running away from a tiger, or surviving a car accident.

For social animals like us, how we’re perceived by others is deeply important. So we need to listen to our clients’ stories and help expand their resources when it comes to their relationships and social networks. 

3 We can work hard to overcome negativity bias

We’re very negatively biased. If you put a cockroach in a bowl of cherries, people won’t eat the cherries. If you put a cherry in a bowl of cockroaches, they will think the one cherry is equally disgusting. It takes far more good messages to outweigh a bad message.

So we have to work really hard to reinforce a positive message, and to help people feel confident to overcome fear of movement and fear of feeling. It’s a long grind sometimes, but it is possible. We can retrain our ability to feel. It’s so easy to be overwhelmed by hopelessness in the face of pain. We can be our own inner cheerleader, whilst also acknowledging that things are difficult. 

4 We need to build stuff up, and calm stuff down.

There are two essential gestures when working with clients recovering from pain – we can build stuff up, and calm stuff down (This one is adapted from Greg Lehman.)

It’s important to help your clients build their capacity and resilience slowly, from a secure base, supporting them to challenge and recover in a graded way. Along the way you can be a cheerleader for them, encouraging them that they can do passionate, amazing things, they will be able to get to the top of the mountain, but they need to go slowly, challenge and recover and practice more before attempting it. 

5 We can get curious about where danger messages are coming from

Certain classic danger messages have been classically overemphasised in our culture – think of the inaccurate term, “you’ve slipped a disc” and the danger message it creates. 

If we focus more on sensitivity rather than structure, we expand our awareness to include all the factors which may be influencing our experience of pain: a divorce, a big tax bill, fear of getting old. These things can make us as sensitive as inflammation processes or a stretched / twisted ligament. They are equally important, because they amplify danger signals.

We can work with the danger messages that are being amplified in your client’s experience, and get curious about where they’ve come from: Why do you believe that getting old is a problem? Why do you believe your joint is damaged? Those are useful questions to explore before we begin to reframe them.  

6 Schedule rest, as well as activity. 

The tennis player Roger Federer sleeps 13 hours a day during tournaments. He’s one of the best sleepers ever, and he’s also one of the best tennis players we’ve ever seen. His intense physical activity and prowess is built upon his capacity to rest and recover.

I was working with a triathlete recently, and we needed to get creative about his rest and recovery. He’s got kids and a busy job – I helped him to see that he can continue to perform as a triathlete, but only if he prioritises and actually builds a rest schedule to accompany his training schedule.

7 We can build skills around the choices we make.

With pain, we’re often responding to very large, old dynamics which evolution prioritises, which can make it harder to make authentic choices when it comes to our response to pain.

We can learn to be more skillful in our response to the messages we receive. We can explore where they come from, realise they are powerful and have been limiting, but that we can be supported to reframe them, make new connections and skillfully enhance our ongoing recreation of our sense of self and lived experience of our bodies.

Even the most nasty, sticky, horrible pain can be transformed by being skillful in how you frame it and getting support to find new choices in response to old problems. 

8 We can turn lead into gold. 

I discussed all of these ideas in depth on the Pain Removed, Performance Improved podcast with Joanne Avison recently.  In the podcast, Joanne quotes Dr Caroline Myss, saying we can “turn the lead of our wounds into the gold of our gifts”.  Instead of seeing the pain we experience as a dead end, it can become the grit that turns into the pearl.

In the podcast, we also spoke about what we’ve learned from Simone Biles when she pulled out of the Tokyo Olympics, the wonder of fascia and post-traumatic growth among many other things. You can listen here.


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