Reflections on Know Pain

By Clem | In Physiotherapy | on March 21, 2017

Five things I learnt from Know Pain in Aberdeen

A few weeks ago I had the pleasure of heading up to Aberdeen with a colleague to spend 2 days with Mike Stewart and the Know Pain: A Practical Guide to Persistent Pain Therapy course. I had been waiting to do this course for a few years even when studying Physiotherapy and was like a giddy school girl in anticipation for the knowledge bombs soon to drop.

Obviously, my prior knowledge and appreciation of Mike’s work makes me quite biased in my opinion on this course but I was not disappointed and in fact had under estimated the effect the course would have on my thought processes.

Having had time to digest the conversations, material and the many, many take home points from the two days, I would like to share five of the biggest learning points I brought back from that trip to Aberdeen. It would be very unfair of me to go through the Know Pain course in its entirety so the points are kept quite general. I would highly recommend you attend this course if you have an interest in helping people with pain. This course is not specifically for a physiotherapist like me but also for GP’s, osteopaths & chiropractors. My colleague is a personal trainer and found it just as thought provoking and informative as I did. Mike has also given this talk to professional sports teams in the UK. This shows the potential benefits people from many different backgrounds can have when enlightened on this very difficult but omnipresent topic.

Being a good teacher is awesome

Mike has an MSc. in Education and it is not at all surprising when you witness him teach. If I had this guy teaching me Economics in school, I’m pretty sure I would be a stock broking genius right now (I hated Economics in school, thanks Mr. Reid).


One of the earliest points Mike tries to get across is that the current education of a health professional is all based on knowledge transfer from the teacher to the student and clinical placement practice. Rarely, if ever, are we taught how to teach. One of my favourite sayings is that “no one cares how much you know, unless they know how much you care”.

Research on interventions for pain puts the education of the patient at a very high priority. With education being so important it is vital that we reflect on how we might achieve clarity of understanding within the patient for what might be happening and how best they might live with it.

Research has indicated that 40% to 80% of medical information given to patients is forgotten immediately. The greater the amount provided, the lower the proportion correctly recalled. The same research found that almost 50% of the information provided will also be remembered incorrectly. It is quite obvious that health professionals are not disseminating knowledge effectively and it may be in part because we do not acknowledge our failings as teachers.

“no one cares how much you know, unless they know how much you care”

You might have a PhD and have every relevant certification known to man but unless you know how best to connect on a human level to the person you wish to help, all that fantastic knowledge will fall on deaf ears. It is important to see the person in front of you not as a shoulder, lower back or ankle but as Danny, Mary or John. Relationship building skills, communication skills and charm are almost as important as clinical knowledge in this respect.

Sidebar: maybe that’s why there are so many Irish physios where I live. The gift of the gab seems to help a lot in this profession.

Talking isn’t the only (or even best) way of communication.

Throughout the day, Mike encouraged us to think creatively about the topic of pain and how it might affect people’s lives. As mentioned in the first point, we are not taught to be teachers and as health professionals, we must put our hands up and admit the industry has a lot of improving to do as regards communication. That may be due to the belief that educating our patients means talking to our patients. This is an understandable association to make but has flaws.

Information giving cannot hold a candle to actually experiencing when it comes to an effective learning experience. We must inspire patients to partake in their own knowledge gathering and become active participants in the process rather than sitting them down and filling their heads with the latest edition of BJSM.

Mike achieves this in ways that did seem admittedly weird at first but very effective. Drawing pictures of your pain, creating collages from magazine cut outs, going on field trips with a temporarily mute partner were just some of the experiments that did not involve spoken words but provided so much opportunity to communicate.

The patient invariably has the answers. We just guide them in the process of discovering those answers. If you really want to help someone, zip it.

The goal is never to kill or get rid of pain but to learn to live beside it.

This next point is one that I have a personal connection with and will write a full post on in the near future. Readers of this blog will know that I live with Ulcerative Collitis (UC), a form of Irritable Bowel Disease. It does result in pain and is incurable. It took me a while to learn how best to live with it but now have it well under control and it barely affects my life (unless I end up on a night out and someone forces me to down a tequila…you know who you are).


A big part of my life with UC is acceptance that the pain is not worth fighting against. Pain is inevitable and necessary in all our lives. Without it, we would all be far worse off. The Ancient One in the recent Doctor Strange movie (go see it) had the right idea (in spite of her questionable choice of hairdressers). In the film she tells her disciple “We never lose our demons, Mordo. We only learn to live above them.”


The Ancient One and Mike apparently go way back

We must avoid thinking that we need to fight off pain, battle it to the death and “kill” it. We need to learn to live with it, understand it and appreciate it. As clinicians we may be guilty sometimes of fostering this battle mode within patients which never ends well.

A book I recently finished called “The Body Keeps The Score” by Bessel van der Kolk, describes alternative approaches in the treatment of trauma.  I was reminded of the extract below as Mike spoke about the topic of living with pain.

“You cannot help, fix, or save the young people you are working with. What you can do is work side by side with them, help them to understand their vision, and realise it with them. By doing that you give them back control. We’re healing trauma without anyone ever mentioning the word”.

“Nerves that fire together wire together”

This is a quote that I learnt from the Louis Giffords books and Mike references this idea throughout. It is called Hebbs Law and I will attempt to basterdise it here. Each time you carry out a task or thought, your brain cells will communicate in such a way that a specific path will represent that action. This path becomes strengthened the more often you carry out that action.

When we first learn a new language or learn to ride a bike these paths are being newly created. In years to come those paths will have strengthened and the act of carrying out those thoughts/actions will become easier and more fluid. This same thinking can be applied to experiencing pain. Movements or thoughts associated with painful experiences are represented by neural pathways and are strengthened the more often they occur. Mike provides fascinating insight into how we might facilitate a way to adapt those neural pathways in order to carry out movement patterns or even thoughts in a pain free manner. Again, this involves collaboration with the patient to come up with alternative ways to carry actions out or re-framing thoughts about certain aspects related to a painful experience.

“We are what we repeatedly do. Excellence, then, is not an act, but a habit.” – Will Durant

“We don’t see things the way they are, we see things the way we are.”

The final big take home point for me was from this powerful quote from the Talmund. Mindset can have a profound effect on a person’s experience of pain. My own dissertation for an MSc. covered this aspect in relation to self-efficacy and joint replacements. Mike makes reference to the work of Professor Elaine Fox on the science of optimism and pessimism and how some of us are glass half full people and some half empty.

A recent study involving 660 individuals aged 50 years or older from the Ohio Longitudinal Study of Aging and Retirement (OLSAR) found that older individuals with more positive self-perceptions of aging, measured up to 23 years earlier, lived 7.5 years longer than those with less positive self-perceptions of aging. This proves a stark reminder that our mindsets and self-perception can play an important role in our long term health.

It goes without saying that telling someone to cheer up and expect them to do so is like telling someone to laugh. It just doesn’t happen on cue. Happiness and optimism is not an on/off switch. It must be fostered from within and for good reason.

As health professionals, it is our jobs to inspire optimism in people. People come to us sometimes in a lot of pain and in desperation. It would be understandable that an element of pessimism starts to permeate into their lives. This is an area I continually work on myself in regards to how I might become more optimistic in my own life and how to foster and grow optimism in others.


These are just five points of many that come to mind when I look back on the two days spent on the Know Pain course. If you have an interest in pain as a clinician, athlete, personal trainer, student or human being, I would highly encourage you to take the opportunity to go to a Know Pain course. You might come away with more questions than answers but that’s always a good thing.


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