The Things We've Learned About Pain
Debbie Patterson and Geoff Bostick
I’m Geoff, an Associate Teaching Professor at the University of Alberta in the Department of Physical Therapy. I have been passionate about the management and study of pain since graduating from Physical Therapy School in 2001. This has led to a side gig as Chair of the Pain Science Division at the Canadian Physiotherapy Association, where we are committed to supporting professional development through several avenues, including online continuing education.
And I’m Debbie, a registered physiotherapist in Ontario and Alberta. Like Geoff, I’m passionate about persistent pain. This has led me to a network of similarly minded people like Dave Walton, Neil Pearson, Diane Jacobs, and Leslie Singer. Together we worked to establish the Pain Science Division of the Canadian Physiotherapy Association. I find myself seeking (sometimes driven), to coach people who are living with pain. I believe that they deserve to understand the hope that science offers in being able to change their pain and improve their quality of life.
This is a blog about things that we have learned about persistent pain and physiotherapy practice, and how we can improve the quality of lives for our patients. We sincerely hope that you can take away at least one lesson from this blog and that you find it useful in the growth or contribution of your practice.
What is the biggest lesson you have learned in your career?
There is elegance in simplicity and simplicity in elegance.
I first heard this phrase in a PhD course in test theory and it has really resonated with me since. We encounter complex problems every day. It is intuitive to aim to solve these problems with complex solutions. In my experience, addressing complex problems often involves a simple approach. For example, think of your most complex pain management case in clinic. The solution almost always begins with active listening, empathy, facilitating understanding of pain and helping people move more. These skills are basic and do not require specialized professional development. I think this perspective draws me to helping people with pain – every expert clinician in the field of pain you talk to emphasizes the importance of attributes such as empathy. At the heart of good pain care are the roots of our profession – listening, empathy, facilitating understanding and movement. With all the technology at our disposal I’ve felt a bit of a drift away from these fundamentals and my passion in pain has helped reunite me with the roots of our profession.
It seems my ongoing life lesson that I know will be a never-ending pursuit, is the need to learn to be authentic.
It means embracing daily the reality of who I am. That includes my shortcomings and my failures as well as my giftedness and passions. I have found that this takes courage on my part, not only as a physiotherapist, but as a person.
As I listen to my patients with persistent pain, I am constantly reminded of the incredible courage that they need to be able to show up each day with pain and with the fears and anxieties about how they will manage not just this day, but every day of their future. I echo Geoff’s sentiments about the importance of listening, empathy, and compassion.
As an orthopaedic physiotherapist, I took many post graduate courses in manual therapy skills, important for the development of my career. Once I recognized that my passion was persistent pain, I was drawn to a different type of ongoing education that emphasized my need to learn to listen, to be able to empathize and to extend genuine compassion. I needed to learn more about how to be authentic in order to have any credibility with my patients. This paired with the expertise of using education, movement, and function to attenuate pain allows me to contribute to the wellness of the people I treat.
What’s another lesson that you have learned?
I’ve learned from my numerous failures in clinical practice.
I would say the theme that encompasses these failures is when I’ve been overly enamored with new information. Professional development has always been an important part of my career. I would often feel invigorated after participating in a course or reading a new article. I would be keen to incorporate new ideas in my practice. I regret not giving more attention to what sufferers have to offer.
I used to be comfortable in the expert role and did not relinquish it enough to those living with pain. On reflection, this is likely why some of the new ideas I was excited about flopped upon application – I was not able to personalize it enough, because I did not try to learn enough from the person living with pain. Readers might think an over exuberance in professional development couched as a failure as somewhat ironic considering part of this blog is about promoting online continuing education through the CPA Pain Science Division. However, it’s not the participation in continuing education that was problematic, it was not taking advantage of sufferer’s expertise on how a new idea could be made meaningful to them.
It seems that I am also passionate about sharing what I have learned about the science of pain, and about the people who live with persistent pain. I wanted to share this knowledge with other physiotherapists. I wanted to encourage them to expand their treatment approach from looking solely at biomechanical problems as the cause of the patient’s pain, to looking at the whole person – someone with thoughts and beliefs, emotions and attitudes, friends and family, life goals and interests – all of which seemed miraculously to influence their pain perception. I wanted them to understand that science was on a journey of connecting those dots and giving credible evidence to the truth of that.
That is why I started to teach continuing education courses in pain science. If I could share my knowledge and experiences, more people with pain could be treated by knowledgeable physiotherapists.
Although there are many benefits to live courses, the use of technology to provide information, and share my patient’s experiences, seemed to be the next most logical step. I am a baby boomer, and I must admit that technology was frightening to me for many years. But as I learned and embraced the possibilities it allows, I am seeing many benefits to online education. It is an honour for me, as a member of the Pain Science Division, to participate in online education.
For over a decade, I have been using technology in the area of tele-rehab, providing treatment online using a secure, encrypted platform. This gives me incredible access to people in pain, anywhere in Ontario and Alberta.
What advice would you give to your 24-year-old self?
The advice I would give my 24-year-old newly graduated self would be: First, be more intentional and reflective with your professional development; and second, participate in a course based on a self-reflection of a perceived gap in knowledge and/or skill. Once completing the course, share new ideas with people living with pain and ask for their perspective. I think this process would have better helped me to make meaning of the new ideas, and more importantly, help me understand how it may/may not be meaningful for the people living with pain. The availability of online continuing education really helps to facilitate this - online courses are accessible and therefore available to help address learning needs as they arise.
The advice I would give to my 67+ year old self is to continue to be passionate. For me at this stage in my life it means ongoing learning about anything that might help others. I am not ready to retire. As a physiotherapist working with people with pain, I have a ministry – a purpose. However, it also means having fun. I am constantly seeking balance between my professional goals and my personal goals. I am trying to find the balance that will allow me to stay fit and healthy, to enjoy hiking, biking, skiing, playing, and laughing with my grandchildren. It means to experience gratitude and joy each day.
I believe this advice is appropriate for any age.
Interested in learning more from Debbie and Geoff? Click here to take their online course, Pain Education: Theory & Practice.