So, you mentioned exercise and being physically active, as a vital component of pain management.

Yes. And I hate that that’s true.

You’re not into sport. Amy Orr No, not at all.

Some people are some people aren’t

No, I know. And it’s, it’s just it sounds like a cliche, right? It sounds like, Oh, it’s the thing that everyone says. You’ll feel better if you exercise, but it’s annoyingly true.

Yeah. And circulation and, you know, the body’s Made to Move. So yeah, I think it’s, for me, it’s a not not just exercise, but the right kind of exercise and training has changed my life. It made a huge difference. So I know how important it is.

And you’re right that the right kind of exercise because, I mean, if you remember You know, chronic pain, you’ve got chronic back pain, then some things are just going to really hurt you and you probably shouldn’t be focusing on those things. And you know, there are other types of exercise or that are going to have a lower impact on your pain. And yeah, I think I think knowing having a lot of different options to stay active is really important. Because you not like, and I don’t, I probably, I’m going to the gym two to three times a week at the moment, and I’m, that’s good for me. But there are times when I go and I can do a full workout and then do strength training and I feel fine. And there are times when I go and I’m like, I just need to paddle around the pool for a bit. Yeah. And you it’s okay to have that range as long as you’re doing something.

Yeah. Yeah, I agree. I think strength training can have a place but I think if you’re feeling Yeah, if you’re not feeling particularly up to it, particularly strength training and weight training.

Yeah. You can hurt yourself doing that.

Yeah, exactly. kind of ease off on that if you’re not feeling it.

Yeah, I agree. Yeah.

And you talk about knowing the difference between good pain and bad pain.

Yeah, exercising. I mean, it’s not like the most comfortable thing in the world, right? Like you’re going to have, you’re going to get tired. If you’re doing it properly, you’re going to get tired, you’re going to get sore muscles, it’s as you push yourself, even if it’s just a little bit. If you’re used to doing you know, 10 minutes on the treadmill, and you say, I’m going to up it to 12 you expect a certain level of tiredness and like just wear as your body, you know, recovers from doing that. And for me, it was really hard, especially not growing up doing a lot of sport. It’s really hard to distinguish between that, and other types of pain. And it’s Like something can hurt without being bad for you.

Yeah, absolutely. Yeah. If you train, then there’s gonna be some soreness and stiffness in the muscles. Yeah, this is not bad for you. Yes. So what how? How would you know, having learned what you’ve learned? Now distinguish between good pain and bad pain.

So that sort of comes back to the pain profile and not as like in such a detailed way as like writing everything down for a pain profile, but having the tools to think about your pain objectively. So for me, part of it is experience and over time you get comfortable knowing what each of the different pains in your body means and what it is.

Yeah. Kind of self awareness. Amy Orr Yes, yeah. But initially, it’s like, it’s really about you know, when you’re at the gym and your muscles start aching, stopping and be able to think, Okay, what what hurts here and how does it hurt? If it’s you know, like a sharp stabbing pain in your heart. That’s not muscle pain. And you can figure that out quite quickly. But if it’s like, well, my legs are a bit sore. And if I have a stretch, I feel a bit better. Then you sort of, it’s much easier to categorize it as good pain or bad pain, if you can easily draw a line to the cause. Yeah, like if you’re, yeah, if you’re just running and it you get winded and a bit sore, then it’s pretty easy to go. Well, I just ran for 20 minutes, which I’m not used to doing so that’s probably why

Yeah. Okay. And you move on to you talk about boundaries. So boundaries that someone kind of puts in place, about what they will accept from from other people. How other people behave towards them and setting boundaries and I guess enforcing them with people kind of overstep them.

Yeah. Well, it’s kind of like what you’re saying earlier about just having your priorities straight. Everyone around you is also dealing with their own stuff. Yes, they have expectations of you just as you have expectations of them. Yeah. And knowing what you’re prepared to give and take with the people around you, and how much you’re willing to, you know, how much leeway you’re willing to give for using your time and your resources or you know, helping them with their emotions and their reactions, even to your own pain, that that’s a choice you have to make it like and it’s … boundaries become kind of important when you have chronic pain because A lot of stuff becomes a lot harder. Yes. And especially because, you know, pain isn’t visible, people are still going to look at you and expect the same things. Yes. And so sort of being able to know in yourself and tell other people, okay, Look, my physical boundaries, like I’m not gonna be able to help you lift this sofa. I’m really sorry, but I’m not doing that, you know, it’s gonna hurt my back is a completely valid thing to say. And that’s a perfectly valid boundary to put in place. And some stuff’s hard, right? Like, the emotional boundaries with close family and friends when you’re in chronic pain can become complicated because especially spouses and parents, they want to help. Yeah, they want to come in and help you fix it and problem solve and they might have quite strong emotional reactions of their own of you know, they’re angry with you or they’re disappointed or depressed or, you know, they’re just desperate to fix it for you. Yeah. And it’s really important to be able to think to yourself distinguish what’s your reaction versus what’s their reaction you don’t own their emotional state, you don’t have to fix it, even if it is related to your pain, it’s not your job to solve that for them. And just like giving, giving everyone a little bit of their own space, I think is really important. And the boundaries when you’re in pain is it’s just it’s one of the only ways that you can properly take care of yourself. Yeah.

And, you know, maybe if you’re going through a particularly sort of bad time on that on any given day, or or any given week or something. You can just, I guess, extend that boundary and say, you know, I can’t do the things. I would I would normally do. Yeah, you know, maybe we would have kids or something.

Absolutely. I mean, boundaries don’t have to be, you know, hard and fast big brick walls that can never be moved. They can be flexible. And as some people have, you know, pain that changes and waxes and wanes over time. Yes. Be able to adapt to that. Yeah. And that that all relies on you having around you people who respect your boundaries and listen to you when you communicate them. And obviously, that’s not always the case.

That isn’t always the case. No,

And that makes life pretty uncomfortable. Yeah, yes, but just because someone isn’t willing to accept your boundary for me, that is not a good enough reason for me to then give up my boundary like I’d have set my boundary for good reason. Just because someone doesn’t like it. That’s I’m sorry. That’s just not good enough.

Yeah. difficult.

Difficult it’s not pleasant. Yeah.

Because then you can end up with conflict. Yes. On top of the original problem Yeah. of someone who wants more from you than you’re prepared to give. Yeah. And it’s, which is, which is also draining you end up you because you’re the next chapter is about resource management, how you use your energy, your time, and your strength and your your emotions. And then you end up kind of wasting it having. pointless fights with someone.

Yeah, it’s, um, I think it takes quite a stern turn of mind to be able to say, this person isn’t respecting my boundaries or was expecting too much for me. So I’m going to cut them out my life. Like that’s not a realistic solution for most people.

It depends who it is. But if it’s the immediate family, then that’s not going to be doable is it?

And if it’s like a colleague at work, for example, you don’t necessarily have a lot of control over that. And some people you can say, okay, friends, they don’t really listen, they’re not really respecting what you say so okay, you know, maybe I’ll hang out with them less or see them a bit less. But for a lot of people, it’s, again, it’s not black and white. For a lot of people, it’s spouses. And it’s not that they’re saying, I don’t care if you’re in pain, or I don’t believe you or anything, it’s just, they expect a little bit more than you can give. And it might not be an unreasonable expectation most of the time, but yeah, it could be that you’re having a bad day or whatever it is, and you have to say, look, I can’t do that. And quite often, the response to that is, well, what do you mean you can’t do that you did it yesterday. Or, you know, you look okay today or whatever it is that they think and you don’t want to have a fight and you don’t want to have to keep explaining yourself and those often seem like the only two options. It takes a lot of energy. Certainly,

Yes. That’s a bit of an intractable problem there, isn’t it?

It is. There’s not. I mean, I wish that there was, like a way out with that, other than just keeping, keeping yourself calm and remembering your boundaries and trying to just have empathetic people around you. But no one can guarantee that all of the time.

No, exactly. Yeah. Life, it can be tough sometimes can’t it?

It can and unfortunately, we all need people around us. So yeah, can’t really get away from it. Yeah.

So part two of the book, mind and mood and we’ve already been, we spoke at the beginning, about concentration and cognitive abilities and how You one’s ability to, to think clearly can can be affected.

Yeah. And it’s it could be because of the pain itself or meds right? Meds are. especially some of the stronger pain meds are notorious for messing with your head. Yeah. And getting you a bit high and a bit dopey and yeah, it’s very difficult to do anything when you’re in that state. Yeah, yes. Yeah, it’s um, it’s one of the things I think, unless you’ve experienced it, people don’t realize that’s part of, of living with chronic pain is that you get a bit fuzzy sometimes. Yeah. And I think for a lot of people, they think, Oh, well, so you know, in that your neck’s sore or your shoulder hurts or whatever, and so it’s hurting your shoulder and that’s it. And it affects all of you and how your brain works.

It kind of wears you down, doesn’t it? If it goes on for months.

I mean, being in pain is really tiring. Yeah, it takes a lot of energy to do the same stuff

And it can cause anxiety.

Yes. Yeah, very much. So. I mean, I can’t think of much that’s more frightening than not being able to trust your own body. Yeah. That’s that’s just scary and not being able to sort of predict what it’s going to do or how you’re going to hurt on any given day. Or if something small like I don’t know, picking up something off the floor will suddenly throw your back out that that’s not going to keep you calm. Having that in the back of your mind. Yeah. And yeah, like, I think, I think chronic anxiety and chronic pain very much go hand in hand. I think it’s something like 77% of the people with chronic pain also have chronic anxiety. It’s just like, stuff isn’t predictable. And you can’t necessarily trust your own body and sometimes your own brain as we just said. So anxiety is its own very big problem, right? And I really only graze on it in the book. Sorry I’m just going to shut my office door one sec. I could hear the dogs running around but I didn’t want them to run in and start barking.

I wasn’t sure whether it was a dog or a child.

It was a dog. So a lot less control than with a child.

Oh, I don’t know about that.

It depends on the age of the child, I suppose. No anxiety is like it things that in of itself. Take a huge amount of time and effort to understand and manage. Yeah, it’s it’s really its own beast. And having to deal with that on top of pain. I think understandably, makes people very angry because you sort of think well, what else? Right? Yeah. And like the anxiety. The anger is really its own beast and requires its own management and its own. Like, like thoughtfulness and care, because getting really angry or being constantly angry actually exacerbates physical pain. Yeah, like physiologically, so it’s Yes, it’s not something that going to help you even if it is very understandable.

Yeah, yeah. Yeah, totally. Yeah, these negative emotions, it can kind of form a feedback loop can’t it?

Yes. Yeah. Which intuitively is kind of easy to understand. Right, because if you think about when you get angry you tense up. Yeah. And that’s that’s happening throughout your body and holding that tension is very unhealthy. Yeah.

Yeah. And the body being you know, the system being full of stress hormones all the time is very unhealthy.

It is. Yeah. Yeah, it’s, it’s one of those amazing things of like, even if you get a handle on the anxiety designed or even if you get a handle on the anger, there’s the pain and they will self reinforce. And it takes a lot of concerted efforts to keep level in terms of anger and anxiety, and like how you’re spending your resources and how you take care of yourself day to day. And as your pain changes, right, freedom and all those things out a new every time something different happens with your pain is a real pain. Sorry, for the pun!

Yeah, okay, shoulding – things you should do.

Again, it’s people’s expectations and your own expectations of yourself right like you said – you’re 24 and you’ve got back pain.

Yeah “I shouldn’t have back pain, not at this age.”

Exactly. That’s that gets in the way of a lot. Yeah. Because you stopped sort of thinking about what you can do or even what you want to do. I mean, this isn’t something that’s unique to people with chronic pain, people of all walks of life will should themselves like “I should better, I should be faster I should be married by now. I should be. I should have this.. I should. Yeah, it’s it’s it’s um it’s a very common but unhealthy way of looking at yourself. And no-one’s perfect right? There’s no there’s no like, I feel like a lot of people hold themselves to this standard of you should be perfect. You should do things a certain way that everyone else does them or if everyone else takes a certain medication and it works well it should work for you and why isn’t it working for me? And I think nobody is like the perfect patient. Nobody is the perfect person. Everyone is feeling their own shortfalls all the time.

Do you really think that i think i’m not sure maybe you’re right. Some people seem quite kind of self satisfied.

I mean, that’s true. I don’t know I think I’ve I’ve possibly slightly cocooned myself with the kind of people I surround myself with that that quite some there on the side of that of you know, striving and always thinking I can do better. There are definitely people who don’t do that. But in in many ways I feel I feel a little bit worse for them because the minute a health problem comes up, and you’re sort of pretty pleased with yourself and you know, think you’re able to cope, the emotion is going to get knocked out of you extremely quickly the minute you know, you get a health problem. Yeah, and then you’ve lost not just your health, but your sense of self.

Yeah.

Yeah, I think in some ways, the worriers have an advantage because you already worrying.

Yeah. Or, yeah, at least looking for, you know, not being certain that you know, the answer to everything and being open to new. New ideas. Yes.

Yeah. And, I mean, yeah, you can’t grow as a person. If you think you’re already perfect. So yeah, I don’t know. I think that’s a I’m sure that there are lots and lots of people who don’t should and sort of think, Oh, well, I’m pretty great. But I suspect it’s fewer than the most people would think. I think. more people are worriers then then we would want.

I think you might be right actually. Yeah. So put on that, kind of a show, for the outside world of being super confident.

Yeah. Which is, which is a really big should. Right? I should be confident I should. Yeah, I should. be brave. Yeah, and it’s OK to not be.

You say Feel free to be weird.

Yes. It’s, um, yeah. Which is something that I’m a phrase that sort of came from just years of me doing slightly odd things. My friends being like, seriously and my friends being like, “that’s just a bit weird”. And me being “well, okay, but you know, I can’t sit in this cinema unless I bring my own cushions sorry.”And just, you know, having to put myself like, obviously where it’s not going to massively impinge on another person. I’m not saying like everyone has carte blanche to be really selfish. Yeah, I’m just sort of meaning that it doesn’t

as long as you what you’re doing doesn’t harm anyone else. It doesn’t really matter what they think. Yeah,

exactly. Like not hurting anybody. Bye. Taking cushions into a cinema or sleeping with a bed wedge, or, you know, any of the frankly, millions of little things that you can do to help yourself on a day to day basis. And a lot of people don’t do that because they’re worried they’re going to get a funny look. Yeah, ot they’re worried that you know, someone’s going think “weirdo” or yeah You kind of have to let that go. Because there are going to be some people that do that like it. Some people aren’t great, but I think more people than you’d expect would just not care. Yeah, I think I think most of us are sort of assuming that we’re like, you know, we walk into a room and everyone’s going to notice what we’re doing, but most people aren’t looking. And just sort of realize that and be like, “OK I’m free to do what I like.”

I read a quote about this. Exactly. This recently, is something like, you know, when you’re young, like in your 20s, and what have you, you you worry about what people think about you. When you get older, like in your middle age, you stop worrying about what people think about you. Yeah, and when you get older still, you realize that no one was thinking about you in the first place.

Yeah, exactly. Right. I didn’t imagine like I think back to when I was like a teenager and in my early 20s, and I think, God, I wish I hadn’t cared as much what other people were doing or, or looking at or seeing in me, or, like I wish I just had the balls to just be like, “I’ll do what I like.” But I think I would have had so much of a better time. And instead worying about what everyone else is thinking and instead of worrying about, you know, doing you,

yeah, well, this is a youth thing very much, isn’t it? You know, there is sort of show their individuality by dressing the same as everyone else. Yeah,

like, you get very self-conscious

The have to belong to a tribe. Yeah, I think this is a very much part of being being young, isn’t it? Yeah. You have to identify with a tribe.

And like, I just remember, and it seems to be I think this is fairly universal, if you’re just a lot more self conscious when you’re younger.

Yeah, and yeah, definitely

It does take. I mean, for most people, it’s just time that that helps wear that away. But I also advocate practice, if you, you know, like when I was first starting to go to the gym fairly regularly and you know, this is me having never really done that before, I was really self conscious of like up in this exercise course and everyone’s going to notice that I, I can’t do half of the stuff they’re doing and I run out of breath and a bright red in the face. And you know, you get really

The only machine I’m really comfortable with the vending machine. Yeah.

And you thought you can get in your head about that. But a really quick way to fix that is to do that every day for you know, a week or two weeks and just realize very quickly that no one else cares. Like or even if they do care or notice it might be just like I had quite a lot of people being like, Well, you know, you look how I feel which is loaded comment, but like other people get really really good. Yeah, exactly. Yeah. Like other people not all Yeah, this is this is hard work or like just even being supportive even if it’s like, Hey, you know I’ve got a bottle of water at back if you if you need to have a drink, or

should I call an ambulance?

Yeah. Yeah, it’s it’s just you have to practice just being like “it doesn’t matter.” Yeah, like when you when you when stuff hurts and you’re trying to do the right things; I’m not sure why other people’s opinions should have any weight against your own comfort level and your own pain.

Yeah, that’s perfectly expressed right there. Yeah. So true.

Yeah, it’s hard though right. Like

it is. Yeah, yeah. We’re social animals.

Yes. Very much so. And that, you know, that herd mentality is like evolutionarily useful. Yeah. But yeah, but yeah, you have to be able to take care of yourself.

Yeah, sure. So consistency goals and giving up.

Yes. So yes, so, like we were talking about with anxiety like, in pain can be pretty, pretty inconsistent, it can be pretty unpredictable. And that’s a really hard thing to deal with. And I think there are a couple of different ways that people can sort of go when they start experiencing chronic pain and one of the ways is, like really trying to control Everything. I’m really trying to say like, Okay, look, I know doing x, y, and Zed hurts me, so I can’t ever do these and these type of things. Yeah, help. And I must do these every day and trying to achieve consistency in your health through controlling everything else. Yes. And that is a very understandable goal like consistency is is great. I think that’s what everyone would want for their health is is not to have any surprises because you know, you do not want to have surprising your healthcare. Not just not a happy combination. And so, yeah, consistency, like, you want it, you aim for it, you try and get it, but it might never be quite in your grasp. Yeah, and that’s one of the things that’s kind of hard to accept. You can certainly get better with practice of pain management. getting something like consistency or I think I think I scored it in the book like a reasonable range of consistencies. Not going to be exactly the same every day. But you have like, a good idea of what the high and the low could be. And, you know, you try and get somewhere in the middle every day. Yeah, that’s, that takes a lot of time and practice, and it requires cooperation from your body as well, right? Like, you’re not going to be in control of if you slip a desk. So it’s, I think it’s important to sort of know what you want, but be able to accept what reasonable Yeah, yeah. And that includes being able to say, okay, you know, what, I give up, I give up on this, I this particular task that I set myself, whilst perhaps something I wanted, or perhaps I thought at the time was reasonable, I might not be able to do it and that has to be okay. Because Just

giving up on something specific maybe on that day.

Yes. Like, giving up and like a general. Yeah. And I’m like, oh, who cares? What is what sort of way but yeah, um, yeah, I mean like it and it’s stupid the things that it can apply to it can be things like, like this morning I woke up and I really wasn’t feeling that great today. And I had through the week I had been like, well, Wednesday I’m going to clean your house. It’s a bit you know, bit filthy and I need to have a clean. Yeah, and it used to be back even though I woke up and didn’t feel great. I do it anyway. Just because, you know, I’ve set myself this task, you know, particularly big task, like just like, just do it and that’s fine. And I’d feel bad about myself. If I say okay, no, it doesn’t really matter if I put off till tomorrow, or I just I won’t do it until I’m feeling better or You know, it’s not it’s not even that dirty, you’ll be fine. And giving yourself to be like, you haven’t done anything wrong by making that choice and by saying, okay, taking care of myself today is more important than the cleaning. Yeah, like so it’s, I feel like giving up gets a bad rap when you say you can’t do something because of chronic pain, but it’s not really giving up. It’s more that you’re prioritizing taking care of yourself. Yeah. Yeah, but that’s hard. Right? Like, friends, especially like and family if you make plans, and then yeah, you have to counsel you have to say, look, I can’t do this anymore. That gets difficult on everybody. And that’s a sort of another time when you have to know in yourself like you might be given up an appointment for you know, a date or whatever. But if you’d gone you would have been fairly useless anyway. Yeah.

You wouldn’t enjoy it would you know? And which kind of defeats the objects a little bit

does and other people will know. Like, I don’t think there are that many people who are going to be really, really good at hiding their pain and being very pretending they’re very happy and jovial. Yeah, most people who know you are going to know that there’s something wrong. And then they feel they’ll feel guilty because they’ll feel like you only came out with an obligation. It just, you know, it starts going back and forth and it can get really messy. iain barker And some days you’re going to feel pretty good. Strength euphoria you called it. Amy Orr Yes. It’s that amazing feeling when you get a little bit of relief or reprieve in your background level of chronic pain. And you suddenly think “Oh I feel great! I can do anything.” And you start thinking “Well, I managed 2 hours at the gym yesterday and I felt great afterwards. I’m gettign stronger, let’s have more sessions at the gym. Let’s do a little bit more.” You can very easily fall out of your own good habits. Which is kind of ironic, becasue the only reason your feeling better is because you have good habits. And because you feel better, you stop doing them. iain barker Yes, I think this is very common, we’ve got short memories. Amy Orr Yes that reminds me of something I heard “If women could remember the pain of childbirth, no-one would have any siblings. You forget quickly, and it’s very understandable because you want to be well. You want to feel good and to think that that means something. It’s important not to fall into that trap, because otherwise you are going to be riding the peaks and the troughs instead of having a nice steady state. iain barker Yeah Amy Orr The peaks and troughs is OK if you don’t have any expectations of your own health, or family who are relying on you or you have no other ties whatsoever and you can just ride your own pain with no concern for anyone else. But the vast majority of us have families and work and responsivilities. And we want to be able to say “I can reasonably do some stuff.” Just letting yourself get caught up in “I feel stronger, I’ll push and push and push and push and then crash” It’s not going to help anything. It’s not going to help anyone else either.

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