Transcript

Supporting employees with chronic pain

24 March 2024
Transcript

Understand the impact of chronic pain and contemporary pain management strategies to support employees experiencing chronic pain and the role that workplaces play in employee wellbeing.

00:02
I did just wanna introduce myself forthose who are on the webinar who don't
00:06
know me. My name is Lauren Reynolds.I'm shared Value Manager at a I a.
00:10
And what that is,
00:10
is I look after our wellbeing ecosystemof all of our programs and partnerships,
00:14
and particularly some of our embracepartnerships that look at supporting our,
00:18
uh, brokers and employers and employees.
00:21
We're making sure that they can get theright information and right treatment to
00:24
support remaining healthy and well,
00:26
so we're able to support customerswhether they're well unwell or recovering.
00:31
I did wanna welcome all ofyou, um, to our webinar today.
00:34
I did want to firstly acknowledge thefact that I'm joining the webinar and
00:37
hosting webinar from the lands ofthe Gadigal people of the OR nation.
00:41
I wanna acknowledge thetraditional custodians on thevarious lands on which you
00:44
all work today,
00:45
and the Aboriginal and Torres StraitIslander peoples participating in this
00:48
webinar,
00:50
we are really excited to welcome youto an a i a embrace webinar around
00:54
supporting employees,experiencing chronic pain,
00:56
and to talk to the impactthat we see pain having on
01:01
our, our partners, the employersand their employees as well.
01:05
And we see this in ourclaims experience too.
01:08
More broadly though than just at a i,
01:10
a chronic pain affects about three anda half million Australians with just
01:15
under 70% of people living withchronic pain being of working age. Now,
01:19
the National Financial Burdenof Pain is estimated to be above
01:23
73 billion in 2018,
01:27
and it's projected to increaseto above 200 billion by 2050.
01:32
So quite sobering, uh,projections there. We at a,
01:37
i a,
01:37
see the impact of chronic pain for ourcustomers with it being the leading cause
01:40
of income protection claimsin both men and women,
01:43
and accounts for a significantamount more than any other claim.
01:47
So including it's 15% more prevalentthan what our second common
01:51
condition, um, causebeing, which is mental,
01:54
mental health or mental health conditions.So from an a I A claims perspective,
01:58
we see that chronic pain impactsthe younger demographic greater.
02:02
So the 20 to 40 years accounts to50% of male income protection claims
02:07
and 30% of for female.
02:09
Although we do see this number graduallyrise for women that we can likely
02:13
attribute to the change of estrogen andmenopause and perimenopause period of
02:17
time because we see those changes occurwith musculoskeletal conditions, um, as,
02:22
as women get older and and approachthat kind of middle age, um, bracket.
02:26
So chronic pain is the leadingcause for our TPD claims as well.
02:30
So it's really kind of no wonder whywe want talk to chronic pain today,
02:35
why we've partnered with Professor LauraMa Mosley and his organization Pain
02:38
Revolution to be able to provideeducation direct to employers and their
02:42
employees about what he's seeing withthe impact of chronic pain in Australia.
02:47
But what he and his teamhave been pioneering forsome time around pain science
02:50
and what role the workplace paysplays to support employee wellbeing.
02:55
At a I a,
02:56
we've been supporting our customers onclaim experiencing chronic pain with a
02:59
program derived from Professor LaurenMosley's Pain Education. And from this,
03:03
we have seen participants experience an85% improvement in their function in a
03:08
relatively short period of time.
03:10
We know that if we can continue tosupport Professor Mosley's education of
03:15
rehabilitation and medical practitioners,
03:18
we can be part of improving the lives ofso many and have a great impact on the
03:21
health outcomes of Australians.So at the end of the session,
03:25
if anyone would like to know more abouthow we support a i a Customers with
03:29
Chronic pain or any other questionsabout supports available for employees,
03:32
whether they're well unwell or recovering,
03:34
please do speak to your a i a relationshipmanager. But more importantly,
03:39
moving on to the star of the show.
03:41
We are honored to partner with ProfessorLaura Mosley and Pain Revolution to
03:45
provide this webinar today. I wantto introduce you to Professor Mosley.
03:50
So Lama is a Bradley DistinguishedProfessor at the University of South
03:53
Australia. He's a clinical andresearched physiotherapist,
03:57
professor of clinical neurosciences andfoundation chair in physiotherapy and
04:01
CEO of the not a nonprofitpain revolution in
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2020, LAMA was made an officerof the Order of Australia,
04:09
which is Australia's secondhighest civilian honor fordistinguished services to
04:13
the fields of pain and its management,education, science, communication,
04:17
and physiotherapy to humanity at large.So, Laura Ma, with no further ado,
04:21
I'll pass over to you if that's okay.
04:25
Thanks, Lauren. Oh, that's a bit odd.When you don't speak for a while,
04:28
you get funny little voice.Thanks so much for having me.
04:31
I'll just share myscreen here. Uh, Lauren,
04:36
let me know if that hasn't worked,but I I think it should be right.
04:41
Uh oh. It's just great to, to beable to do things like this. Like my,
04:45
my job is a research, I run apretty large research group here,
04:49
and as Lauren has said, we, we doa lot of, uh, outreach work, uh,
04:54
primarily in, in rural andregional areas, but, um,
04:58
we're getting more and more approachesfrom metropolitan areas to expand
05:03
our capacity buildingand public education, uh,
05:07
programs into the cities. So,um, we're starting to, I think,
05:11
to penetrate the whole ofthe great Southland. Uh,
05:15
I am, uh,
05:19
on this vast continentsitting on Ghana land.
05:23
So Ghana land runs, uh, Adelaidesort of in the middle of a long,
05:26
skinny section of land. Uh,
05:29
and I pay my respects tothe garner people, uh,
05:32
also to first Nationspeople everywhere. Uh,
05:35
I have a deep respect for the,the incredible connection to land,
05:40
uh, to water, to, to the rivers, tothe sea, and actually to the air.
05:45
And the, the relevance ofthis to someone studying how,
05:48
how the body works and why we havepain is really quite profound,
05:53
that we're understanding now that, thatour connection to the world around us,
05:58
not just the people, butuh, the, the, the earth and,
06:02
and the plants and is really quite aprofound biological connection that
06:07
has implications for health. Uh, so I,
06:10
I certainly feel like I'm on a steeplearning curve of learning from our First
06:14
Nations people, the, theoriginal researchers, uh,
06:18
and pay more respects to elderspast and present and emerging.
06:24
It's really important for me.I'm a, I'm a knowledge generator.
06:27
That's sort of one versionof my job. I'm a scientist,
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so we try to understand things, andwhen you're generating knowledge, uh,
06:35
your brain's always in, its in,in selling that knowledge to you.
06:39
In a situation like this, your brainis always asking what's in it for me?
06:43
And it's impossible, myunderstanding of how the brain works,
06:46
it's impossible to remove that.
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So what we do is put in place as manychecks and balances as we can to control
06:53
it, and we declare it so youknow what's in it for me. So, uh,
06:58
there's a few companies that I'vereceived support from including a i a, uh,
07:03
ipa, which I actually haven'tput up there. Um, is using a,
07:07
a reality virtual reality softwareprogram that I was, I helped, uh,
07:12
the company mate, that'sreality health. Uh,
07:15
and I get royalties from books on pain.
07:17
So I'm gonna secretly be trying to makeyou think you should buy one of my books
07:21
because then I'll get royalties. Sonow that you know what's in it for me,
07:26
I sometimes wonder whether there's anypoint doing what I do, because back pain,
07:31
supposedly the world's mostdisabling health condition
07:36
looks like it's beingcured. So this is just a,
07:39
a quick search on Google,uh, for back pain cure.
07:43
And you can see it's been curedmany times. Uh, in fact, uh, I do,
07:48
you know, I I do feel for the peoplewho are down in the, I think in the,
07:52
the bottom middle, there's aseven day back pain cure. Uh,
07:56
but up in the top right, Ithink there's a 10 minute cure.
07:59
So they've been usurped, unfortunately.Is that really what it's like?
08:04
Well, obviously I'm being facetious.
08:06
So these are the most recent dataon the global burden of disease on
08:10
humanity. So this is worldwide,and I've just put the,
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the Australia and New Zealand data, whichis clumped together at the end there.
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But as far as yearslive with disability and
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disability adjusted life years,
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low back pain is the mostburdensome problem we face.
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Second is major depressive disorder andthen neck pain and other musculoskeletal
08:34
disorders. So theseare disorders that the,
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the disabling feature is pain.
08:41
We now know that having chronicpain, so this is pain that's,
08:45
that's been around for normallymore than three months,
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but the way that we think about it in,
08:49
in our world is the pain thatis overprotective. So it's,
08:54
it you've got more painthan you need to be safe,
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that's associated with substantiallyincreased risk of high mortality
09:03
conditions, depression, suicide, stress,stroke, drug, alcohol dependence,
09:08
cancer, diabetes, metabolicdisease, obesity related diseases.
09:12
So it's not only aproblem in itself, it's,
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it's a significant risk factor,
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sometimes elevating three or four timesthe risk of these other conditions.
09:22
We think primarily, but notexclusively, just because it's,
09:27
you stop moving as much when you'rein pain because it hurts to do so.
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If you look at all, cause mortalityrisk having chronic pain is,
09:35
is up to 20% more risky, uh,
09:40
of an early death.
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So if we were to put all the unmet needof years lived with disability on one
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picture, which is whatthese people have done here,
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this is American data that'svery similar to Australian data.
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And then if we colored in the proportionof all of those conditions that
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represent the entiredisability burden, uh,
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we colored the ones wherepain is the problem in red,
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then we'd cover about 77% ofthe entire disability burden
10:09
on humanity, on Americans. Uh,
10:12
and our data are likely tobe quite similar to that.
10:17
So we also know from, from an economicperspective of treatment costs,
10:21
lost productivity. So workers'comp, uh, income protection, uh,
10:25
costs that chronic back pain plusneck pain is more expensive to us than
10:30
cancer plus diabetes. Uh,
10:33
it's the most common reason forearly retirement from the workforce.
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And those retirees have less than 20%of the savings of people who haven't
10:40
retired because of chronic pain.
10:44
It's more likely to affectwomen. So somewhere between, uh,
10:48
twice as much and maybe even abit more than twice as much, uh,
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of the prevalence iswomen as compared to men.
10:57
But I think more relevant here,and Lawrence touched on that,
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if we look at averageearnings over a lifetime,
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and this is just one of manygraphs, they're quite similar.
11:06
This divides it up into education levels,
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looking at earning capacity as aproportion of what you are earning as an
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18-year-old. This is the general curve.
11:15
So people are reaching their peak intheir, in their forties, somewhere there.
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And then we super impose on that theprevalence of disabling chronic pain
11:23
conditions. And you can seecompletely in consistent with,
11:27
completely consistentwith what Lauren said,
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is that the burden of chronic painis occurring in the most productive
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years of life in their productiveyears, not just for income,
11:37
but for societal contributionsfor parenting, uh,
11:42
for contributing more widelywithin your social and and
11:46
economic network. So it's, it'squite different from, for example,
11:50
ca cancer and diabetes,
11:52
where the bulk of that burdenis occurring later in life.
11:57
We've recognized this problem forquite a long time, 25, 30 years, uh,
12:01
and some aspects of theproblem have changed,
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but some haven't in really surprisingand possibly disturbing ways.
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So we talk about, in our field,
12:11
we talk about top down pressure tochange the way these conditions are
12:15
treated. Uh, and that pressure,uh, looks at collecting evidence,
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providing clinical guides for healthcareprofessionals and doctors to use to
12:25
guide their care inorder to change outcomes.
12:29
So we call this the clinicalguidelines care pathway,
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top-down pressure for change. When,
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when it comes to chronic pain,
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there's a really remarkable thing that'sbeen happening over the last 25 years.
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So around about 25 years,
12:45
these clinical guidelines camein all over the world saying,
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the evidence tells us decrease the,
12:52
the likelihood of someone getting a scanor having surgery because of chronic
12:56
pain.
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Increase our efforts to educatepeople and provide them with active,
13:03
like movement based,
13:04
activity based and self-managementskills and a recovery mindset.
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Uh, so what I mean bythat is that, uh, people,
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while they're after an injury, theymight have chronic pain, but they're,
13:17
they're in a process of gradualrecovery. So that's quite hard to get,
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but the clinical guidelines have beenmoving towards that over the last 25 years
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and started emphasizing educationand active self-management 25
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years ago. And if you had chronic pain,
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now I'm just gonna show you the likelihoodof receiving each of these things.
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So before I do that,
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just take a moment to think abouthow these curves should look.
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So if we have said we want todecrease scans and surgery,
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the top two should slowly,
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gradually go down and we want to increaseeducation, active self-management,
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that curve should run up.
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And this is what's happened tothose curves over that time. So the,
14:00
the top down pressureis not seeming to work.
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So clinical guidelines arecertainly not solving the problem of
14:08
practice. Maybe they're reducinghow steep that that curve is.
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So why is that? Well,
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our research tells us that thethings that are becoming more common,
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even though the evidence tells usthey're not the best things to do,
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makes sense to consumers, to workers,
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to healthcare professionalsand consumers want them.
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So they turn up to their doctorsaying, I need a scan. Uh,
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I'd like to see a specialist. I needsomething that will take this pain away.
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The treatments down the bottom thatwe've known for some time are the best
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treatments we have. They don't makesense to consumers at the moment and,
14:43
and consumers don't want them.
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And healthcare professionals arefaced with a well-meaning healthcare
14:49
professional faced.
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A patient who doesn't want this treatmentis in a really tricky situation.
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We already have a goodsolution to this problem.
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The best journals in theworld have recognized this.
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So in the British Medical Journal,uh, among many papers, uh,
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this definitive analysis of allthe available evidence concludes
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for chronic pain, pain educationgives the most sustainable benefits.
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Pain education gives the mostsustainable benefits in the Lancet.
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Tremendous opportunity exists toimprove outcomes and reduce costs by
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implementing known and bestpractice recommendations,
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education and graded activity.
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Our research tells us there'sthree barriers to this,
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and this is where you guys are allright on the coalface with this.
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And those barriers are that a lot ofhealthcare professionals lack the skills,
15:42
confidence, and support around themto deliver modern pain education.
15:47
It's the best treatment we have. Theylack the skills, confidence, and support.
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And patients, workers, they don't expectthis treatment when they're in pain.
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They think it means that their pain'snot real or is not being taken seriously.
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So it can be quite invalidating whenyou turn up with a sore back and your
16:05
clinician wants, you know, suggest thebest treatment for you is education.
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And it's very easy to think, are yousaying this is all in my head? And we get,
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I'll just see if I'll move my camera.
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So this posture here from the perspectiveof a pain clinician like me is
16:20
called the fuck off posture. Andthat's the posture we get. Uh,
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often when someone comes in with a soreknee, for example, or a sore shoulder,
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and we say something like,we never say this, but if we,
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if they hear something like, you know,
16:33
the best treatment for this iseducation and active self-management,
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then we get that posture. Thethird factor that I think is,
16:41
is making life pretty hard forresearch and clinical groups like ours,
16:45
is that government and philanthropicsupport to deliver the best care is
16:50
almost absent.
16:51
It's less than 1% of that dedicatedto providing care for people who are
16:55
depressed. The burden issimilar, uh, as you see,
16:59
the economic burden isgreater with chronic pain, uh,
17:03
but the government andphilanthropic support is tiny.
17:08
So what do we do? Whatdo you do about it? Well,
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the first thing and the most challengingthing is to rethink how pain works.
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And this is really, really tough to do.
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This is how most of us think pain works,
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and this is how the whole fieldused to think pain worked,
17:25
that we have pain receptors in our bodyand they send a pain message to your
17:29
brain and your brain tells you, oh,you've got pain for, in this case,
17:33
in your toe. So then of course, wefocused treatment on the painful toe and,
17:38
and we did everythingwe could to fix the toe,
17:41
and we even removed the toe ifwe had to. And lo and behold,
17:44
the toe still hurts even whenit's gone. Just think through.
17:50
That's just
17:52
clear evidence that if the toe stillhurts, when the toe is no longer there,
17:57
the problem was no longer in the toe.
18:00
What do we think now abouthow pain works? Well,
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the point of the next image is notfor you to remember how it works,
18:06
but for you to be struckby how, how complex it is.
18:09
So this is a drawing thatI did to capture only the
18:14
things that have been shown in very highquality scientific studies to modify
18:19
pain, to influence pain. Now,
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you can still see on there down thebottom there's this square that says
18:25
millions of sensors. So that's,
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we still have millions of sensors allover the body that tell us what's going
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on.
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But we have a whole lot of other thingsthat we absolutely know influence,
18:37
pain and influence the likelihoodof pain getting better or not.
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We've done a lot of workover the last 10 years, uh,
18:47
with people who haverecovered from chronic pain.
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So we've been doing educationas Lauren said, for 25 years.
18:56
Uh, and there's a,
18:57
there's 75 clinical trials thatshow very clearly that it is a
19:02
good thing to do. Now I dothat, I say good, because the,
19:07
the evidence suggestsit's not very good, right?
19:10
This is what I would call old schooleducation. So these data were emerging 10,
19:15
10 years ago to show, yeah,it's good what you're doing,
19:19
but it could be better. So we respondedto that by going to a whole lot,
19:24
hundreds of people who had recoveredfrom chronic pain. And we asked them,
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why do you think you recovered?
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What did you learn that enabledyou and empowered you to
19:34
take on a recovery journey?
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And that all of that data has beensynthesized into what we call the four
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essential pain facts.
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And if you want to help your workersprevent and overcome persistent pain,
19:48
I suggest you put these under post-itnotes around your desk and you talk about
19:52
them over lunch because they mightseem counterintuitive at first,
19:57
but they actually makea whole lot of sense.
19:58
And the first is that painprotects us and promotes healing.
20:02
And you nearly all of our experiencesof pain are protective. Uh,
20:07
and you can have one now ifyou just squeeze your ear lobe,
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no one will know if you're doing thisright, but you know that I'm doing it.
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Squeeze your ear lobe untilyou have pain and you let go.
20:16
That pain was part of the process thatstopped you from becoming injured.
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Most of the time we have pain, wehave it before we injure tissue.
20:24
So in that way, pain protectsus and promotes healing.
20:27
But it also means that any credibleevidence that suggests that tissue is in a
20:32
greater danger willchange pain. For example,
20:36
this experiment that we did long timeago now where we got a a whole lot of
20:41
supposedly normal volunteers. Now these,
20:44
these are people who volunteerfor pain experiments,
20:47
so they're probably notentirely normal people, right?
20:51
But let's just presume they were,
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they volunteer for a pain experiment andwe put a very cold thermo on the back
20:57
of their hand under a wholerange of different conditions.
21:01
All of the trials they had wereassociated with either a red light,
21:07
which has meaning to it and providesthat person with a cue to say,
21:12
this may be very hot, or it certainlywill be very dangerous, or a blue light,
21:17
which does not give that information.
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And then we average thepain they experienced whenexactly the same stimulus was
21:24
associated with a red light.
21:27
And we compared that to when exactlythe same stimulus was associated with a
21:31
blue light. And this is what happened.So each line is an individual,
21:36
and you can say that on average, ifyou have this very cold stimulus,
21:41
but you see a red visual cue, whichmeans something about protection,
21:45
you have more pain than ifyou saw the blue light. Now,
21:48
there's a couple of people in there.
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You'll see the person atthe very bottom of the,
21:52
the stack of points overthe red queue who has a,
21:56
a horizontal line.
21:57
So the queues made no difference tothat person from a neuroscientific
22:02
perspective, we call that person an idiot.
22:07
And we call, well, we don't really,obviously we don't call 'em that,
22:09
but they're not pickingup on the visual cue.
22:12
That's very important for protection.
22:14
It's not very important forchange in temperature in the skin.
22:18
It's very important for protection.
22:20
And these sort of findingsremind us that pain protects us.
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It doesn't give us a readout or amarker of the state of the tissues.
22:32
What about this experiment?So this is an experiment, uh,
22:35
done in Oxford when I was over there andwe had laser stimuli delivered to the
22:40
sole of the foot ofhealthy normal volunteers.
22:44
But we randomly allocated thosetwo locations on the foot, uh,
22:48
with different instructions. So forthe location at the top, for example,
22:53
we would say to the participant, look,your skin's slightly thinner there,
22:58
this stimulus is probablysafe, blah, blah, blah.
23:02
Or the other point we would say,this stimulus is completely safe.
23:07
So the difference in these twoconditions is the word probably.
23:11
That's it, it's the only difference.Everything else was exactly the same.
23:16
There's a really busyaddition to the slide,
23:18
but I just want you to have a look atthe figure down the bottom, the, the,
23:21
the columns. So when people are told, uh,
23:24
receive a painful stimulus at asite they think is probably safe,
23:28
it hurts more than ifthey're told it is safe.
23:32
The top image just shows that we showed,
23:34
we found brain imaging changesthat were consistent with that.
23:38
So that tells us no one'slying about what they felt.
23:43
So pain protects us and promotes,but how does pain promote healing?
23:48
Well,
23:48
anyone who's injured their ankle willknow that when they get out of bed the
23:52
next day, it reallyhurts. It really hurts.
23:56
And that's because ofinflammation after an injury.
23:59
So when there is a body partthat is injured or inflamed,
24:02
the the safety buffer offeredby pain rapidly expands.
24:07
So in the top image here,
24:09
we have a mountain that one might climband to get to the top of the climb,
24:13
it's a superhuman effort, but youmight break tissues on the way.
24:16
That's the tissue tolerance.You normally don't,
24:20
you hardly ever break tissues.That's because we have pain.
24:23
Pain protects us from breaking thosetissues through a safety buffer.
24:27
But when you have inflammation or injury,
24:30
that safety buffer rapidly expands.
24:33
And that's because of an effect inthe tissues that, that are in danger.
24:38
So that you just put a little bit ofweight on that ankle the next morning and
24:42
your pain sends you through theroof, the ankle's completely safe.
24:46
It just feels like it's not.
24:48
And it's that pain that is stopping youfrom putting any mechanical load through
24:52
tissues that have toheal. So pain protects us,
24:56
and this rapid expansion in thesafety buffer promotes healing.
25:02
However,
25:03
when pain persists beyond the needfor the tissues to be protected
25:08
like that, it now over protectsus and prevents recovery.
25:13
So this is the essential, thethe second essential pain fact.
25:17
And it's very relevant to, tothose images. So this is, uh,
25:21
what happens when chronic painoccurs, the safety buffer increases.
25:26
And you might recognize this asbeing exactly the same as this.
25:31
So it feels like you've still gotan injury or you're really inflamed.
25:34
It feels the same. In fact, ourresearch tells us that pain,
25:39
chronic pain sensitivity feelsworse than acute pain sensitivity.
25:44
So they might feel the same. And thismakes us think the same way about them,
25:49
but their causes are totallydifferent. In chronic pain,
25:52
pain system hypersensitivity is a shiftin how the central nervous system,
25:57
the brain and the immune systemare working. And there's that,
26:00
there's very complex changes that happen,
26:03
but the result is that you don'tneed much of a cue to tell you your
26:08
body party is in danger to cause pain.
26:12
And we call this painsystem hypersensitivity.
26:16
Many factors influence pain,
26:18
and this becomes more andmore obvious as pain persists.
26:23
So if you look at this alittle bit more closely,
26:26
you can start to identify things thatmake that might make sense to you.
26:31
So if you look right down the bottom,what you eat and drink affects pain.
26:36
And it does that through the impactof sugar on inflammatory systems.
26:41
It does it through the impactof metabolic processes.
26:45
And there are very good empiricaldata that when you have pain system
26:49
hypersensitivity,
26:50
some people have very clear effectsof what they eat on, for example,
26:55
their back pain or their knee pain, ortheir shoulder pain or their headaches.
26:59
Some people have very,very small influences.
27:03
But when we think about treating people,
27:05
we think about what are all theinfluences that we can manage
27:10
here to reduce pain and what are all thethings that might be increasing pain?
27:15
If you look on the top right there,the surrounds that you are in,
27:19
who you are with, where you are,
27:22
what's happening in your wider environmenthave all been shown to influence
27:25
pain, all of a sudden as an employer,
27:28
the workplace becomes very importantbecause if there are threatening cues
27:32
around the workplace, thenthat should make pain worse.
27:36
That should increase protection. Andit just, it doesn't just increase pain,
27:41
it increases inflammation, itchanges the way people move,
27:44
it changes their blood pressure.All of these wider, wider things.
27:49
You might also be able to see some,
27:51
some blue sort of generalhealth related things there.
27:56
You might see at the topleft memories, experiences,
27:59
past experiences of injuryand recovery in brown.
28:03
Your knowledge and your beliefsare very potent influences of
28:07
pain.
28:09
We don't try and get people to understandthat whole complex picture there.
28:14
We try and get people to understand theirinternal protector meter and we think,
28:19
okay,
28:19
we know that things in your parentenvironment can tell you what you are in
28:24
danger.
28:24
And we call those things dimsdanger in me and some things in
28:29
your environment can tellyou that you are safe.
28:31
And we call those things sims and wecan apply the same process around your
28:35
beliefs.
28:36
The belief that your bossis a dick is gonna be a dim
28:41
The belief that your your partner ishas got your very best interest at
28:46
heart.
28:47
That will be a sim behaviors likelying in front of a television and
28:51
relying on medicationsto reduce pain is a dim.
28:57
Learning how to use movement tomodulate your pain is a sim past
29:01
experiences. You might havehad a great experience at work.
29:04
You might have had aminor injury at work, uh,
29:06
it was validated and youwere collaborative withyour employer to get back
29:11
to different duties. Greatexperience. That's a sim.
29:15
And all the sims are taking these slidersdown and all the dims are taking the
29:20
sliders up. And that's what determineswhere your protector meter is.
29:24
So, uh, we want that protector meterto get down into the no pain zone.
29:29
Takes a lot of time forpeople to understand why wetreat chronic pain in this
29:33
way and then how we do it.
29:37
But the power is in the fourthessential pain fact that,
29:40
that we now know there are many ways toreduce pain and gradually recover from
29:44
chronic pain. And from ascientific perspective,
29:47
we could say there are many ways toretrain the pain system to be less
29:52
protective again over time. Butthe language we use with consumers,
29:56
with workers is that there are many waysto reduce pain and gradually recover.
30:00
And like everything else,the more you practice it,
30:02
the better those systemsbecome at reducing pain.
30:07
Does it work? Well, we'vegot real world data here.
30:09
So these are data from 1500 or so,1400 or so patients with chronic pain,
30:15
average duration of six years,
30:17
average pain over the last two weeksof about five. All kinds of, uh,
30:21
chronic pain diagnoses. There,
30:24
there are more back pain patientsin here than any other group,
30:27
but there's a lot of knee pain,headache, migraine, fibromyalgia,
30:31
endometriosis, complexregional pain syndrome.
30:36
And what I'm showing you here is theaverage pain over the last two weeks when
30:40
they first turned up for careand then a month later when they
30:45
had really been immersed inan education approach to pain.
30:50
And you can see the red dots andthe blue dots. Now for the moment,
30:54
I will just consider them the same.
30:57
And what you can see hereis in that first month,
30:59
there's no clear drop in painin the first month. But what,
31:04
what we've done to group these into blueand red is that the people who are in
31:08
red are over that firstmonth or up to six weeks.
31:11
They were able to changetheir understanding of pain.
31:14
So the education offerings byhealthcare professionals were effective.
31:18
They were good, they weregood educationalists.
31:21
And those people changedtheir understanding.
31:23
They learned those fouressential pain facts.
31:26
They believed them and they started tothink about how they could apply them.
31:30
The people in red did not learnthem, they didn't believe them,
31:34
and they weren't able to apply them.
31:35
And then we followedthose people for a year.
31:40
And hopefully you can see here thatthose people who reconceptualize how pain
31:44
works,
31:45
understood and applied the four essentialpain facts a year later were very
31:50
much better. This isan outstanding result,
31:54
but the other group didn't change atall. This is a very unsatisfying group.
31:58
Now, now you've probably encounteredpeople in both of these groups,
32:02
but hopefully you can see why wereally want to focus on people
32:07
understanding the journey infront of them and then taking it,
32:10
not just trying to force them towardsa particular journey because it doesn't
32:14
seem to work. These data,
32:17
this paper was the most cited paper inthe leading pain journal of the year that
32:21
it was published most downdownloaded because it,
32:24
it shows very importantthings. One is that if we,
32:28
if we are good pain educators,
32:32
people do way better. And the other is,
32:35
we are only getting this resultin half the people. We see this,
32:38
this is back when the data werepublished. Our results are way better now,
32:42
but we need to focus onbecoming better pain educators.
32:46
So what role can employershave in preventing chronicpain and supporting those
32:49
workers challenged by it? Well, youcan just think about a protected meter.
32:53
Is the workplace psychosociallysafe and physically safe?
32:58
Are the beliefs around injury treatment?
33:01
What to do about treatmentand recovery? Are,
33:03
are they scientificallybased beliefs or are they
33:07
leftovers from when we didn'tunderstand things very well?
33:11
Or are they influenced by acultural approach, for example,
33:14
to put up with it and,
33:16
and deny there's something wrong ormore to the point immediately stop what
33:21
you're doing, uh, and get someoneto go and fix that problem for you.
33:24
Both of those thingshave now been disproved.
33:29
We should be promoting healthylifestyles, sleep, food, drink, uh,
33:32
validating healthy behaviors. Uh,
33:37
I can't see that one 'cause it's outsidevalidate. Oh, that's really important.
33:41
We've gotta validate theexperience that people have.
33:43
And that doesn't mean youvalidate the injury they have.
33:45
It means you validate the experience.Uh, I can see this as brutal for you.
33:50
I can, I can see this. You'rein a world of pain here.
33:53
Let's start to problem solve.
33:55
How we can improve the experiencethat you're having at the moment.
34:02
Encourage active coping skills.
34:04
So coping skills that usetechniques like meditation,
34:09
relaxation, gentlemovement, imagine movement.
34:12
There are a whole lot of active copingskills that we know can reduce pain.
34:19
Encourage people to report things earlyand reassure them about the incredible
34:23
capacity of the human bodyand brain to recover and to
34:28
become even strongerthan it was beforehand.
34:32
And promote in this sensea recovery mindset, uh,
34:35
which is a way of thinkingabout recovery, uh,
34:38
as a long-term journeyrather than thinking abouta treatment that you want to
34:42
have done to you to fixthis problem overnight.
34:50
So these fourth Australian Atlas ofhealthcare variation, this maps all the,
34:54
uh, all the data we can obtain that,
34:56
that the government canobtain about healthcare.
35:00
And it concludes there's great disparityacross different areas of Australia in
35:03
different kinds of things. It'snot quite as bad as California.
35:08
In California.
35:09
The second biggest prediction predictorof whether or not you'll have a knee
35:14
replacement. So the biggestpredictor is having knee pain.
35:18
The second biggest predictor is howclose you live to an orthopedic surgeon's
35:22
clinic. Now, we're not quite as badas that here, but that's California.
35:27
But we can see these clear patternsemerging that towns very close to each
35:31
other.
35:32
One will have a very high rate of opioidprescriptions and one will have a very
35:36
low rate of opioid prescriptions.
35:39
The Atlas of Healthcare variationmakes its clear urgent priority,
35:43
and that is that consumer, thegeneral pub consumers of healthcare,
35:47
the general public and cliniciansneed to be educated as an urgent
35:51
priority. So consumer, general,
35:53
public and clinician educationis an urgent priority,
35:58
and this is what pain revolution'sdoing. So Lauren gave,
36:01
gave me the green light to tell you alittle bit more about pain revolution.
36:05
We are thrilled that we've been supportedby A-I-A-A-I-A is our main supporter
36:10
and has been for five yearsin the programs that we areoffering and the changes
36:14
that we are making to ruraland regional communities.
36:18
So if you wanna learn about Painrevolution, this is our link,
36:20
but I'll tell you a little bit inthe couple of minutes I've got left.
36:24
We target,
36:26
we specifically target the two biggestbarriers to whether or not someone will
36:30
get good care. The first barrier is thishealth professional skills, confidence,
36:35
and support. So we, we,
36:37
our programs provide healthprofessionals with skills, confidence,
36:42
and local support.
36:44
And the next thing we do is wetarget consumer expectations of care.
36:48
So we go direct to public and we dothose things through two pathways.
36:55
First Pathway is through this localpain educator program. So with a's help,
36:59
we run every year a painrevolution, rural outreach tour,
37:02
and we raise as much money as we canto provide scholarships to healthcare
37:07
professionals to becomeconfident, highly skilled,
37:11
knowledgeable pain educators.
37:14
And then we support them to establish alearning network in their community. So,
37:19
uh, we give them strategies of approachingother healthcare professionals and
37:22
doctors forming networks andteaching them what they've
37:27
already learned.
37:29
And then together with the Rural OutreachTour and the Local Pain Collective,
37:34
we target the generalpublic in that community.
37:36
So it's a direct to publicmessaging. We put on seminars, uh,
37:41
we do events for healthcare professionals.
37:43
We have a brain bust that stops inschools and on the Village Green,
37:48
uh, directly facing communi communityagencies. We work alongside,
37:53
uh,
37:54
we've now partnered with over a hundredcommunity agencies to get messages to
37:58
the general public.
38:01
The most exciting developmentin our world, however,
38:04
has been a top secret.
38:07
The government hasn'treleased the embargo on this.
38:09
So I I'm not actually meant to betelling you about this, so, you know,
38:12
don't put it on a public websiteor anything. Uh, but we've got a,
38:17
a decent grant to trial,
38:20
a co-design public messaging campaignin a particular area of Australia,
38:24
which we'll have to remaina secret for the moment. Uh,
38:27
but there we are coupling our programs,pain Revolutions programs with, uh,
38:32
getting alongside communityand designing a strategy of
38:37
public messaging, radio, television,
38:40
social media events, aged care facilities,
38:44
whatever the community tells usis the best way to reach it. Uh,
38:48
and that public messaging campaign willbe focused on those four essential pain
38:52
facts. And, and the fifth, uh, in my,
38:56
my view essential fact iswhat we call bio plasticity,
39:00
which means the ability to changeand the ability to train your
39:05
system to become better over time.
39:08
So here's just an example of how painrevolution would go about what it's doing.
39:13
So this is, these are pictures fromthe Atlas of Healthcare variation.
39:16
And you can see as far as kneereplacements are concerned,
39:20
there's a very dark patch in WesternVictoria and reasonably dark in
39:25
southeastern South Australia. Theyellowy patches is about average.
39:30
And then there's another, uh,that are usually around the,
39:33
the metropolitan cities,uh, that is ideal, uh,
39:37
for the number of knee replacements.You'll also see that for polypharmacy,
39:41
so people on multiple Medicamedications and being 75 years old or
39:46
more, uh, we've got this, again,
39:48
a little area of dark bluedown in this part of Australia.
39:52
And then when we look at theopioid prescription rate,
39:55
I've just highlighted the two linesthat represent the two areas. I,
40:00
uh, either side of that border there.
40:03
So pain revolution looks atthese data and thinks, okay,
40:06
we've got a problem here.
40:08
We've got a problem of more people aregetting knee replacements than need to
40:11
get them. More olderpeople are on poly drugs,
40:15
more people are getting opioidprescriptions. And we could add to this,
40:18
more people are getting spinal cordstimulators than they need to, uh,
40:22
spinal operations offwork, missing school.
40:26
So we go to those communities and wesay, we think you've got a problem.
40:30
Would you like to work together to buildhealthcare capacity and educate the
40:35
public? What happens when we do? Well,
40:37
this is just one example of a lighttouch education campaign in the
40:42
veterans community across Australia.
40:44
So in the first September, 2017,
40:48
they launched a program that if anyveteran got prescribed an opioid,
40:53
they would get a brief in, uh,
40:55
education intervention and sowould their general practitioner.
40:59
And then they followed what happenedover, it was a six month intervention.
41:03
They followed what happenedover the next, uh, two years.
41:06
And the orange dots are what themodeling predict predicted would be the
41:11
opioid prescription rate per 1000.
41:14
And the blue line iswhat actually happened.
41:17
And that equates to 25,000 patientmonths of opioid use being avoided
41:22
in the following two years froma light touch, but very, uh,
41:26
very directed intervention.
41:29
So we are very excited about what wemight be able to achieve if we can get to
41:33
the whole of community.
41:35
So we are currently training localhealthcare professionals around the place,
41:38
including this area in Southeast, uh,south Australia and West Victoria.
41:43
West Victoria. We are bringing thenow world famous pain revolution,
41:48
rural outreach to it's being replicatedin the UK and in two states in the
41:52
us, uh, because it'scool. It's just so cool.
41:57
Uh,
41:58
and we are also gonnaco-design a community-widepublic messaging campaign that
42:02
we will deliver over the next fewyears and then evaluate it all.
42:08
We desperately need partners forthese things. Uh, we need sponsors.
42:13
So, uh, anyone who, who wouldlike to reduce chronic pain,
42:18
uh, and would like to join us, a i a,our main partner, several universities,
42:23
uh, and the Commonwealth government in,
42:26
in taking a whole of communityapproach to just shift the needle a
42:30
bit.
42:31
We only have to reduce some of theseunnecessary treatments by 1% to return on
42:35
the investment. Many timesover, as Lauren said,
42:38
this is a $70 billion a year problem. Uh,
42:41
so any,
42:43
any nudge we can have across the communityso that that next patient turns up to
42:47
their GP and says, look,I've got back pain.
42:51
I've had it for three or four monthsnow. I don't need another scan,
42:55
but can you direct me in the,
42:57
in the right directionfor some good education,
43:01
for some good understandingof how I can slowly recover.
43:06
They're the sort of requestswe wanna see from patients,
43:10
and then we wanna see gps who are ableto say and answer that question. Yes,
43:14
I can. And that's what we're trying to do.
43:17
This is an event where we've gotgoing in the, uh, in Mount Gambia.
43:20
So if you've got any contacts in MountGambia, so excited about this event,
43:24
a fundraiser for pain revolution,safeguarding people produce and producers,
43:29
uh, we're gonna have some top-notchspeakers and it's gonna be fun.
43:33
That's in September. Uh,
43:35
if you know anyone who'd like to sendsomeone to that for a great dinner that
43:39
they pay a little bit much for sothat we take home some cash, I'd love,
43:42
love your support. That'sthe link to Pain Revolution.
43:45
And if you're interested in this stuff,
43:47
check out the animationtame the beast.org.
43:51
And that is that from me.
43:54
Thanks Lauren.
43:55
I'm just gonna jump in at this pointand just kind of highlight that. Um,
43:58
what I said at the top of, um, thesession today as well is that a,
44:02
i a have been supporting our customerson claim who are experiencing chronic
44:06
pain with a program derived from allof your kind of pain education and, um,
44:11
pain science approach. Sofrom this, we've seen, uh,
44:15
over 2000 participants go through ourpain coach program when they're on claim
44:18
with us, leads to an 85%improvement in their function, um,
44:22
in quite a short period of time.
44:24
And so we know that if we can continueto kind of support this pain education
44:27
piece, hopefully we can movethe dial on chronic pain.
44:30
But does link to a questionthat is in the chat to me,
44:33
and please if you have anyquestions, pop them in the chat.
44:35
You can either put them through tomyself or pop 'em through to everybody.
44:38
But it was linking about what can,
44:40
so you mentioned about if yourpeople leader or your manager,
44:44
you perceive them to not be supersupportive, that can become a,
44:48
a dim or a danger. Whatcan people, leaders do?
44:50
What can the workplace do to actuallysupport an individual who's experiencing
44:54
early stages of pain?
44:57
Yeah, it's a great question. I thinkthat, um, the, the single biggest,
45:02
uh, impact we can have, uh, really once,
45:07
once the emergency's over. So ifsomeone has a, has an injury like an,
45:12
an event, then there's clearacute rehabilitation required.
45:17
Once we're over that zone,
45:18
the single biggest thing we can do isprovide an understanding of the problem
45:22
that is reassuring that itwill have a, a resolution, uh,
45:27
if you keep nudging the system backtowards recovery. So practically,
45:32
how do we do that? We,
45:33
we make sure this person hasaccess to good quality material.
45:38
And there are placeslike pain revolution, uh,
45:40
places like a i a whocan promote that. Uh,
45:45
and if possible we have healthcareproviders available who understand. And,
45:50
and that's a challenge thatwe are facing everywhere,
45:52
but we are working hard to createmore and more of those, uh,
45:56
healthcare providers. For example,
45:58
pain Revolution now has trained80 healthcare providers,
46:02
many of whom offer telehealth.
46:04
It's a private thingbetween them and, and, uh,
46:09
a client. It's not a pain revolutionthing, but we do list them on our website.
46:14
Um,
46:14
so these are people who understand andwho have the skills to help that injured
46:18
worker rethink what happens from now.
46:23
And it's, it's remarkablehow many places in the,
46:27
in the recovery journey, people canget derailed towards chronic pain.
46:31
And I might,
46:33
can I just tell a story about my ownexperience not that long ago around this?
46:38
So, uh, you know, you have to rememberthat I've spent the last 25 years,
46:43
30 years researching chronic pain andhow the brain does things and all this
46:46
stuff. Like I have a deep, areasonably deep understanding of this.
46:50
And I was helping my daughter move houseand I lent into the back of our VW golf
46:55
station wagon, lifted up a box, it wasa bit heavier than I expected, and bang,
47:00
I had back pain and itwas sudden and it was
47:05
painful. Uh, and I slowlyleaned out and, you know,
47:10
it was reasonably sore, but I keptdoing what I was doing that day.
47:12
Just moved a bit more carefully.
47:14
I woke up the next day in aworld of pain and because of
47:19
my understanding of thesethings, it never occurred,
47:21
never occurred to me that Icould have done any major damage.
47:24
Just thinking about themechanical loads, it makes sense.
47:28
I haven't done that a while.My system's really ramped up.
47:31
There's a bit of inflammation. So thisprotective buffer has grown really big.
47:36
Uh,
47:36
we've published a paper only weeks beforeon what is the natural history of back
47:41
pain. You know, this ishow well I understand it.
47:43
I'm not trying to blow my trumpet here,
47:45
I'm trying to contrast this withthe vast majority of people,
47:49
five or six days later. It's slowly,
47:51
slowly improving as I would expect fiveor six days later, it starts to spread.
47:57
The pain spreads as a someonewho's informed about neuro immune
48:02
function that I got so excitedabout that spread because I thought,
48:06
here's the system. This ispart of the protective system.
48:10
It's protecting me thatit's spreading. However,
48:14
I asked a few people around me, uh,including complete strangers actually.
48:18
I said, I've had backpain for five or six days,
48:20
and the pain starting to spread,what do you think could be going on?
48:24
And the answers I got included,
48:25
maybe you've damaged somethingmore than you thought.
48:28
It's probably bleeding in there.It's clearly getting swollen inside.
48:32
So these are all the things thatare intuitively sensible and,
48:36
and they're big dims, like they'rebig danger messages. So when you're,
48:40
you know, when you're,uh, in your employees, uh,
48:45
if I've understood that that questionappropriately are really worried about a
48:49
development in their symptoms,uh, it it can help to say,
48:54
did you do way more than normal yesterday?
48:59
They can help and, and see what they'resaying. And if they say yes, well, well,
49:02
that might be a reason for, itmight've overdone things a little bit.
49:05
But normally they'll say no.Say, oh, that's, that's good.
49:08
So it'd be interesting to know why thesystem's protecting you a bit more.
49:13
Let's, let's find someone who can tell,
49:14
help you understand that and give you astrategy to get through the next little
49:18
while. Which might be alittle bit tough. Is that,
49:23
do you think I've spokento that question, Lauren?
49:24
I think you have,
49:25
but you're also probably the only personthat gets excited by the spread of
49:28
pain. Yeah, I knowthemselves. So yeah, <laugh>,
49:32
I don't wanna say that's a bit strange,but that is a bit strange <laugh>.
49:35
But how would that thentranslate to an individual,
49:39
a colleague at work who'sinjured themselves on a bikeon the weekend is kind of
49:44
pain science that we apply,
49:46
particularly when in life insuranceand compensable claims we're, we're,
49:49
we're applying it laterdown the track with the,
49:53
the nature of income protectionand there's a 60 or 90day wait period unless we
49:57
were able to get to them in that waitingperiod time or before they lodge the
50:00
claim. Mm-Hmm, <affirmative>,
50:01
it's usually less about the injury atthat point and more about the chronic pain
50:05
and the pain system reaction.
50:08
Do those kind of principles with chronicpain also apply for someone who also
50:12
went cycling yesterday and is sore?
50:14
Kind of probably leads to that fromthat story you just said. Yeah.
50:17
Great. So someone who went cyclingyesterday and is a bit sore today, uh,
50:21
but didn't have an accident. Um, the,I mean it all, it all applies, right?
50:25
This is human biology.
50:27
This is not weirdness that onlyapplies to chronic pain people,
50:31
it's human biology. But let's say, sofor example, I I'm another example here.
50:35
So the last three daysI was riding my bike,
50:38
I did a hundred ks a day for three days,
50:40
which I haven't done since lastSeptember. And today my legs are sore,
50:45
right? So, uh, I I celebrate that.
50:48
I know that I'm adapting right now I'mthe, the process of becoming stronger is,
50:53
is happening. How do weapply the principles of,
50:56
of the modern principles of pain scienceto that? Well, we can look at, well,
50:59
why am I sore? Because I've got someinflammation. Why else might I be sore?
51:03
Because my,
51:05
my brain has had these experiences beforeand thinks I need to keep you a bit
51:09
safer for another few days, right?
51:11
So we can apply all this sortof truly protected meter model
51:16
to any kind of pain. But let's imaginethe person had an accident on their bike.
51:21
The most important thing isto make sure you're safe.
51:25
Pain does that makes you seekcare. That's the point of it.
51:28
It protects us and it makes youvery sensitive to mechanical load.
51:33
So it promotes healing. But weneed to get checked out. We,
51:37
we need to go to a medical orgood physio practitioner who,
51:41
who knows what to check for,
51:42
knows the questions to answer and makesure you are safe and you don't need an
51:47
intervention to fix the broken bone,
51:51
to heal the smacked ligament, whatever,whatever. It's aside from that,
51:56
we, we, I mean we are alreadyteaching physiotherapists sports.
51:59
I do a lot of work with professionalsports teams o on field of play
52:04
intervention for people who have injuredthemselves because we know what happens
52:08
in,
52:08
in the first three or four daysafter an injury influences the
52:13
trajectory of the whole thing. Sowe want people to understand, okay,
52:18
this injury is this,
52:20
your system will be highlyprotective over the next week.
52:26
So you, it will reallyhurt to, to load that,
52:28
but you are completely safe so longas you apply the load gradually.
52:32
So that's a really key message.
52:34
So as long as you apply a loadgradually straight after an injury,
52:38
you're completely safe because itwill hurt way too much to put yourself
52:43
under threat. Even that is areal nugget of understanding,
52:47
you know, that, that you don't have to,
52:51
you need to respect painbut not be afraid of it.
52:54
Because the whole point ofit is this safety buffer.
52:59
Now we, I could go for days on thatstuff. We run two two day courses for, uh,
53:04
sports physicians on this stuff. So.
53:08
Perfect. Well thank you for that. I'mconscious of time. I might, um, wrap up.