Welcome back to the Healing Pain Podcast with Dr. Joe Tatta & Dr. Bronnie Lennox Thompson
Freedom to move and perform activities is a privilege most people take for granted. For some people suffering chronic pain, the ease of doing simple tasks is a luxury. Chronic pain has been defined as any pain persisting over twelve weeks. It may result from injury or ongoing illness and may be accompanied with other health problems like sleep deprivation, decreased appetite, and fatigue, limiting a person’s strength and movement and lead to depression and disability. While medication, surgery, and other treatments are the immediate solutions, they do not always eliminate the pain. Dr. Bronnie Lennox Thompson, a pain management specialist, has been helping people with chronic health problems achieve their highest potential in life with chronic pain management through developing a combination of cognitive behavioral therapy, acceptance and commitment therapy, as well as physical therapy.
On this podcast, our theme centers around one of the most important topics when it comes to chronic pain and that’s how can you live a full and vibrant life despite having some pain? If you’re in pain much of the time or if you have recurring episodes of pain, chances are you are acutely aware of how it affects the quality of your entire life. This can often be difficult to articulate because pain is invisible. No one else can see it. Only you know the favorite activities you’ve given up, the outings and special occasions you’ve declined, even the friends and family you’ve lost because of your pain-induced limitations. If we allow it to, pain can interfere with every aspect of your life. Let me ask you a few questions, as you settle into this week’s podcast, and prepare for learning. How can you achieve your highest potential as a human despite having some pain? Does your pain have to be 100% gone for you to engage with the things you love again? The ultimate question I’d like for you to reflect on for a few moments before we begin is what would you be doing if pain weren’t a factor? Sit and meditate on that for a few moments after this interview and reflect. So often we listen to these podcasts and we take in such great information, but we don’t take the time to synthesize it and figure out, “What have I just learned and how am I going to now integrate that into my life or into my care with patients,” whatever it may be for you specifically.
Joining me is Dr. Bronnie Lennox Thompson. She is an occupational therapist who holds a Master’s Degree in Psychology as well as a PhD in rehabilitation medicine. Bronnie’s passion is to help people experiencing chronic health problems achieve their highest potential in life. She has worked in the fields of chronic pain management for twenty years helping people develop self-management skills using a combination of cognitive behavioral therapy, acceptance and commitment therapy as well as physical therapies. Bronnie is also a professor at the University of Otago in Christchurch, New Zealand. I love this interview with Bronnie. It’s super important. Sit back, make yourself comfortable and please enjoy.
How To Live Life Well With Pain And Do What You Love with Bronnie Lennox Thompson
Bronnie, welcome to the podcast.
It’s lovely to be here. Thanks for your invitation.
I’m excited to have you on because you’re the first occupational therapist or someone who has a history of being an occupational therapist on the podcast. It’s great that we represent all types of practitioners that work with people who have pain. There are practitioners who are here as well as people who have pain. Looking at your resume and looking over your LinkedIn profile, you’ve got a lot of different initials after your name as a lot of us do but take me along your professional journey. How you entered into healthcare and where you currently are?
I started in my last few years of high school wondering what I was going to do and it was a bit of a do I do physiotherapy ? Do I do occupational therapy, or do I do something else? I applied for both, physiotherapy and occupational therapy and got into both, but the occupational therapy acceptance letter arrived fast. That strike of faith me entirely ended up in occupational therapy. It’s a three-year training course. It’s pretty similar in length and intensity to physiotherapy in Zealand. We don’t tend to have a master’s level programs as entry level in New Zealand. In both professions we work really collaboratively. Occupational therapy in New Zealand is different from the US. My understanding is that some occupational therapists focus so much exclusively on the upper half of the body including the hips and the arms and the physiotherapists deal with the lower half of the body. We don’t do that. We’re a whole person proficient both in physio and OT. It’s a little bit different but similar and we’re looking at the whole piece and how can they do what’s important in their lives and how can we help people progress from needing help to be able to manage independently.
You practiced for a while and then you’ve probably ventured back into school like many of us do.
I did. I’ve done a number of different jobs over the years and almost always in pain management. I came to Christchurch in ‘94 and started my Master’s program in Psychology at the University of Canterbury. I completed that and learned a lot more about theory development and research methodology which since I’m a bit of a geek. After I completed it, I was still working because I have two little children to raise at that time. Then I finished it and started my PhD in 2007 and slaved away a bit that time for a few years. I’ve been teaching on the program at the University of Otago since 2002. When I came in and started teaching on introduction pain and introduction to pain management. My focus is very much pain on the psychosocial aspects of pain. How do we help people understand their pain? What are their thoughts and beliefs about pain? How does it fit things like sleep and emotions and relationships and the most important aspects? I leaned on some of the physical stuff we need to know the neurobiology but at the same time we need to know a lot more about this person who is coming to see us.
They are really important skills no matter who you are, no matter what kind of profession that you are. Switching to talk to people who have pain, if we said twenty years ago, that you can have pain and you could still live well, people probably would have thought that you are little crazy. That we have to completely eradicate pain and that’s changed a lot. What does it mean to you to live well with pain?
We’ve been in themes of persistent pain management since probably the late ‘60s when Wilbert Fordyce who started looking at some behavioral approaches to managing the problem of pain and was starting to say, “Surgery, medications, physical therapy were anything that we do from the rehab spectrum doesn’t necessarily change somebody’s pain levels. We have a lot of people who are out there living with the pain. My focus in my PhD was people who live well with pain, trying to understand how do they manage it? It was inspired in part by my partner who has ankylosing spondylitis and yet he is still fit. Climbs hills, carries backpacks and does mad things like that. I guess what’s happened over the course of the years is that we’ve become more aware of things that don’t work, things that don’t take pain away. I guess that’s increasingly happening over the last probably fifteen years. We’ve started to see fewer and fewer surgeries. We don’t have as many surgeries but there’s a lot of back pain. Even more recently we’re seeing from the research showing that people who had surgeries don’t necessarily do any better than those who don’t. It’s becoming a real thing and I guess when we look at the way the opioid crisis’s has occurred in the States and to a lesser extent in New Zealand and Australia, medications don’t always help and fit. I’ve heard people on high levels of opioids saying, “My pain is still there. Can I have more?” Possibly the higher dose is actually increasing the pain which is a problem.
I’ve been working on helping people live well despite their pain for most of my career. Most of it is about learning what you can do and not let what you can’t do get in the way of what you can do. In essence, it’s about not looking at pain intensity as your key outcome, but thinking about how much is getting in the way of what I want to do? When I talk to patients about what would they be doing if pain was least of a problem for them? One guy I can vividly remember told me, “I’d be out on my motorbike.” This is a man with bilateral upper limb pain that isn’t going to go away. It’s a neuropathic type pain and surgery is not feasible and he’s not responding to medications. I said, “What happened to your pain?” “I got worse.” I said, “Was it worth it?” Watching his face light up, he said, “Yeah. It was worth it. Even though my pain went up, getting out, doing stuff that I love doing meant it was worth it.”
We started on, “How could you do more of what you love?” How can we help you go riding motorbikes and feeling okay? Maybe not going for a three-hour ride, maybe start for an hour at least and just start to build up your comfort zone, your seat of competence that you can manage to do these things. He is a guy who still has this awful pain but he is going after good rides on his motorbike and he started doing things around the house like tiling to kitchen. He is starting to get back into his real life. To me, that’s really the essence of good pain management. It’s not so much about what we do with the pain but how can we help somebody be themselves again? How can we help them express who they really are despite the pain? What we all really want to see is people flourishing despite the experience of the pain.
For most of the physical medicine professions, there has always been a movement toward function. Typically when we’re talking about function, oftentimes it coincides with what someone values in their life. I still think there and even to this day even with the amount of education we have flying around with pain right now, there’s still a switch that needs to go off in a practitioner’s mind that I’m not necessarily fixing someone. I think the practitioner has to be uncomfortable first with himself in the new shoes and the new outfit they’re going to wear as a coper versus a fixer.
The collaborator is someone who walks beside the patient. I guess what I tell people is that we know lots but we don’t know this person and their life and what’s important to them. If we make a suggestion about how they might try to do something differently, in the end, it’s that person who is going to decide whether that fits for them or it doesn’t fit within their lifestyle. That means we need to be quite humble because we don’t know that person’s own life, and that’s quite a challenge. Definitely, from the way I was trained which was, we know what you need and we will tell you and then you’ll go away and you’ll do it and you’ll be happy. It doesn’t always work that way especially with things like home exercise programs. If somebody doesn’t like doing it, it just won’t get done if the person gets cold and non-compliant. Maybe it’s the clinicians themselves is not responsive rather than the person being non-compliant.
That doesn’t mean that if someone comes in, they’re lacking 30 degrees of shoulder flexion that we ignore that. We are treating but I think the question when should we switch from trying to reduce pain versus trying to help people cope and everything because sometimes there can be a fine line in that. Maybe talk more about that.
It is a real challenge especially if you’re working with people with acute pain trying to decide should I be focusing on ways that will change tissues or ways that will change their experience with your pain and my focus of treatment. This is a time when the usual ways to reduce pain becomes problematic. I don’t think as clinicians, we have the right to make a decision for someone. What we can do, is we can start talking about what can we do inside you and drive off what you can manage inside your pain for now? How can help just push that in a little bit deeper? Then we can help the person weight out for themselves what’s going to be most important to them. What’s going to add value to their life? Is it devoting time and energy to reducing pain or is it time and energy expanding who I am and doing things that have meaning and value for me? I’m not going to make a judgment call on somebody else’s life. That’s not my job. A lot of people are unaware that it’s possible to live well with your pain. Many people still think that unless you get rid of pain or gone, life isn’t worth living. I have fibromyalgia. I was 22 when I first hurt my back and got told by a doctor, “I’m really sorry but there’s nothing we can do.” I was absolutely horrified. I thought, “I’m going to have to live like this.”
Luckily, I was advised to rate the challenge of pain by this particular doctor, who’s a wonderful man doctor, Mike Butler. I realized that this pain didn’t mean that I was harming myself. He said, “This is how it is.”I thought, “I’m going to have to live within the confines of distress, of not being able to move, feeling worried about my pain. Not sleeping because I don’t think I can do things. I’m a new grad. What am I going to do for my life? What I think healthcare professionals sometimes forget is that when somebody is learning to live well with their pain, it doesn’t mean that life is going to be better. I’m going to be stuck with the pain the way they’re experiencing right now. Pain is very fluid. It changes all the time. I still have fibromyalgia, it hasn’t disappeared but I do everything that I want to do and enjoy doing. I think we can offer people an understanding, your life can be rich and full and pain is likely to change in ways that they don’t expect. The intensity hasn’t changed but the meaning of my time is that it’s just a noise in my system. That’s a magical change for me because I don’t track my pain very much. It’s there but it’s nothing. I found it in my research as well that people who cope well with their pain live well, “It’s not important to me. It’s just there,” which is cool.
It is. I just had this conversation recently with a friend of mine who’s a psychologist who we were talking about restless leg syndrome and I said, “I’ve had it for a long, long time and it comes and goes. Some days it’s never there and other days, if feels like there’s an army of ants just attacking my calf at night.” She said, “What did you do?” I said, “Meditation and stretching helps it.” Not much else I’ve ever tried helps it, but honestly I just don’t really pay much attention to it. It doesn’t bother me and I fall asleep just fine. The flipside of that is she has a patient right now who the patient reports that when she was at bed at night, she’s constantly kicking and flailing her legs to make it go away. Most of us would probably imagine that will make it worse. Your willingness to be present with some of these is very important when you have either chronic pain or other types of chronic symptoms that patients that we see in clinical practice have. You do a lot of training with clinicians and obviously teaching. You’re in New Zealand which is a little bit different than the United States as far as our healthcare system and our education system. We have to look at these things in context but what types of skills do you feel are essential for a clinician and might be missing from training in university level?
I feel quite strongly about this. I think that basic undergrads entry level, OT, physio, nurse, doctor, gets so little information about pain that it’s next to non-existent. That’s a real problem because even if you get a new graduate who’s enthusiastic, they may know nothing about how pain works. None of us really know how pain works but we have a vast amount of information that we can learn. That’s the very first thing. There are two really important things to learn. One is communication. Being able to reflect, to listen, to hear, to intake with care or being human is crucial because I’ve never heard a patient say, “They didn’t listen enough.” That’s what patient say to me. I’ve never heard them say, “I listen too much.” They say, “They just didn’t listen to me. They didn’t acknowledge me. They don’t care.” I think if we can show the ability to hear what somebody says, that goes a long way toward helping people feel safe. That they can trust us and they can then feel relaxed enough to say what they’re really concerned about. I think those are the two key things. In terms of communication, the actual training that I’ve done in motivational interviewing and acceptance and commitment therapy, and CBT, all tools, probably motivational interviewing is the one that I would use the absolute most because it’s so flexible that anybody can use it. All it does is aid to your listening.
Motivational interview really is the through line with all the types of cognitive and any type of therapy where we are communicating with the patients. Even if you decide you’re going to go study CBT, obviously MI is a big part of that and it’s beneficial.
For me now with acceptance and commitment therapy would be would be my go-to instead of CBT and that’s mainly because I think it’s more flexible. I’ve made very clear that this is available for every profession. It’s not psychology exclusive. Every profession will pick up and use elements of it because it’s about the human condition, it’s not a bad psychopathology. It’s about what makes you feel good about yourself and can you be flourished and can you be flexible or how you see what’s important to you. I think that’s a key thing for living for all of us because shit happens and we’ve got to go with it or we can fight against it in times that we burden ourselves with a whole lot of unnecessary angst which is that’s the ways of life really.
I love acceptance and commitment therapy. It’s a wonderful technique and approach. For everyone, if you’re interested in learning more about ACT, you can of course log on to episode number 75 of the Healing Pain Podcast cancer I spoke with Dr. Kevin Vowles about ACT and he is wonderful. Knowing that we had this biopsychosocial model, chunking those apart into those three different pieces, the social part is one area where we have not spent a lot of time in research or even exploring in clinical practice because sometimes exploration in clinical practice can be a good way. From the social aspect, what do you see as a potential win for treating people with chronic pain that we haven’t maybe looked into or something that maybe you’re doing in practice or you’ve seen done in practice?
If I had a magic wand, I would really like to see concerted effort in public health change to help people understand that pain is not a death sentence and that living with pain is possible. It is a sign a sign of your nervous system letting you know to pay attention. Maybe it’s not really accurate all the time. It might be sneakers and a notch but too soon or but to match. If we could have some broad and general public awareness that especially low back pain because it affects so many people, is something that we can live well alongside. Chances are somebody is going to keep it in their life and that recovery from that is about doing things and not having things done to you but doing things for yourself. That would be fantastic. Our community understanding of back pain in particular becomes more positive rather than you’ve got a bad back and go to bed and you’ve got to stop work. You’re going to stop doing all the things that you love doing and get them into an MRI which is just not helpful for people. If I had a magic wand, that would be the very first thing
For clinicians, I think we need to include people’s family into the indirect consultations. Even as simple as asking somebody at the end of a consultation, “What are you going to tell folks that come about what we’ve talked about? Which a technique of teach back which is useful for clarifying as a clinician that the patient understood what I’m saying. It’s also a great way for them to communicate with their family. That would a really useful thing to do. How are they feeling about pain? What are they telling you? What do they think you should be doing? We start to envelope and involve the family inside our treatments. Same with colleagues at workplace, things perhaps we need to talk to the person about our colleagues and ways where you can have them responding to the pain. Not in a way to suggest that you shall go back to work, which is a good thing for most people. The idea that by understanding that pain is not necessarily a good indicator of what’s going on in the body but it’s a sign that you need to pay some attention to your body, and perhaps that would help to de-threaten the whole experience. That it’s actually normal and a part of life and okay.
Some of the Buddhist principles, they have something called the three jewels and in the three jewels, it’s the teacher, it’s the student and then it’s the community. That’s broken down into the simplest form. What you just articulated is so parallel to that. It’s that if we as a clinician can teach a patient what they can do for their pain and they take that and share with their friends or their family or their community or their church, probably a big win and that’s a wonderful way that we can help enhance the social part of that biopsychosocial model.
There’s some more research happening now seemingly more understanding of even things like how we are viewed as professionals. What’s helps patients see us as being trustworthy and which interestingly through physiotherapist is not wearing a suit and tie. Parts of the research suggested that they are actually more trustworthy when they’re just wearing comfortable clothes but surgeons, probably wearing a suit and tie is a good thing. Those societal judgments about who we are and how we work with people, how we can help people feel comfortable with us that will also enhance what we do. If we can help people feel more comfortable with us, then they may start talking about really important things like intimacy and their relationships. We can start a physical paradigm and doing lots of physical therapy, people talk to us. We’re not delving into sexual abuse or anything like that. We’re just saying, “How is your relationship? How’s the people at home? How can we help you give information that help support and encourages your relationship to flourish?”Relationships do fall apart when people experience pain. They become under stressed and if we remove it, we’re pretending this person is just a little island and no man is an island.
I’d like to ask you a couple of questions as we start to move towards the end. I’m going to ask you question. It’s a fill in the blank. You can fill it in with either a short word or short sentence or whatever comes to mind first. The best way to explore one’s cause of pain is?
Not to bother. I don’t look at the cause, I look at the fact that yes, you do have pain and let’s see what changes and influences your experience.
If pain scares me, the first thing I should do is?
Stop, breathe out and say something like, “Take a chill pill. It’s going to be okay.”
Pain to me means?
It’s intriguing. It’s full of so much complexity and that’s my own pain as well as others. For me, being mindful of my own pain means that every day, every time I do mindfulness and I do a body scan, my pain is different. I’ve had pain for the rest of my life and it’s different every single time I do it. It’s amazing, isn’t it? I can never get bored understanding and experiencing my own pain. I’m not afraid of it but it gives me, “I’m now being curious about it.” With all the information that we have about pain, several PhDs and a lifetime of study have only spent a tiny time part of what we know and that to me is endlessly fascinating.
You used the word there that I use frequently with patients when we get inside the deep conversations of what do I really need to do to get over this, get through this, deal with it. I come to same thing that’s curiosity. That if we can motivate people to the point where often a lot of us are as clinicians, where we’re curious about this process and be present with this thing that we have that oftentimes that just shifts something in someone’s approach and their ability to be willing with what happened in their life. Beautifully said.
I have been speaking with Bronnie Lennox Thompson who is a great occupational therapist and obviously a specialist in helping people with pain. You can learn more about her by visiting her great website which has tons of great information and blogs. It’s HealthSkills.Wordpress.com. Bronnie, tell us what you’re up to in the next year or so regarding all the great things you have going on in the world of pain?
I’m going to the Australian and New Zealand Pain Society meeting in Sydney presenting two workshops. One on occupational therapy and pain management, and one on self-management with Pete Moore who is the Pain Tool kit guy from the UK which will be very exciting. Then I’m coming to Boston. I’ve never been to Boston and that’s for the IASP meeting and that will be really exciting. I’m so looking forward to the biggest meeting in the world of pain geeks and clinicians and researchers and we are definitely looking forward to that. Apart from that, I intend to some more silversmithing and I’m just taking up the role as coordinator for our program. There are probably a few things I’ll do around me. Outside of work, silversmithing and photography. That’s my thing.
Congratulations on your new role. Hopefully, I’ll see you in Boston. We can connect then. I want to thank everyone for joining us today on the podcast. Make sure you share this podcast out with your friends and family. Go on to Facebook, Twitter, whatever your favorite social media handle is and then hit the share, like and love button there. Hop on to iTunes and give us a five star review. You can of course check out Bronnie at HealthSkills.Wordpress.com and stay tuned for the Healing Pain Podcast. We’ll see you next week. Thank you.
About Bronnie Lennox Thompson
Bronwyn Lennox Thompson initially trained as an occupational therapist, graduating from CIT in 1984. She later completed her MSc in Psychology in 1999 at Canterbury University, and in 2015 was awarded her PhD from the Department of Health Sciences at the University of Canterbury, Christchurch, New Zealand. She has worked in pain management for most of her clinical career, with her primary focus on pain management at work. She has practiced in interdisciplinary pain management programmes, private practice, case management both for private organizations, and ACC, primary prevention and secondary prevention, and since 2002, teaching postgraduate papers in pain and pain management at Otago University. Her main interest areas include pain and anxiety, motivation for self-management, resilience and daily coping choices. The effect of her occupational therapy training has never fully left Bronwyn’s aims in pain management. Occupational therapy has always targeted function, or the ability to fulfill life roles despite limitations. In the same way, Bronwyn’s goals for pain management are to help people reduce the functional impact of pain and improve their engagement in living life to the full.
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