Talkin’ about a pain revolution

by Rebecca Barnett

What do neuroscientists eat for breakfast?

Lorimer Muesli

Even for a dad joke, that’s bad. And for those of you who have never heard of Lorimer Moseley or who can’t quite place the name, it’s not even going to make any sense.

Lorimer is obviously not a kind of much-loved breakfast cereal of Swiss-German provenance. He is actually a clinical neuroscientist at University of South Australia and one of the most influential global voices making the case for a major shift in the dominant narrative around persistent pain. However, if you need a proper introduction to the man, the best starting point is his 2011 TedX Adelaide talk  on YouTube, ‘Why things hurt’, with 496,601 views and counting. Go on. Watch it. Watch it now. You won’t regret it. Unless you’re a keen, sarong-wearing bushwalker  with a bad case of ophidiphobia, in which case I would exercise some caution.

So why did I wake up yesterday morning with that bad dad joke fully formed in my head? Or rather, why did that bad dad joke wake me up, with no apparent requirement for conscious input? To answer this conundrum, I need to tackle another question first …

What the FAQ is the Pain Revolution?

Pain Revolution is the conscious brainchild of Lorimer Moseley. It is both a fund-raising event and a community-based public education outreach aimed at helping people to rethink the behemoth of persisting pain. For one week, a traveling roadshow of around 22 cyclists with a passion for improving outcomes for people living with chronic pain and a support crew of equally passionate pain educators/peeps, pedal (and drive) hundreds of kilometres through regional towns, running community education events and providing ongoing help and support to professionals working with people in pain along the way.

The inaugural Pain Revolution cyclists raised $80,000 during the 2017 ride to support the establishment of a network of local pain educators in rural and regional Australia, where chronic pain is most prevalent and least well-addressed.

The 2018 Pain Revolution traveled from Sydney to Albury between April 11 and April 18, stopping at Wollongong, Nowra, Canberra, Cooma and Corryong along the 750-kilometre route. AMT was a proud supporter of the ride this year, offering our services to provide recovery massage for weary riders at the end of each long, challenging day of cycling. This year’s route traversed 11,400 vertical metres (otherwise known as an “upward trend” according to ride captain Steve) – more than two Mt Everests – so you can imagine that’s a lot of metabolites hanging out in around 44 sets of quads. Unsurprisingly, fellow AMT member and co-conspirator, Colin Rossie, and I acceded to many requests for some loving attention to those hard-working quads over the course of our week with the revolutionary riders. But essentially, we provided comfort and a safe space to rest from the physical, psychological and emotional demands of the ride. My most treasured feedback was from a rider who said he was so knocked out by his treatment that he stumbled straight back to his hotel room and slept blissfully and recuperatively for two hours before dinner.

“I’m just going to read for an hour”. Colin Rossie, after an intense shift on the Pain Revolution.

Anyway, in the wake of my involvement with Pain Revolution, my unconscious must clearly still have been cataloguing experiences and memories when it chose to wake me with an exquisitely bad but fully formed dad joke. I can assure you, it’s not my usual alarm clock. Given what had been rolling through my head in the lead up to the ride, though, the dad joke manifestation is probably not that surprising. Let me explain …

Do we really need a Pain Revolution?

My personal journey as a pain revolutionary (of sorts) started in 2006, when I purchased Lorimer Moseley and David Butler’s book Explain Pain.  It was a while before I got to read it because my partner “borrowed” it pretty much the minute it hit my front doorstep with a pleasing postal thud. Shortly after that, the utter bastard (my partner) went off to an Explain Pain workshop at Macquarie University with my bloody book in hand and came back elated by what he had heard and learned. It wasn’t until a decade later – October 2016 – that I finally attended Explain Pain and Graded Motor Imagery myself, swearing and profaning my way through three solid days in a quest to earn as many pens as I could. It worked. I have the pen collection to prove it and I’ll always have the comforting knowledge that David Butler swears more than me. No really, he does.

In the intervening 12 years between buying Explain Pain and supporting the Pain Revolution ride, I became far more health and medical evidence literate broadly, but particularly massage research and pain research literate.

Another really influential thing evolved over that same time period: the massive global phenomenon of social media, especially Facebook and Twitter. I watched the inexorable rise of “pain science” through those platforms, as discussion groups and gurus mushroomed across the social intertubes with all the usual promise and pitfalls.

I was starting to be troubled by what I saw and read on these social media platforms. There was, frankly, some pretty fucked up uses of the pain science canon manifesting. A Frankenstein monster had animated into a brand identity with a misapprehended life of its own. Things seemed to be rapidly refocusing through an old school, reductionist, Cartesian lens … the Emperor’s New Pain Hegemony. Smug paternalism dressed up as sexy neuroscience. Having spent my final year at uni studying critical theory and falling into an enduring love affair with the work of French philosopher, Michel Foucault, I am always queasy and unsure about what Foucault termed ‘regimes of truth’ and conformity. The new “pain science” brand was starting to feel like a regime rather than a revolution in thinking about persistent pain.

At the apex of my doubts, I witnessed an exchange on Twitter that made me cringe: a pain peep with a big following lectured a chronic pain blogger about how she should be interpreting her experience of rehab, informing her that her reactions were wrong and didn’t reflect the science. The need to be right had trumped the need to listen, learn and validate. Blergh.

I increasingly found myself asking all the searching, Sex and the City style questions: had “pain science” jumped the shark? Had it spiraled into a clinically meaningless, neuro-deterministic purgatory of clinician-sanctioned purification rituals? Were persistent pain sufferers just the sum of their centrally-sensitised parts? Had the promise of a patient-centred revolution in pain management given way to a clinician-centric cadre of pain science keepers of the kingdom? Was this just the old dualism dressed up with glittering new neuroscience memes for an internet generation?

How many cows does it take to watch a bicycle tyre being changed? We can only hope this image brings Gary Larson out of retirement. Thank to Steve Kamper for the pic.

Getting back to grassroots

Pangs of silence from the room upstairs

How’s the view there?

Do you read what they’re saying about you?

That you’re no fun

Since the war was won

In fact, you have become all of the things you’ve always run away from.

 

The ascent of Stan

Textbook hippie man

Get rest while you can.

 

Once you wanted revolution

Now you’re the institution

How’s it feel to be the man?

It’s no fun to be the man.

 

Ben Folds

The Ascent of Stan

I went into the Pain Revolution nervously humming Ben Folds and carrying a tiny, glittering thread of uncertainty – a snag in the emperor’s new clothes. Had I unwittingly become part of a new institution that I wasn’t sure I wanted to support?

I needn’t have worried.

Pain Revolution is a genuinely grassroots movement run without any pretentions to ultimate truth or wankery. It’s not in any danger of losing its patient-centred focus, even if one of its aims is also to foster and support clinicians. It’s as much about listening – to patient stories, experiences and insights – as it is about informing and educating. And while it may be underpinned by modern neuroscience, its roots lie deep in the tradition of modernist humanism. And, in our increasingly medicalised lives, even the smallest dose of unabashed humanism feels like a pretty damn revolutionary approach to persistent pain.

The week on the road with the Pain Revolution definitively proved to me that reaching out to communities with compassion, warmth, humour and empathy is a revolutionary act; that listening without judgement or censure is a revolutionary act; that allowing people a safe, unhurried space to tell their pain stories is a revolutionary act; that knowing the science but accepting the messy and wonderful uncertainties of the human experience is a revolutionary act.

… if metaphor is what’s required to bridge the gap between knowledge and knowing, then science must be honest about its fundamental basis in metaphor.

Pain as metaphor: metaphor as medicine

For someone like me who can’t unthink Foucault, the harmonisation of science and narrative remains a deeply revolutionary project. To borrow from my academic hero, Professor Trish Greenhalgh, Pain Revolution fully commits itself to the data and the narrative: not stories or numbers but stories and numbers. Winding back the violent hierarchy, one bicycle wheel revolution at a time – now there’s a pun I can really get behind. And there’s still such a long road to travel.

My only regret is not finding the right moment to ask Lorimer Muesli to explain good pain. But that’s probably a blog post for another time.

About the Author

As the erstwhile Secretary of AMT, Rebecca Barnett has been at the coalface of professional advocacy for 12 years. Her proudest achievements include the release of the AMT Code of Practice in 2013 and the establishment of AMT’s classified massage therapy research database. She is devoted to neologism and foodstuffs with the same specific gravity as havarti cheese but she remains ambivalent about semi-colons.

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Comments

  1. I believe you earn another pen:) thanks Rebecca. As always your honest passionate perspectives are a motivational force in my approach to practice.

    • Holy crap. You’re right!

      Thank you so much for this generous comment Camille. I can’t express how deeply appreciated this sentiment is right now. With much warmth,Rebecca

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