Women's health should be a priority in society. In fact, women's health is vital for society. In terms of persisting (chronic) pain, women seem to suffer more than men. We have some understanding as to why this could be and hence we must address the problem. Chronic pain is one of the largest global health burdens. If pain were understood, the suffering would undoubtedly be eased. My aim is to help society understand pain. Here is my talk tonight, to 'Inspired Women in Medicine'. For further information or if you would like me to talk at your practice or business, please contact me. Pain Coach 1:1 mentoring is also available for clinicians and therapists who want to develop their knowledge and skills in chronic pain. e ~ painphysiolondon@gmail.com

1. Richmond M. Stace
MCSP MSc (Pain) BSc (Hons)
Specialist Pain Physiotherapist

2.  What is the issue?
 What is pain?
 Illustration
 What can we do?

3.  …one of your patients
 A women suffering
pain
 What was the story?
 How did she present?
 What were the
problems?

4.  Pain causes suffering
 2nd arrow
 Pain limits our choices
 At home
 At work
 Socially
 Pain affects
 Our thinking
 Emotions
 Perceptions
 Sense of self

5.  Visit doctor more than men
 Use more pain relief
 Suffer more pain ailments
 IBS, TMD, fibromyalgia
 Report more clinical pain

6.  There are sex differences
 Biologically
 e.g./ hormones
 Perception of women in pain
 Different treatment
 Time to receive Rx
 Much of the research in males
 This MUST change

7.  Chronic pain & depression => top 2 global
health burdens
 Figures
 100 million Americans
 20% of the population
 1:5 children

8.  Medical school
 Healthcare professional training
 Postgraduate training
 CPD

9.  Pain huge global
health burden
 Main reason why
people see doctor or
healthcare
professional
 Poor understanding
of pain
 Outcomes?

11.  Lack of compassion for self
 Perfectionist
 Giving to others but not self
 Minimal or no recharge time
 Frequent feelings of anxiety & worry
 Feelings of guilt

12.  Starts with musculoskeletal pain
 Often a ‘physical’ focus
 The story emerges:
 Aches and pains ~ gradually worsening
 Various life events
 Other health problems, e.g./
 Sensitive gut
 Headaches, migraines
 Pelvic pain, vulvodynia, menstrual pain
 Fertility issues

13.  Perception of our situation
 The story we tell ourselves
 All those annoyances and frustrations
 Hard on self
 Nearer the protect line
 Inflammation
 Off the agenda
 Having children
 Digesting food

14.  Pain(s)
 Suffering
 Loss of sense of self
 Stress
 Anxiety
 Hypermobile

15.  Musculoskeletal pain
 Sensitive digestive system
 Pelvic pain, vulvodynia
 Period pain
 Dysmenorrhoea
 TMD
 Headaches/migraines
 Hypermobility

16.  Overarching biological changes ~ sensitivity
 We need to join the dots
 Switch to protect mode ~ survive mode
 More common in women
 Gradual decrease in activities
 Increase suffering ~ loss of sense of self

17.  Proposed sex differences
 Evolved more sensitive systems to protect
 Detect threat more easily
 Empathy ~ more sensitive to children’s pain
 Temporal summation
 Gradual build up; fits chronic pain
 Change at puberty ~ a time to monitor

18.  ? The change that is important
 Systems detect change and update self model
 Salient network
 More sensitive just before period
 Low oestrogen

19.  A brief look at a complex social phenomena
 Society needs women to be healthy
 Huge economical costs of pain
 Including substandard treatment
 More likely to seek help
 Perceived role
 Beliefs about themselves, life, role ~ conflict?
 Concern for society

21.  Protection from a perceived threat
 Many body systems
 No pain centre or signals
 Is it salient? Is it a threat?
 Prediction that we need protecting
 Predictive coding (processing)
 Poorly related to injury
 Phantom limb pain

22.  Perceptions
 Emotions
 Thinking
 Movement
 Body sense
 Outlook

23.  Anything that is a threat to the self
 Pressure on self ~ worries ~ frustrations
 Poor sleep
 Stress ~ unique perception
 Anxiety (about….)
 Environment
 Prior experience
 Genetics
 Context ~ situation

24.  Change is definite ~ which way?
 Continual updating
 Circular causality
 Pain
 Without any external stimulus
 Context
 Learning
 Updates = on-going protection

25.  Treat the person
 Person feels pain, person gets better
 Understand pain
 As a society
 If people understood pain, suffering would decrease
 Deliver the right messages
 Give patients the knowledge and skills
 Coach themselves; ‘Pain Coach’
 Understanding, resilience, motivation

26.  Right messages about change
 Desired outcome
 Am I heading towards it?
 Am I distracted?
 Programme to follow
 Day to day, moment to moment
 Unified experience of perception, action & thinking

27.  Develop working knowledge
 Reduce fear, engage with living
 Create new healthy habits
 Normalise body sense and movement
 Specific sensorimotor training
 Refresh & renew
 Movement through the day
 Motion is lotion ~ nourishing

28.  Mindful practice
 Create calm
 Focus
 See things for what they are
 Compassion ~ self & others
 Gradual increase in desired activities
 Gain confidence with good experiences

29.  Pain is a huge societal and global problem
 Pain in women in a societal problem
 This must ne addressed
 Starting with understanding pain

31.  www.understandpain.com
 @upandsing

32.  www.specialistpainphysio.com
 Blog
 @painphysio
 07932 689081