Pain Concern

Pain Concern has just returned from the British Pain Society’s 59^th Annual Scientific Meeting, where our Project and Operations Manager, Sam Mason, delivered a brief presentation on Pain Education Sessions. Here are three perspectives on the three-day event…

Roger Knaggs and Jo Brown, President and Executive Director, respectively, of the British Pain Society:

Last week, health professionals, researchers, allied health professionals and people with lived experience of pain from across the world came to Harrogate for the British Pain Society’s Annual Scientific Meeting (BPS ASM). This is the main national meeting where experts share new research findings and discuss how pain care can be improved.

This year’s meeting focused on understanding pain across the whole of life and finding better ways to support people with long‑term and complex pain. Talks covered how pain is processed in the brain, how experiences in childhood can affect pain later in life and how physical, psychological and social factors all interact. There was a clear message that pain is not ‘just physical’ and that good care needs to look at the whole person, not just symptoms.

One of the standout highlights of this year’s ASM has been the enthusiasm and quality demonstrated by our early career colleagues. From the posters to the oral presentations and wider programme activities, their energy, curiosity and commitment to advancing pain science and care have been truly inspiring. They represent the future of our field, and it’s incredibly encouraging to see such strong engagement and innovation coming through.

Another important part of the meeting was the contribution of representatives from the Expert Patient and Carer Committee (EPCC). The committee had created several activities for attendees to participate in, ensuring that the voices and experiences of people living with pain and those who care for them were clearly heard. Their involvement reinforced the message that patients and carers are experts in their own right and essential partners in shaping research, education and services.

Overall, the ASM highlighted the strength and diversity of our multidisciplinary pain community, bringing together clinicians, researchers and people with lived experience to share knowledge and challenge thinking. The quality of discussion and collaboration seen last week will undoubtedly shape better care for people living with pain moving forward.

Tim Atkinson, Chair of the British Pain Society’s Expert Patient and Carer Committee:

As ever, the BPS ASM was a blur of faces, facts and – thanks to the Expert Patient and Carer Committee (EPCC) – fun!

Front: Victoria Abott-Fleming. Back (L–R): Tim Atkinson, Mark Agathangelou, Nick Richardson, Lisa Blanchard.

It’s always lovely to meet new people as well as reconnect with old friends, all of whom are there because they have a vested interest in learning more about (and better managing) pain.

Seeing face-to-face people whom you usually only see on Zoom is an additional bonus, with the social side of the ASM – the ‘extra-curricular’ conversations and networking – often being as valuable as the presentations.

Facts and theories, as presented via plenaries, parallels and posters, inch the intellectual pursuit of knowledge in so many mind-boggling directions it can sometimes feel a little overwhelming. But behind the pure science lies the beating heart of the BPS, as summed up by its strapline – ‘together, we will do more for pain’. There is always a purpose – to understand, in order to assist.

As for the fun, well there’s plenty to be had and this year, thanks to the ‘find the meerkat’ activity (along with interactive ‘pain metaphors’, ‘patient v clinicians’ and ‘what matters most’ boards), there was even more of it on show and it was wonderful to see so many people engaging with the activities devised by the EPCC.

The event really does fly by and no sooner are you setting up and saying ‘hello’ than you’re packing away and saying… ‘see you in Glasgow’ (venue for next year’s ASM)!

Paul Evans, producer and presenter of Airing Pain:

In the spring of 2010 I attended my first ASM in Glasgow. A major landmark for me, it was my return to the world of work following a long absence and final exit from the BBC on the grounds of ill health, fibromyalgia.

I’ve been to every ASM since, and the brief hasn’t changed over the 16 meetings I’ve attended – simply, to record interviews with members of the pain community for future use in Pain Concern’s Airing Pain podcasts.

Simple? No! The BPS generously give us a room to record in and, depending on venue availability, these have ranged from broom cupboards to executive suites! Our room this year was spacious albeit windowless and painted in what I presume was the conference centre’s colour scheme, grey. But what really matters is that it was located at the heart of the conference, meaning my assistant Megan and I felt part of the event.

For it to work seamlessly, preparation is key. Megan had spent months contacting advisors for recommendations, researching and scheduling interviews. My role was to sit in my windowless, grey ‘studio’ and have interviewee after interviewee, eighteen over two days, ‘fed’ to me in succession – a bit like a sausage machine!

Re-focussing my brain to move from one topic to another in quick succession is a challenge. For example, shifting from deeply moving childhood trauma in active war zones to scientific neural modulation research certainly exercises the brain, mine at least!

Stay tuned for episodes produced from this year’s interviews… Otherwise, we look forward to 2027’s return to Glasgow!

This episode is produced in partnership with the British Pain Society. These interviews were recorded at their 2025 Annual Scientific Meeting. The 2026 Annual Scientific Meeting is just weeks away – register here.

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Paul Evans

This is Airing Pain, a programme brought to you by Pain Concern, the UK charity providing information and support for those of us living with pain, our family and supporters, and the health professionals who care for us. I’m Paul Evans, and this edition of Airing Pain is produced in partnership with the British Pain Society.

Jane Quinlan

When doctors saw that the promotional literature said that this New England Journal of Medicinestudy says that addiction is rare in patients with pain, it gave huge amounts of confidence to clinicians to prescribe opioids like they’re going out of fashion.

Emma Davies

Having long-term pain doesn’t necessarily mean that there is something wrong, or that there’s something that can be fixed, or that there’s a tablet that’s going to solve it. There’s an awful lot that people can do for themselves that will massively improve their quality of life, their activity, getting them back to doing the things that they want to be able to do, and also reducing the amount of pain that they have.

Katy Vincent

It’s not a conversation that they would have at the dinner table or on the sofa. You know, for many people, it’s still an area that’s really associated with shame and stigma.

Paul Evans

A recent study by the University of Oxford found that teenagers who experienced moderate or severe period pain, or dysmenorrhea, are significantly more likely to develop chronic pain in adulthood. It found that those with severe period pain at age fifteen had a 76%-higher risk of chronic pain by age twenty-six, relative to those who reported no period pain. Katy Vincent is Professor of Gynaecological Pain at the University of Oxford, and she’s a senior author of the study.

Katy Vincent

When we hear people in adulthood talk about their experiences of menstruation and particularly period pain as a teenager, a lot of them will talk about it as having been their first ever experience of pain, or of severe pain, or of repeated episodes of pain.

We know that most teenagers don’t even go to the doctor about pain. We know that if they do, it’s often normalised and they’re told that it’s just something that they will grow out of. We know that their parents often tell them that it’s something that’s normal, and either if their mothers experience very bad pain themselves, they’ll expect that it’s a normal thing because it’s what they went through – or if their mothers didn’t experience pain, then they may well tell them, don’t be silly, it’s fine, I coped with it fine. But I think that’s a very limited understanding of quite how different people’s experiences of periods can be. Quite recently, there have been a couple of high-profile cases of schools where the headteachers have said that they can’t use period pain as an excuse not to come to school anymore, for example. And there’s an increasing drive to limit access to toilets and to ask for doctor’s letters if people need to manage their periods at school. So I think it’s something that we really need to have a better understanding of, and an awareness more generally about, the problems that period pain can cause for teenagers.

Paul Evans

I do find it quite surprising and a little bit shocking that a teenage girl going through period pains is told to ignore them in school. ‘Get on with it.’

Katy Vincent

I completely agree, and I think that we as a population are often guilty of assuming that normal and common are the same thing. Period pain is incredibly common. It depends how you define it. If you’re talking about any pain with periods, that’s about 90%. If you’re talking about severe pain, stopping people from going to school, doing their normal activities, you’re looking at more like 30–40%, but that’s still really common. But just because it’s common doesn’t mean that it’s normal. It is a normal biological process to have a period. Why would we expect that it should be associated with pain? If everybody said every time I went to the toilet it was painful, we would say that’s not normal. I think we’ve just been really guilty of assuming that these things are normal because they’re common and that, well, if it’s a normal part of being a woman and you’re going to have to live with this for the rest of your reproductive life up until the menopause, then actually you’re going to have to learn to get on with it. To me, that feels wrong because we have treatments available, but, in general, people don’t come and seek help, at least during their teens, and often by the time they do come and seek help, their pain has become much more than just pain with their periods. Or the impact has already happened, it’s already stopped them being a competitive swimmer, or stopped them dancing, or impacted on their academic achievement, for example.

Paul Evans

I’m going to use that word normal, but I’m going to use inverted commas before and after it. When is period pain not ‘normal’?

Katy Vincent

That’s a really good question. I’m going to compare that to heavy menstrual bleeding, first of all, just to put it in context. In the past we used to say heavy menstrual bleeding is losing more than 80 millilitres of blood with your period. Now, who goes around measuring their period loss? You use products to soak it up, you know, deal with it. You don’t actually quantify it. We’ve really moved away from that now. We say, well, heavy menstrual bleeding is bleeding that is heavy enough to impact on your quality of life, or that you consider to be too heavy. And personally, that to me is what I think period pain should be.

You know, if you rate your period pain as 8 out of 10, but it doesn’t impact on you, you can take a couple of paracetamol, a couple of ibuprofen, you can go to school, you can do all the things you want to do, it doesn’t stop you working, it doesn’t stop you sleeping. Well then, just because you say it’s 8 out of 10, I don’t need to make you treat it. But if you say your pain is 2 out of 10, but actually that to you is so bad that you miss two or three days of school, you’ve given up your hobbies, you don’t feel able to leave the house, it’s really impacting on your mental health. Well, I don’t care what number you gave it. Again, that to me is bad enough that we should treat it. To me, painful periods are painful periods that get in the way of your life. They deserve to be treated.

Paul Evans

So, what do you do? What do you tell a young girl who’s maybe fourteen, or as you said, even in primary school, an eleven-year-old?

Katy Evans

One of the first things that I do is talk about how our menstrual patterns have changed so much over the last couple of hundred years. If we go back historically, we were so much less well nourished and our lifestyles were so different, that women in general started their periods around the age of seventeen or eighteen, which was an age that you were then considered marriageable. And we didn’t have any contraception, so you were probably pregnant within a year. You know, all the time that you’re pregnant, you won’t have a period. You would have then breastfed because there’s no formula milk. You would have been undernourished, so you probably wouldn’t have started your periods back again whilst you were breastfeeding, and as soon as your periods came back, you’d have then got pregnant again, and that cycle would be repeated, you know, throughout your life. You know, people had four or five live babies, but probably had some miscarriages in between, and you would probably have died before the menopause. So you’d probably have had about forty periods in your whole lifetime. If we think about the situation nowadays, you start your periods around the age of twelve, thirteen periods a year, and you keep going like that maybe until your late twenties before you have your first baby. You know, you could well have had four hundred periods in your life. So I like to say, actually, it’s maybe not as normal as we think it is to be having periods every month throughout your adolescence.

Paul Evans

I’m just thinking about the embarrassment side of having a period in a co-ed school with a mixed staff.

Katy Vincent

Yep.

Paul Evans

I can’t imagine what some girls have to go through.

Katy Vincent

Yeah I think you’re absolutely right. And I think we really don’t have as much understanding as we would like to about how people from different cultures and different backgrounds, even within, you know, your more traditional UK population, how they think about menstruation more generally, how they think about the use of hormones, how they think about talking about these things. I am a gynaecologist who has two teenage daughters who are so used to hearing me talk about periods all the time that they don’t find that embarrassing, though they would think it was embarrassing if I said it in front of their friends. But for lots of people, it’s not a conversation that they would have at the dinner table or on the sofa. For many people, it’s still an area that’s really associated with shame and stigma and a lot of misunderstandings and beliefs that have been perpetuated through many generations.

I think unless we understand that properly, it’s going to be very hard for us to present our options and encourage people to come forward for treatments if we haven’t really understood what it is that’s stopping people coming forward.

So if we could put some sort of real, policy-type changes into school education. You know, we have menstrual education, but it doesn’t really include pain within it. You know, people learn what a period is and how to manage their periods, but not that painful periods are abnormal and what to do about it. You know, we haven’t educated teachers. We haven’t educated the wider population. I think here’s an area that is absolutely ripe for policy change.

Paul Evans

What advice would you give to a mum or a young girl who has very, very bad period pains? What should they do? Where should they go? When should they start?

Katy Vincent

The first thing is to say that you don’t have to put up with it, that we have treatments available. I’d love to get that message out much more widely so that we see people much more early than we do, because often by the time we see them, they’ve had two or three years of period pain.

I tell them that they should use painkillers. If you can predict when your period is going to come, then get it ready, make sure that you’re ready to start. You have some painkillers with you at the time that your period is due, and take them regularly whilst your period is painful. We know that non-steroidal anti-inflammatory drugs like ibuprofen are probably the best treatment in terms of painkillers for period pain because it is quite an inflammatory process. But paracetamol often works very well too. And you can juggle the two so you can wake up and take some ibuprofen and then a couple of hours later you can take some paracetamol. And as long as you don’t take more than the recommended dose, you can absolutely do that for the first two or three days of your period every month. And that’s not going to do you any harm. So that would be my first message.

I think, again, it’s really tricky in schools because lots of schools won’t allow children to take painkillers with them. So they have to be held by the school nurse with a letter of permission from the parents. And then that makes quite an issue of it, that every three or four hours you’re needing to go to the school nurse and ask for your painkillers. I think that is something that’s challenging, though I absolutely understand why you wouldn’t want to have a group of teenage girls sharing their medicines around in schools. There are reasons why these things are set up, but I think it makes it difficult for teenagers.

Then the next thing that we talk about, if that’s not sufficient, is thinking about how we can manage periods themselves to reduce the periods, as well as reducing the pain, and our common approaches to that is to use hormone therapies. I think it’s really important that we start talking about them as hormone therapies rather than as contraceptives, because we’re not using them for contraception. We’re using them to manage the periods. They happen, most of them, to also be contraceptives, which means that they’re easily available, and we have lots of experience of using them. But I think for many people, it can feel quite wrong to think about starting a young teenager on a contraceptive, whereas actually, if we’re starting them on a hormone therapy for managing their periods, hopefully that feels acceptable to everybody.

Paul Evans

Professor Katy Vincent of the University of Oxford. My interview with Katy and all those in this edition of Airing Pain were recorded at the British Pain Society’s Annual Scientific Meeting, held in 2025, in Newport, South Wales. The British Pain Society is the oldest and largest multidisciplinary professional organisation in the field of pain within the UK, and I’ve been going along to these meetings for the last fifteen years to keep us abreast of developments in the management of pain.

Over recent years, I’ve noticed how terms like patient-centred, self-compassion, mindfulness have gained traction from being, let’s say, sideshow concepts of yesteryear to being the serious and proven components of today’s management of pain. Wellbeing is another such term that’s become something of a buzzword in recent years. It’s not just the absence of ill health, according to NHS England, but includes the way that people feel about themselves and their lives. Phoebe Williams is a health and wellbeing coach working across Hammersmith and Fulham GP practices in London.

Phoebe Williams

What a health and wellbeing coach is, is essentially helping patients in primary care to identify what it is with either their health or their wellbeing that they want to set a goal with to work on, take a bit of control over, and we work over a number of sessions helping them to make changes. It’s less of the medical prescribing model, it’s working with people to identify what they want to change for themselves.

Paul Evans

So just explain how that works. I understand the health bit, but wellbeing, wellbeing has become a buzzword. Just explain to me what wellbeing is.

Phoebe Williams

The way I see wellbeing is really spending the time with the people who are allocated to me, with the patients, and identifying what it is that makes them feel happy, makes them feel fulfilled. That can have a physical element. So, getting out and going outside with your friends can be good for your wellbeing. But also there’s the classic mental health element. If people are experiencing any sort of low mood or anxiety, doing things proactively that help alleviate those things, that is absolutely covering wellbeing.

Paul Evans

So, who do you see, who is sent to you for wellbeing coaching?

Phoebe Williams

On paper, the role of health and wellbeing coaching was created to help alleviate some patients who were seeing the GP multiple times a week, multiple times a month for long-term conditions. So, things that really affected them. On paper, that covers things like diabetes, it covers long COVID. I work a lot with things like low mood, things like anxiety. I work with women who have PCOS. Polycystic ovaries and chronic pain is a huge, huge thing. The reason that the role was created is because I have the flexibility to spend loads and loads of time with people. My appointments are about forty-five minutes, half an hour, forty-five minutes, and I can see them over loads and loads of weeks. So it’s just that I’m able to create a longer-term relationship with people, which I really, really enjoy.

Paul Evans

So when somebody comes to you, I presume the GP or somebody else in the practice has said ‘This person could do with wellbeing. They’ve lived with X conditions for any number of years’. How do they, the patient, react to, well, actually being told we can make you happier?

Phoebe Williams

Again, another reason I love my long appointment sessions is because it’s quite a new role. It’s quite a new idea for some people. Especially if we’re looking at this with a chronic pain lens, people may have felt like they’ve been bounced around from appointment to appointment. So they sit with me for forty-five minutes and we really strip it back to basics. I ask them what is going to improve your life, basically. It’s important for me to know the medical things that are going on, just for context, but I’m not going to advise you on anything medically. What is going to make you feel happier?

An example that always comes up for me is I had somebody that I was seeing for a number of weeks. She’d lived with chronic pain for years and years and years and years and years. Something that came up in our first conversation is that she really wanted to go out and see her friends, but she hadn’t managed to get on a train by herself for many years. So that became the goal of our session, something that we really focused on. So we stripped it back. What things do we need to put into place for you to feel able to get on the train to go and see your friends. Is there anything you need to adapt in your day-to-day life? Do you need to pace yourself with other things you’re doing so you have the energy to do it? It’s really looking in such small detail at things that, as you know, in that instance, really, really made her happy to do that.

Paul Evans

I mean, things like that can be life-changing. You’ve blocked your mind out of things that you, just one thing or maybe many things, but maybe just one thing that you really want to do. But your mind is telling you that you can’t do it.

Phoebe Williams

Yeah. Yeah. Absolutely. Your mind. And also, if you’re living with pain, you feel like your body is telling you that as well. You know, ending most days feeling completely fatigued and exhausted, I guess a big part of the sessions that I do with patients, especially with chronic pain, is knowing that living with pain is the goal, really, if that makes sense. You know, when I’m not there to make the pain immediately go away. We’re not here to fix things, because often it’s just working with it, you know, what can I do that I may well be having some pain that day, but I’m going to live with that pain in a way that works for me. And I’m going to go and see my friends. And it just opens up the world for people. I find that it can be so frustrating, and it can be really sad when people have felt bounced around from appointment to appointment and referral to referral, they’re becoming increasingly more and more in pain, and their world becomes quite small because there are things that they feel they can’t do. It’s just about slowly kind of opening up that world for them. It just improves everything, really. It just gives everything a brighter lens for them.

Paul Evans

That was health and wellbeing coach Phoebe Williams. Well, it would be remiss of me, bearing in mind that this conference is held in Wales, to ignore the important work undertaken by NHS Wales Performance and Improvement. So, way back in 2019, the Welsh Government published its Living Well with Persistent Pain in Wales Guidance. Then COVID came along and all bets were off, and the document was refreshed in 2023. We at Pain Concern were at the relaunch and you can visit that by listening to Airing Pain #139. Well, a report is just the start of a process. So back in June 2025, I spoke with Emma Davies. She’s the National Clinical Lead for Persistent Pain in NHS Wales Performance and Improvement.

Emma Davies

What we’re doing at the moment is reviewing where health boards are up to, in terms of implementing the recommendations from that report. So we’re doing that piece of work, we’ll review where health boards are at the moment in terms of that, and then we will be supporting them to actually put the outstanding recommendations into place. This is all around moving services into primary and community care to make pain management support more accessible to everybody that needs it.

Paul Evans

How exactly are you going to get these things into primary care? When primary care GP health practices, they are struggling at the moment. I would have thought that one of the last things they need at the moment is to have new procedures put on them.

Emma Davies

It’s actually not about getting GPs to do all this work. I think that’s the important thing to say.

At the moment, a lot of our pain management support that health boards provide are sited in hospitals. They’re in secondary care, and that actually makes them inaccessible to lots of people who actually need that support. The idea of moving services out is not just about uplifting those services and putting them into GP surgeries or asking GPs to just take on all the work. It’s about looking at what people living with pain in Wales need, where they think that’s best for them to be found, and then actually working with the people living with pain and with existing services to see what we can deliver using existing staff, but out close to home where people are living and where they need that support on a day-to-day basis.

Ideally, what we’d like is for people to be able to access support really quickly when they need it, and if they do need to be seen in secondary care, on the rare occasion they might need an intervention of some sort, or if they need a higher level of complex support, that they can actually get to that when they need it – as opposed to now when there’s very long waiting lists for lots of our pain services across Wales, and people that might do better with only a little bit of support, but out at home, are waiting just as long as people who need that more complex care.

Paul Evans

I think one of the really important things, I said GPs, but it’s not just GPs, it’s the multidiscipline side around a health service. There’s the pharmacists, there’s the nurses.

Emma Davies

There’s the social prescribers. We’ve got physiotherapists out in practice, a whole range of different stuff. I think what we want to look at really is how do practices want to support their patients living with pain. We’ve been at the British Pain Society conference this week, and we’ve heard about lots of examples where actually this work is being done by GP practices, by the GPs and their multidisciplinary teams. But also what expertise can we take out of secondary care and put into the communities to support those teams? It takes a village, as we say, and that’s perhaps how we need to look at it. Using all of the expertise available and including people like Pain Concern and other third sector organisations as well, to make the most of all that support, but actually make it available to people.

I think a lot of people in Wales don’t even know what support is available to them. They don’t know about the local groups that are already running. They’re just out of the loop and we need to get them back into it.

Paul Evans

I think there’s a big education job to do, not just to healthcare professionals, but to patients as well, to understand that people in their practice who aren’t the GPs are experts in their own fields and sometimes, dare I say, know more about conditions in their field than the GPs. They are the experts.

Emma Davies

I think that’s a fair point. I would say that, I’m a pharmacist, but I think you’re absolutely correct that nowadays within healthcare we have a really wide range of practitioners who are super specialist and who do have an awful lot to offer. And I think you’re right that we probably haven’t got those messages across to the public in the way that we should have done. So we certainly don’t want people feeling fobbed off if they’re seeing a physiotherapist instead of a GP for their bad back, but actually the physio is probably the best person for them.

I think the other thing around this is that we haven’t done enough to raise awareness of pain in public perception, so there’s still this idea, I think, that people develop pain, that there must be something wrong and they need to see a medical practitioner and there needs to be something done about it, when actually, again, as we’ve heard so much this week at the conference, having long-term pain doesn’t necessarily mean that there is something wrong or that there’s something that can be fixed, or that there’s a tablet that’s going to solve it. There’s an awful lot that people can do for themselves that will massively improve their quality of life, their activity, getting them back to doing the things that they want to be able to do, and also reducing the amount of pain that they have. But I don’t think we’ve done enough to get that into the public awareness. So that’s another thing that’s on my agenda to do as well, because if we don’t change the expectation of people coming in to see us in practice, if you’re offered something that doesn’t sound like going to see a consultant in a clinic, you might feel that, well, people are just giving up and they don’t believe me, or they don’t think this is affecting me as much as it is, when in actual fact, what we’re probably doing is directing them towards the best evidence option for them to learn how to live for a longer time with their pain.

Paul Evans

They talk about self-management of pain, which can be interpreted wrongly as ‘you’re on your own’. Or, correctly, as ‘we will help you look after yourself with our support’.

Emma Davies

I prefer supported self-management because I think, as you say, if you’re just told self-management, it does sound like, well we’ve all given up. Off you go. There’s nothing else. When actually there’s still a lot of support that people need. I was listening to one of the presentations yesterday from Benjamin Ellis, who is a consultant rheumatologist, but also does an awful lot of good work with Versus Arthritis. He made the very good point that people can go through a pain management programme and learn lots of skills and do really well, but then something happens, because life happens, and they sort of fall off the rails a little bit, and at that point they need support to get pushed back on, to remember the things that actually worked for them and to get them back on track. That’s one of the really good reasons to actually make sure that the majority of services are out in primary care, because that’s where that person will be when that happens.

Paul Evans

That’s Emma Davies, National Clinical Lead for Persistent Pain in NHS Wales Performance and Improvement. Well, that was recorded in June 2025. Eight months on as I record this edition of Airing Pain in February 2026, I can tell you that progress is being made. I, along with others living with persistent pain, contribute to its development as members of the Musculoskeletal Lived Experience Group and the Clinical Implementation Networks. In short, it’s where clinicians, policymakers and patients all have a say in the future of pain management in Wales. And it wasn’t so very long ago that the patient voice seemed like the least important component of their own pain management. But remember, doctor knows best.

Tim Atkinson is Vice Chair of the British Pain Society Expert Patients and Carer Committee. He’s lived with inflammatory arthritis for over thirty years. He’s author of Where Does it Hurt?, about life with chronic pain, and he’s a lived experience trainer with the Live Well with Pain programme. Incidentally, Emma Davis, who we’ve just heard, is one of its founders. Check it out at livewellwithpain, no gaps there, livewellwithpain.co.uk.

Tim Atkinson

It exists primarily, I think, to train healthcare professionals of all hues, from consultants to GPs, down to social prescribers, in elements of strategic pain management that they can deliver with supported resources to their patients on a very straightforward basis. So, I take part as a lived-experience trainer in some of their training sessions. I’ve done some face-to-face sessions, though we’re mostly online these days, and we just aim to go through what’s called the Ten Footsteps Programme. It breaks down elements like pain in the brain, a bit of scientific understanding at a very user-friendly level, and then works through practical techniques like mindfulness and relaxation acceptance. All the ten footsteps follow from one to the other and build up into a comprehensive toolkit, really, for patient self-management.

Paul Evans

What you’re saying now sounds to me like a programme that is targeted at patients, people living with pain, not necessarily pain professionals.

Tim Atkinson

It’s dual purpose. That’s, I think, the real beauty of it, its selling point. Its USP is that it’s got this dual-pronged attack. They train the professionals to deliver the materials, which are actually targeted at the patients. So it’s not as simple as giving a GP some leaflets or a website to recommend to a patient. It’s far more structured and integrated than that, but it does give patient resources to busy healthcare professionals who might not otherwise have the time to explain in detail some of those self-management techniques.

Paul Evans

What sort of the reaction do you get from the GPs or other healthcare professionals?

Tim Atkinson

Overwhelmingly supportive. What they get, I think, is the confidence to deliver something which is not necessarily part of routine medical armoury. A lot of healthcare professionals don’t feel they’ve got a good understanding of it, they’ve not had the training in it, but it’s an increasing need. Obviously, we know about the mushrooming of chronic pain as a condition and the frightening implications of that over the next few years. So it gives people the confidence to deal with it in a way that’s more likely to have a long-lasting beneficial effect, rather than just sending a patient out with a prescription and hoping for the best. It’s a very broad but very well-structured resource which has got scientific credibility. There is the empirical evidence to show, for example, that participation in the programme does lead to a reduction in opioid prescriptions.

Paul Evans

That’s Tim Atkinson, Vice Chair of the British Pain Society Expert Patients and Carer Committee.

Well, he brought up the subject of prescribed opioids. So what’s wrong with them? Jane Quinlan is a consultant in pain management in Oxford. She works in acute pain management, helping manage people’s pain after surgery or trauma whilst they’re in hospital. But she also runs a clinic for people with chronic pain to help them reduce or give up their long-term use of opioid medications. Here’s the background to what became the opioid crisis.

Jane Quinlan

In 1980, there was a letter written to the New England Journal of Medicine, so a very prestigious journal, from two authors in America called Porter and Jick. Now, what they did was they wrote this letter and said, we’ve just noticed that we’ve all seen 40,000 patients go through our hospital with acute pain. They have all received opioids for their acute pain. But to our knowledge, only four people have developed addiction. Their conclusion is a five-sentence letter. The conclusion was, we can therefore say that despite widespread use of narcotics, another word for opioids, addiction is very rare.

That was published in 1980. In 2017, that letter had been cited, had been referred to, 600 times, and particularly it had been referred to in promotional literature from pharmaceutical companies marketing opioids to say addiction is rare with opioids if you have pain. The original letter was for acute pain patients only, and it wasn’t a proper study. They didn’t follow them up. They didn’t define addiction. It just was a bit of a chat in a pub, essentially. But when doctors saw that the promotional literature said that this New England Journal of Medicine study says that addiction is rare in patients with pain, it gave huge amounts of confidence to clinicians to prescribe opioids like they’re going out of fashion.

That letter was one of the drivers. There were other drivers to the opioid crisis in the United States. It was never intended to be anything of the kind. I think we all know about the opioid crisis in the United States, where all these patients were suddenly put on these drugs that didn’t help their pain, but did get them addicted. And we, as the acute pain community, accidentally were part of that.

Paul Evans

And now the issue is trying to draw back from that.

Jane Quinlan

Completely. Completely. So, opioids, and what we mean by those, we’re talking about morphine, oxycodone, fentanyl, codeine or tramadol, are great for acute pain after surgery or trauma, when the pain system is working exactly as it should do. The pain system is telling us that we have damaged ourselves and we need to be careful. And opioids work really well there.

What we know now that we didn’t know twenty years ago was that chronic pain, pain that’s been going on for longer than three months, represents a dysfunctional pain system. Your pain system isn’t telling you anything helpful. It’s gone wrong. And it’s giving you all these awful messages of pain even though there’s nothing actually wrong with your body. Opioids don’t work for chronic pain, not for the majority of patients, at least.

And opioids are quite dangerous drugs, so they can slow down your breathing, they can give you constipation. They can affect your memory and your concentration. They can reduce your sleep at night. We now know there were long-term effects on your hormones. Some men on opioids have sexual dysfunction without realising that that’s why. And of course, they’re addictive drugs. If you take them for a long time, your body can become dependent on them, and occasionally you can become addicted to them. And that means that the opioids start controlling you, rather than you controlling the opioids. And there’s an increased risk of death.

With all of those things, we now know that people taking long-term opioids for chronic pain actually have a worse quality of life and increased risk compared to those with chronic pain who are not taking opioids, they’re not helping. But because twenty years ago, we thought they were a good idea, we as a medical profession started lots of patients on them. So now we as a medical profession have to take responsibility and support people coming off, which is a difficult thing to do. So we have to make sure that it’s gradual, that patients understand the importance of that, and we give them a lot of support when we’re doing that.

Paul Evans

Is it a difficult equation to balance, really, when people think they’re taking opioids medication because it is making them better, but actually they’re having no effect on the pain?

Jane Quinlan

Yeah, yeah. We see that a lot. A lot of patients I see really feel very strongly that the opioids are helping them and are giving them a better quality of life. So it’s pretty terrifying when someone like me comes along to say, actually, we’re going to take your opioids away, because they panic, because things are going to get much worse. But actually, most patients I see who are taking long-term opioids also describe severe pain. What that tells me is that this isn’t an opioid-sensitive pain that they’ve got. If it was a pain where opioids were going to help, they’d be on much lower doses and they wouldn’t have any pain. If you’re taking opioids and you still have severe pain, if we take the opioids away, your pain will stay the same because they weren’t doing anything. But that’s a huge leap of faith, and I understand completely. That can be very scary for people.

Paul Evans

And I suppose it’s very tempting to prescribe something. It’s not working. Increase it. Not working. Increase it. It’s not working.

Jane Quinlan

Exactly. And we see that all the time. We see a lot of patients on very high doses, not because they wanted the high doses necessarily, but they were told by doctors, we’ll just increase it until it starts working. And now we know it was never going to work. And so again, coming off high doses is a really difficult thing. So we do a really gradual reduction. We warn patients that as they’re coming down the pain may get worse. Anxiety and depression may get worse because your body has got so used to them over these last years, and your brain chemistry has got so used to them, that your brain is thinking, what? Where have they gone? And it feels a very scary time. But that’s not how life will be long-term. It’s just your brain readjusting to life without opioids and that extra pain, extra anxiety, extra depression, settle down as the doses come down.

Paul Evans

And I have talked to people, I know it can be very, very, well, life-changing to come off those high-opioid medications. People say it’s changed my life.

Jane Quinlan

Absolutely, absolutely. And I’m back to the person I used to be. And a lot of them will say, I’ve suddenly realised that I was almost asleep for all those years. You often hear that from family members as well, saying it’s really lovely to see our family member back again, because they’ve been so dopey, they’ve been so down, they’ve not been leaving the house, everything’s been awful for years, they’ve now got themselves back, which is lovely.

Paul Evans

That was consultant in pain medicine Professor Jane Quinlan. I’ll remind you, as I always do, that whilst we in Pain Concern believe the information and opinions on Airing Pain are accurate and sound, based on the best judgements available, you should always consult your health professionals on any matter related to your health and wellbeing. They are the only people who know you and your circumstances and therefore the appropriate action to take on your behalf. Now, it’s important for us at Pain Concern to have your feedback on these podcasts so that we know that what we’re doing is relevant and useful, and to know what we’re doing well, or maybe not so well. So do please leave your comments or ratings on whichever platform you’re listening to this on, or the Pain Concern website. Of course, it’s painconcern.org.uk, and that’ll help us develop and plan future editions of Airing Pain.

I’ll leave you with some important and potentially life-saving advice about the disposal of leftover medicines, particularly opioids, from consultant Jane Quinlan.

Jane Quinlan

Take the leftover opioids to a pharmacy.

Do not, as most people do, leave it in your bathroom cabinet, because we know there’s a risk of overdose for toddlers if they find tablets that they don’t know what they are.

There’s a risk for teenagers who know that there are opioids in the cupboard and want to just give drugs a try, which is terrifying. An interesting study in the States recently said that 50% of opioid addicts in the States had started with prescribed opioids from family or friends. Yeah, I know.

And then the third thing we’ve got to be careful of is if at home you’re not sleeping very well, you’re having a bad day, you sprained your ankle, and there were these painkillers in your bathroom cabinet, you might start thinking, I’ll just have a couple of those. And then that is really dangerous behaviour.

By trying to educate patients to use their opioids wisely, stop them as the pain settles and take the leftovers to a pharmacy, that would make things much safer for patients.

4 May 2026 marks a momentous day for Kieran Hinsley. You see, this is the day of the Milton Keynes Marathon, which Kieran will be running – with chronic pain.

Pain and guilt

At just 25 years old, Kieran’s swollen, stiff fingers prevented him from even doing up his baby girl’s clothes. Why isn’t the guilt of those suffering with pain talked about more? This guilt and the inability to function as he so wished prompted Kieran to fear he was failing both as a dad and a husband.

Pain like a silent rebellion

In his mid-twenties, an age when most young men feel invincible, Kieran’s body was staging a silent rebellion against him. Things were unbearable, yet his further anguish was that he was fighting to be believed. He states, ‘I spent years trying to convince doctors that something was wrong’.

Taking back control

Over the next few years, Kieran’s pain and swelling spread throughout his body. Things got that severe that dressing himself became impossible, as well as not being able to walk sometimes. Now enter the blossoming of Kieran’s resilience, ‘I realised no one was coming to rescue me’, he says, ‘I had to take control’.

Reaching out for hope

It is through the vital information and support that charities like Pain Concern offer that Kieran found a new sense of hope. He now fully accepted his pain but was determined his future wasn’t going to be defined by it.

Present day

Due to the regularity of his flare-ups, Kieran has decided to take his time preparing and training for this marathon. Sleep deprivation and swelling have made some training sessions impossible, but then there have been better days where he has managed two separate five-mile runs. At the forefront of Kieran’s mind is that he is training with the condition rather than pretending it is not there.

You are not alone

Kieran says, ‘I’m running the Milton Keynes Marathon not just as a challenge, but as a statement – to myself, my family and anyone on their pain journey feeling terrified, lost or alone. I want to show them that life can still move forward’.

Support Kieran Hinsley

We ask you to show your support for Kieran. He is going to show that dreams don’t have to die when you live with pain. If anything, they become even more rewarding to achieve.

Donate to Kieran now

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First broadcast: 3 March 2026

Paul Evans

This is Airing Pain Supplement, brought to you by Pain Concern, the UK charity providing information and support for those of us living with pain, our family and supporters, and the healthcare professionals who care for us. I’m Paul Evans.

Edition number 91 of Pain Concern’s Pain Matters magazine will be released on 3^rd March 2026. It’s guest-edited by the Bath Centre for Pain Services Co-Production Team. It focuses on neurodiversity, shining a light on underrepresented challenges and harmful misconceptions, and how every patient is different and needs to be treated, and appreciated, as such.

As an Airing Pain podcast supplement to this important edition, I spoke to Dr Dave Moore, Reader in Pain Psychology at Liverpool John Moores University, who’s researching the pain experiences of neurodivergent, primarily autistic, people. He is himself neurodivergent. So do neurodivergent people experience pain differently to those who are neurotypical?

David Moore

That’s one of those questions that kind of has a simple answer and a more complicated one. The simple answer is no, they don’t. If we bring neurodivergent people into a lab and do pain psychophysics to look at pain thresholds, then thresholds for a neurodivergent population do not seem to systematically differ between a neurodivergent population and a neurotypical population. The slightly more complicated answer is there do seem to be more people within the neurodivergent community who might feel pain slightly differently, so there might be more likelihood of having someone who responds to things a little bit more differently, even if the population overall doesn’t differ. And beyond that, things like anxiety around pain, anxiety around approaching healthcare situations, are more prevalent within neurodivergent people. And for that reason, if you’ve got somebody who’s hurt themselves and is in A&E, they may well be feeling that in a different way to their neurotypical counterparts sat opposite them who’ve done the exact same injury.

Paul Evans

So as far as measuring the pain, the pain might be the same, but the reaction to it is different.

David Moore

Quite possibly, yes. I think there are lots of different ways that might differ, both in terms of the intensity of that pain that’s reported, but also in terms of how that’s communicated to other people. And that might be a very high level of distress in somebody who’s incredibly anxious. But it also might bring in challenges and issues around things like shutdowns and other kinds of issues where a person might actually almost appear catatonic and as though they’re not in pain at all.

I think there’s always that challenge that we have to acknowledge when we’re thinking about how I communicate my pain to you. Any social communication we have has that social value. I’m trying to share my state with you, and the reason I would share my state with you is because I think you can help me. And if for some reason I don’t trust you, I don’t think you can help me, then I might mask that pain. I might hide that pain, I might camouflage it. And we think that might be more common within a neurodivergent population. It’s possible that somebody might be in a considerable amount of pain, but might find the social context so challenging that they may be masking those behaviours. So it’s a really complex picture.

The work that we did early on was much more in that, what are the pain thresholds in autistic people? And are there fundamental differences in the way that the autistic population feel pain? We could keep doing that for probably forty years, but I’m not sure that we’d learn a huge amount more at the moment.

And the need that we have is that autistic people are overrepresented in chronic pain services. About two to three percent of the population are probably autistic, once you correct for underdiagnosis. About a quarter to a third of young people accessing chronic pain services and the most complex level of care appear to be autistic and more widely neurodivergent.

So we’ve got a huge number of autistic people in pain services. And I think that raises two questions. One is when people are in those tertiary pain services, what can we do to remove barriers to accessing healthcare and to improve the outcomes from multidisciplinary pain management services? The other is why is it that neurodivergent people are passing through our primary and secondary healthcare systems and are going on to have acute pain become chronic? So those are really the two questions we’re trying to address at the moment, is how can we best treat pain and how can we best support acute pain to stop it becoming chronic?

Paul Evans

Okay. Let’s start with the first one. How should, how could, somebody with chronic pain who’s autistic or neurodivergent be treated.

David Moore

So the first thing is that the treatments that we have appear to be broadly effective. So I would say that if it’s a young person, in particular, who is presenting as neurodivergent and has chronic pain and is going for a tertiary pain service, then they will probably respond to that combination of pharmacological management, physiotherapy, talking therapies and more general, you know, family support.

But there do seem to be some barriers in there. Our pain management approaches use a lot of imposed metaphor. There’s a story that’s often told about, imagine that we’re on a bus and the bus is going where we want it to go, and then another person gets on and that person’s called pain, and they want the bus to go somewhere else. And then fatigue gets on and it wants… We’ve had a few of our autistic patient partners and participants say, I’m not on a bus, I’m in a pain service, and I can’t imagine not being in a hospital at the moment.

Paul Evans

So in a clinical situation, somebody who has autism and has chronic pain, the clinician who’s been on all the courses is listening very carefully. He moves forward slightly and he’s nodding all the places. Yes, I understand, I really understand what you’re going through. Showing empathy, if you like. That comes across completely differently to the patient.

David Moore

It certainly has the potential to come across very differently. It may be that for somebody a very direct kind of eye contact may be actually quite confrontational and may feel like they’re being judged. Even a sentence like ‘I completely understand what you feel’ is a really common way that we often share our conversations with people. But the reality is, you don’t know how that person feels. You neither have their neurotype nor do you have their chronic pain condition. Again, for a lot of neurodivergent people, communication can become kind of slowed in certain conversations, or people may be very deliberate over words that they pick. And it’s very tempting for a neurotypical person to fill in the words that they are expecting to continue that kind of communication going forward. But that can really invalidate that experience, and giving people just that space to end their own stories or to complete their own narrative. All of these kinds of small things can be challenging.

There’s a really interesting model that we try and keep in our mind with a lot of the work, really all of the work, that we’re doing at the moment. It’s a model that’s quite old now, but it started to pick up a lot of interest in our service. It was developed by a guy called Damian Milton and it’s called the double empathy problem. Essentially, it was a counterpoint to the idea that autistic people don’t have empathy. The idea here was that people empathised, but empathy is a set of behaviours more than anything else. If you don’t empathise in the way that the person you’re talking to receives, then you’ll perceive that person to be unempathetic.

Now, the majority of people are neurotypical, so we have a shared way of communicating, of sharing our experiences, and we get to feel like we know each other quite well. If we’re working with somebody who’s neurodivergent, by definition that’s somebody who has a brain that works in a different way. And because of that, what we find is that if you put two neurodivergent people together, they empathise really well with each other. They have a shared understanding, a shared kind of world. A part of the challenge of this double empathy problem is that you’re trying to build a relationship across neurotypes. You’re trying to have a situation where a neurotypical and neurodivergent person are trying to share their spaces.

An example I would always think of is, if you travel to somewhere in Asia with a very different culture or somewhere in Africa with a very different culture, it may be that you can even learn some of the language, or you can find a common language, you can talk, you can understand, but really understanding the culture and the experiences of that person, where their life is so different to the way that you see it, is a much greater challenge. And the double empathy problem, I think, is not too dissimilar to that. You’re trying to understand somebody who doesn’t view the world, and from the day they were born didn’t view the world, exactly the way that you do or did. It takes a real amount of stepping back and just seeing how is it that I can try and, if not share the space with this person, allow them to try and share their space with me.

I think a part of the challenge is that our best way of managing pain, generally, certainly at scale, is by group treatment. So you may be finding that you’re treating, let’s say, eight people, two of whom are neurodivergent, one of whom may also be currently undiagnosed. Especially for neurodivergent young women or gender-diverse populations, they often receive their diagnosis later and have other complex walkways through that journey. So there’s the possibility that the provider either doesn’t know, or that the general feedback they’re getting is positive. And beyond that, the social anxiety that’s very common within neurodivergent and particularly autistic young people, to go to somebody in a position of authority and say, ‘This isn’t working for me’ is probably not there. So I think one of the challenges is that for a lot of healthcare providers, they probably don’t realise that they’re losing their neurodivergent patients along the way, because no one’s feeding back to them that ‘This metaphor is not working for me’.

Paul Evans

So how do you get that over to the profession?

David Moore

One of the big things that our lab’s saying, whenever we’re invited to speak to healthcare providers now, is if you’re treating people in pain, you’re treating autistic people in pain. The reason that your service is possibly not getting the figures that get you extra funding from the government, or that you’re sitting in meetings and trying to work out why you’re discharging patients who are not recovering, is that you’ve got neurodivergent people in your service who are struggling with the treatment you’re providing. And if you make some small modifications to that treatment, if you’re culturally sensitive in the way that you deal with those young people or those adults as well, then we might just find that we get the double benefit, that there are fewer people suffering, fewer people coming back who need to be treated again. And our services are getting better outcomes, and we can kind of say that we are improving the pain experiences of our patients.

Paul Evans

That’s Doctor Dave Moore, Reader in Pain Psychology at Liverpool John Moores University. Pain Matters, guest-edited by the Bath Centre for Pain Services Co-Production Team, will be available on 3^rd March 2026. Check out the Pain Concern website at painconcern.org.uk for more details.

People are suffering. We’re offering solutions.

For those in pain, and those who care for them, Pain Concern works towards a world where pain is better understood and does not stop people living the life they choose to live. Our latest Impact Report shares what we achieved this year, and what we’re focusing on next.

What we achieved this year

Celebrating 30 years of publishing and podcasting

This year we marked 30 years of trusted information and conversation about pain, and brought that experience together in new resources, including a bumper-size Comprehensive Guide to Navigating Life with Pain, a milestone episode of Airing Pain, and short pain education videos created for screening and professional learning.

The Helpline, someone to turn to

Our Helpline team offers information, support, and empathy, with helpliners who have lived experience of pain.
Around 200 people helped each month by phone and email
Clinically led supervision and training aligned with Helplines Partnership standards

Pain Matters magazine, practical support people can use

Pain Matters shares expert-led discussion and informed self-management support, with contributions from health professionals, researchers, and people living with pain.

Digital subscriptions include the full back catalogue
Free sample issue available for non-subscribers
Audio option available, turning each issue into a podcast
Also available in print

Airing Pain podcast, learning that travels

Airing Pain now includes 150 programmes, bridging professional and public education
Around 1,100 listeners each month.
Recognised for Continuing Professional Development credits by the Faculty of Pain Medicine
Produced in partnership with the British Pain Society at scientific meetings and events

Online community support, peer support since 2010

Our HealthUnlocked community helps people connect and feel understood.

Every month:

1,600 active members
280 new posts
150 new members Impact Report 2025

Pain education sessions, building knowledge and confidence

Our 2-hour Pain Education Session supports people who have had pain for more than 12 weeks. It is delivered by educators with lived experience, through partnership working with the NHS.

Collaboration across 5 health boards
42 education sessions delivered this year

Mindfulness sessions, learning to live with pain and emotions

We continue to deliver online taster sessions and courses led by mindfulness teacher Cath Ashby, supporting people to build skills they can use in daily life.

Every month:

10.5K followers across our social media platforms
17K visits to our webpages
900 downloads of our support resources
2,000 people receive our news

Our goals for the year ahead

Shaping our future

We are bringing patient voices and key stakeholders together to strengthen how pain is understood and prioritised in policy and services. We will keep building partnerships across pain organisations, research communities, and health and care networks. Impact Report 2025

Shaping better-informed, more compassionate care

We will continue to contribute to guidance, education, and professional resources, and we will keep showing what works when people with lived experience sit at the centre of service design and research.

Driving change

Pain is the world’s leading cause of disability and poor health. We will support the International Association for the Study of Pain’s 2026 campaign for Neuropathic Pain, and we will keep developing tools and resources that help people navigate life with pain.

Thank you

If you read, share, volunteer, fundraise, donate, or recommend our resources, you help make this work possible.

Call to action

Read the Impact Report 2025/2026

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First broadcast: 3 February 2026

Paul Evans

This is Airing Pain, a programme brought to you by Pain Concern, the UK charity providing information and support for those of us living with pain, our family and supporters, and the healthcare professionals who care for us. I’m Paul Evans, and this episode of Airing Pain is produced in partnership with the British Pain Society.

Katelynn Boerner

The timing of puberty makes quite a big difference for girls in terms of a variety of different outcomes, including pain. So, going through puberty early is actually associated with a lot of detrimental outcomes for girls.

Rebecca Pearson

I’ve got some footage from the recent Scottish Cup final where Aberdeen beat Celtic on penalties, and I said to my father, who’s an Aberdeen fan, I said, ‘I think they’re going to do it’, by the look of the face of the goalkeeper. And that is a real thing of just how important, that’s – you know, you’ve said, ‘What’s an interaction’ – that’s an interaction. Goalkeeper, striker.

Paul Evans

I promise it’ll all come clear soon. Now, if you’re a regular listener to Airing Pain, you’ll know all about the biopsychosocial model for chronic, or persistent, pain. That is: the physiological, our physical health; the psychological, our thoughts, emotions and behaviours; and the social, that’s everything from our environment, relationships, school, work, money, cultural factors and so on.

So why is this biopsychosocial model so important? Cormac Ryan is Professor of Clinical Rehabilitation at Teesside University. He is also a Community Pain Champion for the Flippin’ Pain campaign, a public health campaign funded by Connect Health. Its mission is to change the way that we think about, talk about and treat persistent pain.

Cormac Ryan

We are as human beings a single entity, and we use the term biopsychosocial as a shorthand way of understanding the different factors that might influence us and how we behave, how we experience things, how we action things. But it’s a bit of a false dichotomy to say that ‘Oh, there are distinct biological things, distinct psychological things and distinct social things’. They’re so interwoven, they play upon each other in such a way that to understand one area is to have some understanding of the others. Understanding how they integrate with each other, how they play with each other, that can be really, really powerful, knowing how things like social communication can actually influence your biology, how your thoughts and your fears can influence your biology and subsequently influence how you interact with people.

Paul Evans

We are socially interacting now. We’re speaking with each other. Our minds, hopefully, are working – well, we’re concentrating. How could that affect our biology? Or, if we weren’t happy doing this, how would that affect our biology?

Cormac Ryan

When we’re doing our public health road shows within the Flippin’ Pain campaign, there’s some studies that I like to draw on particularly, because I just find them so fascinating, they’re great stories.

It’s a rat study. I appreciate it’s not a human study, but you’ll see as I go through why it couldn’t be a human study. But how we are made up is quite similar as mammals, for want of a better word. Rat Community One have noisy neighbours, but considerate neighbours. They play lots of loud music a bit randomly, but between nine and five, normal working hours. The rest of the time, they’re quiet and they’re good neighbours. Rat Community Two have equally noisy neighbours, but they’re really inconsiderate. They will play loud music and make loud noises at any time of the day or night, at really random times.

What the scientists found is that in Rat Community Two, where they had the inconsiderate neighbours, they developed classic signs synonymous with having persistent pain – hypersensitive to pain, fatigue, withdrawal, lots of those signs that we can relate to people. The scientists described these as ‘fibromyalgia-like’ symptoms, but I think one could see it more broadly as just chronic pain-like symptoms.

Another reason why you couldn’t do this with humans is that afterwards all the animals were euthanised, and the scientists then explored their biology. The biology of Rat Community Two, who had the inconsiderate neighbours, had changed – so their physiology was now more in keeping with the physiology of someone with persistent pain. Their nervous system and their immune system had altered in such a way as, essentially, you become better at processing stimuli in such a way as it produces that pain experience. So, stressful-based social interactions had influenced the biology of the individual in such a way as they were more likely to develop and experience pain.

Paul Evans

That’s Cormac Ryan.

So, as I said, in this edition of Airing Pain, I’m focusing on the social component of the biopsychosocial model for pain, and in particular, social interactions – in the broadest terms, any communication that occurs between people.

Adverse conscious interactions – we’re talking the physical and facial and tangible – they can be interpreted by the person you’re interacting with. Joy, sorrow, anger, pain and more. There are unconscious actions that we don’t know we’re making, feelings that we don’t wish to reveal, or even that we don’t know we’re experiencing.

Rebecca Pearson is Professor of Developmental Psychology and Epidemiology at Manchester Metropolitan University. Her research area is in psychological mechanisms underlying child and adolescent mental health and development, including pain.

Rebecca Pearson

We know that people mask emotions. I think that probably stemmed out of work on social masking and autism. I’ve got some footage from the recent Scottish Cup final where Aberdeen beat Celtic on penalties, and I said to my father, who’s an Aberdeen fan, I said, ‘I think they’re going to do it’, by the look of the face of the goalkeeper. And that is a real thing of just how important, that’s – you know, you’ve said, ‘What’s an interaction’ – that’s an interaction. Goalkeeper, striker.

If you think about being in pain and then your loved one, whether that’s your child – so I’m very interested in mum–child interactions, looking at that intergenerational pain – or your partner. You want to protect your child from knowing you’re in pain. You want to protect your partner, you don’t want them to be like, ‘Let’s not go out actually, after all’. What is that doing to the subtleties of human interaction?

So pain masking might be, and this is again where I come to the example, which I do think is a useful one, about the goalkeeper. What’s the ground truth. The ground truth is a concept of, let’s say, the real truth. What’s the emotion? Is the emotion that’s relevant what you feel? And you’re feeling like, ‘I don’t want to be here, I’m in pain, it’s bothering me’. Then there’s the emotion that you show, and how that’s perceived by the other person. Not knowing about the pain, they might be like, ‘They’re annoyed with me’. Then that means two people have a sequence that, over time, gets a bit misaligned. These interactions occur in the moment, but they gain meaning over time, that kind of interplay of sequences.

So you take that tiny interaction of suppressing the pain. Maybe you’re looking a bit not-quite-right to someone who knows you really well. It’s like something’s a bit off. But people tend to make it about themselves, because we all do. I think I’ve annoyed them, right? And then they start to be a bit different. And then the person in pain is like, ‘Oh, they’re now annoyed with me because I’m ruining their day.’ I’ve heard from public contributors and those living with pain, they feel a burden. So it’s all of this – do you see what I mean – this interaction.

Paul Evans

I sort of see masking in that sense, as I have pain. Somebody says, ‘How are you today?’. I’m fine. Well, it’s a lie, but that is masking. But what you’re saying is there are more tells than just me saying I’m fine, but I’m not.

Rebecca Pearson

Yeah, it will be more complex than that, because, actually, probably what you want – or maybe you don’t, I think I would – is you want them to know you’re not really fine.

Let’s flip it to some more strength-based moments. This is what’s been researched heavily and understood heavily as parent–child interactions. We know that you can really pull out those strengths-based moments where the mum has really been attuned to the baby and worked, because the babies can’t tell us, worked out what they want – perhaps all that attunement.

So we know that supportive relationships can be really protective in living with pain. Can we get that understanding of the subtleties to be understanding that actually maybe they’re beginning to feel that it’s a bit much for them, or those precursors, and that little bit of reassurance, it’s okay to tell me you’re in pain.

And one of the other things that’s quite interesting. Again, I’m really afraid I keep going back to this football example, but it’s very good because we’ve got this emotion-reading software, and I’ve just for a demo purpose ran it free. You can break the mask, and you’ll see that outside of this composure, when they win and his teammate comes over, there’s a spike of this happiness, so it’s lifted the emotions out, and that’s a positive emotion. But it’s like, how can we have those safe moments to unlift that, because it’s tiring. We know that from autistic burnout. It’s called that. It’s tiring holding that in. So that might be what’s happening in pain. You’re not just dealing with pain, you’re holding it in for everyone else. And then there’s that burnout. So where are those safe spaces and those connected people that you can say, ‘Actually, I want to go home, I’m feeling, you know’.

Paul Evans

So going back to your goalkeeper and penalty taker. You had worked out that the goalkeeper was going to fail.

Rebecca Pearson

No, he saved.

Paul Evans.

Oh right. Okay. So you had worked out that the goal would be saved and the goalkeeper was –

Rebecca Pearson

Ready for it.

Paul Evans

He was the winner. What would have been in his facial expression hidden from most of us that you thought, ohh.

Rebecca Pearson

Yeah. And I’ve actually put it through the AI software – that agrees with me. Honestly, I’m on record saying it. It’s because he believed he was confident. And when he was interviewed afterwards, they said, well, what was going through your mind? And he said, the manager – I think it’s manager, not a football expert – had said, when we win, not if. And he said, ‘This is your moment to be a hero’. And the reason I thought, ‘I think he might’, was because he micro-smiled. It was almost like, ‘Okay, I’m going to enjoy this’, not ‘I’m scared’. But he was then composed. So I said ‘I think he might’. And he did. He saved two penalties. I mean, this is a little, you know, who knows if I’ve got a career in penalty prediction.

Paul Evans

Well, there’s money in it, I’ll tell you.

Rebecca Pearson

Oh, well, there you go. But it’s something about that, just how powerful that actually is. And maybe I was lucky, but it’s something about that interaction. And I know that they do that in that training. Does this, and all the expertise I bring from a completely different area of work, can that help us understand how living with pain impacts relationships and, most importantly, how to draw on the strengths of those close relationships?

Paul Evans

I put it down. This sort of double masking, if you like. It’s me masking my pain, but you masking what you think of my pain.

Rebecca Pearson

Oh, that’s brilliant. I’ll be quoting double masking. You’ve come up with that? You’ll be on record. Yeah, well, that’s what I said. There’s double ground. Exactly. Because then you can see a cycle. I’m sure we’ve all experienced some loved one being in some form of pain or illness. And you’re like, ‘Oh, I don’t want them to think I’m mollycoddling them either. If they want to carry on, that’s fine’. So exactly. Double masking and double interpretation.

And then you can see it escalating. Because what we’re seeing in the epidemiological work that I’m also involved in is that over time, in large datasets, young people who are living with pain later on report less social connections, less feeling support. And our hypothesis is that they’re withdrawing because they don’t want to be a burden. Or another thing is, might they be getting misinterpreted, as maybe people are like, ‘Oh, what’s up with them?’. You know, but if they just said, ‘Oh, actually, I’m in pain’ or ‘I don’t like you’, it might help that kind of double-de-masking then, perhaps.

Paul Evans

So how does your software, your AI software, work? I mean, what is it looking for.

Rebecca Pearson

This is something that’s out there commercially available. It’s something called FaceReader. I and many researchers use it. It’s been well validated based on the FACS: Facial Action Coding System. It’s based on facial muscles that are well validated to show particular emotions. So that’s what you’re looking for. Every frame is nought-point-nought-two seconds, usually. It will compute based on the specific facial expressions and intensities of emotion. This is yet to be applied to pain research, but certainly in teenagers it’s very predictive of how they’re feeling. So the self-report questionnaire, you get the same as if you got a psychology student to pick that emotion. But it’s giving us that tiny fine-grained time, which I think is nought-point-nought-two seconds. So that’s, you know where I said about, the goalkeeper micro-moment. Now software is opening up that possibility to see these tiny changes.

Paul Evans

Firstly, there’s no end to a research programme. There might be an end to the funding, but learning continues. How do you think this will be used in the future?

Rebecca Pearson

This is the beginning of saying, well, all those things that you’ve raised. What parts of that are helpful in understanding if we can use some of it to reduce the impact on relationships that being in pain has? Can we get those people, whether it’s parents, children, friends, intimate partners, to say, ‘Okay, well, how can we use the strength of our relationship and those momentary interactions, understanding each other’s features and emotional signatures’? Most people with pain say it’s not that they want necessarily the pain to stop – they don’t want it to be having such an impact on their lives. So maybe it can reduce the impact on people’s lives if we understand the strengths of relationships.

Paul Evans

Rebecca Pearson, Professor of Developmental Psychology and Epidemiology at Manchester Metropolitan University.

So, the social component of the biopsychosocial model for pain – that is how everything from our environment to our relationships, school, work, money, cultural factors and so on affects us. Gender and gender identity must be part of that equation. So do boys, girls, non-binary, trans children and young adults experience pain and the care they receive differently?

Katelynn Boerner is Assistant Professor in the Department of Paediatrics at the University of British Columbia in Vancouver, Canada.

Katelynn Boerner

We know that that experience is quite different, and that a lot of that comes from the social expectations. I think from very early on, young people are exposed to the message that boys should ‘Tough it up’ and be stoic and not show their pain – you know, ‘Big boys don’t cry’. Really, what we now call toxic masculinity. I think boys from quite early on learn not to express their pain, particularly in social settings, if they want to appear masculine. And on the flipside, I think those gender biases are also very harmful for girls and young women, who, also from quite early on, can be told that they’re being dramatic or hysterical, or that their pain is all in their head, that it’s not real.

So there’s these toxic gender biases that are imposed on both boys and girls. And what some of my more recent research has been looking at is how do transgender, gender-diverse, non-binary youth experience some of those same norms. A lot of gender-diverse youth will talk about being very aware of those norms and actually using them, even if it’s not helpful in terms of managing their pain, as a way of sharing their gender identity with the world and having people treat them in the way they want to be treated, which I think is fascinating – that these young people are aware, like ‘This is an unhelpful stereotype, but this is the game that I need to play if I want people to take me seriously’.

Paul Evans

I mean, the transgender thing is interesting, isn’t it, because somebody who’s brought up as a boy and transitions into being a girl, you’re really shifting the stream. You know, ‘Big boys don’t cry’ and ‘Be a man about this’ to, as you were saying, ‘Come on now, you know girls don’t do that’.

Katelynn Boerner

Yeah, and then there’s this extra layer of – I think a lot of transgender youth have this experience of not being believed. You know, that idea that they don’t know themselves, or that maybe their gender identity is something’s that going to change again, so nobody wants to take them seriously. So there’s this additional layer of suspicion that a lot of them encounter in the healthcare system, even if actually what they’re seeking treatment for has nothing to do with their gender identity. It still has the potential to colour that healthcare interaction, and that’s where I think we need some of this research in the pain world, because the way that we’re interacting with boys, girls, gender-diverse youth, in theory, should have nothing to do with their gender if we’re focused on their pain. But actually, it’s so relevant.

Paul Evans

It has everything to do with it.

Katelynn Boerner

It does, yeah, and I think what we’re also trying to figure out is, what are the psychosocial components related to gender that impact the pain experience? And what are the things like hormonal experiences that are impacting pain? And we have a lot of reason to believe that the sex hormones that emerge around the time of puberty are playing a big role in discrepancies that we see between men and women in terms of their pain experience, but we don’t really understand enough about how those two things intersect, and we don’t have a really good biopsychosocial perspective.

Paul Evans

What do you think is going on?

Katelynn Boerner

Well, one finding that we see pretty consistently is that differences based on sex and gender tend to emerge after puberty, so there’s certainly a sex hormone role, but puberty in adolescence is also when there’s a lot of social context happening, a lot of social pressure for young people to determine their identity and figure out how to share that with the world. A lot of pressure to start to have some independence in how they’re navigating the healthcare system. So I think it’s a little bit more complicated than just you hit puberty, the hormones appear, and that explains all the differences.

One other thing that we’ve found in our research is that there’s differences in terms of how boys and girls experience social modelling. So we know that pain tends to run in families, and if a child is exposed to pain from a parent, that impacts girls differently than it does boys.

Paul Evans

You mean if the parent has pain?

Katelynn Boerner

If the parent has pain, yes, it impacts the child’s own pain experience differently depending on the sex of the child. What’s interesting is that it doesn’t seem to matter so much the sex of the parent. We initially thought boys would be more impacted by observing a dad than a mom, and vice versa for girls. But from some of our experimental work, we found that actually that’s not the case. It’s girls who see an exaggerated or more intense pain expression from either parent, who experience more pain themselves.

Paul Evans

I thought you were talking about the empathy side of it, but the experience of their own pain is different.

Katelynn Boerner

Which could very well be, at least in part, because of a difference in empathy or social attunement. There’s some other research that suggests that girls might pay more attention to social cues in their environment than boys. It’s entirely possible that what’s going on there is just girls are more attuned to or alerted to what is happening for their parent when they’re undergoing a painful experience, and then when the child undergoes pain, subsequently, that is impacting girls in a different way than boys.

Paul Evans

One thing you have to take into account, I guess, is that boys and girls develop at different times. So a 14-year-old girl might be the equivalent of a 16-year-old boy in maturity.

Katelynn Boerner

Yeah, and there’s some interesting research showing that timing of puberty makes quite a big difference for girls in terms of a variety of different outcomes, including pain. So, going through puberty early is actually associated with a lot of detrimental outcomes for girls, and that would further widen the gap between them and boys. But then the other thing that’s also happening during puberty is, for young girls and women, the start of menstruation. That’s a monthly pain experience, one that, for many young people, is significantly painful. And if you think about that co-occurring with the emergence of other types of pain conditions, it’s a complicated picture. It looks very different for girls than it does for boys. And that’s also why there might be unique experiences for trans and gender-diverse youth.

Something I’ve been thinking a lot about is, how do we use this information to inform healthcare providers about the biases that they might be running up against when they’re assessing pain? There’s a growing body of research that suggests that pain tends to be underestimated for girls relative to boys, and there’s some really interesting experimental research that I cannot take any credit for, I haven’t done, but where they’ve shown adults and healthcare professionals pictures or videos of children undergoing a painful experience. If the adult caregiver or health professional is told this child is a boy, then they rate their pain as being higher than if they’re told this child is a girl, even if everything else remains constant. And these are really profound findings, I think, because the stimuli that are used in these studies are of relatively young children, like children that would be of an age where we actually wouldn’t expect to see any sex differences emerging yet, because they haven’t reached puberty.

Paul Evans

Let me illustrate. Before even you’ve seen the child, there’s a built-in bias. If you’re male, you are scored higher for pain.

Katelynn Boerner

I think part of that comes from this idea that boys are socialised not to show pain. So if you’re seeing pain, then it must be really bad. Whereas we’ve sort of, I think, become desensitised to the pain of girls and women, it’s sort of expected and normalised. So girls and women don’t get rated as having the same level of pain, even if the expression and the stimuli – in some cases, they even use the exact same video of a child who’s dressed and appears androgynously, so that the video is exactly the same, but people are rating their pain differently.

Paul Evans

So girls go through menstruation, they go through childbirth, so women are used to pain, therefore they can cope with it better.

Katelynn Boerner

But it’s interesting to think about how we do normalise different types of pain for different genders. If you think about for boys and men, we really normalise experiencing pain related to physical pursuits like sports or where there’s an aspect of competition, and that’s pain that’s sort of celebrated, but the pain that’s really normalised for girls and women is illness and menstruation and childbirth, maybe that’s celebrated. Those are pains that are perceived differently in terms of what a normal pain experience is for genders.

Paul Evans

So men get man flu. In other words, they go to bed on day one, but women hold their own.

Katelynn Boerner

This is where I think there’s some fascinating work that’s being done looking at gender role threat, which is if you identify as being masculine or feminine, and I think this seems to be true regardless of the sex that you’re assigned at birth, if you identify as masculine, and something interferes with your ability to feel masculine – and if you think about it, pain is a huge interference when it comes to gender roles – if you’re not able to be stoic and strong because you’re in pain, that’s a threat to masculinity. On the femininity side, we can see something similar, where, if pain is interfering with traditional feminine activities, like caring for others, that can feel like a gender role threat as well.

We’ve often thought about sex and gender differences in pain as almost being a bit of a competition. You know, somebody is always being left behind, and whether it’s that not enough women are represented in preclinical research or not enough men are represented in clinical research, and gender-diverse folks aren’t being represented anywhere, really everyone suffers when there’s these inequities, and these gendered stereotypes and biases are harmful to everyone in some way or another.

Paul Evans

This is a societal issue as well in the world of pain medicine. I mean, how do you get around this?

Katelynn Boerner

It’s a great question, because I think it is bigger than what an individual clinician can do. I do think that as we get more awareness of where these biases exist, how they influence our research and then subsequently our clinical care, I think the awareness is a really good start. And we’re still working on that.

Paul Evans

I know it’s easy to pay lip service to these things, but of course, we know that. But actually, if you stick a young trans person in front of somebody with a very, very fixed mind…

Katelynn Boerner

It’s really interesting because we did a qualitative study recently where we talked to trans and gender-diverse youth who have chronic pain, and one of the things that we wanted to hear about was what had their healthcare experiences been like. It was so striking to me, to hear these young people talk about what they needed from their healthcare provider. To be clear, we were talking about healthcare in the context of receiving care for their pain. We weren’t talking about going and getting gender-affirming surgery or hormones or anything like that. Really, when it came to their healthcare, what these young people wanted was just to be treated with respect.

I was admittedly shocked by that, because I was expecting that we were going to come out of this study with a huge list of recommendations for providers to say here’s all your dos and don’ts, and here’s exactly how you should practice if you want to be inclusive and create a welcoming environment. And really it was just respect, like if somebody tells you their name, to use that name, and if a young person is still in the process of figuring out their gender identity, to be okay with the fact that that they’re figuring that out, and to not pressure them. A big one was really things that should probably be standard practice anyway, like asking for consent before conducting a physical exam, and just practicing in a trauma-informed way. It was surprising, and I have to admit a little disappointing, and maybe I was naive in assuming that that would have been the standard, but that was not what I was hearing from these young people.

Paul Evans

That was Katelynn Boerner of the University of British Columbia in Canada, and we’ll return to her in just a minute.

But for now, I’ll remind you that whilst we at Pain Concern believe the information and opinions on Airing Painare accurate and sound, based on the best judgements available, you should always consult your health professionals on any matter relating to your health and wellbeing. They’re the only people who know you and your circumstances and therefore the appropriate action to take on your behalf.

Now it’s important for us at Pain Concern to have your feedback on these podcasts so that we know that what we’re doing is relevant and useful, and to know what we’re doing well, or maybe not so well. So do please leave your comments or ratings on whichever platform you’re listening to this on, or the Pain Concern website, of course, which is painconcern.org.uk. That’ll help us develop and plan future editions of Airing Pain.

So I’ll end this edition of Airing Pain with Katelynn Boerner’s advice for healthcare professionals when dealing with young people.

Katelynn Boerner

There’s some shocking statistics in trans and gender-diverse healthcare research about the incredibly powerful impact of having one adult provide a safe and affirming environment for a young person in terms of how well that can predict risk of suicide. You know, as pain providers, again we’re not necessarily in any sort of position to comment on the legitimacy of someone’s gender identity or to make decisions about gender-related healthcare, but we are in a position to provide support. And I think that is a very privileged position we hold.

GIRFT: A New National Focus on Chronic Pain

A major change is underway for people living with chronic pain. NHS England’s Getting It Right First Time (GIRFT) programme has launched a dedicated workstream to improve pain services across the country. The aim is better care for patients and better support for the professionals delivering it.

“We know that chronic pain affects millions of people in this country and that many thousands are unable to work or attend school as a result,” says Professor Tim Briggs, GIRFT programme lead and NHS England National Director for Clinical Improvement and Elective Recovery. “This workstream has long been a goal for GIRFT and I look forward to seeing the short and long term consequences of the work these clinicians will lead.”

Why this matters

The scale of chronic pain is significant:

One in three adults live with chronic pain
One in five children and young people are affected
Twenty percent of adults with high-impact pain say it prevents them from working

This contributes to millions of lost working days, financial pressure, school disruption, and strain on families.

A whole-system review

To address this need, GIRFT has brought together experts across pain medicine, primary care and paediatric pain. The leadership team includes:

Dr Helen Makins, consultant in pain medicine and clinical lead
Dr Jacqui Clinch, consultant in paediatric and adolescent rheumatology
Dr Graham Syers, GP and system transformation lead

Helen Makins describes the programme as “an exciting and long-awaited opportunity for the field of chronic pain management. I know that there is much excellent work and innovation occurring in all parts of the system and we will be looking to highlight best practice and share this equitably around the country.”

What the workstream will cover

GIRFT will carry out peer reviews with pain services across England to identify variation, opportunities and barriers. Focus areas include:

Inequality in access
Personalised care
Pain education for patients and professionals
Digital support
Work and school participation
Safer prescribing
Access to multidisciplinary pain management programmes

This work will be informed by the Faculty of Pain Medicine’s 2025 gap analysis, which highlights variation in service delivery against national standards.

Why this approach matters

GIRFT has influenced change before. Earlier work on spinal care reduced inappropriate use of repeat facet joint injections for back pain. Repeat procedures fell sharply, releasing funds for rehabilitation-based support near home. Costs dropped from £27.6 million in 2015 to £7.9 million in 2020.

Professor Briggs notes that this reflects GIRFT’s purpose of “addressing challenges in the system and consequently improving the patient experience.”

What this could mean for patients

People living with chronic pain may benefit from:

Earlier access to support
Care that reflects their needs at any age
More consistency between regions
Better guidance on options
A shift toward rehabilitation and education rather than repeated procedures.

Dr Makins says the programme will “provide recommendations for improvement which benefit the large number of people of all ages experiencing chronic pain.”

What this could mean for clinicians

Professionals may gain:

Clearer national expectations
More reliable pathways
Greater focus on evidence-based practice
Peer review support
Shared learning across settings

Looking ahead

This workstream sits within NHS England and aligns with long term health priorities on early intervention, community access and workforce support. With one in three adults affected by chronic pain, progress here could shift outcomes on a national scale.

References and Resources for Pain Matters 90

IMAGINING A FAIRER SOCIETY (Macgregor & Hill O’Connor)

Further Resources

McCartney et al. (2023) Culture as an objective for, and a means of achieving, a Wellbeing Economy. Humanities and Social Sciences Communications, 10, 718. (doi: 10.1057/s41599-023-02240-6)
McCartney et al. (2025) https://www.econstor.eu/bitstream/10419/308087/1/1913503828.pdf
Wellbeing Economy Alliance Scotland: https://www.weallscotland.org/
Some of this piece is from a blog on Pain Concern website: https://painconcern.org.uk/social-security-and-chronic-pain/
Atay et al. (2024) Stemming the tide: Healthier jobs to tackle economic inactivity. The Work Foundation at Lancaster University; 2024 [cited 20/3/25]. Available from: https://www.lancaster.ac.uk/media/lancaster-university/content-assets/documents/lums/work-foundation/WF_Stemmingthetide-Healthierjobstotackleeconomicinactivity.pdf

HOW PAIN IS DISMISSED (Magel & Buchman)

References

Buchman, D. Z., Ho, A., & Illes, J. (2016). You Present like a Drug Addict: Patient and Clinician Perspectives on Trust and Trustworthiness in Chronic Pain Management. Pain medicine (Malden, Mass.), 17(8), 1394–1406. https://doi.org/10.1093/pm/pnv083
Center for American Progress. (2022, December 9). How dehumanizing administrative burdens harm disabled people. American Progress. Retrieved August 29, 2025, from https://www.americanprogress.org/article/how-dehumanizing-administrative-burdens-harm-disabled-people/
Goldberg, D. (2020). Epistemic Injustice, Disability Stigma, and Public Health Law. In I. G. Cohen, C. Shachar, A. Silvers, & M. A. Stein (Eds.), Disability, Health, Law, and Bioethics (pp. 33–46). chapter, Cambridge: Cambridge University Press.
Health Canada. (2020, October). Working together to better understand, prevent, and manage chronic pain: What we heard (Canadian Pain Task Force Report). Government of Canada. Retrieved August 29, 2025, from https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2020.html
Hemeida, S., Conyers-Tucker, H., Brou, L., & Goldberg, D. (2022, December 8). Structural stigma in law: Implications and opportunities for health and health equity. Health Affairs. https://www.healthaffairs.org/do/10.1377/hpb20221104.659710/full/
Murthy, V. H. (2022). Confronting health worker burnout and well-being. New England Journal of Medicine, 387(7), 577–579. https://doi.org/10.1056/NEJMp2207252
Poulin, P., Shergill, Y., Romanow, H., Busse, J. W., Chambers, C. T., Cooper, L., Forgeron, P. A., Harper, A. O., Hudspith, M., Iorio, A., & Lalloo, C. (2018). Researching what matters to improve chronic pain care in Canada: A priority-setting partnership process to support patient-oriented research. Canadian Journal of Pain, 2(1), 191–204. https://doi.org/10.1080/24740527.2018.1433959
Scott, W., Buchman, D. Z., & Vasiliou, V. S. (2025). The multi-dimensional stigma of chronic pain: A narrative review. Current Opinion in Psychology, 62, 101980. https://doi.org/10.1016/j.copsyc.2024.101980
Sukhera, J., Knaak, S., Ungar, T., & Rehman, M. (2022). Dismantling structural stigma related to mental health and substance use: An educational framework. Academic Medicine, 97(2), 175–181. https://doi.org/10.1097/ACM.0000000000004451

HOSTILE BORDERS INFLICT HURT (Roman et al.)

Bibliography:

Roman-Juan, J., Hood, A. M., Marbil, M. G., Birnie, K. A., & Noel, M. (2025). Borders that hurt: the link between anti-immigration attitudes in Europe and the epidemic of chronic pain in immigrant adolescents. Pain, 10-1097.
Roman-Juan, J., Noel, M., Sharma, S., Jensen, M. P., Marbil, M. G., Birnie, K. A., & Miró, J. (2025). Making underrepresented pain visible: Chronic pain disparities among immigrant adolescents in 30 European countries. The Journal of Pain, 105533.

CHILDHOOD ADVERSITY (Hales)

More about CAPE:

CAPE: https://dundee-cape.ac.uk/
Hales, T.G., Singleton, S. The impact of childhood experiences on chronic pain. Pain Matters (2022). 30: 8.
Singleton S., Sneddon C., Bakina A., Lambert J.J., Hales T.G. Early-life adversity increases morphine tolerance and persistent inflammatory hypersensitivity through upregulation of δ opioid receptors in mice. Pain. 2023; 164: 2253-2264. https://journals.lww.com/pain/fulltext/2023/10000/early_life_adversity_increases_morphine_tolerance.11.aspx
Senaratne D.N.S., Thakkar B., Smith B.H., Hales T.G., Marryat L., Colvin L.A. The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis. BMC Med. 2024; 22: 315. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03505-w
Timmins K.A., Hales T.G., Macfarlane G.J; Consortium Against Pain InEquality (CAPE) investigators and Chronic Pain Advisory Group. Childhood maltreatment and chronic “all over” body pain in adulthood: a counterfactual analysis using UK Biobank. Pain. 2025; 166: 1204-1211. https://journals.lww.com/pain/fulltext/2025/05000/childhood_maltreatment_and_chronic__all_over__body.25.aspx
Senaratne, D., Koponen, M., Barnett, K., Smith, B.H., Hales, T.G., Marryat, L., Colvin, L.A. The impact of adverse childhood experiences on analgesia-related outcomes: a systematic review. Brit J Anaesthesia. 2025; 134: 461-491. https://www.sciencedirect.com/science/article/pii/S0007091224005683?via%3Dihub
Timmins K.A., MacDonald R., Beasley M., Macfarlane G.J. Adverse Childhood Experiences and Health at Age 50 Years in the National Child Development Study. JAMA Netw Open. 2025; 8: e2525708. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2838109
Mosler F., Christogianni A., Singleton S., Hales T.G., Rennie J., Colvin L.A., Caes L. Assessing exposure to childhood adversity in adults: A systematic review of validated self-report childhood adversity questionnaires. Psychother Psychosom. 2025. doi: 10.1159/000547529.
https://karger.com/pps/article/doi/10.1159/000547529/930840/Assessing-Exposure-to-Childhood-Adversity-in

MORE COMPASSIONATE & EQUITABLE CARE (Mittinty)

References:

Mittinty MM, Hedges J and Jamieson L. “Building evidence to reduce inequities in management of pain for Indigenous Australian people” Scandinavian Journal of Pain, 2022. https://doi.org/10.1515/sjpain-2021-0173
Mittinty MM, Vanlint S, Stocks N, Mittinty MN, Moseley GL. Exploring effect of pain education on chronic pain patients’ expectation of recovery and pain intensity. Scand J Pain. 2018 doi: 10.1515/sjpain-2018-0023.
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Federico O, Templeton K. A Systematic Review of Sex-Related Differences in Response to Post-Operative Orthopaedic Pain Management Protocols. Kans J Med. 2024
Choshen‑Hillel S, Guzikevits M, Gileles‑Hillel A, Gordon‑Hecker T, et al. Sex Bias in Pain Management Decisions. Proceedings of the National Academy of Sciences, PNAS, 2024.
Dahoud S, Simpson P, Naidoo N. The Influence of Patient Sex on Paramedic Administration of Analgesia for Acute Abdominal Pain in an Australian Ambulance Service. Paramedicine, 2024.

THE LIMITS OF ‘LIFESTYLE’ APPROACHES (Blane)

DIGITAL HEALTH TECHNOLOGIES (Walumbe)

Index

Understanding the Link Between Pain & Stress

How Pain and Stress Are Connected

Common Signs You Might Be Stressed

Free Resources to Help You Manage Stress and Pain

Take a Step Towards a Calmer Mind

Understanding the Link Between Chronic Pain and Stress

3–9 November 2025

Stress is something we all experience, but for people living with long-term pain, it can become a daily challenge. Stress and chronic pain are closely linked, each making the other worse. As a result, learning how they interact, and finding ways to manage stress, can make a real difference to both your wellbeing and your experience of pain.

How Chronic Pain and Stress Are Connected

When we feel stressed, the body’s “fight or flight” system releases stress hormones like adrenaline and cortisol. These can heighten muscle tension, increase heart rate, and make us more sensitive to pain.

In addition, living with ongoing pain can be stressful in itself, causing frustration, fatigue, anxiety, or low mood. Over time, this can create a cycle where stress increases pain, and pain increases stress.

Understanding this connection is the first step in learning how to break that cycle.

Common Signs You Might Be Stressed

Everyone experiences stress differently, but some common symptoms include:

Feeling tense, anxious, or overwhelmed
Trouble sleeping or relaxing
Racing thoughts or constant worry
Changes in appetite
Muscle pain, headaches, or fatigue
Irritability or mood swings
Difficulty concentrating

Recognising these signs can help you take action early – before stress begins to affect your pain and overall wellbeing.

💚 Free Resources to Help You Manage Stress and Pain

At Pain Concern, we provide free information and support to help people live well with pain. During International Stress Awareness Week, we’re highlighting some of our key resources that focus on managing stress, emotions, and mental wellbeing.

Pain Education Sessions

In these 2 hour sessions, explore how stress affects pain and learn practical coping tools.

Explore/Sign-up for free Pain Education Sessions

Mindfulness Sessions & Courses

Free online courses and drop-ins designed to help people manage pain and stress using mindfulness techniques.

View course dates and sign-up

“Managing Emotions with Chronic Pain” leaflet

Some tips on how to address the emotional effects of pain.

Download the free leaflet

“Stress, Pain and Relaxation” leaflet

Understand what stress is, the importance of relaxation when you have chronic pain along with some relaxation exercises for you to try.

Download the free leaflet

🌿 Take a Step Towards a Calmer Mind

You don’t have to live with constant stress. With the right tools, support, and understanding, it’s possible to manage stress more effectively, and in doing so, improve your relationship with pain.

Explore our full range of free resources in our Resources Hub, and take a positive step towards calmer living this Stress Awareness Week.

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People are suffering. We’re offering solutions.

What we achieved this year

Celebrating 30 years of publishing and podcasting

The Helpline, someone to turn to

Pain Matters magazine, practical support people can use

Airing Pain podcast, learning that travels

Online community support, peer support since 2010

Pain education sessions, building knowledge and confidence

Mindfulness sessions, learning to live with pain and emotions

Reaching people through our website, news, and social media

Our goals for the year ahead

Shaping our future

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This episode of Airing Pain explores how social factors impact the onset, experience and treatment of pain.

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GIRFT: A New National Focus on Chronic Pain

Why this matters

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A whole-system review

What the workstream will cover

Why this approach matters

What this could mean for patients

What this could mean for clinicians

Looking ahead

**This episode of Airing Pain explores how social factors impact the onset, experience and treatment of pain.**