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Transcript – Programme 4: Diet, CBT and Mindfulness

How diet can help man­age pain, the ben­e­fits of mind­ful­ness, CBT and exer­cise, and a Q&A with pain spe­cial­ist Mark Turtle

To lis­ten to this pro­gramme, please click here.

In this pro­gramme, Air­ing Pain looks at a range of lifestyle changes and psy­cho­log­i­cal approach­es we can use to help with man­ag­ing pain. Dr Rae Bell tells us how a good diet can help in man­ag­ing pain, telling us about foods which are nat­ur­al painkillers and why we should per­haps give cola a miss. Ron Par­sons describes the exer­cise rou­tine which has helped him to man­age his low­er back pain. 

Chris Main dis­cuss­es Cog­ni­tive Behav­iour­al Ther­a­py and Vidya­mala Burch explains how mind­ful­ness can help peo­ple to live in the moment and accept pain while over­com­ing fear, anx­i­ety and depres­sion. Pain spe­cial­ist Dr Mark Tur­tle answers your ques­tions on weight loss, get­ting referred to a pain man­age­ment pro­gramme by your GP and cop­ing with vis­its to the den­tist in our Q+A session.

Issues cov­ered in this pro­gramme include: CBT/cognitive behav­iour­al ther­a­py, back pain, mind­ful­ness, diet, lifestyle, exer­cise, weight, injury, stiff­ness, stretch­ing, nutri­tion, anti-inflam­ma­to­ry, habits, pain beliefs, caf­feine, Omega 3 and Omega 6.

Paul Evans: Hel­lo and wel­come to Air­ing Pain, a pro­gramme brought to you by Pain Con­cern, a UK char­i­ty that pro­vides infor­ma­tion and sup­port for those who live with pain. Pain Con­cern was award­ed first prize in the 2009 NAP Awards in chron­ic pain and with addi­tion­al fund­ing from the Big Lot­tery Funds Awards For All pro­gramme and the Vol­un­tary Action Fund­ed Com­mu­ni­ty Chest this has enabled us to make these programmes.

I’m Paul Evans and each fort­night Air­ing Pain will look at the top­ics that affect us: the cop­ing mech­a­nisms, med­ical inter­ven­tions and ther­a­pies that might help us regain con­trol of our lives. And in today’s programme…

Rae Bell: Peo­ple need to think care­ful­ly about what they are eat­ing – not only the con­tent of what they’re eat­ing but how many times a day they eat.

Vidya­mala Burch: It real­ly was made plain to me that my sit­u­a­tion was incur­able and so whether I was going to have a good life or a life full of dis­tress and suf­fer­ing was par­tial­ly depen­dent on whether I was going to take respon­si­bil­i­ty for how I live.

Ron Par­sons: Some of the old­er peo­ple with the arthrit­ic pain do find it dif­fi­cult to do the exer­cis­es and yet there are oth­ers, and I can name one who is 86 years old, who reli­gious­ly does her exer­cis­es every day in bed before she gets up and she knows the ben­e­fit of it.

Evans: More on those sto­ries com­ing up. But first a word of cau­tion, that whilst we believe the infor­ma­tion and opin­ions on Air­ing Pain are accu­rate, based on the best judge­ment avail­able, you should always con­sult your health pro­fes­sion­al on any mat­ter relat­ing to your health and well-being. He or she is the only per­son who knows you and your cir­cum­stances and there­fore the appro­pri­ate actions to take on your behalf.

Now bear­ing that in mind, one of our aims on Air­ing Pain is to find answers to ques­tions you’ve raised with us, so please do take advan­tage of this oppor­tu­ni­ty to con­nect with our experts via our mes­sage board, email and not for­get­ting pen and paper.

The first ques­tion today is about back pain: ‘My doc­tors told me that I will be in less pain if I lose weight. Will I? And why?’ Today’s expert is con­sul­tant anaes­thetist and pain spe­cial­ist Dr Mark Turtle.

Mark Tur­tle: First­ly one must remem­ber that pain has a large vari­ety of effects on an indi­vid­ual. It tends to reduce a per­son­’s self-esteem. Being over­weight also reduces a per­son­’s self-esteem, so being over­weight can have an adverse effect on the over­all sit­u­a­tion and there­fore make the per­son less tol­er­ant to their pain and to painful situations.

That’s one back­ground com­ment, but I think specif­i­cal­ly that this may refer to spinal pain and it is often sug­gest­ed that peo­ple with spinal pain should lose weight. Now, there is a rela­tion­ship between weight and spinal pain. It’s not a straight line rela­tion­ship. In oth­er words, some­body who is a lit­tle bit over­weight will not have rather less pain than some­body who is gross­ly over­weight and some­body who’s exces­sive­ly over­weight have more pain again. In fact, what hap­pens is that if you look at the instance of pain and relate it to weight, there is a very small increase in the pain, as weight goes up, until a cer­tain weight is achieved and then the increas­ing pain goes up exces­sive­ly. So, in oth­er words, there is a very small rela­tion­ship, unless you are quite marked­ly overweight.

Now, quite apart from this evi­dence it does seem log­i­cal that some­body might lose a bit of weight to ease their back, because after all, the lum­bar spine in par­tic­u­lar, is the only struc­ture which sup­ports the top part of the body, so if the top part of the body weighs less, that part of the back has to do less work and there­fore one would assume that it would be less painful. And then a final com­ment is that the evi­dence shows that lev­els of activ­i­ty are prob­a­bly the most impor­tant thing with regard to low back pain, in oth­er words, increas­ing activ­i­ty tends to reduce the prob­lems where­as recum­ben­cy makes it worse. And of course the low­er your weight the more like­ly you are going to be able to indulge in phys­i­cal activity.

Evans: That’s con­sul­tant anaes­thetist and pain man­age­ment spe­cial­ist Dr Mark Tur­tle. He’s also pres­i­dent of the Welsh Pain Soci­ety. Lat­er in the pro­gramme we will be talk­ing about nutri­tion and its role in pain man­age­ment, but stay­ing with low­er back pain and phys­i­cal activ­i­ty for the moment, Ron Par­sons lives with his con­di­tion and he’s also patient rep­re­sen­ta­tive to the Fife Pain Man­age­ment Committee.

Ron Par­sons: I’ve got a low­er back prob­lem, which is basi­cal­ly fair wear and tear, prob­a­bly from an old rug­by injury. I’ve also got upper back fair wear and tear, which is caus­ing pain in the neck and the shoul­der areas and just over 18 months ago I broke a wrist, bad­ly, which is turn­ing arthrit­ic now. First thing in the morn­ing it’s very, very stiff.

What I did orig­i­nal­ly, was, go to a chi­ro­prac­tor with a low­er back prob­lem because it was real­ly get­ting very painful. He did a good job on me but then advised me that if I want­ed to keep the back in as good a con­di­tion as it could pos­si­bly be, that I’d have to go through a fair­ly stren­u­ous set of exer­cis­es dai­ly, which I have done reli­gious­ly for 20 years. I still am quite painful first thing in the morn­ing but once I have done the work­out, you know, I can man­age the day. I still get twinges, but I’m able to play golf and real­ly par­tic­i­pate in all the sports that I want to.

First of all I do a light warm up in the morn­ing, just to get the body mov­ing and get the body warm and then I go through a series of about 13, 14 stretch­ing exer­cis­es, exer­cis­ing dif­fer­ent aspects of the low­er back and there are a whole lot, I mean it’s a set of about 14 exer­cis­es and the whole thing with the warm up takes me about 35 min­utes. I also now, of course, have start­ed doing exer­cis­ing on the wrist as well and the neck. And the neck is more again, a series of six exer­cis­es with the neck fol­lowed by relax­ation exer­cise. So my whole exer­cise rou­tine for the hand and the neck and the back now works out now to be about 50 min­utes every morning.

Evans: Ron Par­sons. You’re lis­ten­ing to Air­ing Pain, pre­sent­ed this week by me, Paul Evans, and brought to you by Pain Con­cern, a UK char­i­ty pro­vid­ing infor­ma­tion and sup­port for peo­ple who live with pain and also for those who care for and about us. You will hear about the impor­tance of phys­i­cal activ­i­ty many times dur­ing the course of these pro­grammes but anoth­er key­stone of a self-help pain man­age­ment regime is diet. Rae Bell is head of the mul­ti-dis­ci­pli­nary clin­ic at Hauke­land Uni­ver­si­ty Hos­pi­tal, Bergen in Norway.

Rae Bell: Clin­i­cians should start to exam­ine their pain patients’ diets because this has­n’t been the usu­al work up for a chron­ic pain patient. I know that my col­leagues at the pain clin­ic at Hauke­land in Nor­way ini­tial­ly were rather scep­ti­cal, but they also began to ask their patients what they ate and the first thing they dis­cov­ered was the same that I had not­ed: that many patients had poor diets.

Many of our patients are depressed and they don’t feel like mak­ing food; they don’t earn a lot of mon­ey, so they can’t buy every­thing they want to eat. And so it’s espe­cial­ly impor­tant, I think, that chron­ic pain patients have a good healthy bal­anced diet and there are sev­er­al rea­sons for this: first­ly, the ner­vous sys­tem has the capac­i­ty to damp­en pain – I’m sure most peo­ple have heard of the body’s own mor­phine like sub­stances called ‘endor­phins’. In order to be able to func­tion opti­mal­ly, the ner­vous sys­tem requires spe­cif­ic nutri­ents, such as essen­tial amino acids – there is one called ‘tryp­to­phan’, which is very impor­tant in the body’s own pain damp­en­ing sys­tems and tryp­to­phan is found in chick­en and sea food, turkey, avo­ca­dos, bananas… There’s just a sort of an exam­ple. So on the very basic lev­el the ner­vous sys­tem needs nutri­ents. We know that spe­cif­ic vit­a­min defi­cien­cies can cause pain prob­lems, for exam­ple, vit­a­min B12 defi­cien­cy can cause very unpleas­ant periph­er­al poly neu­ropa­thy, which is a nerve pain in the feet and also pos­si­bly in the hands. Vit­a­min D defi­cien­cy can cause dif­fuse mus­cu­loskele­tal pain.

Evans: Now the media is full of claim and counter-claim of what is and what isn’t good for us. So what should we know about food before believ­ing the headlines?

Bell: I think it’s real­ly impor­tant that com­mon sense is involved when con­sid­er­ing what kind of food we should eat because we are bom­bard­ed with a jun­gle of mis­in­for­ma­tion and lots of weird diets and I don’t think pain patients should be on weird diets.

The World Health Organ­i­sa­tion pub­lished a report in 2003 where they described how there’s been a huge change glob­al­ly mov­ing from pre­dom­i­nant­ly plant-based foods to high ener­gy foods and they were espe­cial­ly focus­ing on the bal­ance between the intake of Omega 3 fat­ty acids and Omega 6 fat­ty acids. And the ide­al ratio in these fat­ty-acids is 4:1, four times the amount of Omega 6 com­pared to Omega 3, but in the, for exam­ple, the aver­age Amer­i­can diet today, the amount of Omega 6 is around 15–25 times the amount of Omega 3 intake.

Omega 6 fat­ty-acids are found in red meat, dairy prod­ucts and espe­cial­ly in, for exam­ple, soya oil and soya oil is used to make a lot of fast foods and snacks. So I think the wide­spread use of soya oil has con­tributed to high lev­els of Omega 6. Omega 3 is found in fat­ty fish, oily fish, also in flaxseed oil, flaxseed and wal­nuts. That’s some exam­ples of food­stuffs hav­ing rel­a­tive­ly high lev­els of Omega 3.

And Omega 6 has to do with inflam­ma­tion. We need to have a cer­tain sup­ply of Omega 6 because we need to be able to have inflam­ma­tion in the body to heal injury, but if we get too much that can cre­ate its own prob­lems. And Omega 3 has an anti-inflam­ma­to­ry effect, so one aspect with regard to diet and I think for pain patients is to ensure that one has suf­fi­cient lev­els of Omega 3 and that one reduces the amount of Omega 6.

Evans: We will stay with the sub­ject of diet, because it’s so impor­tant and should be so easy to address in our lives as we try and man­age our pain. Here’s Rae Bell of Hauke­land Uni­ver­si­ty Hos­pi­tal in Nor­way again.

Bell: There are actu­al­ly a num­ber of food­stuffs that have been demon­strat­ed to have anti-inflam­ma­to­ry effects, just like non-steroidal anti-inflam­ma­to­ry drugs, for exam­ple, in vir­gin olive oil there is a sub­stance called olio­cam­fole and it has been shown to have a sim­i­lar effect to ibupro­fen. And this is real­ly inter­est­ing because non-steroidal anti-inflam­ma­to­ry drugs have a lot of adverse effects, so if we can achieve some of the same effect through a diet, that would be ideal.

Now, if we think about antiox­i­dants – antiox­i­dants are found in many food­stuffs and many antiox­i­dants have anti-inflam­ma­to­ry effects, for exam­ple, resver­a­trol is an antiox­i­dant which is formed in cer­tain plants when they are under attack by bac­te­ria or insects and it’s found in the skin of red grapes and I’m sure every­one will be hap­py to know in red wine and it has a pow­er­ful anti-inflam­ma­to­ry effect. Oth­er antiox­i­dants are found in the red­dish-blue pig­ments in like blue­ber­ry skins and cher­ries. But the prob­lem is there’s a lot of hype in the media and when you watch tele­vi­sion, lots of adver­tise­ments say­ing, ‘Buy this antiox­i­dant prod­uct.’ But actu­al­ly you don’t real­ly need a huge intake and the best way to get antiox­i­dants is through the diet, not through pills.

And I think most peo­ple will know whether their diet is healthy or not. If we are busy, we’re on the run and we just have a lit­tle snack here and there, that’s not good enough. We need to be get­ting vit­a­mins; we need to be eat­ing fish – more fish, less red meat; lots of fresh veg­eta­bles – green leafy and bright­ly coloured veg­eta­bles, because it’s the colour pig­ments which con­tain the antiox­i­dants. So if you think of a colour­ful Mediter­ranean kind of diet then you are on the right track.

Evans: So that’s what we should eat, but what should we avoid?

Bell: Spe­cif­ic food­stuffs can increase pain. I am work­ing… I have some col­leagues in France who are doing very good sci­ence on an area called ‘polyamines’, which is very inter­est­ing. Polyamines reg­u­late a recep­tor in the ner­vous sys­tem which is involved in increas­ing pain. Oranges, orange juice con­tains very high lev­els of polyamines. That does­n’t mean that you should stop drink­ing orange juice, it just means you should think twice before drink­ing many glass­es a day or huge num­bers of oranges. Peanuts have quite high lev­els of polyamines.

Then there is the ques­tion, the whole ques­tion of cof­fee. For the chron­ic pain patient, cof­fee can dis­turb sleep, every­one knows about that, and when you have chron­ic pain and you can’t sleep, you sleep poor­ly, then you will feel the pain more strong­ly. If this is con­sumed on a reg­u­lar basis it can increase risk of devel­op­ing a chron­ic dai­ly headache. It has inter­ac­tions with anal­gesic drugs; it increas­es the effect of parac­eta­mol and aspirin and that’s why it’s used as what we call a co-anal­gesic. There are some pain reliev­ing drugs which con­tain caf­feine, but caf­feine has oth­er attrib­ut­es which are not ben­e­fi­cial at all, actu­al­ly deleterious.

High lev­els of caf­feine can link to osteo­poro­sis, so if you drink more then six cups of cof­fee a day your risk of devel­op­ing osteo­poro­sis is increased and this is also the same for cola. I’m amazed by how much cola my patients drink and I have patients that drink reg­u­lar­ly, every day, four litres of some kind of cola bev­er­age and cola con­tains phos­phor­ic acid, caf­feine and sug­ar. I mean, the taste might be nice, but it has noth­ing pos­i­tive about it oth­er­wise and it can cause osteo­poro­sis in the same way as drink­ing large amounts of cof­fee because it has such high caf­feine levels.

Evans: That was Rae Bell of Hauke­land Uni­ver­si­ty Hos­pi­tal in Norway.

Back to our mes­sage board… and this is anoth­er ques­tion we have received: ‘I’ve just fin­ished a 3‑month course at a pain man­age­ment clin­ic. I’ve had chron­ic pain for 8 years and it’s tak­en me all that time and a new GP to get help. For five years I was house-bound and depressed. Why don’t all GP’s know about pain man­age­ment and why does it take so long to get help?’

Answer­ing your ques­tions today is Dr Mark Tur­tle, Pres­i­dent of the Welsh Pain Society.

Tur­tle: Right at the begin­ning I would say that we must dif­fer­en­ti­ate between dif­fer­ent forms of pain mea­sure­ment. Now I assume by the way the ques­tion is put, that one is refer­ring to a cog­ni­tive behav­iour­al-ori­en­tat­ed pain mea­sure­ment pro­gramme, rather than a sequence of treat­ments with­in the pain clinic.

Now, one of the things one has to remem­ber is that there is a lack of knowl­edge, not only from soci­ety in gen­er­al, but from health pro­fes­sion­als. I’m think­ing in terms of under­stand­ing about chron­ic pain, what the reme­dies are, how you man­age it. It’s not taught, for exam­ple, to any great degree at med­ical school. Tied up with this often is that it’s not a con­ven­tion­al ill­ness which peo­ple under­stand; it does­n’t fol­low the ‘med­ical mod­el’ – what I mean by that is that some­body presents with a symp­tom, the health pro­fes­sion­al attrib­ut­es it to a par­tic­u­lar patho­log­i­cal dis­ease process, applies the appro­pri­ate rem­e­dy for that con­di­tion and then expects the symp­toms to dis­ap­pear. The trou­ble with chron­ic pain is that it often does­n’t fol­low that mod­el, either because you can’t find the cause or the treat­ment is worse than the cause or there is no spe­cif­ic treat­ment for that par­tic­u­lar con­di­tion. So we’ve got a lack of under­stand­ing and inabil­i­ty some­times to take the patien­t’s prob­lems seriously.

There is also a lot of lack of infor­ma­tion and maybe even dis­in­for­ma­tion, so that some­times the GP and the peo­ple work­ing in his prac­tice may actu­al­ly not know what is avail­able and may have heard per­haps that, for exam­ple, the wait­ing list is extreme­ly long, when in fact that may not nec­es­sar­i­ly be the case.

Now, the final prob­lem, which is, I’m afraid very, very impor­tant and that is finan­cial con­straint. Some­thing like 1 in 5 peo­ple in the pop­u­la­tion have a chron­ic pain prob­lem, so the num­ber of peo­ple we are talk­ing about with­in the UK is extreme­ly large. So that even if we had an ide­al sys­tem, it would be dif­fi­cult to apply that for all those peo­ple, so unfor­tu­nate­ly it is like­ly they are going to have to be in some sort of strait some­where in the sys­tem and the health pro­fes­sion­als are wor­ried that the whole sys­tem will get clogged up.

But just com­ing back to my orig­i­nal point, I believe that every GP ought to know about their local pain clin­ic, but that trained clin­ic may then make use of a pain man­age­ment facil­i­ty and so won’t under­stand why a gen­er­al prac­ti­tion­er may not know the full details of what is con­tained with­in that pain clinic.

Evans: Mark Tur­tle referred there to cog­ni­tive behav­iour­al ther­a­py or CBT, so what is that?

Chris Main is Pro­fes­sor of Clin­i­cal Psy­chol­o­gy at Keele Uni­ver­si­ty where he’s research­ing how best to devel­op patient-cen­tred approach­es to care, par­tic­u­lar­ly with peo­ple who have low­er back pain.

Chris Main: Cog­ni­tive behav­iour­al ther­a­py is a way of look­ing at the patient and the sit­u­a­tion they are in – look­ing at their beliefs about pain, look­ing at what they are actu­al­ly doing. And it’s sur­pris­ing how often we are unaware of habits that we’ve devel­oped. We are all quite capa­ble of build­ing up good habits and bad habits and I think that some­times look­ing at this care­ful­ly, doing a bit of detec­tive work per­haps on your­self, per­haps keep­ing a diary under some guid­ance will help you iden­ti­fy things you are doing that per­haps you weren’t aware of. I think, more impor­tant­ly, iden­ti­fy­ing things that are in fact unhelp­ful, or super­sti­tions that we have that are real­ly not very useful.

But the role of the pro­fes­sion­al in this sit­u­a­tion is to offer some guid­ance in terms of their expe­ri­ence of work­ing with peo­ple that have got pain. And indeed in pain man­age­ment pro­grammes for many years we’ve built up patients’ sto­ries of all sorts of dif­fer­ent ways that peo­ple cope with sit­u­a­tions. And real­ly the whole pain man­age­ment move­ment has been devel­oped on the basis of real con­cerns, real prob­lems that patients actu­al­ly have. We’ve known for a long time that show­ing peo­ple how to relax is help­ful, can coun­ter­act mus­cle spasm and, sur­pris­ing­ly, it can make peo­ple less tired. There are clin­ics in the coun­try which are teach­ing things like mind­ful­ness, which patients find help­ful. Not every­one, but cer­tain­ly there is a pro­por­tion of peo­ple that are helped by var­i­ous types of relax­ation that help them to get rid of some the stress in their bod­ies, because pain is a stressor.

Evans: Now, Pro­fes­sor Chris Main men­tioned clin­ics that offer mind­ful­ness. What is mind­ful­ness? Well, one of the organ­i­sa­tions that offer train­ing in the area is Breath­works. They have run pro­grammes for a wide vari­ety of organ­i­sa­tions, rang­ing from local author­i­ties to NHS trusts. Vidya­mala Burch found­ed the organ­i­sa­tion in 2001 and it’s based on her own expe­ri­ence of liv­ing with chron­ic pain for the last 35 years.

Burch: I was in hos­pi­tal in New Zealand in Auck­land. I was very ill, had a big, sort of per­son­al cri­sis and there were a few sig­nif­i­cant events in that time. One is that I had a ter­ri­ble night. It was a real sort of dark night of the soul and I thought, ‘Oh my God, I just can­not get through to the morn­ing’. And then I had this oth­er voice that came in, that said to me very, very clear­ly, ‘You don’t have to get through till the morn­ing, you just have to get through the moment.’ And my whole expe­ri­ence com­plete­ly changed – I relaxed, I soft­ened and I thought, ‘Well, I can do that – I can get through this moment and I can get through this moment and I can get through this moment.’

And that was such a per­son­al­ly sig­nif­i­cant expe­ri­ence that it changed my life. It com­plete­ly changed my per­spec­tive on how I relat­ed to the past and how I relat­ed to the future. So rather than be caught up in all these regrets about the past or anx­i­eties about the future, I thought, ‘Well, that’s all just in my head. The only thing that I’m ever real­ly expe­ri­enc­ing is just this moment and I can do more than just sur­vive this moment, I can live this moment fully.’

Anoth­er thing that hap­pened dur­ing that time in hos­pi­tal is, they sent a chap­lain to see me, I think because they did­n’t quite know what to do with this young woman, who had an incur­able spinal injury and it was obvi­ous that I need­ed help. So the chap­lain was this love­ly, elder gen­tle­man that came and sat by my bed and held my hand and he asked me to visu­alise a time when I’d been hap­py and a place when I’d been hap­py and so I went back to the moun­tains of New Zealand, where I’d done a lot of climb­ing in my teens. Then he brought me back to my hos­pi­tal bed and that was also very sig­nif­i­cant because I felt total­ly dif­fer­ent, because of what I had done with my mind. My actu­al expe­ri­ence of pain lying in a hos­pi­tal bed had­n’t changed at all and yet my over­all expe­ri­ence of myself as a human being had com­plete­ly trans­formed by what I’d done with my mind. And I came out of the hos­pi­tal real­is­ing I had this huge tool at my dis­pos­al which was my mind.

Evans: So that’s the back­ground, but what is the cen­tral prin­ci­ple that Vidya­mala Burch and Breath­works is teaching?

Burch: It’s aware­ness. We are teach­ing peo­ple to be aware of their expe­ri­ence in the moment phys­i­cal­ly, men­tal­ly and emo­tion­al­ly. And if you are aware of what’s hap­pen­ing, you can then divide it up into two dif­fer­ent com­po­nents that we call pri­ma­ry and sec­ondary suf­fer­ing. So in the case of my back pain, the pri­ma­ry suf­fer­ing is the unpleas­ant sen­sa­tions in my back and my legs and my neck and var­i­ous oth­er places as I’m sit­ting here.

The sec­ondary suf­fer­ings are all the ways, if I’m not aware, that I react auto­mat­i­cal­ly to that pri­ma­ry suf­fer­ing. So, phys­i­cal­ly, it will be sec­ondary ten­sion. So because I’ve got these unpleas­ant sen­sa­tions, I tense against them, which makes my pain worse. I may have men­tal states which are unaware reac­tions to the pain, like cat­a­strophis­ing – think­ing, ‘Oh my God, when is this going to end? I can’t bear it, I’ve had it for ever, it’s not fair, poor me, why me?’ – those kind of things. And the emo­tion­al sec­ondary suf­fer­ing will be things like fear, anx­i­ety and depression.

So we accept that an indi­vid­ual will have all these expe­ri­ences going on, that’s nor­mal, but what we do is we encour­age peo­ple to turn towards their expe­ri­ence, get to know it and then tease apart the pri­ma­ry and the sec­ondary. Then we teach peo­ple how to accept the pri­ma­ry suf­fer­ing, to accept the unpleas­ant sen­sa­tions that are unavoid­able if you are liv­ing with chron­ic pain, but not to accept the sec­ondary suf­fer­ing. We teach peo­ple how to reduce or even over­come the sec­ondary suf­fer­ing, which is the fear and the anx­i­ety, the cat­a­stro­phiz­ing, the sec­ondary ten­sion and so on.

What we do on our cours­es, is on the first week we are very wel­com­ing, we’re very kind and then we get every­one to lie down, those peo­ple that can, we get them to lie down. We pay atten­tion to the com­fort and we go, ‘Have you got the right height of pil­low? Is it just right? Would you like a blan­ket? Would you like an eye bag? Would you like some­thing under your knees to sup­port your low­er back?’ etc., etc. And then we will lead a body scan which is this way of going through the body and just very, very gen­tly, very, very grad­u­al­ly, invit­ing aware­ness inside the body. And at the end of that peo­ple have had an expe­ri­ence of accept­ing their pain because for most peo­ple, actu­al­ly, it’s such a relief to stop fight­ing. It’s so exhaust­ing run­ning away from your­self all the time.

Evans: Vidya­mala Burch of Breathworks.

And mind­ful­ness is some­thing that might be rel­e­vant to the last of today’s ques­tion­ers on our mes­sage board. ‘I’ve been liv­ing with back pain for the past 10 years and I nor­mal­ly use relax­ation to man­age it. How­ev­er, I find den­tal treat­ment very stress­ful and the pain of hav­ing fill­ings makes it absolute­ly impos­si­ble to relax and makes my pain a lot worse. What can you sug­gest I do?’ Dr Mark Turtle.

Tur­tle: The first thing to say is that, ‘well done’, you’ve obvi­ous­ly worked out ways of man­ag­ing your prob­lem, you’ve accept­ed that there is a dif­fi­cul­ty which isn’t going to evap­o­rate and you’ve demon­strat­ed that there are strate­gies, which you can employ to turn your sit­u­a­tion into one that is tol­er­a­ble. And I’m sure that you can find some help to expand the val­ue of what you are doing to enable you to expe­ri­ence this rather stress­ful situation.

And the first thing that we must remem­ber is that you are not par­tic­u­lar­ly unique. It is well recog­nised that peo­ple find going to vis­it the den­tist a stress­ful expe­ri­ence and yet with­out nec­es­sar­i­ly hav­ing a log­i­cal expla­na­tion. The first thing I would sug­gest is that you try and find some­body to give you a lit­tle bit of help in talk­ing it through – so a coun­sel­lor, par­tic­u­lar­ly a psy­chol­o­gist, who under­stands about these things, because plan­ning in advance is the key to it real­ly. It’s work­ing out what you’re going to do when you get in that sit­u­a­tion, because if sub­con­scious­ly you have in the back of your mind a fear that you are going to lose con­trol in that sit­u­a­tion, it almost is guar­an­tee­ing you will do. Where­as if you feel that you have some strate­gies up your sleeve, you’re some way towards being able to cope with that situation.

Some peo­ple will find alter­na­tive prac­ti­tion­ers able to give them this sort of advice. If none of this real­ly gets you any­where, then it may be appro­pri­ate to go and see your doc­tor and it may be con­sid­ered accept­able and appro­pri­ate to be giv­en a seda­tive to take before­hand. If this is the case, of course, you would want to involve your den­tal prac­ti­tion­er as well, so that every­body knew what was happening.

Evans: Dr Mark Tur­tle. And don’t for­get that Air­ing Pain is here to help you, so if you would like to put a ques­tion to our pan­el of experts, then please do via Pain Con­cern’s mes­sage board, email or good old-fash­ioned pen and paper. And you can down­load or sub­scribe to all the pre­vi­ous edi­tions of Air­ing Pain from And final­ly, I leave you with some sound advice from Rae Bell.

Bell: Pain patients should be increas­ing the amount of Omega 3, reduc­ing the amount of Omega 6, think­ing of eat­ing a colour­ful meal with fresh fruit and veg­eta­bles, cut­ting out cola, reduc­ing the amount of cof­fee. Don’t drink cof­fee with caf­feine in it after 12 in the mid­dle of the day if you have sleep prob­lems. Peo­ple need to think care­ful­ly about what they are eat­ing – not only the con­tents of what they’re eat­ing, but how many times a day they eat. I have a num­ber of pain patients who per­haps only eat once or twice a day and if you have a ten­sion headache that can be trig­gered or exac­er­bat­ed by irreg­u­lar eat­ing, too-long inter­vals between meals. So we rec­om­mend that our patients eat three main meals and two light meals between the main meals, so that you are eat­ing reg­u­lar­ly through the day.


  • Rae Frances Bell, Head of Mul­ti­dis­ci­pli­nary Clin­ic, Hauk­land Uni­ver­si­ty Hospital
  • Vidya­mala Burch, Founder of Breathworks
  • Ron Par­sons, Patient
  • Chris Main, Pro­fes­sor of Clin­i­cal Psy­chol­o­gy, Keele University
  • Dr Mark Tur­tle, Con­sul­tant Anaes­thetist and Pain Specialist.