In Your Pants with Dr. Susie G - The Milestones of Overcoming Pain

Episode Date: August 25, 2020

Living well, with persistent pain or a health concern, is a process that can illuminate your own plan for overcoming pain. Pain and psychology are tightly weaved together. When Dr. Bronnie Lennox Thompson began her PhD she was curious about understanding why some living a life in pain are able to live a fulfilling life despite the pain, and why there are those who were not able to, through evidence based approaches. Dr. Bronnie shares with us a process to take charge of your future and overcome the pain. It can feel so incredibly satisfying to discover you're already halfway through your journey to feeling better! No need to hit the 'reset' button, or order a new body, you're half-way there!

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Hello, friends, and welcome to another In Your Pants podcast episode. I'm so glad that you're here with me today. In today's episode, I'm chatting with Dr. Bronnie Lennox-Thompson, and Dr. Bronnie and I dive into the meanings of pain and how we can live well with pain. And I know that might sound very weird and strange to even think about because pain is such a negative experience most often times.

And so we're going to be talking about that. We're also going to be exploring what it means to be willing to experiment with pain in perhaps maybe some clever ways that you may have not thought of and why this is really important for your well-being. We chat about the difference between goal-setting versus value-based living. And we talk about the graded exposure therapy, which is a unique type of therapy to help with turning down the neurological noise when it comes

to pain and also helping you to get back to living, which is really important. So we take you through the steps with that. And lastly, we have a conversation around how to build a support team for your journey and why that's really important. And most importantly, what you should be looking for when you are building this network of support. So lots of wisdom from Dr. Brani in this episode. You don't want to miss it. And to officially introduce Dr. Brani to the show, I'm going to share her wonderful accomplishments. So Dr. Brawny is the academic leader in postgraduate programs in pain and pain management in the Department of Orthopedic Surgery and Musculoskeletal Medicine at the University of Otago, Christchurch,

New Zealand. She's taught postgraduate courses in pain and pain management since 2002, while also working clinically in persistent pain management as an occupational therapist. Her research interests are in clinical reasoning and persistent pain, daily coping processes used by people living with persistent pain, and the effects of postgraduate education on attitudes and practice of clinicians working in pain and pain management. This is one show you don't want to miss, and I hope you thoroughly enjoy it. Hi, Bronnie. Thank you so much for being on the In Your Pants podcast today.

It's an absolute pleasure, Susie. I'm so looking forward to our conversation. Thank you. And let's dive right in, no pun intended. But I'm curious to hear your story about how you went from being an occupational therapist to a psychologist to a PhD in rehab medicine. Can you share a little bit about your journey? So I started as an occupational therapist way back in the early 1980s and I was one of the first private practitioners in New Zealand because our market's fairly well controlled and so I looked at return to work and because I was really fascinated by people's jobs actually I'm nosy so and then I realized that most of the people I was seeing had persistent pain as their main limiting factor so that got

me started down the pain road and then I realized that my training in occupational therapy didn't wasn't strong in research and so to learn good research methodologies and theory and statistical analyses and things I did my master's in psychology which was also I looked at theory building and how do we actually know some philosophy of science how do we know that what we're looking at is is a real phenomenon and that sort of thing and the aim always was to go on to do a PhD because I really wanted to say surely there can be some evidence-based approaches to understanding how we can help people with pain live better live well what a beautiful story thank you and that goes into the next question I have for you which is probably a really big question but what is it

what does it exactly mean to live well with pain like how would you explain that to someone good question um so I was inspired with my PhD question which looked at how do people live well it's a grounded theory by my partner so my partner is a manly man um and he has ankylosing spondylitis Now he's been, you know, Kiwi blokes are a thing. They are very staunch and manly and they go out hunting and we call it tramping, you'd call it hiking and camping in the wilds and bringing back the galump and great deer on their backs and pig hunting, you know, all that sort of stuff. And with his ankylosing, he had widespread pain, he had really high inflammation levels

and it didn't settle down for many many years and so I thought how is it that this man is still working he still works as a high country fire fighter he works full-time in a mortuary he's a mortuary technician and how how is it that he can be so physically active when the people that I work with have persistent pain and they're not and coincidentally I live with persistent pain as well so I have fibromyalgia and so I wanted and I don't feel like I'm limited by that so I really wanted to understand what it is that made the difference and so what I read around I think was around late about 2006 ish um there's a study that came out that identified about 15 percent of people who live with persistent pain actually say i'm i'm living really well i've got high levels

of pain but my disability is not that high and i'm not distressed by my pain and i was curious so that's the description of um people who live well and i also noticed in in the news media there would be articles on um athletes who are extremely fit but they say well i've got ankylosing spondylitis or i've got you know chronic pelvic pain or i've got migraines and I'm still competing and in New Zealand we have a big history of Mahi Drysdale who's an Olympic rower is and he's he's a three-time gold medal winner at the Olympics and he lives with ankylosing spondylitis and so I thought this is a thing so these are living well to me is acknowledging that you have pain knowing that you're not harming yourself being able to get

on and do the things that you think are important to you while doing anything that it takes to live well and that's what i found out from the participants in my research that they had gone through this big process of trying to make sense of what was happening they got a label usually they'd got um and that important it was important to them to have a diagnostic label that says we know what this thing is they'd spent some time establishing what that meant the symptoms meant on daily life and and in that period of making sense they're kind of a marking time just looking after the essentials but at some point they said if this is the way it is if this is not going to go away then I'm just going to get on with it

and so that was like a decision point where people just said well you know as long as I've got someone on my side who's going to be there for me a treatment provider that believes me that weighs the flag on my behalf that cheers me on then I'm going to get on and live my life and do the things that matter to me even if I do them in a different way from the way that I've done before and then I'll learn some coping strategies and I'll just start doing it oh my gosh my future right and in your experience how long does it typically take for someone to re I guess come to that conclusion that you're talking about? Because I can imagine that it's the people that I work with, it's a very long journey before they even have an understanding of perhaps why they

hurt. Because with pelvic pain, I mean, there isn't a single cause or known cause that we know of. And it's a bit abstract as well, because you can't really show others, you know, blatantly where you hurt you know like it's yeah it's very hard and so you've got the psychosocial aspects that are um barriers to support and getting care and and also social you know having um a social construct and social support around that as well so yeah I guess let's talk about that about how long does does it take for someone to kind of come to that conclusion um in your experience so much a time frame

because it was more about going through these processes so if it takes you a long time to get a label, for somebody to say, yes, I know what this thing is I've got a name, it's not a mystery anymore, it's not a scary thing

we know what it is if that takes a long time, that's going to delay the time before you can say, well if this is the way it is, I'm going to get on with it also if your problem is unpredictable because part of this the second part of you know after you've got your name or as you're getting the name for it you're also trying to work out what does this mean what's the impact on my daily life if you have unpredictable pain that sometimes it's

there sometimes it's not sometimes it's really intense sometimes it's pretty bad you know either way it's going to be harder to feel confident that i can predict what i can do next week and that's one of the most i think finding out what increases your pain what reduces your pain dims and sims if you like um that is going to make a big difference you know to how quickly you come on to saying oh this is the way it's going to be then then i can get on with my life another driver was what is it that you really value in your life what's important um so i have um examples of particularly women who said well i'm i'm the mother and if i don't do these things they won't get done so i'm just going to have to do them and that was like a gritted teeth

determination i'm going to do them which is not quite what the living well brought and so the they might be doing a lot but feeling highly distressed by doing it and it was only after they'd been able to get a label they felt like yeah we can make some sense of this that that distress drops there's a process um so it seems to be you know those ingredients are having somebody who's a trustworthy clinician who's going to listen who's going to say look you do what you need to do i'm going to be here give it a go experiment see what it's like not saying oh no you shouldn't do that or i'm trying to push people into treatments that they weren't ready for but somebody who's actually going to partner you seems to be really really important right and and

almost like having that sooner than later absolutely in fact the people in my study said they were talking about people who'd been present right at the very beginning of their journey often it wasn't a family doctor it would have been a physiotherapist it might have been a counselor it might be um an osteopath it might be somebody who just does does that function for them um and that process of kind of making sense and having somebody at your side helps people feel like this is not as scary it doesn't have to take over me and I guess that's the overarching sort of theory from explanation was that people have to learn how can they still be themselves despite this enormous disruption to their world and those things that make you you

like for me it's creating things i've got to be making something creative um and work are those those two really important to me if i don't do those things i don't feel like myself so with my fibromyalgia i have to find ways i can still do those things despite my pain so i do things in little bits. So it seems to be that integrating that, yes, I've got this pain, but it doesn't take my soul. It doesn't eat my soul, even though it feels like it can at times. It's how can I rebuild my soul so that I know that I am who I am. Right. And I think you're hitting on a very important concept there of there's some grief that happens with a chronic illness or persisting symptoms um it's almost robbing of your robbing of your life of your well-being and that essence

of who you are that sense of self and i think it's just so important like having that coach or someone to facilitate that process to rediscover perhaps you know who who is it that i am or or like like a vision board i love doing vision board exercises with people because it's it's really hard to lose that sense of self and i think just redefining that for someone you know moving forward is it can be quite helpful what are your thoughts on it i totally agree i think actually the sense of self is one of the aspects of living with pain that we've not dealt with very well we've tended to say well are you depressed or are you anxious and go to a psychologist and um can you do these practical things and we'll help you do those things and go to work and and forgetting

that you can do all those things that they can feel like living by numbers you know those paint by numbers pictures yes yeah and they never look real and here we are inserting people into a life that looks right but it's not doesn't fit and it's that blurring it's that softening it's the the vibrancy that comes with being authentic and living to your values and being flexible that seems to make life make people feel like they're reoccupying their sense of self like sitting back inside themselves again belonging in their own bodies which can be sometimes really challenging and scary exploration is that valid to say yeah yeah it is for a while because in you have to let go of some of the things that you thought were given like if you've always

thought of yourself as the manly man who gets on and builds things and plays rough and tumble with your children and you can't how you have to let go of some of that to be able to feel okay to be dad and a father in a different way and similarly for for women if you've been a really competent hard-working woman and this thing comes in throws your life sideways how can you still feel competent still feel hard-working in a different way and that does mean maybe letting go of those um shoulds and musts and you know the time frames that we live to or try to you know in the way that we can beat up on ourselves for failing to do that without acknowledging that there are different ways to express those really important values and i suppose that's what's

drawn me to acceptance and commitment therapy because it is about understanding what is important to you and being committed to find ways to make it happen but letting your noisy chattery voice that mind that keeps showing up and telling you oh you shouldn't be doing this all good people don't do that do a job once do it right and do it you know don't leave a job half done all that sort of meta message i think we with act we learn how to let those voices be there but just say hold on this is what's more important to me right right and how would you brawny address because maybe you've probably had this comment or question post to you before but so you're just telling me to just accept it right it can be quite acceptance it's almost like for some like okay i'm throwing

in the, I'm just going to have to live, you know, in misery for, for, for the rest of my life. I mean, how could you, how could you just sit there and tell me to just accept it? Like what, how do you, how do you handle those situations? And I know I've, I've even been there in my own life and perhaps maybe you yourself, but, um, yeah. Don't say the word acceptance to someone with persistent pain because you will deserve the slapping you'll get. I talk about willingness and and so i run um group programs with primarily men i don't know why but primarily men and i ask there's always one motorcyclist in the group and i ask them have you ever gone out on your motorbike gone out for an hour or so come back and that your pain has flared right up but said to yourself

all that was worth it you'll find somebody will say yeah yeah i've done that and they feel really guilty and i'm i sort of talk about so it's worth it so what are the things that are worth it to you to be willing to experience a change in your pain and so i prefer to use the word are you willing in certain circumstances to let your pain do what it does in order to do something really important for example if you're a mum and you've got a four-year-old and it's their birthday party and you are feeling awful you'll probably carry on and do it because you're willing to see you know to put your body on the line if you like to see your child do something that's important to them and you and so I put a you know it's about it's not a black and white rule to be accepting

or willing it's pick your times pick the moments that it's okay and then choose how you can build around that the recovery time that you probably need yes yes and that's important right like so so that's great that you brought that up because how important is having a plan or a recovery plan or a flare-up plan in in working with yeah exactly okay let's talk about that because I think that's really important because one thing that's true about persistent pain is even when it settles down you are likely to have a flare-up it's going to happen um i've got one at the moment um so i've had back pain i with my fibro it moves from place to place and this this one's been around for about two weeks two and a half weeks now and though i with everybody that i work with

I talk about setback planning and what to do in a flare-up so setback is when your usual plan has fallen off the rails and often a setback can simply be that you're feeling good and so you don't do the things that you know are really good for you because you're feeling good um and then I look at um and so that's about how do you recognize those times that you're likely to have a setback things like birthdays and christmas and um holidays and those when life is going to be a little bit different so can you create a slightly more flexible plan for those times forewarned is forearmed so that's my setback planning and then flare-ups is when when you do get an increase in pain that is unexpected or even if you expect it what are the things that

help you regroup and it might be how can i start to do the things that are my regular plan but start with a lower pitch or slightly less frequent just you know piece by piece so setting that up i think is just part of living learning to live flexibly with this um unwelcome visitor it's you know i i often use the description of um a squatter that comes in that's in your house and if you if you're not careful they'll come and sit on your lap and they'll sit right in front of the tv screen and they'll take the remote control from you and you're sitting there and how did this happen sounds like my dog yeah yeah try and change it well you take the remote control back first and when you

shove it over just beside you you probably think that chucking it out the front door is not going to work you let the you know shove it over to the next seat and gradually as you don't give it so much room it may never disappear but it might live out in in the garden shed and just come and visit every now and again and if it does going back to what do i what did i do before oh that's right i went on with my life and ignored it and it went or not ignored it but made room and didn't pay a lot of attention just happened to notice it right right right and just creating some space yes to sit with it to allow it to be present because fighting against pain and either pretending that it's not there

and just gritting your teeth and getting on with it seems to keep it hanging around. So we need to say, actually, it's not the same as if I didn't have a dream. I have to find smart ways of doing things. Pretending that you can argue against it and resist it doesn't work either because then you get angry and you're still sore

and then you get tired. and then just sort of letting pain sit on your lap taking over the remote control and watching your tv um that is just losing who you are so i think the kinder gentler flexible way is just shove it over make a little bit of room you can sit beside me pain just sit there for a bit and when you're ready you can go off where you want to and that's flexible oh that's awesome so how would you where would someone start with that type of practice i guess maybe maybe this is going to go into exposure therapy or we could talk about that too but how how would you initiate that process or what suggestions would you have um the first step is really noticing

um when we have pain we often either obsess over that area that's visiting it poking it prodding it metaphorically as well as physically testing out whether it's still sore yeah um and so we we pay it can pay a lot of attention to that area but at the same time we can be really scared and where the most intense part is and where's the border between where it's sore and where it's not sore and we notice the other parts that are not sore are you noticing that um funny crackly sound oh okay that's right um so i think i think making that um noticing i talk about noticing parts of your body that don't get a lot of stuff like your belly button when was the last time

you actually paid attention to your belly button or your earlobe um or your elbow you know those sorts of parts of your body that you don't notice and then i ask the person to switch their attention to that sore spot how big is it how where's the center of it what you know how quickly does it go from just being mild to very intense over that part of your body so that's the first part of sort of noticing the pain it's very inconsistent it keeps changing moment by moment and i think that's getting familiar with feeling what it feels like so mindfulness practice is certainly a big part but not in a i want to become relaxed sense but in a i'm curious i really don't know what this feels like oh i wonder how big it is today i wonder if it pulses i wonder if it's tingly that

sort of um making room yeah yeah so essentially being present with sensations without necessarily a storyline maybe yes exactly not judging it as good bad or or oh thank goodness it's gone or or just feeling that it is there and allowing it to be there and participants in my research used that all the time it was on judgment um one of the things that this contrasts with is back in the day when i was first doing pain management it was about um not not attending to your pain trying to ignore it which doesn't work for one thing because it comes back and taps you on the shoulder but also um it's really clear that people with pain do monitor their pain and how it changes over the course of a day or a week and partly that the people

that i spoke to said that that's so that they can decide flexibly what will i do today not in a all or nothing but in a how can i accommodate this today to do what's important what are the range of things i can do to help me deal with what i want to do and by the way i've got this pain tagging along um so that kind of noticing was not a judgment it was just a notice oh look i've got this today um which takes that emotional sting away from that pain right because it's bad enough to have the pain without having the emotions that go with it yeah and especially little boys that says well you should be doing this and why didn't you do that and you should feel guilty about this and all of that stuff right oh and that's that's i have to say that's 10 fold plus plus plus when

we're dealing with the genitals so i would like it's very because we ought to be and we should be ashamed of this whole area of who we are right but there's a reason that it's you know as such a um an emotionally important area it's a source of pleasure you know it's it's also a source of where our instant where our you know when we get the bottom falling out of our life we get this sinking dread we feel you know we have all of these sensations that are emotionally resonant and we can't talk about them because they're naughty bits right don't do that don't say penis oh no oh you said that out loud it's the girly bits it's the pink bits and yet it's you know we deal with these every single day and i i'm really grateful for

my occupational therapy training because you know pooing peeing having sexual intercourse just playing with yourself you know having a period these are all things that are part of daily living that occupational therapists can quite rightly sit with and say hey we can help with that we do only most of the time you know we say well we'll help you get on and off the toilet we don't actually talk about what you're doing when you get there right well we'll give you a long-handled stick so you can access your your rear to to do a clean but you know we won't actually talk about the fact that you don't want to have sex and that that's part of your relationship and that sense of intimacy and connectedness is such an important part because pain is so isolating it's so

nobody knows how sore you feel or what it feels like to be your kind of sore add the shame of you know this is my body part that we don't talk about and having to expose yourself to all these investigations with strangers looking up your fanny and you know all of that sort of stuff very invasive very hugely and I do I really do worry when I see quite young women being exposed to invasive medical procedures without first exploring what they can do to help themselves yes and the same goes for men I have to say because I do work as as you i have a lot of men predominantly my practice and um even because you know to a man this is about masculinity this represents the sense of strength and control and i'm manly

and this whole masculinity sense of identity is so threatened and it's so rarely discussed it's so rare to find anybody talking about that except amongst us kind of interesting people like you and sandy oh yes it is a small world isn't it it is absolutely and it's quite neat because of that because because we have a community where we can learn to normalize conversations i'm hoping that we can then broaden this beyond our our sort of pelvic community and i'm not a pelvic therapist but i i'm a pain therapist why why can't we talk about this with every person because intimacy and the pelvis is part of everybody's body absolutely and a foundation in the hierarchy of needs like you know if you're looking at maslow's hierarchy of

needs like pooping peeing sex excretion food water safety those are our basic physiological functions and if every time you you go to pee you have this incredible fear it's going to move or you're going to leak because you can't get there far enough or that stuff that needs to be talked about right sorry on my soapbox no not at all it's totally appropriate for sure and i'm sure listeners really appreciate this conversation um that being said exposure therapy let's talk about what what that is and maybe we can chat about how one would use that in relation to private areas yeah so exposure therapy the way that i'm talking about it is not about changing the pain it is about changing your relationship to that pain that's about feeling the fear

because most people are apprehensive it's going to hurt um feeling that fear but allowing yourself to do it anyway being willing that's the way i approach it so in pelvic pain the way that um i've done it or sandy and i've kind of springboarded off this we have a whole bunch of photographs of things that people do like sitting like cycling wearing jeans um wearing getting on and off the toilet sitting on a hard chair getting down to the to the ground squatting all of those sorts of things and we ask um and the way i do it with any pain problem i ask the person to rank these photographs first of all we sort them into two piles things I don't bother doing because they're not important things that are important and then we rank the ones that are

important into things that I'm really okay doing and things I'm not and then we take the things that I'm not okay to do and we rank them from least scary to freak me out man this is spooky not going there and then we start at the bottom the things that are least freaky and what i encourage people to do is to start to use the mindfulness to think about the values why is this important to me what is so important about doing this for me um and then we use that conscious non-judgmental awareness to do it and to make room for the fear because there will be some just a little because we don't want to start right up the high but but just a little that anxiety about doing it and also the the thinking the mind chatter that says this is going to hurt

this is going to be bad so we're trying to encourage people to be present in the now not remembering the last time they did it when it might have hurt or anticipating that this time that's going to hurt but just being what is happening here and now and for most people um they've overestimated the threat so they said this is going to be super scary and really sore and they've underestimated their ability to manage it to be okay with it and so we start nudging into that fear zone and we let the anxiety subside because it does we can't stay at a high level of worry for very long and then we and so i help people rate their the yuckiness we have the yuckiness scale because it's not just pain it's the whole ooh yuck i don't want to do the whole

experience yeah yeah so the yuckiness before what do you think the yuckiness is going to be 0 to 10 and then after you've done it what's the yuckiness and usually it drops nine times out of 10 it will drop every now and then it will stay at about the same level and that's okay we'll just sit with that for a little while once it drops though then we can say okay so i've done it here with this nice safe therapist makes me feel good and it's all controlled so the mission for the next week is to go do the same thing in your world right this is my ot side coming out so so if your first um thing was i'm going to sit flat footed on a comfy chair without moving for five minutes without getting up and jiggling then i'll do that in every single chair that looks a

bit like this one around and i'll take photos of the chairs so we'll send photos of the places that i've sat that's great yeah so we just practice generalizing um the context because it's quite easy to do something in a safe environment but where it's a bit unpredictable where it's not the context is busier or it might be quieter or you can't move like if you have to sit for a business meeting

and you think oh I can't sit for that long then sitting for a I'd encourage people to sit for five minutes just five minutes in that meeting and just in that meeting room perhaps without the rest of the people there

just in that meeting room it shows you that yes i can do this and confidence builds confidence so the next week we come back and we do the next thing on that hierarchy so if that one is i'm going to walk wearing a pair of tight-fitting jeans or a lycra pair of lycra pants or something then let's do that and so we just keep practicing and it's very slow and very gentle um it should it might increase pain a fraction but because we've um determined that it is you're willing to feel that discomfort and yes it's a bit anxiety provoking what we notice is the pain intensity drops as the fear

drops and that's been demonstrated in lots of different areas of pain rehabilitation where when you do it the fear inflates the pain intensity you can drop that fear the pain intensity also drops and your body starts to get more comfortable starts to associate feeling uncomfortable with this new position new learning or new patterns creating new positive experiences around those and you will have flare-ups and if that happens we go back a couple of steps on that on that hierarchy but most of the time i've found that once people have gone up about three or four on a 10-step hierarchy that suddenly something switches it's a penny drops and they will start to do stuff by themselves

that they've never thought of being able to do before and my job is done. It's really, it's a very, it's almost magical. It's so exciting to see somebody's confidence grow. You know, not so much with pelvic pain but with people who have avoided going to the shopping mall because it's too busy, there's too many people and I might get bumped into

and then to find that they've gone to a music festival on the weekend. You know, it's just, it makes you feel so good. Oh, absolutely. You're giving, you know, people are getting their lives back. Yeah, yeah. And it's not that their pain is completely gone. Right. For most people, pain will hang around and it fluctuates.

It's just that the fear that's going to completely knock me out and it's very scary and it's going to take all my energy to cope with suddenly fades which I like oh that's amazing that's great so Bronnie for those who are looking to gather a wellness team of support for themselves what should what should they be looking for in a practitioner or provider um who's speaking this language I I presume you know so what are some of the things that we should look out for i think for first of all you need to trust that person so you need to feel they connect with you and they take you seriously they're listening they're not judging you they're just saying hey i'm here and they take that time to validate that you've got

this experience that it's been tough and that's you know and they're willing to let you be present with your own crying or whatever anger whatever I think that's the very first thing then the second thing I think people in my study said they really wanted was they called it a trustworthy clinician but what they were describing was when they went to the physio the physio said well look I've been looking out some exercises for you they've tailored it and look i printed these out and these ones are and they'd circle the specific exercise so tailoring the treatment but also demonstrating that they thought of that person outside of a session that maybe they'd follow up with a phone call or a text saying how's it going what's happening they remember you when

they came when you came back in and say hey how did you go with that thing that we tried out so it's those little bits of um personalizing of not saying no don't do this but hey why don't we treat that as an experiment that's a i think that's a first those are the two most important things is that you feel this person is on your side if they're disengaged or they're just not interested it's very hard to feel that this person cares enough and i think that's yeah that warmth that sense of connection is really important um then in terms of the who so to learn about doing um things like graded exposure so some psychologists will do this um but i would suggest partnering with a really good pelvic therapist for pelvic pain in fact i think it

depends on the confidence of the pelvic therapist i don't think it matters your professional background to be honest so occupational therapists physiotherapists osteopaths massage therapists maybe but definitely it's about you as a therapist thinking i'm okay with bearing witness to this person feeling quite distressed because it is scary and i'm going to be confident that they'll do it they can manage it because it's about you believing as a therapist this person yes you're going to make it not with an inflated sense and not with a sense that I as a therapist am doing anything but that I've got confidence in you as a person that you are resilient and robust enough to do this yourself because people with

persistent pain are the toughest people I know we deal with an invisible disability that is weird poorly understood and we are still here living good lives you know even if we're living a life that doesn't feel very good we are still here and that shows that we've got capabilities that perhaps just don't get acknowledged people with pain are really tough people absolutely oh i had a patient have a he had a t-shirt and on the back it said perseverance doing doing the inevitable despite the evidence to the contrary i think it said it's just that's exactly what you're saying and that's so true i see this with everyone i i work with absolutely that resilience that we you know and i think people can go to therapists who almost need the patient to be broken to feel okay

about what they do so when what i've discovered from my phd and working with people is that when somebody feels confident and they become their own expert in their own bodies and maybe they've done some extra reading about pain and they've learned stuff for themselves that makes them partners equal partners and my job is just to be your cheerleader I'm here to be on your side that's all and I can guide you because I'll probably listen to a few more people who've got pain than you and I've probably learned some stuff from those people but I don't know what's going to work right you know I'm here to help you experiment with stuff yes absolutely so there's there's a path that's just what are what are the secret ingredients for your special sauce

yeah what's your mix and and i don't know what it's going to be and how can we create that wiggle room um i call it wiggle room you'll discover this so this is um you know the chinese finger track yes i have a bunch of them in my office so we go into the experience to feel because you can't just bulldoze your way out because you'll break it or you won't be able to get out you have to go in and then you have to find lots of little wiggly ways to create space to to be you and to become who you are in order to free yourself from the trap and that's really my job is to say hey i wonder if you tried this one oh have you thought about this hey that didn't work the first time i i wonder if we just twisted it this way whether that might help and that's that's being creative

and it's not my job to find the solution but to help you explore your choices right right exactly that like yeah collaborating brainstorming together yeah because we make a damn fine team yes oh yeah what's that sense of teamwork because as i said pain's really isolating and to feel like you you're really on your own with therapists that are distant or disbelieve you or step back is even more isolating because you're going to find help and if they won't give you that the respect to sit there with you then i would say don't include them in your team they may be the best therapist in the world for this this condition but if they don't care you're probably not going to feel that loved 100 yeah absolutely 100 100 so speaking of

connection bronnie how can our listeners connect with you learn more about you you have a wonderful blog yeah so the blog is www.healthskills.co.nz and i've been blogging since 2007 so it's um i've been slowed down a little bit because i'm writing a book chapter at the moment but i'm i will still be poddling in there i post usually once a week but there's a back catalog um the other way is through facebook either my health skills page or um just me bronnie lennox thompson um i think i'm getting to the point where i'm getting getting to the maximum number of people i'm allowed to friend but you can always follow um and there's also the exploring pain group and um pain for ot and yeah a whole bunch of groups that i'm i'm a member of so do

don't be shy um on twitter i am i'll have to spell it a d i e m u s f r e e or edema's free long story but um that's that's what it is and i can't change it because i've It would mean starting from the beginning again. And LinkedIn, I'm also on LinkedIn. So just under Bronnie Jenkins Thompson. So I'm reasonably easy to find. That's wonderful. And I'll make sure to link all of those platforms

to the show notes and the resources that you talked about. That was wonderful. Well, thank you so much, Bronnie. I really appreciate your time, your wisdom. This is such a wonderful conversation and for sharing your story and helping others persevere in the face of adversity and life struggles. So thank you so much.

Absolute pleasure, Susie. Wonderful to meet you. Likewise. I'll see you in February, San Diego. That's right. We can't see you everywhere. Maybe we're in a hot tub is all I'll say. Don't mix the hot tub and gin.

Oh, not a good combo. No. No, it was the Canadians. I blame them. Oh, those darn Canadians. Those Northerners. It was Empress Jin. And it was...

Oh, God. Finest people ever helped me with that lot. After the end of that. Because I was not well. Well, hopefully this next time it's going to be a very different thing. It'll be fun. It'll be so cool. I'm so looking forward to seeing you guys.

Likewise. Likewise. Hugs and kisses. And to all our listeners out there, thank you so much for listening. This is Dr. Suzy G in lovely wellness for your pelvis. Until next time. Bye, my friends. Thanks for listening to today's episode.

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