How to Break Free from Chronic Pain and Reclaim Your Life with Professor Peter O'Sullivan #472

1. Cultivate Hope for Recovery

Actively cultivate hope for change and recovery from pain, believing that you can regain the ability to function and do the things you value in life.

2. Trust Body’s Healing Capacity

Understand that your body has an amazing ability to heal, with disc prolapses often reabsorbing naturally, which can reduce fear and build hope around pain.

3. Change Your Pain Narrative

Actively work on changing the story and beliefs you hold about your pain, as this is one of the most important steps to effectively tackle it.

4. Holistic Pain Management

Address both the psychological and biomechanical aspects of pain, seeking healthcare practitioners who build trust and empower you with hope, as popular strategies often fall short.

5. Embrace Movement as Healing

View movement as a healing friend, not an enemy, and actively engage in it to support your body’s recovery and overall health.

6. Prioritize Movement for Back Health

Prioritize regular movement, physical activity, and engaging in a healthy lifestyle for the health of your back, rather than adopting advice that leads to overprotection.

7. Avoid Over-Guarding and Protection

Be mindful of subconsciously tensing and guarding your back due to pain, as this overprotection can create a cycle of secondary pain, hypervigilance, and avoidance of normal activities.

8. Stop Belly Sucking & Core Bracing

Stop constantly bracing your core or ‘sucking in your belly,’ as this inhibits diaphragmatic breathing, drives your stress response, and can negatively impact your pelvic floor and overall body tension.

9. Practice Diaphragmatic Breathing

Practice diaphragmatic breathing to promote relaxation, reduce stress, and allow your core muscles to function optimally, rather than bracing and resorting to inefficient upper chest breathing.

10. Integrate Breath into Movement

Integrate diaphragmatic breathing and relaxation practices specifically into activities that cause you pain, that you avoid, or that you fear, rather than only doing them in ‘safe’ places.

11. Relax Body, Re-engage Normal Movement

Actively learn to relax your body and re-engage in normal, natural movements, challenging and breaking rigid ‘posture rules’ that may be unhelpful.

12. Trust Natural Movement Patterns

Stop consciously trying to lift or move in rigid, ‘proper’ ways for everyday tasks; instead, trust your body’s natural movement patterns, as people without pain don’t overthink these actions.

13. Vary Posture, Avoid Rigidity

Actively vary your posture throughout the day and avoid holding rigid, ‘straight back’ positions, as your spine needs movement for health.

14. Use Symptoms as Lifestyle Signals

View symptoms, including pain, as signals from your body about the current state of your life, prompting you to reflect on and change aspects of your lifestyle.

15. Manage Stress to Prevent Pain

To reduce the likelihood of pain triggers, address underlying factors like stress, tiredness, and being run down, as these significantly increase vulnerability to pain.

16. Reframe Pain Meaning

Actively reframe the meaning you assign to pain; instead of viewing it as damage, consider if it’s a sign of growth or a signal to adapt, making it less scary and more controllable.

17. Gain Control Over Pain

Seek strategies that help you understand, control, and predict your pain (e.g., relaxation, breathing, specific movements, walking), as a sense of control reduces fear and makes pain less scary.

18. Develop Pain Exacerbation Plan

Develop a personal exacerbation plan for pain flare-ups, recognizing that triggers are often stress, illness, or inactivity, and know what steps to take first.

19. Move During Pain Flare-Ups

Recognize that most pain flare-ups are linked to stress, inactivity, poor sleep, or fatigue, not new tissue damage; respond by moving, relaxing, and re-engaging in physical activity, rather than prolonged rest.

20. Graded Loading Strengthens Back

Understand that repeated, graded spinal loading makes your back, bones, discs, and muscles stronger; avoid depriving your back of load, as this is detrimental to its health.

21. Improve General Well-being for Pain

Improve your general well-being by focusing on the four pillars of health—food, movement, sleep, and relaxation—as this holistic approach can significantly alleviate back pain and other symptoms.

22. Address Subconscious Emotional Burdens

Reflect on and address any subconscious emotional burdens or unresolved stress in your life, as these can profoundly influence and perpetuate physical pain.

23. Contextualize Acute Pain Triggers

When experiencing acute pain, reflect on what was going on in your life at that time (e.g., stress, tiredness, other issues), as these factors are often more relevant than a specific injury.

24. Seek Personalized, Validating Care

Seek healthcare that prioritizes listening to your full story, validates your pain experience, and helps you understand the unique factors driving your pain to create a personalized recovery program.

25. Target Valued Activities for Recovery

Personalize your recovery program by identifying and targeting the specific activities you value and want to get back to (e.g., picking up kids, playing tennis, traveling), rather than following a generic plan.

26. Empower Self-Management of Pain

Actively seek and utilize tools and strategies that empower you to self-manage your pain condition, putting yourself in the driver’s seat of your recovery.

27. Define Good Pain Care

Define ‘good care’ as receiving a clear understanding of your condition, being empowered to make changes in your life, and getting back to activities you value.

28. Build Trust with Clinician

Build a trusting relationship with your clinician, viewing them as a coach who will guide you safely, build your skills, and help you return to valued activities.

29. Ask “What If I Do Nothing?”

Always ask your doctor, ‘What happens if I do nothing?’ to understand the natural course of your condition and avoid unnecessary interventions.

30. Leverage Pain Relief for Action

If you opt for a pain-relieving procedure, use the temporary relief as an opportunity to actively re-engage in your life and establish healthy practices to reduce the need for future interventions.

31. Back Pain Rarely Serious

Be reassured that lower back pain is rarely a serious medical condition, with serious underlying pathologies present in only about 1% of cases.

32. Manage Back Pain at Any Age

Do not believe that back pain will inevitably become persistent or worsen with age; it can be effectively managed at any age, and age-related changes on scans are often normal and not the cause of pain.

33. Normal Scan Findings Are Not Damage

Understand that terms like ‘disc degeneration’ or ‘disc bulges’ on scans are often normal, age-related changes found in many people without pain, and do not necessarily indicate damage or the cause of your pain.

34. Don’t Overprotect Non-Injury Pain

If your back pain is not linked to a specific injury, avoid protecting it, as there is no tissue damage to guard against and protection can be counterproductive.

35. ‘Poor Posture’ Not Pain Cause

Dispel the belief that ‘poor posture’ when sitting, standing, or lifting is a cause of lower back pain, as there is no evidence to support this.

36. Core Strength Not Pain Panacea

Understand that weak core muscles don’t necessarily cause back pain, and a strong core isn’t a guaranteed protector; focus on physical activity you enjoy, and avoid constantly tensing your core.

37. Movement Pain Not Always Harm

Understand that pain during exercise or movement is not always a warning of harm to your spine; avoid overprotecting if there’s no history of trauma, as this can be unhelpful.

38. Avoid Low-Value Pain Treatments

Be aware that strong medications (like opioids), injections, and surgery are often ’low-value care’ for lower back pain, carrying significant risks with limited or no long-term benefits.

39. Rethink ‘Proper’ Lifting Technique

Do not solely rely on the belief that lifting with a straight back and bent knees is inherently protective or preventative of back pain, as there is no evidence to support this ergonomic advice.

40. Beware Scan Report Language

If you receive a scan, be cautious of the language used in the report and its interpretation by healthcare professionals, as it can significantly influence your beliefs and outcomes.

41. Seek Empowering Clinician Language

Seek healthcare practitioners who use careful, empowering language when discussing your condition, as their words can profoundly influence your beliefs and recovery.

42. Seek Evolving Clinicians

Be aware that some healthcare practitioners may hold outdated beliefs about pain; seek those who are open to evolving their practice and integrating new evidence.

43. Expect Emotional Support from Physio

Expect your physiotherapist to engage with and address the emotional aspects of your pain, as it is an integral part of persistent pain experience.

44. Utilize Evolve Pain Care Academy

Visit the Evolve Pain Care Academy website (a free resource) for summarized, open-access, evidence-based information and patient stories to empower both patients and clinicians in a partnership approach to pain management.

45. Understand CFT Components

If exploring Cognitive Functional Therapy (CFT), understand its three core components: making sense of your pain, controlled exposure to feared movements, and comprehensive lifestyle changes.