A patient recommended this book to me after the best week she’d had in months. She had chronic pain, and had hit rock bottom the week before. We spoke about the complex nature of chronic pain, and the conversation reminded her of this book. She’d benefited from applying its advice in the past, but remembered that she’d never actually finished reading it. Coming back to it with renewed optimism (and on the back of treatment and exercise), she felt different about her pain. It was still there, a bit better; but not so much of a bother. “Something has changed in me” she smiled.
Dr Peter Abaci works in the US, as a medical doctor and pain specialist. Because he works in the American system, some of what he writes is not applicable to us, such as his explanations of the insurance and healthcare systems (the chapter “The Politics of Pain”, and within that “Is Your Doctor Set Up To Fail You?”). The benefit of reading this is it highlighted to me how much of an advantage we have as osteopaths: we have plenty of time and no quotas! We are in the perfect position to apply his advice.
Conquer Your Chronic Pain is, as you might expect, essentially a guide to overcoming pain. The framework it follows is the bio-psycho-social model (BPS). This is a holistic idea that health is multifaceted, and it can be applied to chronic pain. To break it down:
- Bio (biological) factors: The physical stimulus of the pain. Ergonomics and posture. Exercise and activity. Diet.
- Psycho (psychological) factors: How we perceive our pain; pain beliefs. Avoiding doing what we love because we think it will make things worse. Stress!
- Social factors: The support network. Culture. Relationships and dependence.
Abaci’s overarching message is that present day healthcare does not address all three of these factors. For chronic pain, that’s not good enough. Throughout the book, he reiterates the need for a “team” to combat chronic pain. Physical therapists, occupational therapists, and yoga teachers all address various facets of the pain, and the combined effect is what it takes to get through it. But the patient still needs to take control: it’s up to you to get exercising, doing something creative, and to practice proper breathing.
“The true ‘magic bullet’ for chronic pain is the understanding that both the problem and the cure lie within”
Similar to It’s All In Your Head, the book involves a lot of real life examples. Relatability is important. Many of Abaci’s patients started off with a back problem. Some have had surgery, and still have the pain. He reiterates that surgery is only part of the solution, and doesn’t have much impact on the “pain brain”- his term for the physical changes that the brain goes through when subjected to chronic pain.
At this point, Abaci takes us quite deeply into neurology. You may be inclined to skip the neuroscience paragraphs, or skim over words like “amygdala” and “glial cells”- but knowledge is power! When you understand what is going wrong, you can start to correct it. It’s only once he’s explained the physiology behind pain that he lets you into the plan of action for getting past it.
Although the book was only published a couple of years ago, pain science is advancing quickly. It’s the consensus now that “chronic” is a less appropriate term than “persistent” pain. The video below by Lorimer Moseley is one I’ve played to patients in the treatment room many times. It’s a great introduction for someone who’s been suffering and never really had an empathetic explanation.
Another brilliant video is about accepting pain. This might sound almost pessimistic, but Tamar explains in the description:
“It took me a long time to understand that acceptance was not the same as giving up or losing hope, but instead I’ve come to see it as a conscious decision to completely engage with life, including pain.”
The metaphor falls a bit flat if the pain is something that can be reduced (as is often the case), but the idea is still very solid. This comes from the perspective of Acceptance and Commitment Therapy (ACT). A good introduction to that can be found here. Although it tends to fall under the umbrella of counselling or psychotherapy, the BSO/UCO ran a three year research project combining ACT and osteopathy – OsteoMAP.
Back to the book- if I were to summarise it in one word, it would be “supportive”. It is refreshingly holistic, addressing all factors of the biopsychosocial model. But it is not overwhelming- a lot of the content is common sense, supported by frameworks that are applicable to the recovering patient. “Seven Rules for Eating Mediterranean Style”, and “Getting Through to your Doctor” are just a couple of titles of lists to help you get on top of chronic pain. I can see myself recommending this book to many of my own patients to come, but I would also recommend it to the people around that person. If friends and families understand and support the patient, then everyone is already heading in the right direction.