040 - If you take a strong stance on effective management of pain, you're missing the point

040 - If you take a strong stance on effective management of pain, you're missing the point

The Pain Weapon Dave Renfrew speaks with Andrew Zacharia on the great debate over effective pain management.

Which side are you on and should you even have a side? :man-shrugging::woman-shrugging:

Find out how to create structure as well as flexibility in the way that you treat the human in front of you! :heart_eyes:

Transcript

spk_1:   0:01
This's the I'm a view podcast getting you private practise ready. We give you fresh ideas on mindset, communication and clinical skills so you can have a full field career. Everyone welcome Teo. Another absurd of the review podcast today. We've got a special guest. He may be our first returning guests. And after his supposed podcast, I don't think he thought he would ever get invited back. But we have a Renfrew, the pain weapon, how I made it.

spk_0:   0:37
There's a man. I think I really try to behave myself that first time too. So I think I was always hoping for a return slot. But I'm glad that the have extended the opportunity. So appreciate it.

spk_1:   0:50
You're always going to get another in by mate. We all love your feedback was right that probably our most listen to podcasts ever. Surely. Well,

spk_0:   0:59
that would probably just be by Mom just listening to it like 16 times. Right

spk_1:   1:02
on Looby out. Probably way. Want to get you one for a specific reason? One, because you're an absolute weapon in helping people in pain, but also because this sorry much debate always going on. And I really think you have amazing view on it. So essentially that great debate in how to treat pain effectively. But we've talked about that. The fact that ever has such strong views and opinions in this debate is potentially the reason why everyone is missing the point. What do you think?

spk_0:   1:38
Yeah, absolutely. I mean, when you look at it, no matter what your degrees or what you're biases or what your favourite thing is or what you've been taught when you look at it over the last, however many years 30 40 years. Fundamentally, as we've treated persistent pain, particularly the classic examples of lower back pain as we've treated, it's gotten worse so that everyone has everyone's done stuff to it. It's gotten worse now. There's lots of reasons for that. The look. I've been in many of them myself. So I'm not. I'm not saying don't get on social media and, you know, start well, start by giving me point, but eventually you just end up insulting people. Or maybe I just do that, but they don't debate it, but I think the whole thing is admitted. Point of it, right? So whole point is that what we've been doing hasn't really worked, and we don't really know what does. So I just always find it funny that people can be so sure of what to do when that whatever that thing is lots of times doesn't work. Lots of toys makes people worse. And overall, the problem continues to get worse. So, e, I think that dogmatic view of what you should do or shouldn't do or how it works or anything like that, I think as a rule, I'm always sceptical that anyone who says stuff like that because the fact is we just don't we just don't know, right?

spk_1:   3:15
Exactly. I think, as you said, the dogmatic view almost. Yeah, it needs to be a certain way. Like the Classic one always is manual therapy. Right on. Yeah, really will go deep into just manual therapy. Yes or no. But the fact that there are people who are 100% yes, in all cases at 100% No, in all cases, as you said, misses the point, right? Yeah. E taking the condition you're seeing out of it.

spk_0:   3:42
Yeah. Yeah. E find with that debate when I enter into it, people misunderstand with times when I'm saying to you like I do it like I'm a critic off it. I'm probably on there. Don't do it side of it, but not sorry, that's for me the wrong. I'm on the I'm on the operating table quiet, and it's in the manual therapies or some or many ofthe Herbie sucks, right? So yeah, it does. But that doesn't mean I don't work. So I think the reasons that you do it have to bay. That's the whole thing. Has me person, Patient centre that can be therapist centred. So if you do it because you think you're awesome matter and you think it fixes everyone and you've spent 100 grand on training for it, then they're the wrong reasons. If you do it because the person in front of you thinks that that's what's going to help him, and then you can get them to through that you can get them to do other things that are better for them, and that's that's the difference. So when when even even using the big example of say at Americans like even when he started saying that, I think that's what he meant, it does suck as a treatment. But that's the thing. What? Everything does suck when you look at it in isolation and as an across entire spins of populations. Nothing is is great because the problem still massive. So so that's the whole point, right? That whether you're saying it's awesome or it's not, you're missing the point that whatever it is that you choose to do, it's not that thing that you do. It's probably more so how you do it and then what? You're what The endgame is in terms ofthe your interaction with that person and their life. And I think that's a much more important question to answer.

spk_1:   5:33
Yes, so powerful in terms of as you said like everything sucks in isolation on I understand, agree like someone comes in and you just educate, and that is it that will still be potentially poor. Outcomes. Yep, And I'm speaking to alarm a once and East, and he talked about Lauren Mosley and he talked about pain. Science and pay. Education is like there's actually no good evidence for it unless you do it with exercise now is it? Just exercise, though, and you know, this further studies now that we reference and I'm review where there's a study that looked at pain education. Now what they actually did in that could be up for debate. But they did to one hour blocks of pain education compared it to active listening and had similar results. So do you now go out, do a study on exercise, active listening? And that's actually better than exercise and pain education, like you just go down so many rabbit holes around the nitty gritty and like it needs to be done. I get that. But as you said, like everything in isolations sucks. Wait, just treat the person in front of you. Reason. Everyone have great reasoning skills, reason what you need to apply and when it's not working, I think maybe this is the key. When it's not working, be willing to change your approach.

spk_0:   6:52
Absolutely. That's the if you're if you're sort of when you're when you're approaching the person in pain. I think that ecosystem analogy is really good. One like it's you're dealing with that person's ecosystem you're not dealing with. They're back for their brain or their spinal cord or their whatever you're dealing with that person on DH. Their current experience of their pain in their life, right? So I think that approaches a therapist is really useful like you. You're you've got access to this huge widespread of stuff that you can do and you can use any or all of it. But the thing that determines that isn't your sort of recipe. It's like, I can't 0.1. Do this appointment to do this Use this technique is this technique you're able to then fit what you, Khun due to that person and you probably didn't even find lots of people that you're not even the best person to see them. I find that of all the time. Now the people will for whatever reason, some people will find me out thinking, OK, say, treat people we pay them about. And when I meet them in my head, I'm going, Yeah, like this. This isn't going to work like it, they're not. They put it was providence that they find you rude and our overbearing or whatever it is, you know, they just don't like May. So that doesn't matter how much I know about stuff. What? How much I can tell them if they don't want to hang out with someone away. So doesn't matter how super fantastic you are with any kind of tour for technique. The thing that's going to determine your success or not is it's way more complicated. And in that ecosystem level, like your eco system, the ecosystem have toe match or a least agree with each other. Otherwise, it's just not going to work

spk_1:   8:55
if it's just so interesting even to look back. And we'll look over some of discussions that happened online and where everyone talks from their own point of view there in bias, their own narratives. And I get that. But even watching debates where you see two people debating two separate things like it's the person that goes. But what about this part of the patient's ecosystem? You need to do it for this, and then the other person goes, What about the other part that you need to do this? And instead of going great, one of you used both of these things because both things are part of the same person's ecosystem. Try and debate which one is the best in which one you should do.

spk_0:   9:35
Yeah, and invariably just ends up is a pissing contest like that's what it is like. It's when two people it's amplify, don't line. You can get away with saying shit that you can't get away with in person. Yeah, yes, that's right Into the will get two people that like talking particularly about either themselves or things that they're interested in but don't like listening. It just gives them a megaphone. Just say whatever they want without actually taking into consideration what the other person's saying. So it's not a debate. A debate has to be where your response is measured against what that person has said. It just it just turns into two people yelling like, That's what it is. So and And I think the further that goes down that rabbit hole, the further away from the point of what we're trying to do, it gets like we're trying to make what we do better for the people that are coming to see us. That's the thing. And I need the screaming at age and, like I'm not again. Like I said, I'm not saying Don't do it. I do it better than most people so but it's really like what you say when you stop and look back and you go right. What did I achieve there? And most of the time it's like, well, but not really. I just yelled at that dickhead and he yelled at me

spk_1:   11:00
a good time. That's just t much so I guess from the reason why I guess we won't talk about this is because you're a young health profession when you're seeing all this like bloody hell like what I do, right? Like I don't know, everything has an argument. I'm scared of asking a question because everyone's Teo Street Mi tio or tell me to go read that articles. But we I think we both agree No. So just new gods, But young health professionals, you know, your 1st 3 to 5 years, even they've got all the skills already. I think your favour favour lines, new grads can save the world. But how did they get? Absolutely agree? They've got the skills. But that hesitation is that fear. Did Teo do and say things because of all this stuff going online?

spk_0:   11:54
Yeah, yes, completely, I guess. Inhibit them from venturing into asking questions online and getting a response without fear of being shut down. But it probably is more than whether that's a factor or not. But but certainly the consulate with a persistent pain person can be pretty scary like you are. Invariably, they've got shit by heroes. Go shit, right? But But if you give any pay for a long time, you've got some shit. There's no doubt about that and that that's a bit of a burden for youto temporarily handle, and I think it can. It can often sort of subject you away from the framework in your head about to doing assessment on what you want, like assault and all those sort of things. No severe pain or persistent pain or scary other ship in sort of divert your attention from that. So, But funnily enough, I think that the things that clinicians have access to that can really help people. We're in a lot of pain or many pay for a long time. It's not there. It's not their school. So it's their Sorry it's not there. So the things they were taught in uni or courses about different ways to treat and stuff like that, it's it's just that it's that human stuff, right? So bye. Empathy is empathy is gold like, if you can not sympathy. So it's not like you poor bastard. Look, you know it's not. It's not given them flowers and a box of tissues. It's really just been there with them at that time. So listen Teo their storey and and just have a bit of a pier in Connexion about the fact that that must be really hard to have dough is and you can sort of see what have they got to this point. But then been a bit of a source ofthe positivity and hope that things can get that on. And I think I mean, I'm a cynical old bastard, and I I've always found that be hard. But I guess the thing Teo like that's when you're young, health professional. That's probably what you've got in spades, right? You've got enthusiasm. You've got that the might get in trouble from Michael Risk here, but I don't know any other way is to say it. Say I call it the capacity to give a fuck like that's the Yeah, that z the just. If you've got that, then you're going to be a really good clinician, particularly pain people no matter what. And I think older clinicians have lost that capacity for For what? Lots of different reasons. There. You know that, E. I guess hearing here in pain storeys a lot can be a bit of a burden to deal with or they've got other shit in their box. You know that they're worried about their business or their family or their blood, so they're tied to their their methodology. And then ethnology is getting slammed by some dickhead from Newcastle on social media. So I think when you it's just weird, I kind of be right, like when you're at this stuff, but the it's when your guess your skill set is may be at its lowest, but your capacity is mighty and it's a pious. So I think that concentrating on that human elements is why you should be confident in doing it rather than rather than scared of it.

spk_1:   15:40
You just come out of union. You've been doing this socialising right. You should be greater

spk_0:   15:46
than Zeus. Humans have always like. That's how we've always interactive get storeys storytelling. So they're going to tell you a storey and then you listen to it and then you might use some other storeys. Teo may be changed there, slowly change there or give them different narratives. Give different ideas that you might think about any going experiment with what might work. Because no one friggin knows. No one knows so and things like even things like education and exercise. And the hall marks off modern pain care. Even how they work, we don't know. So you know, like I've got a pretty decent gym set up in my clinic and we really like resistance training and that sort of stuff. I simply needed very strong people much stronger than me, that have persistent pain. So it's no, I like it. There are so many different things that you could do, and everyone will probably need different a different set of it. So and the recipe thing that, like the rial toolbox approach to treaty, I think is a bit floored. And I think it takes some focus away from what actually works, which is a lot of that more human stuff that we don't know, maybe I don't know. It just gets maybe no emphasised or drilled out of us or whatever it is, whatever happens. But I think that's where our young conditions can can sit.

spk_1:   17:23
I think it's scared, like I think it's scary. Tio, come out in tow any health profession and almost say, Look, it's what I've learned is important, but there's going to be an element of how I interact. It's a human Tio will disperse and get better on Well, it's now like almost looking at. It's no longer how good in my hands on skills that I can practise, but it's good and my at connecting with a human by sucking that practise that there are ways. But you come out of you not knowing those ways.

spk_0:   17:59
It's true. That is definitely true. And I think maybe that it's that loss of that certainty essay. So you need gives you, like, yes, you're awesome. Our example. A CZ physios like you go to Physio school and your new air tight that you couldn't fixed everyone like that's just physios. The best. You you can fix everyone, don't listen to anyone else blah, blah, blah, blah, blah. And then you get out and lots of things can happen, like so you goto a practise where that's still the mentality and they throw lots of three million people on DH. Maybe that treatments on their good or you go somewhere else and you get you don't get a lot of help and you get swamped with lots of hard things and you sort of feel a bit dishes in franchise or the 3rd 1 is just come toe. This is the important one, I think. And everyone gets to this point at some point and then really becomes quite effective after it is that they realised that that, like, they're a little speck in this massive universe, they're never gonna never going to fix everyone. And they get to that sort of comfort with the whole uncertainty of it. So rather than that, that being then debilitating and going on Well, I guess maybe some people do like they D'oh! Screw it. I'm going to go work in, you know, investment banking and making a $1,000,000,000 for shell or something like that.

spk_1:   19:28
Yeah, well, that it's now doing something completely different right

spk_0:   19:35
and good on him. That's for That's fine, you know. But I think that getting to the realisation like breaking off that that cliff of I know everything you then get right. Well, I don't know everything, but I know a fair bit. And Aiken, Aiken, do some pretty cool stuff here and let's see what I can do it like, Let's have a crack, you know, kiss. It is persistent pain and low back pain when it whichever one you want to do. Like it's everyone's business like it is costing us as a species, a huge amount year on year. So I mean, it's in everyone's best interest to get better at it. So whether you've been practising for a minute or a decade, I think that having an interest in what happens to people is a good thing. And I think where not just physios. Nowt like any for clinicians. Alan Health clinician in particular is really well placed to do that. And there's a lot of really cool stuff that you, Khun dio, even if we don't know how way best to do it.

spk_1:   20:40
E think I'm very impressive. How deep were going here, Dave? I thought this was quite a rant on a real date. We've gone gone the latter i

spk_0:   20:52
e. A sort of boxy Tony this morning, holding hands rather than soap boxing and screaming at people that their tickets.

spk_1:   21:04
I love it. I especially love what you said about being comfortable in uncertainty, and I think even when you said it, I think that really defines how you go later in your career, right? Like if you do well in your 1st 5 years, 10 years and all of a sudden they're becomes uncertainty around what you're doing. So let's say new research comes out and says, What you're doing isn't best practise anymore or just your only uncertainty. You're not getting the same results that you thought you used to get. If you're comfortable with that and maybe the adult is having the ability to adapt and be flexible with what you do, then maybe that's where it leads Teo that kind of once they're older. But jaded therapists that really just isn't enjoying life isn't enjoying practise anymore.

spk_0:   21:58
Yeah, and like you said all the time, just that inability. Teo, like a lot of cognitive flexibility. So So when you're treating people with long term pain, they will all have certain beliefs and thoughts, and a lot of that has been given to them by the medical and health systems. So part of what you're trying to do gradually is it is sort of break up a few of those, maybe less than helpful things that they've. They've come to believe about themselves and reframe it in a way that's a bit more positive. And the future is a bit brighter. Yes, so that's a really that's a big ask. That's why you can't do it in one session. You can't you can't come in and go. You've got like that. Okay, Most of it will get better after six weeks that no matter what you do, here's a bit of the resource is Gore and read them and you'll be fallen. That doesn't work with humans because they've got this emotion of shit that they've got in their head from wherever else that you just have to tap away out gradually, and that's really tricky to do. It's pretty straightforward, but it is tricky. So as a clinician, if you don't have that cognitive flexibility to move with overtime as things that all happen, you respect the person in front of you to do it. So I think having that first, like being aware enough off things that what you can and can't say. We'll do with certainty what we what. We know what we don't know and just being comfortable Teo to evolve as it evolves mean even what we talk about now, like GPS frameworks and Barbara Barbara, that would be different. That would change like it. Xena's throne. It's just realising that it's the best of what we've got and it will be get better in the future, which is what we're asking our patients. Toa do from a treatment point of view

spk_1:   24:00
so so good it'll evolve right, and we need to involve

spk_0:   24:03
it. That's it. So is it So it's one like, sceptical event. Anyone that's got the answer for the cure or they put their last name in front of some methods that fixes everything My Bush it made. It just goes up to like 150 kissed Ilya. It's like made you just cracking jokes like there is no friggin way. You have got the answer it sze mind boggling that I don't know people. They get comfortable with a certain way of doing things and then they think are I'll package this up and put my face on it and I'll sell it and it's just crap work that would be And it was slightly attention in terms of courses and stuff to do. If anything's got method at the end of it, I just I'd run for the hills. We're in for a method. Yeah, and honestly, like it'll be a weekend of booze and talking like this. So if you came to do that and pay me for it, then let's do it. But I get it for free. There's lots, of course, is that I think I teach you how they teach it a framework. They teach the thie ideas and the evidence and all of that sort of stuff, but they sort of leave it. And I think that that that's where I would be spending my money as a young condition on courses. That's the how are not necessarily to what

spk_1:   25:29
it's the exactly it is. To quote our great shame. Davis have run it through your philtre. ItT's national Beato Not do I know this, but how good am I at this? That's the environment wannabe in, and that's the way forward. That's where growth could happen.

spk_0:   25:48
Yeah, and that doesn't change either. like, if anything, it The further you go, the more you realise how little you do. Actually, no. But the weird reverse of that is that it actually, for me personally like that just gives me more and more confidence. And then the drive to then going, Well, let's let's do something about it. Like what? No one has an answer. So let's I may as well try and make stuff about that. Because no one no one can tell me that I'm wrong, eh? So I made a crack.

spk_1:   26:19
I totally agree. Totally agree. So day, I'm gonna give you the tough challenge. Now, how do we summarise what we've just gone over? Whatever its mean, Let's strike that sum up with three points,

spk_0:   26:32
three points. This isn't my strong suit. May give me

spk_1:   26:35
a little bit. I'll go first. A night you talked about? Well, I think throughout you talked about Be careful of anything dogmatic. No need to be a certain way. I think that's probably a nice look out for that. If someone's got the answer, they definitely don't have the answer.

spk_0:   26:54
That z it. I think that's it there on. Then I guess the other one is that think of frameworks rather than recipes like you want. You want a structure to how you approach stuff, so it's so you're not just like stumbling in the dark. Do you want to have a logical structure? But it's in the It's not recipe based. It's not Step one stitches, that three. It's like these are the things that that I'm going to need the information from them, and I'm going to fill my friend work with that. And then out of that comes the plan framework rather than recipe.

spk_1:   27:31
And then probably just adding to that. Like as you said, you need structure and probably towards them. We talked about how to not become so jaded as you go on as a professional. It's have that flexibility. So have structure, have flexibility, move on and move with change. Well, things will always

spk_0:   27:50
that's you and just not only Teo. Just get comfortable with it, but embrace it like there are literally no friggin rules. Like if you can. If you can come up with an idea and justify it, you know, and it's it's far. Well, look, they probably disclaim it there like you can't just do whatever the hell you want, then charge people for it. But when it's coming in terms of what do like what? Where do we go from here? You've got much chance of working that out. Is anyone? So what could That stick cites the shit out of me like a just like right? So what do we want to do about it? And there's plenty of people around that I think in the same thing. And I think that that cheque, that framework to change stuff, I think that is that's accelerating, if anything. And it's you know, that Z really cool. Like I thinkit's graduated. Now you've got more opportunity and mohr scope to make a massive difference than reckon ever before.

spk_1:   28:52
Yeah, get excited, Get excited. That's right. I'm excited. I'm excited. We thank you very much for your time and your I think we'll have to do a part three at some point.

spk_0:   29:09
Well, all good things come in Chile.

spk_1:   29:11
Yes, of course, of course. Now I think listens out there. Hope you've enjoyed Dave Renfrew and myself having a chat about pain, all things pain. I think in the end, I don't know, I could best summarise that lever. Some questions. I'm sure they'll be lots off them, but we're more than happy to answer them. Thanks for listening. Once again, guys. What a time to be alive. This's the I'm a view podcast getting you private practise ready. We give you fresh ideas on mindset, communication and clinical skills so you can have a full field career.